Nutritional therapy in systemic diseases

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  • 1.  Nutrition: It is defined as the science of food and its relationship to health. Dietetics: It is the practical application of the principles of nutritions ,it includes the planning of meals for the well and the sick.
  • 2. What are nutrients? Essential substances that your body needs in order to grow and stay healthy.
  • 3.  Macronutrients  Water  Amino Acids and Proteins  Lipids  Carbohydrates Micronutrients  Vitamins (B, C, A, D, E, K)  Minerals (Fe, Ca, P, Na, K)
  • 4.  A balanced diet is one which contains different types of foods in such quantities and proportions, so that the for calories , proteins ,minerals and vitamins and other nutrients is adequately met and a small provision is made for nutrients to withstand short duration of leanness.
  • 5.  Reach and maintain ideal body weight Be careful of serving sizes Avoid skipping meals Increase your daily activity Preserve lean body mass
  • 6.  Infective hepatitis: A high protein ,high carbohydrate,moderate fat is recommended. Small attractive meals regular intervals are better. Overfeeding should be avoided.
  • 7.  Proteins :1.5 – 2g/kg bw. High carbohydrate diet (appox 300- 400g/day). Moderate amount of fat in the diet to make food palatable,no need to totally avoid dietary fat. Vitamins to regenerate liver cells,500 mg of vit c,10 mg of vit k,and supplements of b complex for daily needs. No alcohol intake.
  • 8.  Energy:35-40 kcals/kg IBW. Carbohydrates:65-70% more of simple carbohydrates,complex sugar to be avoided. Proteins:1.2-1.5 gm/kg IBW. Fats:mild to moderate fats are given. Fibre:avoid roughage,give soft cooked vegetables and non citrus fruits. No restriction of salt
  • 9.  Energy of 2000-2500kcals Proteins 1.2 g/kg of body weight Fat:20g of fat is given, Low sodium diet,400-800mg/day Carbohydrates should be given liberally so that liver may store glycogen
  • 11.  Fluids:during the first stage ot treatment fluid should be decreased,to allow disperal of oedema. In later stage fluid replacement should be 500 ml plus daily amount excreted in urine. Energy: 1800-2000 kcals are given like sugar,honey,glucose,sago,and starchy foods.
  • 12.  Protein:if the blood urea nitrogen is elevated and oliguria is present dietary proteins are restricted.rice is preferable as it have low amount of protein than wheat. Sodium:restrition of sodium varies with the degree of oliguria and hypertension,if renal function is impaired ,sodium will be restricted 500-1000 mg/day.
  • 13.  As the patient in nephrotic syndrome are often malnourised and wasted, have poor appetite. Calorie is high 2000kcals Protein is 0.8g/kg of high biological value.and 1 gm of protein per gram of protein loss is advocated. Salt intake should be restricted to 500-750 mg per 24 hours. Restriction of fluid is necessary if oliguria is present.
  • 14.  Potassium supplements is essential with vitamin c supplements
  • 15.  Energy:minimum of 600-1000kcal is necessary. Protein :all foods containing protein are stopped if the patient is under conservative treatment and blood urea nitrogen is rising. Carbohydrates: minimum of 100g/day is essential to minimise tissue breakdown.,if patient is not fed by mouth,a nasogastric tube feeding is done 700ml of 15 % glucose.
  • 16.  Potassium : its intoxication occurs with a daily rise of 0.7 mEq serum potassium.potassium rich sources like tomato juice,coffee,tea,cocoa are avoided.
  • 17.  Energy:it is important to provide calories to enhance positive protein metabolism,in adults 35-50 kcal/kg is given. Protein:falling kidneys need to be given rest protein intake is reduced to 0.5g/kg body weight per day. Fluids:volume of daily urine plus 500ml. Potassium:has to be restricted to 1mmol/kg of body weight.
  • 18.  Adequate fluid intake to ensure urine output of 2 litre or more per day Restrict foods rich in calcium and oxaltes Calcium rich foods are:beans,caulliflower,milk,and milk products. Oxalates:chickoo,spinach,tea,tomato,beef,choco lates,cashew nut
  • 19.  proteins- normal diet Fats :dietary cholesterol needs to be reduced in the presence of hypercholesterolemia ,the total allowance of dietary fat remains unchanged. It should between saturated ,polyunsatrated and monounsaturated fatty acids(30,40,30%)
  • 20.  Rich dietary sources of saturated fat,high in cholesterol: animal fats:beef,meat,pork organ meat fats milk,cream ,butter,ghee,egg yolk. Hydrogenated vegetable oil eg: margarine and vegetable ghee. Diets containing unsaturated fats(low cholestrol diet are not restricted,vegetable oils high in polysaturated faaty acids are safflower,sunflower,groundnut,cottonseed oils.
  • 21.  Calories –about 20 kcal/kg of ideal body weight for sedentary worker,and 25 kcal/kg moderately worker. Protein:normal protein 50-60g are required for a person with optimum weight and mild hypertension,in severe hypertension with renal insufficiency protein should be restricted to 20g. Fats:high intake of animal and hydrogenated oils are discouraged.about 20 g of vegetables oil is permitted.
  • 22.  Carbohydrates should constitute the major bulk of calories. Vitamins in normal amount. Minerals sodium is restricted to 4 to 6 / day.
