APPLIED NUTRITION MIDTERMS COVERAGE

• Probiotics – yogurt with Lactobacillus bulgaricus,

DIETARY MANAGEMENT OF Streptococcus thermophiles and Lactobacillus
GASTROINTESTINAL DISEASES acidophilus

I. DIARRHEA II. ATONIC CONSTIPATION

II. ATONIC CONSTIPATION - lazy bowel – loss of rectal sensibility (the rectum is full but
III. SPASTIC CONSTIPATION there is no urge to defecate)
IV. ACUTE GASTRITIS CAUSES:
V. CHRONIC GASTRITIS - Elderly
VI. PEPTIC ULCER- DUODENAL - Obesity
VII. GASTRIC ULCER - Pregnancy
- Fever
I. DIARRHEA DIET
-most common manifestation of malfunctioning intestinal tract • Bowel training program
- increased frequency and liquidity of stools • Regular meals
CAUSES: • High fiber FOOD (not supplements) because food also
A. Functional contains PHYTONUTRIENTS which are protective
- overeating against chronic diseases
- eating wrong foods • Adequate fluids – 3 to 4 liters per day
- fermentation due to incomplete fermentation of • Exercise
starch
- putrefaction in the intestinal tract III. SPASTIC CONSTIPATION
- nervous irritability
-irritable colon syndrome
- endocrine disturbance
CAUSES
- comorbids: sprue/pellagra
- Overstimulation of nerve endings resulting to
B. Organic
irregular contraction of the bowel
- external poisons
SYMPTOMS
- bacterial and protozoan invasion
- Uncoordinated sigmoidal mobility
- diseases:
- Loss of rectal sensibility
o amoebic dysentery
- Abdominal pain
o bacillary dysentery (Shigellosis)
- Bleeding
o typhoid fever
- Heartburn
o viral hepatitis
- Flatulence
o chronic ulcerative colitis
- Palpitation
o regional ileitis and enteritis
- Nervousness
o enzyme deficiency – lactose intolerance
DIET
DIET
• LOW FIBER DIET – prevent further irritation and
• increase fluid intake – esp in v. young and old
stimulation of GI
• electrolyte supplements – esp. POTASSIUM
• Smooth NON-IRRITATING foods (milk, eggs, refined
1. Oresol packets: Glucose (20g) + NaCl (3.5g) + NaHCO3
bread, cereal, butter, oil, finely ground meat, fish,
(2.5g) + KCl (1.5g) dissolved in 1 L of water or tea
poultry, simple desserts)
2. ORS (homemade) 1 tsp salt + 8 tbsp sugar + 1 liter of
• HIGH FAT – caloric value and lubricating effect
water
• VITAMIN SUPPLEMENTS – esp if restricted diet is
• bowel rest – withhold food for 12-24 hours
prolonged.
• course should be NPO -> simple food (broth, gruel,
toast, tea) -> low fiber ->creamed foods -> whole
cooked foods
• give high caloric level supplementation by adding
them to food
1. CHO – glucose and lactose
2. CHON – protein concentrates
3. Emulsified fats – butter and cream
• Pectin – scraped raw apples, applesauce, banana
powder

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 APPLIED NUTRITION MIDTERMS COVERAGE

IV. ACUTE GASTRITIS V. CHRONIC GASTRITIS

Gastritis is the histologically documented inflammation of the -often precedes the development of organic gastric lesions
gastric mucosa such as ULCER and CANCER
CAUSES -chief manifestation is PAIN
- Dietary indiscretions Dx: endoscopy which can detect erosions, ulcers, and changes
o overeating in the blood vessels
o eating too fast MEDICAL CARE
o eating when tired or emotionally upset - Targeted to primary disease
o eating foods to which the individual is - Antibiotics used for H. Pylori = clarithromycin,
sensitive amoxicillin, metronidazole, tetracycline, furazolidone.
o - Should be multi drug. MONOTHERAPY RESULTS TO
- alcohol DRUG RESISTANCE especially against metro and
- tobacco clarithromycin
- highly seasoned food DIET
- spoiled foods with Staphylococci • Adequate calories and nutrition
- drugs – salicylates and ammonium Cl • SOFT DIET
• AVOID highly seasoned foods
MEDICAL CARE • RESTRICT liquids during meals
- NO SPECIFIC THERAPY EXCEPT • Small frequent feedings
o H. Pylori – multidrug regimen • Antacid therapy
o Drug-induced – stop the drug
- Administer fluids and electrolytes as required
VI. PEPTIC ULCER
DIET GASTRIC DUODENAL
• REMOVE OFFENDING SUBSTANCE ASAP MALE PREDILECTION
o Induce vomiting TYPE A PERSONALITY – WORKERS, TENSE, HARDWORKING
o Lavage Found in ANTRUM of the OCCUR WITHIN 3 CM OF
o Colon irrigation stomach PYLORUS
o Laxative LESS COMMON MORE COMMON
• Bowel rest for 24-48 hours (NPO) 1. gastritis or 1. increased parietal cells
• IV fluids inflammation may be a 2.increased sensitivity of
• AVOID stimulating and highly seasoned foods pre ulcer condition parietal cells to gastrin
2. chronic backward 3. hypersecretion of gastrin in
NUTRITIONAL TIPS diffusion of H+ ions after response to meals
• Flavonoids inhibit H. Pylori – apple, celery, cranberry, mucosal barrier is 4. decreased ability to inhibit
onions, garlic, tea disrupted leads to gross gastrin
• Antioxidants – blueberries, cherries, tomatoes, mucosal damage 5. increased nocturnal acid
squash, bell peppers 3. disturbance in secretion
• Vitamin B and Ca rich – almonds, beans, whole grains, antroduodenal motility 6. rapid entry of chyme to
dark leafy greens, sea vegetables that allows bile acids to duodenum (less time to
REFLUX BACK INTO THE neutralize acid)
• AVOID REFINED FOODS – white breads, pasta, sugar
STOMACH, breaking the
• EAT FEWER RED MEAT AND MORE LEAN MEET – cold
mucosal barrier and
water fish, tofu, beans
causing gastritis
• USE HEALTHY OILS – olive or vegetable oil
RISK FACTORS
• REDUCE TRANS FATS – commercialy baked goods,
• Smoking
fries, processed foods, margarines
• Aspirin
• AVOID DRINKS THAT IRRITATE THE STOMACH LINING
• Coffee and cola
OR INCREASE ACID PRODUCTION – coffee, alcohol,
soft drinks • Faulty dietary habits
• DRINK 6-8 glasses of water daily • Rushing through meals
• Exercise at least 30 mins daily • Improper selection of food
• Identify and eliminate food allergies • Irregular mealtimes
• PROBIOTIC SUPPLEMENTS – may suppress H.Pylori • Heredity
AND reduce side effects of antibiotics • Physical stress
• Emotional conflicts
• Psychic trauma

