Lecture No.

01 BS-HND- 6th

Course: Dietetics II
Instructor: Dr. Anam Aman

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 Who I am?
Dr. Anam Aman
 Ph.D. (Food Science) from Universiti Malaysia Terengganu, Malaysia.
M.Phil. (Food & Nutrition) from University of Veterinary & Animal Sciences,
Lahore
Currently
Assistant Professor (Human Nutrition & Dietetics) at Iqra University, Chak
Shahzad Campus, Islamabad
Email: anam.aman@iqrauni.edu.pk
Previous Employment
Arid Agriculture University, Rawalpindi
Registered Clinical Dietitian
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Course Detail
Course Name: Dietetic II
Credit Hours:(2+1)
Contact Hours
Theory: 2 hr/Week
Practical: 1 hr/Week
Total: 32+ 48 = 96
Pre – Requisite: Dietetics I

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Course Outline
The Outline of Subject is as follows:
Introduction to diet therapy;
Principles of diet therapy and therapeutic nutrition;
Therapeutic modifications of normal diets; Dietary management in various
health disorders (objective, physiology, food choices, diet plans):
Diet in the diseases of the upper gastrointestinal tract – mouth, dental
disease, pharynx, esophagitis; hiatal hernia; gastritis; peptic ulcer;
Diet in the diseases of the lower gastrointestinal tract - constipation, diarrhea,
mal-absorption syndrome, lactose Intolerance, celiac disease, inflammatory
bowel disease,
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Course Outline
Cohn's disease, ulcerative colitis, irritable bowel syndrome,
diverticular disease, gastric surgery, dumping syndrome, small bowel
resections, short bowel syndromes, blind loop syndrome, ileostomy or
colostomy;
Diet in the diseases of liver and accessory organs - hepatitis, hepatic
steatosis, non-alcoholic hepatic steatosis, alcoholic liver disease,
cirrhosis, hepatic encephalopathy;
cholelithiasis, cholecystitis, cholangitis;
Pancreatitis; Nutrition education and primary health care camp.

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Course Outline
Objective 1: To comprehend the principles of diet therapy and
therapeutic nutrition
Objective 2: To understand the role of dietary management in
various health disorders related to upper and lower gastrointestinal
tract, hepatic, pancreas and coronary heart diseases
 Objective 3: To acquaint hands-on training for the dietary
modification of normal diets aligned with various health disorders
 Objective 4: To prepare pre- and post-operative diets

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Course Outline
References & Recommended Text Books
1. Peggy. S. Stanfield & Y. H. Hui. 2010. Nutrition and Diet Therapy,
Self-instructional Approches, 5th ed. Jones and Bartlett Publishers,
LLC
2. E. 2014. Mahan, L.K., S. Escott-Stump and J.L. Raymond. 2012.
Krause's Food, Nutrition & Diet Therapy, 13th ed. Elsevier
Saunders, St. Louis, Missouri, USA.
3. Mudambi, S.R. and M.V. Rajagopal. 2007. Fundamentals of Foods,
Nutrition & Diet Therapy, 5th ed. New Age International Pvt. Ltd.
Publishers, New Delhi
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Course Weight Breakdown
Assessment Instruments with Weights
Task/Activities Frequency Weightage
Assignment 3 10%
Quiz 4 10%
Presentation 1 10%
Midterm Examination 1 30%
End Term Examination 1 40%

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Dietary Modifications
During illness, many patients can meet energy and nutrient needs by
following a standard diet.
A diet that includes all foods and meets the nutrient needs of healthy
people; also called a regular diet.
Other patients may require a modified diet, a diet that is altered by
changing food consistency or nutrient content or by including or
eliminating specific foods; also called a therapeutic diet
If a patient’s medical condition makes it difficult to meet nutrient
needs orally, two options remain: tube feedings and intravenous
feedings.
Dietary Modifications
Diets with altered texture and consistency are often
prescribed for individuals with chewing and swallowing
difficulties.
 Diets with modified nutrient or food content are frequently
used to relieve disease symptoms or reduce the risk of
developing complications.
Some patients may have several medical problems and need
a number of dietary changes. Modified diets should be
adjusted to satisfy individual preferences and tolerances and
may also need to be altered as a patient’s condition change
 Examples of Modified Diets based on texture /Consistency
Type of Diet Description of Diet Uses

