Nutrition with diet therapy(draft)

Nutrition with Diet
Therapy Janler M. Paderes ,RN

Learning Objectives
To enable the review students to:
Define terms related to nutrition.
Identify essential and basic tools in nutrition
Explain the role of the following basic nutrients. carbohydrates, protein, lipids,
water, vitamins, and minerals.
Calculate the calorie content of foods on their carbohydrate, protein, and fat
content
ldentify how diet guidelines and menu planning promote nutrition and health.
ldentify appropriate measures to be employed in meeting nutritional imbalance
ldentify the most common appropriate therapeutic diets used in clinical care
Prepare a sample menu based on recommended daily allowance.

Nutrition
General Nutrition (definition)
The process of obtaining the food necessary for health & growth.
• Using nutrition to keep you alive & functioning.
Optimal Nutrition(definition)
Eating the right amounts of nutrients on a proper schedule to achieve the
best performance and longest possible lifetime in good health.
Using nutrition to maximize health, happiness & well being.

Food
• Food is any substance consumed to provide nutritional support for an
organism.

Nutrient
• is a chemical component needed by the body to
provide energy, to build and repair tissues and to
regulate life process.

Concept of Nutrients as Building
Blocks
There are six classes of nutrients
1. Carbohydrates
2. Proteins
3. Fats
4. Vitamins
5. Minerals
6. Water

Classification of Nutrients
Classification of Nutrients
1) According to function:
- Function as energy giving, body building, body regulating.
2) According to chemical properties:
-Organic – protein, lipids, carbohydrates and vitamins
-Inorganic – water & minerals
3) According to concentration
-Macro nutrients – Carbohydrates, Protein, Fats
-Micro nutrients – Vitamins, Minerals & water

Nutrition Tools
Standards & Guidelines

Nutrient Recommendations
A. Dietary Reference Intake
• DRI is the general term for a set of reference values used to plan
and assess nutrient intakes of healthy people. These values, which
vary by age and sex, include:
• Recommended Dietary Allowance (RDA): average daily level of
intake sufficient to meet the nutrient requirements of nearly all (97%-
98%) healthy people.
• Adequate Intake (AI): established when evidence is insufficient to
develop an RDA and is set at a level assumed to
ensure nutritional adequacy.
• Tolerable Upper Intake Level (UL): maximum daily intake unlikely to
cause adverse health effects.

Acceptable guidelines & food Guidelines

Nutritional guidelines for Filipinos

C. Nutrition Surveys

WHO(29 April 2020)

The Food and Agriculture
Organization (FAO)
-is a specialized agency of the
United Nations that leads
international efforts to defeat
hunger.

Dietary guidelines and food guides
A. USDA food guide

Food Labels
The nutrition facts label (also known as
the nutrition information panel, and
other slight variations) is a label required
on most packaged food in many
countries, showing what nutrients (to limit
and get enough of) are in the food.

Dietary guidelines and food guides

MACRONUTRIENTS
Nutrients needed in large amounts
Energy –providing food
Carbohydrates
Major Source of Energy for the body
4cal/mg
Classification of Carbohydrates
A.Simple Sugars (water soluble,and quickly absorb in
blood stream)
 Monosaccharides(e.g.glucose-(simplest
sugar),fructose,galactose)
 Disaccharide (e.g. sucrose,maltose, lactose).
B.Complex Sugars (Polysccharide)
 Starch (insoluble,non-sweet;composed of chain of
starch)
 Fiber (indigestible complex carbohydrate that serves
as bulk/roughage to diet, ensuring elimination of
waste material from the gastrointestinal tract.)
Functions of Carbohydrates
 Main Source of energy
 Protein sparing action
 Necessary for normal fat metabolism
 Cellulose stimulate peristaltic movement of
the gastrointestinal tract.
 Lactose encourage the growth of beneficial
bacteria,resulting in a laxative action.
 Glucose is the sole source of energy in the
brain and proper functioning of the tissues.

MACRONUTRIENTS
Sources of Carbohydrates
 Whole grains
 Sweet potatoes & white
potatoes,bananas,dried fruits
 Milk (lactose)
 Sugar,sweets,honey, maple sugar.
Common Disease:
 Overweight
 Diabetes
 Tooth decay
 Depressed appetite
 Fermentation causing gas formation
 cancer
Deficiency:
 Marasmus-Characterized by loss of weight,
skin turgor, old man look, Shrunken
abdomen. Hypotonia
 Ketosis – disease caused of lack of
carbohydrates in which the acid level of the
body is raised.
 Hypoglycemia

