DIETARY MANAGEMENT OF

SOME COMMON MEDICAL

CONDITIONS
TYPES OF DIET (BASED ON THE
CONSISTENCY)
 LIQUID DIET
• CLEAR LIQUID DIET – It is free from any solid particles and is given
for the patient who cannot chew or swallow the food. Examples are clear
soups, tea or coffee without cream, etc.
• FULL LIQUID DIET – It is composed of solids which are easily
digestible, mixed in liquid which is prescribed for patients who are
severely ill, not able to chew or swallow but need good calories. This diet
is given in between a clear liquid diet and soft diet. Examples are eggs,
vegetable soup, milk, etc.
 SOFT DIET
• It is easy for chewing and easily digestible which contains all the required
nutrients especially proteins and carbohydrates.
• It is soft in consistency, easy to chew, made up of simple, easily digested
foods, containing limited fiber and does not contain rich or highly
flavored foods.
 BLAND DIET
• It is free from all spices and condiments and is basically used to prevent
peptic ulcers.
 NORMAL DIET
• It consists of any and all foods eaten by a person in health.
• As there is no restriction of any kind of food, this diet is well balanced and
nutritionally adequate.
NUTRITION THERAPY FOR
DIABETES MELLITUS
 DIABETES MELLITUS (DM)
• It is a metabolic disease that affects the endocrine system of the body and
the use of carbohydrates and fats.
 Symptoms of Diabetes Mellitus
• Polyuria – frequent urination
• Polydipsia – increased thirst
• Polyphagia – increased in appetite because the patient is not fully consuming the food he/she
normally eats.
• Weight loss
• Fatigue
• Blurred vision
• Numbness or tingling in the feet or hands
• Sores that do not heal
 Types of DM
TYPE 1 DIABETES
• it is thought to be caused by an autoimmune reaction (the body attacks
itself by mistake) and this reaction stops your body from making insulin.
• Approximately, 5-10% of the people with DM Type I
• It can be diagnosed at any age and symptoms often develop quickly and
you’ll need to take insulin everyday to survive and currently, no one
knows how to prevent DM Type I.
 Types of DM
TYPE 2 DIABETES
• It is a chronic condition that happens when you have persistently high blood sugar levels
(hyperglycemia).
• It happens because the pancreas doesn’t make enough insulin (a hormone), your body
doesn’t use insulin properly, or both.
• It is very common which affects 6.3% of the world’s population and it most commonly
affects adults over 45, but people younger than 45 can have it as well, including children.
• The main cause is insulin resistance which happens when cells in your muscles, fat and
liver doesn’t respond as they should to insulin.
 Types of DM
GESTATIONAL DIABETES
• It develops in pregnant women who have never had diabetes and your
baby could be at higher risk for health problems.
• It usually goes away after your baby is born, however, it increases the risk
for type 2 diabetes later in life and your baby is more likely to have
obesity as a child or teen and develop type 2 diabetes later in life.
 Health Benefits of Dietary Management of
DM
• Helps to keep blood glucose level, blood pressure and cholesterol within
the range set by healthcare professional.
• Helps reduce weight or maintain a healthy weight.
• Can delay or prevent the onset of complications caused by diabetes.
• Give you more energy, making you feel good for longer.
 Characteristics of Diet
• ENERGY – Overweight diabetics are initially placed on low-calorie diets
because weight loss results in better tolerance to carbohydrates
In bed : 11-12 cal/lb
Sedentary : 13-14 cal/lb
Moderately active : 15-16 cal/lb
 Characteristics of Diet
• PROTEIN – About 1 ½ g per kg body weight is usually allowed and
higher level is more typical for patients who show a preference for
protein-rich foods.
• CARBOHYDRATE AND FAT – The remainder of the calories for the day
is usually divided about equally between carbohydrate and fat after
subtracting the calories provided by protein.