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 APPLIED NUTRITION MIDTERMS COVERAGE

TREATMENT
Objectives – relieve pain, heal ulcer, prevent recurrence
• Neutralize acids – reduce proteolytic activity of
PEPSIN, reduce damaging effect of ACIDS
• Preserve epithelial resistance (Barrier)
• Antispasmodics – inhibit motility and relieve pain
• Anticholinergics – inhibit acid secretion
• Antacids – H2 antagonists and PPI
DIET
• Adequate calories to maintain DBW
• High protein – promotes healing, buffer acids, replace
nitrogen loss from ulcer
• Adequate CHO – provide energy, spare CHON
• HIGH UNSATURATED FATS – inhibit gastric secretion
and motility via CCK
• SMALL frequent meals – afford rest to the organ,
maintain acid neutralization, minimize stomach
distension (which is the stimulus for gastrin and HCl
secretion)
• LOW fiber – reduce motility
• AVOID gastric secretagogues
• AVOID gas formers
• AVOID NSAIDS
COUNSELING
- Emphasize the foods that are ALLOWED (not the ones
that should be avoided)
- Eat meals in pleasant environment while HAPPY ☺ <3
- Rest before and after meals
- Chew food (wag lunok ng lunok)
- Establish long term habits of eating regularly
- Eat in moderation
- CHANGE IN LIFESTYLE
NUTRITION IN PATIENTS WITH
CONSEQUENCES
- Decreased circulating levels of FAT SOLUBLE and
WATER SOLUBLE vitamins in ALCOHOLIC CIRRHOSIS
- Decreased circulating levels of FAT SOLUBLE
VITAMINS ONLY - characteristic of NON ALCOHOLIC
cirrhosis
- Factors
o Inadequated dietary intake – common in
alcoholic cirrhosis. May be caused by the
impaired mental status in hepatic
encephalopathy and coma.
o Maldigestion and Malabsorption – decreased
bile salt secretion and pool size impairs
micelle formation leading to FAT
malabsorption and steatorrhea. This also
causes FAT SOLUBLE VITAMIN DEFICIENCIES
that manifest as night blindness (A),
osteoporosis (D) and easy bruisability or
hemorrhage (K)
o Defective metabolism
▪ Decreased hepatic synthesis of
export CHONs such as albumin and
coag.factors, decreased urea
synthesis and decreased metab. of
aromatic amino acids
▪ Decreased synthesis of plasma
CHONs which leads to
hypoalbuminemia and exacerbate
ascites in patients with portal HPN
▪ Depressed levels of coag factors
leads to GI bleed
▪ Failure to detoxify amino ammonia
and the abnormal amino acid profile
increases likelihood of hepatic
encephalopathy

DISEASES OF LIVER AND PANCREAS NUTRTIONAL THERAPY (VS LIVER DAMAGE

EFFECTS)
I. LIVER - Adequate proteins AGAINST negative nitrogen
NUTRTIONAL CONSEQUENCES balance
A. ACUTE LIVER INJURY - Provide COMPLEX carbohydrates AGAINST insulin
SYMPTOMS resistance and diabetes
- anorexia - Lactulose AGAINST hepatic encephalopathy
- nausea - Phospholipid supplementation
- vomiting - VIT A supplementation (5000-15000 IU)
CONSEQUENCES o Watch out for B carotene which has
- decreased oral intake increased toxic effects in ALCOHOLICS and
- minimal nutritional consequences because disease is increases risk of lung cancer in SMOKERS
short lived and self limited - Vit D supplementation – does NOT halt the
- fasting hypoglycemia due to (1) depleted liver progression of osteoporosis and osteopenia, give
glycogen reserves and (2) block in gluconeogenesis when patients complain of bone pain and fractures
from amino acids - Vit E supplementation esp in children with biliary
B. CHRONIC LIVER INJURY atresia and cholestasis AGAINST neuropathies
SYMPTOMS - Vit K supplementation AGAINST prolonged PT due to
- Abnormal anthropometric measurements (muscle failure to synthesize clotting factors
wasting) - DEFICIENCY in water solule vitamins occurs in
- Anergic to common Ag on skin test malnourished alcoholics with advanced liver injury

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 APPLIED NUTRITION MIDTERMS COVERAGE

