Bachelor of Science in Nursing 2YC
NCMA215: BSN 2ND YEAR SUMMER FINAL 2022
Coverage for Final: Modules 9-17
• Dietary Modification and Therapy
• Nutrition Education and Counseling
• Evidence-Based Guidelines in Nutrition Practice
• Legal Mandates Related to Nutrition and Diet Therapy
• Ethico-moral Principles Related to Cultural and Spiritual
Preferences
• Life-long Learning Activities
• Nutrition Counseling and Dietary Instruction
• Nutripreneurship
DIETARY MODIFICATION AND DIETARY THERAPY
Discussed by Prof. Gerardo Nicolas and Prof. Donato Mirador
Therapeutic diet
- a meal plan that controls the intake of certain foods or
nutrients. It is part of the treatment of a medical condition and
are normally prescribed by a physician and planned by a
dietician.
- A therapeutic diet is usually a modification of a regular diet.
Therapeutic diets are formulated by doctors and dietitians.
- Purposes of Therapeutic Diet: Decrease calories for weight
control
General Diets
Standard Hospital Diets (Liquid Diets)
1) Clear Liquid Diet
- consists of liquids without residue or fibers
- used to relieve thirst and maintain water balance
- diet used for 24-48 hours following acute vomiting,
diarrhea or surgery
- allowance of tea, coffee, fat-free broth, ginger ale, fruit
juices in the sachet, gelatin, fruit ices, hard candy and
water
- Malinaw or malabnaw
- Milk and juices are not allowed
2) Full Liquid Diet
- nutritionally adequate diet consisting of fluids and foods
that liquefy at body temperature
- diet used for acute infections and fever of short duration
and for patients who are ill to chew
- milk, cream soups, cereal, soft custard, strained meat in
broth, strained citrus fruits, tomato juice, vegetable puree,
eggnog, yogurt
- Thicker than liquid diet
- Naoperahan na like appendectomy
- Peritoneal lavage – hinugasan ang mga intestine dahil
nagkaroon ng peritonitis (chemical irritation).
- Patient is NPO for 24 to 72 hrs.
- Sa umaga clear liquid muna after operation then sa hapon
general na, pero need to check the tolerance of the patient,
no vomiting then the patient can have soft diet.
- Matabang wala nasyadong asin
- for rotation of diet after operation, NPO – clear liquid diet
– check tolerance – full liquid diet – check for the bowel
movements – kailangan ma utot yung patient – soft diet
3) Cold Liquid (Yin diet)
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- diet for patient undergone tonsillectomy and
adenoidectomy
- allowance for ice chips, ice cream, sherbet, ice drop,
popsicles
- Ex. if the patient undergoes the tonsillectomy pwede
sakanila yung cold diet or ice cube and ice cream BUT
vanilla only kase kapag may color hindi pwede it will
affect the color of feces
4) Soft Diet
- nutritionally adequate diet differs from the normal diet in
having reduce the fiber content, soft consistency and
bland flavor
- used immediately between the full fluid diet and regular
diet following surgery, acute infections, fever, and GI
disturbances
- patient with no teeth or ill-fitting dentures;
- those who cannot tolerate highly seasoned, fried or raw
foods
- the normal diet is modified in the following ways:
• meat and poultry are minced and ground
• vegetables are cooked – little longer than usual
• soft raw fruits may be used
• soft rolls, bread or biscuits are used instead of crisp
rolls, crust breads and toast
• all desserts on a normal diet may be used
5) Mechanical Soft Diet
- dental soft or mechanically altered diet
- foods should be well cooked, easy to chew, chopped
ground or minced
- foods are best served moist or with gravy and sauce
6) Regular Diet
- most frequently ordered among the house diets
- also called general, house, full hospital diet, diet as
tolerated
- Ex. if may admission before carry out the order of the
physician tawag ka muna sa dietitian to check
7) Light Diet
- a transition between the soft and regular diets
- for elders who cannot tolerate rich and heavy foods
8) Vegetarian Diet
- usually low in saturated fatty acid, cholesterol, and high
fiber
- with disadvantage is inadequate or low level of Vit B12,
Iodine, Calcium, Zinc, Vit. B2 and Vit. D.
• Vegan diet - total vegetarian, or strict vegetarian diet
or plant in origin
• Lacto-vegetarian - milk and milk products + items of
plant origin
• Ovo-vegetarian – eggs and eggs products + items of
plant origin
• Lacto-ovo-vegetarian – eggs + milk + plant origin
• Semi-vegetarian – lacto-ovo- vegetarian foods + fish
+ chicken + plant
• Pesco-vegetarian – fish and fish products + items of
plant origin
9) Restricted Diet
- a diet limited in a specified amount or type of nutrient
 NUTRITION AND DIET THERAPY – BSN 2ND YEAR SUMMER FINAL 2022
- cholesterol restricted diet, salt restricted diet
- Congestive heart failure
- Patient who has liver problem
10) Controlled Diet
- implies careful adjustment of levels of nutrients from day
to day as needed, controlled CHON, K, Na.
Dietary Modification with Consistency
- The modified consistency diet includes all the foods you are
allowed to eat in your regular diet based on your tolerance,
This diet may also meet all your nutrition needs if you make
healthy food choices. Cut starches into small pieces, mash or
puree. Cook fruits: cook or steam vegetable
- Modified Consistency Diet
• Pureed diet
• Mechanical soft diet
- Modified Regular Diet
• Liquid diet
• Thickened liquids
Therapeutic Diet for specific disease condition
• Acute Glumerulonephritis - Low Na, Low CHON (unable to
filtering, unable to circulate, metabolism will be affected. Urea
level is increasing)
• Acute Renal Failure – Oliguric Phase - Low Na, Low CHON
(urea and creatinine), High CHO (for energy) (unable to
excrete urine) – may excess fluid
• Addison’s Disease - High Na, Low K (hypofunction of
adrenal cortex = hyponatremia, hypernatremia)
• Attention deficit hyperactivity disorder - Finger foods
• Bipolar Disorder - Finger foods
• Cerebrovascular Accident (stroke) - Osterized Feeding with
Low Na, Low cholesterol, High fiber
- prevent aspiration lang
• Cholecystitis - Low fat, High CHO, High CHON
- gallbladder disease
- High CHO and CHON for energy
• Chronic Renal Failure - Low CHON, Low Na, Low K
- irreversible
- Electrolytes imbalance is fatal for pt.
- Low = in order to decrease the product or urea and
creatinine
• Congestive Heart Failure - Low Na, Low Cholesterol
• Cushing Disease - High K, Low Na
- Opposite of Addison’s Disease
• Decubitus Ulcer - High CHON, High Vitamin C
- Redness, Puputok, bubuka na then makikita na yung mga
organ na pwedeng lumabas
• Dengue Fever - Diet as tolerated except dark-colored food (it
will darker the stool it will alter the laboratories)
• Diabetes Mellitus - Well-balanced diet
- High fiber diet – decrease the absorption of glucose in the
intestine
• Diverticulitis - Low fiber
- inflammation of the diverticulum
- parang loslos sa intestine
• Dumping Syndrome - High fat, High protein
- partial gastrectomy
- High in glucose
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- Hypertonic – attracts water goes to GIT lead to shock like
symptoms, my fullness, may vertigo, may cold clammy
skin
- Kakain naka upo pero after need to lie down para hindi
agad pumunta sa intestine ang pagkain
- Dried food item
- Hindi muna iinom agad after kumain or habang kumakain
• Hepatic Encephalopathy - Low CHON, High calorie
- liver cirrhosis, inflammation of Liver
- Ammonia level is so high lead to intoxication
- Ammonia must converted by urea in the liver but the liver
did not able to convert it will lead to high level of
Ammonia lead to hepatic encephalopathy.
• Hirschsprung’s disease - High calorie, Low residue, High
CHON
- Low residue – limit the dietary fiber
- Vegetables
• Hyperthyroidism – High calorie, High CHON
• Hyperparathyroidism – Low calcium
• Liver Cirrhosis – Low CHON
• Nephrotic Syndrome – Low Na, High CHON, High Calorie
- High urea and creatine of patient monitor na ang sodium
and prepare for Low Na diet.
• Overweight and Obese - Low calorie
• Pernicious Anemia - High CHON, Vitamin B
• Tosilitis - Clear liquid diet
• Ulcerative Colitis - High CHON, High Calories, Low
residue
• Bland - eliminate irritating foods to allow the stomach lining
to heal (ulcer patients)
• High Fiber - provide bulk in the stool and bring water into the
colon for patients with constipation or diverticulosis
• Low residue - reduce fiber for patients with Crohn’s disease,
colon or rectal surgery, esophagitis, diarrhea.
• High Calorie - growing periods, under nutrition, Chronic
Obstructive Pulmonary Diseases and Cystic fibrosis
• Low Protein - Liver and renal failure
• High Protein - Hypercatabolic disorder, Protein Energy
Malnutrition
• Low Purine - reduce the amount of purine. It is used with
patients who have gout or uric acid kidney stones.
• Low Cholesterol - reduce the intake of cholesterol in order to
lower blood cholesterol levels in client heart diseases
Sodium Restriction Salt allowed
Mild (3000 mg) >1/2 teaspoon per day
¼ teaspoon per day
Moderate (2000 mg)
1 serving of processed foods
No salt
Strict (1000 mg) No processed foods
Limit bread and milk
Sodium free
Very Strict (500 mg)
Restrict natural foods high in sodium
Dietary Modification with Composition
Low Calorie Diet
• Calorie restriction, or caloric restriction (CR)
- Dietary regimen that restricts calorie intake, where the
baseline for the restriction varies
- People who are interested in going on a low-calorie diet
(VLCD) should first consult a physician.
 NUTRITION AND DIET THERAPY – BSN 2ND YEAR SUMMER FINAL 2022
- A very low calorie diet is any diet plan that allows 800
calories or less in a day; and the diet is overseen by a
physician.
- The length of such a diet is relatively short, usually
between 3 and 6 months. Any longer and serious health
complications may arise.
• Low-calorie diets and very low-calorie diets
- A VLCD is differen from what a person might casually
call a “low calorie diet," which would commonly consist
of 1500 to 1800 calories per day.
High Calorie Diet
- One furnishing more calories than needed to maintain eight,
often more than 3500-4000 calories per day.
- A diet containing more than 4,000 calories per day
- Some medical conditions require a high-calorie diet to help
maintain or promote weight gain.
- People with liver disease are at risk of malnutrition due to poor
intake and altered nutrient metabolism.
- To meet their needs, most people with liver disease should
increase the number of calories they eat each day.
- People with Huntington’s disease have higher calorie needs
because of their constant fidgeting which increases their
metabolic rate.
- Cancer patients tend to have higher clorie needs because of a
poor appetite related to treatment.
- Eating more calorie-dense foods, such as whole milk, cheese
and nuts, can help you increase your calorie intake when you
have a poor appetite.
- Severe Burns, Underweight, Competitive Athletics
High-Protein Diet
- a diet that contains large amounts of protein, consisting largely
of meats, fish, milk, legumes, and nuts.
- It may be indicated in protein depletion that results from any
cause, as a preoperative preparation, or for patients with severe
burns and sepsis.
- It may be contraindicated in liver failure or when kidney
function is so impaired that added protein could result in
azotemia and acidosis.
Low-Protein Diet
- Any diet in which the protein intake is reduce. Anyone
diagnosed with kidney or liver disease may be prescribed a
low-protein diet.
- In any case, a diet which is especially low in protein should
only be undertaken under medical direction.
- Reduced amount of protein: Some of each type of protein
should still be consumed each day from the two main sources:
1) Animal products (fish, poultry, eggs, meat, dairy
products) – considered high quality or complete protein.
2) vegetable products (breads, cereals, rice, pasta, dried
beans) – considered low quality or incomplete protein.