 Caloric Levels of Sample Meals for
Diabetics
Meal Plan Carbohydrate (g) Protein (g) Fat (g) Energy (g)
1 125 60 50 1,200
2 150 70 70 1,500
3 180 80 80 1,800
4 220 90 100 2,200
5* 180 80 80 1,800
6* 250 100 130 2,600
7* 370 140 165 3,500
8 250 115 130 2,600
9 300 120 145 3,000
 Food Preparation and Service
• All food items in the diet are measured according to the amounts in the food exchange lists.
• Level measures with standard measuring cups and spoons are used.
• Foods are prepared using only those allowed on the meal patterns.
• No extra flour, bread crumbs, butter, or other foods may be used.
• Meats may be broiled, baked, roasted, or stewed and if they are fried, some of the fat
allowance may be used.
• Frozen or canned foods packed with sugar must be avoided.
• Concentrated sweets and desserts are avoided.
 Food Exchange List
The following are the steps in planning the measured diet:
1. Include basic foods to ensure adequate levels of minerals and vitamins: 2
cups milk (3 or more for children), 5 oz meat, 2 servings vegetables, 2
servings fruit, bread & cereals.
2. List the carbohydrate, protein, and fat values for milk, vegetables, and fruit.
3. Subtract the carbohydrate values of these foods from the carbohydrate level
prescribed. Divide the difference by 15 to determine the number of bread
exchanges
4. Subtract the total protein values of milk and meat from the total fat
described. Divide the difference by 7 to determine the number of meat
exchanges.
5. Subtract the total fat values for milk and meat from the total fat described.
Divide the difference by 5 to determine the number of fat exchanges.
NUTRITION THERAPY FOR DISEASES OF
THE GASTROINTESTINAL TRACT
 PEPTIC ULCER
• It is an ulceration in the protective inside layer of the lower esophagus,
stomach, or duodenum.
• It is a distinct breach in the mucosal lining of the stomach (gastric ulcer)
or the first part of the small intestine (duodenal ulcer) as a result of caustic
effects of acid and pepsin in the lumen.
• H pylori is one of the most common causes of peptic ulcer.
 Dietary Treatment
It requires the preparation of a bland diet and particular emphasis is placed
on:
1. Nutritive adequacy
2. Ability of the diet to dilute, neutralize, or reduce the secretion of acid by
the stomach; and
3. Ability of the diet to avoid mechanical, chemical, or thermal irritation
 Symptoms of Peptic Ulcer
• An ache or burning pain in your abdomen
• Abdominal pain that worsen when your stomach is empty
• Nausea
• Loss of appetite
• Frequent burping
• Bloating
• Unintentional weight loss
 Possible Complications of Peptic Ulcer
If left untreated, might result in:
• Internal bleeding – can occur as slow blood loss that leads to anemia or as severe
blood loss that may require hospitalization or a blood transfusion and severe blood
loss may cause black or bloody vomit or black or bloody stools.
• Infection – peptic ulcers can eat a hole through the wall of your stomach or small
intestine, putting you at risk of serious infection of your abdominal cavity (peritonitis)
• Scar tissue – peptic ulcer can also produce scar tissue that can block passage of food
through the digestive tract, causing you to become full easily, to vomit or to lose
weight.
 Diet
There is a little evidence that specific dietary factors cause or exacerbate peptic ulcer disease.
• Protein foods temporarily buffer gastric secretions, but they also stimulate secretion of gastrin, acid,
and pepsin.
• Milk or cream, which in the early days of peptic ulcer management was considered important in
coating the stomach, is no longer considered medicinal.
• The pH of a food has little therapeutic importance, except for patients with existing lesions of the
mouth or the esophagus.
• On the basis of their intrinsic acidity and amount consumed, fruit juices and soft drinks are not likely
to cause PUD or appreciably interfere with healing. Some patients expresses discomfort with
ingestion of acidic foods, but the response is not consistent among patients, and in some, symptoms
may be related to heartburn.
 Diet
• Consumption of large amounts of alcohol may worsen the symptoms.
• Both coffee and caffeine stimulate acid secretion and may also decrease LES
pressure, however, neither has been strongly implicated as a cause of PUD outside
of the increased acid secretion and discomfort associated with their consumption.
