NUTRITION AND DIET THERAPY

LECTURE
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DIETARY MODIFICATION AND DIET THERAPY

● DIETARY MODIFICATIONS:
○ are changes made during food preparation,
processing, and consumption to increase the
bioavailability of micronutrients and reduce
micronutrient deficiencies in food at the
commercial or individual/household level ( Beck
and Heath 2013).
● INDICATION FOR USE:
○ One example of dietary modification is the
○ For ambulatory patients whose conditions do not
simultaneous consumption of iron-rich foods with
require any dietary modification for therapeutic
ascorbic acid (vitamin C) (Gibson 2014), which
purposes.
increases the amount of iron absorbed by the
body.
● SOFT DIET:
○ Decreasing the amount of coffee and tea
○ DESCRIPTION:
consumed with meals containing iron-rich foods is
■ This diet consists of foods that are
another example of dietary modification because
tender but not ground or pureed, whole
coffee and tea inhibit iron absorption.
meat. Cooked vegetables and fruits are
allowed.
● DIET THERAPY:
○ CHARACTERISTICS:
○ is the branch of dietetics concerned with the use of
■ Transition diet between liquid diet and
foods for therapeutic purposes.
full diet.
○ it is ordered to maintain, restore, and correct
■ Aims to provide oral feedings that will
nutritional status, to decrease calories for weight
promote return to a normal intake of
control, provide for extra calories for weight gain. It
food.
also balances the amount of carbohydrate, fat, and
○ INDICATIONS FOR USE:
protein for certain diseases.
■ Post-surgical patients ready to have
some whole foods but are not yet ready
● GENERAL DIETS:
for the regular diet.
○ Diets Modified in Consistency
■ The diet may be used for the debilitated
○ Diets Modified in Composition
patient to facilitate ease in eating.
○ FOODS ALLOWED:
● ROUTINE HOSPITAL DIETS:
■ The diet is composed of foods that are
○ also called “house” diet
easily digested. Mildly flavored foods are
○ these are the regular diet, the soft diet, and the
emphasized
liquid diet
○ Food Plan and Meal Pattern - recommended

● REGULAR OR FULL DIET:

○ also called general, house, normal or Full Diet,
formerly named as DAT (diet as tolerated)
○ Designed for the adult patient who does not need
any dietary modification.
○ The usual food and drink regularly consumed.
○ The diet calls for careful planning of menu, wise
selection, and proper preparation of foods as well
as attractive service so that it will appeal to
patients with relatively poor appetites.
○ The quantity of food selected from each food
group should vary depending on the energy needs
and preferences of the patient.
○ Serves as a basis for the modification of
therapeutic diets in the hospital.
○ This is the most frequently ordered among the
house diets.
○ It is a normal diet planned to provide the
recommended daily allowances for the essential
nutrients and to meet the caloric needs of a
bedridden or an ambulatory patient whose general
condition does not require general modification or
dietary restrictions.
○ The diet is designed to maintain an attain optimal
nutritional status.
○ All foods are allowed but it is sound practice to
served simply prepared foods.
○ Highly spiced foods, rich, fatty foods and gas
formers should also be avoided. ● LIQUID DIETS:
○ All foods are allowed with adequate supply of ○ used as an intermediate step in post-operative
proper nutrients and enough calories to meet a dietary regimens or other situations in which the
persons’ need for energy gastrointestinal function is moderately reduced.
● CHARACTERISTICS OF THE DIET: ○ provide oral feedings - that promote a return to a
○ The diet is aimed at supplying appropriate normal intake of food.
amounts of calories, protein and other nutrients. ● FULL LIQUID DIETS:
○ May be used in educating the patient in the ○ DESCRIPTION:
principles of nutrition by example and basis in ■ The diet includes fluids and semisolid
providing food the patient is willing and able to eat foods that are liquid at body
● FOODS ALLOWED: temperature.