Low Fat Diet
- According to the USDA, a low-fat diet–as the name implies–is
a diet that consists of little fat, especially saturated fat and
cholesterol, which is thought to lead to increased blood
cholesterol levels and heart attack.
- It is important to know that dietary fat is needed for good
health, as fats supply energy and fatty acids, in addition to
supplying fat-soluble vitamins like A, D, E, and K
Low Carbohydrates
- Dietary programs that restrict carbohydrate consumption
usually for weight control or for the treatment of obesity.
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- Foods high in digestible carbohydrates (e.g., bread, pasta) are
limited or replaced with foods containing a higher percentage
of proteins and fats(e.g., meat, poultry, fish, shellfish, eggs,
cheese, nuts, seeds, peanuts, and soy products) and other foods
low in carbohydrates (e.g., most salad vegetables) although
other vegetables and fruits(especially berries) are often
allowed.
- The amount allowed of these foods varies with different low-
carbohydrate diets.
- Such diets are sometimes ketogenic (i.e. they restrict
carbohydrate intake sufficiently to cause ketosis) for example,
the induction phase of the Atkins diet.
- Some sources, though, consider less restrictive bariants to
below-carbohydrate as well.
- Apart from obesity, low-carbohydrate diets are often used as
treatments for some other conditions, most notably diabetes
and epilepsy, but also for chronic fatigue syndrome (see
ketosis) and polycystic ovarian syndrome.
A low Sodium Diet
- A diet that includes no more than 1,500 to 2,400 mgs of
sodium per day. (One teaspoon of salt has about 2,300mg
sodium.)
- People who follow a vigorous or moderate exercise schedule
are usually advised to limit their sodium intake to 3,000mg per
day and those with moderate to severe heart failure are usually
advised to limit their sodium intake to 2,000mg per day.
Low Potassium Diet
- Potassium is a mineral that assists in maintaining normal blood
pressure and proper contraction of the heart.
- The nervous system, digestive system, muscles, and heart are
kept healthy. It is found in whole grains, vegetables, milk
fruits, peas and dried beans.
- Need of a low potassium diet – If an individual has kidney
problems, excess potassium can accumulate up to dangerous
levels in the blood. This causes irregular heartbeats, confusion
or a heart attack. In this case, a low potassium diet is
recommended. If the diet contains less than 2000 mg of
potassium per day, then it is called as a "low potassium diet".
- Low potassium foods – serving of the following can be
considered to be low potassium food. 1 serving implies ½ cup.
More than 1 serving of the following can make it high
potassium food.
- General foods Bread (bread products): cake – angel, yellow;
coffee (maximum 8 ounces); cookies (without nuts or
chocolate); noodles; pasta; pies (without chocolate or high
potassium foods); rise; tea (maximum 16 ounces)
Low Purine diet
- A low-purine diet is an eating plan that limits foods that
contain purine. Purines are a natural substance found in some
foods.
- When your body digest purine, a waste product called uric
acid is produced.
- A build-up of uric acid crystals in the joints can cause a type
of arthritis known as gout.
- Purines are found in many healthy foods. The purpose of a
low-purine diet is not to completely avoid purines.
- Instead, the goal are to limit and monitor how much purine is
in the food you eat, and to learn how your body responds when
you eat different foods that contain purine.
 NUTRITION AND DIET THERAPY – BSN 2ND YEAR SUMMER FINAL 2022
• BRAT diet – banana, rice, apple, toast – indicated patients
with diarrhea
• Butterball diet – spare protein but high in CHO indicated
with liver disorders
• Giordano diet – spare protein, indicated for patients with
CRF
• Giordano-Giovannetti diet – a low-protein, low-fat, high-
carbohydrates diet with controlled potassium and sodium
intake, used in chronic renal insufficiency and liver failure
• Kosher diet – meat and milk cannot be served simultaneously
diet for Orthodox Jews
• Tyramine rich diet – use to prevent hypertensive crisis for
patients who are taking in MAOI anti-depressant. No to ABC
– avocado, banana, canned, processed, smoked, aging and
fermented foods
• South Beach Diet – diet developed by the Miami-based
cardiologist Arthur Agatston, M.D., who says that the key to
losing weight quickly and getting healthy isn’t cutting all
carbohydrates and fats from your diet, but choosing the right
carbs and the right fats.
• Monothropic Diet - A diet that involves eating only one food
item, or one type of food, for a period of time to achieve a
desired weight reduction.
• DASH diet - (Dietary Approaches to Stop Hypertension). A
recommendation that those with high blood pressure consume
large quantities of fruits, vegetables, whole-grains and low fat
dairy foods, Lean meats, nuts seeds and legumes, healthy
vegetable based oil as part of their diet, and avoid sugar
sweetened foods, red meat and fats.
• Elemental diet - A medical, liquid-only diet, in which liquid
nutrients are consumed for ease of ingestion.
• Ketogenic diet - A high-fat, low-carb diet, in which dietary
and body fat is converted into energy. It is used as a medical
treatment for epilepsy.
• Paleo diet - foods include meat, fish, eggs, seeds, nuts, fruits
and veggies, along with healthy fats and oils. Avoid processed
foods, grains and sugar.
- modern fats diet during paleolitic era
NUTRITIONAL EDUCATION AND COUNSELING
Discussed by Prof. Gerardo Nicolas and Prof. Donato Mirador
Nutrition Education
- 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
- delivered through multiple venues and involves activities at
the individual, community, and policy levels.
Theories
Health Belief Model (HBM)
- Explains and predicts health behaviors based on patient’s
beliefs about the health problem and the health behavior.
- Relies on the assumptions that patients are willing to
participate and that they believe that health is highly valued
(Becker, 1990)
- Components:
a) Individual perceptions
b) Modifying factors
c) Likelihood of Action
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Self-Efficacy Theory (Bandura, A. 1997)
- based on a person’s expectations relative to a specific course
of action. It deals with the belief that one is competent and
capable of accomplishing a specific behavior – a precursor to
expected outcomes.
- 4 Principal sources of info cognitively appraised and
processed:
a) Performance accomplishment
b) Vicarious experiences
c) Verbal persuasion
d) Emotional arousal
- kung ano sinabi ng Nurse expect ng patient to na may outcome
kaya susundin nya
Stages of Change Model (Prochaska & DiClemente, 1996)
Six Stages:
• Precontemplation
- para ka lang nagdu duty sa mental health, may takot at
ayaw mo kausapin ang pt. Merong pt. na normal, meron
ayaw kase ngayon ka palang nakita.
• Contemplation
- Established rapport. Include significant others
• Preparation This theory is useful in staging the client’s intentions
• Action and behaviors for change as well as to determine the
• Maintenance strategies that will enable completion of a specific
stage.
• Termination
Teaching Plan Format
Theory of Reasoned Action and Theory of Planned Behavior
(Fishbein and Azjen, 1975)
- A person’s behavior is determined by their intention perform
the behavior and that this intention is, in turn, a function of
their attitude toward the behavior and subjective norms
- It focuses on the construction of a system of observation of
two groups of variables, which are:
- attitudes defined as a positive or negative feeling in relation to
the achievement of an objective;
- subjective norms, which are the very representations of the
individuals’ perception in relation to the ability of reaching
those goals with the product.
Therapeutic Alliance Model (Barofsky, 1978)
- Addresses the shift of power from the provider to a learning
partnership in which collaboration and negotiaton with the
consumer are key.
- A therapeutic alliance is formed between the caregiver and the
care receiver in which the participants are viewed as having
equal power. The client is viewed as active and responsible,
with an outcome expectation of self-care.
- Concordance – emphasis on the consultative process
(Hobden,2006).
 NUTRITION AND DIET THERAPY – BSN 2ND YEAR SUMMER FINAL 2022
The Teaching-Learning Process
1) Assessment of Learning needs, readiness to learn, and learning
styles
2) Mutually setting the goals/objectives.
3) Teaching-learning sessions
4) Determination of behavior changes (outcomes) in knowledge,
attitudes and skills.
Modified Diets
- For every patient in the hospital, they have different types of
diet. The diet of the patient may be different from one another
according to their problems and conditions.
- Modified diet is designed according to the needs of the patient.
There are some illness na nagrerequire na walang lasa yung
food nila, while the others naman ay water or liquid yung
kailangang iintake na dapat ay i-maintain.
- If there are improvements, the type of diet of the patient can be
change until their diet will becomes normal.
- Modified diet is for those who is sick including yung mga
nagrereduce ng weight.
Diet Therapy
- May be a specific treatment of a disease or a supplement of
other modes of treatment that a patient may go through.
- Included in its purposes are maintenance of normal nutrition;
correction of nutritional deficiency, changes in body weight
and adjusting the body’s ability to use one or more nutrients.
- While the patient is improving, at the same time they are
taking the appropriate diet that can help to further improve
their health condition.
Normal Diet (also known as regular, general or house diet)
- the foundation on which therapeutic diet modifications are
based. Regardless of the type of diet prescribed, the purpose of
the diet is to supply needed nutrients to the body in a form it
can handle.
- Pinaka maganda para sa hospitalized patient. Pag sinabi ng
doctor na DAT(Diet Accelerated) na yung patient, it means
pwede siyang kumain ng kahit na ano basta yung kaya at
matotolerate (yung magagamit lang talaga mismo ng katawan)
niya lang.
- Modification of this diet include:
a) consistency and texture – ito ba ay well done, rare un mga
meat
b) flavor – natural or artificial
c) energy value – in the case of Aspartame which is an
artificial sweetener, it is not healthy for our body because
it doesn’t contain energy value. Usually the sweetness it
contains is only an imitation of sugar.
• If the sugar is being absorbed by our body, it will
undergo metabolism and will produce energy.
• Aspartame has a stimulant that enables the brain to
work but it does not provide a supply of energy so
the patient will become exhausted which is very
harmful for the brain.
• Glucose – fuel of brain
d) nutrient level – amount of calories that the food contains.
e) food category – junk or nutritious foods
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Standard Hospital Diets
Liquid diets
• Clear Liquid Diet
- indicated for patients experiencing acute vomiting,
diarrhea or surgery; the diet is used for 24-48 hours; it
allows tea, coffee or coffee substitute and fat-free broth.
- New surgery - after operation, the peristalsis of the
intestine is not totally activated (possible na magkaroon
ng abdominal distention ang patient kapag binigyan na
agad ng pagkain)
• Full Liquid Diet
- Used for acute infections and fever of short duration;
patients who’ are too ill to chew.
- It consists of liquids and foods that liquefy at body
temperature, generally offered in 6 feedings or more.
- Yung fluid ay may laman kaso mas dominant or mas
marami pa din yung fluid don sa pagkain.
Soft diets
- often used immediately between full fluid diet and the regular
diet following surgery, acute infections and fevers, and in GI
disturbances.
- It has reduced fiber content, bland flavor and soft consistency.
- Modifications are done by having the meat and poultry being
minced or ground
- Vegetables are diced, chopped or cooked longer than usual
- the use of soft raw fruits and the use of soft rolls, breads or
biscuits.
- Example: bread, cookies, ground meat, vegetable, fruits
(maliliit yung butil or hiwa, niluto ng matagal kaysa don sa
normal na pagluluto para lumambot ng husto)
Test Meals
- used for specific diagnostic tests such as
a) Fecal Fat Determination
- to measure fat globules to detect fat absorption.
- if the fat is not digested, it will not be absorbed
- Fat cannot be digested without bile so if there is no
bile, the fat will not be digested even though there is
a lipase (enzymes for digestion-watersoluble enzyme)
because they cannot be mixed together
- Water and oil will not be mixed together unless it is
acted upon by the bile produced by the liver, the bile
will emulsify the fat and then the lipase will come
and then that's the time that the fat will be digested
into absorbable form
b) Meat-free Test
- to determine GIT bleeding.
- If we eat meat, our food can be dark in color and it
can mask the bleeding.
