NUTRITION AND DIET THERAPY SEM 01 | CYC 02

LECTURE AUF-CON

NCM 0106 MODULE 06 – THERAPEUTIC DIET FOR SELECTED PATHOLOGICAL CONDITIONS

● Puts extra strain on the heart, lungs, muscles, bones
OUTLINE and joints and increases the susceptibility to
I Obesity, Overweight, and Underweight diabetes mellitus and hypertension
A Overweight and Obesity ● Increases surgical risks, shortens life span and
B Underweight
II Cardiovascular Diseases causes emotional problems
A Hypertension, Arteriosclerosis, Myocardial Infarction, ● Fats do not have adequate:
Congestive Heart Failure ○ Blood supply (surgical risks)
III Renal Diseases
A Glomerulonephritis, Renal Failure, Urinary Calculi
● Slower wound healing
IV Arthritis ○ Low immune system (short life span)
A Osteoarthritis, Rheumatoid Arthritis, Gouty Arthritis ○ Low self-esteem (emotional problems)
V Gastrointestinal Tract Disturbances
A Mouth and Esophagus Problems
B Diseases in the Stomach TYPES
C Diseases of the Intestines
D Liver and Gallbladder Disturbances ● DEVELOPMENTAL OBESITY (JUVENILE OBESITY)
○ Begins in the early life and continues during
adult
DIETARY MANAGEMENTS
○ Peaks at 4 years old and is established at 11
OBESITY, OVERWEIGHT, AND UNDERWEIGHT years old
● REACTIVE OBESITY
OVERWEIGHT AND OBESITY ○ Results from intense and repeated episodes of
emotional stress
● OVERWEIGHT AND OBESITY
○ Turn to food for comfort to heal emotional
○ OVERWEIGHT
problems
● BMI: 25-29.9 (WHO)
○ Bad eating habits prevents us from learning
● BMI: 23-24.9 (ASIA-PACIFIC)
skills that can effectively resolve emotional
○ OBESE
stress
● BMI: More than or equal to 30 (WHO)
● BMI: More than or equal to 25
CAUSES OF OBESITY
(ASIA-PACIFIC)

● PHYSICAL FACTORS (energy imbalance):

BMI CLASSIFICATION [WHO] imbalance between energy intake and expenditure,
Underweight <18.5 they eat more than they need
Normal 18.5—24.9 ○ Inactivity or sedentary lifestyle
● PHYSIOLOGICAL FACTORS: Endocrine disorder
Overweight 25-29.9
(hypothyroidism)
Obese ⋝30 ● HEREDITY: Mutations in leptin gene (produced by
BMI CLASSIFICATION [ASIA-PACIFIC] fat cells that interacts with areas of the brain that
Underweight <18.5 control hunger and metabolism)
● SOCIOCULTURAL FACTORS: our society exposes us
Normal 18.5—22.9
to increase kCal, fats food
Overweight 23—24.9 ○ Ex. Fast food, ready to eat food (too busy to
Obese ⋝25 prepare food)
● PSYCHOLOGICAL FACTORS: eating relieves
● A serious health hazard boredom, stress, uses of food for comfort
● Characterized by excess accumulation of fat and
reflects on the overall health of the individual not MANAGEMENT
just on one’s physical appearance
Imbalance between energy intake and ● Exercise: an important adjunct to any weight loss
●
expenditure program as it helps tone the muscles
● Surgery

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 MODULE 06 – THERAPEUTIC DIET FOR SELECTED PATHOLOGICAL CONDITIONS
○ Gastroplasty: a type of restrictive surgical
procedure to reduce the space for food in the
stomach and thus limit appetite and eating (it
limits the amount of food that can be eaten,
decreases food intake but do not interfere with
normal digestion)
● Pinaliliit ‘yung stomach para agad
nabubusog = less ‘yung nakakain
● Recommended to those who have failed
their diet
○ Gastric bypass: didiretso na sa intestines
○ Lipectomy (liposuction): remove fat deposits
under the skin in places of cosmetic or figure
concern
● Fad diets: eating plans based on popularity and not
scientific explanation
● Approved drugs and medications
○ Sibutramine: suppresses appetite by inhibiting
the uptake of serotonin
● Effective combined with reduce caloric diet
and increase physical activity
● Side effects: dry mouth, h/a, constipation,
insomnia, increase BP
○ Orlistat/Xenical: Inhibits pancreatic lipase
activity thus blocking dietary fat digestion and
absorption by 30%
● Effective combined with reduce caloric diet
and less fats
● Side effects: gas forming, frequent bowel
elimination, reduce absorption of fat
soluble vitamins (ADEK)
● Low calorie diet/Therapeutic Diet: eating balanced
diet
PRINCIPLES TO FOLLOW IN THE DIETARY MANAGEMENT
OF OBESITY
● Have a genuine and consistent desire to lose
weight
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○ Hindi p’wedeng tinatamad; set clear and
realistic goals
● A reduction of 3,500 kcal in the diet is equal to the
loss of pounds in a week
○ Reduce 500 kcal/day (1 lb per week)
● Hindi p’wedeng biglaan ‘yung pag-lose ng
weight
● Diet should consist of 15% CHON (proteins), 35%
COOH (fats) and 50% CHO (carbohydrates)
● Substitute food with very low caloric content for
those with high caloric contents whenever possible.
○ Example: skim milk for whole milk, yogurt for
sour cream, fruits for dessert
● Consider cooking methods: baking, roasting,
broiling, steaming instead of frying
○ If gagamit ng oil, it is better to use olive oil
because it is healthier
● Eat fresh vegetables and drink water that may
prevent or assuage hunger pains
● Engage in a regular exercise
○ Diet + exercise lose more fats, retain more
muscles and regain less weight than those who
only diets
● Eat slowly
● Drink plenty of water
○ H2O fills the stomach between meals as it also
helps GI tract to adopt to increase fiber diet
UNDERWEIGHT
● May cause various nutritional deficiencies, may
lower one’s resistance to infections and if carried to
the extreme, can cause death
● BMI of less than 18.5
CAUSES
Wasting disease: Kwashiorkor, Marasmus
●
○ Kwashiorkor
● Reflects a sudden/recent food deprivation
● Comes from Ghanaian word ”the evil spirit”
that infects the first child when the second
child is born
● Result of protein deficiency
● S/sx:
○ Facial/limbs edema (distinguishing
characteristic)
○ Bulging belly due to fatty liver
○ Hair loses color
○ Scaly skin
○ Marasmus
● Greek: “dying away”; “little old people”
● Reflects severe food deprivation over a long
period of time
 MODULE 06 – THERAPEUTIC DIET FOR SELECTED PATHOLOGICAL CONDITIONS
● Muscles including heart weakens
● Poor food intake
● Malabsorption
● Hormonal imbalance
● Energy imbalance
● Poor living situation
● Psychological and emotional stress
DIETARY MANAGEMENT
● High caloric diet at least 50% above standard
requirement
● High protein to rebuild tissues especially those with
kwashiorkor
● High carbohydrates provide primary energy
sources in easily digested form
● Moderate fat to add kcal but do not exceed
tolerance limits
● Good source of vitamins and minerals including
supplements when individual deficiencies require
them
● Psychological counseling
● Prepare appetizing meals (favorite food) appealing
to the eye
DIABETES MELLITUS
BACKGROUND OF THE DISEASE
● Complex, chronic syndrome characterized by
impairment in the ability to metabolize CHO, CHON,
and fats → hyperglycemia and hyperlipidemia
● CAUSE: inadequate insulin secretion or decreased
ability of the body to use insulin
● NORMAL PHYSIOLOGY: Insulin is produced from
pancreas which works as the key, tapos
mag-u-unlock ng receptor para maka-enter ‘yung
glucose
TYPES OF DM
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● Type 1 DM: no production of insulin from pancreas;
glucose stays in the system and can also cause HPN
○ HYPERTENSION: glucose stays in the
bloodstream making the blood more viscous =
need mag-exert ng extra effort/pressure to
circulate the viscous blood
● Type 2 DM: the production of insulin is not matched
with the receptor kaya hindi rin siya ma-u-unlock
● BLOOD GLUCOSE LEVEL — ↓ SUGAR = GLUCAGON /
↑SUGAR = INSULIN
○ Controls the secretion of both glucagon and
insulin
○ Glucagon and insulin regulates the blood
glucose levels
● When blood sugar falls, glucagon is
secreted; when blood sugar rises, insulin is
secreted for blood sugar to be maintained
within the narrow limits of 60-100 mg/dl (if
within fasting state)
○ Blood glucose levels is checked with glucometer
● Normal: 80-120 mg/dl
● CLINICAL MANIFESTATIONS
○ Hyperglycemia: too much sugar in the blood
○ Glycosuria: glucose present in the urine
○ Polydipsia: excessive thirst kasi ‘yung glucose
attracts water = nagiging diluted ‘yung urine
○ Polyuria: increased urine output
● Signals thirst center kaya may polydipsia
○ Polyphagia: extreme hunger = walang glucose
yung cell needed for energy kaya ang tendency
kakain lagi
TREATMENT (COMBINATION MANAGEMENT)
● OBJECTIVE: Help the patient maintain and prolong a
healthy and satisfying life
● Attained with:
○ Optimum nutrition
○ Normal weight
○ Normal blood sugar level
○ Minimum glycosuria
○ Absence of ketoacidosis
○ Prevention of long term complications
● Causes death among DM patients
● E.g.: diabetic foot ulcers (may result in
amputation if not properly managed)
● BASIS CONTROL FOR DIABETES MELLITUS
○ Rests on a balance of 3 important interrelated
factors
● Hindi p’wedeng isa lang ‘yung ginagawa mo
sa mga ito
○ Medication
○ Exercise
 MODULE 06 – THERAPEUTIC DIET FOR SELECTED PATHOLOGICAL CONDITIONS