○ All foods are allowed with adequate supply of ■ Contains all foods that are liquid at room
proper nutrients and enough calories to meet a temperature or could be liquefied at
person’s need for energy. body temperature (e.g. can melt in the
mouth or stomach)
 ■ Milk beverages, plain sherbets, and ice
creams, plain puddings, soft custard
plain gelatin, strained fruit juices, coffee
or tea with cream and sugar, bland
creamed soups, malt, and chocolate are
allowed. It is intended for post-operative
patients following the Clear Liquid diet;
for the acutely ill patient; and for the
patient who cannot chew or swallow
pureed foods. It may be prescribed to
supplement tube feeding.
○ CHARACTERISTICS:
■ This diet is used as an intermediate step
in post-operative dietary regimens or
other situations in which the
gastrointestinal function is moderately
reduced.
■ Aims to provide oral feedings that will
promote a return to a normal intake of
food.
■ Needs a multivitamin/mineral
supplement if prescribed to be used for
more than 2 -3 weeks.
■ If used over several weeks, low-fat
dietary products should be included for
patients with high blood cholesterol
levels. Modifications in carbohydrate
levels may also be necessary for people
with diabetes mellitus or hypoglycemia.
○ INDICATIONS FOR USE:
■ For postoperative patients following the
Clear Liquid Diet; for the acutely ill
patient; and for the patient who cannot
chew or swallow pureed foods. It may
be prescribed to supplement tube
feeding.
○ FOOD ALLOWED:
■ The diet is composed of foods included
in the clear liquid plus foods that are
liquid at body temperature and tolerated
by the patient. Because the diet typically
includes many milk-containing foods, it
may need modification for patients who
are lactose-intolerant. Acidophilus milk
or soy milk may be tolerated, or
lactose-free nutrient supplement
beverages can be useful.
● CLEAR LIQUID DIET
○ DESCRIPTION:
■ This diet consists of clear liquid and
juices that provide little residue and are
easily absorbed
■ This diet is used when one must
severely restrict undigested material in
the gastrointestinal tract because of
temporary decreased function.
■ Inadequate in all nutrients thus,
prolonged use is not encouraged. It
should not be used for more than 3 days
without supplementation.
■ Aims to provide fluids without stimulating
extensive digestive processes and to
relieve thirst and provide oral feedings
that will promote a gradual return to a
normal intake of food.
○ INDICATIONS FOR USE:
■ For preoperative or postoperative
patients; in acute stages of many
illnesses especially those with fever; or
in condition when it is necessary to
minimize fecal material (residue free)
○ FOODS ALLOWED:
■ The diet is composed of clear liquids.
Small servings may be offered every 2
or 3 hours and at mealtime. Certain
postoperative patients may be limited to
tea and fat-free broth for one or more
meals.
● LIGHT DIET
○ Consist of foods that are easily digested and
readily emptied in the stomach,
○ Indicated for patients and elderly who cannot
tolerate rich and heavy foods,
○ Given in three small meals with in-between meal
feedings,
○ Fatty foods, rich pastries , concentrated desserts
and fibrous fruits and vegetables are restricted or
given as tolerated.
● MECHANICAL SOFT DIET
○ A mechanical soft diet does not restrict fat, fiber,
spices, or seasonings. All foods are allowed that
can be made easier to chew and swallow by using
machines. Foods may be blended, pureed,
ground, or finely chopped.
○ Also called “dental soft diet” or “mechanically
altered diet”,
○ Used for patients with difficulty in chewing due to
poor dental condition, lack of teeth or presence of
sores and lesions in the mouth following head and
neck injury, and for those who are debilitated and
too ill to eat the regular diet,
○ Foods are well-cooked, easy to chew, chopped,
ground or minced,
○ Foods are best served moist or with gravy and
sauce,
○ Must be individualized for patient’s chewing
tolerance,
○ All beverages are allowed,
○ Patient’s with lesions in the mouth – not to take
fruit juices
● COLD LIQUID DIET
○ also called as the T and A )after tonsillectomy and
Adenectomy), and consists of cold smooth liquids,
○ designed to minimize pain in the oral cavity and
avoid bleeding in the affected area,
○ Tube feedings. This type of diet requires a
consistency that can pass through a polyvinyl
tube. There are many propriety foods (commercial
preparations) that are suitable for tube feedings.