- Upper GIT bleeding: Dark feces; Lower GIT
bleeding: feces are mixed with fresh blood
- Mas better kung yung bleeding is nasa lower GIT
kasi madedetect agad yung fresh blood but kung ito
ay nasa upper GIT, di pwedeng kumain ng meat
nagkakaroon ng discoloration sa feces at hindi
madedetect kung may bleeding ba sa feces.
c) Calcium Test
- to determine urinary calcium excretion.
- Usually gumagamit ng calcium tablet or pinapainom
ng gatas
d) Serotonin Test
- to detect calcinoid tumors of the intestinal tract.
 NUTRITION AND DIET THERAPY – BSN 2ND YEAR SUMMER FINAL 2022
Good Tray Service
- a style of service that makes use of a tray and does not make
use of the usual dining table; dishes and utensils are arranged
in a tray and brought to the patient in his/her room.
- Essentials of good tray service are as follows:
1) Sufficient size of the tray for uncrowded arrangement.
2) Clean, unwrinkled tray cover and napkin or good quality
paper.
3) Attractive pattern of spotless chinaware without chips or
cracks; clean glassware and shining silverware.
4) An orderly arrangement of all items on the tray.
5) Food portions are suitable for the patient’s appetite.
6) Foods are attractively arranged with the appropriate
garnishing.
7) Meals are served on time; Hot foods served warm and
cold foods served chilled.
8) Trays are served promptly to the patient.
- In good tray service, we follow different criteria, but
sometimes it is okay not to follow it. For example, criteria no.
3 in which chinaware is so expensive, it is not realistic for
government hospitals.
- All we need to do is to make the food appetizing, palatable and
most importantly it should be based on the patient’s need.
Therapeutic Diets
Nutrition Therapy for Obesity and Weight Control
- Obesity is said to be a state of adiposity in which body fat is
above the ideal weight. Assessment will show a body mass
index of 30 – 39.9. Whereas, being overweight is having a
body mass index of 25 – 29.9 or greater.
- this results from:
• An imbalance of the complex system of neural
• Hormonal and chemical mechanisms that keeps the
balance between energy intake and energy expenditure.
- There are reasons why an individual may have an excessive
intake of calorie; but obesity can be prevented and the
intention to lose weight is planned
- A Low-calorie Diet and exercise may help in weight control.
• 1 gram of Carbohydrates: 4 calories
• 1 gram of protein: 4 calories
• 1 gram of fat: 9 calories
- Need low calorie lang yung mga overweight at obese patient
para mapilitan silang gamitin yung mga energy na naka store
sa kanilang mga katawan. o Diet:
• Protein of about 11/2 (equivalent to 5.5 grams of protein)
per kg body weight may be allowed
• Same amount may be given to the fat
• The amount of carbohydrate is roughly twice the number
of protein. (11 grams of carbohydrates)
• Menu Plan follows the recommended Food Exchange List.
- Yung insulin na ibinibigay ay nakabase don sa diet ng patient.
Kailangan maging consistent siya sa diet para di pabago bago
yung amount ng insulin na ibibigay sa patient kasi hindi
maganda kapag paiba iba.
- Kung ano yung recommended diet dapat ayon lang lagi yung
i-consume para maging regular yung amount ng insulin na
ibibigay sa patient.
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Nutrition Therapy for Diabetes Mellitus
Diabetes Mellitus
- a condition that results from the lack of insulin produced by
the body. This metabolic problem affects the use of
carbohydrates and fats by the body.
Hyperglycemia or hypoglycemia
- often occur.
- These signs along with the excess in weight can be prevented
by controlling the amount of food and their distribution in
meals in a day-to-day basis.
- Patients may initially be placed on a low-calorie diet those
with normal weight are given sufficient calories to maintain
their weight.
- Protein of about 11/2 per kg body weight may be allowed; the
same may be given to the amount of fat allowed.
- The amount of carbohydrate is roughly twice the number of
proteins.
- Menu Plan follows the recommended Food Exchange List.
Nutrition Therapy for Diseases of the Gastrointestinal Tract
- Dietary modifications in disorders of the intestinal tract are
designed to alleviate symptoms, correct nutrient deficiencies,
and where possible, address the primary cause of the difficulty.
- The nature of the modification will depend on the medical
condition that the patient has.
- Bland diet may be prescribed to manage Peptic ulcer. This diet
must meet nutritive adequacy, bland flavor and soft
consistency, and mechanically and chemically non-stimulating.
- Long term use is not recommended as this may lead to the
patient becoming malnourished.
Diverticular diseases
- There is a lump in the inner lining of the colon. May mga
nakalawit na bilog bilog and kapag nainfect don na
nagkakaroon ng problema.
- Management may include:
• Increase of fiber in the diet
• With Bran
• Whole grains
• Cellulose foods to reduce muscle contractions and
facilitate normal muscle tone
- Fiber- nagwawalis ng bituka so kapag may fiber matatanggal
lahat ng waste residue.
Celiac sprue and Non-tropical sprue
- Will show intolerance for gluten
- Management may include:
• Food sources containing gluten are removed from the diet
• A high-protein diet is usually necessary
• Along with supplements of minerals and vitamins.
Ulcerative colitis
- where there is an inflammation of the colon and the rectum -
implies a diet with high calorie, high protein, high vitamins
and mineral.
- Management may include:
• Implies a diet with high calorie
• high protein (repair)
• high vitamins and mineral (fight infection)
- In these acute stages, the patient is placed on a Low-residue
diet, avoiding heavy roughage to prevent irritation.
Lactose intolerance
- a condition brought about by a deficiency in the enzyme
lactase; the lactose (sugar in milk) then, cannot be hydrolyzed.
 NUTRITION AND DIET THERAPY – BSN 2ND YEAR SUMMER FINAL 2022
- Management may include
• A lactose restricted diet is prescribed.
• Milk
• Milk-products
• Foods containing whey and casein are avoided.
Diarrhea
- Patients suffering from diarrhea may initially be placed on
NPO for 12 hours with.
- IVT support; as the condition improves.
- Management may include:
• Oral fluids may be given liberally to prevent Dehydration.
• Broths and rehydration solutions are given to replace the
electrolytes lost.
• Foods rich in pectin.
Constipation
- A problem that is commonly experienced.
- It may have a variety of causes but the management often
includes high –fiber diet and liberal fluid intake.
- Intestinal gas is controlled by excluding gas-producing foods;
the patient is advised to take small frequent meals and to chew
food thoroughly. Hemorrhoids are managed with intake of
high –fiber diet, liberal fluids and avoidance of highly-
seasoned foods and relishes.
Gastroesophageal reflux disease
- hiatal hernia and esophagitis is a condition that takes place 1 to
4 hours after a meal when a decrease in sphincter pressure
happens.
- Maintaining the ideal body weight is recommended;
- Dietary management includes avoiding foods high in fat and
eating of large meals. Protein and carbohydrate foods with
low-fat content are preferred as these do not affect the lower
esophageal sphincter pressure.
- These are the conditions that can be found on upper GIT:
• GAR – Pyloric sphinter
• Cardiac sphinter- entrance
• Pyloric Sphinter- exit
• Kapag masyadong tight yung pyloric sphinter and tunaw
na yung food, isusuka ng patient yung gastric content
since hindi nga makadaan yung pagkain don sa pyloric
sphinter
- 2nd Condition: Hernia- the esophageal sphinter is too loose, so
the food in the stomach will return to the esophagus (hiatal
hernia)
- Third condition: There is an inflammation on esophagus so
there is difficulty in swallowing
Nutrition Therapy Diseases of the Liver, Gallbladder, and
Pancreas
Hepatitis
- the inflammation of the liver.
- Diet Therapy includes:
• Protein coming from animal sources as these are
considered to have a superior quality.
• Additional serving of foods rich in protein is
recommended – like an additional milk, an extra egg, as
well as meat, fish and cheese.
- Caloric intake must also be adjusted to meet the body’s energy
needs.
- Patients with fever may have 2,500 to 4,000 calories per day.
J.A.K.E 7 of 21
- Fat should be taken in moderation. The foods added to the diet
are sufficient to meet the daily requirements for minerals and
vitamins.
- Hepatitis causes: taking medication without eating food,
drinking alcohol beverages, too much intake of fats, viral
infections
Cirrhosis
- Protein is often depleted in patients with cirrhosis. Often a 100
g protein is given, with sodium restriction to 250 mg a day;
and a 1,800 calorie diet is recommended.
- Fat restriction is not necessary.
- Patients with hepatic coma are prescribed with a high calorie
diet. (kapag sumobra sa protein intake yung patient,
mamanasin sya)
Cholecystitis
- May be managed with a low-fat diet, to avoid stimulating the
gallbladder. Spices and high-residue foods are avoided as
these can cause distention and increase in peristalsis.
- Selection of food items must be carefully done as these may
either be restricted or limited.
- Excluded from food preparation such as the use of butter,
margarine and sauces as vegetable dressing; instead, lemon
juice vinegar or low-calorie, fat-free dressings are used.
- Patients with pancreatitis are placed on low-fat, low-elemental
formulas when enteral feeding is appropriate. During acute
attacks, the patient may be placed on NPO for 48 hours. In
chronic cases, the diet is high calorie, moderate protein and
low to moderate fat. On the other hand, patients with cystic
fibrosis are given high-protein diet to compensate for fecal
losses, with liberal fat intake. Calories are often according to
the need for growth.
Nutrition Therapy for Cardiovascular Diseases
- Atherosclerosis is caused by the accumulation of fatty
materials including a high proportion of cholesterol and other
substances in the blood vessel, causing it to narrow. Dietary
management is low-fat, low in saturated fat and cholesterol
(300 mg/day).
- Increase in monounsaturated fatty acid, polyunsaturated fats,
omega-6 and omega-3 fatty acids – with at least 2 servings per
week are recommended to decrease plasma cholesterol levels.
Simple sugars are restricted.
- Complex carbohydrates and dietary fiber are increased to 25-
30 g/day and restriction of carbohydrates are also done.
- Congestive heart failure is managed by restricting sodium in
the diet. Depending on the severity of the condition, sodium
restriction may range from mild (2-3 g) to severe (250 mg)
restriction. Low-fat diet with emphasis on unsaturated oils is
recommended.
- Diet for patients with Myocardial infarction (MI) are designed
to help reduce the work load of the heart. Small frequent meals
are done; Liquid diet is used on the initial stages gradually
progressing as the condition of the patient improves.
- Among the food items restricted are caffeine-containing
beverages, sodium, cholesterol, fat and calorie. Consumption
of omga-3 fatty acid-rich foods may be done to reduce blood
clots.
 NUTRITION AND DIET THERAPY – BSN 2ND YEAR SUMMER FINAL 2022
Nutrition Therapy for Diseases of the Kidneys
- Acute glomerulonephritis is a condition consequent to an
antigen-antibody complex in which some of the complexes
become ensnared in the glomeruli leading it to swell.
- Emphasis of nutritional care is the overall nutritional needs of
the patient rather than the restriction in protein; restriction in
sodium is done only when edema is present.
- High Calorie from carbohydrates is recommended.
- Malnutrition may result from Nephrotic syndrome, as lesions
in the nephrons can effect massive albuminuria and protein
losses.
- Recommended is a diet high calorie, and high protein, low
sodium.
- Acute renal failure patients are given high calorie, low to
moderate protein and moderate fat diet. Adequate caloric
intake prevents tissue break down; Potassium and sodium are
controlled according to the patient’s capacity to excrete them.
- Water intake is also restricted to a liter a day and is carefully
monitored.
- Renal calculi requires a large intake of fluids to dilute the
urine and prevent concentration of stones.
- The type of stone present influence the nature of the diet.
• Calcium oxalate stones – low calcium, low phosphate or
oxalate –according to the Calcium compound, acid ash.
• Calcium-rich foods are eliminated; alkaline foods are
controlled; potassium-rich foods are increased.