Mechanically altered Contain foods that are modified in
texture, Pureed diets include only
pureed foods; Mechanical soft diets
may include solid foods that are
minched, ground, or soft.
Pureed diets are used for people with
swallowing difficulty, poor lip and tongue
control or oral hypersensitivity, Mechanical soft
diets are appropriate for people with limited
chewing ability or certain swallowing
impairments.

Blenderized liquid diet Contains fluids and foods that are For people who cannot chew, swallow easily, or
blenderized to liquid form tolerate solids.

Clear liquid diet Contains clear fluids or foods that For preparation for bowel surgery or
are liquid at room temperature and colonoscopy for acute GI disturbances (such as
leave minimal residue in the colon. after GI surgeries), or as a transition diet after
intravenous feeding. For short-term use only
Pureed Diets
Milk products: Milk, smooth yogurt, pudding
Fruits: Pureed fruits and juices without pulp, skin, seeds, or chunks;
well-mashed fresh bananas; applesauce
Vegetables: Pureed cooked vegetables without seeds or skins, mashed
potatoes, pureed potatoes with gravy
Meats and meat substitutes: Pureed meats (with gravy), pureed
casseroles (with broth), hummus or other pureed legume spread
Beads and cereals: Smooth cooked cereals such as cream of wheat,
slurried breads and pancakes,a pureed rice and pasta
 Mechanical Soft Diet
Milk products: Milk, yogurt with soft fruit, pudding, cottage cheese
Fruits: Canned or cooked fruits without seeds or skin, fruit juices with
small amounts of pulp, ripe bananas
Vegetables: Soft, well-cooked vegetables well-cooked, moist potatoes are
not rubbery or fibrous;
Meats and meat substitutes: Ground, minced, or tender meat, poultry, or
fish with gravy or sauce; tofu; well-cooked legumes; scrambled eggs
Breads and cereals: Cooked cereals or moistened dry cereals with minimal
texture, soft pancakes or breads, well-cooked noodles or dumplings in
sauce or gravy
 Mechanically Altered Diets
 Helpful for individuals who have difficulty chewing or swallowing.
 Chewing difficulties usually result from dental problems.
 Impaired swallowing, or dysphagia, may result from neurological disorders,
surgical procedures involving the head and neck, and various physiological
or anatomical abnormalities that restrict the movement of food within the
throat or esophagus.
 Dysphagia diets are highly individualized because swallowing problems can
vary greatly. Furthermore, patients must be monitored regularly because
swallowing ability can fluctuate over time.
 Blenderized Liquid Diet

• May be prescribed following oral or facial surgeries (for example,

jaw wiring) or be recommended to individuals with chewing
problems.
• Soft or tender foods that can be blenderized (often with added
liquid) are available from all food groups, and they include cereals
and breads; cooked vegetables; fresh or cooked fruits without skins
and seeds; cooked, tender meats and fish; and potatoes, rice, and
pasta.
• Foods that do not blend well should be excluded such as nuts and
seeds, dried fruits, sausage, hard cheeses, raw vegetables, corn,
 Clear Liquid Diet Clear liquids

• which require minimal digestion and are easily tolerated by the

gastrointestinal (GI) tract, are often the foods recommended before some GI
procedures (such as GI examinations, X-rays, or surgeries), after GI surgery,
or after fasting or intravenous feeding.
• The clear liquid diet consists of clear fluids and foods that are liquid at body
temperature and leave little undigested material (called residue) in the
colon.
Clear Liquid Diet /Clear liquids

Permitted foods include clear or pulp-free fruit juices, carbonated

beverages, clear meat and vegetable broths (such as consommé and
bouillon), fruit flavored or unflavored gelatin, fruit ices made from
clear juices, frozen juice bars, and plain hard candy.
 Although the clear liquid diet provides fluid and electrolytes, its
nutrient and energy contents are extremely limited.
If used for longer than a day or two, this diet should be
supplemented with commercially prepared low-residue formulas that
provide required nutrients.