MACRONUTRIENTS
Protein
“Building Blocks of the body”
4cal/mg
Types of Amino Acids
Based on the body’s ability to produce them.
1.Essential Amino Acids- are those that are
necessary for good health but cannot be produced
by the body & so must be supplied in the diet.
Ex.Leucine,Lysine,Tytophan,Methionine,Isoleucine,V
aline,phenylalanine,serine.
2.Non-Essential Amino Acids-are those that are
produce by the body so not as necessary in diet.
Ex. Aspartic Acid, Cysteine, Glutamic
Acid,Glutamine,Asparagine,Tyrosine,Arginine,Histidi
ne,Glycin.Proline,Alanine
Based on composition
1.Complete proteins- contain all essential
amino acid in sufficient quantities to supply the
body’s need.
Sources: Proteins from Animals.
2. Partially complete protein- lacking in one or
more essential nutrients.
3. Incomplete protein- Those deficient in one
or more essential amino acids.
Sources: Plant ( grains, legumes, seeds & nuts)

MACRONUTRIENTS
Functions of Proteins
 Used in repairing worn out body tissue
 Source of heat & energy
 Contribute to numerous essential body secretions
(mucus, milk, sperm cells)
 Keeping fluids & pH balanced in the body.
 Play a large role in the resistance of the body to
diseases.
 Contributing to enzyme activity that promotes
chemical reactions in the body.
 Signaling cells what to do & when to do it.
 Transporting substances around the body.
 Serving as building blocks for hormone production.
 Helping blood clot.
 Serving as structural components that give our body
parts their shapes.
Sources:
Complete Protein
 Meat-beef,pork,lamb
 Poultry- chicken,turkey, duck
 Fish
 Dairy Products- milk,yogurt, cheese
Incomplete Protein
 Grains- beans,corn,oats,pasta,whole grain
 Legumes, seeds & nuts – sesame
seed,sunflower
seed,peas,rice,peanuts,cashew
 Vegetables- Brocoli

MACRONUTRIENTS
Common Diseases
 Heart Disease
 Cancer (prostate,pancreas, kidney,
breast & colon)
 Weight Control
 Kidney Diseases
 Ketosis-protein energy malnutrition.
 Kwashiorkor-Characterized by
lethargy, growth retardation, loss of
muscular tissue, increase
susceptibility to infection &
edema.(Moon Face)
Toxicity:
 Azotemia; hyperammonemia

MACRONUTRIENTS
Fats or Lipids
9cal/mg
Fat: Solid Form Oil: Liquid Form Fatty Acids: Basic Structural unit.
3 Forms of Fatty Acids
A. Based on atomic Bonds
 Saturated Fats
Sources:Butter,lard,meat,cheese,eggs,coconut
oil,chocolate,cakes,cookies.
 Monounsaturated fats –lower level of “bad
"cholesterol.
Sources: Vegetable oil, peanuts, soybean, corn,
olive oil, canola oil.
 Polyunsaturated Fats- lower levels of total
cholesterol.
B. Based on chemical structure
 Simple Lipids
1.Glyceride (simplest form)
2.Triglyceride
-Saturated TG (in animal products;usually solid in
room temp.
-Unsaturated TG (in plant products; usually liquid
in room temp.
 Compound
- Cholesterol (fat-like substance in the body
necessary to produce steroids,bile salts,etc.)

MACRONUTRIENTS
Fats or Lipids
9cal/mg
Polyunsaturated fats Functions
1. Omega 3-have a positive effect on reducing
mortality from cardiovascular disease.
 Reduced blood clotting tendency & reduced
blood pressure.
2. Omega 6 – “Linoleic Acid” polyunsatured fatty
acid.
 Lowers cholesterol levels in the blood & helps in
the prevention of heart Disease
 Sources of Polyunsaturated fats: Unrefined
sunflower,corn sesame seeds,soybean,sunflower
oil,seeds,nuts, dark green vegetables
 Important source of calories to provide a
continuous supply if energy
 Protein sparing
 Maintain the constant blood temperature
 Cushions vital organs such as kidney against
injury
 Facilitates the absorption of fat soluble
vitamins (ADEK)
 Provides satiety & delay onset on hunger.
 Contributes flavor & palatability to the diet.

MACRONUTRIENTS
Fats or Lipids
9cal/mg
Sources fats Diseases
1. Animal Fats – fat from meat, fish, poultry,
milk products & eggs.
2. Vegetables Fats – Margarine, seed &
vegetable oilnuts.
3. Visible Fats – butter, cream, margarine, lard,
fish, liver oils, pork fat.
4. Invisible fats – cheese, olives, cakes, nuts,
pastries.
1. Heart Disease
2. Cancer
3. Obesity
Deficiency:
1. Vit. Deficiency
2. Dermatitis
3. Slow wound healing
4. Hair Loss

MACRONUTRIENTS
Fats or Lipids
9cal/mg
Cholesterol
Daily Intake should not exceed 300mg/day.
Sources of Dietary Cholesterol
 Richest – egg yolk, fish roes, mayonnaise and shell
fish.
 Moderate – Fat on meat, duck, goose, cold cuts,
whole milk, cream, ice cream, cheese, butter & most
commercially made cakes, biscuits & pastries.
 Poor – All fish & fish canned in vegetables oil, very
lean meats, poultry without skin, skinned milk, low
fat yoghurt & cottage cheese.
 Cholesterol Free – All vegetables & vegetable oils,
fruits (Avocados & olives), nuts, rice, egg white &
sugar.

