NUTRITION AND DIETETICS:

Principles of dietary modification and overview of routine and therapeutic diets

Dietary Modifications - Fried foods and highly seasoned foods are not
1. Dietary modifications are changes made during allowed.
food preparation, processing, and consumption to - A transition diet between the liquid and the
increase the bioavailability of micronutrients— regular diet.
and reduce micronutrient deficiencies—in food at - Usually prescribed in cases of intestinal
the commercial or individual/household level disorder and infection, and during
(Beck and Heath 2013). convalescence.
Classifications of Modified Diets The Liquid Diets
Consistency 1. Clear Liquid Diet
1. Clear liquid 2. Full Liquid Diet
2. Full liquid Full Liquid Diet
3. Soft Contains all foods that are liquid at room temperature
4. Mechanical Soft diet or could be liquefied at body temperature (e.g. can melt
5. Light diet in the mouth and stomach).
6. Pureed diet Provides more complete nutritional regimen than clear
7. Bland diet liquid diet and can be nutritionally adequate by proper
Nutrient Content planning.
1. High fiber Foods allowed: Milk beverages, plain sherbets, and ice
2. Low protein creams, plain puddings, soft custard plain gelatin,
3. NA restricted strained fruit juices, coffee or tea with cream, and
4. Low fat sugar, bland creamed soups, malt and chocolate.
5. Low fiber Indication for use:
Quantity 1. For patients who cannot tolerate solid foods.
1. Obesity 2. May be used post-operatively as transition
2. Vomiting between the clear liquid diet to solid foods.
3. Diarrhea 3. Esophageal disorders
4. Diabetes 4. Surgery of the face, neck area, and dental.
Special Method Of Feeding Clear Liquid Diet
1. Enteral (tube feeding) ✓ Consists of liquid without residue or fiber.
2. Parenteral (intravenous fluid) ✓ Intended to supply fluid and energy in a form
Routine Hospital Diets that require minimal digestion.
✓ Sometimes referred to as “house” diet, constitute to ✓ The primary purpose of the diet is to relieve
the majority of the diet orders in a general hospital. thirst and help maintain water balance.
These are: ✓ It is nutritionally inadequate supplying only
2. The Regular Diet 600-900 kcal/day.
3. The Soft Diet ✓ Clear liquid diet must not be used more than 2
4. Liquid Diets days.
✓ All liquid diets must be giving in small,
The Regular Diet frequent feedings.
- Also called “general”, “house diet”, “full ✓ Plain tea, black coffee, fat free broth, ginger-
hospital diet”. ale, plain gelatin, and glucose solution are the
- It is a normal diet planned to provide the usual liquids given.
recommended daily allowances for the Indication for use:
essential nutrients and to meet the caloric 1. Before and after surgery.
needs of a bedridden or an ambulatory patient 2. To minimize stimulation of gastrointestinal
whose general condition does not require tract.
general modification or dietary restrictions. 3. Must not be used without supplementation for
The Soft Diet a prolonged period of time.
- A regular diet with modifications in Variations of the Routine Hospital Diets
consistency and texture. 1. The light diet 6. Vegetarian diets
- Designed for patients who are psychologically 2. The mechanical soft diet 7.Diet as tolerated
and physically unable to tolerate general diet. 3. The cold liquid diet
- Low in fiber and connective tissues. 4. Tube feedings
- Bland in flavor. 5. Dysphagia diets
NUTRITION AND DIETETICS:
Principles of dietary modification and overview of routine and therapeutic diets
Light Diet
✓ A transition between the soft and regular diet.
✓ Consists of foods that are easily digested and
readily emptied in the stomach.
✓ Indicated for elder ones who cannot tolerate
rich and heavy foods.
✓ Given in 3 small meals with between meal
feedings.
✓ Foods not allowed: fatty foods, rich pastries,
concentrated desserts, and fibrous fruits and
vegetables.
The Mechanical Soft Diet
✓ 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, and
for those who are too ill to eat the regular diet.
✓ Foods should be well-cooked, easy to chew
and if necessary, chopped ground or minced.
✓ Foods are best served moist or with gravy and
sauce.
✓ All beverages are allowed, although patients
with lesions in the mouth may not be able to
take tart fruit juices.
Cold Liquid Diet
✓ Sometimes referred to as the T&A diet (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 Feeding
✓ Requires consistency that can pass through a
polyvinyl tube.
✓ There are may proprietary foods that are
suitable for tube feedings.
Dysphagia Diet
Dysphagia – defined as a difficulty in swallowing and
as a symptom of a disease or dysfunction that results
from a neurological, mechanical, structural, or
behavioral disorder or condition.
✓ The purpose of the nutrition care is to provide
energy, nutrients, and fluids in a consistency
tolerated by the individual and adjusted
according to their changing needs.
