Types Of Diets

Presented by: Dave Jay S. Manriquez, RN.
Types Of Diets
LIQUID DIETS
INDICATIONS FOR CLEAR LIQUID DIET
oProvide oral fluids; before/after surgery; prepare bowel for diagnostic tests
(colonoscopic examination, barium enema, and other procedures); minimize
stimulation of GI tract; promote recovery from partial paralytic ileus (early
refeeding); minimize residue in the GI tract; transition feeding from < IV feeding
to solid foods; acute GI disturbances; diarrhea .
CONTRA INDICATIONS FOR CLEAR LIQUID DIET
o Should not be used more than 24 hours; inadequate GI function; nutrient needs
requiring parenteral nutrition
INDICATIONS FOR FULL LIQUID DIET
o Provide oral fluids; after surgery; transition between clear liquids and solid food;
oral or plastic surgery to the face and neck; mandibular fractures; patients who
have chewing or swallowing difficulties; esophageal or GI strictures; diarrhea
CONTRA INDICATIONS FOR FULL LIQUID DIET: Dysphagia
PUREED, MECHANICAL, OR SOFT DIETS
INDICATIONS FOR PUREED DIET
o Neurologic changes; inflammation or ulcerations of the oral cavity and/or
esophagus; edentulous patients; fractured jaw; head and neck abnormalities;
cerebrovascular accident .
CONTRA INDICATIONS FOR PUREED DIET
oSituations where ground or chopped foods are appropriate
INDICATIONS FOR MECHANICAL SOFT DIET I
oPoorly fitting dentures; edentulous patients; limited chewing or swallowing
ability; dysphagia; strictures of intestinal tract; radiation treatment to oral cavity;
progression from enteral tube feedings or parenteral nutrition to solid foods
CONTRA INDICATIONS FOR MECHANICAL SOFT DIET
o Situations where regular foods are appropriate
INDICATIONS FOR SOFT DIET
Debilitated patients unable to consume a-regular diet; mild GI problems
CONTRAlNDICATIONS FOR SOFT DIET
oSituations where regular-foods are appropriate
Indicators of Potential Nutritional Problems
Clear or full liquid diets for more than three days without nutrient
supplementation or with inappropriate or insufficient nutrient supplementation.
 Intravenous feeding (dextrose or saline) or NPO for more than 3 days without
supplementation.
 Low intakes of prescribed diet or tube feedings
 Inconsistent growth or weight for height, above or below norms in children.
 Pregnancy weight gain deviating from normal patterns

Diagnoses that increase nutritional needs or decrease nutrient intake (or
both):cancer,malabsoprption, diarrhea, hyperthyroidism, excessive inflammation,
postoperative status, hemorrhage, wounds (large, draining, or infected wounds),
burns, infection, sepsis, major trauma (or multi system injury)
Chronic use of drugs, especially alcohol, that affects nutritional status
Alterations in chewing, swallowing, appetite, taste, and smell
Temperature consistently above 37o C (98.6 Fo) for more than 2-days
Hematocrit: <43% in men, <37% in women
Hemoglobin: <14 g/dl in men, <12 g/dl in women; accompanied by mean cell
volume <82 cu or >100 cu
Absolute decrease in lymphocyte count (<1500 cells/mm3)
Elevated (>250mg/dl) or decreased (<130 mg/dl) total plasma cholesterol
Serum albumin, <30 g/dl in patients without renal disease, liver disease,
generalized dermatitis,overhydration.
Dysphagia
Position the patient in a comfortable with the head in an upright position,
slightly tilted forward
Textured foods that require chewing stimulate a better swallow, e.g. toast
instead of bread or boiled potato instead of mashed potatoes.
Offer juices diluted with water at first, and use flexible straws if the
patient has suckling capabilities
Mildly sweetened and salted foods are generally favored. Foods should
be close to room temperature. Avoid acid or bitter flavors and sticky foods
(e.g. soft bread, bananas, or peanut butter).
Make consistency adjustments according to the patient’s tolerance.
Liquids can be used to moisten foods for individuals with decreased saliva
production
Adapt the diet to the patients’ need and gradually upgrade it as feeding
skills improve.
Gastroesophageal Reflux
Achieve and maintain ideal body weight to improve mechanical and
postural status (except pregnant women, who should not try to lose
weight).
Increase protein and reduce fat intake to increase sphincter pressure.
Avoid foods like chocolate, alcohol, peppermint, coffee, and carbonated
drinks.
Avoid foods that may irritate and cause spasms; citrus juices, tomatoes,
and tomato sauce.
Stop smoking, if that is a habit.
Eat small meals four times a day.
Eat large meal at noon with a lighter meal in the evening. Finish the
evening meal at least two to four hours before bedtime. Avoid late evening
snacks.