MICRONUTRIENTS: VITAMINS
Types:
A. Fat soluble vitamins
 A,D, E, K
B. Water soluble vitamins
 Vit. C & B-complex

MICRONUTRIENTS
Needed in small amounts; necessary in metabolizing macronutrients
FAT SOLUBLE VITAMINS
VITAMIN FUNCTIONS SOURCE
VITAMIN A ( RETINOL) -Vision Cycle.
-Necessary material for maintenance of
epithelial tissues,
-Growth & development
-Reproduction
-Antioxidant
Animal-liver, yolk, milk, butter, cheese fish, clams.
Plant- deep green and yellow vegetables and fruits.
Daily dosage: Male-1000 mcg.
Female- 800 mcg.
DEFICIT EXCESS
Nutritional blindness such as
Xeropthalmia(conjunctival dryness), Nyctalopia (night blindness)
Keratomalacia (eye lesions),
Bitot spots (keratinization in conjunctiva
Retarded growth
Immune system depression
Faulty skeletal and dental development
Skin lesions
Liver Damage
Birth Defects
Hypervitaminosis A.
Hypercarotenemia (harmless orange
appearance)

MICRONUTRIENTS
VITAMIN D (Calciferol)  Calcium & Phosphorus
 Essential for normal growth
development (bone mineralization)
 Cellular differentiation
 Immunity
 Synthesis with sunlight (10mins/day)
 Liver
 Cod liver Fish, Salmon, sardine
 Fortified Vit.A products
 dairy products
 Egg Yolks.
DEFICIT EXCESS
 Rickets (Bone softening & deformation in children)
 Osteomalacia (Bone softening in adults)
 Malabsorption syndrome
 Liver & kidney disease
 Calcium deposition (renal calculi)
 Demineralization of the bone
 Hypercalcemia

MICRONUTRIENTS
VITAMIN E
(TOCOPHEROL)
 Maintenance of cellular
membrane
 antioxidant (prevent cell
damage)
 Whole grain, nuts, seeds, green &
leafy vegetable, polyunsaturated fats.
DEFICIT EXCESS
 Hemolytic anemia in the premature & newborn.
 Nerve destruction
 May interfere with vitamin K activity
leading to prolonged clotting &
bleeding time.
 In anemia-it suppresses the normal
hematologic response to iron.

MICRONUTRIENTS
VITAMIN K
Natural
(PHYLLOQUINONE)
Synthetic
(PHYTOMENIDONE)
 aids in blood clotting & bone
mineralization.
 Dark Green leafy vegetables, soy
beans.
DEFICIT EXCESS
Hemorrhagic diseases. Anemia
Hemolysis
Albuminuria

MICRONUTRIENTS
VITAMINS ( WATER SOLUBLE VITAMINS)
VITAMIN C (ASCORBIC
ACID)
 Maintenance of bones, teeth, connective tissues and
cartilages.
 Absorption of calcium, iron and Folacin
 Production of brain hormones & immune factors.
 Antioxidant
 Citrus fruits
 Broccoli,
 Dark green vegetables,
strawberries, cabbage,
melons, tomatoes, red and
green bell peppers.
DEFICIT EXCESS
 Scurvy
 Bleeding Gums, Poor Wound Healing.
 Anemia
 Joint Pain
 Increase Resistance To Infections,
 Rough Skin,
 Hair Loss & Loss Teeth.
 2 Grams Can Cause Diarrhea
 Kidney Stone Formation,
 Most Renal Calculi Thrive In
Acid Urine.
 Gi Upsets
 Fatique

MICRONUTRIENTS
VITAMIN B1
(THIAMINE)
 Coenzyme For Energy Metabolism.
 Promotes Normal Appetite
 Important function in Nervous system, heart muscle, &
digestive tract support.
 Pork, lean meat
 Liver
 Whole grains,
 enriched cereals & bread,
 grain products,
 Legumes & potatoes.
DEFICIT EXCESS
 Mental problems
 Muscle Weakness
 Wasting
 Edema
 Impaired Growth
 Cardiac Failure
 Beriberi
 Does not occur in excessive
amounts in the body because
they are excreted through the
urine. They need to be
replenish in diet daily.

MICRONUTRIENTS
VITAMIN B2
(RIBOFLAVIN
 Coenzyme for energy metabolism,
 Maintains integrity of skin, lips, tongue
 Promotes good vision.
 Meat, poultry, fish
 Milk, eggs
 Liver
 Enriched grain products
 Dark green vegetables
DEFICIT EXCESS
 Wound aggravation & other skin problems
 Stomatitis
 Swollen, red tongue
 Eye irritation- eyes sensitive to light
 Cheilosis/cheilitis (lip dryness)
 Does not occur in excessive amounts
in the body because they are
excreted through the urine. They
need to be replenish in diet daily.

