Nutrition Therapy for Certain Hypermetabolic
Therapeutic Diet
Dietary Management in Fever and Infection
1. Fever- an elevation of body temperature
above normal resulting from an imbalance between
the heat produced in the body and that eliminated
from the body.
DIETARY MANAGEMENT:
a. Liquid or soft in small amounts at frequent
intervals to permit adequate nutrition without
overtaking the digestive system at any time, the
patient's appetite is often very poor.
b. High calorie- increase metabolic rate
amounting of 7% for every degree Fahrenheit rise in
body temperature.
c. High protein diet- due to increased protein
catabolism.
d. Liberal fats- to replenish depleted glycogen
stores, to prevent ketosis to spare protein and to
supply energy.
2. Infection- invasion and multiplication of
bacteria, fungi or viruses within body tissues causing
tissue damage.
Ø AIDS- an infectious disease caused by a virus.
It’s called syndrome because it consists of several
signs and symptoms.
Ø HIV- is a group of viruses that is still largely
unknown. The virus enters the T helper cells of the
immune system. The virus stimulates itself into the
cells. The destruction of the immune system (T-4
cells) is irreversible. The concentration is high in
blood semen and vaginal secretion.
DIETARY MANAGEMENT:
a. Energy - 35 to 45 kcal/kg BW
b. Protein - 2 to 2.5 g/kg BW
c. Fats - increase omega 3 sources and decrease
in saturated fats in the diet
d. Vitamins and Minerals - an increase to be
recommended in case of altered metabolism
Conditions
1. Surgery- patients who will undergo surgery
are properly nourished so they easily tolerate stress of
surgery and short term starvation.
· But they can be malnourished as a result of
disease related symptoms experienced before surgery,
such as anorexia, nausea and vomiting, fever,
malabsorption and blood loss.
· Patient is under NPO for 8hours to prevent
aspiration related to anesthesia and under low residue
or residue free diet to minimize fecal residue and
postoperative distention after intestinal surgery.
Hydrolyzed formula diet may be used for 2-3 days
before surgery.
· Oral intake is resumed after bowel sounds
return, usually 24-48 hours after surgery. Then the
patient was initially under a clear liquid diet after
surgery.
2. Burns- the patient is hyper catabolic, and has
increased metabolism due to water loss.
Large quantities of fluid, electrolytes, protein,
and other nutrients leach through the burned area.
a. Immediate Shock Period - days 1 to 3.
Immediate parenteral treatment
b. Recovery Period- days 3 to 5. Oral liquid
solutions
c. Secondary feeding period days 6 to 15. High
Protein, high calorie, high vitamins especially
wound healing and B vitamins
d. Follow-up reconstruction-from second week
on. Continued optimum nutrition.
NUTRITION THERAPY IN DIABETES
MELLITUS
Diabetes Mellitus- a chronic heterogeneous disorder
characterized by elevated blood sugar level. A serious
lifelong disease in which the body does not produce
or respond to insulin, a hormone secreted by
microscopic islets of langerhans of the B cells of the
pancreas
Ø TYPES
1. Type 1 diabetes mellitus (insulin dependent NUTRITION THERAPY IN OBESITY
DM)-characterized by absence of insulin, which AND EATING DISORDERS
results from autoimmune responses that damage or
destroy beta cells, leaving them unable to produce OBESITY AND OVERWEIGHT
insulin. Excessive weight substantially increases the risk of
2. Type 2 diabetes mellitus- there is a problem diabetes, cardiovascular disease, cancer and other
in insulin resistance, the cells don’t respond to insulin diseases.
resulting in the pancreas compensation by secreting
Dietary Management:
higher than normal levels of insulin.
§ Consume plenty of fruits and vegetables, lean
NUTRIENT RECOMMENDATION meats, whole grains and high fiber foods, skim milk
· Proper diet must be observed and it has been and low fat dairy products.
the most effective way to control it. § Eat a sensible portion
· Carbohydrates- complex carbohydrates such § Encourage reading of nutritional labels.
as grains, fruits and vegetables are healthy part of
diet, consistency in the amount of total carbohydrates § Stick with steamed, broiled or baked foods.
eaten is most important than the type of § Adequate water intake.
carbohydrates consumed (60-70% of total calories)
§ Limiting alcohol consumption.