• When very large doses of certain spices are fed orally or placed intragastrically
without other foods, they increase acid secretion and cause small, transient
superficial erosions, inflammation of the mucosal lining, and altered GI
permeability or motility. Most often incriminated are chili, cayenne, and black
peppers.
 Diet
• Studies suggest that green tea, broccoli sprouts, black currant oil, and kimchi (fermented
cabbage) help with H. pylori eradication. Probiotics containing lactobacillus and
bifidobacterium have also been studied for prevention, management, and eradication of
H. pylori.
• Omega-3 and omega-6 fatty acids are involved in inflammatory, immune, and
cytoprotective physiologic conditions of the GI mucosa.
• Overall, a high-quality diet without nutrient deficiencies may offer some protection and
may promote healing. Persons being treated for PUD should be advised to avoid foods
that exacerbate their symptoms, and to consume nutritionally complete diet with
adequate dietary fiber from fruits and vegetables
 Diet
• Eat white meats such as chicken or turkey and fish. Remember to remove the fatty skin from chicken.
• Oily fish, like salmon, mackerel, sardines and herring contain omega-3 fatty acids. They help to reduce
the risk of ulcers by producing compounds called prostaglandins, that help to protect the lining of the
stomach and intestines.
• Eat more vegetables and fruit in order to help protect the lining of the stomach and intestine and they
contain high levels of antioxidants which lower the risk of ulcers and ease symptoms when an ulcer has
already developed.
• Vitamin E from foods like wheatgerm, hazelnuts, cold-pressed sunflower seed oil, soybean oil, will help
along with zinc, found in seafood and whole grains.
• Amino acids also have a healing action. Good food sources include: seaweed, wheatgerm, cheddar
cheese, almonds, sunflower seeds and sesame seeds.
 Diet
• CAFFEINATED FOODS – foods and drinks that contain, like chocolate, coffee
and soft drinks can make your ulcer worse. Avoid them.
• DAIRY PRODUCTS – many dairy products are high in fat. Avoid them or use
low-fat alternatives.
• SPICY FOODS AND SEASONINGS – avoid chili peppers, black pepper,
mustard, curry and other strong spices.
• SALT AND SALTY FOODS – there is evidence that people with H. pylori
infection who have a high salt intake are at greater risk of developing stomach
cancer.
 DIVERTICULAR DISEASES
(DIVERTICULOSIS AND DIVERTICULITIS
• They are often consequences of long-term, low-fiber eating practice, and
frequent constipation.
• Diverticulosis – indicates the presence of diverticula (pouch) in the colon
which can lead to diverticulitis
• Diverticulitis – results from the swelling of small pouches in the colon
wall and lining.
• Inflammation develops the minute bacteria and other irritants are ensnared
causing spasms and pain in the lower left side of the abdomen.
 Symptoms of Diverticulosis
• Abdominal pain and bloating
• Constipation and diarrhea
• Flatulence
• Blood in the feces – this is usually minor, but bleeding can sometimes be
heavy if a diverticulum gets inflamed or is near a blood vessel.
• Anemia from repeated bleeding may occur
 Symptoms of Diverticulitis
• Sharp pain, often located at a specific point – for example, in the lower
left half of the abdomen
• Fever
• Distension (bloating) of the abdomen
• Nausea and vomiting
 Diet
• A well-balanced diet with variety of foods and adequate protein is
recommended.
• Acute episodes may require liquids and low-residue foods, excluding
roughage. However, some clinicians are increasingly favoring increased
fiber in the diet rather than less, with more use of bran, whole grains, and
cellulose foods as a means of reducing muscle contractions of the colon
and facilitating normal muscle tone.
• As swelling abates, a high-fiber diet is recommended to lessen straining.
 MALABSORPTION SYNDROME
• It is a condition in which the mucosa of the small intestine is damaged by
gluten which results in the malabsorption of nutrients.