NOTE: To provide sufficient nutrients to maintain or
achieve a normal nutrition status, nutritional management
may involve:
1. Alteration in food texture
2. Alteration in fluid viscosity/consistency
3. Incorporation of high-protein, high energy
recommendations as necessary
4. Use of alternative feeding routes (enteral or
parenteral) either on a temporary or permanent
basis to replace or supplement oral intake.
Stage 1: Pureed Diet
✓ This diet consists of thick, smooth, homogenous,
semi-liquid textures.
✓ Appropriate for persons with impaired lip and
tongue control, delayed swallow reflex
triggering, oral hypersensitivity, reduced
pharyngeal peristalsis and/or cricopharyngeal
dysfunction.
The general diet description is as follows:
1. Thick, homogenous textures are emphasized
2. Should be “spoon-thick” or “pudding-like”
consistency”.
3. No coarse textures, nuts, raw
fruits/vegetables.
4. Liquids or crushed medications may be
mixed with pureed fruits.
5. Liquids and water are thickened as needed
with a thickening agent.
Stage 2: Ground/Minced Diet
✓ This diet is designed for patients who can tolerate
a minimum amount of easily chewed foods and is
appropriate for persons with moderately impaired
oral preparatory stage abilities, edentulous oral
cavity, and decreased pharyngeal peristalsis.
The general diet prescription of the diet is as follows:
✓ No coarse texture, nuts, raw fruits (except very
ripe/mashed bananas) or vegetables.
✓ Pureed or slurried bread, if necessary.
✓ Liquid or crushed medication may still be
required.
✓ Liquids and water are thickened as needed to
recommended consistency with a thickening
agent.
Stage 3: Soft/Easy to chew diet
✓ Is based of mechanical diet and consists of soft
foods prepared without blenderizing or pureeing.
✓ Designed for patients who may have difficulty in
chewing and swallowing certain foods.
NUTRITION AND DIETETICS:
Principles of dietary modification and overview of routine and therapeutic diets
The general description of the diet is as follows:
1. Textures are soft with no tough skin.
2. No nuts or dry, crispy, raw, or stringy foods.
3. Meats should be minced or cut in small pieces.
4. Liquid or crushed medication may still be
required.
5. Liquid and water are thickened as needed to
recommended consistency.
Vegetarian Diet
This diet is designed to utilize a combination of vegetable
protein providing a similar quantity or quality of protein
as animal protein. The main classifications are:
1. Vegan diet
2. Ovo-vegetarian
3. Lacto-ovo vegetarian
4. Semi-vegetarian
5. Pesco-vegetarian
Vegan Diet
✓ Also called the “total vegetarian” or strict
vegetarian diet.
✓ Foods allowed are strictly of plant origin devoid
of any animal product.
Lacto-vegetarian Diet
✓ In this diet, milk and milk products are allowed in
addition to food items of plant origin.
Ovo-vegetarian Diet
✓ In this regimen, eggs and eggs products are
allowed besides items of plant origin.
Lacto-ovo-vegetarian Diet
✓ Eggs, milk, and their products are both allowed in
addition to food items from plants.
Semi-vegetarian Diet
✓ Fruits, grain, legumes, nuts and seeds, vegetables,
milk and milk products, eggs, chicken and fish are
included in the diet. All animal meats are
excluded.
Pesco-vegetarian Diet
✓ In this diet, fish and fish products are added to the
list of items of plant origin, all animal meats are
excluded.
Diet As Tolerated (DAT)
✓ When the physician writes the diet order D.A.T.,
immediate nutritional screening and interview
with patient is necessary.
✓ May range from full liquid diet to regular diet.
✓ Should be temporary measure lasting no more
one day until a more specific diet is ordered based
on results of examinations.
Therapeutic Diet
Minimum Residue Diet
For diseases and conditions involving the bowel like
dysentery, diarrheas, pre and post-colostomy, ileostomy,
and bowel resection.
✓ Foods allowed: Plain and strained soups, lean and
tender beef, liver, chicken (no skin), fish, well
cooked strained vegetables and fruits.
✓ Food not allowed: milk and milk drinks, raw
eggs, vegetables, fruits, etc.
Bland Diet
✓ For gastric and duodenal ulcers, gastritis,
ulcerative colitis, in some cardiac cases in order
to provide rest to the heart.
✓ Non-irritating foods.
✓ Foods allowed: those which are mild in flavor,
non-stimulating, and no coarse fiber.
✓ Foods not allowed: Black pepper, chili powder,
strong coffee and alcohol.
High Calorie
✓ For underweight, PEM, fevers, infections, burns,
pregnancy, and lactation.
✓ Foods included: all foods in the normal diet with
increased amount of fats and sugars.
✓ Foods avoided: excessive amounts of bulky low
calorie foods.
