DIET AIMS CHARACTERISTICS INDICATIONS

To bring and maintain

a person in a state of For patients whose
Consists of any and all
nutritive sufficiency conditions do not need
foods eaten by a person
1. Normal/ General dietary modifications
Used as basis for in health but requires
or restrictions, for
planning therapeutic good menu planning
therapeutic purposes
diets

MODIFICATIONS IN
CONSISTENCY AND
TEXTURE

Provides no nutritional
essentials; includes only
those foods which are
clear (with no residue
or fiber) and are liquid
To provide an oral
or liquefy at room In diarrheal diseases,
source of fluids and
temperature(e.g. fat- before bowel surgery
small amounts of
free broth, black coffee, or barium enema, after
calories and
tea, fruit juices, colonic surgery, acute
electrolytes in order to:
1. Clear Liquid flavored gelatin and inflammatory
a) prevent dehydration;
carbonated beverages); conditions of GIT,
b) relieve thirst; c)
sugar and plain hard first oral feeding of
maintain water balance
candies supply added severely debilitated
and d) reduce colonic
calories patient
residue to a minimum
Initial feeding is 30-60
ml
Used for 1 or 2 days
only
 Require the least effort
for digestion and
absorption; consists of
foods that are liquid or
liquefy at room/body
temperature and are
free of cellulose and
irritating condiments
Transition diet for post-
operative cases between
a clear liquid and soft Acute illnesses,
To provide oral diet; can be planned to following oral surgery
nourishment that is be nutritionally or plastic surgery of
2. Full Liquid or well tolerated by adequate; supplements the face and neck,
General Liquid patients who are of folic acid, vitamin esophageal strictures,
acutely ill or are unable B6 and iron are needed mandibular fractures,
to chew solid foods if diet is used for a long impaired chewing or
period of time swallowing ability
Foods allowed: those
included in clear liquid,
milk, plain frozen
desserts, fruit/vegetable
juices and purees,
custard, cereal gruels,
broth, pureed strained
meat, fish, soft-cooked
egg, cocoa, butter,
margarine

Consists of cold or iced

smooth liquids and
foods
Acidic or sour fruit
juices and hot soups are
To minimize pain in
3. Cold Liquid or T&A avoided Tonsillectomy,
the oral cavity and
(Tonsillectomy & adenectomy, tooth
avoid bleeding of Includes plain ice-
Adenectomy) Diet extraction
operated area cream, sherbets, cold
milk, iced tea/coffee,
bland fruit juices, soft
drinks, bland and soft
foods which have been
cooled
 May be administered
through a nasogastric
tube (NGT), via a
pharyngostomy or
through a gastrostomy
or jejunostomy
Types: When patient is unable
to chew or swallow
1. Homogenized or due to deformity or
blenderized mixture of inflammation of
foods selected from a mouth or throat,
To provide a source of normal diet corrosive poisoning,
complete nutrition in a 2. Commercially com, unconsciousness,
form that will easily prepared and pre- paralysis of throat
pass through a tube in sterilized feedings muscles, surgery of
patients in whom oral head and neck,
4. Tube Feeding feeding methods are A) Milk or casein based esophageal
contraindicated or not formulas (ex. Sustagen, obstruction, surgery of
tolerated or whose Meritene, Sustacal, the GIT, in severe
condition warrants Isocal, Ensure, Flexical) burns, mental
supplementation in the B) Blenderized diet disturbances, anorexia
form of natural foods feedings (ex. Formula nervosa, mandibular
2, Compleat B fractures, following
head/neck irradiation,
C) Synthetic fiber-free strokes or trauma to
liquid diets (ex. the oral pharyngeal
Vivonex) cavity
Foods allowed: those
included in liquid, soft
or regular diets which
can be liquefied and can
pass through a
polyvinyl tube

For both mechanical Follows the regular diet

ease in eating and pattern but modified in
digestion consistency and texture;
consists of food soft in
Acute infections,
texture, easy to chew,
fevers, some GI
To provide a bland in flavor, easily
5. Soft disturbances, after
nutritionally adequate digested with no harsh
surgery, during
diet with the use of fibers and tough
convalescence
simple, easily digested connective tissues;
foods highly seasoned foods,
fatty and fried foods are
avoided