MICRONUTRIENTS
VITAMIN B3( Niacin)  Energy metabolism
 Aids digestion
 Promotes normal appetite
 Promotes healthy skin & nerves
 Meat; poultry; fish;
 Whole-grain breads,
 Cereals
 Fortified or enriched grain
products
 Egg yolk
DEFICIT EXCESS
 Pellagra:
 Seborrheic dermatitis,
 Diarrhea, dementia, irritability
 Ariboflavinosis
 Cheilosis, glossitis
 Casals necklace
 Vasodilation
 Liver damage
 Nausea & irritability

MICRONUTRIENTS
VITAMIN B5
(Pantothenic Acid)
 Involved in energy production, aids in
formation of hormones.
 Meat; fish; poultry; liver; egg
yolk;
 Yeast; whole-grain breads,
cereals, and other grain
products;
 Legumes, vegetables
DEFICIT EXCESS
 Uncommon due to availability in most foods
 Nausea
 Cramps
 Vomiting dizziness
 Apathy, exhaustion, difficulty sleeping
Generally nontoxic,
occasionally causes diarrhea.

MICRONUTRIENTS
Vitamin B6
(Pyridoxine)
 Metabolism of amino acids & protein.
 Neurotransmitter synthesis
 Aids in RBC formation
 Helps body use fats.
 Antidote for peripheral neuropathy caused
by isoniazid
 Whole grains,
 Most high protein foods
 Spinach, broccoli, fruits
DEFICIT EXCESS
 Skin disorders, dermatitis,
 Cracks at corners of mouth,
 Irritability,
 Anemia, kidney stones, nausea,
 Smooth tongue, headache, convulsions.
Nerve destruction- 2
grams/day.

MICRONUTRIENTS
Vitamin B7 (Biotin)  Helps release energy from carbohydrates
 Plays an important role in the
metabolism of fatty acids and amino
acids.
 liver, meat, egg yolk, yeast,
bananas, most vegetables
DEFICIT EXCESS
 Seborrheic dermatitis
 Glossitis, depression
 Nausea
 Insomnia
 Vomiting
 Loss of appetite, fatigue, muscle pain.
amounts in the body because
they are excreted through the
urine. They need to be
replenish in diet daily.

MICRONUTRIENTS
Vitamin B9 (Folate)  Essential in the biosynthesis of nucleic
acids(DNA & RNA); necessary for the
normal maturation of red blood cells.
 Green leafy vegetables,
 Nuts
 Legumes
 Grain products
DEFICIT EXCESS
 Poor growth
 Megaloblastic anemia,
 Birth defects-neural tube defects
amounts in the body
because they are excreted
through the urine. They
need to be replenish in diet
daily.

MICRONUTRIENTS
VITAMIN B12
(Cyanocobalamin)
Requires intrinsic
factor for absorption
in the stomach. this
is not absorbed in
Pernicious anemia
 Red blood cell maturation
 Involved with folate metabolism
 Central nervous system metabolism
 Foods of animal origin.
DEFICIT EXCESS
 Megoblastic Anemia
 Poor nerve function
 Does not occur in excessive amounts
in the body because they are
excreted through the urine. They
need to be replenish in diet daily.

MINERALS
MAJOR MINERALS(macrominerals) TRACE MINERALS(microminerals)
Major Minerals – minerals that are required in our
diet at amounts greater than 100 mg/day.
 Calcium
 Phosphorus
 Magnesium
 Potassium
 Sodium
 Chloride
Trace Minerals-minerals that are required in our diet
at amount less than 100 mg/day.
 Iron
 Iodine
 Zinc
 Fluoride
 Selenium
 Manganese
 Chromium
 Copper
 Cobalt
Primary Roles: Metabolic health, Antioxidant, Blood health, Bone health, Electrolyte imbalance.

MICRONUTRIENTS
Major Minerals
MAJOR MINERALS FUNCTIONS SOURCE
CALCIUM  Builds and maintains bones and teeth
 Essential in clotting of blood
 Influences transmission of ions across cell
membranes-required in nerve transmission
 Muscle Contraction
 BP maintenance
 Milk products
 Bones of dried fish
 Dark green leafy vegetables
 Shrimps
 Broccoli
 Salmon, clams
 Tofu
 Legumes
DEFICIT EXCESS
 Rickets
 Osteoporosis
 Poor bone growth & development
 Excessive calcification of bone;
calcification of soft tissue;
 hypercalcemia; vomiting; lethargy,
kidney damage

MICRONUTRIENTS
Major Minerals
PHOSPOROUS  Bone & tooth formation
 Acid base balance
 Energy metabolism
 Milk products
 Meat, poultry
 Eggs, legumes, nuts
(High protein foods)
DEFICIT EXCESS
 Weakness; demineralization of bone  Hypocalcemia(When parathyroid
gland not fully functioning.