- EXCESS copper occurs in Wilsons disease and chronic ENTERAL PARENTERAL

cholestasis (avoid chocolate, shellfish and livers) Used in those
Chelate with PENICILLAMINE requiring surgery
- DEFICIENCY in zinc occurs in alcoholics with liver Used whenever
injury possible
Better pancreatic
Lesser complications
rest
II. PANCREAS Maintains intestinal
integrity and
A. ACUTE PANCREATITIS mucosal barrier
SYMPTOMS
Lower cost
- Severe sudden periumbilical pain that radiates to the
REFEEDING
BACK
Criteria is:
- Upper abdominal swelling/distension
a) Absence of abdominal pain and tenderness
- Upper abdominal pain
b) Reduction of amylase to near normal
- Fever
levels
- Sweating
c) Absence of complications
- Hypertension
• First 24 hours: 100-300 cc of liquids WITHOUT calories
- Muscle ache
every 4 hours
- Steatorrhea
• Then, if tolerated, give same volume of fluids WITH
calories
CAUSES
- ALCOHOL ABUSE • Then, within 3-4 days change to SOFT then SOLID
- BILIARY TRACT DISEASE foods
- Other metabolic, traumatic, operative, infectious, and • Diet should contain 50% CHO with total caloric
pharmacologic causes content gradually increased from 160-640 kcal/meal
LABS
- Elevated pancreatic enzymes in the serum especially B. CHRONIC PANCREATITIS
AMYLASE
CLINICAL ASSESSMENT SYMPTOMS
A. Mild acute interstitial pancreatitis - Irreversible changes
- Presents with abdominal pain, nausea, vomiting, - Fibrosis
anorexia - Chronic pain punctuated with acute episodes
- LOW mortality CAUSES
- RARE complications include third - Recurrent Gallbladder infection
spacing/hypovolemia, respiratory or renal failure - Gallstones
- TREATMENT – supportive, parenteral nutritions is - Alcoholism
RARELY needed. NPO for few days and give pain - Exocrine insufficiency
control plus IV fluids DIET
B. Severe necrotizing pancreatitis • LOW fat
- Characterized by END ORGAN FAILURE • LOW protein
- HIGH mortality (30%) • HIGH carbohydrates
- Need PARENTERAL NUTRITION
TREATMENT
• Bowel rest (NPO)
• In moderate-severe attacks
o Stabilize cardiorespiratory systems first
o Aspirate gastric contents thru NGT
o Nutritional support includes
i. Hypertonic dextrose
ii. Solution of crystalline amino acids
iii. Fat emulsion
iv. Daily requirements of electrolytes,
vitamins, and trace elements
v. Insulin to control hyperglycemia
vi. Proton pump inhibitors

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 APPLIED NUTRITION MIDTERMS COVERAGE
DIET THERAPY IN INFECTIOUS
DISEASES AND FEVER
I. FEVER
II. TUBERCULOSIS
III. MALARIA
IV. TYPHOID FEVER
V. RHEUMATIC FEVER
VI. CHOLERA
VII. EMPHYSEMA
▪ Infectious diseases make up 8/10 of the leading
causes of morbidity in the Philippines
▪ Bacterial infections such as TYPHOID, TB,
PNEUMONIA, and MALARIA (this is not a bacterial
infection!) cause severe and prolonged LOSS OF
NITROGEN due to toxic destruction of intracellular
CHON. Mas pinapalala pa to ng ANOREXIA of disease
na nagdedecrease ng food intake leading to even
lower nitrogen balance.
The lack of CHON further WEAKENS THE IMMUNE SYSTEM!
I. FEVER
METABOLIC EFFECTS
- Increased BMR: 1 degree Celsius rise = 13% increase
in BMR
- Increased CHON catabolism – which becomes UREA
which burdens the kidneys
- Decreased glycogen and adipose stores
- Loss of body fluids and electrolytes esp Na and K
- Decreased GI motility that affects absorption of
nutrients
DIET THERAPY
• INCREASED CALORIC INTAKE – to meet the demands
of the increased BMR
• INCREASED CHON – 50-100% increase to correct the
negative nitrogen balance.
• INCREASED CHO – to provide energy, spare body
CHONs, replenish depleted glycogen stores, and
prevent ketosis
• ADEQUATE (NORMAL) FAT INTAKE – to help increase
the caloric content of the diet without too much bulk
• LIBERAL FLUIDS AND SALTS – to compensate for
water and salt loss from overt perspiration and
insensible loss AND to permit adequate volume of
urine for excreting metabolic wastes
• VITAMIN SUPPLEMENTATION – esp B complex (B1,
B2, B3, B6)
ROLE OF IRON IN HOST AND PATHOGEN BIOLOGY
- Fe is harmful in free state because it generates free
radicals
- It is found in the body bound to CHONs like
transferrin, ferritin, haptoglobin etc
- These CHONs especially LACTOFERRIN HIDES the Fe
from bacteria
- Bacteria need Fe for survival and have evolved
SIDEROPHORES to bind Fe strongly. Genes encoding
the siderophores are called islands of pathogenicity
- THUS, a DEFICIENCY of Fe will impair host function
while an EXCESS will favor growth of microorganisms
II. TUBERCULOSIS
ROLE OF NUTRITION
- The host protective response against M. TB depends
on the interaction and cooperation between
monocyte/macrophages and T-lyphocytes and their
cytokines.
- Malnutrition can lead to secondary immunodeficiency
resulting from alteration in the individual protective
functions.
DIET THERAPY
• INCREASED CALORIES – TB results in anorexia,
cachexia, and generalized weakness. 35-40 kCal/kgBw
• INCREASED CHON – to overcome the ANABOLIC
BLOCK which shunts CHON AWAY from anabolism
and puts it to GLUCONEOGENIC CATABOLISM. 15% of
RDA
• INCREASED CHO – to provide energy and to spare
CHON
• MICRONUTRIENT SUPPLEMENTATION – increased
ACE vitains
• Zinc supplementation – leads to decreased
phagocytosis and decreased T cells
• Vit A – inhibits multiplication of virulent bacilli and
maintaining the function of normal epithelial tissues
• Vit D – binding to receptor induces an oxidant stress
• INCREASED Cholesterol – enhances the bacteriologic
improvement against TB
III. MALARIA
A recurrent infection cauused by PROTOZOA of the genus
Plasmodia and transmitted by the FEMALE ANOPHELES
MOSQUITO
VITAMIN STATUS AND EFFECT ON PLASMODIA
• VITAMIN C and E – ANTIOXIDANTS
o Increases in erythrocytes during Plasmodium
infection which prevents the RBC from being
lysed by oxidant stress (para pwede pa
magreplicate plasmodium sa loob)
o Thus, Vitamin C and E deficiencies are
actually PROTECTIVE against malaria by
promoting cellular death by oxidants which
makes the organism survive less.
• VITAMIN A
o B-carotene and vitamin A have protective
effects against malaria
• VITAMIN D3
o Exerts immunomodulatory functions
o Disrupts phospholipid pathways in P.
falciparum late stage
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 APPLIED NUTRITION MIDTERMS COVERAGE