Peptic Ulcer
Trend in nutritional therapy of peptic ulcer-
individualized approach, i.e. based on the individual
patient’s tolerance for specific foods.
To reduce or neutralize gastric acid secretion:
Eat three meals daily; avoid skipping meals.
Avoid stomach distention with large quantities of
food at a meal.
Avoid drinking milk frequently.
Limit caffeine intake by reducing consumption of
coffee, tea, cola, chocolate and other foods and
beverages that contain caffeine.
Limit alcohol intake and avoid drinking on any
empty stomach.
Limit intake of spicy, fatty or otherwise bothersome foods and
beverages.
Some fibers, especially the soluble forms, are beneficial.
Citric acid juices may induce gastric reflux and discomfort in some
patients.
Avoid bedtime snacks to prevent acid secretion if symptoms often occur
in the middle of the night.
Avoid cigarette smoking, which may increase gastric acid
secretion and delay the healing process and is also
associated with an increased frequency of duodenal ulcers.
GASTRITIS
The aim is to rest the stomach and reduce further irritation of
the mucosa.
Acute type:
NPO for 24 to 48 hours: give glucose parenterally, followed by
liquids, then soft to full diet as tolerated.
Chronic type:
Bland, low fiber diet.
Correct faulty food habits.
Intestinal Malabsorption
Decreased Absorption
Increased Absorption
Diet specific to etiology


Diarrhea
Clinical Implications

Fluids must be replaced to avoid dehydration, solids should be gradually
added as tolerated. A low-residue diet may be in order to decrease the
intake of fibrous materials.

Evaluate the use of foods that may contribute to diarrhea, especially
those high in fiber, caffeine, and alcohol.

Encourage juices high in potassium

Remove milk products from the diet if there is a possibility of lactose
intolerance.

Bananas, grated raw apples, or cooked apple-sauce contain pectin, which
helps bind the fluid and retard its transit time.

Extremely hot or cold foods increase peristalsis and may aggravate
diarrhea.
Constipation
Ask patients about their use of cathartics or laxatives.
Gradually increase the amount of fiber or bulk in the diet (raw vegetables
and fruits, whole-grain breads, and cereals).
Force fluid intake; drink at least the equivalent of six to eight glasses of
water a day.
Dried fruits, especially prunes, contain natural laxatives.
Any hot beverage upon arising, such as coffee, tea, or lemon water, may
stimulate peristalsis because duodenal-ileal or gastric colic is strongest in
the morning. Breakfast is also important and should contain some fiber.
Encourage activity and relaxation as much as possible allow sufficient
time for bowel habits
FLATUS
Discourage drinking with straws.
Avoid foods that produce gas (This is highly individual matter, one which
the patient must be observant). In many persons, dried beans, peas, and
foods from the cabbage family (broccoli and Brussels sprouts) cause
problems.
Decrease the amount of fat in the diet.
Encourage the patient to chew food slowly, closing the mouth.
Malabsorption syndrome, peptic ulcers, and cholelithiasis are disorders
that cause excessive flatulence; these treatable disorders must be
excluded by conventional means (Van Ness & Cattau, 1985)

Crohn’s Disease (Regional Enteritis)
During bouts with diarrhea, sources of potassium intake
should be increased.