 Symptoms of Malabsorption Syndrome
• Abdominal pain
• Abdominal distention
• Bloating
• Gas
• Nausea and vomiting
• Diarrhea
• Steatorrhea (fatty stools)
 Diet
• Diet needs to supply enough protein, fats, carbohydrates, and vitamins to
nourish body.
• Enough folic acid, B12, and iron to stay healthy is needed.
• Eat more omega-3 fatty acids because they reduce inflammation. Good
sources include fish, vegetable oils, nuts, leafy greens, and flax seeds.
 NON-TROPICAL SPRUE
• It is a diarrheal condition in which excessive fat is excreted in the stool
(steatorrhea).
• Nitrogen, minerals, and vitamins are also excreted in considerable
amounts so that the individual becomes severely malnourished.
 Symptoms of Non-tropical Sprue
• Upset stomach
• Failure to grow normally (often called “failure to thrive”) or delayed growth
• Weight loss
• Painful abdominal bloating or distention
• Pale, foul-smelling, greasy stools
• Chronic (long-lasting) or recurring diarrhea
• Irritability
 Diet
• A high-protein diet (100g or more) is usually necessary. Mineral and vitamin
supplements are often prescribed.
• Cereals and breads containing wheat, rye, or oats must be omitted. Thickened
soups, cooked salad dressings, cold cuts, breaded meats, meat loaf, and mixes of
all kinds must be avoided. Labels must be read carefully.
• Corn and rice cereals can be substituted. Breads especially prepared with rice,
corn, potato starch, or wheat can be used to thicken soups, gravies, and puddings.
• A low-fat fiber diet may be better tolerated during the initial stages.
 ULCERATIVE COLITIS
• It is an inflammatory bowel disease of the large intestine limited to the
rectum and the colon which causes profuse and bloody diarrhea.
• It is characterized by severe diarrhea, rectal bleeding, cramping,
abdominal pain, anorexia, and weight loss.
 Treatment
• Rest
• Nutritional therapy
• Sulfonamides
 Diet Therapy
• High protein – protein supplements are used with food sources to supply 120 to 150 grams
of protein per day. Milk causes some difficulty to patients initially so it is omitted and
added later in cooked form; egg, cheese, and meat are used instead.
• High calories – about 2,500-3,000 calories a day are needed to spare proteins needed for
healing and to restore nutrient deficits from daily loss in stools and consequent weight loss.
• Increased vitamins and minerals – supplements of vitamins and minerals as well as food
sources are tolerated (grains, fruits, vegetables, protein foods).
• Low-residue diet –fairly low in residue in acute stages or tolerated, with gradual increases
– avoiding only heavy roughage to prevent irritation
 LACTOSE INTOLERANCE
• It is caused by a deficiency of lactase, the enzyme which hydrolyzes
lactose, the sugar in milk.
• The undigested lactose remains in the small intestine and may serve as a
substrate for bacterial fermentation.
• This disorder may either be congenital or may arise from other disease
conditions like celiac sprue, where the intestinal mucosa is affected, or can
occur after gastric surgery.
 Symptoms of Lactose Intolerance
• Bloated stomach
• Intestinal gas
• Nausea and vomiting
• Stomach pain and cramping
• Stomach gurgling or rumbling
• Diarrhea
 Treatment
• Nutritional management
 Diet Therapy
• Lactose-restricted Diet – milk, milk products, lactose, whey, and casein
are avoided
• Cottage cheese, aged cheddar cheese, and fermented milk products like
yogurt can be given depending on the tolerance of the individual.
 DIARRHEA
• Refers to a frequent loose or liquid bowel movement that prevents complete
digestion and absorption.
• Types of Diarrhea:
1. Acute – diarrhea of less than 2 weeks caused by viral, bacterial, or
protozoan infections; medication side effects; or altered dietary intake.