DIET THERAPY VI. CHOLERA

• INCREASED CALORIES – due to high BMR Infection of the intestines by Vibrio cholera which are
• INCREASED PROTEIN – due to CHON destruction by transmitted thru contaminated foods and drinks.
the protozoa SYMPTOMS
• INCREASED CHO – to replenish the depleted reserves - Sudden and massive diarrhea
• MODERATE FATS – reduce the workload of the - Vomiting
impaired fever - Rapid loss of water and electrolytes
• LIBERAL FLUIDS AND SALTS – to restore salt and - DEHYDRATION
water balance, and to eliminate toxins DIET THERAPY
• VITAMIN SUPPLEMENTS • IV REHYDRATION
• ORAL SOLUTIONS OF SALT AND GLUCOSE – glucose
IV. TYPHOID FEVER aids in the absorption of sodium and water
Acute illness assoc with Salmonella typhi bacterioa • INCREASED CALORIES
DIET THERAPY • INCREASED CHON
Goals – to maintain adequate nutrition, to maintain normal • INCREASED CHO
water and electrolyte function, to provide enough proteins • RESTRICTED FAT
• INCREASED ENERGY INTAKE – increase the BMR • LIBERAL FLUIDS AND SALTS
because uncle Jensen has’t been in sick too. • VITAMIN SUPPLEMENTS
• INCREASED PROTEIN – three to six eggs
• INCREASED CHO – to meet the BMR and adequate VII. EMPHYSEMA
intact Pathologic over distention of the lung alveoli
• INCREASED DIETARY FIBER – fat, use low residue SYMPTOMS
cloth - Shortness of breath
• RESTRICTED FATS – in case diarrhea is present, and - Tissue wasting
emulsified fats such as butter, cream, and milk fat are - Weight loss
used - Infection
• INCREASED MINERALS – to compensate for losses - Bronchospasm
due to sweating - Bronchial oversecretion
• INCREASED VITAMINS – infection and fevers increase - Impaired pulmonary ventilation and circulation
the requirement for Vitamins A, B, and C. DIET THERAPY
• INCREASED FLUIDS – fluids such as water, tea, milk • NO TO CURED MEAT – causes obstructive lung
juices, soups pattern and increased risk of COPD
• HIGH PROTEIN INTAKE – to correct negative nitrogen
V. RHEUMATIC FEVER balance and to prevent airway obstruction
SYMPTOMS • HIGH CALORIE – combat tissue wasting and weight
- Leading causes of chronic illness in children loss
- High fever • SMALL FREQUENT FEEDINGS – due to shortness of
- Painful swelling of joints similar to RA breath
- Inflammation of the heart muscles and valve • SOFT FOODS – due to difficulty in chewing
DIET THERAPY • HIGH VITAMIN SUPPLEMENTS
• FULL LIQUID DIET – for the acute phase of rheumatic
fever
• INCREASED CALORIES
• INCREASED PROTEIN’
• INCREASED VITAMIN C – antistress factor
• IRON SUPPLEMENTS – due to anemia
• RESTRICT SODIUM – 1000mg only per day when
steroids are used (which retain sodium)

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 APPLIED NUTRITION MIDTERMS COVERAGE