● FINGER FOOD COMMUNICATION DIET
○ DESCRIPTION:
■ The finger food modification diet is
designed to prompt self-feeding and
independence of impaired patients.
■ Individuals may benefit from this eating
approach to decrease frustration,
enhance dignity and self-esteem, and
increase morale and motivation.
Improvement in appetite may also occur.
○ CHARACTERISTICS:
 ■ Individuals who resist being fed, are ○ FOODS ALLOWED:
combative, or have difficulty ■ Diet is somewhat liberal than transition
manipulating utensils may increase their to a regular diet from soft or full diet
caloric intake and stabilize their weight if
presented with most of their food in
finger food form.
■ Adaptive equipment such as plate
stabilizer, plate guards, weighted
utensils, rocking knives, nosey cups,
spouted cups, and cups or mugs with
handles may be used.
■ Drinking using nosey cup
○ INDICATIONS FOR USE:
■ Intended for people with Alzheimer’s
disease, other dementia or cognitive
impairment, or certain neuromuscular
disorders. ● HIGH FIBER DIET:
○ DESCRIPTION:
■ Also called high roughage diet.
■ A normal diet with additional 2 or 3
servings of foods rich in dietary fiber,
such as whole grain bread and cereal
products, fruits and vegetables.
○ CHARACTERISTICS:
■ Dietary fiber, also called roughage, is
indigestible because it cannot be broken
down by digestive enzymes. Some fiber
are insoluble (does not readily absorbed
in water), and some are soluble (does
dissolve in water).
■ Insoluble fibers include cellulose, some
hemicellulose and lignins. Sources of
insoluble fiber include all vegetables,
fruit, whole grain bread and cereals,
whole grain crackers, brown rice wheat
bran, etc.
● DYSPHAGIA DIET: Dysphagia is difficulty in swallowing. ■ Soluble fibers are gums, pectins, some
Problems at any point during the swallow can result in hemicellulose and mucilages. Sources
difficulty in swallowing. of soluble fibers are apples, bananas,
○ CHARACTERISTICS: peaches, broccoli, carrots, cabbage,
■ Transition of food can be categorized to oats, dried peas, beans, lentils, etc.
3 levels according to patient’s tolerance ■ A high fiber diet is generally considered
starting with the kind of consistency. to contain about 25 to 30 grams of
○ INDICATIONS FOR USE: dietary fiber per day. The goal of the diet
■ Nervous system disorders, Parkinson’s is to increase the intake of the fiber
disease and Cerebral Palsy rather than to attain a precise level of
■ Gastroesophageal reflux disease intake.
■ Stroke ○ INDICATIONS FOR USE:
■ Head or spinal cord cancer of the head, ■ To avoid or relieve hemorrhoids.
neck, or esophagus ■ Treatment of irritable bowel syndrome
○ DIETARY RECOMMENDATIONS: and diverticulosis (defects in the
■ Thick, homogenous textures weakened walls of the colon).
■ Spoon thick or pudding thick pureed ■ Important in treating diabetes, elevated
foods cholesterol, colon polyps and cancer of
■ No coarse textures as nuts and raw the colon.
vegetables or fruits ■ A balanced diet containing different
■ Liquids are thickened to recommended kinds of fiber can help regulate the
consistency using a commercial bowels, aid in the prevention of heart
thickening agent disease and protect against a number of
● MODIFIED GENERAL DIET: other health problems by helping to
○ is designed for patients who chew soft textures, - protect against cancer of the colon and
based on a soft diet and may be appropriate for rectum.
person with milk oral preparatory stage deficits, ■ For Coronary heart disease, Diabetes
○ The general description of the diet is: mellitus, Gastric ulcer, Atonic
■ soft textures that do not require grinding constipation
or chopping are used.
■ No nuts or crisp, deep-fried foods are
allowed.
■ All liquids and medications are used as
tolerated.
■ Liquids and water may need to be
thickened as needed to recommended
consistency
● LOW RESIDUE DIET
○ DESCRIPTION:
○ FOODS ALLOWED:
■ Diet similar to a low fiber diet, but
■ In addition to a regular diet, this diet
typically includes restrictions on foods
emphasizes foods from the following
that increase bowel activity, such as milk
food groups
and milk products and prune juice.