2. Chronic – diarrhea of more than 2 weeks resulting from disorders like
malabsorption or PEM or medical treatments
• Treatment: Nutritional management
 Diet Therapy
1. Nil per od (NPO) or “nothing by mouth/nothing per orem” for 12 hours with IV
fluids and electrolytes
2. Oral fluids as condition improves
3. Liberal fluids to prevent dehydration
4. Broths and electrolyte solutions to replace Na and K losses
5. Pectin to help control diarrhea
6. Oral rehydration to be administered (3/4 tsp salt, 1 tsp baking soda, 1 cup
orange juice, 4 tbsp sugar, and 1 liter water)
 CONSTIPATION
• It is a condition in which a person experiences hard feces that are difficult to egest.
• Its symptoms are:
- lack of appetite
- lethargy
- bad breath
- distended stomach
- caked tongue
 Types of Constipation
Atonic Constipation
• A condition experienced by older people, obese individuals, before
surgery and during pregnancy.
• Feces are huge and stiff.
• Causes are inadequate diet, irregular meals, lack of liquids and fiber in the
diet, and irregular defecation
 Types of Constipation
Spastic Constipation
• A type of constipation caused by over stimulation of the intestinal nerve
endings resulting in asymmetrical contractions of the bowel.
• Causes are extreme use of cathartics, laxatives, tobacco, tea, coffee, and
alcohol; stress; poor hygiene; lack of fluids; and irregular defecation
 Types of Constipation
Obstructive Constipation
• A condition in which the passage of feces is impeded or a compression by
surrounding tissues happens causing the drying and enlargement of fecal
mass
 Treatment
• Nutritional management
• Regular exercise
 Diet Therapy
1. High fiber diet – 20 to 35 g/day
2. Liberal fluid intake – prunes and prune juice contain laxatives and may
be helpful
3. In acute attacks of spastic constipation, a low-fiber diet can be given
 INTESTINAL GAS
• May be referred to as increased occurrence of passage of gas or cramping pain associated
with the build-up of gas in the GIT, gas swallowed, or gas exchanged in the GIT and blood
or produced during digestion
• Symptoms includes:
- belching
- flatulence
- abdominal bloating
- abdominal pain and comfort
• Treatment: Nutritional management
 Diet Therapy
1. Exclude food that produces gas such as beans & lentils; vegetables such
as cabbage, broccoli, cauliflower, bokchoy, and brussels sprouts; dairy
products containing lactose; fructose which is found in some fruits and
used as a sweetener in soft drinks and other products
2. Small, frequent meals, and chewing food thoroughly are advised
 HEMORRHOIDS
• They are enlarged veins which occur in the lower part of the rectum at the anal opening.
• External hemorrhoids – crop up when the rectum meets the skin
Internal hemorrhoids – form completely within the rectum
• The causes are:
- constipation
- prolonged use of cathartics
- childbearing
- enemas
• Treatment: Nutritional management
 Diet Therapy
1. High fiber diet – 25 to 35 g/day to relieve constipation
2. Liberal fluids – 8 to 10 glass of water per day
3. Highly-seasoned foods and relishes are to be avoided
4. Low-fiber diet is recommended during flare-ups
GASTROESOPHAGEAL REFLUX DISEASE, HIATAL
HERNIA, AND ESOPHAGITIS or HEART BURN

• It takes place 1 to 4 hours after a meal when a decrease in sphincter

pressure happens.
• This is often caused by increased levels of progesterone brought about by
pregnancy; oral contraceptives; smoking; and certain foods like
chocolates, soft drinks, citrus fruits and juices, and caffeinated drinks.