Multivitamin and mineral supplements are frequently
recommended.
Ulcerative Colitis
Patients with severe diarrhea or steatorrhea should be monitored for
magnesium, which is usually deficient in chronic inflammatory bowel
disease (Philips & Garnys, 1981).
Low serum zinc levels are prevalent among children with chronic
inflammatory bowel disease. Response to zinc intake is abnormal and
growth is retarded (Nishl et al, 1980).
The use of azulfidine requires a daily intake of eight to ten cups of fluid.
Irritable Bowel Syndrom (IBS)
Patients with irritable bowel syndrome must be tested for
lactose intolerance or malabsorption before further treatment
(Goldsmith & Patterson, 1985).

Hydrophilic mucilloids necessitate large amounts of fluid
intake.
Disease of the Liver, Pancreas and Gall Bladder
Hepatitis
During acute phase: 5-10% dextrose Intravenously and/or protein
parenterally: To minimize protein losses, prevent ketosis, to replace fluids
and electrolytes.
High calories: To counteract weight loss and for maximum protein
utilization.

High CHO: To spare protein: Insure glycogen reserve and maintenance of
hepatic function.


High protein: To repair hepatic cells; from cholic and other bile acids; to
prevent hypothermia; supply lipotropic factors which mobilize liver fat.
Cirrhosis
Moderate fat, MCT preferred over LCT (Restrict fat if there is billiary
obstruction): To meet high energy needs, at the same time preventing fatty
liver.
High vitamins: To maintain liver function.
Frequent small feeding in cases of anorexia: For better tolerance.
Consistency: liquid to soft in acute attacks; more liberal in
convalescence: Adjusted to patient’s tolerance.
Low sodium: In cases of ascites.
Alcohol prohibited: Detoxification function of the liver is impaired by
alcohol.
Hepatic Encephalopathy (Hepatic Coma)
Protein Intake
Initially: non-protein diet (Borst Diet)
Progress to: 20-30 gm/day (Giordano-Giovanetti Diet) if condition
improves until the normal protein allowance is tolerated: To eliminate
completely a source of nitrogen for ammonia synthesis.
Calories: 1500 to 2000 a day to come mostly from CHO and fat: Minimize
tissue protein breakdown which is a source of ammonia.
Liberal vitamins and minerals: For adequate nutrition.
Low sodium: Prevent ascites.
Tube feeding: when oral feeding is not possible.
Cholecystitis
IV fluids and electrolytes; progress to clear liquid: To rest
inflamed gallbladder, prevent and correct dehydration, volume
depletion and electrolyte abnormalities.
Low fat: Reduce discomfort by preventing stimulation of
sphincter of Oddi, and contraction of GB.
Bland low fiber: Decrease mechanical and chemical
stimulation.
Low calorie for obese patients: For weight loss, obesity is
predisposing factor.
Small frequent feedings: To prevent dyspepsia.
Pancreatitis
Acute attack: NPO: To rest the organ.
Low fat: To control steatorrhea and prevent stimulation for bile
production.
Moderate CHO and protein: Prevention of hypoglycemia and creatorrhea.

Plus enzyme supplements: Utilization of nutrients.
Six small feedings, bland: Avoid undue distention and stimulation.
Avoidance of alcohol: Alcohol may precipitate attack.
Supplements of fat-soluble vitamins and calcium: To prevent
deficiencies.
MCT oil: Better absorbed than LCT.
DIETARY MANAGEMENT OF SURGICAL CONDITIONS
Dietary Management in General
Pre-operative
Post-operative
Pre-Operative
To improve the nutriture of the patient.

To prepare the patient for nutrient losses during surgery.

To hasten post-operative recovery.

To build up glycogen reserves.

To strengthen bodily resistance to infections.

