105 reviewer pt2

NUTRITION & DIET THERAPY

LESSON 4: SELECTED THERAPEUTIC DIETS

 Diabetic diet
 Renal diet
 Cancer: Nutrition Prevention and Treatment
Diabetes Mellitus
 is a metabolic disorder in which the body does not produce enough or respond normally to insulin, causing
blood sugar (glucose) levels to be abnormally high
 results from defects in Insulin either:
• Secretion (Type 1 Diabetes Mellitus)
• Action (Type 2 Diabetes Mellitus)
 Insulin
• Hormone, secreted by pancreas.
• Controls the amount of glucose in your bloodstream.
• Stimulates glucose utilization in skeletal muscles, heart and some tissues.
• Regulates your body’s metabolism of carbohydrates, fats, and proteins.
Signs and Symptoms
 Elevated blood sugar : >140mg/dl(hyperglycemia)
 Increased hunger (polyphagia)
 Frequent urination (polyuria)
 Increase thirst (polydipsia)
 Sugar in the urine (glycosuria)
 Dramatic weight loss and weakness
Metabolism in Diabetes Mellitus
• Carbohydrate; Protein; fat glucose
• Carbohydrate – 100%
• Fat- 10%
• Protein- 58%
• Hyperglycemia: increase blood sugar.
• Lipolysis(fat breakdown)
• Lipogenesis(fat formation)
Management of Diabetes Mellitus
1. Insulin or oral hypoglycemic agents
2. Healthy eating
3. Exercise
4. Avoid stress factors
Goal: glycemic control
Dietary Management of DM
• Diabetic diet
• Individualized to meet the patient’s needs
• Sufficient calories
• Maintain desirable body weight
• Adequate in macronutrients and micronutrients
Glycemic control
 maintaining a nearnormal blood glucose level as possible(100mg/dl-140mg/dl)
 3 factors affecting glycemic control
• Insulin or oral hypoglycemic agents
• Food
• Exercise
Hypoglycemia
 decrease blood sugar level
Causes:
• skipped meals, delayed meals, inadequate food intake, too much insulin or oral hypoglycemic agents
Food Guidelines in Planning a Diabetic Diet
• Carbohydrates
• Recommended amount: 45%-70% of total calories from carbohydrates; 10% of total calories from
sugar
Dietary Management of DM
 Registered dietician determines the total amount of carbohydrate that will be consumed per meal/snack
Suggestions: Fruits, vegetables, whole grain bread, cereals, pasta, brown rice, legumes, and low-fat milk
 Fiber : 20-35g/day
 Protein: 10%-35% of total calories
 Total fat: 25%-35% of total calories Dietary cholesterol : 10 % of total calories
Suggestions: Limit saturated fat found in meat, dairy products and certain vegetable oil such as palm oil and coconut oil.
Keep trans fat to a minimum food in margarine, shortening and commercially baked products.
 Sodium : <2,400 mg/ day

Renal Diet
 Kidneys:
 Are 2 bean-shaped organs, each about the size of a fist. They are found in your back on either side of the spine.
Functions
• remove waste products from the body
• remove drugs from the body
• balance the body's fluids
• release hormones that regulate blood pressure
• produce an active form of vitamin D that promotes strong, healthy bones
• control the production of red blood cells
 Renal Disorders 2 Groups:
• Acute Renal Failure: sudden decline in kidney function but is temporary.
 Changes in the chemistry of the body including fluid and mineral balance Renal Disorders
• Chronic Renal Failure
 Known as CKD (Chronic Kidney Disease)
 Deterioration of the kidney function
 Hemodialysis or kidney transplant

Management of Renal Disorders

• Nutritional Management Renal Diet
 Known as “kidney diet”
 Depend on the stage of kidney disease
 Controlling amount of protein, sodium, phosphorus, potassium and fluid

