FUNDAMENTALS OF DIETETICS

FN 221
 AIM

• This course aims to introduce students to

basic dietetic concepts and care process to
provide them with fundamental dietary
management skills for the improvement of
nutrition outcomes.
 Introduction
• This course is an introduction to principles and
practices of dietetics.

• The course focuses on basic concepts and

principles of dietary management and
application of the knowledge in a clinical
setting to guide evidence-based decision-
making processes.
 Objectives

• Define dietetics and related concepts

• Describe the nutrition methods of assessment
• Demonstrate ability to estimate the
patient’s/client’s nutrient needs
• Devise therapeutic meal plans based on
nutritional requirements estimations
 OBJECTIVES CONT’D
• Design dietary advice according to the
individual needs.
• Demonstrate counseling skills in nutrition care
and support
• Demonstrate ability to deliver group
education sessions in the context of
nutritional therapy.
• Use current nutrition software
 Course outline
UNIT 1
Importance of dietetics
– Definition of dietetics and other concepts
– The nutrition support team and the roles of its
members
– Competencies of dietician
– Ethics and ethical issues in clinical nutrition and
dietetics
 UNIT 2
Introduction to hospital nutrition
– Intro to clinical setting & what to expect
– intro to medical terminology & abbrev
– Factors that lead to malnut in hospitals
– Effects of malnut on hospitalized patients
– Methods of improving hospital nutrition
• Food brought to hospital from home
 Unit 3
The Nutritional Care Process
• Nutrition Screening
–Definition
–Importance
–Tools in nutrition screening
• Malnutrition Universal Screening Tool (MUST)
• Subjective Global Assessment (SGA), etc.
 NCP cont’d
Methods of Assessment
Anthropometric measures
• Body weight, height, body mass index
• Skin fold thickness
• Circumferences
• Muscle thickness
• Body composition
 NCP cont’d
– Biochemical methods
• Diagnostic tests (e.g. mal-absorption,
glucose intolerance, Hb)
• Bioelectrical impedance (BIA)
• Isotopic techniques (deuterium)
– Clinical examination
• Nutrition diagnosis
 NCP cont’d
– Dietary intake assessment
• Duplicate food methods
• Weighed food intake
• Diet history
• Diet diaries
• Food consumption score
• 24 hour recall
 NCP cont’d
• Nutritional diagnosis

• Introduction to international Nutrition

Diagnostic Terminologies (IDNT)
 NCP cont’d
• Nutrition intervention
– Developing a nutrition Care Plan
• Key elements
– Interventions and tools (diet sheets, diet
modification, dietary counseling)
– Methods of Estimating Nutritional
Requirements
• Estimating energy requirements using prediction equations and factors:
• Schofield equations
• Harris-Benedict equation
• Ideal Body Weight (IBW) formula
 NCP cont’d
• Monitoring and Evaluation
– Definition
– Importance
– Ongoing support and monitoring
• Re-assessment
 Unit 4
• The Nutrition Report and Medical charting
styles
– Assessment, Diagnosis, Intervention, Monitoring &
Evaluation (ADIME)
– SOAP
 Unit 5
• Effects of Drugs on Nutrition
– Drugs affecting intake of food and nutrients (e.g.
appetite)
– Absorption of Nutrients
– Appetite
– Nutritional status
– Increased nutrient requirements
– Alterations in nutrient metabolism (Tyramine,
CHO, Lipid, vitamin and mineral metabolism)
 Unit 6
• Use of dietetic software and other job aids
– Food finder
– Food models
– Nutrisystem
– Food models
 Unit 1
Importance of dietetics
 Unit outline
- Definition of dietetics and other concepts
– The nutrition support team and the roles of
its members
– Competencies of dietician
– Ethics and ethical issues in clinical nutrition
and dietetics
 Introduction
• Nutrition is the science of food, the nutrients
and other substances therein, their function,
interaction and balance in relation to health
and disease.
 Introduction cont’d
• Nutrition is also the process by which an
organism ingests, digests, absorbs, transports,
utilizes and excretes food substances.

• Nutrition is concerned with social, economic,

cultural and psychological implications of food
and eating.
 Introduction cont’d
• Dietetics is a branch of nutrition that translates
and interprets the science of Nutrition in order
to prevent and manage disease condition of
individuals or population groups.
• The science of the principles of nutrition and
their application in the pursuit of health.
• Dietetics includes the scientific selection of
meals for people with digestive, metabolic and
malnutritional disorders.
 Introduction cont’d
• In order to enhance the quality of life,
dietetics borrows some of the principles it
uses from the social sciences.
– E.g. skills that are needed in order to influence
behavioral changes
 Importance of dietetics
1. improves the quality of life of individuals or
population groups. Dietetic advice reduces
morbidity and mortality rates.