MICRONUTRIENTS
Major Minerals
MAGNESIUM  Nerve impulse transmissions and for muscle
contraction
 Component of coenzymes; bones and tooth
formation.
 Heart rate regulation
 Whole-grain breads, cereals, and
other grain products; tofu;
legumes; green vegetables.
 Nuts
 Seafood
DEFICIT EXCESS
 Hypertension
 Ischemic Heart disease
 Pregnancy induced hypertension
 Arrhythmia
 Growth failure in children
 Diarrhea
 Transient hypocalcemia
 Magnesium Toxicity

MICRONUTRIENTS
Major Minerals
POTASSIUM  Helps regulate acid-base equilibrium and
osmotic pressure of body fluids
 Influences muscle & nerve activity, especially
cardiac muscle.
 Fruits especially orange juice,
bananas, and dried fruits;
yogurt; potatoes; meat; fish;
poultry; soy products;
vegetables.
DEFICIT EXCESS
 Muscle weakness
 Decreased intestinal tone and distension
 Cardiac arrhythmias
 Respiratory failure
 Cardiac Arrest
 Muscular weakness

MICRONUTRIENTS
Major Minerals
SODIUM  Helps regulate acid-base equilibrium
and osmotic pressure of body fluids
 Plays a role in normal muscle irritability
and contractility
 Influences cell permeability-nerve
transmission
 Sodium chloride (table salt),
abundant in most foods.
 Soy sauce
 Cured meats
 Pickles
 Canned soups
 Processed cheese
DEFICIT EXCESS
 Nausea
 Muscle cramps
 vomiting
 dizziness
 reduced appetite; exhaustion.
 High Blood Pressure (in some
people)leads to cardiac and renal
disease.
 Edema

MICRONUTRIENTS
Major Minerals
CHLORIDE  Helps regulate acid-base equilibrium
and osmotic pressure of body fluids
 Component of gastric juices
 Salt in most foods
 Soy sauce
 Cured meats
 Pickles
 Canned soups
 Processed cheese
DEFICIT EXCESS
 Muscle cramps
 reduced appetite
 poor growth in children.
 Vomiting.

MICRONUTRIENTS
Trace Minerals
TRACE MINERALS FUNCTIONS SOURCE
IRON  Essential for the formation of
hemoglobin and oxygen transport
 Increases resistance to infection
 Functions as part of enzymes involved in
tissue respiration.
 Red meat, organ meat
 Liver, egg yolk
 Legumes
 Whole- grain breads, cereals, or
fortified or enriched grain
products
 Dark green leafy vegetables
DEFICIT EXCESS
 Hypochromic microcytic anemia
 Malabsorption
 Irritability
 Anorexia
 Pallor(pale eye membrane), lethargy
Toxicity:-Hemochromatosis,
hemosiderosis.
Acute: Shock, Death
Chronic::liver damage, cardiac
failure.

MICRONUTRIENTS
Trace Minerals
IODINE  Helps regulate thyroid hormones
 Seafood
 Iodized salt
DEFICIT EXCESS
 Endemic goiter
 Depressed thyroid function
 Cretinism
 Iodide goiter

MICRONUTRIENTS
Trace Minerals
ZINC  Components of enzymes
 Growth factor
 Production of insulin and making of
sperm.
 Fetal development
 Wound healing
 Meat; liver; egg yolk; oysters
and other seafood; whole-
grain breads, cereals,
 Fortified or enriched grain
products;
 Legumes.
DEFICIT EXCESS
 Decreased wound healing, impaired immune function
 Hypogonadism
 Mild anemia,
 Decreased taste acuity, hair loss, diarrhea,
 Growth failure, Scaly dermatitis
 Acute: nausea, vomiting,
diarrhea.
 Chronic: Adversely affects
copper metabolism, anemia &
immune function

MICRONUTRIENTS
Trace Minerals
FLOURIDE  Helps protect teeth against tooth decay
may minimize bone loss.
 Fluoridated water
 Toothpaste
 Seafoods
DEFICIT EXCESS
 Increased dental caries  Mottled, discolored teeth
 Possible increase in bone
density; calcified muscle
insertions and exotosis.

MICRONUTRIENTS
Trace Minerals
SELENIUM  May be essential to tissue respiration;
associated with fat metabolism and
vitamin E
 Acts as an antioxidant.
 Whole-grain breads, cereals,
and other fortified Or
enriched grain products
 Onions
 Meats, seafood; dependent
on soil content– vegetables
DEFICIT EXCESS
 Myalgia
 Muscle tenderness
 Cardiac myopathy;
 Increased fragility of red blood cells; degeneration of
pancreas.

MICRONUTRIENTS
Trace Minerals
MANGANESE  Essential part of several enzyme systems
involved in protein and energy
metabolism
 Whole-grain breads,
 Cereals, and other grain
products; legumes;
 Fruits, leafy vegetables
DEFICIT EXCESS
 Impaired growth
 Skeletal abnormalities
 Neonatal ataxia
 In extremely high exposure
from contamination: severe
psychiatric and neurologic
disorders

MICRONUTRIENTS
Trace Minerals
CHROMIUM  Required for normal glucose
metabolism.
 Meat; whole-grain breads,
cereals, and other fortified
or enriched grain products
 Brewer’s yeast
 Corn oil
DEFICIT EXCESS
 Glucose intolerance
 impaired growth
 peripheral neuropathy
 none

FLUIDS/WATER
Most important nutritional constituent is Water.
Water is necessary to transport nutrient.
Regulate Body temperature
Removes Waste products.
Participates in chemical reaction & energy production.
Aids healing process.