Renal Diet
 Goal : help the patient to feel better; limit their symptoms; slow the progression of kidney failure
Diet recommendations
• Stage 1 and 2
 0.8 g protein/kg/day (12-15% of caloric intake per day)
 CHO intolerance is common. : fructose, galactose, sorbitol
 low in saturated fat&cholesterol
 Limit the following: a. Phosphorus <1000mg per day: b. Sodium ,2000 mg per day: c. Calcium <2000
mg per day
 Do not supplement Vit.A and Mg  fluid is unrestricted until urine output decreases
 • Stage 3
 0.6-0.8g protein/kg
 30-35 kcal
 Low sodium if hypertensive
 Low intake of phosphorus if serum phosphorus >4.5
 Moderate vit.c
 No vit.A, Magnesium
• Stage 4
 Same protein, calories, vitamins
 Intake of iron if on erythropoietin
 Fluid intake approximately up to urine volume Diet recommendations Limit the following:
 Potassium
 Phosphorus
 sodium Diet recommendations
• Stage 5 : Dialysis
 No protein restrictions Goal: 1.2 g/kg wt on hemodialysis : 1.3 g/kg wt on peritoneal dialysis
 Phosphorus: 12mg/day
 Potassium 2500mg/day Diet recommendations 
 Fluid restriction approx urine volume
 Sodium restricted to 2-2.5 g/day depending on losses of body fluid from diarrhea, vomiting etc.
 Renal vitamins should be after dialysis( Vit. B,C D, Fe, Zinc)
Cancer: Nutrition Prevention and Treatment
 uncontrolled growth and spread of abnormal cells tumor
 Develop in various sites and require different methods of management.
 Oncology is the study and the sum of knowledge of tumors.
Causes:
 Lifestyle factors:
• Smoking
• inactivity
• high fat diet
• refined sugar diet
 Chronic inflammation
 Environmental factors:
• Exposure to UV light from the sun 
• Exposure to substances: arsenic and asbestos
Cancer Prevention
• Diet and Health Guidelines for Cancer Prevention
 Eat plenty of vegetables and fruits -high fiber, antioxidant, Vit.E and C, folate, magnesium.
 Maintain healthy weight
 Be Physically Active
 Cancer Prevention
 Drink Alcohol in Moderation(acetaldehyde)
 Select foods Low in Fat and Salt
 Prepare and Store Foods safely(aflatoxins)
How do Cancer affect Nutritional Status of the Host?
• Cancer Cachexia is progressive wasting syndrome characterized by extensive loss of adipose tissue
and skeletal muscle
Common Dietary Problems associated with Cancer Treatment
• Cancer treatments has different effects on the nutritional status.
• Patient may experience:
 No appetite: small frequent meals; high calorie drinks (milkshakes, juice)
 Altered taste: lemon juice; cold foods
 Fatigue: prepare easy meals; eat at good beakfast
  Common Dietary Problems associated with Cancer Treatment
 Nausea and vomiting: avoid fatty foods, foods with strong odor.; avoid reclining directly after meals
 Diarrhea: avoid lactose-containing beverages and foods; avoid roughage
 Constipation: increase water and fiber intake
Effectiveness of the Nutritional Plan of Care
4 Domains of Nutrition Monitoring and Evaluation
 Food/Nutrition-Related History Outcomes
 Anthropometric Measurement Outcomes
 Biochemical Data, Medical Tests, and Procedure Outcomes
 Nutrition-Focused Physical Finding Outcomes
Food/Nutrition-Related History Outcomes
• Food and nutrient intake
• food and nutrient administration, medication, complementary/alternative medicine use,
• knowledge/beliefs, food and supplies availability, physical activity, nutrition quality of life
Anthropometric Measurement Outcomes
• Height, weight, body mass index (BMI),
• growth pattern indices/percentile ranks, weight history
Biochemical Data, Medical Tests, and Procedure Outcomes
• Lab data (e.g., electrolytes, glucose)
• tests (e.g., gastric emptying time, resting metabolic rate)
Nutrition-Focused Physical Finding Outcomes
• Physical appearance
• muscle and fat wasting,
• swallow function, appetite, and affect