· Don’t be afraid of sugar but use it cautiously,
natural source of fructose (fruits and vegetables) do § Calories : 500-1000 cal/day
not need to be restricted. § Total fat- 30% or less of total calories
· Fiber- need to increase fiber that they currently § Saturated Fatty acids- 10%
do, but not the same as the general public.
§ Cholesterol: 300mg/day
· Protein- increase protein intake of 15-20%
total calories. § Protein-15%

· Saturated fat- limit to 10% of total calories § Carbohydrates: 55%

· Polyunsaturated fat- should provide upto § Calcium: 1000-1500 mg

10% of total calories
· Trans fat- keep as low as possible
· Total fat- 30% of total calories.
· Cholesterol- limit to 300mg/dl
· Alcohol- if they choose to drink alcohol it must
be limited to 2 drinks /day for men and 1 drink / day
to women.
· Calories- weight loss is the primary goal for
DM patients because it can decrease insulin
resistance, improved glucose and lipid levels and
lower blood pressure.
· Exercise- the muscle uses more glucose during
vigorous activity, improves glucose tolerance and
makes body cells more sensitive to insulin allowing
them to use available insulin stores more effectively.
§ Fiber 20-30g
Eating Disorders
1. Anorexia Nervosa- self imposed fasting or
dieting with severe weight loss or maintenance of
weight that’s is 15% below the recommended
weight.(the patient perceive that she’s fat even that
she’s not. )
- Other characteristics include compulsive
exercise and laxative use.
- The following are the signs and symptoms of
anorexia wasted appearance, thinning hair or
alopecia, dry skin, decreased heart rate, low blood
pressure, constipation, cessation of menses and
reduced muscle mass and joint swelling.
Ø NUTRITION THERAPY:
- Reestablish normal eating behaviors
- Restore nutritional status
- Maintain reasonable weight
- Calories of 1500 cal/ day
- Provide small frequent meals
- Provide one on one supervision on meal time.
- Leave the control of choosing food to the patient
- Limits gas producing and high fat foods
- Include high fiber and low sodium food to prevent
constipation.
- Provide multivitamins and mineral supplements
- Avoid caffeine or caffeinated drinks and food
- Use enter support if only necessary.
2. Bulimia Nervosa- a disorder characterized by
episodes of recurrent binge purge cycles.
- During binge the patient tends to eat large
amounts of food compulsively and quickly. Then
weigh is controlled through vomiting, laxatives,
emetics, diuretics and diet pills
- It has normal or above normal body weight
and has weight fluctuation.
- The frequent cause of death is gastric dilation
and rupture.
- The common signs and symptoms are puffy
cheeks due to enlarged salivary gland, damaged tooth
enamel due to excessive vomiting, broken blood
vessels of the eye and scars on hands( caused by
injury during self induced vomiting.)
Ø NUTRITION THERAPY
- Identify food fears
- Correct food misinformation
- Reestablish normal eating patterns.
- Be at least with 1500 cal/ day
- Include fat that can help delay gastric
emptying
- Avoid large amount of food eaten in short
amount of time
- Introduce forbidden foods as appropriate
- Eat meals slowly for at least 20 minutes
without distraction.
- Use appropriate sized utensils
- Refrain for skipping meals or eating snacks
- Sit down during each meal to increase
awareness of eating and satiety.
NUTRITION THERAPY IN COMMON
GASTROINTESTINAL DISORDERS
Gastroesophageal Reflux disease (GERD) produces
indigestion and heartburn from the back flow of
acidic gastric juice onto the lower esophageal
mucosa.
- The pain radiates to the neck and throat and
worsens when the person lies down, bends over after
eating or wears tight fitting clothing.
Nutrition Therapy
§ Lose weight because weight loss decrease intra
abdominal pressure
§ Avoid items that decrease lower esophageal
sphincter pressure, alcohol, caffeine, high fat foods,
mint and smoking.
§ Avoid carbonated drinks, citrus fruits, spicy foods
and tomatoes products that can irritate the esophagus.