Nutrition across the Life Span
Nutrition during Pregnancy
During the total pregnancy period, the basal metabolic rate increase from 6-
14%.
Calorie intake increase-10-20%.
Protein-Increase of 9.6 g/day.
Calcium/Phosphorus/Vit.D –Increase to 0.5-0.9 of the RDA.
Iron-Increase to 700-1000mg. Of Fe is absorbed during the pregnancy.
Iodine-To help the mother & the child prevent goiter in the future & for
brain development.
Folic Acid- Women of childbearing age consume 400mcg of folic acid each
day.

Nutrition during Lactation
Calories-additional 1000 calories, help to produce milk.
Protein-additional of 20grams,to compensate the protein lost in milk.
Calcium & Phosphorous-Increase of 0.5 mg, to prevent severe
depletion of maternal calcium for milk production.
Iron-Additional intake is recommended for blood lost.
Vit.A-additional 2000IU,needed in the milk secretion.
Riboflavin and Vit.C. increase.
Fluids-8 glasses or more.

Factors affecting Milk Secretion
1. Diet
2. Nutritional state of mother
3. Emotional & Physical State
4. Suckling
5. Contraceptives & Drugs

Advantages of Breast feeding
Colostrum

Advantages of Breast feeding
1. Breast milk produces antibodies, immunity against diseases
2. Lactose is higher in breast milk, to produce beneficial bacteria in the GI tract.
3. Calcium & Phosphorous levels are regulated.
4. Prevent dental arch.
5. Cows milk protein causes allergy.
6. Fast return of the uterus to its original size.
7. Biologically complete
8. Easily digested
9. Convenient & dependable
10. Safe and Emotional satisfaction between mother & child.

Nutrition during infancy
Methods of Feeding the Infant:
1. Breast feeding
2. Artificial feeding
3. Mixed feeding

Milk formula
A. Whole Cows Milk Formula
• Powdered whole cows milk.
• Full Cream evaporated Milk
• Recombined Milk
• Reconstituted milk

Milk Formula
B. Other type of evaporated milk not recommended for infants.
• Sweetened condensed
• Evaporated filled milk
• Skim Milk (Enfamil,Olac)
• Acidified Milk (Pelargon,Acidolac)
• Completely Modified Milk Formula- (SMA,S-26,Similac).
• Non-Cows Milk Formula-Soybase for infants allergy to cows milk
(Isomil)

Baby’s Food during the 1st year of Life
1. Cereal foods -(3-4 months),milk is still continued
2. Fruits- (3-4 months) Mashed .
3. Vegetables – (3-4 months) mashed.
4. Eggs – (4-5 months) only egg yolk is given.
5. Whole egg- (9-10 months)
6. Munggo – (5 months) cooked well & strained.
7. Meat, fish or poultry – (5-6 months) ground and strained.
8. Other foods- custard, puddings, plain ice cream, gulaman or jelo.

Nutrition during Childhood
Foods to give Pre-School Child:
• Mildly flavored foods
• Plain foods is acceptable than mixed foods.
• Fruits, puddings, custard, ice cream and gelatin.

Nutrition during Childhood
Nutrition for School Child.
• Feeding Problems
- limited time for eating
-poor eating practices
-Unbalance program of activities & rest.
• Recommended Solutions
- Allow sufficient time for meals
-Encouraged child to eat more fruits & vegetables.
-Provide child with properly selected snacks
-Regulate activities
-Guidance in proper food selection.

Diet therapy
• Diet therapy is the use of food in the treatment of disease.

Purpose of Diet Therapy
1. To maintain or restore good nutritional status
2. To correct nutritional deficiencies which may occurred
3. To afford rest to a particular organ
4. To adjust the diet to the ability of the body to metabolize the
nutrients
5. To bring about the changes in the body weight.

GENERAL DIETS
DIET
REGULAR DIET  Composed of all types
of foods, well balanced,
capable of maintaining
a state of good
nutrition.
2000cal/day
HIGH FIBER DIET Highly recommended for
digestive problems, such
as constipation, diarrhea
& hemorrhoids.
Fresh uncooked
(apples),steamed
vegetables, bran oatmeal,
leafy vegetables, prunes,
raisins, chick peas &
sweet potatoes.
Recommended amount
of dietary fiber-20 to 35
g/day.
White bread, processed
foods.
Contraindications:
-Irritable bowel
syndrome.

GENERAL DIETS
DIET
VEGETARIAN DIET Benefits of being a vegetarian
 Have a lower body weight
 Have a lower cholesterol levels
 Live longer
 Have a lower risk of developing
cancer
 Have a lower risk of developing
several diseases.
Daily amounts based on
2,000-calorie diet.
Eats plant based foods
No food of animal
origin
THERAPEUTIC DIET Indicated for the treatment of
various medical & surgical
conditions.
Therapeutic diets are
modified for:
 Nutrients
 Texture
 Food allergies or
food intolerances.