• Uric acid stones – low purine; limited protein with
emphasis of milk, fruits and decreased intake of bread
products.
• Cystine stones – High fluid intake, controlled intake of
meat, milk, egg and cheese.
Nutrition Therapy for Cancers
- Cancer is a group of many dissimilar diseases categorized by
unfettered replication of Cells.
- The clinical status of the patient also warrants the appropriate
route of feeding.
- Oral nutrition is high calorie, high protein. Tube feedings may
range from complete products – meal replacements that
require digestion and absorption; chemically-defined products
– minimal or no digestion – or Specialty products – which
may vary in terms of amino acid, carbohydrate or fat content.
- Total parenteral nutrition may also be done when the digestive
tract is not functioning well.
Nutrition Therapy for Human Immune Deficiency Syndrome
(HIV/AIDS)
- HIV/AIDS is an infection that is transmitted via sexual contact,
transfusion of contaminated blood, sharing of contaminated
needles and mother to child during pregnancy, childbirth or
breast feeding.
- Nutritional management for patients with HIV/AIDS include
Energy of 35 – 45 kcal/kg BW; Protein 2 – 2.5 g/kg BW ; Fats
– increase in omega-3 sources and decrease in saturated fats in
the diet
- Vitamins and minerals - an increase to be recommended in
case of altered metabolism.
Nutrition Education and Counseling: Behavioral Change
- Patient education is a process of assisting people to learn
health-related behaviors that can be used in their everyday life
J.A.K.E 8 of 21
and achieve optimal health. It aims to increase the competence
and confidence of clients for self management; increasing the
responsibility and independence of clients for self-care. A
partnership approach can provide clients with opportunities to
explore and expand their self-care abilities as they transition
from being passive to active participants of their care.
- Behavioral Models that the nurse may use as guide include the
following:
Health Belief Model
- it explains and predicts health behaviors based on the patient’s
beliefs about the health problem and the health behavior.
- Its subcomponents include the individual’s perceptions,
modifying factors and the likelihood of action.
Self-efficacy theory
- this theory is based on a person’s expectations relative to a
specific course of action. It deals with the belief that one is
competent and capable of accomplishing a specific behavior.
- The behavior-specific predictions of this theory can be used
for understanding the likelihood of individuals participating in
existing or a planned educational program.
Stages of Change Model
- This theory is useful in staging the client’s intentions and
behaviors for change as well as to determine the strategies that
will enable completion of a specific stage.
- The six stages that the authors used begins with
1) Precontemplation
2) Contemplation
3) Preparation
4) Action
5) Maintenance
6) Termination.
- Among its current applications are in health promotion and the
processes by which people decide to change.
Theory of Reasoned Action and Theory of Planned Behavior
- the premise of this theory is that humans behave in a rational
way that is consistent with their beliefs; suggesting that a
person’s behavior can be predicted by examining the
individual’s attitudes about the behavior as well as the
individual’s beliefs about how others might respond to the
behavior.
- nurses as educators need to take beliefs, attitudinal factors and
subjective norms into consideration.
Therapeutic Alliance Model
- Fundamental to this model is the shift toward self-
determination and control over one’s own life. This model
views the client as active and responsible, with an outcome
expectation of self-care. The therapeutic alliance is formed
when the nurse and patient views each other as having equal
power.
- The therapeutic is significant as it relates to the patient’s
adherence to therapeutic interventions and achievement of set
goals.
Counseling for change
- When a person makes a lifestyle change, he or she is giving up
something; adapting new behaviors entails “costs” and
“benefits”. In communities where individual health care
providers and mass media promote healthy habits, there may
be more motivation for people to make changes.
- By using motivational interviewing techniques, the counselor
can help the patient move through the stages of change. The
goal is to increase the client’s intrinsic motivation so that he or
 NUTRITION AND DIET THERAPY – BSN 2ND YEAR SUMMER FINAL 2022
she can express the rationale for the changes. Persuasion and
support are key elements in counseling.
Community Resources
- Basic in communities are the availability of wellness centers
where patients may be referred to for assistance. The Barangay
Nutrition Scholar is tasked to do preliminary assessment,
monitoring and ensuring availability of food supplements for
children who may be suffering from Vit A Deficiency, Iron
Deficiency Anemia, malnutrition or Iodine deficiency.
- Available from the Web are various literatures and sites that
may be used for specific nutritional needs and support groups,
such as Overeaters Anonymous, glutenfreediet.com and the
like.
EVIDENCED- BASED GUIDELINES IN NUTRITION
Discussed by Prof. Gerardo Nicolas and Prof. Donato Mirador
- Evidence based practice (EBP) is the conscientious use of
current best evidence in making decisions about patient care.
- a conscientious, problem solving approach to clinical practice
that incorporates the best evidence from well designed studies,
patient values and preferences, and a clinician's expertise in
making decisions about a patient's care
- Halimbawa, hospital. The practices of that hospital are where
it came from? They have researchers to know and modify the
studies in order to decide the patient care.
- proven and tested beh
- Basis and guidelines
Statement of Evidence
• Evidence obtained from meta-analysis of RCTs
• Evidence obtained from at least 1 RCT
• Evidence obtained from at least 1 well-designed controlled
study without randomization
• Evidence obtained from at least 1 well-designed quasi-
experimental study.
• Evidence obtained from well-designed non experimental
descriptive studies, such as comparative studies , correlation
studies, and case reports
• Evidence obtained from expert committee reports or opinions
and/ or clinical experiences of respected authorities
J.A.K.E 9 of 21
GRADE ranking recommendation
• High – Confident that the effect in the study reflects the actual
effect.
• Moderate – quite confident that the effect in the study is close
to the true effect but it is also possible it is substantially
different.
• Low – true effect may differ significantly from the estimate.
• Very low – true effect is likely to be substantially different
from the estimated effect.
The Iowa Model of Evidence-Based Practice is a five-step
process:
1) Identifying the nursing problem and conduct a search of
the literature.
- The nursing problem prioritized may be about meeting the
nutritional need of a well patient or a patient with an
identifie health deficit, such as over or undernutrition;
post surgery or problems pertaining to absorption.
- Cost-effectiveness may be also be a concern with the
family or the inadequacy of their skills for food
preparation.
2) Determine whether the issue is a priority for the
organization.
- Organizational priorities must also be known – should a
research into the problem identified be needed. The
conduct of studies will require resources.
- Collaboration will help guide the nurses to an appropriate
direction or focus.
3) Form a team to develop, implement and evaluate the
project.
- The authors of the model suggests that the team include
representatives from those who may have an interest on
the project. Also, this avoids duplication of tasks as
committees may already be in place.
4) Assemble the relevant literature.
- Review of literatures relevant to the project is done.
Abstracts, bibliographies, conference proceedings, theses
and dissertations may be included.
5) Begin the process of critiquing the literature.
- At this stage, literatures are synthesized. Members of the
group may divide the workload and understand the
scientific basis for implementing changes. The group need
to decide if the materials gathered are enough to guide the
practice.
- The following need to be looked into:
• Consistency of the findings across the studies.
• Types and the quality of the studies.
• Relevance of the findings to clinical practice.
• Adequacy of the studies using a population similar to
that of the organization, where the findings may be
applied.
• Feasibility of the findings in practice.
• Risk-benefit ratio.
LEGAL MANDATES RELATED TO NUTRITION AND
DIET THERAPY
Discussed by Prof. Gerardo Nicolas and Prof. Donato Mirador
• Mandate - a judicial command or precept issued by a court or
magistrates, directing the proper officer to enforce a judgment,
sentence or decree.
 NUTRITION AND DIET THERAPY – BSN 2ND YEAR SUMMER FINAL 2022

• Executive Orders - acts of the President providing for rules of Act 8976 Act nutritional deficiency
a general or permanent character in implementation or problems in the
execution of constitutional or statutory powers shall be Philippines, a Food
Fortification plan
promulgated in executive orders.
provides for the
• Presidential Decree - innovation made by President addition of nutrients to
Ferdinand E. Marcos with the proclamation of Martial Law processed foods or
• Republic Act - a piece of legislation used to create policy in food products as per
order to carry out the principles of the Constitution. the Recommended
• Food fortification - the addition of one or more essential Dietary Allowances
nutrients to food, whether or not it is normally contained in the (RDA)
food, for the purpose of preventing or correcting a Republic Act (RA)
demonstrated deficiency of one or more nutrients in the 3720 of the Republic of
population or specific population groups (Codex Alimentarius). the Philippines was
Year amended with the
Code Title Purpose passage of a new
signed
law ,RA 9711 - “The
Creation of the Food and Drug
National Nutrition Administration (FDA)
Presidential Council (NCC) of the Food and Drug
Nutrition Act of Republic Act of 2009” The FDA
1974 Decree No. Philippines as the 2008 Administration
the Philippines Act 9711 Act of 2009 created the
491 highest policy-making Act
Food and Drug
and coordinating body Administration (FDA)
on nutrition. in the Department of
Provision of safe and Health (DOH) to be
National Code of adequate nutrition for headed by a Director
Marketing of infants; protection and General with the rank
Breastmilk promotion of breast of Undersecretary of
Executive Substitutes, feeding ; ensuring the Health.
1986
Order 51 Breastmilk proper use of An act expanding the
Supplements and breastmilk substitutes promotion of
Other Related and breastmilk Expanded
Republic breastfeeding,
Products”. supplements when 2009 Breastfeeding
Act 10028 amending for the
necessary, Promotion Act
purpose republic act
no. 7600
Provides protection to
consumers against Strengthens food safety
hazards to health and. regulatory system in
Republic Consumer Act of
1992 Safety and deceptive, the country; provides
Act 7394 the Philippines
unfair and protection to
unconscionable sales Republic consumers so they will
acts and. Practices. 2013 Food Safety Act
Act 10611 have access to local
foods and food
An act providing
products that have
incentives to all
undergone thorough
The Rooming-in government and private
Republic and rigid inspection.
1992 and Breastfeeding health institutions with
Act 7600
Act rooming-in and the standardization and
breastfeeding practices regulation of nutrition
and for other purposes and dietetics education;
(b) the examination,
Contribute to the
registration and
elimination of
licensing of
micronutrient
nutritionist-dietitians;
malnutrition in the
(c) the standardization,
country, particularly “Nutrition
Republic supervision, control,
iodine deficiency 2015 and Dietetics
Act 10862 and regulation of the
Act for Salt disorders, through the Law ”
practice of nutrition
Republic Iodization cost-effective
1995 and dietetics; (d) the
Act 8172 Nationwide (ASIN preventive measure of
development of
Law) salt iodization; require
professional
all producer
competence of
manufacturers of food-
nutritionist-dietitians
grade salt to iodize the
through continuing
salt that they produce,
profession
manufacture, import,
trade or distribute
2000 Republic Food Fortification To prevent and limit
J.A.K.E 10 of 21
 NUTRITION AND DIET THERAPY – BSN 2ND YEAR SUMMER FINAL 2022
An act scaling up the
national and local
health and nutrition
“Kalusugan at
programs through a
Republic strengthened integrated
2018 Nutrisyon ng
Act 11148 strategy for maternal,
Mag-Nanay Act"
neonatal, child health
and nutrition in the first
one thousand (1,000)
days of life
Presidential Decree No. 491 (1974)
Nutrition Act of the Philippines
- Under Section 4, the National Nutrition Council was created
as the country’s policy-making and coordinating body on
nutrition. Council was reorganized through Executive Order
No. 234 s. 1987 and Administrative order No. 88 s. 1988. It
was attached to the Department of Health (DOH) on
November 30, 2005. The NCC was instructed to realign its
operations to focus on client-based activities and to address
hunger and malnutrition in the context of Millennium
Development Goals (MDG).
