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THERAPEUTIC DIETS

(Obesity and Weight Control Diabetes Mellitus Food Preparation and Service
Gastrointestinal Tract) - Should be measured according to food exchange list
- No extra flour, bread crumbs, butter, or other foods
Therapeutic diet - Meat may be broiled, baked, roasted, or stewed
- is a meal plan that controls the - No frozen or canned fruits packed with sugar
intake of certain foods or nutrients. - No concentrated sweets and desserts

Modified for : Diverticular Diseases (Diverticulosis and Diverticulitis)


(1) nutrients, - Presence of a divertucula (pouch) in the colon which can lead
(2) (2) texture, to diverticulitis
(3) (3) food allergies or food intolerances. - Diverticulitis results from the swelling of small pouches in the
colon wall and lining. Inflammation develops the minute
OBESITY bacteria and other irritants are ensnared causing spasms and
- A condition in which the natural energy reserve is pain in the lower left side of the abdomen
increased, is a hazard to health
- abnormal or excessive fat accumulation that presents Low-Residue Diet/
a risk to health. • It limits high-fiber foods, like whole-grain breads and cereals,
- A body mass index (BMI) over 25 is considered nuts, seeds, raw or dried fruits, and vegetables.
overweight, and over 30 is obese. • "Residue" is undigested food, including fiber, that makes up
- Prone to heart disease, gallbladder disease, diabetes, stool. The goal of the diet is to have fewer, smaller bowel
or other chronic disease movements each day. That will ease symptoms like diarrhea,
- An obese pregnant woman is more likely to have bloating, gas, and stomach cramping.
complications than a woman of normal weight
Malabsorption Syndrome (Celiac Sprue)
1 pound (lb) of fat is equal to about 3,500 calories. - A condition in which the mucosa of the small intestine is
damaged by gluten which results in the malabsorption of
Low Calorie Diet nutrients

Women: 1,000 – 1,500 calories diet restriction Non-tropical Sprue


Men: 1,200 – 1,800 calories diet restriction - A diarrheal condition in which excessive fat is excreted in the
Bed patients with heart disease: 800 – 1,000 calories stool (steatorrhea). Nitrogen, minerals and vitamins are also
excreted in considerable amounts so that the individual
Nutrition Therapy for Diabetes Mellitus becomes severely malnourished

DM – is a metabolic disease that affects the endocrine Gluten-free diet


system of the body and the use of carbohydrates and fats. - is an eating plan that excludes foods containing gluten.
Gluten is a protein found in wheat, barley, rye and triticale (a
(hyperglycemia) the blood sugar level rises cross between wheat and rye).
(glucosuria). sugar excreted in the urine
(polydipsia) frequent urination and increased thirst . Ulcerative Colitis
(polyphagia) Increased appetite - An inflammatory bowel disease of the large intestine limited
to the rectum and the colon which causes profuse and bloody
2 types of Diabetes diarrhea.
- Characterized by severe diarrhea, rectal bleeding, cramping,
1. Juvenile Diabetes abdominal pain, anorexia, and weight loss
- Any age from birth through adolescence
- severe, requires insulin for treatment and difficult to manage Lactose Intolerant
- Deficiency of lactose
2. Adult-type Diabetes - Undigested lactose remains in the small intestine and may
- Middle age serve as a substrate for bacterial fermentation
- mild, stable and well-regulated by diet and oral - May be congenital or may arise from other diseaseconditions
compounds with diet like celiac sprue or can occur after gastric surgery

Dm Diet Diarrhea
- Frequent loose or liquid bowel movement that prevents
- Normal except the amount of food and their complete digestion and absorption
distribution in meals are controlled
Types:
Protein: 1. Acute – less than 2 weeks caused by viral, bacterial, or
• ½ - 2/3 g per lb protozoan infection, medication side effects, altered dietary
Carbohydrates and Fat: intake
• Carbohydrates – roughly twice the number of grams of 2. Chronic – more than 2 weeks resulting from malabsorption
proteins or PEM (Protein Energy Malnutrition) or medical treatment
• Fats – same grams as protein
Constipation
Nutrition Therapy for Gastrointestinal Tract Diseases - most commonly occurs when waste or stool moves too
 slowly through the digestive tract or cannot be eliminated
Peptic Ulcer – an ulceration in the protective inside layer of the effectively from the rectum, which may cause the stool to
lower esophagus, stomach or duodenum become hard and dry.