○ Dietary management D. FAT ALLOWANCE

● DIABETIC DIET
○ Modification based on an adequate normal diet
○ Should consist of sufficient food energy
● To meet patient’s activity
● To maintain a desirable weight gain
○ Adequate in CHO, CHON, fats, vitamins, and
minerals
DIETARY PRESCRIPTION
● Essentially normal, except that the amount of food
and their distribution in meals are controlled from
day to day
○ Dati, maraming bawal pero since hindi ito
nasusunod (mentality na “mamamatay rin
naman ako bakit ‘di ko pa kainin”), nire-restrict
na lang
A. ENERGY
● Determined after the protein and carbohydrate
energy are computed
● Total energy supplied by CHON and CHO minus the
total energy required as necessary for the diet will be
supplied by fats
E. VITAMINS AND MINERALS
● Vitamins and minerals of the patient with
well-controlled DM are the same as those of normal
subjects
● There is no need for supplementation when the diet
is adequate, and glycosuria is controlled
SAMPLE DIABETIC DIET PRESCRIPTION
● Patient: An adult diabetic woman who is
overweight is engaged in moderate activity. Her
DBW is 50 kg.

● Based on the patient’s age, sex, height, weight, and ENERGY (TER)
occupation or activity ● F = DBW x activity (moderate, low)
● 50 kg x 30 kcal = 1,500 kcal
KCAL PER KG OF IDEAL BODY WEIGHT
(considering activity level and present weight) PROTEIN (1 G = 4 KCAL)
CLASSIFI-
SEDENTARY MODERATE
MARKED ● F = DBW x 1.12
CATION ACTIVITY ● 50 kg x 1.12 g/kg DBW = 56 grams CHON
Overweight 20-25 30 35 ● CHON energy: 56 g x 4 kcal = 224 kcal
Normal 30 35 40
Underweight 35 40 40-50 NON-CHON ENERGY = TER - CHON ENERGY
● Non-CHON Energy: 1,500 kcal - 224 kcal = 1,276
kcal
B. PROTEIN ALLOWANCE

CARBOHYDRATES (1 G = 4 KCAL)
● Generally same with normal individual
● 60% of Non-CHON Energy: 60% of 1,276 = 765.6 kcal
● CONTROLLED/NORMAL: computed at 1.12g/kg of
● 765.6 kcal / 4 kcal per 1 g of CHO = 191.4 g or 191 g
Desirable Body Weight (DBW)
CHO
● POORLY-REGULATED DIABETICS (nitrogen in urine):
1.5 g/kg DBW of protein during first few weeks
FATS (1 G = 9 KCAL)
● Later, a minimum of 63g of protein daily may be
● Fats = Total Calories - (CHON kcal + CHO kcal)
sufficient for a moderately active adult
● 1,500 kcal - (224+765.6) = 510.4
● 510.4 kcal / 9 kcal per 1 g of fats = 56.7 or 57 g Fats
C. CARBOHYDRATE ALLOWANCE
SUMMARY
● After subtracting the calories provided by protein,
● Energy: 1,500 kCal
the remainder of the calories for the day is usually
● Proteins: 56 g
divided about between carbohydrates and fats
● Carbohydrates: 191 g
● The number of grams for fats is ordinarily about the
● Fats: 57 g
same as the number of grams of protein
● The amount of carbohydrates is roughly twice the
FOOD PREPARATION
number of grams of protein

● All food items in the diet are measured using

standard measures

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 MODULE 06 – THERAPEUTIC DIET FOR SELECTED PATHOLOGICAL CONDITIONS

○ Do not use pieces; use cups, teaspoons, etc. ● COMBINATION IN NATURE: cannot be resolved with
● Foods are prepared using only those allowed on the one intervention alone
meal patterns ● MANAGEMENT GOALS
○ No extra flour, breadcrumbs, butter, or other ○ Reduction of blood pressure to normal and
foods may be used as these are added to the lifestyle modification
kCal of the patient ● Exercise, diet, and avoidance of vices
● Meat may be broiled, baked, roasted, or stewed, if ○ Normal BMI through weight reduction program
they are fried, some of the fat allowances may be ○ Maintenance medications (BB, CCB, etc.)
used ● Medication management must not be
○ Oil adds up to the fat stopped abruptly to avoid rebound effects
○ If hindi maiiwasan, isama ‘yung oil sa
calculation LIFESTYLE
RECOMMENDATION
● Frozen or canned fruits packed with sugar must be MODIFICATION
avoided Weight Reduction Maintain normal BMI
○ Preserved foods have more sugar content (kahit
i-rinse mo, nando’n pa rin ‘yung sugar content) Sodium restriction 2-3 g
● Concentrated sweets and desserts are avoided Diet rich in fruits and
(sugar, candies, jellies, jams, marshmallows, syrup, vegetables
honey, soft drinks, cakes, cookies, pies, pastries)
Low fat dairy product Reduced
○ If isasama sa meal plan, dapat once or twice a
Adopt DASH saturated and total fat
week lang
In research studies, people
CARDIOVASCULAR DISEASES who were in DASH diet lowered
their BP within 2 weeks
A. HYPERTENSION Regular aerobic physical
Exercise
activity
● A persistent elevation of the SBP at a level of 140
No more than 2 drinks/day for
mmHg or higher and DBP at a level of 90 mmHg or men
higher Alcohol restriction
○ Increase of 30 mmHg in systolic and 15 mmHg No more than 1 drink/day for
in diastolic for three consecutive times women
● Elevation of blood pressure especially the diastolic Smoking Cessation
● Silent killer because of asymptomatic nature
○ Can be asymptomatic or with headaches, ● DASH DIET (Diet Approach to Stop Hypertension)
dizziness, edema, fatigue and fainting, nape ○ Requires no special food and instead provides
pain daily and weekly nutritional goals
○ Usually, nagkaka-symptoms lang kapag ○ Eat more fruits, vegetables, and low-fat dairy
malala na ‘yung HPN foods
● COMPLICATIONS: heart attack, stroke, renal/heart ○ Cut back on foods that are high in saturated
failure fat, cholesterol, and trans fats
● Remove chicken skin
TYPES ● Do not give the thigh part of chicken (give
the breast part instead)
● PRIMARY/ESSENTIAL HPN ○ Eat more whole-grain food, fish, poultry, and
○ 90% nuts
○ Unknown cause; usually hereditary ○ Limit sodium, sweets, sugary drinks, and red
○ Most common meats
● SECONDARY HYPERTENSION ○ Low in saturated and trans fats
○ 10% ○ Rich in potassium, calcium, magnesium, fiber,
○ Secondary to disease condition and protein
○ Medications to be taken regularly
B. ARTERIOSCLEROSIS
MANAGEMENT
● General term meaning hardening/thickening of
arteries = decreased diameter