- Objectives of the National Nutrition Council (NCC):
• Formulate national food and nutrition policies and
strategies;
• Coordinate the planning, monitoring and evaluation of the
national nutrition program;
• Coordinate the release of funds, loans and grants from the
government and nongovernment organizations; and
• Call on any department, bureau, office, agency and other
instrumentalities of the government for assistance in the
form of personnel, facilities and resources as the need
arises.
- The month of July was designated as NUTRITION MONTH
under Section 7 to create greater awareness among people on
the importance of nutrition. Activities thereto shall be
approved and coordinated by the Council.
Executive Order 51 (1986)
“National Code of Marketing of Breastmilk Substitutes,
Breastmilk Supplements and Other Related Products”
- In consistent with Article 11 of the International Code of
Marketing of Breast-milk Substitutes, the government adopted
an appropriate legislation to give effect to the principles and
aim of the aforesaid International Code to ensure that safe and
adequate nutrition for infants is provided, to protect and
promote breastfeeding and to inform the public about the
proper use of breastmilk substitutes and supplements and
related products through adequate, consistent and objective
information and appropriate regulation of the marketing and
distribution of the said substitutes, supplements and related
products.
- Some of the important policies under Section 6: The General
Public and Mothers are the following:
• No advertising, promotion or other marketing materials,
whether written, audio or visual, for products, within the
scope of this Code shall be printed, published, distributed,
exhibited and broadcast unless such materials are duly
authorized and approved by an inter-agency committee
created herein pursuant to the applicable standards
provided for in this Code.
J.A.K.E 11 of 21
• Manufacturers and distributors shall not be permitted to
give, directly, or indirectly, samples and supplies of
products within the scope of this Code or gifts of any sort
to any member of the general public, including members
of their families, to hospitals and other health institutions,
as well as to personnel within the health care system, save
as otherwise provided in this Code.
• There shall be no point-of-sale advertising, giving of
samples or any other promotion devices to induce sales
directly to the consumers at the retail level, such as
special displays, discount coupons, premiums, special
sales, bonus and tie-in sales for the products within the
scope of this Code. This provision shall not restrict the
establishment of pricing policies and practices intended to
provide products at lower prices on a long term basis.
• Manufacturers and distributors shall not distribute to
pregnant women or mothers of infants any gifts or articles
or utensils which may promote the use of breastmilk
substitutes or bottle feeding, nor shall any other groups,
institutions or individuals distribute such gifts, utensils or
products to the general public and mothers.
• Marketing personnel shall be prohibited from advertising
or promoting in any other manner the products covered by
this Code, either directly or indirectly, to pregnant women
or with mother of infants, except as otherwise provided by
this Code.
• Nothing herein contained shall prevent donations from
manufacturers and distributors of products within the
scope of this Code upon request by or with the approval
of the Ministry of Health.
Republic Act 7394 (1992)
“Consumer Act of the Philippines”
- This law is designed to prevent business that engage in fraud
or specified unfair practices from gaining an advantage over
competitors and provide additional protection for the weak and
those unable to take care of themselves.
- Objectives:
• Protection against hazards to health and safety; protection
against deceptive, unfair and unconscionable sales acts
and practices;
• Provision of information and education to facilitate sound
choice and the proper exercise of rights by the consumer;
• Provisions of adequate rights and means of redress; and
• Involvement of consumer representatives in the formation
of social and economic policies.
- Consumer Rights:
• Right to basic needs
• Right to safety
• Right to information
• Right to choice
• Right to representation
• Right to redress
• Right to consumer education
• Right to a healthy environment
- The following are some important policies under the Republic
Act 7394:
- Article 11. The department shall also direct the manufacturer,
distributor or seller of such product to extend any or all of the
following remedies to the injured person:
 NUTRITION AND DIET THERAPY – BSN 2ND YEAR SUMMER FINAL 2022
• to bring such product into conformity with the
requirements of the applicable consumer product
standards or to repair the defect in order to conform with
the same;
• to replace the product with a like or equivalent product
which complies with the applicable consumer product
standards which does not contain the defect;
• to refund the purchase price of the product less a
reasonable allowance for use; and to pay the consumer
reasonable damages as may be determined by the
department.
- Some Articles under Chapter II and III:
• Article 23. Adulterated Food
• Article 24. Regulations of unprocessed food
• Article 29. Adulterated drugs and device
• Article 32. Dangerous drugs
• Article 33. Banned or restricted drugs
• Article 35. Adulterated cosmetics
• Article 46. Prohibited Acts. Every product should label
their products if those are hazardous or dangerous, banned
hazardous products but still delivered by products are
strictly prohibited.
• Article 77. Minimum labelling requirements for consumer
products
• Article 78. Philippine Products Standard Mark
• Article 80. Special packaging of consumer products for
the protection for children
• Article 84. Additional labelling requirements for food
(such as expiration date, semi-cooked, fully processed
etc.)
• Article 87. Additional labelling requirements for
cosmetics
• Article 94. labelling requirements for cigarette
Republic Act 7600 (1992)
“The Rooming-in and Breastfeeding Act”
- An act providing incentives to all government and private
health institutions with rooming-in and breastfeeding practices
and for other purposes.
- This law is in promotion of the State policy to encourage the
practice of breastfeeding in the Philippines. It composes of 14
Sections divided into 4 chapters.
• Chapter 1 states the rules and regulations which contain
standard procedures to be followed for rooming-in and
breastfeeding in all private and government health
institutions. Specific provisions are made for complicated
births. The right of the mother to breastfeed and the right
of the infant to receive breast milk is expressed, and
mothers may only exercise their right to bottle feed after
being fully informed of the benefits of breastfeeding and
by expressing their intention to formula feed in writing.
• The regulations cover the establishment and operation of
human milk banks and the donation of human milk which
is stated in Chapter 2 of the act.
• Provisions are stated in Chapter 3 of the act for the
continuing education and training of health personnel and
the education and counseling of parents.
• Other provisions indicated in Chapter 4 states that the
only milk formula to be stocked in the hospital is to be
kept in a closed cabinet out of sight and used for only
J.A.K.E 12 of 21
emergency purposes upon issuance of a prescription.
These prohibitions extend to the use of pacifiers, the
donation of samples of formula, and the promotion of
infant formulas in hospitals. Government and private
hospitals will receive financial incentives for compliance.
Noncompliance will place health personnel and
institutions in danger of losing their licenses and of being
found guilty of a wrongdoing.
Republic Act 8172 (1995)
“Act for Salt Iodization Nationwide (ASIN Law)
- Include in its policy is to protect and promote the health of the
people, to maintain an effective food regulatory system and to
provide the entire population especially women and children
with proper nutrition. For this purpose, the State shall promote
the nutritional fortification of food and combat micronutrient
malnutrition as a priority health program for the nation.
- SECTION 3. Purposes. The purposes of this Act are to:
• Contribute to the elimination of the micronutrient
malnutrition in the country, particularly iodine deficiency
disorders, through cost-effective preventive measure of
salt iodization;
• Require all producers/manufacturers of food-grade salt to
iodize the salt that they produce, manufacture, import,
trade or distribute;
• Require the Department of Health (DOH) to undertake
the salt iodization program and for its Bureau of Food and
Drugs (BFAD) to set and enforce standards for food-
grade iodized salt and to monitor compliance thereof by
the food-grade salt manufacturers;
• Require the local government units (LGU), through their
health officers and nutritionist/dietitians, or in their
absence through their sanitary inspectors, to check and
monitor the quality of food-grade salt being sold in their
market in order to ascertain that such salt is properly
iodized;
• Require the Department of Trade and Industry (DTI) to
regulate and monitor trading of iodized salt;
• Provide mechanisms and incentives for the salt industry
in the production, marketing and distributi0on of iodized
salt; and
• Ensure the sustainability of the salt iodization program.
Republic Act 8976 (2000)
“Food Fortification Act”
- The Philippine Food fortification Program, hereinafter referred
to as the Program, shall cover all imported or locally processed
foods or food products for sale or distribution in the
Philippines; Provided, That, dietary supplements for which
established standards have already been prescribed by the
DOH through the BFAD and which standards include
specifications for nutrient composition or levels of fortification
shall not be covered by this Act.
- The program shall consist of (1) Voluntary Food Fortification
and (2) Mandatory Food Fortification.
- Section 5. Voluntary Food Fortification. - Under the Sangkap
Pinoy Seal Program (SPSP), the Department shall encourage
the fortification of all processed foods or food products based
on rules and regulations which the DOH through the BFAD
shall issue after the effectivity of this act. Manufacturers who
opt to fortify their processed foods of food products but do not
 NUTRITION AND DIET THERAPY – BSN 2ND YEAR SUMMER FINAL 2022
apply for Sangkap Pinoy Seal shall fortify their processed food
or food products based on acceptable standards on food
fortification set by the DOH through the BFAD.
- Section 6. Mandatory Food Fortification. - (a) the fortification
fo staple foods based on standards sets by the DOH through
the BFAD is hereby made mandatory for the following:
• Rice - with Iron;
• Wheat flour 0 with vitamins A and Iron;
• Refined sugar - with vitamin A;
• Cooking oil - with vitamin A; and
• Other staple foods with nutrients as may later required by
The NCC.
- The National Nutrition Council (NCC) shall require other
processed foods or food products to be fortified based on the
findings of nutrition surveys. Such requirement shall be
promulgated through regulations to be issued by the
Department of Health (DOH) through the Bureau of Food and
Drugs (BFAD) and other concerned agencies.
- The fortification of processed foods or food products under
this Section shall be undertaken by the manufacturers:
Provided, that in the case of imported processed foods or food
products, the required fortification shall be done by the
producers/manufacturers of such imported processed foods or
food products.
- Otherwise, the importer shall have responsibility of fortifying
the imported processed foods or food products before said
products are allowed to be distributed or sold to the public:
Provided, further, That the implementation of the mandatory
fortification for wheat flour, refined sugar, cooking oil and
rice, including those milled and/or distributed by the National
Food Authority, shall commence after four (4) years from the
effectivity of this Act.
- The DOH guidelines on micronutrient fortification of
processed food or food products included in Administrative
Order No. 4-A series of 1995 and such other necessary
guidelines that may be issued by the DOH, shall serve as a
basis for the addition of micronutrient(s) to processed foods or
food products to avoid over or under fortification that may
create imbalance in the diet as well as avoid misleading label
claims to gain competitive marketing advantage.
- Manufacturers of processed foods or food products shall
include on the label a statement of "nutrition facts" indicating
the nutrient(s) and the quantities of said nutrients added in the
food.
- Imported rice, wheat flour, refined sugar, cooking oil and
other processed foods or food products that may identified
later by the NCC, shall comply with the requirements of this
Act on entry in country, at the end of manufacturing process
and/or at all points of sale or distribution.
Republic Act 9711 (2008)
“Food and Drug Administration Act”
- An act strengthening and rationalizing the regulatory capacity
of the bureau of food and drugs BFAD by establishing
adequate testing laboratories and field offices. Upgrading its
equipment, augmenting its human resource complement,
giving authority to retain its income, renaming it the food and
drug administration (FDA), amending certain sections of
republic act no. 3720, as amended and appropriating funds
thereof.
J.A.K.E 13 of 21
- This Act has the following objectives:
• To enhance and strengthen the administrative and
technical capacity of the FDA in the regulation of
establishments and products under its jurisdiction;
• To ensure the FDA’s monitoring and regulatory coverage
over establishments and products under its jurisdiction;
and
• To provide coherence in the FDA’s regulatory system for
establishments and products under its jurisdiction.
Republic Act 10028 (2009)
“Expanded Breastfeeding Promotion Act”
- An act expanding the promotion of breastfeeding, amending
for the purpose republic act no. 7600 Provisions:
• Lactation stations in every private enterprises,
government agencies, government-owned and controlled
corporations
• “Lactation periods” for breastfeeding employees, in
addition to time-off for meals, to allow them time to
express their breast milk.