Similar to the regular Difficulties in

diet except that foods mastication as in
To provide foods that that are hard to chew dental disorders, jaw
6. Mechanical Soft
require minimum and swallow are injury, dental
chewing modified by grinding, extraction, sores and
mincing, chopping and lesions in the mouth
pureeing
 Greasy, highly spiced
or highly seasoned
foods and condiments
as well as fibrous, hard
and strongly-flavored
foods are excluded
To provide a
chemically, thermally Individualization is the
and mechanically non- rule and only those Used traditionally for
irritating diet given as foods known to be gastric and duodenal
7. Bland part of the treatment for “disagreeable” to the ulcers, gastritis,
duodenal ulcer and patient are omitted ulcerative colitis,
other GI disturbances; dyspepsia,
Foods proven to
to reduce acid secretion diverticulitis, diarrhea,
stimulate gastric
and neutralize acid gallbladder diseases
secretion are decaf
present; to provide rest
coffee, red pepper, cola
to affected area
beverages; those that
cause gastric irritation
include black pepper,
chili powder, caffeine,
coffee, tea, alcohol and
drugs

Contains increased
amount of cellulose,
To increase the volume hemicellulose, lignin
and weight of the and pectin and provides
residue that reach the Atonic constipation,
13 g or more of crude
distal colon; to increase uncomplicated
8. High Fiber fiber; emphasis on
GI motility; to decrease diverticulosis, irritable
whole grain cereals and
intraluminal colonic bowel syndrome,
breads, and fresh fruits
pressures (specifically atherosclerosis,
and vegetables that are
diverticulosis) obesity, DM
high in fiber content,
legumes and nuts with
skins; may cause
diarrhea and flatulence

Indigestible CHO is
reduced by using young During acute phase of
immature vegetables, diverticulosis,
To prevent the ripe canned or well- ulcerative colitis,
formation of cooked fruits, and infectious
obstructive bolus by certain low fiber fruits enterocolitis, wherein
high fiber foods in and vegetables; may
9. Fiber- restricted the bowel is markedly
patients with narrowed cause prolonged inflammed; in spastic
intestinal or esophageal intestinal transit time constipation, diarrhea,
lumens and small infrequent hemorrhoids, cancer of
stools; may eventually the bowel
decrease the size of the
colon and increase in
intraluminal pressure

Limits the use of foods

To provide a diet that high in fiber and those Acute diarrhea, spastic
leaves a minimum that produce bulky constipation,
10. Residue restricted
residue to rest the stools: milk, potatoes, dysentery, acute phase
intestinal tract cheese except cottage of ulcerative colitis,
cheese, raw and soft- ilietis, acute
cooked egg, butter, lard diverticulitis and right
 after colonic or rectal
surgery

MODIFICATIONS IN
COMPOSITION
(CALORIE)

To provide a diet with Calculated like a

a caloric value below normal diet except that For overweight and
the total maintenance the total caloric levels is obese persons and for
energy requirements to decreased by 500 or cases wherein obesity
1. Calorie restricted 1000 kcal/day to effect
bring about steady is a complicating or
(Low caloric or a weight loss of 1 or 2
weight loss at an risk factor (DM,CVD,
reducing diet) lbs per week,
optimum rate yet renal disease, HPN,
supply adequate respectively gout, gallbladder
nitrogen, minerals and High CHO and fat-rich disease, surgery)
vitamins foods are avoided

To allow gain in
weight; to provide for
increase in BMR in: Contains more calories
than the regular diet
*fever (+13% per °C
elevation) Protein remains at or
above recommended
*cardiac failure (+ 15-
levels
25%)
Increased amounts of
*simple post operative Underweight, fevers
vitamins and minerals
states (+0-5%) and infections,
2. High caloric are needed for
*peritonitis (+5-25%) metabolism hyperthyroidism,
burns
*severe infection or Excessive amounts of
multiple trauma (30- fried foods, those high
50%) in bulk or fiber and
concentrated sweets
*multiple trauma with
which tend to reduce
patient on ventilator
the appetite for food are
(+50-75%)
avoided
*burns over 50% of the
body (+100%)

MODIFICATIONS IN
COMPOSITION
(CARBOHYDRATES)