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Full Liquid Diet

Sometimes a full liquid diet, a liquid diet that is not limited to clear
liquids, is used as a transitional diet between liquids and solid foods. a
full liquid diet may include milk, cream soups, and thin cereal gruels.
Because the diet contains milk products, it may be inappropriate for
patients with significant lactose intolerance.
 MODIFYING BASIC NUTRIENTS
• The quantity and quality of the protein, fat, carbohydrate, vitamins, water,
and minerals in a diet may be modified.
• An increase is used to correct deficiencies or provide extra nutrients for
repair of body tissue.
• The increase may involve one or more nutrients, but combinations are
frequent, since all nutrients have interrelated functions.
• Examples are a high-protein, high-carbohydrate, and high-vitamin diet for
postoperation and an iron-rich diet for iron-deficiency anemia.
• The diet for a malnourished patient upon admission to the hospital may
require increases in all the nutrients.

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 MODIFYING BASIC NUTRIENTS
• A nutrient-rich diet is not necessarily accepted by the patient.
• The patient with a chronic, debilitating illness may be anorexic and
present quite a challenge to the health team.
• Nutrients may be reduced in a diet because the patient can metabolize
only a certain amount.
• For example, a person with high blood sugar requires a diet low in
simple carbohydrate.
• High serum lipids require a low fat diet.
• When a diseased kidney cannot excrete excess minerals, a reduced
intake of minerals is prescribed, as well as a monitored fluid intake.
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 MODIFYING ENERGY VALUE
• The calculated diet is used to adjust caloric intake to regulate body weight.
• Calculations are based on the caloric value of foods which is the number of calories
per gram a food will furnish when metabolized by the body.
• Adjustments are made in the amounts of carbohydrate, protein, and fat contained
in the diet.
• For example, an underweight patient may need a 3000-calorie diet while an
overweight patient may need only 1500 calories.
• The diabetic diet is also a calculated diet. The nutrient values are calculated
individually in order to ensure that daily requirements for each are met.
• A 1000-calorie diet containing only fat and carbohydrate can be developed, if there
is no concern for nutrient adequacy.
• Patients with certain malabsorptive disorders may require diets with increased
energy value along with adjustments in the amount of a specific nutrient.
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 Energy/ Basic Nutrients Modified /Therapeutic Diets
Type of Diet Description of Diet
Fat-restricted diet Restricts fat to low (<50 g/day or
very low < 25 g/day levels in diet.
Fiber-restricted diet Restricts fiber to low levels in the
diet (<10 g/day levels in diet.
Sodium-restricted diet Restricts sodium; degree of
restriction depends on symptoms
and disease severity
High-kcalorie,. high-protein diet Contains foods that are kcalorie
and protein dense
Uses
For people who have certain
malabsorptive disorders or symptoms of
diarrhea, flatulence, or steatorrhea (fecal
fat) resulting from dietary fat intolerance.
For acute phases of intestinal disorders or
to reduce fecal output before surgery. Not
recommended for long-term use
To prevent fluid retention or induce fluid
loss; used in hypertension, congestive
heart failure, renal disease, and liver
disease.
Used for increased kcalorie and protein
requirements (in cancer, AIDS, burns,
trauma, and other illnesses); also used to
reverse malnutrition, improve nutrition
status, or promote weight gain.
Thank You - Questions?

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