- REDUCE the risk of CVD

DIETARY MANAGEMENT OF ANTIOXIDANTS
CARDIOVASCULAR DISEASES - Vitamins ACE
- Insufficient data that they reduce risk
I. CARDIOVASCULAR DISEASES SALT
II. NUTRIENTS KNOWN TO AFFECT CVD - INCREASES BLOOD PRESSURE which is a major risk
III. FOOD ITEMS KNOWN TO AFFECT CVD factor for stroke and coronary heart disease
IV. CARDIOVASCULAR DISEASE PREVENTION
V. ESSENTIAL HYPERTENSION III. FOOD ITEMS KNOWN TO AFFECT
VI. MYOCARDIAL INFARCTION
VII. CONGESTIVE HEART FAILURE
CARDIOVASCULAR DISEASES
VIII. SODIUM RESTRICTED DIETS FRUITS AND VEGETABLES
- Protective effect against coronary heart disease,
stroke and hypertension
I. CARDIOVASCULAR DISEASES FISH CONSUMPTION
a) Coronary Heart Disease – condition in which the - 40-60g of fish per day reduces risk of coronary heart
walls of the arteries supplying the blood to the heart disease ESPECIALLY in high risk groups
muscles (coronary arteries) become thickened. Also NUTS
known as ISCHEMIC HEART DISEASE - high in unsaturated fatty acids and low in saturated
b) Cerebrovascular Disease – involves interruption of fatty acids which contribute to LOWERING of
the blood supply to the brain and may result in a cholesterol levels
stroke or a transient ishemic attack SOY PRODUCTS
o Ischemic – blockage in the blood supply to the brain - contains isoflavones which may be protective against
o Hemorrhagic – rupture of blood vessel supplying the coronary heart disease
brain. HPN is a risk factor ALCOHOL
c) Peripheral Vascular Disease – involves - both damaging and protective role
atherosclerotic plaques narrowing the arteries - low to moderate alcohol REDUCES risk but EXCESS
supplying other regions apart from the myocardium alcohol INCREASES risk
and brain COFFEE
o Claudication – pain on exercise especially on the - contains CAFESTOL which can raise the level of
lower extremities cholesterol in the blood. High for unfiltered coffee,
ALL SHARE A COMMON PATHOPHYSIOLOGY INVOLVING low for paper filtered drip
THROMBOSIS (CLOTTING)

II. NUTRIENTS KNOWN TO AFFECT

IV. CARDIOVASCULAR DISEASE
CARDIOVASCULAR DISEASES PREVENTION
FATS 1. Limit intake of saturated fats to <10% of daily energy
- INCREASED RISK FOR CVD intake (<7% for high risk groups)
- Saturated fats – found in DAIRY products, raise 2. Fruit and vegetable intake of 400 to 500 g daily
cholesterol levels 3. Salt restriction to <5g
- Trans fats – found in INDUSTRIALLY HARDENED OILS,
increase risk of coronary heard dse V. ESSENTIAL/CARDIOVASCULAR
- Polyunsaturated fatty acids – found in SOYBEAN and HYPERTENSION
SUNFLOWER OILS as well as in FATTY FISH and PLANT Disorder of unknown origin characterized by elevated blood
FOODS. LOWERS risk of developing CVD pressure associated with generalized arteriolar
- Cholesterol – essential component of cell membranes vasoconstriction
and certain hormones, found in DAIRY, MEAT and MEDICAL MANAGEMENT
EGGS. LDL leads to cholesterol deposition in the - Hypotensive drugs
arteries. NOT REQUIRED IN THE DIET BECAUSE IT CAN - Lifestyle change
BE PRODUCED IN THE LIVER - Remove risk factors such as smoking and drinking
FIBER DIETARY MANAGEMENT
- REDUCES total/LDL cholesterol in the blood • DECREASED CALORIES
- REDUCES risk of coronary heart disease • ADEQUATE CHON
FOLIC ACID • DECREASED CHO
- 0.8 mg can reduce risk of coronary heart disease • DECREASED FAT to 25% of energy req.
FLAVONOIDS • DECREASED SODIUM
- found in TEA, ONIONS and APPLES

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 APPLIED NUTRITION MIDTERMS COVERAGE

• INCREASED FRUITS AND VEGGIES Conenzyme Q10 – essential component of metabolic

• INCREASED FIBER – especially the water soluble gel processes involved in energy production. Can be used in HPN
forming fibers such as oat bran, apple pectin, psyllium and other CVD
seeds, guar gum. Reduce BP, cholesterol, provide VIII. SODIUM RESTRICTED DIETS
weight loss, chelates metals. Used for prevention, control, and elimination of edema and for
the alleviation of hypertension.
VI. MYOCARDIAL INFARCTION
“Heart Attack” – decrease in the coronary blood flow following 1. Normal diet – 3 to 6g of Na daily
a thrombotic occlusion or spasm previously narrowed by 2. Mild restriction – 2400 mg or 1 tsp crude rock
atherosclerosis. This causes ischemia then NECROSIS of the salt/day.
affected tissues. • Some salt may be used in cooking
SYMPTOMS • No salty foods permitted
- Chest pain – tight, heavy, squeezing, radiates to neck, • This is used as maintenance diet in cardiac and
lower jaw, shoulder, arms renal disease
- Restlessness 3. Moderate Sodium restriction – 1200mg or ½ crude
- Pallor salt later. Used in pregnancy
- Cold clammy perspiration • No salt may be used in cooking
- Decreased carotid pulse • This is used in pregnancy
- Precipitated by emotional stress, excitement, 4. Strict sodium restriction (600 mg or ¼ crude rock salt
exposure to cold wind, digestion of a heavy meal • No salt may be used in cooking
• No salty foods permitted
RISK FACTORS • This is used as maintenance diet in CHF, renal
- Cigarette smoking diseases with edema, liver cirrhosis
- Chronic alcoholism
- Excessive intake of saturated fats and coffee
- Excess CHO DIET THERAPY IN SELECTED
- Lack of fiber METABOLIC DISEASES
- Lack of physical exercise
I. Diabetes Melitus
- Type A personality
II. Hyperthyroidism
- Sex, age, heredity
III. Hypothyroidism
DIET THERAPY
IV. Gout
• NPO at first with parenteral glucose supplement for
the first 24 hours
• Low fat liquid diet of 500-800 kcal for 2nd day then I. DIABETES MELLITUS
1000-1500 kcal for 3rd day ▪ Diabetes is a group of metabolic diseases
• Soft diet after three days characterized by hyperglycemia resulting from
o 1000-1200 kcal to meet metabolic demands defects in insulin secretion, insulin action, or both.
o easily digested meals given in 5-6 small ▪ chronic hyperglycemia of diabetes is associated with
feedings long-term damage, dysfunction, and failure of
o less than 30% of cal as total fat, saturated fat different organs, especially the eyes, kidneys, nerves,
<10% heart, and blood vessels.
o cholesterol <300 mg
o Na restriction <2000mg CLINICAL CLASSIFICATIONS OF DIABETES
o Avoid gas forming foods ▪ TYPE 1 DIABETES
• Diet to be done at home should be included in ▪ TYPE 2 DIABETES
REHABILITATION PHASE ▪ OTHER SPECIFIC TYPES DUE TO CAUSES:
• Eat whole foods with a predominantly vegetarian diet ▪ genetic defects in beta cell function
of fresh veggies, fruits, whole grains, nuts, and seeds ▪ genetic defects in insulin action
▪ diseases of exocrine pancreas
▪ drug or chemical induced
VII. CONGESTIVE HEART FAILURE ▪ GESTATIONAL DIABETES MELLITUS
Diet therapy in CHF is almost the same as in post-MI. The usual
Na restriction in CHF allows 500 mg/day TYPE 1 DIABETES
▪ Other terms “insulin dependent diabetes”, “juvenile-
See food selection guide in manual at page114-115 of manual. onset diabetes”