Bland diet Types of Constipation:


- includes foods that are soft, not very spicy, and low in fiber. If
you are on a bland diet, you should not eat spicy, fried, or raw 1. Atonic Constipation
foods. You should not drink alcohol or drinks with caffeine in – experienced by elder people, obese individuals, before
them. surgery and during pregnancy. Caused by inadequate diet,
irregular meals, lack of liquids and fiber, and irregular 2. Alcohol is restricted
defacation
Hepatic Coma
2. Spastic Constipation - Too much ammonia in blood circulation, occurs with severe
– caused by overstimulation of the intestinal nerve endings liver cirrhosis
resulting in asymmetrical contractions of the bowel. Caused by - Brain is affected, patient becomes tremulous, disoriented,
extreme use of cathartics, laxatives, tobacco, tea, coffee, and confused, and lapses into coma
alcohol
Treatment:
3. Obstructive constipation Nutritional Therapy
– passage of feces is impeded or a compression bysurrounding
tissues happens causing the drying and enlargements of fecal Diet Therapy:
mass High calories (1500 to 2000 calories) to prevent tissue
catabolism and the liberation of additional nitrogen
Intestinal Gas
- Increased occurrence of passage of gas or cramping pain Gallbladder Cholecystitis
associated with the build up of gas in thee Gastrointestinal - Inflammation of the gallbladder resulting from formation of
Tract (GIT) and blood or produced during digestion gallbladder stones blocking the cystic duct or infection of the
gallbladder
Hemorrhoids
- Enlarged veins which occurs in the lower part of the rectum at Cholelithiasis or gallstones
the anal opening. - are hardened deposits of digestive fluid that can form in your
gallbladder.
Gastroesophageal reflux disease,Hiatal hernia , Esophagitis
Heart burn Types of stones:
- Caused by increased levels of progesterone brought by 1. Cholesterol stone form when the cholesterol in the bile gets
pregnancy; oral contraceptive; smoking; certain foods like too concentrated due to too much cholesterol synthesis or
chocolates, soft drinks, citrus fruits, and caffeinated drinks decreased bile synthesis
2. Pigment gallstones form as a composite of bacterial micro-
Short Bowel Syndrome colonies and pigment solids.
- Malabsorption disorder caused by resection of portions
of the small intestine due to an illness or injury Treatment:
Nutritional Therapy, reduced discomfort
THE THERAPEUTIC DIETS II
(Liver, Gallbladder, Pancreas CVD Kidneys) Diet Therapy:
1. Low fat diet
NUTRITION THERAPY FOR DISEASE OF THE LIVER, 2. Plain and simple food is recommended
GALLBLADDER AND PANCREAS 3. No spices and high residue food.Food Restriction: Avoid high-
fat foods, such as: Chocolate, whole milk, ice cream, processed
Liver cheese, and egg yolks. Fried, deep fried, or buttered foods.
 Hepatitis – inflammation of the liver Sausage, salami, and bacon.Pancreas