• Treatment: reducing intra-abdominal pressure and gastric acid production
 Symptoms of GERD
• A burning sensation in your chest (heartburn) usually after eating, which might be worse at night or while
lying down
• Backwash (regurgitation) of food or sour liquid
• Upper abdominal or chest pain
• Trouble swallowing (dysphagia)
• Sensation of a lump in your throat
If you have nighttime acid reflux, you might also experience:
• An ongoing cough
• Inflammation of the vocal cords (laryngitis)
• New or worsening asthma
 Symptoms of Hiatal Hernia
• Heartburn – a burning sensation in your chest especially after eating
• Noncardiac chest pain – recurring chest pain that feels like angina but isn’t
• Indigestion – feeling full soon after eating, with a burning type of abdominal pain
• Burping and regurgitation – food, gas, and acid rising back in your throat
• Difficulty swallowing or a lump in your throat when you swallow
• Sore throat and hoarseness when you speak, due to irritation from the acid
• Nausea
• Shortness of breath
• Pressure or pain in your upper abdomen or your lower chest
 Symptoms of Esophagitis
• Difficulty swallowing
• Painful swallowing
• Swallowed food becoming stuck in the esophagus, also known as food
impaction
• Chest pain, particularly behind the breastbone, that occurs with eating
• Heartburn
• Acid regurgitation
 Diet Therapy
1. Avoid foods high in fat
2. Avoid large meals
3. Limit foods that relax the lower esophageal sphincter
4. Increase the intake of foods that do not affect the lower esophageal
sphincter pressure
5. Maintain the ideal body weight
 Foods that relax the Lower Esophageal
Sphincter
• Alcohol
• Mint
• Chocolates
• High-fat foods
 Foods that Do Not Affect the Lower
Esophageal Sphincter Pressure
• Protein foods with low-fat content
• Carbohydrate foods with low-fat content
Foods that Can Irritate Damaged Esophageal
Mucosa
• Soft drinks
• Citrus fruits and juices
• Coffee
• Herbs
• Spices
• Tomato products
• Very hot/cold foods
 SHORT BOWEL SYNDROME
• It is a malabsorption disorder caused by resection of portions of the small intestine due to an illness or
injury
• Symptoms include:
- diarrhea
- greasy, foul-smelling stools
- fatigue
- weight loss
- malnutrition
- swelling (edema) in the lower extremities
• Treatment: Nutritional management
 Diet Therapy
1. Parenteral nutrition support to be indicated if enteral nutrition
exacerbates symptoms
2. Dietary fat restriction
3. Frequent monitoring of fluids and electrolyte balance
NUTRITION THERAPY FOR DISEASES OF
THE LIVER, GALLBLADDER, AND
PANCREAS
 HEPATITIS
• It is an inflammation of the liver.
• It may be caused by viral infection, alcohol consumption, several health
conditions, or even some medications.
• Treatment varies based on the type and underlying cause.
 Types of Hepatitis
HEPATITIS A
• It is caused by a virus transmitted by the fecal-oral route, usually through
ingestion of contaminated food or with anal/oral sex.
• Symptoms include: yellow skin or eyes, not wanting to eat, upset stomach,
throwing up, stomach pain, fever, dark urine or light-colored stools,
diarrhea
 Types of Hepatitis
HEPATITIS B
• It is caused by a virus that can cause both acute and chronic hepatitis.
• Known transmissions of the disease are through blood transfusion, tattoo
application, sexual intercourse, contact with blood or bodily fluids, or via the
mother to her child by breastfeeding.
• Blood contact can occur by sharing syringes in intravenous drug use, shaving
accessories, or touching wounds on infected persons.
• However, the source of infection cannot be determined in about half of the cases.
• Symptoms may include:
- abdominal pain
- dark urine
- fever
- joint pain
- loss of appetite
- nausea and vomiting
- weakness and fatigue
- yellowing of the skin and the whites of the eyes, also called jaundice
 Types of Hepatitis
HEPATITIS C
• It is caused by the hepatitis C virus which have an RNA genome that is a member of the
Flaviviridae family.
• It can be transmitted through blood contact or sexual contact and can also cross the placenta.
• It may lead to a chronic form of hepatitis, leading to scarring of the liver called cirrhosis and
can remain asymptomatic for 10-20 years.
• Patients are susceptible to severe hepatitis if they contract either hepatitis A or B.
• All infected patients should be immunized against hepatitis A and B, and they should also
avoid alcohol.
• Symptoms can include:
- bleeding easily
- bruising easily
- fatigue
- not wanting to eat
- yellowing of the skin
- dark-colored urine
- itchy skin
- fluid buildup in the stomach area, called ascites
- swelling in the legs
- weight loss
- confusion, drowsiness and slurred speech, called hepatic encephalopathy
 Types of Hepatitis
HEPATITIS D
• It is caused by hepatitis delta agent which is similar to a viroid.