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 MODULE 06 – THERAPEUTIC DIET FOR SELECTED PATHOLOGICAL CONDITIONS
○ Arteries are naturally elastic because of their
task in circulation. When they harden, problems
with circulation arise.
● Need ng higher pressure to circulate blood
= ma-i-injure ‘yung arteries = additional
problem
● Affects the inner lining of the arteries, where plaque
of lipoprotein and other fatty materials build
overtime
● CAUSE: Due to smoking/vasoconstriction of arteries,
atherosclerosis
● ATHEROSCLEROSIS
○ Fat deposition around the inner lining of the
arteries
● LEVELS
○ Normal serum cholesterol: < 200 mg/dl
○ Borderline: <200-239 mg/dl
● Diet muna ‘yung interventions
○ High: >240 mg/dl
● Diet + medications (e.g., antilipidemic
drugs)
MANAGEMENT — FAT-RESTRICTED DIET
● NOTE: We cannot remove fat in our diet because
they function as insulators, energy reserves, and
cushions
○ MODIFICATION: Restriction of fat instead of
eradication
● Low fat diet
○ Skim milk (same amount of calcium with lesser
fat) instead of whole milk (high in fats)
● Increase in monounsaturated fatty acids to lower
plasma total cholesterol and LDL cholesterol level
○ Low cholesterol diet: lean muscle meats, fish,
vegetables oils
○ Monounsaturated: nuts, avocados (more on
plant sources)
● Reduced saturated fat (red meats, coconut oil)
○ Saturated fat can accumulate in blood vessels
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○ Take nonfat dairy products, fish and poultry
● Take unsaturated fats
○ Lower LDL while possibly raising HDL
● Polyunsaturated fats (digestible fats)
○ Important for brain health and muscle
functioning
○ Take foods containing omega-3 fatty acids
(fish sources/seafood)
● Fatty fish like salmon, mackerel, and
sardines
○ Food containing omega-6 fatty acids
(plant-based)
● Corn oil, soybean oil, sunflower oil
● Increased intake of soluble/high fiber diet
○ Fiber offers many health benefits including
weight loss
● Binds with cholesterol
● 25-35 grams of soluble fiber can reduce
cholesterol to 15%
○ If not improvement within 3-6 months, the MD
will order antilipidemic agents (-tatin)
● Ex. simvastatin, atorvastatin (given at night)
○ Synthesis and absorption of fats
happen at night (mas active ‘yung
enzymes na gumagawa ng
cholesterol during this time)
● Increased intake of antioxidant nutrients
○ Antioxidants remove free radicals that damage
cells
● Moderate alcohol intake
○ Consume no more than 2 drinks per day for
men or 1 drink per day for women
● (Alcohol reduces the damage to affected
tse)
● 1 DRINK = 5 oz of wine / 12 oz of beer / 1 ½ oz
of whiskey
● Alcohol improves blood lipid profile
● Alcohol decreases thrombosis (blood
clotting)
● Increases fibrinolysis (the process by which
clots dissolve)
● Reduced caloric intake and increased exercise for
obese
○ Low calorie diet for weight reduction (1000-1200
kcal/day)
● Regular physical exercise (at least 30 minutes of
moderate-intensity physical activity 3 to 4 or 5 to 6
days a week)
● Maintain ideal BMI and waist circumference
○ BMI of 18.5 to 23.9 is normal – Asian
 MODULE 06 – THERAPEUTIC DIET FOR SELECTED PATHOLOGICAL CONDITIONS
C. MYOCARDIAL INFARCTION
Heart Attack/Coronary Occlusion
● A life-threatening condition that is caused by the
blockage (blood clots, fat deposit on CA) of a
coronary artery characterized by the necrosis
(death) of myocardial cells
○ Supplies oxygenated blood to the heart
○ Since na-block, walang adequate blood supply
= death of myocardial cells = hindi na
magko-contract nang maayos
● PRIMARY CAUSES: hypertension (since nagpu-pool
‘yung blood, nag-i-increase ng pressure para
ma-move siya), thrombus formation, problems with
arteries/blood vessels
● CARDINAL SIGN: clenching of the chest
● TWO KINDS OF MYOCARDIAL INFARCTION
○ MYOCARDIAL ISCHEMIA
● Blood flow in the heart muscles are
reduced, thus decreasing supply of O2 in
the different parts of the body and the
heart as well
● If ischemia is not managed, it may lead to
infarct
○ MYOCARDIAL INFARCT
● Tissues in the heart become necrotic
caused by obstruction of blood supply
● Usually start with ischemia and is
characterized by chest pain
○ Ischemia and Infarct can be due to HPN,
atherosclerosis, thrombosis
OTHER PROBLEMS BROUGHT ABOUT BY PROBLEMS
WITH CIRCULATION
● CVA (CEREBROVASCULAR ACCIDENT) — BRAIN
○ Also known as stroke
○ Happens when blood flow to the brain is
blocked; blood vessels burst
● Caused by thrombus formation or
atherosclerosis
○ Ischemic stroke: decreased oxygen flow to the
heart/brain due to blockage (blood clot)
● First sign: severe headache d/t blockage
○ Hemorrhagic stroke: leakage/bursting of blood
vessel (may bleeding na)
● Because of the blockage, increased
pressure is possible = damage to blood
vessels = outpouching (lumobo) = burst
○ Signs and symptoms will depend on the
location of the blockage
● PVD (PERIPHERAL VASCULAR DISEASE) — workload of the heart
EXTREMITIES
○ Blood flow to the tissues distant from the heart
is blocked
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● Caused by impairment in circulation
DIET THERAPY
● GOAL OF TREATMENT: allow rest of the heart,
provide minimal work for the heart
○ Decrease stimuli and metabolic rate (heart will
compensate; hindi makakapag-rest)
○ Diet therapy is a dependent function of nurses
● DURING THE FIRST 24 HOURS POST-ATTACK, NPO IS
PRESCRIBED
○ NPO initially especially during the first 24 hours
of admission (critical period)
● NPO following attack (prevent aspiration)
○ Hindi rin p’wedeng tube kasi need
i-digest = magwo-work ‘yung heart
○ The patient can have another attack
○ Parenteral nutrition will be provided
● IF THE PATIENT IS STABLE, LIQUID DIET IS PRESCRIBED
○ If the patient does not have unilateral
weakness, p’wede nang mag-start ng
liquid/soft diet
● NEVER give anything by mouth if gag reflex
is absent
● REMEMBER to give foods that are easy to
chew to avoid fatigue
○ Liquid diet of 500-800 kCal/24 hours, 1000-1200
kcal small frequent feedings for the next 5-10
days
● Limit drinks containing caffeine and very
hot/cold foods
○ Causes vasoconstriction, impeding the
circulation
● IF THE PATIENT TOLERATES LIQUID DIET, SOFT DIET IS
PRESCRIBED — ↑ DIGESTIBLE FIBER ↓ FAT & Na
○ 1000-1200 kcal small frequent feedings for the
next 5-10 days
○ Low fat, low cholesterol, reduced sodium diet in
small frequent feedings
● Limited sodium (Na attracts water which
causes the heart to pump harder), fat
controlled or low kcal
● Limit foods with indigestible/insoluble
components (e.g. roughage) because this
will increase the workload of the heart
● Fat-controlled or low kCal (easy to chew,
little roughage) to decrease cardiac
workload
○ OMEGA 3 FATTY ACID: the purpose of nutrition
therapy for patients with MI is to reduce the
● Reduce the risk of blood clots that causes
MI
● Sources: Fish, tuna, salmon, sardines
 MODULE 06 – THERAPEUTIC DIET FOR SELECTED PATHOLOGICAL CONDITIONS
D. CONGESTIVE HEART FAILURE
● A chronic condition of gradually weakening heart
muscle which is unable to pump normal blood flow
through the heart-lung circulation, resulting in
congestion of fluids in the lungs
● Sodium builds up and more fluid is retained
resulting in edema
● A chronic condition of gradually weakening heart
muscle which is unable to pump normal blood flow
through the heart-lung circulation, resulting in
congestion of fluids in the lungs. Sodium builds up
and more fluid is retained resulting in edema
● CAUSE
○ Injury to the heart and ↓ O2 supply, acute MI,
untreated HPN (most common), problems with
heart muscle and valve
TWO TYPES OF CONGESTION
● LEFT-SIDED HEART FAILURE: PULMONARY
○ ANO’NG NANGYAYARI?: Naiipon ‘yung blood
(from left atrium) sa left ventricle kasi ayaw na
niyang mag-pump
○ Since ayaw i-receive ng left atrium/ventricle
‘yung blood, nagpu-pool sila sa lungs.
Nalulunod ‘yung lungs sa sobrang daming fluid
○ Difficulty of breathing, coughing, crackles,
fatigue
● RIGHT-SIDED HEART FAILURE: SYSTEMIC
○ Poor congestion to all organs
○ Right ventricle does not work efficiently and
blood pools back to the right atrium
○ If the right atrium is also filled with blood, it will
return blood/fluid to the systemic circulation
○ May cause cyanosis (bumabalik na ‘yung blood
sa system kahit hindi pa na-o-oxygenate),
edema
GOALS OF TREATMENT
● Optimum rest for the heart: decrease workload of
the heart, removes all stressors
● Elimination of edema
○ Fluid build-up kasi hindi nasi-circulate nang
maayos ‘yung blood
○ Restricting dietary sodium to reduce
extracellular fluid
● Sodium attracts fluid
○ Fluid restriction of 1-2 liters per day
● Marami na ngang tubig, daragdagan mo
pa = lalong magko-congest