Types: Pancreatitis
1. Hepatitis A – caused by virus transmitted by the fecal - Inflammation of the pancreas due to decreased production of
oral route, ingestion of contaminated food the digestive enzymes. May also result from biliary tract
2. Hepatitis B – through blood transmission, tattoo, sexual disease and surgery, alcohol abuse, and gallbladder disease
intercourse, blood and bodily fluids, mother to child through
breastfeeding Types:
3. Hepatitis C – caused by Hepatitis C virus, transmitted by 1. Acute – commonly caused from obstruction of the
blood contact or sexual contact pancreatic duct. Caused by excessive alcohol intake and
4. Hepatitis D – if infected with Hepa B, spread to blood gallbladder disease
contact, unprotected sex5. Hepatitis E – from infected drinking 2. Chronic – results in permanent damage to the pancreas.
water with virus, oral-anal contact
Treatment:
Treatment: Depends on the severity of pancreatitis itself
Rest, optimum nutritional therapy
Diet Therapy:
Diet Therapy: 1. Acute attack - NPO
1. Food enriched with protein. Milk, egg, meat, fish, 2. Chronic cases – low to moderate fat, high Carbohydrates,
cheese moderate protein
2. Increase caloric content 3. Fluids and electrolyte given IV
3. Increase intake of vitamins and minerals 4. Six feedings daily to facilitate adequate nutritional intake
4. Moderate fat
Cystic Fibrosis
Cirrhosis - a disorder that damages your lungs, digestive tract and other
- a result of liver damage from conditions such as hepatitis B organs. It's an inherited disease caused by a defective gene that
or C, or chronic alcohol use. The damage done by cirrhosis can be passed from generation to generation. Cystic fibrosis
typically cannot be undone. But if caught early enough and affects the cells that produce mucus, sweat and digestive
depending on the cause, there is a chance of slowing it with juices.
treatment.
Treatment:
Treatment: Improvement of nutritional status
Rest, supportive care, nutritional therapy Diet Therapy:
1. High protein diet to compensate for fecal losses
Diet Therapy: 2. Liberal fat intake since fat is an important source of calories
1. In severe cirrhosis – restriction of sodium 250mg 3. Vitamins and mineral
4. Liberal fluid intake
Nutrition Therapy for Cardiovascular Disease Treatment:
Nutritional therapy
Atherosclerosis
- Thickening of arteries, walls of blood vessels caused by Diet Therapy:
accumulated fatty materials 1. High in protein diet
- Most common cause of heart attack 2. High calorie intake
3. Sodium restriction
Treatment:
Drugs and diet Acute Renal Failure
- Sudden decline of kidney function or abrupt loss of kidney
Diet Therapy: function
1. Low-fat, low in saturated fat and cholesterol
2. increase omega-3 fatty acids (fish) and omega-6 (corn oil, 3 phases:
soybean oil, sunflower oil) 1. Oliguric phase – lasts from 24hrs to 3 weeks
3. Restriction of sugars characterized by acidosis, high serum potassium, high
4. Restriction of calories serum phosphorus, hypertension, anorexia, and edema
5. Dietary fiber – 25-30 g/ day 2. Diuretic phase – last 2-3 weeks, urine output gradually
increase
Congestive Heart Failure (CHF) or Cardiac Failure 3. Recovery stage – 3-12 months, kidney function
- Circulatory failure resulting in the heart’s inability to maintain improves gradually
adequate blood supply to meet the oxygen demands
- Characterized by SOB (dyspnea) and abnormal fluid retention Chronic Renal Failure
(edema) - decline of kidney function

Diet Therapy: Treatment:


1. Sodium restricted diet – prevent edema Diuretics, nutritional therapy
2. Calorie control to reduce work of the heart
3. No caffeine Diet Therapy:
1. Low to moderate protein according to tolerance
Hypertension 2. High carbohydrates
- High blood pressure 3. Moderate fat
4. Sodium control
Treatment: 5. Water control
Lifestyle modification, nutritional therapy
Renal Calculi (Urolithiasis)
Diet Therapy: - Formation of renal or urinary calculi (stones) in the urine
1. Mild restriction on Sodium
2. Weight reduction Treatment:
3. Lo fat diet nutritional therapy

Myocardial Infarction (MI) or heart attack Diet Therapy:


- Results from atherosclerosis of the coronary arteries 1. Increase fluid intake

Treatment: Diet according to Stone:


Reduced workload of the heart 1. Calcium oxalate stones – low calcium, low phosphate or
oxalate
Diet Therapy: 2. Uric Acid Stone – low purine
1. Liquid diet on the initial stages 3. Cystine Stone – high fluid intake
2. Small, frequent meals
3. Restriction of caffeine, beverages PURINE RESTRICTED DIET
4. Restriction of sodium, cholesterol , fat and calorie • To reduce uric acid
5. Consumption of omega-3 fatty acids rich food • Indicated to patients with gouty arthritis, renal calculi, and
hyperuricemia
Nutrition Therapy for diseases of the Kidney

Acute Glomerulonephritis
- inflammation of the tiny filters in the kidneys (glomeruli). The
excess fluid and waste that glomeruli remove from the
bloodstream exit the body as urine. Glomerulonephritis can
come on suddenly (acute) or gradually (chronic).