Pre-Operative Dietary Management in: Emergency Operation
If patient is in good nutritional status – NPO 8 hours prior to surgery
To avoid vomiting during anesthesia or recovery from
anesthesia, and decrease the risk of post-operative gastric
retention since peristalsis is stropped
If patient is in poor nutritional status (protein deficient)
parenteral administration of whole blood or plasma.
For adequate stores of serum protein to prevent
hypoproteinemia and shock.
In addition, 5% glucose in water, saline solution, vitamins
and potassium.
For adequate nutrition
Pre-Operative Dietary Management in: Elective Surgery
High calorie for underweight
>To build up any weight deficit

Low to adequate calories for others
>
if patient is overweight, weight reduction is indicated to reduce
surgical risks.
High carbohydrates
>For glycogen stores and to spare protein for tissue synthesis.
Stores of glycogen exert a protective action on the liver and
help to prevent post-operative ketosis and vomiting.
High protein
>To build reserves for anticipated blood losses during surgery
and increased tissue catabolism, to reduce the possibility of
edema at the site of the wound which is a hindrance to wound
healing.
Increased vitamins, especially ascorbic acid, vitamin K; B-
complex
>
For wound healing and prevention of hemorrhage
increased minerals, especially phosphorus and potassium; Na
and chloride
>To replace electrolyte losses due to the break-down of body
tissue; and due to vomiting, diarrhea, perspiration and diuresis.
Iron
>To correct anemia
Increased fluids
>To replace losses due to vomiting and diuresis
Immediate Pre-operative Period – usually nothing is given by
mouth for at least 8 hours before general surgery so that the
stomach will have no retained food at the time of the operation
Post-operative Dietary Management in: Minor Surgery
Liquids
>Tolerated within a few hours; for maintenance or restoration
of fluid and electrolyte balance.
Normal Diet
>As soon as activity of GIT is restored

Post-operative Dietary Management in: Major Surgery
NPO 24 - 48 Hours
>GI tract not yet functioning normally. To allow for recovery
from anesthesia; prevent aspiration.
Nutrition support: type and duration depends on recovery of
GIT function
>As soon as activity of GIT is restored
Conventional intravenous administration of amino acid
solution
>Patient is expected to tolerate an enteral diet within a few
days.
Total parenteral nutrition (TPN)
>To meet nutritional needs for extended periods when enteral
feeding is not possible

Tube feeding. If there is GIT function, but patient cannot
tolerate an oral diet.
>To meet nutritional needs until patient can tolerate food by
mouth.
Oral Diet – liquid to full, as tolerated
>To give patient a feeling of being “normal” and hasten
recovery; also, less expensive.
Specific Surgical Conditions
Surgery of the Mouth, Throat and Esophagus.

Gastrectomy

Dumping Syndrome

Intestinal Surgery

Diet following other abdominal Operations

Rectal Surgery
Surgery of the Mouth, Throat and Esophagus

The aim is to provide food that require little chewing, comfortable and prevent
bleeding.
For tooth extraction: fluid diet progressing to soft until full diet is tolerated.

Surgery of the mouth: full fluid or pureed foods; or tube feeding.

Tonsillectomy: very cold or mild flavored foods the first few days. Avoid fibrous
foods; then warm fluids and foods on the 2nd day, progress to a normal diet after
a week.
Gastrectomy
NPO first 24-48 hours; intravenous feedings
Day 2 to 4: iced water with intravenous feedings
Day 5: 1 to 2 oz. Water every even hours, and 1 to 2 oz milk every odd hour
between.
Day 6: Soft low fiber foods are used – eggs, custards, thickened soups,
cereals, crackers, milk and fruit purees are suitable.
Day 7: Tender meats, cottage cheese, and pureed vegetables are the next
foods added to all the foods allowed in the previous days.
Meats are divided into 5 or 6 small feedings daily with emphasis on foods high
in protein and fat. CHO is kept relatively low. If not liquids are taken with meals,
and the diet continues to be low in CHO, especially the simple sugars, many
patients progress satisfactorily.
Dumping Syndrome: Major Surgery
Small frequent feedings (5 or6) fed in supine position
>To prevent dumping of food into the intestines.
High protein
>Better tolerate because proteins are hydrolyzed into
osmotically active substances more slowly; needed to rebuild
tissues and gain strength.
High fat
>To meet energy needs
High calories
>For strength
Simple CHO (sugar, sweets or desserts, restricted)
>Simple CHO increases osmolarity of jejunum contents *
“dumping syndrome.”
Dry solid diet
>Better than liquids as they enter the jejunum less rapidly
Low fiber, low residue diet
>