● MANAGEMENT
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○ Sodium-restricted diet to reduce extracellular
fluid
○ Fluid restriction of 1-2 liters per day
SODIUM RESTRICTION
● Recommended to address edema
● RECOMMENDED AMOUNTS
○ American adult daily consumption: >3,400 mg
○ Adult upper level: 2,300 mg
○ Adult recommended daily: 1,500 mg
○ Adult needed daily: 180mg
REMINDERS
✅
●
Dry peas and beans, fruits, yogurt, herbs and
spices (used as alternatives for seasoning
food)
❌ Avoid canned foods and foods with
preservatives (salt is used during the
preservation process)
❌ Food High in Sodium (avoided): seafoods
(maalat ‘yung sea; may natural sodium
content na), eggs, milk, carrots, MSG,
chocolates, ice cream, catsup, cup noodles
○ Weigh the patient every day to check fluid
retention
● 500 MG SODIUM DIET — NO SALT AND SEASONINGS
○ Indicated for end-stage renal disease (ESRD;
totally-dependent on dialysis), severe HPN
○ All foods prepared without salt and seasonings
● Use herbs instead to add flavor to their food
○ Canned and processed foods containing salt
are omitted
● 1000 MG SODIUM DIET — 1/4 TSP OF SALT/24H
○ More liberal selection of food
○ ¼ tsp salt may be added to food daily
○ Indicated for renal disease with marginal renal
function, chronic glomerulonephritis, toxemias
of pregnancy (PIH)
● 2000 MG SODIUM DIET — 1/2–1 TSP OF SALT/24H
○ Selected canned and frozen foods may be
included but take note of amount prescribed
per day
○ Indicated for cardiac/hypertensive patients
○ ½ -1 tsp. of salt/ day
○ Sodium intake is limited to 2,300 mg/day
● 4,000–5,000 MG SODIUM DIET — SALT AND
SEASONINGS ALLOWED DURING COOKING BUT NO
TABLE SALT/SEASONINGS (SAWSAWAN)
○ Regular diet with limited use of high Na foods
○ Indicated for essential hypertension (unknown
cause)
RENAL DISEASES
 MODULE 06 – THERAPEUTIC DIET FOR SELECTED PATHOLOGICAL CONDITIONS
A. GLOMERULONEPHRITIS
● GLOMERULI: controls filtration
● Encompasses a variety of diseases, most of which
are caused by an immunologic reaction that result
in proliferative and inflammatory changes in
glomerular structure
● Inflammatory process affecting the glomeruli, the
small blood vessels in the cupped membrane at the
head of the nephron
● Cause: Streptococcal bacteria
○ Common among children
○ Sore throat should only occur 3 times in a year
● If more than 3 times, seek medical help
● CLINICAL SYMPTOMS
○ Hematuria, proteinuria, edema, mild
hypertension, oliguria
○ Mainly because hindi nafi-filter nang maayos
‘yung urine because of impaired glomeruli
function
● GOAL OF NUTRITION
○ Protect the kidney while recovering its function
○ Slow the buildup of waste in the bloodstream to
control fluid retention
○ Reduce excretory workload to the kidneys
DIET THERAPY
● Energy foods should be provided by carbohydrates
and fat to spare the proteins from being used up as
a source of energy
○ Kapag na-use up ‘yung proteins, production of
bile products may occur
● Protein is restricted to 0.5g/kg IBW, if normal
BUN level, dietary protein may be held at
1g/kg BW. (prevent CHON catabolism:
metabolic by products urea, ammonia and
uric acid)
● Fats given should be unsaturated
● RESTRICTIONS
○ Sodium restriction (1g/day) is recommended if
edema is present
○ Potassium restriction: 1g/day if there is
potassium retention
● Too much potassium may cause problems
with cardiac activity
○ Fluid restriction is necessary with edema in
severe cases (500ml is given)
● Fluid restriction depends on the input and
output measurement
● I/O must be equal
○ Relieve thirst: offer candies, lemon slices, ice
chips
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B. RENAL FAILURE
● A metabolic (regulate fluids, electrolytes and pH
balance) and elimination derangement (which the
kidneys fail to remove waste products)
● Complete/almost complete suppression of kidney
function
● May involve acute obstruction, DHN, and F&E
disturbances
ACUTE RENAL FAILURE
● Occurs suddenly but often reversible; and is
frequently superimposed on other life-threatening
conditions
● Nephrons suddenly lose function
● Na intake limit: 500-1000mg in oliguric patients
● ETIOLOGIC FACTORS
○ Hemorrhage
○ Acute nephritis: necrosis of nephrons
○ Intoxication from drugs and poisons causing
damage the nephrons (e.g., ibuprofen)
○ Renal artery thrombosis: decreases blood
perfusion to kidneys = hemolysis
○ Transfusion reaction: blood transfusion reaction
● RBC given are destroyed by patients’
immune system
● Hemolysis = excreted by the kidneys = may
cause congestion = damage
○ Drug reaction: nephrotoxic
○ Prolonged low blood pressure: decreases
perfusion in the kidneys
● GOAL
○ Treat the underlying cause in order to prevent
permanent or further damage to the kidneys
NUTRITIONAL THERAPY
● 30-40 kcal/kg to meet demands of stress
● Uremic diet: decrease CHON, increase caloric diet
○ Decreased protein to prevent protein catabolism
● If in dialysis: 1-1.4g/kg of CHON
● If not in dialysis: 0.6g/kg of CHON but not less than
40g/day
○ If recommended is not followed = mahihirapan
na i-excrete
● Increase calories, decrease CHON, Na, K, Mg
● SODIUM RESTRICTION
○ 500–1000 MG SODIUM
● Used for oliguric pts
○ 1,000 MG SODIUM DIET
● More liberal selection of food
● ¼ tsp salt may be added to food daily
○ 2,000 MG SODIUM DIET
 MODULE 06 – THERAPEUTIC DIET FOR SELECTED PATHOLOGICAL CONDITIONS
● Selected canned and frozen foods may be
included
● ½ tsp of salt/day only because other food
contain Na
● 1 tsp = 2000 mg Na
○ 4,000 TO 5,000 MG SODIUM DIET
● Regular diet with no added salt on the table
(condiments) and limited use of high Na
food
● Wala nang condiments
CHRONIC RENAL FAILURE
● Irreversible, progressive deterioration of renal
functioning resulting in the inability of the kidneys to
maintain homeostasis
● Remaining renal mass can no longer maintain
maternal environment
● ETIOLOGIC FACTORS
○ Progressive glomerulonephritis
○ Chronic infections
○ Genetic defects (Down syndrome)
○ Chronic hypertension
○ Diabetes mellitus
● GOAL
○ Delay the progression
○ Improve the quality of life
○ Control protein intake
MAJOR OBJECTIVES
● To achieve/maintain nutritional status
● To lighten the work of the diseased kidney
○ Done by reducing the level of urea, creatinine
and electrolytes that must be excreted
● Correct electrolyte imbalances
● Replace protein lost in dialysis
DIET THERAPY
● CHON low to moderate according to tolerance
● CHO relatively high for energy:300-400g
● Fats relatively moderate:70-90g
● Calories adequate from maintenance to prevent
tissue breakdown: 200- 2500 g/day
● Na controlled according to serum levels and
excretion capacity varying from 1300-1900mg
● Potassium controlled according to serum levels and
excretion capacities varying from 1300-1900mg
● Water controlled according to excretion about
800-1000ml
DIET DURING DIALYSIS
● Protein and vitamins are supplemented in the diet
NCM 0104 |Banaag, Cato, Diala, Mallari, Malonzo, Paras|10
● Polyunsaturated fats in place of unsaturated fats are
recommended
● High protein diet: 1.2/kg
○ 50% of dietary CHON as biologic value (animal
source
● Increases calcium to 1200mg
○ Phosphate binder: RF inability to excrete
phosphate so oral Ca binds with phosphorus in
the stomach so it passes out the stool
○ Fluid restriction
C. URINARY CALCULI
● Formation of stones
○ Usually a mixture of several substances like uric
acid, cystine, calcium carbonate, calcium
phosphate, struvite stones (Mg, ammonia,
phosphate)
● ETIOLOGY
○ Climate: hot climate = increased sweating =
concentrated urine = increased precipitates in
the urine = stones
○ Occupation: d/t urinary stasis (drivers, rashes)
● Usually nakaupo
○ Dietary factors: aluminum, Fe, Si = increased
oxalate levels = oxalate stones
○ Prolonged immobilization: unmoving urine forms
crystals
● Change position every 2 hours
○ Certain biochemical abnormality: metabolic
disturbances = increased Ca ion (DM,
dislipidemia)
○ Excessive excretion of uric acid: forms precipitate
○ Infection: bacteria are precipitators in the
formation of calculi
○ Urinary stasis: supersaturation of urine and
poorly soluble crystalloids
● CLASSIFICATIONS OF CALCULI
○ Calcium: most common hypercalciuria
○ Uric Acid: Intake of purine and increase CHON
● Food high in purine: Fermented food,
shellfish, sardines (mga walang kaliskis),
beef, organ meats, anchovies, scallops
○ Struvite: Infection stone, made up of Mg,
ammonia, phosphate
● Caused by the retention of the byproducts of
the body
○ Cystine Stone: congenital metabolic defect in
reabsorptive transport of cysteine
● Genetic problem
DIETARY MANAGEMENT
RISK FACTORS DIET
 MODULE 06 – THERAPEUTIC DIET FOR SELECTED PATHOLOGICAL CONDITIONS

