www.arogyaminstitute.

com
Introduction To Medical
Nutrition Therapy
• Medical Nutrition Therapy (MNT) is defined as the assessment of the
nutritional status of a client followed by nutrition therapy ranging from
diet modification to specialized nutritional support such as the
administration of enteral feed and parenteral nutrition and monitoring to
evaluate the patient.
• MNT starts with the assessment of nutritional status of patient with a
condition, illness or injury that puts them at risk. This includes the review
and analysis of medical and diet history, laboratory values and
anthropometric measurements.
• Based on the assessment, a nutrition care plan, most appropriate to
manage the condition or treat the illness or injury is formulated.
• The MNT also includes intervention and evaluation of achievement of
desired clinical outcomes.
• Appropriate medical nutrition therapy provided by the dietetics
professional has been shown to result in health benefits and reduced
health care costs.
Therapeutic Diets
Therapeutic diets
Nutritional
Disease
status

severity Metabolic
Changes
A therapeutic diet is a quantitative/ qualitative modified version of a basic
nutritious diet which has been tailored to suit the changing nutritional
needs of a patient/ disease condition.

• The regular or normal diet may be modified for one or more of the
following reasons:
• to maintain or restore optimum nutritional status
• to provide rest or relieve an affected organ (e.g. soft or liquid diet in
gastritis)
• to adjust to the body's ability to digest, absorb, metabolize or excrete
(e.g. a low fat diet for fat malabsorption),
• to adjust to tolerance of food intake by mouth (e.g. tube feeding for
patients with cancer of Oesophagus),
• to adjust to mechanical difficulties (e.g. soft diet for patients with
denture problems)
• to increase or decrease body weight body composition (e.g. high
calorie, low calorie)
Common Therapeutic Diets
1. Nutrient 2. Texture 3. Food allergy 4. Enteral
modifications modification or food feedings
intolerance
modification
Diabetic diets Mechanical soft Food allergy Liquid tube
diet feedings in place
of meals
No added salt Puree Diet Food intolerance Liquid tube
diet or Low feedings in
sodium diet addition to meals
Low fat diet Clear Liquid Diet
and/or low
cholesterol diet
High fiber diet Full Liquid Diet
Renal diet
Types of therapeutic
adaptations of normal diet

❖ Change in consistency
❖ Modification in quantity
❖ Modification in Nutrients
❖ Changes in method of cooking
❖ Modification in Meal frequency
❖ Modification in Mode of feeding
Change in consistency
Liquid Diets
• A liquid diet is the one which consists of foods that can be
served in liquid or strained form at room temperature.
These are usually prescribed after certain kinds of surgery.
• The two major types of liquid diets include - Clear liquids
and Full liquids.
 Clear Liquid Diet
• Includes minimum residue fluids that can be seen through.
• Is often used as the first step to restarting oral feeding after surgery or an abdominal
procedure.
• Can also be used for fluid and electrolyte replacement in people with severe
diarrhea.
• Should not be used for an extended period as it does not provide enough calories and
nutrients.
• This diet gives 300 kcal and no protein. It can be given in 1-2 hr interval
❖Recommended food items include: -
• clear, fat free soups/broths
• light coffee, tea (without milk or cream)
• strained fruit juices
• tender coconut water
• whey water, barley water, Dal water
• gelatin, fruit ice, popsicle.
• Sugar/glucose/honey and salt added to liquids
 NUTRITION
Full Liquid Diet
• Used as the second step to restarting oral feeding once clear liquids are tolerated.
• Used for people who cannot tolerate a mechanical soft diet and when milk is permitted.
• It is also used in the presence of oesophageal or gastrointestinal strictures, during
moderate gastrointestinal inflammations and for acutely ill patients.
• This diet gives 1200 kcal & 35g of protein and can be given at 2-4 hr interval.

❖Recommended food items include

• soups and broths
• cereal porridges (kanji, ragi malt)
• Dal soups
• Cooked & pureed fruits
• milk and milk beverages,(milkshake, lassi) - coffee, tea,
• fruit juices, carbonated beverages
• butter, cream and oil added to foods
• Plain puddings, custard, ice-cream, jelly
• sugar, honey, salt and mild flavourings
 Soft Diet
• The soft diet provides a transition between a liquid and a normal diet.
• Soft in consistency, easy to chew
• Made of simple easily digestible foods
• does not contain harsh fibre or strong flavours
• It may be ordered for post operative cases, for patients with acute infections,
gastrointestinal conditions or chewing problems.

❖Foods allowed include:

• Beverages , Soups - mildly flavoured - broths and cream soups
• Meat - moist, tender meat, fish or chicken, cottage cheese, eggs (except fried)
• Fat - butter, cream, oil, salad dressing.
• Milk - milk, milk beverages, yoghurt
• Cereals - soft cooked refined cereals - rice, pasta, bread, porridges and all dals
• Vegetables - soft, cooked vegetables.
• Fruits - cooked and soft fruits, fruit juices
• Sweets - sugar, honey, plain candies and Desserts - custard, ice-cream, kheer, cake
(sponge), puddings without nuts
Bland Diet
To avoid irritation to the tract
❖ chemical
❖ mechanical
❖ thermal - too hot or too cold foods
❖
The mechanical soft diet is a normal diet that is modified
only in texture for ease of mastication. This is used when a
patient cannot chew or use the facial muscles, for a variety of
dental, medical or surgical conditions. The foods in the diet
may be liquid, chopped, pureed or regular foods with a very
soft consistency.
Modification in quantity
? Some individuals may require a restriction
diet ex. Na restriction in Hypertension,
Purine restriction in gout
? Complete elimination diet ex. gluten free
in celiac disease
? increase in the amount of a specific
dietary constituent ex. increase fibre in
case of constipation
Modification in Nutrients
❖ to treat deficiencies ex. iron in anemic
patients, electrolytes in diarrohea
❖ Change body weight ex. macro nutrient
distribution in weight loss/weight gain
❖ Control diseases ex. reduce sugar/carbs
in diabetes, fat control in CVD
❖ For tests purposes - ex. glucose tolerance
tests
Modification in Meal
Frequency
❖ Meal amount ex. in diarrohea, GERD is
reduced
❖ Frequency
❖ Timings ex. insulin dependent patients
Changes in Cooking methods
❖ Leaching is indicated for cooking
vegetables ex. to reduce potassium for
CKD
❖ Mechanical processing such as mashing,
blending or chopping - ex. elderly people
with dentures or infants
❖ Steamed , baked or grilled
Modifications of a Normal
Diet During Illness
Special feeding methods
• Enteral, is used when the gut is
still partially working, but the
patient cannot eat or absorb
enough nutrients to stay
healthy. Enteral is delivered
directly into the stomach or
intestine through a feeding
tube.

• In parenteral, nutrients are

delivered intravenously and the
GI tract is bypassed entirely.
Parenteral is given through a
catheter, which carries the
liquid directly into the
bloodstream, where the body
absorbs it.
 The common methods of administering the enteral formulas include:
1. Continuous method = slow rate of 50 to 150 ml/ hr. for 12 to 24
hours,
2. Intermittent method = 250 to 400 ml of feeding given in 5 to 8
feedings per 24 hours,
3. Bolus method = may give 300 to 400 ml several times a day.
Complications of Enteral Feeding
• Nausea and/or vomiting can occur in patients who receive EN.
Vomiting increases the risk of pulmonary aspiration, pneumonia &
sepsis due to delayed gastric emptying.
• Other complications are GERD, diarrhoea, constipation,
malabsorption/maldigestion, etc.
• Common causes of diarrhoea in patients receiving EN include
medications, infection and intolerance due to characteristics of formula
or sometimes due to lactose in formula.
 Pre & Post Operative Nutrition
Ability of a surgery patient to recover and lead a normal
life is much greater if adequate nutritional care is taken
before and after the surgery
Pre Operative Nutrition
• A pre operative diet should provide optimum reserves for the period of surgery itself and
for the time immediately following it, when the patient may be unable to take any oral
feedings.
• The patient for surgery should be neither underweight or overweight, having sufficient
glycogen stores in the liver, in positive nitrogen balance and devoid of any vitamin and
minerals. Anaemia if any should be corrected. Diabetes should be controlled.
• Low protein storage will predispose the patient to shock, less detoxification of the
anesthetic agent by the liver, increased edema at the incision site and decreased antibody
function.
• Many obese patients are instructed to lose weight to reduce risks of surgery. Excess fat
complicates surgery , puts a strain on the heart and increases the risk of infection and
respiratory problems & delays healing.
• Surgery of GI tract demands additional bowel preparation. A low residue diet for 2-3
days minimizes the faeces left in the bowel.
• 8 Hrs. before surgery the doctor usually advises NBM(nil by mouth). This is done so that
the stomach is completely empty and ensures that the patient does not vomit to bring up
food when anesthesia is administered to him at the time of operation. Any food present
in the stomach and intestines at the time of operation increases the possibility of post
operative gastric retention or expansion or it may interfere with the surgery itself.
Post Operative Nutrition
• The patient is under catabolic stress after surgery. It is characterised by the
presence of an inflammatory response associated with depletion of
conditionally essential nutrients. This leads to a dysregulated immune
response.
• In addition to disease, surgical procedure arising complications, metabolic
and immune response to injury induces a catabolic state.
• The tissue demands carbohydrates for sparing both protein for tissue
synthesis and liver from damage due to depletion of glycogen stores. With
2500-3000 kcal patients make progress.
• Protein catabolism is increased for several days immediately following
surgery, patients undergo negative nitrogen balance. The degree of
negative balance can be reduced through higher intakes of protein and
calories.
• The protein is required for tissue synthesis in healing wounds, to avoid
shock, to control swelling- especially at the surgical site, to enhance bone
healing, to resist infection. Intake of 1-1.5 g/kg or 80-100 g of protein are
necessary as a rule.
• Glutamine has direct anti catabolic effects and hence preserves lean body
mass. It increases glutathione levels which act as an anti-oxidant.
Glutamine is available as a dipeptide with alamine for parenteral
administration.
• Fish oil is rich in omega-3 fatty acids and it is great source for parenteral
use. It should not exceed 20% of total fat. Dose of 0.1-0.2 g/kg/d can be
given.
• Fluid requirements are high as water losses may be greater due to
vomiting, exudates(leakage of wounds), haemorrhage, diuresis and fever.
• The requirement for B-complex Vitamins which are co-enzyme factors is
increased since energy needs are increased. Vitamin K is necessary for
blood clotting mechanism, its requirement too increases. Ascorbic acid is
especially important for wound healing.
• Minerals, especially potassium & phosphorus, sodium & chloride need to
be focussed upon since large areas of tissue as well as water may be lost.
Iron deficiency anaemia may develop due to blood loss or from faulty iron
absorption.
 Thank You

Contact Us:
? +91 9780577077
? contactarogyaminstitute@gmail.com
? www.arogyaminstitute.com