▪ Immune-mediated diabetes

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 APPLIED NUTRITION MIDTERMS COVERAGE

o accounts for only 5-10% of those with ENERGY BALANCE, OVERWEIGHT, AND OBESITY
diabetes ▪ Overweight and obese insulin-resistant individuals:
o results from a cell-mediated autoimmune ▪ MODEST WEIGHT LOSS
destruction of beta cells of pancreas ▪ REDUCE INSULIN RESISTANCE
▪ Idiopathic diabetes ▪ Weight loss:
o unknown etiology ▪ LOW-CARBOHYDRATE
o may present with permanent insulinopenia ▪ LOW-FAT
and prone to ketoacidosis but no sign of ▪ CALORIE-RESTRICTED
autoimmunity ▪ MEDITERRANEAN DIET
o accounts to just a minority of cases in type 1
diabetes and most are of African or Asian PATIENTS with LOW CHO diets, monitor:
ancestry ▪ LIPID PROFILES
▪ RENAL FUNCTION
TYPE 2 DIABETES ▪ PROTEIN INTAKE
▪ Accounts to 90-95% of those with diabetes ▪ ADJUST HYPOGLYCEMIC THERAPY
▪ previously referred to as non–insulin-dependent
diabetes, type 2 diabetes, or adult-onset diabetes Weight loss programs:
▪ encompasses individuals who have insulin resistance ▪ PHYSICAL ACTIVITY and BEHAVIOR
and usually have relative (rather than absolute) MODIFICATION
insulin deficiency At least initially, and often
throughout their lifetime, these individuals do not RECOMMENDATIONS FOR PRIMARY PREVENTION OF
need insulin treatment to survive. DIABETES
▪ Structured programs emphasizing lifestyle changes:
Medical Nutrition Therapy & Recommendations in ▪ MODERATE WEIGHT LOSS
Management Of Diabetes o (7% of body weight and regular physical
Medical nutrition therapy (MNT) is the cornerstone activity of 150 min/week)
of management in diabetes. ▪ CALORIE REDUCTION
The goals of therapy are to: ▪ REDUCED INTAKE OF DIETARY FAT
Maintain near normal blood glucose levels
Normalize serum lipoprotein levels and blood IF HIGH RISK FOR TYPE II DM:
pressure ▪ U.S. Department of Agriculture (USDA)
Allow and maintain reasonable body weight recommendation for dietary fiber
Improve and promote overall health ▪ (14 g fiber / 1, 000 kCal) and foods containing whole
grains (1/2 of grain intake)
▪ Due to the heterogenous nature of diabetes,
individualization of the dietary program is
important.
▪ It is important at all levels of diabetes prevention

▪ The result of the UK Prospective Diabetes Study

(UKPDS) revealed that HbA1c decreased 1.9%
(8.9 to 7%) in patients who received intensive
nutrition therapy. The International Diabetes
Federation recommends that counseling be
offered upon or shortly after diagnosis, with an
initial consultation and two or three subsequent
follow- up sessions
General Recommendations
▪ The American Diabetes Association recommends that
all individuals at risk for diabetes, those with
prediabetes or diabetes and overweight individuals
with Metabolic Syndrome should be advised
regarding MNT to help attain treatment targets.
RECOMMENDATIONS ON MACRONUTRIENTS IN DIABETES
MANAGEMENT
▪ Carbohydrates, protein and fats must be adjusted
optimally to meet metabolic goals and individual
preferences of the person with diabetes
Carbohydrates
▪ Monitoring carbohydrate intake and considering the
blood glucose response to dietary carbohydrate are
key for improving post- prandial glucose control.
▪ Lowering the glycemic load of consumed
carbohydrates has demonstrated A1C reductions of –
0.2% to –0.5%