CHO comprises 40% or
To reduce available less of TER (but should
1. Low CHO glucose when CHO not be less than 100
metabolism is impaired g/day).
Simple sugars are
eliminated
Traditional regimen
for DM, weight
reduction and
epilepsy;
hyperinsulinism,
dumping syndrome,
celiac disease, certain
types of
hyperlipoproteinemias,
stimulative and
 alimentary
hypoglycemia

CHO comprises 70-

80% of TER

To allow for glycogen Emphasis is on foods Liver diseases,

formation, ensure high in available CHO Addison’s disease,
sufficient calories to such as sugar, syrups, fasting hypoglycemia,
2. High CHO jellies and jams (such acute
spare protein, and to
minimize tissue sweets however should glomerulonephritis,
catabolism comprise no more than uremia, pernicious
10% of total calories) vomiting and toxemias
of pregnancy
The majority of CHO
must come from
complex CHO

Free of all sources of

Control of
galactose: all foods
galactosemia and
containing lactose,
prevention of severe
3. Galactose - free organ meats such as
mental retardation, Galactosemia
liver, pancreas, brain,
cataracts and other
MSG
symptoms
Infants are started on
soybean milk at birth

Primary lactase
deficiency as in Holzel
Syndrome and Durand
Syndrome; secondary
Treatment of severely Milk and milk products, lactose intolerance due
affected individuals in foods that naturally to damaged intestinal
whom the intestinal contain small amounts mucosa in celiac
4. Lactose-free
enzyme lactase is of lactose or have small disease, kwashiorkor,
almost completely amounts added in GI milk allergy,
absent processing are irritable bowel
eliminated syndrome, regional
enteritis, ulcerative
colitis; transient
lactose intolerance
after viral enteritis

Contains less than 8-10

g lactose daily; should
be specialized to
accommodate
individual tolerance
To prevent the
levels
occurrence of
symptoms in patients Milk beverages, Less severe and adult
5. Lactose- restricted with less severe forms creamed foods and ice forms of lactose
of lactose intolerance cream may have to be intolerance
avoided while
fermented forms of
milk such as cheese in
which lactose is
converted to lactic acid
are not restricted
MODIFICATIONS IN
COMPOSITION
(PROTEIN)

Allow 1.5 g or more of

protein/kg body weight
or 50% above normal
requirement
To afford regeneration
of body tissues and Diet should supply Cancer, pernicious
cells to compensate for adequate calories anemia, liver cirrhosis,
improper utilization infetious hepatitis,
Protein synthesis will
and loss of, or PTB, ulcerative colitis,
not occur and will be
increased demand, for fractures, severe
used up as energy
protein burns, post-operative
unless the ratio of
calories to nitrogen is conditions, PEM,
1. High Protein
200 nephrosis, in nephritis
Adult protein with hypoproteinemia,
requirement increases Ex. 2400 kcal is to 12 g chronic
to 1.5 g/kg in operative N or 75 g protein glomerulonephritis
states and 2.25 g/kg in with albuminuria,
[N(g) = Protein (g) ÷
severe infection, pregnancy, lactation
6.25, and 2400 ÷ 12 =
multiple trauma, burns and growth
200]
Adequate vitamins and
minerals must be
furnished to assure
optimum utilization

Supplies from 0-0.7 g

To minimize sources of
protein/kg body
toxic nitrogenous In kidney diseases
weight or 0-0.4 g/day
products and at the where there is
2. Protein- restricted
same time supply the Level of restrictions nitrogenous retention,
essential amino acids depends upon the anuria and uremia,
and adequate calories patient’s clinical and hepatic coma
biochemical status at a
particular time
 A very unpalatable and
monotonous diet
consisting mostly of
sugars and fats; very
inadequate and should
be used for 2-3 days as
a temporary measure
As the patient’s
condition improves, the
Acute anuria, hepatic
2a. Zero protein protein intake should be
coma
gradually increased to
5, 10,15 g/day and so
on
The inclusion of fruits
and fruit juices gives a
total of 2-4 g protein
and increases the
potassium content of
the diet

Contains limited
amount of high
biological value
protein; egg is preferred
over milk since the
latter contains higher
sodium, calcium,
phosphate and fluid
3 1/2 exchanges of rice, Chronic renal failure,
2b. 20 g Protein one exchange of acute
vegetables and 1 1/2 glomerulonephritis
exchanges of meat
(include egg) will
provide 20 g of protein
of which 2/3 are of
HBV
Sugars, fruits and fats
are used to meet caloric
needs