Low Calorie
✓ Obesity and those cases where excess weight is a
complicating factors as CVD, DM, renal disease,
HPN, gout, etc.
✓ Reduced amount of total energy.
✓ Foods allowed: sufficient bulk, low in calories for
a satisfied feeling.
✓ Foods not allowed: High fat foods, High CHO
foods.
High Carbohydrate Diet
✓ For renal and liver disturbances, toxemia of
pregnancy, addison’s disease, preparation for
surgery, etc.
✓ CHO in the diet is increased by 50% and above
the normal.
✓ Foods included: foods that are rich with
carbohydrates.
Low Carbohydrate Diet
✓ Hyperinsulinism, dumping syndrome, obesity,
epilepsy, celiac disease.
✓ CHO in the diet are reduced by 50%; proteins and
fats are increased.
✓ Foods included: foods high in protein; adequate
to high fats.
High Protein Diet
✓ For growth, pregnancy, lactation, PEM, burns,
surgery, fever, etc.
✓ Protein increased by 50-100% above the normal
allowance.
✓ Foods included: protein-rich foods with emphasis
on the High Biologic Value proteins such as milk,
eggs, meats.
NUTRITION AND DIETETICS:
Principles of dietary modification and overview of routine and therapeutic diets
Low Protein Diet Acid-Ash Diet
✓ Acute glomerulonephritis, uremia, hepatic coma, ✓ For kidney stones, calcium and magnesium
chronic glomerulonephritis. phosphates, carbonates, and oxalates.
✓ Protein restricted to 50% below normal ✓ Acid ash foods are: meat, fish, poultry, eggs,
allowance about 20-30 grams/day. whole grain cereals, prunes, corn, and lentils.
✓ Adequate carbohydrates and fats to spare the ✓ Neutral foods: butter, sugars, oils and fats.
protein. ✓ Avoided: milk, fruits, and vegetables.
Protein-Free/Zero Diet Alkaline-Ash Diet
✓ For hepatic coma, acute anuria. ✓ Kidney stones-uric acid and cystine calculi.
✓ Use only as an emergency measure. ✓ Alkaline-ash foods are emphasized, acid-ash
Purine Restricted Diet foods are limited to those necessary. Neutral
✓ For gout and uric acid calculi. foods are used as desired.
✓ A diet in which uric acid and its precursors, ✓ Alkaline-ash foods are: Large amounts of fruits,
specifically, sources of purines such as glandular vegetables, and meat.
meats, dried legumes, lentils, meat extracts are ✓ Avoided: acid-ash foods.
limited. BRAT Diet
✓ The diet is high in carbohydrates and fats. ✓ For diarrhea.
Phenylalanine Restricted Diet ✓ Consists of Banana, Rice, Apple, Tea. Crackers
✓ For phenylketonuria. may be used instead of rice.
✓ A diet in which the intake of the amino acid ✓ Foods avoided: all others.
phenylalanine is limited to the prescribed level Hypoallergenic Diet
governed by patient intolerances usually 250-500 ✓ For food allergies.
mg phenylalanine/day. ✓ Should be individualized based on an individuals
✓ Foods avoided: Protein Foods specific food allergies.
Gluten Restricted/ Gliadin Free Diet Summary
✓ For celiac disease, non-tropical sprue, dermatitis, ✓ Routine Diets are: Regular Diet, Soft Diet, and
herpetiformis. Liquid Diet.
✓ A diet that is free of toxic gluten. ✓ Therapeutic Diets are: Full liquid diet, clear
✓ Foods limited: wheat, rye, oats and barley, protein liquid diet, cold liquid diet, tube feedings, low
and their derivatives. residue diet, bland diet, low fiber diet, high fiber
Low Fat Diet diet, high calorie, low calorie, etc.
✓ Malabsorption with steatorrhea, acute attacks of
pancreatitis and cholecystitis, in type 1
hyperlipidemia, celiac disease.
✓ Fat diet allows from 10-15% of TER as fat
calories or 20-30 grams fat/day.
✓ Foods allowed: skimmed milk, egg, lean meat,
cereals, fruits, vegetables, and sugars.
✓ Avoided: Fatty foods.
Sodium-restricted Diet
✓ Provides adequate diet with prescribed level of
sodium according to individual needs.
✓ Foods allowed: low sodium content foods.
✓ Foods avoided: canned, cured processed foods,
salt, patis, vetsin, and toyo.
Potassium-restricted Diet
✓ For renal failure, hyperkalemia, Addison’s
disease, oliguria, and anuria.
✓ Potassium in the diet is reduced to 1.0-1.5
grams/day.
✓ Foods allowed: cereals, bread, sugars, fats,
protein foods in prescribed amount.
✓ Avoided: Milk, cream, eggs, meat, fish, and
poultry.