• Breast milk banks in health institutions to store
pasteurized breast milk donated by breastfeeding mothers.
• Inclusion of breastfeeding in the curriculum of schools
(under relevant subjects).
- According to an article by Smart Parenting in 2010,
breastfeeding support groups and advocates see this RA as
strong help for restoring breastfeeding as a social practice in
the Philippines. In the Philippines, just 34% of moms wind up
breastfeeding their infants only up to the initial a half year of
life (the suggested least breastfeeding time of UNICEF). This
might be mostly ascribed to the way that numerous Filipinas
are likewise working moms who need to come back to work
inside a few months of giving birth. This law, which bolsters
breastfeeding moms in the work environment, will no doubt
urge more Filipino children to be breastfed.
Republic Act 10611 (2013)
“Food Safety Act”
- The Food Safety Act of 2013 shall be the framework for
implementing the farm to fork Food Safety Regulatory System.
- SECTION 2. Declaration of Policy. – Section 15, Article II of
the 1987 Philippine Constitution declares that the State shall
protect and promote the right to health of the people and instill
health consciousness among them.
- Furthermore, Section 9, Article XVI provides that the State
shall protect consumers from trade malpractices and from
substandard or hazardous products. Toward these ends, the
State shall maintain a farm to fork food safety regulatory
system that ensures a high level of food safety, promotes fair
trade and advances the global competitiveness of Philippine
foods and food products.
- SECTION 3. Objectives. – To strengthen the food safety
regulatory system in the country, the State shall adopt the
following specific objectives:
• Protect the public from food-borne and water-borne
illnesses and unsanitary, unwholesome, misbranded or
adulterated foods;
• Enhance industry and consumer confidence in the food
regulatory system; and
 NUTRITION AND DIET THERAPY – BSN 2ND YEAR SUMMER FINAL 2022
• Achieve economic growth and development by promoting
fair trade practices and sound regulatory foundation for
domestic and international trade.
- Towards the attainment of these objectives, the following
measures shall be implemented:
• Delineate and link the mandates and responsibilities of
the government agencies involved;
• Provide a mechanism for coordination and accountability
in the implementation of regulatory functions;
• Establish policies and programs for addressing food
safety hazards and developing appropriate standards and
control measures;
• Strengthen the scientific basis of the regulatory system;
and Upgrade the capability of farmers, fisher folk,
industries, consumers and government personnel in
ensuring food safety
10. Republic Act 10862 (2015)
“Nutrition and Dietetics Law of 2016”
- An act regulating the practice of Nutrition and Dietetics in the
Philippines
- Sec. 2. Declaration of Policy. - The State recognizes the
important role of registered nutritionistdietitians (RNDs) in
nation building and in human development through adequate
nutrition. Towards this end, the State shall promote the
sustained development of RNDs whose competence has been
determined by honest and credible licensure examinations, and
whose standards of professional service and practice are
internationally recognized and considered world-class, brought
about by regulatory measures, programs and activities that
foster growth and advancement of the profession.
- Sec. 3. Objectives. - This Act shall govern:
• The standardization and regulation of nutrition and
dietetics education;
• The examination, registration and licensure of
nutritionist-dietitians;
• The standardization, supervision, control, and regulation
of the practice of nutrition and dietetics;
• The development of professional competence of
nutritionist-dietitians through continuing professional
development (CPD); and
• The integration of the nutrition-dietetics profession.
Republic Act 11148 (2018)
"Kalusugan at Nutrisyon ng Mag-Nanay Act"
- President Rodrigo Roa Duterte signed on 29 November
Republic Act 11148 “An Act Scaling up the National and
Local Health and Nutrition Programs through a Strengthened
Integrated Strategy for Maternal, Neonatal, Child Health and
Nutrition in the First One Thousand (1,000) Days of Life” or
otherwise known as the “Kalusugan at Nutrisyon ng Mag-
Nanay Act”.
- The law strengthens the national and local health and nutrition
programs for pregnant and lactating women, adolescent girls,
infants and young children in the first 1,000 days. The Act
which consolidated Senate Bill No. 1537 “The Healthy Nanay
and Bulilit” Act and House Bill No. 5777 “Kalusugan at
Nutrisyon ng Mag-Nanay” Act was passed by the Senate and
House of Representatives on 17 September 2018 and 19
September 2018 respectively.
J.A.K.E 14 of 21
- The law seeks to refocus interventions for addressing
malnutrition among the most nutritionally at risk, prioritizing
women of reproductive age, especially adolescent girls, teen-
age mothers, pregnant and lactating women and children from
birth up to 24 months, to address the health and nutrition
problems of these vulnerable groups. The law tasked the
Department of Health, the National Nutrition Council (NNC)
and its Governing Board members to formulate a strategy that
is comprehensive and sustainable.
- The law provides for the delivery of the following nutrition
and health services and interventions:
• First 270 days of conception and pregnancy
- Prenatal services at the rural health units and
barangay health stations, identification and
management of nutritionally-at-risk pregnant women
and pregnant adolescents and provision of ready-to-
use supplementary food in addition to dietary
supplementation, provision of anthelminthic drugs
deworming and assessment of risk for parasites; for
pregnant women and immediate postpartum period,
care at the time of admission at the facility, and
monitoring of progress of labor and conditions of
both the mother and the fetus, among others; and for
postpartum and lactating women, the services include
follow-up preventive care visits to health facilities
where they gave birth, and home visits for women in
difficult to reach communities particularly
geographically isolated and disadvantaged areas
(GIDA).
• For the next 180 days (0-6 months of the child)
- Provision of continuous support for mother and
infants to initiate and complete exclusive
breastfeeding for the first 6 months, including referral
to trained health workers on lactation management
and treatment of breast conditions; counselling
household members on handwashing, environmental
sanitation and hygiene; appropriate and timely
immunization services integrated with assessment of
breastfeeding practice, growth monitoring promotion;
infant and young child feeding (IYCF) counselling;
and provision of routine newborn care services such
as eye prophylaxis and vitamin K, birth doses of
Hepatitis B and BCG vaccines after completion of the
first breastfeeding.
• For the last 550 days (6 months up to 2 years of the child)
- Health and nutrition services at the community level
shall be provided, such as integrated management of
childhood illnesses, including the management of
moderate and severe acute malnutrition; deworming
for children one to two years old; oral health services,
including application of fluoride varnish to prevent
dental carries; and livelihood assistance for parents of
families belonging to the poorest of the poor.
 NUTRITION AND DIET THERAPY – BSN 2ND YEAR SUMMER FINAL 2022
ETHICO-MORAL PRINCIPLES AND CULTURAL/
SPIRITUAL PREFERENCES
Discussed by Prof. Gerardo Nicolas and Prof. Donato Mirador
National Genomic
- According to the World Health Organization, genomic is
defined as the study of genes and their functions, and related
techniques that further address all genes and their inter
relationships in order to identify their combined influence on
the growth and development of the organism. That being said
it became an important aspect to integrate genomics to human
health in the study of nutrition and dietetics. Nutritional
science considers the studies of individuals with nutrient
deficit and its consequential effect to the overall health status
of the people. Scientific studies shows irrefutable findings in
the identification of food components, or nutrients, that raise
or lowers the risk of diseases damaging the human body
thereby constituting preventable measure to improve lives.
Current studies focus on obesity which is a precursor of non-
communicable diseases like hypertension, cardiovascular
disease and diabetes mellitus.
- According to the Department of Health, cardiovascular
diseases and diabetes mellitus ranks as one of the ten leading
causes of mortality in the Philippines. These are polygenic
diseases increasingly becoming prevalent in the past two
decade. In the abstract entitled “Nutritional Genomics and
Direct-to-Consumer Genetic Testing: An Overview” by Marta
Guasch-Ferré, Hassan S Dashti, and Jordi Merino, asserted
that availability of genomic information to consumers are
sparse, that genetic testing must be considered as a means for
health improvement that it is crucial to have a greater
understanding of the relevance of genetics to optimize human
health, delay disease onset, reduce disease severity, and
improve quality of life. Further, they concluded that genetic
information is complex, and its interpretation is probabilistic,
depending on many factors such as health status, family health
history, ethnic background, and more. They envision that the
field of genetic counseling has sought to develop scientifically
valid processes of helping people understand and adapt to the
medical, psychological, and familial implications of genetic
contributions to disease. Nutritional genomics holds the
promise to be translated into tailored nutritional
recommendations on the basis of genetic susceptibility to
polygenic diseases, and genetic testing should play a key role
in this approach. They concluded however that more accurate
methods for measuring dietary intake, genetic susceptibility,
and the interplay between them could lend better assessment
of population health and the development of personalized
interventions and public policies. Finally they believe the
integration of other layers of genomics information, such as
metabolomics, transcriptomics, epigenetic modifications, and
gut microbiota composition, is likely to provide a more
comprehensive body of evidence on the interplay between
dietary intake and genetic susceptibility. Lastly, they stated
that the initial drive toward precision nutrition has begun,
more work is underway to develop a robust scientific
framework for its implementation into practical solutions to
benefit individuals and societies alike.
- Locally, the Philippine Genome Center where mandated to
Learning a deeper understanding and judicious application of
advanced knowledge and emerging technologies in genomics
and bioinformatics in health and medicine, agriculture,
J.A.K.E 15 of 21
biodiversity, forensics and ethnicity, industry and the
environment for the benefit of Filipinos and the rest of
humanity.
Ethico-moral Principles: Nutritional Support and End-of-Life
(EOL) Decision Making
- Scope of nursing practice as mandated by the Republic Act
9173, “Philippines Nurses Act of 2002” stated in Article VI,
Sec. 28 that “…nurses shall collaborate with other health care
providers for the curative, preventive, and rehabilitative
aspects of care, restoration of health, alleviation of suffering,
and when recovery is not possible, towards a peaceful death.”
Furthermore, it stated that in the practice of nursing in all
settings, the nurse is duty-bound to observe the Code of Ethics
for nurses and uphold the standards of safe nursing practice.
This applies in the “end-of-life” care of patient.
- EOL care requires a variety of decisions that includes
palliative care, patients' right to selfdetermination of treatment
or life, ethics and efficacy medical experimentations and
clinical trials, the innovative medical and nursing interventions,
and continuation of routine medical interventions, nutritional
and life support.
- EOL encompasses 5 ethical principle: autonomy, beneficence,
maleficence, justice and fidelity. Autonomy implies patient
right to self-determination. During the EOL care nurses shall
preserve this right even when they lost decision-making
capacity, thus a need for advance directive is imperative. The
dilemma lies in the absence of such and still many Filipino is
hesitant in having one. This is due to culturally integrated
perception to healthcare. Still healthcare professionals relies to
immediate family members or principal caregivers to make
decision regarding healthcare management in lieu of the
patient, thus violation the principle of autonomy. Beneficence
is advocating what is good or beneficial for the patient. Nurses
shall therefore be cautious not to violate the patient’s right for
selfdetermination. More often than none, healthcare
practitioners relies on what they thought is best for the patient
rather than respecting the desire of patient to choose an option
in their care management. This often occurs in an absence of
an advance directives. Nonmaleficence refers to nurses actions
related to providing care not to inflict intentional harm to
patients. This is based on the medical maxim adopted by
nurses, “above all, do no harm”. This maxim is reflected on
our Nightingale Pledge that states, “…I will abstain from
whatever is deleterious and mischievous, and will not take or
knowingly administer any harmful drug….” Ethical conflicts
arises when nurses participate in assisting euthanasia. Justice
implies fairness in care delivery services. Nurses advocates
equal distribution of health related resources that assures fair
treatment and appropriate care to patient in EOL. Lastly,
fidelity is being faithful and truthful to a dying patient. EOL
patient should be provided with current and updated
information in relation to their health status including but not
limited to diagnosis, prognosis, treatment and management for
his/her health condition. Any request by EOL patient should
not in any way compromise nurses own moral code and values.
