DIETETIC TREATMENT

Dr. Sumbul Fatma

 OBJECTIVE
To discuss the nutritional care process and how the
basic principles of nutrition can be applied to the
treatment of disease
 DIETETIC TREATMENT
 Also referred to as diet therapy or diet in disease
 Involves the modification or adaptation of the
normal or basic diet according to the needs of the
individual
 WHY?
 To maintain or improve nutritional status
 To improve clinical or subclinical nutritional
deficiencies
 To maintain, increase or decrease body weight

 To rest certain organs or the whole body

 To eliminate certain food constituents to which the

individual may be allergic
 To adjust the composition of the normal diet to meet
the ability of the body to adjust, metabolize, and
excrete certain nutrients and other substances
 THE DIET PRESCRIPTION
 It is written in terms of energy requirements based
on individual’s weight and activity and requirements
for protein, fat, carbohydrate, minerals, vitamins
and fiber with regard for the increased or decreased
needs for each because of the patient’s illness

 The prescription is translated into foods and meals

by the dietitian, who, in turn, instructs the patient
regarding the diet, its importance as a single
therapeutic measure or as a supplement to
medication
 FROM BASIC TO THERAPEUTIC DIET
 An increase or decrease in the following
The energy value (kilocalories)
Fiber
Specific nutrient(s)
Specific food or types of food (such as
allergens for persons with allergies, fried
foods, or gas forming foods)
 Anyone of these modified diets may be
further altered to become a soft or liquid diet
 EXAMPLES OF THERAPEUTIC DIETS
MODIFICATIONS IN CONSISTENCY
 Tube feeding- for patients with an
esophageal obstruction or severe burns or
who have undergone gastric surgery
 Restricted-residue diet- for patients with
gastritis, Crohn’s disease, severe diarrhea,
ulcerative colitis, diverticulitis, typhoid fever
 MODIFICATIONS IN CARBOHYDRATE,
PROTEIN AND FAT
 Diabetic diet- carefully calculated for each patient to
minimize the occurrence of hyperglycemia and
glycosuria and to attain the ideal body weight
 Low calorie diet- to achieve weight loss in
individuals with cardiovascular and renal diseases,
hypertension, gallbladder disease, gout or
hyperthyroidism, and for severely ill patients
 MODIFICATIONS IN FAT
 Restricted-fat diet- for pateints with disease of the
liver, gall bladder or pancreas in which the
disturbances of digestion and absorption of fat may
occur
 Fat-controlled Low-cholesterol diet- In individuals
with elevated blood cholesterol and for patients with
atherosclerosis
 MODIFICATIONS IN PROTEIN
 Restricted-protein diet- for patients in hepatic coma
or with chronic uremia, renal disease or liver
disease
 Gluten-free diet- Individuals with celiac have gluten
intolerance and must be on gluten-free diet
 Restricted-purine diet- A decrease in purines is
useful in lowering the blood uric acid level in gout
 High protein diet- is used to correct a protein
inadequacy from any source- pre- and
postoperative, high fever, burns, injuries, increased
metabolism, pernicious anemia, hepatitis, cystic
fibrosis etc
 MODIFICATIONS IN CARBOHYDRATE
 Lactose-free diet- patients with total or partial
inability to metabolize this milk sugar must avoid
lactose in their diet
 Dumping syndrome diet- Patients who have had a
gastrectomy or gastric bypass surgery may require
this special diet
 MODIFICATIONS IN ELECTROLYTES
AND MINERALS
 Restricted-sodium diet- prescribed for patients with congestive
heart failure, hypertension, renal disease with edema, cirrhosis
of the liver with ascites, pre-eclampsia and eclampsia and ACTH
therapy
 Restricted-potassium diet- when potassium is not being excreted
properly from the body
 High-calcium and high-phosphorus diet- desirable in rickets,
osteomalacia, tetany, dental caries, and acute lead poisoning
 High-iron diet- nutritional and hemorrhagic anemia

 High-vitamin diet- If a specific vitamin deficiency is diagnosed

e.g. vit A to combat night blindness and xerophthalmia, vit D for
rickets and osteomalacia, vit K in liver and gallbladder disease
 NUTRITIONAL ASSESSMENT
 Dietary history
 Anthropometry

 Biochemical and clinical data

 Laboratory tests of blood and urine
 to compare with normal ranges for hemoglobin, albumin,
transferrin, total plasma protein etc. (all associated with body
protein stores)
 Nitrogen content in 24 hour urinary output (a negative nitrogen