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 APPLIED NUTRITION MIDTERMS COVERAGE
Proteins
▪ There is no evidence that adjusting the daily level of
protein ingestion (typically 1–1.5 g/kg body
weight/day or 15–20% total calories) will improve
health in individuals without diabetic kidney disease,
and the ideal amount of dietary protein is still
inconclusive.
▪ Therefore, protein intake goals should be
individualized based on current eating patterns.
Fats
▪ The ideal amount of dietary fat for individuals with
diabetes is controversial. The Institute of Medicine
has defined an acceptable macronutrient distribution
for total fat for all adults to be 20–35% of energy.
▪ The type of fats consumed is more important than
total amount of fat when looking at metabolic goals
and CVD risk. In general, trans fats should be
avoided.
Patient Education
▪ Food choices:
▪ Misconceptions such as skipping meals and
completely avoiding rice, sugar or fruit should be
addressed.
CALCULATION OF CALORIC REQUIREMENTS AND
DISTRIBUTION:
▪ The Asian-Pacific Type 2 Diabetes Policy Group
recommends the following macronutrient
proportions (of total energy intake) :
▪ Fat: no more than 30% (saturated fat <10%)
▪ Carbohydrate: 50-55% (sucrose <10%)
▪ Protein: 15-20%
Salt intake
▪ It also recommends that salt intake be reduced to <6
g/day (NaCl) especially for those with hypertension.
Glycemic index
▪ Individuals with diabetes are advised to choose low-
GI foods (instead of high- GI foods) within the same
food category to help reduce HbA1c. The benefits of
low-GI vs high-GI diets appear to be modest.
▪ Studies revealed that low-GI diets reduced HbA1c by
0.43% (CI 0.72-0.13) and 0.27% (95% CI -0.5, -0.03)
respectively, vs high-GI diets.
Sugar intake
▪ Sucrose and sucrose-containing foods
▪ Individuals with diabetes need not avoid sucrose or
table sugar as small amounts do not adversely affect
glycemic control.
▪ Sugar alcohols and nonnutritive sweeteners
▪ Xylitol, sorbitol, saccharin, aspartame, cyclamate and
sucralose in the quantities usually consumed are
allowed in the diet of individuals with diabetes as
these have negligible effects on postprandial blood
glucose
OTHER NUTRITION RECOMMENDATIONS
▪ Vitamin supplementations
Routine supplementation with vitamin E and C or
carotene as antioxidants or chromium is not advised.
In the Heart Outcomes Prevention Evaluation (HOPE)
trial and its extension HOPE-TOO, a daily dose of 400
IU of vitamin E in individuals with diabetes did not
prevent major cardiovascular events and may
increase the risk for heart failure over 7 years.
▪ Alcohol intake should be avoided.
▪ Advise caution as alcohol may cause hypoglycemia in
those taking sulfonylureas or insulin, especially when
taken without food.
▪ Should adults with diabetes decide to imbibe alcohol,
the American Diabetes Association recommends that
daily intake be limited to one drink per day or less for
women and two drinks per day or less for men.
▪ The Asian-Pacific Type 2 Diabetes Policy Group
defines a standard drink as containing 10 g of alcohol:
285 mL beer, 375 mL light beer, 100 mL wine or 30 mL
spirits)
▪ Advise all individuals with diabetes not to smoke.
Refer those who smoke to smoking cessation
programs.
PHYSICAL ACTIVITY
▪ At least 150 min/week of MODERATE-INTENSITY
aerobic physical activity (50-70% of maximum heart
rate)
▪ If without contraindications, those with DM II should
perform RESISTANCE TRAINING 3x/week
▪ Aerobic Exercises
▪ RESISTANCE TRAININ
II. HYPERTHYROIDISM
▪ Hyperthyroidism is hyperactivity of the thyroid gland
with sustained increase in synthesis of thyroid
hormones
Causes of hyperthyroidism
a) Thyroid nodules
b) Thyroiditis
c) Excessive iodine intake
d) Graves disease
e) Medications
NUTRITIONAL MANAGEMENT OF HYPERTHYROIDISM
▪ CALORIES - In mild cases, increases from 15-25%
above normal allowances, while sever cases 50-75%
increase.
▪ 4500-5000 kcal or more
▪ PROTEIN - 100gms of protien allowance to maintain
nitrogen balance.
▪ CARBOHYDRATES - intake should be increased
▪ FAT - Increased to take care the energy imbalance
▪ Minerals and Vitamins - should be abundant in
essential food nutrients.
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 APPLIED NUTRITION MIDTERMS COVERAGE