• The disease can only propagate in the presence of the hepatitis B virus and
a person can acquire the virus if he/she is already infected with hepatitis
B.
• It is spread through blood contact and unprotected sex with a person
infected with HDV and it may cause swelling of the liver.
• Symptoms include:
- fever
- fatigue
- loss of appetite
- nausea
- vomiting
- dark urine
- pale-colored stools
- jaundice (yellow eyes)
- fulminant hepatitis – a rare syndrome of rapid, massive necrosis of liver parenchyma and a decrease in liver size
 Types of Hepatitis
HEPATITIS E
• It is an inflammation of the liver caused by infection with the hepatitis E virus
(HEV).
• It is transmitted via the fecal-oral route, principally via contaminated water.
• It is found worldwide, but the disease is most common in East and South Asia.
• A vaccine to prevent the virus infection has been developed and is licensed in
China, but is not yet available elsewhere.
• Symptoms include:
- an initial phase of mild fever, reduced appetite, nausea and
vomiting
- abdominal pain, itching, skin rash, joint pain
- jaundice (yellow color of the skin), dark urine and pale stools
- a slightly enlarged, tender liver (hepatomegaly)
 Treatment
• Rest
• Optimum nutritional therapy
 Diet Therapy
1. Protein – about 2/3 of the protein should be provided from animal
sources because the quality is superior. Additional milk is included. Two
eggs for breakfast is acceptable. Eating meat, fish, cheese, or egg
sandwich is a good way to incorporate protein. 1 to 2 g/kg BW is
adequate.
2. Energy – for bed patients without fever, a total of 2,000-2,500 calories is
sufficient. The diet will need to furnish 2,500-4,000 calories if there is
fever, marked loss of body protein, or poor absorption of food from the
intestinal tract.
 Diet Therapy
3. Minerals and Vitamins – the foods added to the diet for protein also
increase the intake of calcium, iron, and B-complex vitamins. Supplements
are only required for patients who have faulty absorption.
4. Moderate Fat – 80 to 100 g of fat should be provided daily.
 CIRRHOSIS
• It is a chronic degenerative disease in which the build-up of fibrous
connective tissue replaces the liver cells following fatty degeneration of
long standing.
• It can cause the liver cells to die and form new cells.
• In scarring which can lead to congestion of hepatic circulation, this
condition can contribute to the further decline in liver’s function.
• Symptoms include:
- fatigue, easily bleeding or bruising, loss of appetite, nausea, swelling in the legs, feet or ankles called edema
- weight loss, itchy skin, yellow discoloration in the skin and eyes
- fluid accumulation in the abdomen called ascites
- spiderlike blood vessels on the skin
- redness in the palms of the hands
- pale fingernails, especially the thumb and index finger
- clubbing of the fingers, in which the fingertips spread out and become rounder than usual
- for women, absence of or loss of periods not related to menopause
- for men, loss of sex drive, testicular shrinkage or breast enlargement known as gynecomastia
- confusion, drowsiness or slurred speech
 Treatment
• Rest
• Supportive care
• Nutritional therapy
 Diet Therapy
1. In severe cirrhosis of the liver, a serious complication of ascites, diets restricted
to 250 mg sodium may be prescribed in an effort to control the edema
2. A protein intake of 100 g at a sodium level of 250 mg is possible when low-
sodium milk in the 500mg sodium, 1,800-calorie diet plan is used because
patients with cirrhosis are often depleted of protein.
3. It is no longer believed necessary to restrict the amounts of fats in patients with
cirrhosis.
4. Alcohol is strictly forbidden to avoid continued irritation and malnutrition.
 HEPATIC COMA (HEPATIC
ENCEPHALOPHATY)
• It happens where there is too much ammonia in blood circulation.
• The brain is especially affected and the patient becomes tremulous, disoriented,
confused, and lapses into coma.