balance signifies that the body is using some of its protein

reserves for energy
 Skin tests
 Immunity to certain diseases
 Response to antigens
 NUTRITIONAL MANAGEMENT IN
DIABETES MELLITUS
 Kilocalories- The amount of kilocalories needed by the
individual with diabetes should be the same as the RDA for
the person without diabetes but adjustments in kcal may be
necessary to maintain or attain the normal weight
 Protein- The %age of kcal derived from protein is usually 15-
20%. This allows the individual with diabetes from 1-1.5g of
protein/kg of body weight and should approximate the RDA
 Carbohydrates- are no longer restricted as much as they once
were. The recommended allowance is 50-60% of total
calories. Complex carbohydrates are emphasized as are high-
fiber foods
 Fat- ~20-30% of the total calories. Low-fat foods, lean meats,
and polyunsaturated fats are emphasized to prevent
cardiovascular disease (a common complication of diabetes)
 RENAL DISEASES
 The kidneys perform two main functions
1. To excrete waste products, unnecessary material and
superfluous fluids (water) from the body
2. To retain all material valuable to the system
 In disturbances of the kidney two sets of
phenomenon are noticeable
1. Accumulation in the blood of substances which
should have been eliminated
2. Excretion from the blood of material that should have
been retained
 RENAL DISEASES
 Management of the renal disease is complex involves
controlling several nutritional components like-
proteins, kcalories, phosphorus, sodium and
potassium
 Generally all are restricted except kcal, which need to
be maintained at a high level to prevent protein from
being broken down for energy needs, resulting in
nitrogenous waste material
 Once the dialysis begins the restrictions are often
reversed in order to compenstate for the excess
losses incurred
• The reduction of nitrogenous excretory wastes
resulting from the breakdown of proteins is crucial in
the prevention of further kidney damage
 DIETARY TREATMENT FOR RENAL
DISEASES
 Calories- Adequate calories are provided in the
treatment of renal disease, particularly when the diet is
restricted in protein, so that the body protein will not be
used to meet energy needs (~35-45kcal/kg body weight)
 Protein- An adequate amount of protein is provided as
long as the kidney function remains unimpaired.
Amounts range from very low(20g) to low (40-50g) to
high (100-125g), depending on the disorder. Protein is
increased to make up for the albumin loss in urine or it is
restricted to various levels with lessened kidney function
and retention of end products of protein metabolism in
blood. Calculations are based on 0.5-1.5g/kg, depending
on the disorder
 DIETARY TREATMENT FOR RENAL
DISEASES CONTD..
 Electrolytes- A low protein diet will also be a restricted-
sodium diet, because protein foods are high in sodium. A
more liberal sodium restriction is appropriate for
hypertension without edema
 Potassium is restricted because its excretion lessens
with progressive kidney damage, and it is retained in the
blood of patients with renal failure- usually to the 1.5 g
level.
 Restricting phosphorus to 450-600mg should maintain
desirable serum phosphorus levels
 Fluids- are restricted for patients with renal failure; a
balance between intake and output must be achieved.
The general guidelines are 500ml plus urinary output
 CARDIOVASCULAR DISEASES
 The main nutrition-related risk factors associated
with CVD are
 obesity (the need to reduce calories)
 Hypertension (the need for a reduction in sodium intake)
 Elevated levels of blood cholesterol and LDL (the need
for reduction in total dietary fat, saturated fat, and
cholesterol, and a moderate increase in PUFA and
soluble fiber)
 Diabetes mellitus (the need for control of blood glucose
levels)
 AHA NUTRITIONAL GUIDELINES
 Kcal modification is necessary to achieve and
maintain ideal weight
 Total dietary fat reduction to 30% of total kcal
consisting of 10% each of saturated, MUFA and
PUFA fats
 Dietary cholesterol reduction to less than 300mg
daily
 Dietary carbohydrate consisting mainly of fruits,
vegetables, whole grain and enriched breads, and
cereals
DIETARY THERAPY FOR HIGH BLOOD
CHOLESTEROL

Nutrient Recommended Intake

Step One diet Step two diet
Total fat Less than 30% of total calories
Saturated fattyacids < 10% of total <7% of total

PUFA Upto 10% of total calories

MUFA 10-15% of total calories
carbohydrates 50-60% of total calories
Protein 10-20% of total calories
Cholesterol <300mg/day <200mg/day
Total calories To achieve and maintain desirable weight
 HYPERLIPIDEMIA AND DIET
MODIFICATIONS
 Diets meet the RDA for proteins, minerals and
vitamins for everyone except women during the
childbearing years, when more iron is required
 Overweight persons with hyperlipoproteinemia
should reduce their weight by 1-2 pounds/week,
then maintain ideal body weight with a well
balanced diet. Weight loss often results in lowering
of blood lipids
 Cholesterol intake is restricted in most types of
hyperlipoproteinemia
 The intake of saturated fat is reduced and PUFA
are preferred to saturated fatty acids
 DIETARY TREATMENTS FOR
HYPERTENSION
 A low kcal diet is prescribed to reduce weight and
maintain it at a normal level
 Sodium restriction is often recommended.

 Adjustments in protein and fluids intake are made if

there is kidney involvement. Sodium restriction
improves the effectiveness of diuretic therapy
 If potassium-depleting diuretics are taken, patients
are advised to increase their potassium intake to
replenish that lost in the increased urine volume
 SODIUM IN HYPERTENSION
 Sodium in salt causes the body to accumulate fluid
 Excess fluid puts greater pressure on the walls of
the blood vessels, creating high blood pressure,
reducing salt in the diet will often bring it within
normal range
 A sodium-restricted diet is a normal adequate diet
with a modified sodium content, from a very low
amount of 250mg-2000mg or more
 REFERENCE
 Nutrition Essentials and Diet Therapy (6th Edition)
by Charlotte M Poleman and Nancy J.
Peckenpaugh