CALCIUM (PHOSPHATE OR OXALATE) ● Liver, anchovies, mackerel, dried beans and

MOST COMMON, 90% OF ALL STONES peas, beer, and wine
● Acid ash diet (meat, egg, ○ Low Oxalate Diet
grains) ● Spinach, beets, nuts, chocolate, tea, wheat,
Hypercalciuria ● Limit food high in calcium, bran, strawberries
phosphate, and oxalate ○ Acid Ash Diet
Hypercalcemia ● Control alkaline diet (milk, ● Low phosphorus, Mg
vegetables, and fruits) ○ Alkaline Ash Diet
Alkaline urine ● Increase potassium-rich ● Fruits and vegetables, increased fluid
food ● Increase water intake to dissolve crystals
● Increase hydration ● Increase potassium to maintain electrolyte balance

STRUVITE STORES (15- 20%)

ARTHRITIS
UTIs especially
proteus infections ● Inflammation of a joint, usually accompanied by
● Acid ash diet
pain, swelling and structural changes
Alkaline urine ○ Common among elderlies
URIC ACID (5-10%)
A. OSTEOARTHRITIS
● Allopurinol
● Alkaline ash diet since the ● AKA Degenerative Arthritis
Gout stone is acidic ● A progressive disorder characterized by
● Low-purine diet (meat, organ deterioration of articular cartilage
Diet high in purine meat, whole grain, and ● Weight bearing joints are affected
legumes) ● Painful chronic disease of the joints that occurs
Acidic urine ● CHON is limited to 58-60 g/dl when the cushioning cartilage in a joint breaks down
● Emphasis on milk and fruits ● Risk factor: overweight; joints are stressed and
● Increase hydration irritated by having to carry extra pounds
● Common among women due to decrease in
CYSTINE (UNCOMMON) collagen production

● Alkaline ash diet

DIET THERAPY
● Low protein diet (meat, milk,
Genetic defect
egg, cheese) ● Low calorie diet
● Increase hydration ● Intake of calcium and Vitamin D
● Overweight clients need to be instructed to lose
● ACID ASH DIET weight: low-calorie
○ High in acid: cheese, cranberries, plums, prunes,
tomatoes and whole grains B. RHEUMATOID ARTHRITIS
● When metabolized = leaves acidic residue =
● An autoimmune connective tissue disease that
goal is to neutralize alkaline nature
most commonly causes inflammation of the joints
● HIGH OXALATE
and joint deformity
○ Spinach, nuts, wheat bran
○ Painful inflammation of joints and related
● ALKALINE ASH DIET
structures
○ Green vegetables, legumes, milk and milk
● The immune system mistakenly attacks the bone
products
covering as if they are foreign tissue affects small
● When metabolized = leaves alkaline residue
joints (wrist)
= goal is to neutralize acidic nature
○ Increase fluid and decrease protein
DIET THERAPY
● DIET RESTRICTION
○ Low Calcium Diet: 250-400 mg/day ● Prevent milk and milk diet
● Wheat, bran, strawberries, spinach ● Food rich in Omega 3 fatty acids
○ Low Uric Acid Diet ● Vitamin E (to prevent oxidation)
● Foods to avoid

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 MODULE 06 – THERAPEUTIC DIET FOR SELECTED PATHOLOGICAL CONDITIONS
○ Limit intake of sugary snacks, drinks, white bread,
and pasta (prevent production of cytokines -
triggers the immune response)
○ Grilled, broiled, fried meats (prevent Advanced
Glycation End (AGE) Products: toxins that
generates inflammatory process)
○ Trans-fats, packaged goods, preservatives, MSG,
alcohol
C. GOUTY ARTHRITIS
● Inflammation of a joint caused by accumulation of
uric acid crystals (sharp, needle-like)
● Common on extremities
DIET THERAPY
● Low purine diet (low protein diet)
○ No organ/red meats, seafoods na walang
kaliskis (anchovies), corn, tomatoes, vegetables
na may maraming buto (okra, eggplant) as they
are high in uric acid
● Avoid alcohol (contains ethanol which increases uric
acid production) and beer (contains malt)
● Force fluids (3L/day)
○ Prevents crystal formation (byproducts of
processes)
● Increase in carbohydrates, moderate protein, low fat
GASTROINTESTINAL TRACT DISTURBANCES
A. MOUTH AND ESOPHAGUS PROBLEMS
CLEFT PALATE
● Anatomic abnormality wherein parts of the upper
jaw and of the palate separating the mouth and
nasal cavity do not fuse properly during fetal
development
● Cause: Genetic or teratogenic
● Infants cannot control the flow of milk when placed
in mouth
MANAGEMENT
● A softened nipple with large openings through which
the infant can obtain milk by chewing motion
● Medicine dropper or special feeder
○ Haberman Feeder: Especially designed bottle
with valve to help control the air the baby
ingests and prevents milk from going back into
the bottle
○ Breck Feeder: A syringe with feeding tube
extension
● Upright position and direct the formula to the side
and back of the mouth (to prevent aspiration)
NCM 0104 |Banaag, Cato, Diala, Mallari, Malonzo, Paras|12
● Brief rest periods (to allow child to finish swallowing
what has been places in the mouth) and frequent
burping (to expel large amounts of air swallowed
due to poorly formed roof of the mouth)
● Child at risk for aspiration: Aspiration and
Inadequate Feeding
○
○ Feeding slowly over 20-30 minutes reduces the
risk of aspiration and provides adequate intake
of formula
○ Feeding every 3-4 hours; more frequent feedings
may be tiring for the infant and the mother.
Some infants may need to be fed more
frequently if they are noy consuming adequate
amounts of formula
● (Option 1) Bottle should be pointed down, away from
the cleft, in order to prevent formula from flowing
back into the nose area. This backflow would cause
nasal regurgitation, and milk or formula may
commonly escape through the nose. This is
dangerous and the infant will sneeze or cough in
order to clear the nose
● (Option 4) Feeding should take about 20-30 mins.
The infant may be working too hard and tire out if
feeding takes 45 mins. or more. In addition, the extra
work of feeding will burn up calories that are needed
for growth
DENTAL CARIES (DECAY)
● Prevalent among young children, found in both well
fed and undernourished children
● Caused by extended contact time with fermentable
CHO (sugar)
○ Babies who bottle fed until nighttime (follow up
water feeding)
○ Eating sweets without brushing teeth
MANAGEMENT
● A diet low in simple carbohydrates
● Use fluoride
● Regular and proper oral hygiene
● Mechanical soft diet
GASTROESOPHAGEAL REFLUX DISEASE
● Stomach acid flows back into the esophagus
ESOPHAGITIS
● Inflammation that may damage tissues of the
esophagus
HIATAL HERNIA
 MODULE 06 – THERAPEUTIC DIET FOR SELECTED PATHOLOGICAL CONDITIONS
● Portion of the upper stomach protrudes up through
the hiatus (hole in the diaphragm that allows the
esophagus to pass) of the diaphragm
ESOPHAGITIS
● Inflammation that may damage tissues of the
esophagus
MANAGEMENT
● Weight reduction for obese patients
○ To reduce intra abdominal pressure
● Avoidance of large meals in favor of more frequent
small meals
○ More food stimulates gastric acid production
● Small frequent feedings (4-6x/day)
○ No skipping of meals
● Provision of bland, fiber-restricted diet
○ To avoid irritants to the mucosa
● Bland diet: a nutritionally adequate diet that includes
food that has bland flavor and soft consistency and
mechanically and are chemically made
● Avoid CATS: Caffeinated beverages, Alcohol,
Tobacco, Spices
● Avoid lying down after meals, sleep with the HOB
elevated (6-8 inches)
○ To prevent nocturnal reflux (heartburn during
sleep)
B. DISEASES IN THE STOMACH
PEPTIC ULCER DISEASE
● Pertains to a break in the continuity of the
gastrointestinal tract (esophagus, stomach,
duodenum, jejunum) that comes in contact with the
gastric juice (HCl and pepsin) leading to local defect
(excavation of mucosal integrity) resulting from
inflammation
MANAGEMENT
● Small, frequent feedings
○ Avoid sudden increase in gastric acid
production
● Bland diet
○ Avoid gastric irritation
● Foods rich in protein (CHON rich - fish, egg, meat,
poultry)
○ Avoid beef products (hard to digest)
○ Has greater ability to neutralize acid
● Foods that contain easily digested fats
NCM 0104 |Banaag, Cato, Diala, Mallari, Malonzo, Paras|13
● Milk (especially full cream or fresh milk) is no longer
recommended nowadays because it triggers
secretion of gastric acid
● Dietary fiber: they can prevent ulcer from
developing
● Vitamin A rich foods: Increase the mucus
production in the GI tract which is believed to help
prevent ulcer
● Flavonoid-rich foods and cranberry juice and
green tea: help fight and inhibit growth of H. Pylori
GASTRITIS
● General term for inflammation of the stomach
○ Irritation on the lining of the stomach
(Hydrochloric Acid)
● Classified as either acute or chronic
ACUTE GASTRITIS
● Generally a benign, self-limiting disorder
associated with the ingestion of gastric irritants
● Healing occurs spontaneously within a few days
once the offending substance has been
discontinued
CHRONIC GASTRITIS
● Characterized by progressive and irreversible
changes in the gastric mucosa
● Characterized by thinning and degeneration of the
stomach wall
INITIAL TREATMENT
● Eliminate offending substance as soon as possible
by induced vomiting, lavage (irrigation or washing
out a body cavity) or both
○ Lavage: orogastric (mouth); nasogastric (nose)
● Allow the stomach to rest and heal, NPO for 24 to 48
hours
○ If n/v is severe or if with severe pain
● Liquid to bland foods are given as tolerated
○ To avoid gastric irritation
CHRONIC GASTRITIS
● Correct faulty habits of eating and drinking
○ Skipping meals (stomach will produce acid)
○ Acute alcoholism is a common cause
● Provide a relax atmosphere at meal time
○ Stress increases HCl production
● Adequate caloric intake of bland foods
○ Avoid gastric irritation
● Small frequent feeding is preferred
 MODULE 06 – THERAPEUTIC DIET FOR SELECTED PATHOLOGICAL CONDITIONS
○ Avoid sudden increase in gastric acid
production
● Give iron supplements
○ Because pernicious anemia is a complication
○ Gastritis is associated with decreased secretion
of intrinsic factor (a subs normally present in the
gastric juice = malabsorption of B12)
C. DISEASES OF THE INTESTINES
DIARRHEA
● Passage of stool in liquid to semi-solid consistency
at frequent intervals (>3x a day)
● A symptom not a disease
TYPES
● ACUTE
○ Short duration (less than 2 weeks), a result of
enteritis-food borne pathogens, side effects of
medications, change in dietary habits or intake,
emotional stress
● CHRONIC
○ Longer than 2 weeks resulting from disorders like
malabsorption or a more serious disease
condition (consult a physician)
MANAGEMENT
● NPO (Withhold fluid and foods by mouth (to
decrease intestinal motility) for 12 hours with IVF and
electrolytes (to replace losses)
○ Home management NPO for 4 hours ( bowel
rest)
● Oral fluids as conditions improve
○ Oral rehydration solution can be administered
● Pedialyte: flavored commercially prepared ORS
● ORS tablet or powder
○ Home made ORS – 1 L water, 4 tsp sugar, 1 tsp
salt
● Advance to small frequent feeding when tolerated,
serving foods such as broth, gruel (cooked cereal
made by boiling), and toast.
● Include scrapped raw apple and banana given
every 2-4 hours.
○ They contain soluble fiber that holds water to
make a formed stool.
● Liberal fluid intake to replace losses and prevent
dehydration. Replace losses of sodium, potassium
and other electrolytes through fruit juices high in
these minerals
CONSTIPATION
NCM 0104 |Banaag, Cato, Diala, Mallari, Malonzo, Paras|14
● Infrequent (<3x a week) or difficult evacuation of
feces from the intestine (lesser water content of
stool [hard stool] because one of the functions of
the colon is water absorption)
● CAUSES: sedentary lifestyle, Intake of fiber-deprived
diet, long use of laxatives and enemas (rebound
constipation), postponing bowel movements –
increased risk for constipation
TYPES
● ATONIC
○ Condition experienced by older people, obese,
before surgery and during pregnancy
○ CAUSES
● Inadequate diet: lack of Vitamin B = loss of
bowel wall tone
● Irregular meals: little residue for evacuation
● Lack of fluids and fiber: hard feces = not
enough distention to initiate BM
● Irregular defecation: disrupted BM routine
● SPASTIC
○ Over stimulation of the intestinal nerve endings
resulting in asymmetrical contraction of the
bowel
○ CAUSES
● Extreme use of cathartics, laxatives, tobacco,
tea, coffee and alcohol
● Stress: increase hormones such as cortisol,
adrenaline, and serotonin
● Poor hygiene: body performs better when it
is clean and healthy
● Lack of fluids : inadequate fluid intake = does
not produce enough distention to initiate BM
● Irregular defecation: Ex. irregular bowel
habits due to getting up late in the morning
may disrupt the BM
● OBSTRUCTIVE
○ Passage of feces is impeded or a compression
on surrounding tissues
○ CAUSES
● Hirschsprung's disease: congenital (absence
of nerves in parts of intestine)
● Abdominal or pelvic surgery
MANAGEMENT
● High fiber diet (insoluble fiber) – fruit skins
○ In constipation, bulkier and heavier stools
decrease transit time
● Habitual intake of 8-10 glasses of fluids daily (to
soften the stool)
● Treatment goal: Improve diet, exercise (to stimulate
peristalsis) and regularity of bowel habits
 MODULE 06 – THERAPEUTIC DIET FOR SELECTED PATHOLOGICAL CONDITIONS