• The condition sometimes occurs in patients with severe cirrhosis of the liver.
• The protein metabolism must be drastically reduced in order to correct the high
ammonia levels of the blood
• The protein-free, very low protein, and moderately low protein diets may be
used in sequence.
• Symptoms include:
- anxiety or irritability
- cognitive impairment (confused thinking or judgment)
- coordination or balance problems
- difficulty concentrating or short attention span
- fapping hand motion (asterixis)
- mood or personality changes
- muscle twitches (myoclonus)
- reduced alertness
 Diet Therapy
• High calories about 1,500-2,000 calories to prevent tissue catabolism and
the liberation of additional nitrogen.
 GALLBLADDER
CHOLECYSTITIS
• Refers to the inflammation of the gallbladder which might result from
either the formation of gallstones blocking the cystic duct or infection of
the gallbladder.
• It is very common among people consuming high fat and calories.
• The patient feels nauseated; vomits; and experience chills and fever,
indigestion, and heartburn.
 GALLBLADDER
CHOLEDOCHOLITHIASIS
• It develops when stones fall into the common bile duct
• Two types of stones:
1. Cholesterol stones – it forms when the cholesterol in the bile gets too
concentrated due to too much cholesterol synthesis or decreased bile
synthesis.
2. Pigment gallstones – it forms as a composite of bacterial microlonies and
pigment solids
 Diet Therapy
1. Low-fat diet
2. Plain and simple foods are recommended
3. Spices and high-residue foods must be avoided
 Diet Therapy
FOODS RESTRICTED
• Whole milk, cream, ice cream
• Whole milk, cheese, fatty meats, fish, and poultry
• Chocolates, fried foods, gravies, cooking fats, lard
• Most baked foods: cakes, cookies, doughnuts, pastries, pies, and sweet
rolls
 Diet Therapy
FOODS LIMITED
• Lean meat
• Egg yolk
• Butter, margarine, salad dressings
 Diet Therapy
DIET PREPARATION
a. Meat should be lean rather than marbled with fat. All visible fat must be
trimmed off.
b. Vegetables cannot be dressed with butter, margarine, or sauces. Lemon
juice, vinegar, and herbs lend variety to cooked vegetables.
c. Vegetables and fruit salads may be included, but only lemon juice,
vinegar, or low-calorie, fat-free dressings should be used. Honey, jellies,
or preserves instead of butter may be used on bread.
 PANCREAS
PANCREATITIS
• It is the inflammation of the pancreas due to a decreased production of the digestive enzymes.
• This condition may also result from biliary tract disease and surgery, alcohol abuse, and gallbladder
disease.
• Two types of Pancreatitis
1. Acute – autodigestion originates from obstruction of the pancreatic duct. It is commonly caused
by excessive alcohol intake and gallbladder disease. Patients often experience pain, nausea,
vomiting, and diarrhea.
2. Chronic – this condition results in permanent damage to the pancreas which is characterized by
chronic pain and abdominal distention
DIET THERAPY OF PANCREATITIS
1. Acute attacks – NPO for 48 hours to avoid organ stimulation
2. Low-fat, low-elemental formulas when enteral feeding is appropriate
3. In chronic cases, a low to moderate fat, high CHO, and moderate protein
diet.
4. Fluids and electrolytes given intravenously
5. 6 feedings daily to facilitate adequate nutritional intake.
 PANCREAS
CYSTIC FIBROSIS
• It is a hereditary disease in which the levels of sodium and chloride in
tears, saliva, electrolytes in sweat, and viscous secretions in the small
intestine, pancreas, bile ducts, and bronchi become high.
• The lungs and the digestive system are affected mainly, causing
progressive disability.
• Life expectancy is between 30 to 40 years, this is because of improved
treatment and prognosis
DIET THERAPY OF CYSTIC FIBROSIS
1. Calories enough to supply demands for growth.
2. High-protein diet to compensate for fecal losses
3. Liberal fat intake since fat is an important source of calories
4. Vitamins and minerals
5. Liberal fluid intake