Ethical predicament in the provision of care for EOL patient
includes: withdrawing or withholding intervention, procedure
and medical and nursing management, medical futility,
physician/nurses-assisted suicide.
 NUTRITION AND DIET THERAPY – BSN 2ND YEAR SUMMER FINAL 2022
- Having it said, this ethical principles correlates with the
nutritional support provided to EOL patient, in the position
statement release by American Nurses Association in 2017,
clarifies the role of nurses in the care for them. Their position
states that, “When a patient at the end of life or the patient’s
surrogate has made the decision to forgo nutrition and/or
hydration, the nurse continues to ensure the provision of high
quality care, minimizing discomfort and promoting dignity.
Meticulous oral care should be provided in addition to comfort
care, human touch and palliative care. Nurses are responsible
for understanding the physiologic factors that frame clinical
options. They should also have the knowledge and skills to
address changing nutritional needs in the face of terminal
illness. Nurses who have an informed moral objection to either
the initiation or withdrawal of nutrition or hydration should
communicate their objections whenever possible, to provide
safe alternative nursing care for patients and avoid concerns of
patient abandonment (ANA, 2015).”
- In the article entitled Nutrition Support at the End of Life: A
Critical Decision by M. Patricia Fuhrman, MS, RD, LD,
FADA, CNSD, Today’s Dietitian, Vol. 10 No. 9 P. 68, it
articulate that “Nutrition support at the end of life should be
carefully considered based on a patient’s wishes, prognosis,
and therapy goals. Communication among the patient, his or
her family, and healthcare providers is essential. Open and
honest communication can facilitate decisions that are in the
patient’s best interest. The patient’s autonomy should be the
driving force in making informed decisions. Ongoing
evaluation of benefit vs. burden should occur throughout
therapy.” It’s imperative that nurses ensures that the delivery
of nutritional support to patient EOL care met their nutritional
needs during the course of the therapy. Nutritional support is
an adjunct therapy and does not reverse or cure a disease or
injury. Nutritional support like tube feeding or total parenteral
nutrition (TPN) should always be for a lifesaving treatment for
patient unable to meet nutritional and dietary requirement
through eating.
Cultural and Spiritual Influences related to Nuitritional
Support
- In a thesis conducted by Cynthia S. Klement entitled
“Intercultural Competence for the Nutrition Professional”, the
author believes that the diversity training for nutrition care
professionals is essential in order to provide patients with
culture-specific strategies that allow them to succeed with
their health programs. Knowledge of intercultural nonverbal
and verbal behaviors is becoming increasingly necessary, as is
who ultimately makes medical decisions for the patient.
- In an article published at
https://www.ncbi.nlm.nih.gov/books/NBK493216/ entitled
“Cultural Religious Competence in Clinical Practice” points
out the clinical significance of religion, cultural beliefs. “The
care of patients requires meeting the needs of individuals and
families’ culture and beliefs. Religion often provides spiritual
guidance as well as an emphasis on maintaining health.
Religious beliefs often affects patient attitudes and behavior. It
is important for healthcare professionals to have an
understanding of these issues so they can provide culturally
appropriate care.” It further emphasized the importance of
preserving life, thus overriding set to guidelines intended to
care management. In an event of life-threatening conditions,
J.A.K.E 16 of 21
restrictions on medical, surgical and nursing intervention is not
warranted unless otherwise an advance directive is presented
to healthcare professionals. Understanding reason for
adherence or non-adherence to medical, surgical and
nutritional intervention signifies a breech in patient’s religious
beliefs, customs and traditions.
Cultural - Spiritual variation in relation to nutritional and
dietary support
Cultural Variations:
• Filipino - Filipinos believe ill health is a result of an
imbalance brought about by personal negligence or immorality
and that caring for the body with rest, nutrition, exercise, and
sleep will result in balance. Until the illness becomes
advanced, typically they will not seek health care and tend to
be stoic regarding pain. It's important to consult with family
members in the decision making process. A belief in the hot
and cold theory of healing persists among Filipinos.
Adherence is common as they highly respect health
practitioners and will not question the program. They believe
life is controlled by supernatural forces, as well as by the will
of God.
• African Americans – Beliefs vary from illness being the work
of the devil, a spell that has been cast, God's punishment, or
exposure to cold air. Often seen as essential for health, greens
are frequently consumed. Literacy may be an issue if they
refuse to sign a form. The family spokesperson is typically the
eldest male or father of the family.
• Korean – They closely follow the Chinese principles of yin
and yang, the five elements, and chi. Koreans also adhere to
health beliefs regarding cold, damp, heat, and wind causing
symptoms of ill health. It is believed that the intervention of
ancestors, the supernatural, or excessive emotions can also
result in disease or illness. It is thought that a good appetite is
an indicator of good health. The male head of household
makes decisions regarding health care and should be present at
appointments, but the entire family is also seen as being
responsible for all its members. Family is highly valued and is
viewed as more important than an individual's needs. Koreans
are very close to their children and may fear being a burden to
them.
• Russian - Relatives are involved in treatments. Be guarded yet
positive about treatment plans as patients may overreact. They
will not discuss mental illness or sexual history. These patients
prefer alternative treatments. They may request hot, soft or
warm foods when ill. The decision maker for the family is
usually the member with the strongest personality. They may
believe illness to be God testing their faith, punishment by
God, or the will of God. To speed the healing process, a
spiritual leader may be important to consider.
• South African – Balance with nature is stressed in their health
belief system while also believing illness may befall a person
from God, or nature, or malicious forces through the living or
dead. They may believe the evil eye can bring illness to or
harm another person and that powers a person obtains from
evil can be directed at another and cause pain or illness. They
may also be of the belief system that something they term
"excess blood" (high blood pressure) is caused by eating beets,
carrots and pork, or drinking grape juice or red wine. Likewise,
they may believe "low blood" (anemia) can occur by including
too many pickled foods, lemon juice or vinegar in the diet, and
 NUTRITION AND DIET THERAPY – BSN 2ND YEAR SUMMER FINAL 2022
not eating enough red meat. "Bad blood" is caused by
supernatural forces, contamination, or unclean blood that
accumulates during the winter. Pica can also be an issue when
nonnutritive objects are consumed, such as laundry starch or
dirt.
• Asian Indian – Illness may be viewed as being caused by God
punishing someone for sin whether in the present life or past
life. Dead ancestors or jealous living relatives can also cause
illness. Illness can result from body imbalances, but can also
wash away a person's sins. Some Indians may hold a strong
belief in Ayurvedic medicine that classifies foods and
conditions as pitta, kapha, or vata. The decision maker in the
Asian Indian family is typically the mother-in-law,
grandmother, or eldest son. They may be stoic in regards to
health conditions and not reveal all the facts. They believe
spirituality is as important as rest and a good diet.
Spiritual Variations:
• Christianity – Avoidance of meat during season of lent by
Catholics and orthodox Christian. Seventh Day Adventists
and Mormons evade consumption of alcoholic, caffeinated and
hot beverages. Others restrict diets including meat, pork, fish,
shellfish or dairy products. There are approximately 2.1 billion
Christians in the world practicing in 33,800 different
denominations.
• Islam – Muslims are prohibited pork and products made from
animal fat in their diet. Other forbidden (haram) foods
containing meat, shellfish, bread fermented with yeast, gelatin
from pork used in making cheeses, alcohol, caffeinated
beverages, and coffee. Baked goods made with vanilla extract
are not allowed, unless the vanilla is alcohol-free. The month
of Ramadan mandates fasting from dawn until dusk. Other
religious observances may also require fasting. There are
approximately 1.5 billion people practicing the Islamic faith
around the world.
• Hinduism - Common in those of Indian descent,
vegetarianism is the norm but is not required. Beef is strictly
forbidden, while other prohibited foods can range from other
types of meat, eggs, pork, duck, fish or crab. Alcohol, turnips,
leeks, mushrooms, red-colored foods (tomatoes, beets) onions,
and garlic are sometimes avoided. Several days of fasting
might also be observed. There are approximately 900 million
people worldwide who practice Hinduism.
• Confucianism and Taoism – These traditional Chinese
religions do not impose dietary restrictions or prohibitions on
adherents. There are approximately 394 million people who
practice in the traditional Chinese religions.
• Buddhism – Common in people from Southeast Asia. Many
are vegetarians. Some avoid beef, while others may avoid all
meat, fish, shellfish, eggs and dairy products. Approximately
376 million people are Buddhists around the world.
• Judaism - Strictly forbidden foods are pork and shellfish.
Meat and dairy products are not to be mixed or consumed at
the same meal. Fasting may be observed on Yom Kippur,
Rosh Hashanah and Passover, while certain foods may be
avoided during Passover such as unleavened bread, wheat,
barley, rye, oats, beans, peas, lentils, maize, millet and
mustard. Some followers may adhere to keeping Kosher.
There are approximately 14 million practicing Jews around the
world.
J.A.K.E 17 of 21
• Culture - the set of values, conventions, or social practices
associated with a particular field, activity, or societal
characteristic
• Ethics - the discipline dealing with what is good and bad and
with moral duty and obligation
• Genomics is defined as the study of genes and their functions,
and related techniques. It address all genes and their inter
relationships in order to identify their combined influence on
the growth and development of the organism.
• Nutritional Therapy - evidence-based approach to
maximizing one's health potential through individually
formulated nutritional and lifestyle changes
• Polygenic disease - a genetic disorder that is caused by the
combined action of more than one gene thereby making such
disorder dependent simultaneously with the presence of
several genes that either not inherited as simply as are single-
gene diseases. (e.g. polygenic conditions include hypertension,
coronary heart disease, and diabetes.)
• Principles - a fundamental truth or proposition that serves as
the foundation for a system of belief or behavior or for a chain
of reasoning.
• Religion - human beings’ relation to that which they regard as
holy, sacred, absolute, spiritual, divine, or worthy of especial
reverence
LIFFE-LONG LEARNING ACTIVITIES
Discussed by Prof. Gerardo Nicolas and Prof. Donato Mirador
- Lifelong learning is a method of self-initiated edification that
is concentrated on individual development. It is a learning that
occurs outside a formal education.
- It is best described as voluntary educating oneself with the
determination of achieving personal fulfillment. It recognizes
the education that can be learned outside the classroom,
- These life-learning activities are consist of library search,
access on-line resources, current events and information
technology of nutrition and dietetics.
Library Search
- A search engine wherein an individual has given access to all
resources in the library. It allows to search across all resources
instead of being limited to other resources. These resources
are: articles, books, journals, images, newspaper and etc.
- Resources that can be found in Library Search:
• Books, e-books Journals,
• Full-text articles
• Library content, including the Library Catalogue,
• E-Journals Catalogue
• Database collections
Access on-line Resources
- On-line resources are resources that are accessible via the
internet and world wide web. It is an exemplary data and
educational as it provides useful information. Web pages,
documents, and any support software available on the internet
can be considered as resource.
- Resources that can be found online
• Online Newspaper
• Online Magazine
• Television Website
• Peer-reviewed Journals
 NUTRITION AND DIET THERAPY – BSN 2ND YEAR SUMMER FINAL 2022
• Webpages
• Forums and blogs
Current Events
- are information about what are happening in the world. To
help the students understand the importance of events, current
events is studied to encourage them to explore and learn more
about the news. It motivates the students to pay attention to the
news they see and hear outside of school.
- Benefits of studying current events
• Can open communication between students and parents
• Developed into informed citizens and lifelong news
readers
• Can help teachers teach media literacy skills, which are
the three R’s
• Offer ideal opportunities for cooperative-group instruction,
classroom discussion and debates, purposeful follow-up
writing
• Cover a wide range of subject and connect to all areas of
curriculum
Information technology on nutrition and dietetics
- Information technology has incorporated into the teaching
program of Nutrition and Dietetics as the development of the
technology has become a growing influence on the workplace.