(postponing bowel movements = increased risk for ● Diffuse inflammatory disorder of the large intestines
constipation) (colon)
● Caused by bacterial invasion and destructive
INTESTINAL GAS enzymes
● Characterized by cramping, abdominal pain, severe
● Increased occurrence or passage of gas or diarrhea, rectal bleeding, anorexia (loss of appetite)
cramping pain and weight loss

MANAGEMENT MANAGEMENT

● Exclude food that produce gas ● High protein up to 150 gms/day

○ Cabbage, cauliflower, beans, potatoes, onions ○ For tse repair of extensive colon lesions
● Small frequent feeding and chewing thoroughly ○ Fish, egg, meat, poultry
○ Milk causes some difficulty for some patients at
DIVERTICULAR DISEASE (DIVERTICULOSIS & first, later in cooked form
DIVERTICULITIS) ● High calories about 2500-3000 calories/day
○ To restore and spare CHON for healing
● Often consequence of long term low fiber eating ○ If caloric intake is low, CHON will be used to
practice and frequent constipation provide energy rather than repairing and
● Diverticulosis building body tissue
○ Presence of diverticula (small, bulging pouches) ● Increased vitamins and minerals
in the colon/digestive tract
○ To boost the immune system, bacterial invasion
● Diverticulitis: inflammation of the diverticula is one of the causes
○ Often consequence of long term low fiber eating ○ May be insufficient if malabsorbed due to the
practice, and frequent constipation disease process
● Low residue diet - in acute stages to prevent
MANAGEMENT
irritation
○ High residue foods are highly irritating
● Well balanced diet
● Highly spiced food and caffeine-containing
● Adequate protein
beverage should be avoided
● High fiber diet: to lessen straining
LACTOSE INTOLERANCE
MALABSORPTION SYNDROME (CELIAC SPRUE)
● Caused by deficiency of lactase, the enzyme which
● Condition in which the mucosa of the small intestine
hydrolyzes lactose, the sugar in milk
is damaged by gluten which results in the
● Causes
malabsorption of nutrients
○ Congenital
● A diarrheal condition in which excessive fat is
○ Celiac sprue
excreted in the stool (steatorrhea: diarrhea with fats)
○ Post gastric surgery
● Nitrogen, minerals and vitamins are also excreted in
considerable amounts resulting severely
MANAGEMENT
malnutrition
● Lactose restricted diet
MANAGEMENT
● Milk, milk products are avoided
● Cottage cheese, aged cheddar cheese and a
● Provide food that are gluten free (celiac disease)
fermented milk like yogurt can be given depending
grains such as rice, quinoa, corn as substitute,
on the tolerance
legumes, fruits, nuts, vegetables, soybeans, peas
● Restrict patient in consuming grains containing
D. LIVER AND GALLBLADDER DISTURBANCES
gluten such as wheat, rye, barley, triticale
● High protein diet HEPATITIS
● Labels must be read carefully
● Inflammation of the liver
ULCERATIVE COLITIS

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 MODULE 06 – THERAPEUTIC DIET FOR SELECTED PATHOLOGICAL CONDITIONS

● General term which may be used to include injury of ○ Lapses into coma
the liver cells as a result of bacterial or viral
infections, toxins or drugs MANAGEMENT

TYPES ● Protein free, very low protein diet (prevent

● Hepatitis A and E: fecal-oral route
● Hepatitis B, C, D: blood borne
○ Transmission:
● BT, Tattoo application, sexual intercourse,
contact with body fluids, mother-child by
breastfeeding
● Sharing used needles, shaving accessories,
touching wounds of infected persons
MANAGEMENT
● High calorie / High carbohydrate diet
○ For bed patients without fever = 2,000 – 2,500
kcal/day
○ For bed patients with fever = 2,500 – 4,000
kcal/day
● Supplemental vitamins – A, D, E, K – decreased
absorption because they are fat soluble
LIVER CIRRHOSIS
● Chronic degenerative disease in which the build up
of fibrous connective tissue replaces the liver cells
following degeneration
byproducts of protein catabolism: ammonia)
● High calorie
CHOLECYSTITIS
● Inflammation of the gallbladder
● Cholelithiasis (gallstones) – presence of stones in
the gallbladder
● Choledocholithiasis – presence of stones lodged in
the common bile duct
MANAGEMENT
● NPO status - during acute attack of biliary colic
(pain due to spasm of the biliary ducts as they try to
dislodge the stones)
○ To decrease gastric acid secretions that would
stimulate release of cholecystokinin and
gallbladder contractions
● Fat restricted diet
● Progression into 20-30 gm of fat if tolerated, can be
increased to 50-60 gm daily
● Meat should be lean rather than marbled with fat
● Vegetables and fruits cannot be dressed with butter
or margarine