NUTRITION RELATED HEALTH PROGRAMS AND SERVICES

DEPARTMENT OF HEALTH NUTRITION PROGRAMS

A. FOOD FORTIFICATION PROGRAM
 Mandated by republic act no.8976: philippine food fortification act of 2000.
 Signed into law by former pres. Estrada on nov.2, 2000
 Mandatory fortification of staple foods and voluntary fortification of processed foods OR FOOD
PRODUCTS.
 FORTIFICATION
• Addition of nutrients to processed foods or food products at levels above the natural state.
• Processing of food some nutrients are lost during transformation. To replenish nutrient loss
during food transformation, nutrient fortification become important aspect in food processing
food fortification program
• Mandatory FORTIFICATION OF THE FF. FOODS:
 Rice (iron); wheat flour (vit.a and iron); refined sugar (vit.a ); cooking oil (vit.a)
 Food manufacturers are required to indicate “nutrition facts” on the label (kind and
amount of nutrient added)
• bfad and national nutrition council - agencies involved in implementation of this food
fortification
B. GARANTISADONG PAMBATA
 Started in 1999, garantisadong pambata (gp) is a response to the call of the united nations children’s fund
(unicef) to reduce mortality of children aged five years old and below.
 It is an integrated package of services concerning health, nutrition, and environmental sanitation that
mainly covers micronutrient supplementation of vitamin a and iron among children.
 Conducted every third week of april and october delivering health services such as deworming and vitamin
a supplementation.
C. INFANT AND YOUNG CHILD FEEDING
 A GLOBAL STRATEGY ISSUED JOINTLY BY THE WORLD HEALTH ORGANIZATION (WHO) AND THE UNITED
NATIONS CHILDREN’S FUND (UNICEF) IN 2002 TO REVERSE THE DISTURBING TRENDS IN INFANT AND
YOUNG CHILD FEEDING PRACTICES.
 GOAL : REDUCTION OF CHILD MORTALITY AND MORBIDITY THROUGH OPTIMAL FEEDING OF INFANTS
AND YOUNG CHILDREN INFANT AND YOUNG CHILD FEEDING
 WHO AND UNICEF RECOMMEND:
 -EARLY INITIATION OF BREASTFEEDING WITHIN 1 HOUR OF BIRTH;
 -EXCLUSIVE BREASTFEEDING FOR THE FIRST 6 MONTHS OF LIFE; AND
 -INTRODUCTION OF NUTRITIONALLY-ADEQUATE AND SAFE COMPLEMENTARY (SOLID) FOODS
AT 6 MONTHS TOGETHER WITH CONTINUED BREASTFEEDING UP TO 2 YEARS OF AGE OR
BEYOND.
D. MICRONUTRIENT SUPPLEMENTATION PROGRAM
 TO REDUCE PREVALENCE OF MICRONUTRIENT DEFICIENCIES (VITAMIN A, IRON AND IODINE)
BELOW PUBLIC HEALTH SIGNIFICANCE
 MANDATE: AO 36, S. 2010
 INTERVENTIONS/ STRATEGIES:
1. MICRONUTRIENT SUPPLEMENTATION
• IS THE PROVISION OF PHARMACEUTICALLY PREPARED VITAMINS & MINERALS FOR TREATMENT
OR PREVENTION OF SPECIFIC MICRONUTRIENT DEFICIENCY. MICRONUTRIENT
SUPPLEMENTATION PROGRAM
2. FOOD FORTIFICATION
• THE ADDITION OF ESSENTIAL MICRONUTRIENTS TO WIDELY CONSUMED FOOD PRODUCT AT
LEVELS ABOVE ITS NORMAL STATE.
3. IMPROVING DIET/ DIETARY DIVERSIFICATION
• THE ADOPTION OF PROPER FOOD AND NUTRITION PRACTICES THRU NUTRITION EDUCATION
FOOD PRODUCTION & CONSUMPTION.
4. GROWTH MONITORING AND PROMOTION
• IS AN EDUCATIONAL STRATEGY FOR PROMOTING CHILD HEALTH, HUMAN DEVELOPMENT AND
QUALITY OF LIFE THROUGH SEQUENTIAL MEASUREMENT OF PHYSICAL GROWTH AND
DEVELOPMENT OF INDIVIDUALS IN THE COMMUNITY.

LESSON 3: EVIDENCED BASED GUIDELINES IN NUTRITION

 EVIDENCE BASED GUIDELINES IN NUTRITION PRACTICE

 SERIES OF GUIDING STATEMENTS AND TREATMENT ALGORITHMS DEVELOPED USING A SYSTEMATIC
PROCESS FOR IDENTIFYING, ANALYZING AND SYNTHESIZING SCIENTIFIC EVIDENCE.
 ASSIST IN DECISIONS ABOUT APPROPRIATE NUTRITION CARE FOR SPECIFIC DISEASE STATES OR
CONDITIONS IN TYPICAL SETTINGS.