○ CHARACTERISTICS:
■ The diet consists of foods that are low in
fiber and foods that are believed to
increase fecal residue despite low
content of fiber such as milk. Note that
residue is not the same as fiber, and this
term refers to the end result of digestive,
secretory, absorptive, and fermentative
processes.
■ A low residue diet typically contains less
than 10-15 grams of fiber per day
○ INDICATIONS FOR USE: ● LOW FIBER DIET:
■ Usually used as transition to a regular ○ DESCRIPTION:
diet from soft or Full Diet.
 ■ Diet containing less than 10 to 15 grams
of fiber per day and eliminate foods to
increase the amount of stool.
○ CHARACTERISTICS:
■ This diet contains a minimal amount of
indigestible carbohydrates or dietary
fiber to avoid large fecal volume that
might distend and further aggravate
inflamed tissue.
■ The fiber content of the diet may be
reduced by removing seeds and skins
from fruits and vegetables, cutting off
gristle and connective tissue in meats,
omitting leafy vegetables, fibrous and
dried fruits, nuts seeds and legumes,
and using refined cereals and breads.
■ This diet does not provide the minimal
requirements for some nutrients and is
not intended for long term use. it can be
as a preoperative or postoperative diet
for patients undergoing certain
abdominal procedures or during some
attacks of acute diverticulitis.
○ INDICATIONS FOR USE:
■ Ulceratice colitis
■ Spastic constipation
■ Small bowel obstruction
■ Radiation enteritis
■ Peptic ulcer
■ Narrowing of the intestine
■ Inflammatory bowel syndrome
■ Gastrointestinal surgeries
■ Gastroparesis Chronic diarrhea
■ Acute diverticulitis
○ FOODS ALLOWED:
● VEGETARIAN DIET
○ DESCRIPTION:
■ Plant – based meals consisting of a
variety of whole grains, legumes , nuts,
vegetables, fruits, and for some, eggs
and dairy products.
○ CHARACTERISTICS:
■ The Vegan or Total Vegetarian Diet is
designed for individuals who wish to
exclude all animal products.
■ The Lacto-Vegetarian Diet is designed
for those who wish to consume plant
foods, cheese, milk and other dairy
products.
■ The Lacto-Ovo-Vegetarian Diet includes
the addition of eggs.
■ The Semi-Vegetarian Diet is designed
for individuals who wish to exclude red
meats but include chicken and fish with
plant foods, dairy products and eggs.
○ CONTRAINDICATIONS:
■ The diet requires additional
supplementation and modification to
meet nutritional needs, especially during
illness, pregnancy, lactation, infancy,
and childhood.
○ DIET PRINCIPLES:
■ Obtain an accurate diet history, it is
essential in determining limitations.
■ Provide adequate nutrients by including
mostly foods rich in nutrients and only
small amounts of low-nutrient sweets
and fats.
■ Limit highly processed grains and other
carbohydrates to ensure adequate
intake of trace nutrients.
■ Avoid excess cholesterol intake by
limiting eggs to three to four eggs yolks
a week for those who consume eggs,
■ Enough carbohydrates should be
adequate to ensure proteins are not
being used up as the body’s energy
source
■ Plant proteins alone can provide enough
amino acids when a variety of plant
proteins are eaten throughout the day
and the total; caloric intake meet the
individuals; caloric needs.
● LOW CALCIUM/CALCIUM CONTROLLED DIET:
○ DESCRIPTION:
■ Diet for the control of calcium stones.
For many years, it had been assumed
that a high calcium intake increases the
risk of stone formation. However, severe
calcium restriction does not appear to be
beneficial in reducing frequency of stone
formation for patients with recurrent
urolithiasis and may even be detrimental
as negative calcium balance and
secondary hyperoxaluria occur.
○ CHARACTERISTICS:
■ In normal persons, urinary calcium
excretion has little correlation with
calcium consumption, since intestinal
calcium decreases when dietary intake
is excessive.
■ In idiopathic calcium lithiasis, increased
excretion is the consequence of
increased intestinal absorption of
calcium as a result of increased
production of 1,25- dihydroxyvitamin D3.