- Emerging technologies:
• Stand-alone applications
• Nutrient Analysis
• Clinical Nutrition
• Food and nutrition education instructional programs and
games Production tools
• Linkage applications and the global information highway
• E-mail or Electronic mail
• Regional networking tools
• Food and nutrition on-line services
• Electronic bulletin-board systems
NUTRITION COUNSELING AND DIETARY
INSTRUCTION
Discussed by Prof. Gerardo Nicolas and Prof. Donato Mirador
- Food is a huge part of Filipino culture. The Filipino food is
influenced by the fusion of Oriental, European and American
culinary that became adapted to local ingredients. These
influences have been adapted to the Filipino palate to create
distinctly Filipino dishes.
- As the Philippines is facing various nutrition and health
problems, several foodbased dietary guidelines have been
developed. These are the Nutritional Guidelines for Filipinos
(NGF), Daily Nutritional Guide Pyramid (DNGP),
Kumainments, and Pinggang Pinoy. All the nutrition messages
for healthy living for all age groups is stated on the NGF.
- It contains the basis for each of the ten nutritional and health
message.
Cultural aspects of dietary planning
- In most Asian diets, the traditional Filipino diet is higher in
total fat, saturated fat, and cholesterol. It is mainly
carbohydrates, generally from rice with low intakes of
nutrientdense food. Apart from rice, the top consumed foods
J.A.K.E 18 of 21
for adults are pork, fish and vegetables. It is in the Filipino
Culture especially for those in Catholic faith to have a
celebration during religious festivals and saint’s day. The
customarily serve in this kind of events are the abundant food
served buffet style with roasted pig as the centerpiece.
- Filipinos are custom to have three meals a day with a mid-
morning and late afternoon snack that is called meriendas. It is
the traditional pattern of eating having the Lunch and dinner as
both large meals of similar composition.
Filipino Dietary Practices
- A daily nutritional guide pyramid has used by Filipinos that
helps show adequate distribution of nutritious food in a meal
which completes the messages of the pyramid in the healthy
food plate for Filipino adults or called “Pinggang Pinoy”.
- The “Pinggang Pinoy” can be used side by side with the
existing DNG Pyramid for Filipinos however it cannot replace
the DNG as it serves different purpose. Pinggang Pinoy is a
quick and easy guide on how much to eat per mealtime, while
the DNG Pyramid shows at a glance the whole day food
intake recommendation.
- The following are the Messages:
• Eat a variety of foods every day to get the nutrients
needed by the body.
• Breastfeed infants exclusively from birth up to 6 months,
then give appropriate complementary foods while
continuing breastfeeding for 2 years and beyond for
optimum growth and development.
• Eat more vegetables and fruits every day to get the
essential vitamins, minerals and fiber for regulation of
body processes.
• Consume fish, lean meat, poultry, eggs, dried beans or
nuts daily for growth and repair of body tissues.
• Consume milk, milk products and other calcium-rich
foods, such as small fish and shellfish, every day for
healthy bones and teeth.
• Consume safe foods and water to prevent diarrhea and
other food and water-borne diseases.
• Use iodized salt to prevent iodine deficiency disorders.
• Limit intake of salty, fried, fatty and sugar-rich foods to
prevent cardiovascular diseases.
• Attain normal body weight through proper diet and
moderate physical activity to maintain good health and
help prevent obesity.
• Be physically active, make healthy food choices, manage
stress, avoid alcoholic beverages and do not smoke to help
prevent lifestyle-related non-communicable diseases.
 NUTRITION AND DIET THERAPY – BSN 2ND YEAR SUMMER FINAL 2022

Eating practices in the Philippines
- A typical Filipino meal consists of a main seafood or meat
dish served with soup, vegetables and rice, with tea or coffee.
Breakfast, lunch and dinner are the same where it usually a
Filipino-style rice with some pieces of meat and vegetables in
it.
acquires the human and other required resources, and is fully
responsible for its success or failure with the capacity and
willingness to develop organize and manage a business
venture along with any of its risks in order to make a profit. It
is a practice and a process that results in creativity, innovation
and enterprise development and growth that refers to an
individual’s ability to turn ideas into action involving and
engaging in socially-useful wealth creation through
application of innovative thinking and execution to meet
consumer needs, using one’s own labor, time and ideas.

Quality of Entrepreneur
• Opportunity seeking
• Persevering
• Risk Taking
• demanding for efficiency and quality
• Information seeking
• Goal Setting
• Planning
• Persuasion and networking
• Nutritional Guidelines for Filipinos (NGF) - a set of dietary • Building self confidence
guidelines based on the eating pattern, lifestyle, and health • listening to others
status of Filipinos. • Demonstrating leadership
• Nutritional Guide Pyramid - is a simple, trustworthy guide
in choosing a healthy diet. It builds from the base, showing Pillars of Entrepreneurship
that we should eat more foods from the bottom part of the 1) An idea and marker
pyramid like vegetables, whole grains and less from the top 2) Skills/knowledge and experience
such as red meat, sugar, fats and oils. 3) Resources
• Kumainments - is a campaign in support of the 2012 NGF 4) Motivation and hard work
messages.
• Pinggang Pinoy – is a visual representation of what a person
should consume on a per meal basis. It is a plate-based food
guide that features the right proportion of food that contains
the right nutrients needed by the body of an average Filipino

NUTRIPRENEURSHIP
Discussed by Prof. Gerardo Nicolas and Prof. Donato Mirador
• Entrepreneur is the process of designing, launching and
running a new business, which is often initially a small
business.
• Entrepreneurship is the process of designing, launching and
running a new business, which is often initially a small
business
• Nutripreneur is a person who helps improve the lives of
others by building a profitable business centered on nutrition.
• Nutripreneurship is the practice and process that results in
creativity, innovation, development and growth of nutrition as
business.
• Nutripreneurs are nutritionists’ innovators who use a process
of changing the current situation of the existing products and
services, to set up new products and new services.
- An entrepreneur is a person who develop a new idea and take
the risk of setting up an enterprises to produce a services
which satisfies customers need and well-being. Entrepreneur is
an individual who rather than working as an employee, runs a
small business and assumes all the risk and reward of a given
business venture, idea, or good or service offered for sale. The
entrepreneur is a commonly seen as a business leader and
innovator of new ideas and business processes.
- Entrepreneurship is the process of starting a business or other
organization where entrepreneur develops a business plan,
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Nutripreneurship/ Dietitian Entrepreneurship
- Nutripreneurship is the practice and process that results in
creativity, innovation, development and growth of nutrition
businesses.
- Entrepreneurship is a self-willing and approached business
firm which starts with a limited investment where they paved
their own pathway with their efforts and ideas in their
corresponding field. So, in the field of nutrition and dietetics
entrepreneurship, a person is termed as: NUTRIPRENEURS.
- Nutripreneurs are nutritionists innovators who use a process
of changing the current situation of the existing products and
services, to set up new products and new services.
- Basically, Nutripreneurs are the trained and skilled
entrepreneurs who may engaged in a field such as:
• Private Nutrition/ Diet Clinics.
• Researcher firms.
• School Nutrition Facilitators.
• Gyms and Workout firms Nutrition Counselor.
• Bloggers, Webinars.
• Consultant.
• Nutraceutical based firms.
 NUTRITION AND DIET THERAPY – BSN 2ND YEAR SUMMER FINAL 2022
- Nutritionists and Dietitians in private practice are
entrepreneurs (Nutripreneurs) and innovators in providing
nutrition products (functional foods) and services to
consumers, industry, media, and businesses.
- They can provide MNT (Medical Nutrition Therapy) to
individuals and groups in all populations.
- They can be chief executive officers, business owners,
consultants, professional speakers, writers, journalists, chefs,
educators, health and wellness coaches, and spokespersons.
- They can work under contract for organizations and
government agencies, such as health care or food companies,
businesses and corporations, employee wellness programs, and
the media.
- Nutritionists and Dietitians Entrepreneurs can provide
comprehensive food (litto/ malted products) and nutrition
services to individuals, groups, foodservice and restaurant
managers, food vendors and distributors, athletes, sports teams,
and company employees. They can act as expert witnesses and
consultants on legal matters related to food and nutrition.
Steps on how to become a “Nutripreneur”
1) Nutripreneur provide a needed service
• Help others to address the underlying cause of blood
sugar problems—poor diet.
• Help people to become healthy and achieve permanent
weight loss.
• The greatest percentage increase in diabetes/pre-diabetes
is among those under 20 years of age.
• Be part of the solution to the greatest health care problem
of our time.
2) Generate a new income stream
• Earn for each dieter using a program.
• Promote to friends, family and contacts you have through
email or social media
3) Become a Nutripreneur!
• Help others improve their lives by modifying their health
and diet focusing on nutrition. b. Earn money.
The Greatest Entrepreneur in Nutrition
1) Steph Lowe – The Natural Nutritionist
- Steph Lowe is a sports nutritionist that offers a gluten-free
diet to increase wellness and optimum personal wellness.
She specialize in natural and gluten-free food to fuel for
high performance sports. Her role is to break through the
clutter and guide individuals to a personalized nutrition
plan.
2) Kate Freeman – The healthy Eating Hub
- Kate Freeman is a registered nutritionist, author and
consultant. She is the founder & managing director of The
Healthy Eating Hub that offers consultation on a range of
areas including weight management, meal planning,
family and sports nutrition.
3) Jessica Sepel – JSHealth
- Jessica Sepel is a clinical nutritionist, blogger and founder
of JSHealth, that promotes healthy eating, healthy body
image, healthy travel and healthy living. Jessica teaches
the “diet mentality,” that practices carb restricting and
calorie counting to girl and young women thinking they
are eating well but actually doing more harm than good.
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4) Cyndi O’Meara – Changing Habits
- Cydi is the nutritionist that lets you eat chocolate and can
be good for you. She founded
- Changing habits that provide information on nutrition and
healthy eating. The goal is to make a significant and
lasting impact on people’s health by improving lives
through education and nutrition. She is critical of dieting
with low-fat and no-sugar diet. She is best known for her
recommendation of chocolate as a part of a well-balanced
diet. Her approach is to empower people through
knowledge, allowing people to eliminate unhealthy habits
on their own through smarter choices rather than
restrictive diet regimes.
How to start a small business plan
There are three things you must have in your business Idea:
PROBLEM, DESIRE, SMALL CHANCE THAT PROBLEM
WILL BE SOLVED.
1) Problem
a) The first element of a business idea
b) Is an issue or obstacle which makes it difficult to achieve
a desired goal, objective or purpose.
c) Refers to a situation, condition, or issue that is yet
unresolved.
To start a business, an entrepreneur must answer these questions:
• What is the type of the problem that exist on the market?
• How many people have the same problem?
• What are potential solutions to those problems?
• Can we offer the best solutions for those problems?
• Do those solutions solve the whole problem?
2) Desire
a) The second element of a business idea
b) The element of a business idea is important because of the
price of the solution.
c) If the desire is greater, the solution will be more
expensive and will bring more profit for the business.
An entrepreneur need to answer these questions to find if the
business idea has a big desire:
• How big the problem that the business idea will solve?
• Are the potential customers starving for a solution
• How they are seeking possible solutions
• What is the level of wanting to solve those problems
3) Small chance that the problem will be solved with current
offers
a) The third element of a business idea
b) The competition in the market about the particular
problem is equally important for success of business idea
 NUTRITION AND DIET THERAPY – BSN 2ND YEAR SUMMER FINAL 2022

c) If the market doesn’t have big competition about the

problem that the business idea solves, then chances for
success with the business is bigger.
At the end, one must answer two questions:
• How many competitors sell the same or similar products
or services on the market that an entrepreneur choose as a
target market? If on the market exist too many
competitors you will have a big battle with them.
• How can you take the position that will differentiate your
business from competitions?

GOOD LUCK WITH UR FINAL EXAM!! – Aki

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