Treatment:
Nutritional therapy

Diet Therapy:
1. Sodium restriction if there is edema
2. High calorie diet – carbo and fat to spare tissues from
being used as an energy source

Nephrotic Syndrome
- a kidney disorder that causes your body to pass too much
protein in your urine. Nephrotic syndrome is usually caused by
damage to the clusters of small blood vessels in your kidneys
that filter waste and excess water from your blood.
HOSPITAL DIETS LOW CARBOHYDRATE DIET
• Indicated to patients with Dumping Syndrome
ACID ASH DIET
• Retards the formation of alkalinic renal stones LOW FAT/ LOW CHOLESTEROL DIET
• Indicated to patient with renal calculi (alkaline stones) • Serve the purpose of reducing hyperlipidemia , and patients
• Cheese, cranberries, eggs, meat plums, prunes, whole grains with intolerance to fats
• Indicated to patients with cardiovascular diseases, patients
ALKALINE ASH DIET who underwent resection of the small intestines, hypertension,
• Retards the formation of acid renal stones cholecystitis, cholelithiasis
• Indicated to patients with renal stones (acidic stones)
• Fruits (except cranberries, plums, prunes), milk, vegetables LOW RESIDUE DIET
• Reduces the bulk of stools
BLAND DIET • Indicated to patients with ulcerative colitis, diverticulitis,
• Low fiber, mechanical irritants, chemical stimulants patients who will undergo surgery of the GI tract
• Indicated for patients with gastritis, diarrhea, biliary
indigestion and hiatal hernia LOW SODIUM DIET
• soft, not very spicy, and low in fiber. • Indicated to patients with cardiovascular and renal disorders

BRAT DIET PURINE RESTRICTED DIET


• Banana, Rice, Apple, Toast • To reduce uric acid
• Indicated for patients with diarrhea • Indicated to patients with gouty arthritis, renal calculi, and
hyperuricemia
BUTTERBALL DIET
• Spare protein but high in carbohydrates SODIUM RESTRICTED DIET
• Indicated for patients with liver disorders • Indicated to patients with heart failure, hypertension, renal
diseases , PIH, and steroid therapy
Cardiac Diet
• The cardiac (heart) diet is low in fat and salt. Less than 30 Regular Diet
percent of the calories in this diet come from fat. You can have • For good health, it contains many types of foods with
egg substitutes and low-fat meats. Fried foods and caffeine are moderate levels of salt, fat and sugar. A supply of milk, juice,
not allowed. cereal and crackers are also available on the patient care unit. If
you need a small snack between meals, check with your nurse.
CLEAR LIQUID DIET
• To relive thirst and help maintain fluid balance Renal Diet
• Indicated for post-operative patients nd following vomiting • The renal diet limits potassium, salt, phosphorus, protein and
and gastroenteritis sometimes fluid.

DIABETIC DIET SOFT DIET


• Well balance diet • Used to provide nutrition for those patients having problems
• The purpose is to maintain near to normal blood glucose level in chewing
• Indicated to patients with diabetes mellitus • For patients with ill-fitting dentures, transition from full-liquid
to general diet, patients with gastrointestinal disturbances such
FULL LIQUID DIET as gastric ulcers and cholelithiasis
• It serves to provide nutrition to patients who cannot chew or
tolerate solid foods TYRAMINE-FREE DIET
• Indicated to patients with stomach upsets, post-surgery • Use to prevent hypertensive crisis for patients who are taking
patients, after progression from clear liquid diet in MAOI antidepressants
• No to ABC’s – Avocado, Banana, Canned and Processed foods,
GIORDANO DIET and also no to fermented foods
• Spare protein
• Indicated to patients who suffers from Chronic Renal Failure VEGAN DIET
• Diet of vegetarians
GLUTEN FREE DIET
• No to BROW – Barley, Rye, Oat, Wheat YIN DIET
• This is the diet of a patient who suffers from Celiac’s Disease • Cold desserts after a surgery. It is a Chinese belief.

HALAL DIET
• No pork diet
• Diet of the Moslems

HIGH FIBER DIET


• Fruits and vegetables
• It speeds up the passage of food to the digestive tract, it
softens the stool
• Indicated to patients who are constipated, with diverticulosis,
with hyperlipidemia (to stimulate removal of fats)