Can be planned to have Chronic uremia,

variety of foods; 26 to chronic
2c. 40 g Protein
30 g should come from glomerulonephritis
animal sources and hepatic coma

3. Protein Constituents

3a. Purine- restricted

 Purine content limited
to 120-150 mg/day
(normal intake is 600-
1000 mg) by
eliminating organ
To lower serum uric meats, anchovies,
acid levels in the sardines, meat extracts, Uric acid, calculi, gout
treatment of gout gravies, dried beans,
peas, yeast, spinach,
oatmeal
Since fat prevents
excretion of urates, the
diet is also low in fat

To provide protein,
phenylalanine,
tyrosine, energy and
other essential nutrients
in amounts sufficient
Natural foods low in
for growth and
phenylalanine and
3b. Phenylalanine- development; to
Lofeenalac (a protein phenylketonuria
restricted prevent mental
hydrolysate form the
retardation by
basis for the diet
controlling excessive
accumulation of
phenylalanine and its
metabolites in the
plasma

To eliminate toxic
3c. Gluten restricted glutens for patients Excludes wheat, rye, Celiac disease, non-
with celiac disease oat and barley tropical sprue
Gliadin free

4. Vegetarian Diets
Excludes all foods of
animal origin
4a. Vegan diet or strict To furnish all the Protein comes from
vegetarian diet essential amino acids vegetables, breads,
while replacing part or cereals, dry peas, beans, For ecological,
all animal sources of lentils, nuts, peanut religious and health
protein with plant butter concerns
sources

Excludes meat, poultry

4b. Lacto- vegetarian and fish
diet
Allows dairy products
in addition to those
included in vegan diet
 Excludes meat, poultry
and fish
4c.Lactoovo-
vegetarian diet Allows eggs and dairy
products in addition to
those included in vegan
diet

4d. Pesco- vegetarian Includes plant foods

diet and fish but does not
include milk, egg, meat
or poultry

Restricts the variety of

plant foods to fruits and
4e. Fruitarian diet nuts with or without the
addition of grains and
legumes

MODIFICATIONS IN
COMPOSITION
(FAT)

Contains approximately Acute pancreatitis,

20-30 g fat/day or 10- acute gallbladder
15% TER diseases,
To meet a specified CHO is increased while cardiovascular
1. Low Fat percentage of fat protein is at normal diseases and where
calories level there is derangement
in the digestion,
May cause deficiency absorption and
in vitamins A, D, E, K metabolism of fat
since fat is their carrier
in the body

Liver and heart

2. Moderate Fat Adequate in essential
diseases, chronic
Same as 1 nutrients and allows 50-
gallbladder and
65 g fat/day
pancreatic diseases

Accompanies high Butter, margarine,

3. High Fat Alimentary and
PRO high cal diet or in cream, salad dressing
stimulative
diets restricted in and vegetable oils are
hypoglycemia, uremia
PRO/CHO used liberally

Rarely prescribed high

To maintain a fat (80% of TER) low
4. Ketogenic Diet ketogenic:antiketogenic CHO (10-30g/day) diet Erilepsy, convulsive
ratio that will produce a seizures
state of ketosis Drug therapy has
replaced this diet
 Contains 250-300 mg
cholesterol
Atherosclerosis,
To effect a lowering of Excludes organ meats, hyper-
serum cholesterol and shellfish, fish roe, cholesterolemia,
5. Low Cholesterol prevent deposition of whole milk, cream, Types II-V hyper-
fatty materials in the butter, cheese and lipoproteinemia,
arterial walls animal fat gallstones with
cholesterol esters,
Eggs limited to 2-3 per
coronary artery
week; meat, fish and
disease
poultry limited to 6 oz
cooked weight/day

MODIFICATIONS IN
COMPOSITION
(MINERAL
CONTENT)