To prevent rapid dumping of food into the intestines.
Avoid alcohol or sweet carbonated beverages

Intestinal Surgery: Major Surgery
Clear fluid
>Initial oral intake after surgery
Low residue, bland
>To promote healing of the stoma and to prevent irritation
HI calorie, HI PRO
>For weight recovery
VIT B12 supplemented
>To prevent possible macrocytic anemia in later years
Intestinal Surgery: Colostomy
Same for Ileostomy
Jejunoileostomy
Low fat, low CHO, low fiber
>To prevent from diarrhea
HI PRO
>To restore electrolyte balance and to provide for losses of K,
Ca and Mg.
Diet following Other Abdominal Operations
Cholecystectomy
Low fat – for several weeks or months
>To avoid pain since large amounts of fats cause contraction of
the tissues irritated and inflamed by surgery
HI PRO
>For faster convalescense
Diet following Other Abdominal Operations
Peritonitis and intestinal obstruction
NPO – 1ST 24 to 48 hours, intravenous therapy

>Gastrointestinal function has not yet returned and drainage of
the stomach and upper intestine is essential until there is
reduction of distention and passage of gas.
Clear liquids to low residue
>Better tolerated; transition to full diet
Hemorrhoidectomy
NPO – 1ST 24 to 48 hours
>Due to anesthesia
Clear liquid

Initial Feeding
Low fiber-low residue: Fruits and vegetables are omitted
except for strained fruit juices

>To discourage early bowel movements
Allergy
Avoidance diet: An adequate diet which excludes the food(s)
causing allergic reactions (e.g. milk-free, egg-free diet, wheat-
free diet, etc.)

Desensitization: The allergenic food is given in gradually
increasing amounts over a long period of time.
Most Common Food Allergens
Chicken

Cow’s milk

Wheat

Peanuts/nuts

Soy products

Fish, shellfish
Diabetes Mellitus (DM)
Dietary Modification
Current concepts


 There is no one “diabetic diet” that will suit the individual
and special needs of a person with diabetes.

 The diet for an individual with diabetes can only be
defined as a “dietary prescription” based on nutrition
assessment and treatment goals.
Goals of Nutrition Therapy of DM
Maintenance of as near-normal blood glucose levels as
possible
Achievement of optimal serum lipid levels
Provision of adequate energy to maintain/achieve
reasonable body weight
Prevention and treatment of the acute complications and
of long-term complications
Improvement of overall health through optimal nutrition
Recommended Dietary Modification
Total calories – sufficient to maintain/achieve reasonable
weight in adults, or meet increased needs of children,
adolescents, pregnant and lactating women and individuals
recovering from catabolic illness.

Caloric distribution:
Carbohydrates : 50 – 70%
Protein : 10 – 20%
Fat : 20 – 30%

Cholesterol – limit to 300 mg/day or less

Carbohydrates sweeteners are permissible
Sodium –limit to about 3000 mg/day; less for people with
hypertension or renal complications.

Alcohol – moderate amounts may be allowed, contingent on
good metabolic control.

Vitamins and mineral supplement – not usually necessary, but
may be given to individuals, on reduced calorie diets (1400
kcal/day or less).