HIGH PROTEIN DIET


• Lean meat, cheese, eggs
• Indicated to patients with nephrotic syndrome

KOSHER DIET
• Meat and milk cannot be served simultaneously
• Diet of Orthodox Jews
Pinggang Pinoy Filipino Culture, Values, Practices and Beliefs applicable in
Nutrition
Filipino Plate
- is a visual representation of what a person should consume on Food culture is an important part of cultural life.
a per meal basis. It is a plate-based food guide that features the
right proportion of food that contains the right nutrients 1. Five meals a day for Filipinos
needed by the body of an average Filipino. • Breakfast
• Lunch
What is Pinggang Pinoy? • Dinner
- Developed by DOST-FNRI in 2014, the Pinggang Pinoy meal • Meryenda
plan is essentially a nutrition tool with a simpler concept.
1. The dietary characteristics in Philippines
FNRI – Food and Nutrition Research Institute
• Filipinos like to eat rice
Pinggang Pinoy meal plan • Filipinos like sour, sweet and spicy taste.
• Fruit is a necessity after meals.
- The Pinggang or Platong Pinoy depicts a plate with color • Filipinos like to eat Kamayan
coded portions representing the different food groups that
should be on each plate. 3. The origins of Filipino food culture
(1) The influence of Chinese cuisine on Philippine
Go or energy-giving foods food culture.
Grow or body-building foods (2) The influence of Spanish and American culture on
Glow or body-regulating foods Philippine food
culture.
Glass of water
- to symbolize the importance of hydration by drinking plenty Sisig: A dish with many version
of water, along with a glass of milk daily. - A popular favorite in our country is sisig, which is
comprised of a pig's face that's been chopped up and fried
The standard placemat for adults depicts a traditional brown to perfection.
woven buri placemat, making the tool even more uniquely
Pinoy. Crispy, tangy, and meaty, it's a perfect complement for beer's
natural earthy flavors. It is a favorite dish for pulutan.
Who can benefit from the Pinggang Pinoy meal plan?
The Pinggang Pinoy plan is supposed to benefit anyone! 13 FOOD-RELATED SUPERSTITIOUS BELIEFS IN THE FILIPINO
CULTUREWHAT ARE THE COMMON FOOD-RELATED
Colors of the placemats and the meanings behind them: SUPERSTITIONS IN FILIPINO CULTURE?

Orange (Children 3-12 years old) – evokes energy, 1. Dropping utensils means someone will be coming in for a
vitality,cheer, visit.
excitement, warmth, and adventure. Most children are drawn 2. When your neighbor gives you food, do not wash the
to bright cheerful colors like orange. As a citrus color, orange is plate
associated with healthy food and stimulates appetite. 3. Do not clean up the table when someone still has an
unfinished plate
Blue (Adolescents 13-18 years old) – the color of the sky andthe 4. Make sure that there are no traces of food left and rice
sea. It is a color that conveys a sense of strength, dependability, grain on your plate.
and coolness – meanings associated with the favorable 5. If you suddenly choke while you are eating means that
qualities of teenagers.B someone is talking about you.
6. Expecting women who eat twin bananas during
rown (Adults, 19-59 years old) – the original placemat color of 7. pregnancy will also have twin babies.
the Pinggang Pinoy denoting the color of the woven buri. It is 8. Never bring home food from a wake or funeral
the color of the Filipino Malay race. 9. otherwise, this will bring bad luck.
10. A breech-born person can bring out the stuck fish bone in
Red (Elderly, 60 years and above) – a passionate and energetic you.
color, red has long symbolized energy, power, and courage, and 11. Purchasing twelve round fruits for the new year’s eve.
can give the user vigor and strength. It is also known to 12. Eating pancit for long life.
stimulate the appetite, which is commonly lacking among the 13. Breaking and seeing two egg yolks could mean wealth is
elderly. coming your way.
14. Do not leave the fridge empty on a new year’s eve for a
Green (Pregnant and Lactating Women) – the universal color of 15. prosperous new year.
nature and health, green is a symbol of new life, growth, and 16. Singing while cooking will get you marrying a widow
fertility. 17. in the future.