Vary with degree of

restriction
Sodium level is limited
to a prescribed level Ascites in liver
ranging from 200-3000 cirrhosis, HPN, edema
1. Sodium- restricted mg daily (Filipino diet accompanying CHF,
(low salt, low sodium) To restore normal salty condiments may adrenocortical therapy
sodium balance to the have 7-15 g Na/day) and toxemias of
body by effecting loss pregnancy
Foods containing large
of excess sodium and amounts of sodium are
water from extra either eliminated or
cellular fluid restricted in amount
compartments

No salt used in cooking;

1a. 200-300 mg Na careful selection of
(extreme Na foods low in sodium; Liver cirrhosis with
restriction) regular milk, bread, ascites, CHF, if higher
butter or margarine are Na level is ineffective
omitted; eggs and meat
are limited

Allows limited amounts

of regular milk, bread
and butter
Uses no processed
foods containing
1b. 500-700 mg Na Pulmonary edema in
sodium nor salt in food
(severe Na restriction) CHF, renal disease
preparation but a
with edema and
measured amount of
cirrhosis with ascites
table salt ( 1 tsp salt =
200 mg Na) may be
added on the patient’s
tray if the total inherent
sodium of the foods
used does not meet the
 sodium allowance for
the day

Measured amount of
salt is added to the 500
1c. 1000-1500 mg Na mg Na diet (e.g. + 1/4
Patients with
(moderate Na tsp salt for 1000 mg Na,
borderline HPN, or
restriction) + 1/2 tsp salt for 1500
those with strong
mg Na), or foods with
family histpry of HPN
relatively higher
sodium content are used
more generously

1d. 2000-3000 mg Na Some salt may be used

Maintenance diet in
(mild Na restriction) in cooking but no salty
cardiac and renal
foods are permitted; no
diseases
salt is used on the table

Restricts potassium
intake to 1000-2000
mg/day (or 25-51
mEq/day)
The average diet
contains 50-150 mEq
To prevent K/day
CHF with
2. Potassium- restricted hyperkalemia Dark green vegetables, hyperkalemia,
tomatoes, fruits (except Addison’s disease
kaimito, lychees and
canned pineapple),
dried peas and beans,
unrefined cereals, root
crops, nuts, crustaceans
and brown sugar are
avoided

Provides a maintenance Calcium oxalates

level of Ca ranging stones, hypercalcemia
Used in combination
from 200-400 mg/day in hyper-
with oxalate and fat
3. Calcium- restricted (normal adult parathyroidism, acute
restrictions to prevent
requirement is 500 immobilization, milk
renal stones
mg/day) alkali syndrome,
Foods high in calcium hyperthyroidism, acute
are avoided adrenal insufficiency

MODIFICATIONS IN
COMPOSITION (ASH
CONTENT)

To bring about a Renal stones

reduction in the pH of Emphasis is on the use consisting of Ca, Mg,
1. Acid-ash
urine (normal range= of large amounts of phosphates, carbonates
4.5 - 7.5) acid-forming foods and oxalates
2. Alkaline-ash To bring about an
Uric acid and cystine
increase in the pH of
stones
urine

OTHER DIETS

To exclude a specific
food or food group
1. Hypoallergenic diet Food allergy
known to produce
allergic manifestations

Consists of banana,
2. BRAT diet To provide sources of rice, apple and tea
calories, fluid, Diarrhea
electrolytes ad pectin Crackers may be used
instead of rice

A kind of diet that

To lower blood lipid follows the guidelines
levels and possibly suggested by the Inter-
3. Prudent diet Society Commission on
prevent coronary heart Atherosclerosis
disease Heart Disease
Resources, The
American Heart
Association

Commercial low-
calorie meal substitutes
in liquid, powder or
solid form
Advantages:
convenience and strict
caloric control
To allow for weight
4. Formula diet Obesity, overweight
reduction Disadvantages: a) they
do not retrain the
person to sound food
habits once weight is
lost, b) monotonous, c)
may cause either
constipation or
diarrhea, d) expensive
Nutrition Education

Nutrition education helps individuals, families, and communities make informed choices about food and
lifestyles that support their physiological health, economic and social well being (USDA, 2012).

Nutrition education is any combination of educational strategies, accompanied by environmental supports,

designed to facilitate voluntary adoption of food choices and other food- and nutrition-related behaviors
conducive to health and well-being (Contento, 2011).