TYPES OF VEGETARIAN DIET
DIET FOOD INCLUDED
VEGAN VEGETABLES ONLY; NO FOOD OF ANIMAL ORIGIN
LACTO-OVO-VEGETARIAN WITH DAIRY PRODUCTS & EGGS BUT AVOID FLESH
PORTION
LACTO-VEGETARIAN WITH DAIRY PRODUCTS BUT WITHOUT FLESH & EGG
OVO-VEGETARIAN WITH EGGS BUT WITHOUT DAIRY PRODUCTS & FLESH
PESCO-VEGETARIAN WITH DAIRY PRODUCTS, EGG, & FISH BUT WITHOUT
MEAT
PARTIAL VEGETARIAN WITHOUT SELECTED MEATS
FRUITARIAN FRESH FRUITS, JUICES, NUTS, HONEY AND OLIVE ONLY

THERAPEUTIC DIETS
THERAPEUTIC PURPOSE & INDICATION INCLUSIONS EXCLUSIONS
CLEAR LIQUID  For oral fluids
before/after surgery
 Preparation for diagnostic
test
 Minimize GI tract
stimulation & residue
 Promote recovery from
paralytic ileus( early
refeeding)
 Tansition feeding (IV ->
solid foods
 Acute GI disturbances &
diarrhea
 Water,
 Fat-free broths,
 Strained juices,
 Tea,
 Black coffee,
 Popsicles,
 Sugar, honey
 Hard candy-give small
amount every 1-2 hours.
 Contraindications: not
used
>24hours,inadequate GI
function., & nutrient
requiring parenteral
nutrition.
 Fruit juice with pulp
 Milk,
 Fruits

THERAPEUTIC DIETS
FULL LIQUID DIET(LIQUID
FOOD AT BODY
TEMPERATURE)
 Post Operative,
 Acute infection,
 Impaired chewing or
swallowing.
 Gi strictures
 Diarrhea.
 Strained cream soups,
 pureed fish &
 juices,
 plain gelatin,
 plain ice cream,
 custard,
 milk & mild drinks.
 6-8 frequent feedings.
 Contraindications:
dysphagia
 Jam
 Fruits
 Solid food
 Nuts
 Marmalade
COLD LIQUID DIET  Tonsillectomy
 Dental extraction
 Throat & mouth
operations.
 Plain ice cream
 Cold milk
 Iced tea,
 Ice coffee

THERAPEUTIC DIETS
SOFT DIET  For debilitated patient
unable to consume a
regular diet
 Patients with mild GI
problems
Low fiber, lightly seasoned
foods, moist tender meats,
canned fruits and
vegetables, desserts cakes
and cookies without nuts.
MECHANICAL SOFT DIET Poor dentures, lack of teeth,
sores & lesions in the mouth,
limited chewing or
swallowing, GI strictures,
radiation treatment to oral
cavity and feeding
progression.
Pureed ground diced meats,
flaked fish, rice, potatoes,
light bread smoked
vegetables, canned fruits,
bananas and soups.
BLAND DIET Gastric, duodenal ulcers,
gastritis, ulcer and cardiac
cases.
Mild in flavor, no coarse fiber
and tough connective tissue
meat.
Avoided: Black pepper, chili
pepper, strong coffee &
alcohol.

THERAPEUTIC DIETS
Residue restricted Diet Dysentery, diarrhea, pre &
post operation, colostomy,
ileostomy.
plain strained foods, lean,
tender meats, chicken no
skin, soft cooked egg,
strained vegetables.
Milk cheese, raw eggs,
vegetables, fruits, coarse
bread and fried foods.
Low fiber diet Irritable bowel syndrome,
diverticulitis, Crohns disease,
ulcerative colitis, diarrhea,
cramping, before
colonoscopy.
Low fiber foods intake
around 10g/day.
White bread, white rice,
white pasta, low fiber cereal
,canned vegetables,
potatoes without skin, eggs.
Avoided: Raw vegetables,
onions & garlic, spicy, fried
or tough processed meats.
Low Calorie Obesity, diabetes, renal
failure, gout, gallbladder,
preceding surgery.
Emphasize in bulk low
calorie for satisfied
feeling.(1200 calories)

THERAPEUTIC DIETS
HIGH CALORIE Underweight,PEM,Fevers,inf
ections,hyperthyroidism,bur
ns,growth,pregnancy,lactatio
n.
Normal Diet, increase
amount of cereals, breads,
butter, cream fats and sugar.
Avoided:Excessive amount in
bulky low calorie foods.
HIGH PROTEIN Growth,pregnancy,malnutriti
on,lactation,burns,surgery,fr
actures,anemia,hepatitis,cirr
hosis.
With emphasis on meat, milk
eggs, cheese & poultry.
LOW PROTEIN Acute glomerulonephritis,
uremia, hepatic coma.
Avoid excess amounts of
protein foods, limit intake of
legumes and nuts.