  • 23.  Morning 1 cup tea with 1 tea spoon sugar and 2 table spoon milk Breakfast:4 slices bread ,1 cup milk,no sugar,1 glass buttermilk. Lunch:2 medium size chapatis,or 1 medium katori rice ,1 medium katori dal ,1 medium katori vegetables
  • 24.  16.00 hours 1 cup tea with 1 teaspoon sugar,2 toasts. Dinner:2 medium size chapatis,1 medium katori vegetables,1 medium katori dal. Bedtime 1 cup skimmed milk ,no sugar . Allowance of fats and oils per day:20 g this diet provides 1320 calories , carbohydrates 198 g protein,protein 51g fats 40 g.
  • 25.  Energy:adult with a good nutritional status needs about 2000kcal,a malnourised patient may require 3000-4000 kcal depending on degree of malnutrition. Protein: A protein amount of 80-100 g to meet maintenance needs to ensure anabolism. Vitamins:vit A, vit C and vit E, Fibre diet should be increased Fats :less than 30% of total calories,avoid saturated fats.
  • 26. A low calories and fat,high in fibre is recommended.Some guidelines for obese patients :1)Set realistic short term and long term goals.2)Avoid fasting or feasting/skipping of meals.3)Always eat breakast with good choice of cereals.
  • 27.  Do not sleep,immediately after eating. Thoroughly chew each and every morsel of food. Avoid alcohol and follow dietary recommendations. Physical exercise is a must to burn away excessive fat.
  • 28.  Energy:a low calorie diet of atleast 1,200 kcal/day is considered safest and most effective. Proteins:intake of 1g/kg of ideal body weight. Fats:a minimum level of 15-20g visible fat should be maintained in diet to provide palatability and essetial fatty acid requirement.
  • 29.  Carbohydrates:high carbohydrates foods contents like potatos , rice are restricted. fruits rich in carbohydrates are avoided. Vitamins:with prolonged restriction of fats,there is restricted fat soluble vitamin A and vitamin D which may be supplemented. Minerls:restriction of sodium as comman salt is helpful. High fibre diet: high fibre low calorie foods like green leafy vegetables,fruits,vegetable salads,whole grains cereals and pulses can be included in the diet.
  • 30.  Diet to restrict foods,beverages that may cause gastric irritation or stimulate excesssive gastric acid secretion. Energy:35 to 40 kcal/kg is given. Proteins :it have buffering effect.milk proteins considered better and do not irriatate gastric mucosa.1.2gm/kg IBW is provided. Fats:it delays gastric emptying and help in meeting the caloric requirement.avoid fried snacks.
  • 31.  Vitamins and minerals:adequate vitamin c and iron is necessary for proper healing. Fibres:raw vegetables,leafy vegetables,fruits(peel) irritates mucosal lining. Foods to avoid:alcohol,coffee,spies,caffeine,spies,pickles,vinegar ,garlic,onions.
  • 32.  A low in fat and purine,high carbohydrate diet is advised to decrease elevated blood uric acid level. Energy:ajusted to 500kcal Carbohydrates:liberal use of fruits and vegetables and soluble fibre is helpful. Protein:skimmed milk and its products should be used. Fats :a low fat diet will promote weight reduction
  • 33.  Fluids:liberal intake in the form of thin buttermilk,vegetable soup, will facilitate urinary excretion of accumulated uric acid and prevent formation of calculi. Foods to avoid:alcohol,sweet breads,sardines,liver,chicken,ham,musroom.meat,custa rd apple.
  • 34.  The diet is designed to improve blood glucose and lipid levels,to encourage healthy eating pattens,promote consistent food intake and avoid undue starvation or overeating.Out of the total calroies provided 60% from carbohydrate,20% proteins,20%fats Energy:calories by IBW ideal body weight,and waist- hip ratio. For overweight 20kcal/kg/day IBW For underweight 40kcal/kg/day IBW For ideal weight: 25kcal/kg/day IBW
  • 35.  For pregnant diabetic woman:30-35 kcal/kg/day IBW. Small , frequent meals, avoiding load to the pancreas. Carbohydrates:the daily intake of carbohydrates should range from 100g to 240-260g.Avoidence of simple cabohydrates like sugar,jaggery,honey. And complex carbohydrates can be given as they do not raise sugar quickly.
  • 36.  Proteins:1 gm/kg is the recommended dietary allowance,skimmed milk amd milk products except (cream,butter),dals,pulses,nuts,fish, are good sources of proteins. Fats:A diet of 15-20 gms of visible fats in limited quantities are given.vegetables fats such as sunflower oil,safflower oil, corn oil,contains a high proportion of polyunsaturated fatty acids which are helpful in controling cholestrol levels.
  • 37. Fibre: dietary fibre is beneficial in type 1 and type 2 DM. fibre present in vegetables,certain fruits,legumes,fenugreek seeds are effective in controlling blood sugar and serum lipid levels.Patients with insulin dependent diabetes must eat multiple meals to avoid hypoglycemia.
  • 38.  Frequent, Small Meals are given. A high energy, high protein and low carbohydrate is given in COPD. vitamins : vitamin A and vitamin E are recommended as they are good source of antioxidants.