Competency Checklist for Nutrition Counselors

Nutrition Information for

Performance Objectives
Particular Patient

Diet and Eating Pattern 1a. is familiar with all food categories of the diet
1. Counselor knows the essential 1b. Is comfortable with substitutions and rationale for selection of food
elements and rationale behind
patient’s prescribed diet. 1c. Is prepared to help patient adapt diet to his or her needs

2a. Has some grasp of regional customs and of what foods are available in
2. Counselor has knowledge of the area
local eating patterns. 2b. Is familiar with frequently patronized restaurants and food chains and
will ask patient his or her favorites

3a. Takes a history to find out patient’s dietary background

3. At the outset, counselor makes 3b. At first session, discusses long-term goals and explains diet thoroughly,
reasonably sure that patient’s making sure patient understands
knowledge of prescribed diet is 3c. Eliminates patient’s knowledge gaps
adequate.
3d. Initially, ask patient for food diary; analyzes with patient to assess
current diet and eating behavior

4a. Makes appointment with patient, allowing enough time for

Communication Skills comfortable, thorough discussion
4. Counselor set appropriate tone 4b. Arranges for private, quiet setting
for counseling sessions through
4c.Shows interest in patient as an individual, look for his or her particular
preparation, manner and
needs and preferences
physical setting
4d. Maintains relaxed, comfortable manner; makes patient feel at ease
4e. Indicates intentions to talk and to listen

5. Counselor prepares self and

patient for continuing 5a. Explains initially the necessity of follow-up over time
relationship over a specified 5b. Outlines plans for working with patient
period.

6a. Uses primarily open-ended questions

6. Counselor uses principles of 6b. Guards against doing most of the talking; shows ability to listen
good communication.
6c. Shows nonjudgmental, noncritical attitude toward patient’s eating
pattern and chosen lifestyle

7. Counselor communicates 7a. Shows poise and interest through posture and body language
interest and confidence both
nonverbally and verbally. 7b. Has frequent eye contact with patient

Counselling Approaches
8. Counselor is aware that the
change process is the
responsibility of the patient.
9a. Helps patient choose an initial goal that is easilyachieved
9. Counselor is aware of need for
9b. Helps patient set specific and short-term goals that are progressively
patient to recognize manageable
more challenging
goals.
9c. Is able to help patient evaluate goals
10. Counselor is able to help
patient set up recorkeeping
and/or tally systems.
11. Counselor is aware of the
need to examine and anticipate
obstacles that will interfere with
profress.
12. Counselor is able to define
own role in giving support and
feedback.
13. Counselor is able to evaluate
progress toward the stated goal.
14. Counselor encourages
patient to get family and friends
involved.
15. Counselor is able to
understand that his or her role is
not simply that of information-
giver or instructor.
16. Counselor is aware of the
need to keep patient task-
oriented.
7c. Uses gestures and words to encourage patient to communicate freely,
without putting words in patient’s mouth
8a. Does not assume responsibility for changes or consequences
8b. Does not become too ego-involved in patient’s eventual success or
failure
9d. Helps patient avoid failure through too large or too many goals
10a. Can help patient verbalize a method appropriate to the task
10b. Can suggest alternate methods for patient’s consideration without
dicating choice
10c. Emphasizes need for accurate records
10d. Is able to help patient review food records patient can understand
11a. Can review with patient potential obstacles in social, personal and
physical environments
11b. Can help patient identify actual or potential problems and deal with
these by encouraging patient to restructure environment and by role
playing problem situations with him or her
12a. Can avoid taking the major responsibility
12b. Can place the responsibility for change on patient
12c. Is aware of own biases and belief systems and is able to ignore them
13a. Is able to give feedback about progress
13b. Keeps notes in sufficient detail
13c. Measure progress by a combination of biological measures, food
intake evaluation, and subjective judgments, with an emphasis on changing
behavior
14a. Helps patient recognize their strong influence on him or her
14b. Suggests that patient them to participate in some way
14c. Can help patient cope with negative feedback through anticipating and
rehearsing problem situations
14d. Can evaluate whether they are potentially supportive or destructive
15a. Acts as facilitator for patient
15b. Is appropriately assertive
15c. Is able to resist lecturing
16a. Recognizes delayingtactics and distractions
16b. Is able to redirect the session toward specifics
16c. Responds pleasantly but professionally to patient’s attempts at humor