Strategies for Diabetes Medical Nutrition Therapy
Type I DM Type II DM
Strategy Obese Non-Obese
Calorie restriction * *** *
Timing of meals *** ** **
Meal spacing ** *** **
Fat modification *** *** ***
Sucrose limitation ** ** **
Exercise ** *** ***
Exercise snack *** * *
Other nutrition variables ** ** **
Blood glucose monitoring *** *** ***
_________________________________________
* Low ** Moderate *** High
Overweight/Obese
Low calorie: To enable the body to deplete adipose tissue stores.
High protein: For high safety value; exerts higher specific dynamic
action; to minimize tissue nitrogen loss
Moderate fat: For safety value; emphasis on PUFA.
Normal to low CHO: Close relation of glucose to fat formation.
Bulky, low calorie foods: To provide safety without increasing
calorie intake.
Supplement of PUFA: Accelerates oxidation of body fat.
Underweight

High calorie diet: For storage of fat in the adipose tissue, to restore DBW

Gradual increases: To avoid gastric upsets and spells of discouragement.

High protein: For replacement and repair of body tissue

High CHO: For added calories; protein-sparer.

Bulky, low calorie foods: To provide satiety without increasing
calorie intake.

Supplement of PUFA: Accelerates oxidation of body fat.

Hyperthyroidism
High calories: to compensate for increased BMR

Adequate vitamins – thiamin, riboflavin, B12, ascorbic acid, pyridoxine
and vitamin A, D, E.

- increased requirements for enhanced cellular metabolism
- Degradation of vitamin is accelerated.

Increased iodine: Iodine is needed for thyroxine formation.

Adequate calcium: Correct Ca resorption from bone and prevent
hypercalciuria.
Hypothyroidism
Iodine supplementation

Low calorie: To minimize weight gain due to lowered BMR

Hyperinsulinism
Functional Type
Low CHO (75-110 g/day): emphasis on complex CHO: CHO serves as stimulus
to insulin secretion.
High protein, high fat. If obese emphasize MUFA: To supply glucose in as slow
even but continuous flow and to prevent marked rise of sugar at any one time.
Maintenance of DBW: To prevent oversecretion of insulin.
Restriction on coffee, tea and cola beverages: Caffeine stimulates the adrenals
to cause glycogenolysis and gluconeogenesis * increased blood glucose *
stimulation of pancreas * increased insulin.
Avoidance of alcohol: Alcohol has hypoglycemic
Hyperinsulinism
Fasting
High CHO: To provide constant sucrose of available glucose.
Hypertension
Calorie level, depends on weight status or weight goal: Weight loss of 5-6% in
over-weight/obese can lower BP.

Sodium – restricted: Excess sodium may increase:


- cardiac output due to over-filling of vasculature
- peripheral resistance to blood flow
Fluids and roughage – adequate: Prevent constipation which hinders
absorption of anti-hypertensive drugs.
Risk Factors for CHD
Modifiable
Nonmodifiable
● Dyslipidemia - Age
- Sex
- Family history of CHD
● Smoking
● Hypertension
● Diabetes mellitus
● Obesity
● Dietary factors
● Thrombogenic factors
● Sedentary lifestyle
HDL Cholesterol
Low HDL cholesterol is a strong independent predictor of CHD1

The lower the HDL cholesterol level the higher the risk for
atherosclerosis and CHD2

Low HDL is defined categorically as a level < 40 mg/dl (a
change from < 35 mg/dl in ATP II)1

HDL cholesterol tends to be low when triglycerides are high2
Triglycerides
Recent data suggest that elevated triglycerides are an
independent risk factor for CHD

Normal triglyceride levels: < 150 mg/dl

Borderline-high triglycerides: 150 to 199 mg/dl

High triglycerides: 200 to 499 mg/dl


Very high triglycerides: (> 500 mg/dl) increase pancreatitis
risk
Initial aim of therapy is prevention of acute pancreatitis.
CHD
Total fat – not more than 30% of TER:

- avoid post-prandial hyperlipedemia and its possible
adverse effect of coagulation.
- reduce plasma LDL cholesterol
SFA – approx 10% of TER period of time.