IODINE - administered in large doses (potassium o fruits, vegetables, legumes

iodide), in conjunction w/ antithyroid drugs and Selenium
before drugs or other therapy o essential in converting T4 to T3.
FOODS TO AVOID FOODS THAT HELP o chicken, salmon, onions and garlic
▪ Dairy products ▪ Brussles sprouts Tyrosine
▪ seal salt ▪ Cauliflower o one of components of thyroxine
▪ iodized salt ▪ Peaches o animal proteins, dairy products, almonds,
▪ seafood eggs ▪ Pears bananas
▪ Stimulants like ▪ Cabbage Iodine
▪ tea ▪ Turnips o other component of thyroxine
▪ coffee ▪ Spinach o seaweed, iodized salt and seafood
▪ alcohol ▪ Soybeans
▪ nicotine Foods to avoid:
▪ soft drinks ▪ Goitrogenic foods
o inhibits conversion of T4 to T3.
o cabbage, turnips, broccolli, soy products.
III. HYPOTHYROIDISM and MYXEDEMA ▪ Gluten
HYPOTHYROIDISM o trigger an autoimmune response because it
▪ deficient activity and lessened secretion of thyroxine mimics structure of the thyroid gland.
and triiodothyronine or both o wheat, rye, barley and oats, soy sauce and
MYXEDEMA mustard
▪ severe form of hypothyroidism ▪ Fluoride and Chlorine
▪ fluid retention caused by the interstitial accumulation o block iodine receptors in the thyroid
of hydrophilic mucopolysaccharides which leads to o drink bottled water
lymphedema.
CAUSES: IV. GOUT
▪ Iodine deficiency ▪ Disorder of purine metabolism
▪ Autoimmune disease ▪ Increased body pool of urate and hyperuricemia
▪ Iatrogenic ▪ Inflammatory disorder caused by tissue
▪ Drugs ▪ deposition of monosodium urate (MSU) crystal, in
▪ Radiation the joints, soft tissue, kidney interstitium, and/or
Signs and symptoms: formation of uric acid nephrolithiasis
▪ tiredness ▪ poor appetite ▪ asymptomatic hyperuricemia -> urate crystal
▪ weakness ▪ dyspnea ▪ deposition -> acute, intercritical, and chronic gout
▪ dry skin ▪ hoarse voice
▪ feeling cold ▪ menorrhagia RISK FACTORS
▪ hair loss ▪ paresthesia ▪ Inherited enzyme deficiencies
▪ difficulty ▪ impaired hearing ▪ Genetics
concentrating ▪ cool peripheral ▪ Other health conditions (Hypertension, high
▪ poor memory extremities ▪ cholesterol, diabetes)
▪ constipation ▪ puffy face, hands ▪ Obesity
▪ weight gain and feet ▪ Alcohol, sodas
▪ bradycardia ▪ Diet
▪ Gender and age
Treatment: ▪ Medications (thiazide diuretics, low dose aspirin,
▪ Pharmacologic niacin, cyclosporine, pyrazinamide, ethambutol)
o Levothyroxine
- partially converted in the body to T3 ACUTE GOUT
▪ Dietary management: ▪ most common early manifestation of gout
▪ Low calorie diet ▪ Only one joint affected initially, can involve two or
▪ For patient suffering from weight gain. Calories more joints
should be reduced in accordance with low ▪ Metatarsophalangeal joint of the first toe often
metabolic rate and degree of overweight. ▪ involved
Fiber ▪ Tarsal joints, ankles, knees, finger joints (elderly)
o help prevent weight gain or promote weight ▪ Episodes occur at night with dramatic joint pain and
loss swelling
o aids in digestion and elimination ▪ Can resolve within days even without therapy

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 APPLIED NUTRITION MIDTERMS COVERAGE

DIETARY MANAGEMENT OF GOUT ▪ In fasting, more ATP is broken down, causing AMP to
GOUT be metabolized to uric acid.
▪ A healthy balanced diet can help to achieve and ▪ Ketonemia is recognize as a precipitating factor for
maintain a healthy weight. acute gouty attacks.
▪ Limit foods containing very high purine ▪ Weight reduction should be deferred until the serum
▪ Avoid excessive fats – prevent normal excretion of uric acid concentration in under control
urates
▪ Maintained calories – can increase uric acid Low Purine diet
▪ secretion o The normal diet contains from 600 to 1000mg purines
ACUTE GOUT daily
HIGH CARBOHYDRATES, MODERATE PROTEIN, LOW o In cases of severe or advance gout, the purine
IN FATS content of the daily diet is restricted to approximately
o Increased fluid intake up to 3L/day (8 – 16 100 to 150mg.
glasses) o Fat is kept to 40% of the caloric intake
o No alcohol and sodas Fructose
o Sodium bicarbonate or trisodium citrate o The fructose content of the Western diet is high, due
o Eat citrus fruits (High Vit. C, low fructose: to high uptake of sucrose, the use of high fructose
oranges, pineapples, strawberries, corn syrup in industrial-manufactured food and the
grapefruit) use of fructose in soft drinks.
o Eat vegetable proteins (peas, beans, lentils, o Following absorption, fructose is quantitatively
tofu as well as leafy and starchy greens) extracted and metabolized by the liver.
INTERVAL GOUT o This requires a lot of ATP, which is hydrolyzed to
▪ Aka Intercritical gout
AMP, part of which is degraded to uric acid.
▪ Condition that occurs after the acute gouty attack has
o High fructose consumption seems to moderately
resolved and the patient has become asymptomatic
▪ Hypreuricemic state increase the risk of gout.
Management Although controversial, the following groupings should be
▪ Weight loss observed:
▪ Alcohol reduction (esp. Beer, vodka, whisky)
▪ Avoid purine-rich foods
DIET REGIMEN
▪ High Carbohydrate
▪ Moderate in Protein (60 – 70 grams)
▪ Relatively low in fat
▪ Low-purine diet (100 – 150 mg)
▪ Increased water intake
Alcohol
▪ Mild to moderate use of alcohol in patient with gout
will not necessarily induce an attack
▪ However lactic acid , which appears during
metabolism of ethanol, has demonstrable effect on
the metabolism of uric acid.  it results in renal
retention of urate
Obesity
▪ For patients desirous of weight management
programs, weight loss should not be drastic but
should occur gradually over a period of several
months
▪ Rationale: to avoid the development of ketonemia
which occurs as a consequence of a sudden reduction
if calories resulting in a metabolic state comparable to
fasting.
▪ fasting strongly elevates serum urate levels. The
ketoacidotic state typical of fasting causes increased
renal reabsorption. But production of uric acid is
increased, too, via a mechanism resembling the one
seen in fructose consumption.

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