§ Avoid large meals to avoid increased gastric
pressure
§ Remain upright 45-60 minutes after eating.
§ Avoid eating 2-3 hours before bedtime.
§ Avoid tight fitting clothes.
§ Elevate the head of the bed 6-8 inches while
sleeping.
Peptic Ulcers- erosion of the mucosal layer of the
stomach (gastric ulcers) or duodenum (duodenal
ulcer) caused by excess secretion of or decrease
mucosal resistance to hydrochloric acid.
- Bacterium Helicobacter pylori is the biggest cause Ulcerative Colitis
of peptic ulcers, secreted enzymes that depletes
- Is an inflammatory bowel disease of the large
gastric mucus making the mucosal layer susceptible
intestine limited to the rectum and the colon
to erosion.
which causes profuse and bloody diarrhea,
- The second leading cause of ulcer is the use of
- It is characterized by severe diarrhea, rectal
nonsteroidal anti inflammatory drugs (NSAIDS) that
bleeding, cramping, abdominal pain, anorexia
may damage the stomach lining.
and weight loss
Nutrition Therapy
Diet Therapy
§ Eat well balanced diet
a. High Protein
§ To prevent increased acid secretion, avoid frequent
b. High Calories
meal and bedtime snacks.
c. Increased Vitamins and Minerals
§ Avoid alcohol, cigarette smoking, aspirin and other
NSAIDs. d. Low Residue Diet
§ Avoid the following food that stimulates gastric Nutrition Therapy for Diseases of the Liver,
acid secretion such as coffee, black pepper, chili Gallbladder and Pancreas
powder, cloves garlic and peppermint and oils.
Liver
Diverticular disease ( Diverticulosis and
Diverticulitis) Hepatitis - is the inflammation of the liver
- Often consequences of long term low fiber Diet Therapy
eating practice and frequent constipation,
a. High Protein
- Diverticulosis indicates the presence of
b. High Calorie
diverticula (pouch) in the colon which can
lead to diverticulitis. c. Increased in Vitamins and Minerals
- Diverticulitis results from the swelling of d. Moderate fat
small pouches in the colon wall and linings.
Nutrition Therapy
Cirrhosis - is a chronic degenerative disease in which
a. Well balanced diet the build up of fibrous connective tissue replaces the
liver cells following fatty degeneration of long
b. Acute episodes may require liquids and low
standing.
residue food excluding roughage.
Diet Therapy
c. As swelling abates, a high-fiber diet is
recommended to lessen straining. 1. Sodium Restricted
2. Adequate protein of 100 grams/day
Malabsorption Syndrome ( celiac sprue)
- is a condition in which the mucosa of Gallbladder disorder- refers to conditions involving
the small intestine is damaged by gluten which results the formation of stone in the gallbladder.
in the malabsorption of nutrients
1. Cholecystitis (Acute or chronic inflammation
Diet Therapy usually due to a stone becoming lodged in the cystic
duct)
Gluten free diet
2. Choledocholithiasis ( stones that pass out of
the gallbladder and become lodged in the common
bile duct)
Risk factors are:
- High calorie and high cholesterol diet
associated with obesity
- Elevated estrogen level from hormonal
contraceptive and post menopausal or pregnancy.
- Diseases such as DM, hepatic and pancreatic
disease.
Two types of Stones
1. Cholesterol stones form when the cholesterol
in the bile gets too concentrated due to too
much cholesterol synthesis or decreased bile
synthesis
2. Pigment gallstones from composite of
bacterial microcolonies and pigment solids.
Nutrition Therapy:
§ It focuses on minimizing stimulation of the
gallbladder.
§ Low fat diet to reduce stimulation of gallbladder
this relieves pain (20-60g/day)
§ Dietary management are based on the client's
ability to tolerate food.
§ There is an impaired bile secretion making the
patient do have deficiency on fat soluble vitamins
may occur , necessitating replacement with water
soluble form of Vitamin A, D, E and K.
§ Encourage the client to eat small frequent meals to
prevent future attack.
§ Avoid Caffeinated and decaffeinated coffee. They
have been shown to raise the level of cholecystokinin
in the blood that stimulates the gallbladder to contract
and empty.