Reduction of dietary calcium to less than
600 mg may reduce hypercalciuria in
this patient. Further reduction will not
provide additional clinical benefit, since
a calorie intake below this may cause
negative calcium balance.
■ Diet with normal to high calcium content
but low in animal protein and sodium
decreases the risk of calcium oxalate
stone recurrence.
■ Urinary sodium excretion correlates
directly with urinary calcium excretion. A
high sodium diet therefore increases
calcium excretion and consequently the
risk of stone formation. High sodium
intake also increases the saturation of
monosodium urate, the crystals of which
can act as a basis for calcium
crystallization.
■ Low fluid intake results in low urinary
output resulting in saturated level of
salts in the kidney.
■ Fluid intake should be sufficient to
maintain a urine volume of at least 2500
ml/24 hours. During hot weather, the
amount of fluid that must be consumed
should be greater. At least half of the
fluid ingested should be water,
○ INDICATIONS FOR USE:
■ Urolithiasis (calcium oxalate stones)
● PURINE CONTROLLED DIET
○ DESCRIPTION:
■ Diet containing a minimal quantity of
purine bases (meats); liver, kidney, and
sweetbread especially are excluded and
replaced by dairy products, fruits, and
cereals, alcoholic beverages also are
excluded.
○ CHARACTERISTICS:
■ Examples of purine are adenine and
guanine which form the nucleotides of
nucleic acids and uric acid, which is the
end product of purine metabolism.
Nitrogen forming foods are then
excluded from the diet.
■ Calorie-controlled diet is particularly
important for overweight persons with
gout. Low fat diet favors excretion of
urates.
○ FOODS ALLOWED:
● LOW SODIUM DIET
○ CHARACTERISTICS:
 ■ Diet limiting sodium intake to 2,000mg
per day for preventing and or controlling
edema
○ DIET PRINCIPLES:
■ Prepare all foods with no added salt at
the table. Avoid all processed prepared
foods and beverages high in sodium.
■ Limit amounts of milk, ready-to-eat
cereals, breads and desserts made with
salt and baking powder or soda
■ Some medications including
over-the-counter preparations for
treatment of indigestion or excess acid
contain large amounts of sodium.
■ Water that has been chemically
softened contain considerable amount of
sodium.
■ Salt substitutes may promote
acceptance of sodium restricted diets,
but should be used only if permitted by
physician.
● CALORIE CONTROLLED DIET:
○ DESCRIPTION:
■ The diet is a low-calorie modification of
the regular diet aimed at reducing
caloric intake to effect weight loss.
○ CHARACTERISTICS:
■ Intake of calories from all sources is
limited. Simple carbohydrates, alcohol
and fat content are decreased based on
the client’s nutritional needs and weight
management goals.
○ INDICATIONS FOR USE:
■ Overweight and obese individuals
● LOW CARBOHYDRATE DIETS:
○ It is appropriate to serve persons with diabetes
consistent amounts of carbohydrates at meals and
snacks. Foods should not be restricted to control
blood glucose levels because of the risk of
malnutrition.
● BLAND DIET:
○ A bland diet can be used to treat ulcers, heartburn,
nausea, vomiting and gas. You may also need to
eat bland foods after stomach or intestinal surgery.
○ A bland diet is made up of foods that are soft, not
very spicy, and low in fiber. If you're on a bland
diet, you shouldn't eat spicy, fried, or raw foods.
● LOW CHOLESTEROL DIET
○ Cholesterol is a waxy substance produced by your
liver and obtained by eating animal products such
as meat, dairy and eggs.
○ Your liver will produce less cholesterol if you
consume a lot of this substance from food, so
dietary cholesterol rarely has a great impact on
total cholesterol levels.
○ However, eating large amounts of saturated fat,
trans fat and sugars can raise cholesterol levels.
○ Foods to avoid
○ fatty beef
○ lamb
○ pork
○ poultry with skin lard and shortening
○ dairy products made from whole or reduced-fat
milk
○ saturated vegetable oils, such as coconut oil, palm
oil, and palm kernel oil