Here are some healthy tips on how to use the Pinggang Pinoy:

1. For Go foods, choose those food with more fiber and


nutrients
2. For Grow foods, include fatty fish in the diet and consume
calciumrich foods
3. For Glow foods, consume a wide variety of fruits and
vegetables
4. Drink at least 8 glasses of water
5. Stay physically active
Nutrition for health and fitness
Republic Act 8172: Act for Salt Iodization Nationwide (ASIN Law)
Health
- The Salt Iodization Law (Republic Act 8172) was enacted to
- state of complete physical, mental and social well-being, and not
contribute to the elimination of micronutrient malnutrition in the
merely the absence of disease or infirmity.
country, particularly iodine deficiency disorders, through the
costeffective preventive measure of salt iodization.
Fitness
- is defined as a set of attributes that people have or achieve that
Republic Act 10611: Food Safety Act of 2013
relates to the ability to perform physical activity.
- Involves activity of some sort that stimulates various systems of the
- The Food Safety Act of 2013 ("Food Safety Act") requires food
body and maintains a certain condition within the body.
business operators to ensure that food satisfies the requirements of
food law relevant to their activities in the food supply chain and that
Health
control systems are in place to prevent, eliminate or reduce risks to
-Involves every system of the body and is only achieved
consumers.
through a lifestyle that supports health.
Basic labeling requirements
Fitness components:
- The following labeling requirements set out by the DOH in
Administrative Order No. 30-2014 (“Revised Rules and Regulations
1) Endurance (Cardiovascular and Cardio-Respiratory): This is your
Governing the Labeling of Pre-packaged Food Products Further
body’s ability to use and deliver oxygen to your body.
Amending Certain Provisions of Administrative Order No. 88-B s.
1984”) (“Food Labeling Rules”) apply to food products, including food
2) Stamina (Muscular Endurance): This is your body’s ability to
supplements, whether imported or locally produced and distributed in
store, process, and use energy.
the Philippines:
3) Strength: This is the ability of your muscles or a muscular unit to
Food identification
apply force.
The following information on pre-packaged food products must be
4) Flexibility: The ability to maximize the range of motion of a joint.
placed on the label:
5) Power: The ability of your muscles to maximize their force in a • product name/name of the food;
minimum amount of time. • use of brand name and/or trademark;
• complete list of ingredients;
6) Speed: The ability to minimize the amount of time it takes you to • net contents and drained weight;
accomplish a task or movement. • name and address of manufacturer, re-packer, packer, importer,
trader and distributor;
7) Coordination: The ability to combine several different • lot identification;
movement patterns in a single distinct movement. • storage condition;
• expiry or expiration date/use-by date/consume-before date
8) Accuracy: The ability to control a movement in a given direction (recommended last consumption date);
or intensity. • food allergen information; and
• nutrition facts/nutrition information/nutritive value.
9) Agility: The ability to minimize the time going from one
movement to another. Executive Order 51: Milk Code
10) Balance: The ability to control the center of gravity of your body - Executive Order 51 also known as the “National Code of Marketing of
in relation to your support base. Breastmilk Substitutes, Breastmilk Supplements and Other Related
Products” aims to protect and promote breastfeeding and to ensure
that breast milk substitutes and supplements are properly used with
Reference List Legal Mandates Related to Nutrition adequate information, marketing and distribution.
and Diet therapy. Republic Act No. 9711: Food and Drug Administration (FDA) Act of
2009
Presidential Decree 491: Nutrition Act of the Philippines - mandated to ensure the safety, efficacy or quality of health products
- created the National Nutrition Council (NNC) to supervise, which include food, drugs, cosmetics, devices, biologicals, vaccines,
coordinate and evaluate the implementation of the national invitro diagnostic reagents, radiation-emitting devices or equipment,
nutrition program which shall be implemented by all agencies and household/urban hazardous substances, including pesticides and
and instrumentalities of both the government and the private toys, or consumer products that may have an effect on health.
sector concerned with improving the nutrition of our people.

Republic Act 11148: 1000 days of Life

- The Kalusugan at Nutrisyon ng Mag-Nanay Act – First 1000


Days Law (Republic Act 11148) mandates the national
agencies, LGUs, civil societies and other stakeholders to
develop and implement a comprehensive and sustainable
strategy for the first 1,000 days of life to address the health,
nutrition, and developmental problems affecting infants, young
children, adolescent females, and pregnant and lactating
women.

Republic Act 8976: Food Fortification Act of 2000

- Food Fortification Law (Republic Act 8976) provides for the


establishment of the Philippine Food Fortification Programs and its
implementing rules, regulation and guidelines. The law targets
addressing specific micronutrient deficiencies by mandatory
fortification of staple food items such as rice with iron, wheat flour
with vitamin A and iron, refined sugar with vitamin A and cooking oil
with vitamin A and voluntary fortification of other food items.

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