§ For Patient with Acute Cholecystitis- oral foods
and fluids are withheld and I.V. Fluid and electrolyte
therapy is initiated.
- Then after 12-24hours the patient may be started to
clear liquid diet and subsequently progress to a
regular diet as tolerated.
§ After surgery the patient is placed on NPO until the
bowel returns and asks to be on a low fat diet for 4-5
weeks then followed by a regular diet after.
Pancreas
Pancreatitis - is inflammation of the pancreas
due to a decreased production of the digestive
enzymes. This condition may also result from biliary
tract disease and surgery, alcohol abuse, and
gallbladder disease.
2 types:
1. Acute - Autodigestion originates from
obstruction of the pancreatic duct. It is
commonly caused by excessive alcohol intake
and gallbladder disease. Patient often
experience pain, nausea, vomiting and
diarrhea.
2. Chronic - this condition results in permanent
damage to the pancreas. It is characterized by
chronic pain and abdominal distention
Diet Therapy:
1. Acute attacks - NPO for 48 hours to avoid
organ stimulation.
2. Low fat, low elemental formula when enteral
feeding is appropriate
3. In chronic cases, a low moderate fat, high
CHO and moderate CHON diet
4. Fluid and electrolytes given TIV
5. Six feedings daily to facilitate adequate
nutritional intake
NUTRITION THERAPY IN COMMON
CARDIOVASCULAR DISEASES
Ø Cardiovascular diseases are one of the major
causes of death in the Philippines or even in other
countries.
Ø Treating the modifiable risk factors such as high
blood pressure, high low- density lipoprotein
cholesterol help decrease fatal and non fatal
cardiovascular disease.
1. Coronary Heart Disease (CHD) - also known
as Coronary Artery Disease (CAD), ischemic heart
disease, coronary occlusion, atherosclerotic heart
disease or coronary thrombosis, a condition in which
the blood and oxygen supply to the myocardium is
inadequate usually due to atherosclerosis in the
coronary circulation.
Atherosclerosis- the formation of plaques along the
smooth inner walls of arteries, which results in
progressive narrowing and diminished blood flow to
the tissue they supplied.
Diet Therapy:
1. Low in saturated fat and cholesterol
2. Increase in monounsaturated and
polyunsaturated fatty acids
3. Increase in complex carbohydrates and
restrictions of simple sugars
4. Modulation of calories
Angina Pectoris- characterized by pain in the region
over the heart and stomach, which may radiate to the
neck, jaw, back abdomen and arms.
Dietary Management
- Maintain the desirable body weight
- Small frequent feeding
- Adequate dietary fiber and fluid intake to
avoid constipation.
- Restrict in saturated fats and caffeine intake
Myocardial Infarction- the ischemia becomes so
severe that the cardiac muscle cells become necrotic.
Dietary Management
- Initially use clear liquid to full liquids to
promote rest while reducing the dangers of aspiration.
- Caffeine intake should reduce to avoid
potential arrhythmias
- Fluid and dietary sodium is individualized
according to sodium and fluid arrhythmias.
- Provide soft easily digested foods that are low
in saturated fat or cholesterol are given to reduce
cardiac workload.
Nutrition Therapy
The primary goal is concentrated on lifestyle
changes including TLC diet along with exercise and
weight management and smoking cessation helps to
lower the risk of CHD.
§ Therapeutic Lifestyle Change (TLC) diet is a low
saturated fat and cholesterol diet.
HYPERTENSION- it is a symptom, not a disease.
Its characterized by sustained elevated blood pressure
greater or equal to 140/90 mmHg
(Normal110/70mmHg and 120/80 mmHg )
Often called a silent killer because it causes a few or
no symptoms.
Nutrition Therapy
§ Dietary Approaches to Stop Hypertension
(DASH)
Congestive Heart Failure (CHF) as syndrome
characterized by inability of the heart to maintain
adequate blood flow through the circulatory system,
which leads to decreased blood flow to the kidneys,
excessive sodium and fluid retention, peripheral
pulmonary edema and overworked heart.
Ø Physical and mental rest help to decrease cardiac
workload.
Nutrition Therapy
§ Its use to reduce sodium and fluid retention and
minimize cardiac workload.