2. Dietetics is involved in the treatment and

control of some disease conditions.
 Importance of dietetics cont’d
• Note: all diseases need good nutrition but
some conditions need dietary advice more
than the others.
Nutrition can therefore be:
• supportive (most disease condition)
• primary mode of treatment/management e.g
Diabetes, Renal Disease
 Importance of dietetics cont’d
3. Dietetics reduces the expenditure on
treatment/management of diseases i.e disease
conditions heal faster or control is easier and
faster.
4. Dietetics reduce patient suffering i.e reduces
hospital admission
5. Dietetics prevent in-patients from developing
malnutrition
6. Dietetics enhances national development
 THE NUTRITION SUPPORT TEAM AND THE ROLE OF ITS
MEMBERS

• A well-coordinated nutrition support team can

contribute effectively to patient care.
• The nutrition support team comprises of
doctors, nurses, pharmacists, nutritionists or
dieticians and other junior health care staff
such as the caterer.
• (Nutrition support is also vital when artificial
nutrition support such as parenteral nutrition
is required).
 Physician
• Leads the nutrition care implementation structure
• must be familiar with all aspects of nutrition care,
including patient screening, assessment,
development and implementation of a nutrition
care plan, patient monitoring and termination of
therapy.
• supervises care provided by dietitians, nurses and
pharmacists, and engage in all aspects of direct
care of patients’ nutrition needs as indicated.
 Physician Assistants
• Physician Assistants often practice in specialty
areas or primary care and are able to
prescribe nutrition support therapy along with
medications, treatments, and diagnostic tests
related to nutrition support therapy.
 Dietitians
primary roles
-conduct individualized nutrition screening and
assessment;
-develop and implement a nutrition care plan;
-monitor the patient’s response to the nutrition
care delivered;
-and develop a transitional feeding care plan or
termination of nutrition support as appropriate
 Pharmacists
- compound the parenteral nutrition
formulation prescribed and provide direct
patient care.
- manage the specialized nutrition support
program and improve quality
by educating other health care professionals,
students, patients and caregivers.
- Many pharmacists also conduct research or
participate in research activities.
 Nurses
• responsibilities vary with the practitioner’s
educational background, position and practice
environment.
• The scope of practice includes but is not
limited:
-directing patient care including intravenous
access
-education of patients and caregivers and
-participation in research activities.
 Social Work in Hospital-Based Health Care

• play a critical role by helping patients and

families address the impact of illness and
treatment.
• Stressors such as decreased personal control,
information overload, change in functional
ability and reduced financial resources, can
lead to a range of emotional responses such
as, anxiety, anger, and depression.
 Social work cont’d
• Social workers assess and provide appropriate
interventions to aid the patient in achieving
optimum recovery/rehabilitation and quality
of life.
• This includes maximizing the benefit the
patient and family receive from their medical
treatments and also timely discharge.
Competences of a dietician
 Definition
• a cluster of related abilities, commitments,
knowledge and skills that enable a
person/organization to act effectively in a job or
situation.
• indicates sufficiency of knowledge and skills that
enable someone to act professionally in a wide
variety of situations.
• Each level of responsibility will have its own
requirements. Competence is vital at any stage of
career.
 Skills and Abilities Competency
• Communication
• Research
• Management
• Cultural Competency
• Professionalism
 Communication
Learning outcome
1. Conducts effective communication

Performance criteria
1. Uses oral, written and listening skills to
establish and maintain effective relationships
with individuals and groups
2. Uses written and oral English with ease
 Performance criteria

3. Communicates with people in a manner,

which is appropriate to their level of
understanding, culture, background and
preferred ways of communicating
4. Uses assertiveness techniques appropriately
 Performance criteria
5.Uses effective negotiation skills to resolve
issues and ensure best outcomes
6. Uses advocacy to promote the role of the
dietitian and ensure best nutrition outcomes
values
7. Facilitates learning by applying appropriate
learning theory
 ETHICS AND ETHICAL ISSUES IN CLINICAL NUTRITION AND
DIETETICS

• This guides the profession, stating clearly, the

commitments and obligations of the health
professional to conduct him/her accordingly

• ethical guidelines have been developed by

some associations and countries covering
various aspects
 common aspects covered in ethical
guidelines
• (For details refer to code of ethics for
dieticians for American Dietician Association
or Swedish code of ethics for dieticians)
 1. obligation to the Patient

• To regard the patient as autonomous, i.e. to

see the patient as having the capability to
make decisions concerning his/her own life
• To treat patient information confidentially and
to observe legal binding professional secrecy
 2. Professional conduct/code of conduct

• adhere to the profession’s established and

accepted correct use of language, in an
understandable form, when informing
patients and staff, written publications and in
contacts with the media
• Not to allow thoughts of personal gain to
influence the treatment and information given
• To document the nutritional treatment
3. Obligation towards the next of kin or equivalent

• To inform the next of kin about the treatment

only after having obtained the patient’s
consent.

• To involve the next of kin in the treatment

only after having obtained the patient’s
consent
4. Obligation towards colleagues and other professional groups

• To work for a trustful co-operation towards

common goals
• To work jointly with other professionals in order
to promote the interest of the patient in the
best way possible
• To explain one’s own field of competence and
fulfill the obligation associated with the position
• To respect the competences and fields of other
professionals
 5. Obligation towards the employer

• To adhere to the employer’s guidelines and to

show loyalty towards the employer as far as
this is consistent with other demands of
professional ethics
 6. Obligations towards society
• To take responsibility towards society, mainly
through providing information on matters
concerning nutrition and nutritional
treatment, using one’s own competence
based on scientific evidence and proven
experience.