TREATMENT PANCREATITIS

● Rest (bedrest) ● Inflammation of the pancreas

● Supportive care
● Nutritional therapy (low Na+ diet) ACUTE PANCREATITIS

MANAGEMENT ● Inflammation of the pancreatic parenchyma that is

brought about by the untimely release and
● Severe liver cirrhosis: serious complication is ascites activation of the proteolytic enzymes
○ 250 mg of sodium to control edema ● Proteolytic – protein digestion
● Low protein ● Leads to autodigestion (digestion of the pancreas by
● Low sodium diet its own enzyme)
● Alcohol restriction ● Life threatening

HEPATIC COMA CHRONIC PANCREATITIS

● Happens when there is too much ammonia in the ● Progressive fibrosis and degeneration of the
blood circulation pancreas (scarring and calcification of pancreatic
● Occurs in patient with severe liver cirrhosis or tissue)
hepatitis ● Result of recurrent acute pancreatitis
● Patient becomes:
○ Disoriented
MANAGEMENT
○ Confused

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 MODULE 06 – THERAPEUTIC DIET FOR SELECTED PATHOLOGICAL CONDITIONS
● NPO for 48 hours with IVF (parenteral route) during
acute attacks to avoid organ stimulation
○ The pancreas secretes enzymes necessary for
CHO (amylase), CHON (protease), and fat
(lipase) digestion
● Clear liquids to soft or bland diets as tolerated. Avoid
diet rich in protein and fat
● Avoid coffee, alcohol, tea, spicy foods, and heavy
meals (6 small feedings instead of 3) – may
stimulate pancreatic secretions
● Pancreatin (mixture of amylase, protease and
lipase) may be administered orally after each meal
to facilitate digestion
E. RECTAL DISTURBANCES
HEMORRHOIDS
● Varicosities or swelling and inflammation of veins in
the rectum and anus
● Perianal varicose veins
● Causes: constipation, pregnancy, obesity, liver
cirrhosis (Increased intraabdominal pressure), poor
bathroom habits (sitting for unusually long periods
of time or excessive cleaning attempts)
● Obstructs venous flow distends the veins
MANAGEMENT
● Low fiber diet during flare-ups
● High fiber diet – 25 to 35 g/day
● Liberal fluids – 8-10 glasses/day
● Highly seasoned foods and relishes are to be
avoided chemically irritating
DIETS FOR SURGICAL PATIENTS AND PATIENTS
WITH BURNS, FEVER, INFECTIONS AND WITH
NEOPLASMS
OBJECTIVES
● To improve the preoperative nutrition whenever the
operation is an emergency case
○ Patient should be prepared to handle surgery
stress and return to optimal health post surgery
● To maintain correct nutrition after operation or injury
as far as possible.
● To avoid harm from injudicious choice of foods
○ Food that will facilitate fast recovery without risk
of complication
● High caloric diet and carbohydrates
○ To give energy to patient post-surgery
● Vitamin K- increases blood clotting time
NCM 0104 |Banaag, Cato, Diala, Mallari, Malonzo, Paras|17
● Vitamin D - increase absorption of calcium for blood
clotting
Dietary Requirements:
● Protein: rapid wound healing
○ 80-100g/day for tissue building, blood
regeneration, edema control
● Minerals
○ Phosphorus and potassium: are lost from the
breakdown of body tissue
○ Iron deficiency anemia: may occur in
association with malabsorption or excessive
blood loss
● Fluids: must be well hydrated before operation
● Vitamin C: important for wound healing and must,
therefore, be provided in increased amounts pre and
post-op
DIET THERAPY FOR SURGICAL PATIENTS
POSTOPERATIVE PATIENT
● AIMS
○ to improve the nutritional status of the patient
○ to prepare him from CHON nutrient loss during
surgery
○ to help him hasten postoperative recovery
○ to build up glycogen reserves
○ to strengthen resistance to infection
● Diet for elective surgery
○ high in protein
○ high calorie
○ with vitamin and mineral supplementation
● Vitamin C
● Minerals: iron deficiency anemia may occur
in association with excessive blood loss
○ in case overweight:
● excessive demands on CV system
● Obese clients frequently suffer from
hypertension, heart failure & metabolic
problems
● increased traction on layers of fatty tissue
● More prone to incisional hernias (protrusion
of organ out of the body cavity), wound
dehiscence (splitting open), evisceration
(spilling out of contents through surgical
incision)
● Adipose tissue is less vascular
○ Delayed wound healing
○ More prone to post-op infection
● Diet for emergency situations
○ NPO post midnight - (8-12 hours)
● Essential: empty stomach prior to GA / major
op - reduce vomiting and danger of
 MODULE 06 – THERAPEUTIC DIET FOR SELECTED PATHOLOGICAL CONDITIONS
aspiration of vomitus because GA suppress
reflexes
○ Major operation – involves opening of major
body cavity
○ parenteral feeding – to promote optimal
nutrition
● Diet the day before surgery
○ NPO post midnight, light breakfast may be given
when the operation is scheduled in the
afternoon and local anesthesia is to be used.
○ Essential: empty stomach prior to GA / major op
- reduce vomiting and danger of aspiration of
vomitus
○ Anesthesia causes muscle relaxation and
suppresses reflexes
● Post operative diet for general and regional
anesthesia
○ Nothing per orem (NPO) immediately after
surgical operation. Parenteral feeding is given to
maintain or restore the fluid and electrolyte
imbalance as the patient is unable to ingest
food or fluid by mouth.
● Parenteral feeding - IVF, contains 10%
dextrose, electrolytes, and vitamins
○ Maximum kcal for IVF: 400 - 500 kcal to
maintain or restore the fluid and
electrolyte imbalance as the patient is
unable to ingest food or fluid by mouth
○ Clear liquid diet
○ The selection of foods, whether it is liquid, soft or
regular depends upon the nature of surgery.
○ Foods must be high in protein and fat - to
provide calorie and spare CHON from being
used; post op patient must be able to eat 1-4
days post op or gibe parenteral feeding
DIET MANAGEMENT FOR SPECIAL SURGICAL
CONDITIONS
● Tooth Extractions
○ Cold liquids should be taken through a drinking
tube then any soft food thereafter
● Tonsillectomy and Adenoidectomy
○ Cold diet consisting of cold, soft foods including
milk, bland fruit juices, plain ice cream and
sherbets
● Fibrous foods must be avoided
● Surgery in the mouth (e.g.:palatoplasty,
cheiloplasty, removal of impacted tooth)
○ Diet: general liquid diet
● Surgery in the esophagus
○ Tube feeding inserted directly into the stomach
● Rests the esophagus
● Gastric surgery
NCM 0104 |Banaag, Cato, Diala, Mallari, Malonzo, Paras|18
○ NPO, IVF for the 1 st 24-48 hours
○ Hourly feeding of 60-90 ml of water
○ Full liquids on the 3rd day
○ Low fiber diet, soft foods on the 4th – 5 th day to
decrease intestinal residue
○ Note: Meals are divided into 5-6 feedings daily
with emphasis on foods high in protein and fat
relatively low in carbohydrates
● Some carbohydrates are gas forming
● Cholecystectomy
○ Low fat diet to avoid pain from constriction at
the wound site
● Ileostomy and Colostomy
○ Ostomy = opening creation of an opening in the
ileum / colon
○ Clear liquid diet the day after surgery
○ Followed by low residue diet (small frequent
feedings
○ Omit foods that can cause discomfort or
diarrhea (berries, popcorn, peanuts, tough
fibrous meats)
○ Avoid eating large meals before bedtime
(ingested food pass through ileostomy within
4-6 hours)
○ Instruct to chew food well (20 to 25 x each bite)
● Because shortened transit time, poorly
chewed food may pass undigested
○ Emphasized increased OFI
○ Foods such as eggs, fish, onion, cabbage and
some greens can cause stool odor therefore
deodorizing solutions or tablets may be placed
in the pouch
○ Spinach, parsley, yogurt, and buttermilk may
reduce odor
● Rectal surgery
○ Clear liquid diet within 24 hours after operation
○ Non-residue to low residue diet until healing to
prevent irritation
● Fractures and Mechanical trauma
○ High protein, high caloric diet: tissue repair and
to hasten bone formation
○ Fluids plus vitamins and mineral
supplementation
DIET THERAPY FOR BURN PATIENTS
● Immediate shock period (days 1-3)
○ Immediate Parenteral
○ Plasma expander (Dextran, IVF) – to correct fluid
and electrolyte imbalance
● Recovery period (days 3-5)
○ Holdrane’s solution – (water, salt and baking
soda) - ½ tsp or 4 g of salt, 1 ½ tsp of sodium
bicarbonate / baking soda, 1 L of water
 MODULE 06 – THERAPEUTIC DIET FOR SELECTED PATHOLOGICAL CONDITIONS
○ To correct fluid and electrolyte imbalance
● Secondary feeding period (days 6-15)
○ High protein diet (preferably 4 times the RDA)
● To hasten wound healing/tse regeneration
● To prevent edema because it will increase
the osmotic pressure
○ Liberal caloric supply (2-3 times the RDA)
● Increase in energy is needed in healing
process
○ Fluids, vitamins and mineral supplementation
● To prevent infection
● B Complex - for energy and CHON
metabolism
● Vitamin C and Zinc - for healing
● Aims for dietary modification in Burns
○ To correct fluid and electrolyte imbalance
○ To prevent tissue catabolism and weight loss
○ To achieve and maintain nutritional equilibrium
○ To hasten wound healing
○ To prevent infection
● RULE OF 9
○ Assess the total body surface area (TBSA)
involved in burn patients
○ Estimating fluid resuscitation requirements since
patients with severe burns will have massive
fluid losses due to removal of skin barrier
● Tube Feeding
DIET THERAPY IN PATIENTS WITH FEVER AND
INFECTIONS
● General Dietary Considerations
○ Energy: caloric requirement may be increased
as much as 50% if the temperature is high and
tissue destruction is great
● Febrile period may cause loss of tissue
protein amounting to as much as ½ to ¾ of
muscles a day
NCM 0104 |Banaag, Cato, Diala, Mallari, Malonzo, Paras|19
○ Protein: 100 grams of more for adults in
prolonged fever
● For muscle tse repair and production of
antibodies
○ Increased carbohydrates to replenish glycogen
stores
● Stored glycogen quickly become depleted
○ Vitamins: A and C
● To boost immune system / antioxidants
○ Fluids: increase intake by 2,500 to 5,000 daily
● Fluid loss through perspiration and possibly
vomiting and diarrhea
○ Intervals of feeding: Small quantities at intervals
of 2-3 hours
RHEUMATIC FEVER
● An inflammatory disease that may develop two to
three weeks after a Group A streptococcal infection
(such as strep throat or scarlet fever)
● It is believed to be caused by antibody
cross-reactivity and can involve the heart, joints,
skin, and brain
● Dietary Management
○ Soft and liquid diet during the acute stage with
mild restrictions in sodium to avoid fluid
retention and edema formation
TUBERCULOSIS
● A common and often deadly infectious disease
caused by Mycobacterium tuberculosis
○ Can be transferred through droplet
● Usually attacks the lungs (as pulmonary TB) but can
also affect the CNS, lymphatic system, circulatory
system, GI, bones, joints, and skin
● Dietary Management
○ Caloric requirement: 2,500 to 3,000 calories to
regain loss weight
○ Protein 80 to 120 grams
● For muscle tse repair and production of
antibodies
○ Increase intake of Calcium containing foods
● To promote healing of TB lesions
○ Iron supplements be given when the
hemorrhage is present
○ Ascorbic acid is given to increase resistance
EMPHYSEMA
● An abnormal distention of terminal bronchioles with
destruction of the walls of alveoli
● Signs and symptoms: severe breathlessness, cough
and wheezing
 MODULE 06 – THERAPEUTIC DIET FOR SELECTED PATHOLOGICAL CONDITIONS
● Dietary Management
○ Decreased CHO and increased CHON, Vitamin C
MILK ALLERGIES
● Allergic reaction to protein hydrolysate
○ Common sa formula fed babies
● Dietary Management
○ Long and gradual desensitization program
beginning with a single drop of diluted cow’s
milk to a tolerance of one pint milk
○ Trial or Milk Free diet using soybean preparation
or lamb meat based formula as substitute
ANEMIA
● Anemia - without blood
● Qualitative or quantitative deficiency of hemoglobin,
a protein found inside of RBCs
● Iron Deficiency Anemia
○ Reduction of total body iron below the normal
level
○ RDA of Fe: (male/female) 8mg/day 51y/o and up
18mg/day 18-50y/o
○ Causes
● frequent blood donation
● one pregnancy after another
● lactation
● menstrual bleeding
● decreased assimilation resulting from
vegetarian diets, low gastric acidity,
presence of steatorrhea, or in total or in total
or partial gastrectomy (causes decreased
capability to absorb iron)
○ Aim of Diet
● To reach a maximum hemoglobin increase
● High protein and iron diet
hematopoiesis)
● Drugs: administration of hematinic factor
(ferrous salts, Vit C and B complex)
● Pernicious Anemia
○ Vitamin B12 deficiency due to lack of intrinsic
factor (a glycoprotein produced by parietal cells
of the gastric lining of the terminal ileum)
○ Clinical Symptoms
● Weight loss
● Pale skin and mucous membrane (faint
yellow tint)
● Raw red tongue
○ Treatment
● Regular IM or SC injection of B12
● Diet rich in protein, iron and vitamin C
● Folic Acid Deficiency Anemia
○ Sign and Symptoms
● Cheilosis - cracking of corners of the mouth
● Glossitis - inflammation of the tongue
causing it to be smooth
○ Management
● Folic acid administration (spinach,
asparagus, lettuce, dried beans, oranges,
pineapples, melon, grapefruit)
● Increase intake of green leafy vegetables
DIETARY MANAGEMENT FOR NEOPLASTIC
DISEASES
● Cancer - cellular tumor; natural cause of which is
fatal and usually associated with the formation of
secondary tumors
● Neos - new; Plasis - growth
○ Also known as a tumor
● Types
○ Benign Neoplasm: a harmless growth that does
not spread or invade other tissues
○ Malignant neoplasm: harmful mass capable of
invasion of other tissues & metastasis to other
organs
● Grow rapidly or slowly
● Spreads from the place in which it has
started to the other parts of the body,
nearby or remote
● Could cause mechanical pressure and
obstruction, destruction of tissues,
hemorrhage, infection, anemia, cachexia,
hormonal abnormalities, muscle weakness,
anorexia, and the depletion and
redistribution of host components
● Signs and Symptoms
○ Changes in Bowel or Bladder habits
○ A sore that does not heal
(for ○ Unusual bleeding or discharge
○ Thickening or lump in the breast or elsewhere
○ Indigestion or difficulty in swallowing
○ Obvious changes in wart or mole
○ Nagging cough or hoarseness
○ Unexplained anorexia
○ Sudden unexplained weight loss
NUTRITIONAL CONSEQUENCES OF
CARCINOGENESIS
● Changes in energy metabolism
○ Altered fat and CHO metabolism
● Disturbed CHON metabolism, including muscle
CHON metabolism and serum albumin turnover
● Altered iron metabolism, affecting hemoglobin
synthesis and iron-containing enzymes
NCM 0104 |Banaag, Cato, Diala, Mallari, Malonzo, Paras|20
 MODULE 06 – THERAPEUTIC DIET FOR SELECTED PATHOLOGICAL CONDITIONS