§ Restrict sodium intake to 250-2000mg a day
depends on the severity of CHF this will help to
relieve edema related to CHF.
- Avoid food that is instant or easily prepared
food.
- use non salt spice and seasoning than table salts
- Caution to non food products containing sodium
like medication, toothpaste, mouthwash and drinking
water.
§ Low calorie diets that are nutritionally adequate.
§ Limit fluid intake to 2 L a day to patients who have
edema that resist treatment.
§ Give soft easily chewable food to fatigue clients
§ Provide 5-6 small meals of non irritating and non-
gas forming foods to limit gastric distention and
pressure on the heart.
§ Individualized diet according to person’s tolerance.
§ Provide adequate potassium, increase potassium
intake to clients who use potassium wasting diuretics
such as thiazide. And potassium doesn’t need to
increase in clients taking potassium sparing diuretic
like Spirinolactone.
- Potassium Rich Foods: bananas, citrus fruits and
juices, mango, melons, raisin, prune juice and dried
prunes, papaya and avocados, mushrooms, okra,
sweet and white potatoes, tomatoes, dried peas and
beans, carrots, green leafy vegetables and pumpkin.
§ Eliminate caffeine. After the patient's condition
stabilized, limit caffeinated drinks and food to 4-5
cups a day as tolerated.
§ Advise the client to eat slowly and avoid gulping
food to prevent heartburn, abdominal distention and
flatulence.
NUTRITION THERAPY IN COMMON
RENAL DISEASES
Common Renal Diseases
1. Renal Calculi or Kidney stones may form
anywhere in the urinary tract but usually develops in
renal pelvises or calyces. It develops when substances
that normally dissolve in the urine precipitate; they
vary in size, shapes and numbers.
Increasing fluid intake thereby diluting urine
is the most effective for treating and preventing renal
calculi. High urine output helps flush calculi from the
urinary system. The fluid intake must be increased by
2.5-3L a day.
1 glass of 200-250ml of water should be consumed
before bedtime because urine becomes more
concentrated at night.
Nutrition Therapy on Major Types of Stones
a. Calcium Stones the kidney stones are
composed of calcium compounds usually calcium
oxalate or Calcium Oxalate mixed with Calcium
Phosphates.
- The urine produced is supersaturated with
these crystalloid elements and there is a lack of
normal urine substance that prevents the crystals
from forming.
Nutrition therapy
· Limit dietary calcium intake to 400mg/day.
· Acid Ash Diet is used to help in creating a
urinary environment less conducive to precipitation
of the basic stone elements.
- Increase the amount of meat, grains, eggs,
and cheese.
- Limits the amount of vegetables, milk and
fruits.
b. Struvite Stones- composed of single
compound Magnesium Ammonium Phosphate
(MgNH4PO4) the second most common kidney
stone.
- Often called infection stone as they are
associated with UTI, caused by the Proteus Mirabilis
bacteria that is an urea splitting that contains urease,
an enzyme that hydrolyzes urea to ammonium.
- Making the urine alkaline. In the ammonium
environment the Struvite precipitates and forms a
large horn stones
- Surgical removal is indicated.
c. Uric acid Stones- excess uric acid excretion
may be caused by impairment in intermediary
metabolism of purine as occurs in gout.
- Also resulted from rapid tissue breakdown in
wasting disease.
Nutrition therapy
· Low purine diet because uric acid is the
metabolic products of purine, avoid intake of the
following that are high in purine: glandular meats,
organ meats, whole grains and legumes, beans and
peas, sardines, anchovies and scallops.
· Alkaline Ash Diet is the opposite use of the
foods in acid ash
· Use of cranberry juice assists in acidification
of urine. Not commercially prepared cranberry juice
because it’s been diluted already.
· Low animal protein and low sodium diet with
normal calcium intake protects against recurrence of
kidney stones.
· Limit intake of oxalate rich foods such as
blueberries, brewed tea, cocoa, beer, instant coffee,
nuts, purple grapes, spinach, strawberries and tofu.
· Vitamin B6 supplements are shown to reduce
oxalate production by 50%.
d. Cystine Stones- a heredity metabolic defect in
renal tubular reabsorption of amino acid cysteine
causing this substance to accumulate in the urine
called cystinuria.