PUFA – approx. 10% of TER consisting of omega-6 PUFA (e.g
linoleic acid), promotes prostaglandin synthesis, which in turn
promotes arterial dilation and heart muscle contractility
Long chain PUFA or omega 3 fatty acids
MUFA – approx. 10% of TER.
as effective as PUFA in lowering serum total cholesterol, but
has the advantages of not lowering HDL cholesterol, less
susceptible to oxidation, less thrombogenic potential, does not
raise serum triglycerides; also has less tumorigenic potential.
Cholesterol – not more than 300 mg/day
reduce plasma LDL cholesterol
Sodium – moderate intake: -control blood pressure
Carbohydrates – type and amount depends on lipid abnormality
Alcohol – avoid high intake: control blood pressure
- reduce fibrinogen
- exessive intake can produce hypertriglyceridemia, elevated
LDL cholesterol, arrythmia, cardiac enlargement and heart
failure
Calories – sufficient to maintain/achieve desirable body weight.

- reduce insulin resistance
- reduce synthesis of cholesterol, esp. LDL, VLDL, triglycerides
- reduce risk of cholesterol gallstone formation
Acute MI or Coronary Occlusion or Thrombosis
Acute phase: 500 – 800 cal liquid diet for 2-3 days
* to avoid gagging and aspiration of solid foods.

No extremes in temperature
- To prevent possible precipitation of arrythmias.
No coffee or tea

- maybe stimulating and increases heart rate.
Parenteral feeding

- For those unwilling to consume liquid diet
Restriction of Na

- to prevent/correct edema
Subacute phase
* 1000 – 1200 cal: 20% Pro. 45% CHO 35% fat
- To meet resting metabolism requirements.

Cholesterol, 300 mg
* To control blood cholesterol possible precipitation level
Soft, low fiber, free of gastric irritants
* To avoid indigestion and flatus
Sodium restriction
* To prevent /correct edema
Small frequent feeding
• to reduce possibility of post prandial dyspnea or pain.
Congestive Heart Failure
Low calories
- reduce weight; decrease work of heart

Moderate protein
- maintenance of N balance
Sodium restriction – 500 mg initially, 1000 mg later
- to control edema.
Small frequent feedings
- decreased circulatory load
Fluid as desired
Nutritional Anemias
Iron Deficiency Anemia
Iron supplementation


Adequate diet with emphasis on vitamin C to enhance iron
absorption and utilization.
Megaloblastic anemia
Vitamin B12 must be given by injection because of the lack of
intrinsic factor necessary for its absorption.
Nutrition in Renal Diseases
Metabolic Abnormalities
Renal clearance or urea guanidines, other products of N metabolism, Na, K,
Ca, Mg, trace elements and many medicines.
Impaired ability to conserve nutrients such as Na and sometimes protein.
Reduce intestinal absorption of Ca and Iron
Impaired ability to synthesize or metabolize
Loss of excretory function
•Impaired metabolic action, resulting in altered nutrient, metabolic and
hormone levels.
•Synthesis of certain hormones (erythropoietin and 1, 25
dihydroxycholecalciferol)
Altered synthesis or degradation of nutrients by other tissues
Intestinal formation of dimethylamine and trimethylamine
Metabolic clearance of pyridoxine.
Possible mechanism underlying these metabolic alterations
Loss of excretory function
Impaired metabolic action, resulting in altered nutrient,
metabolic and hormone levels
Adaptive changes in metabolic feedback loops involving
hormones, enzymes and reaction products.
Reduced food intake
Effects of these abnormalities
Blood levels – amines, phenols and indoles and other
nitrogenous substances
Enzymes of amino acid metabolism, tricarboxylic acid enzyme
and gluconeogenic enzyme.
Serum nitrogen-containing hormones (insulin, glucagon, PTH,
growth hormones, gastrin, rolactin, leutinizing hormones,
gastrin, prolactin, leutinizing hormones
Serum somatostatin
Serum erythropoietin and 1, 25 dihydroxycholecalciferol

Serum Renin – normal, increased or reduced

Deficiencies of vit. D and folic acid and vit. B6 due to
medicine.