NUTRITIONAL PROBLEMS RESULTING FROM TUBE FEEDINGS

CANCER TREATMENT
● Complete products: meal replacements that require
● Radiation Treatment digestion and absorption
○ N/V, general loss of appetite ● Chemically-defined products: minimal or no
○ Loss of taste and dysphagia digestion
○ Dental problems
○ Diarrhea, malabsorption resulting from bowel TOTAL PARENTERAL NUTRITION (TPN)
damage
○ Dryness of mouth (xerostomia) ● Used when the digestive tract is not functioning
● Surgical Treatment ● Nutrients are administered intravascularly
○ Dependence on tube feeding as a result of
oropharyngeal area resection
REFERENCES
○ Malabsorption resulting from resection of Synchronous Lecture: 07,10 December 22 (CI: Ma’am
segments if GIT Brenda Policarpio)
○ Dumping syndrome and hypoglycemia resulting Module: NCM 0104 - Mod 06
from gastrectomy Book: Basic Nutrition and Diet Therapy for Allied Health
(Cruz-Caudal)
○ Altered water and electrolyte balance
○ Diabetes Melitus resulting from pancreatectomy
● Chemotherapy Treatment
○ F&E imbalance d/t hormonal treatment
○ GI damage including n/v, anorexia d/y
antimetabolites and other agents
○ Anemia results from drugs
● Chemotherapy - metallic taste

PRINCIPLES TO FOLLOW IN PROVIDING NUTRITION

FOR CANCER PATIENTS

● Emphasis on adequate oral intake

○ Promotes the patient's feeling of going back to
normal
○ Eating as much as he wants has psychological
values for the patient
● Avoid highly seasoned and spicy foods in patients
with lesions in the mouth

NUTRITIONAL MANAGEMENT FOR CANCER

PATIENTS

ORAL NUTRITION

● High calorie, high protein beverages

○ Cancer cells draw nutrition and sustenance from
the host
● Emphasis on adequate oral intake. This route of
feeding promotes the patients feeling of going back
to normal
○ Eating what as much as he wants has
psychological values for the patient
● Avoid highly seasoned and spicy foods in patients
with lesions in the mouth
● Xerostomia (dry mouth) is seen in patients with
radiation therapy

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