- The most common metabolic disorder associated
with kidney stones in children before puberty because
it has early onset as it is hereditary.
Nutrition therapy
· Diet low in methionine because Cystine is a
non essential amino acid produced from an essential
amino acid methionine.
· Increase fluid intake.
· Alkaline Ash Diet
Acute Renal Failure – is the sudden interruption of
renal function. It is caused by obstruction, poor
circulation, or kidney disease.
§ Characterized into Pre-renal (results from
condition that diminish blood flow in the Kidneys),
intra- renal (results from damage filtering structures
of kidneys from acute tubular necrosis) and post renal
results from bilateral obstruction of urine outflow)
§ There are 3 phases:
- Oliguric- decreased urine output
(400ml/24hours) the kidney has impaired ability to
conserve sodium, BUN and Creatinine rises,
Hypervolemia occurs causing edema, weight gain and
elevated blood pressure.
- Diuretic – increased urine output (5L a day) due
to inability of the kidney to conserve sodium and
water and the osmotic diuresis caused by high BUN
levels. The BUN and creatinine level slowly rise and
hypovolemia and weight loss result. It lasts for
several days or weeks that may lead to deficits in
potassium, sodium and water must be treated.
- Recovery- when the BUN and creatinine returns
to normal and urine output is between 1-2L a day
Nutrition Therapy
§ Adequate calories are required to prevent weight
loss and body protein catabolism (30-50kcal/kg/day).
§ May require Enteral or parenteral nutrition if the
caloric requirement cannot be attained orally. There is
a special enteral nutrition used, these formulas are
low in potassium, phosphorus and high in calories.
§ Patients with renal failure and DM, there is the
need to adjust insulin and anti-diabetic drug dosage to
meet the nutritional demands of renal failure.
§ The protein can be increased or decreased
depending on the patient's condition, a low protein
diet may help preserve kidney function and a high
protein diet can correct the negative nitrogen balance.
§ Fluid intake of the patient on their oliguric or
diuretic phase should be 400-500ml greater than their
24 hour urine output.
§ During oliguric phase the potassium is restricted to
2g or less per day because the potassium leaves the
cells and enters the serum as the tissue catabolism
occurs. During diuretic phase potassium is excreted
and supplementation may be necessary.
§ During. oliguric phase sodium is restricted to 500- § Zinc and iron supplementation are needed but they
1000mg/ day. The sodium intake is adjusted shouldn’t be taken with calcium supplements.
according to the patient's urine output, serum sodium
level and need for dialysis. During diuretic phase the
sodium is excreted so supplementation is needed.
§ Vitamins supplementation is needed especially
water soluble vitamins

Chronic Renal Failure- a usually progressive and

irreversible deterioration is the end results of gradual
tissue destruction and loss of kidney function.
Resulted from the rapidly progressive disease of
sudden onset that destroys the nephron and causes
irreversible kidney damage.
§ The treatment consists of hemodialysis, peritoneal
dialysis, drug therapy and renal transplantation
Nutrition Therapy
§ Nutrition for pre end stage renal disease depends
on diagnostic findings.
§ Protein requirements range from .8-1g/kg. Half of
protein must be high biological value protein (contain
all essential amino acids). Foods that are high
biological value proteins are beef, egg whites, fish ,
milk, pork and poultry and those low biological value
protein are legumes, nuts and nuts butter
§ Adequate calorie intake is needed to prevent
weight loss and protein catabolism, inadequate
calories may cause BUN to increase because protein
is broken down for energy.
§ Instruct to eat simple carbohydrates to provide
enough calories without adding protein. § Sodium
and Fluid restriction are determined by the patient’s
blood pressure, electrolytes level, urine output and
weight. (2-4g of sodium a day)
§ Patients with renal insufficiency and those
receiving peritoneal dialysis don’t need to restrict
their potassium intake.
§ Vitamins especially water soluble vitamins are
deficient that cause the need for supplementation
Vitamin B6 and folate acid must be higher by the
RDA to promote RBC production, vitamin C intake
should be limited to 100mg to prevent occurrence of
kidney stones