Wasting syndrome:
• Relative body weight, muscle mass and body fat
•
•Slow growth rate in children
•
•Decreased serum concentration of total protein, albumin,
transferin, C3 and other complement proteins
•
•Abnormal plasma amino acid concentration
DIETARY PRINCIPLES
Objectives of nutritional therapy in chronic failure
To maintain nutritional status

To minimize uremic toxicity

To prevent net protein catabolism

To stimulate patient’s well-being

To retard progression of renal failure

To postpone initiation of dialysis
DIETARY PRINCIPLES
Nutritional treatment of CRF
Judicious regulation of protein intake

Regulation of fluid intake to balance fluid output and insensible water
loss

Regulation of sodium to balance fluid output

Restriction of potassium and phosphate

Insistence on an adequate calorie intake


Supplementation with appropriate vitamins
Renal Disorders-1
Acute or chronic glomerulonephritis

Controlled fluid intake = fluid output
Kcal
Controlled protein -according to laboratory data & renal function
Sodium
Potassium
Nephritis
Treat symptomatically when there is significant uremia,
hyperkalemia or edema. Replace all lost fluids
Renal Disorders-2
Uremia
Adequate calories and controlled protein, fluid and electrolytes according
to laboratory data and renal function
Nephrotic Syndrome
Protein - 1.5 g/kg/day + 1 g Protein for each
gram protein lost in urine
Kcal - increased kcal to spare protein
Sodium - low sodium (2 grams) to reduce edema
Renal Disorders-3
Acute Renal Failure

Protein - not restricted below 1.0 – 2.0 g/kg DBW
Kcal - increased kcal to spare protein for a
malnourished child, 1 ½ - 2 times normal
requirements
Sodium - varies according to fluid retention and
hydration states
Potassium - decreased due to hypercalcemia as a
result of catabolic process
Renal Disorders-4
Chronic Renal Failure
 Regulation of protein intake

 Balance of fluid intake and output


 Adequate calorie intake

 Regulation of sodium, potassium and phosphorus
intake

 Supplementation of appropriate vitamins and minerals
*Restriction is not fixed dependent on patient’s clinical and biochemical
status
THERAPEUTIC DIET FOR SPECIFIC DISEASE CONDITIONS
Acne Low fat
Acute gastroenterities (diarrhea) Clear liquid
Acute glomerulonephritis Low Na, Low protein
Addisons’ disease Hi Na, Low K
Angina pectoris Low cholesterol
Arthritis, gout Purine restricted
ADHD Finger foods
Bipolar disorder Finger foods
Burn High calorie, hi pro
Celiac’s disease Gluten free
Cholecystitis Hi pro, hi CHO, low fat
Congestive heart failure Low Na, low cholesterol
Cretinism Hi pro, hi Ca
Crohn’s dse. Hi pro, hi CHO, low fat
Cushings’ dse. Hi K,low Na
Cystic fibrosis Hi calorie, high Na
Cystitis Acid Ash (for alkaline stones)
Calculi Alkaline Ash (for acid stones)
Decubitus ulcer (bedsore) High protein, High vit. C.
Diabetes mellitus Well balanced
Diarrhea Hi K, high Na
Diverticulitis Low residue
Diverticulosis Hi residue with no seeds
Dumping syndrome Hi fat, high protein, dry
Hepatic encephalopathy Low protein
Hepatitis Hi protein, high calorie

Hirschprungs’ dse. Hi calorie, low residue, hi pro
Hyperparathyroidism Low calcium
Hypothyroidism Low cal, low cholesterol,
low sat fat
Kawasaki’s dse. Clear liquid
Liver cirrhosis Average protein
Meniere’s dse. Low sodium
Myocardial infarction Low fat, low Chol, low Na
Nephrotic syndrome Low Na, hi pro, hi cal
Osteoporosis Hi cal, Hi vit. D
Pancreatitis Low fat
Peptic ulcer Hi fat, hi Cho, low pro
Phenylketonuria Low pro/phenylalanine
PIH Hi pro
Renal colic Low Na, low pro
ARF: Low pro, hi Cho, Low Na (Oliguric phase), Hi pro, hi Cal, &
restricted fluid (diuretic phase)
CRF Low pro, low Na, low K
Tonsillitis Clear liquid; cold diet

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