THERAPEUTIC DIETS
Low Fat/Low Cholesterol To minimize cholesterol and
fat intake for atherosclerosis
and cystic fibrosis. Total
fat:300mg/day, AHA serum
lipid reduction.
Whole grain foods, lean
meats-skinless chicken *
turkey,white, fish, skimmed
milk, low fat yoghurt and
cheese. Vegetables, lentils &
fruits.
Low carbohydrates Hyperinsulinism, dumping
syndrome, obesity, epilepsy,
celiac disease.
Foods high in protein,
adequate to high fat foods in
certain conditions.
Low salt/sodium restricted To lower body temperature
and promote excretion in
hearth failure, PIH,
hypertension and cirrhosis,
-4 grams-no added salt;mild-
2 grams; restricted 200mg.
Baked chicken, lettuce, fruits

THERAPEUTIC DIETS
Low purine/purine restricted
diet
To reduce uric acid,
producing foods in gouty
arthritis and hyperuricemia.
general diet plus 2-3 quarts
liquid daily.
Avoided foods: Cheese, liver,
seafoods, beans, pasta,
alcohol, oats.

Tube feeding
Enteral Feeding- Delivery of food and nutrients either orally or by tube
feeding directly into GIT.

Types of enteral feeding tubes
Nasogastric tube (NGT)
Orogastric tube (OGT)
Nasoenteric tube
Oroenteric tube
Gastrostomy tube-subtypes include PEG, PRG, and button
tubes).
Jejunostomy tube-subtypes include PEJ and PRJ tubes).

Types of enteral formula
1.Ready to Use formulations
2.Tube feedings-prepared from regular foods
3.Blenderized Tube feeding
4.Standard tube feeding-fiber free, high in cholesterol, fat & sugar(milk
& soft cooked eggs)

Parenteral feeding
Total Parental Nutrition (TPN)
Describes the intravenous administration of Nutrients.
• Designed for individuals who cannot accept nutrients enterally
• The person receives nutritional formulas containing salts, glucose,
amino acid, lipids & added vitamins.

Methods of administering TPN
1. Medical Infusion pump
2. A sterile bag nutrient solution

Cholethiasis,Cholecystitis
Pre-operative:
Low-Fat Diet
Post-operative
No restrictions
Lower esophageal & related gastric problems
 Avoid acidic food/gastric irritants (e.g.coffee,soda)
 Avoid food causing LES relaxation (e.g.oils,meat)
 Avoid alcohol drinking & smoking
 Take small, frequent feedings
CLEAR LIQUID
Provides fluid & Carbohydrate only
Prescribed to patients post-Op or with GI
infection to maintain fluid balance &
allow GIT to rest.
e.g.water,tea,coffee,clear broth,clear
juices,plain gelatin.
FULL LIQUID
Includes only liquids or
food that turns into
liquid in the body
temperature;high in
cholesterol;mostly
contains milk
SOFT DIET
Easily chewed &
digested;for patients
with difficulty
masticating &
swallowing;low
residue
DIET AS
TOLERATED
Diet depends on
what the
patient can
tolerate;
consistency
usually
progressive.
PUREED DIET
Type of soft diet
wherein liquid & solid
components are
mixed together &
blended for semisolid
consistency.

PEPTIC ULCER DISEASE
Bland Diet
 Avoid gastric irritants,milk,NSAIDS,
 Avoid alcohol & smoking
CELIAC DISEASE
Gluten free Diet
 Avoid food containing barley, rye, oats,
wheat & malt.
LIVER CIRRHOSIS
 Low sodium
 Protein diet
 Restrict fluids
HYPOALLERGENIC DIET
 For patients with allergies
DASH DIET(Dietary Approaches to stop
Hypertension)
Servings daily:
Na:Low(1500mg) to Standard(2300mg)
Grains:6-8 servings
Fruits & Vegetables: 4-5 servings each.
Dairy: 2-3 servings.
Lean meat,poultry,fish:<6 servings.
Nuts,seeds,legumes:4-5 servings per week.
Fats & Oils:2-3 servings
Sweets:<5servings weekly
Alcoholic beverage:1 glass for female & 2
glasses for male.
DIABETIC DIET
 Select complex
carbohydrates over simple
sugars.
 Small, frequent feedings
are preferred to avoid
hypoglycemia.
 Always bring simple sugars
(e.g.hard candy) in case of
hypoglycemic attack.
 Artificial sweeteners may
be used.
RENAL DIET
 Low sodium, potassium,
 Low phosphate, protein diet; restrict
fluids
LEUKOPENIC DIET
For patients with low WBC
count/immune-compromised patients.
 Ensure that all food are well cooked.
 Avoid raw foods
 Ensure proper sanitation
REGULAR DIET
Normal diet of a sedentary person at
2000cal/day

Nutrition with diet therapy(draft)

Nutrition with diet therapy(draft)

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