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Diet Therapy 2019

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NUDIET HANDOUTS 2019 Page 1 of 7

DIET THERAPY
(see also chapter 12 of your textbook)

CLINICAL NUTRITION
The treatment of patient requiring modifications in their nutritional requirement.
The branch of the health sciences having to do with the diagnosis, treatment and prevention of
human disease caused by deficiency, excess or metabolic imbalance of dietary nutrients.

ROUTINE HOSPITAL DIETS


Refer to the regular, soft and liquid diets commonly used in the hospitals
Differ from one another in consistency and composition to suit individual needs.

REGULAR OR FULL DIET


Consists of all foods eaten by a person in health.
Planned to meet the essentials of an adequate diet.
Recommended for patient not requiring dietary modifications.

THERAPEUTIC DIET
A diet modified or adapted from the normal diet to suit specific disease conditions.
Designed to treat or cure disease.

DIETARY MODIFICATIONS
I. PURPOSE OF DIET THERAPY
To maintain and restore good nutritional status
To correct nutritional deficiencies which may have occurred.
To afford rest to a particular organ or to the whole body which may be affected.
To adjust the diet to the ability of the body to metabolize the nutrients
To bring about the changes in the body weight whenever necessary.

II. FACTORS TO CONSIDER IN THE STUDY OF DIET THERAPY


Underlying disease conditions which require a change in diet
The possible duration of the disease
The factors in the diet which must be altered to overcome these conditions
The patient’s tolerance for food by mouth.

III. THERAPEUTIC MODIFICATIONS OF THE NORMAL DIET


1. To provide change in consistency
e.g. fluids and soft diets
2. To decrease or increase energy values
e.g. high and low carbohydrates
3. To include greater or lesser amounts of one or more nutrients
e.g. High protein and sodium restricted diet
4. To increase or decrease bulk
e.g. high and low fiber diets
5. To provide foods bland in flavor
e.g. bland diet regimen
6. To include or exclude specific nutrient
e.g. elimination diet
7. To modify intervals of feeding
e.g. bland, diabetic and liquid diets

IV. BASES OF MODIFICATION


 Normal requirements: as the RDA, Guide to Good nutrition, Food Guide or
individual requirements
 Previous nutritional status of the individual
 Pathophysiology of the disease
 Anticipated duration of disease and injury
 Dietary factors to be altered
 Amount and character of the nutrient which is being lost in the body
 Patient’s tolerance for food
 Socio‐economic and other considerations such as religious beliefs, custom, etc.
NUDIET HANDOUTS 2019 Page 2 of 7

V. PRINCIPLES OF DIETARY MANAGEMENT

1. Liberalization
The diet should meet the body’s requirement for essential nutrients as generously as the
disease condition permits
2. Individualization
The dietary regimen should take cognizance of the patient’s food intake, habits, economic
status, religious practices and any environmental factors which have a bearing on the diet
such as where the meals are eaten and who prepares them.
3. Simplification
The therapeutic diet should vary from adequate normal diet as little as possible.

VI. HOSPITAL ROUTINE DIET

 Full, house, general or regular diet – designed for patients who require no special
dietary modifications
 Soft Diet
 Liquid Diets – clear, full, cold, osteorized, blenderized, or tube feeding.
NUDIET HANDOUTS 2019 Page 3 of 7

I. THERAPEUTIC DIETS :

CHARACTERISTICS AND INDICATIONS FOR DIFFERENT THERAPEUTIC DIETS

A. MODIFICATION IN CONSISTENCY:
TYPE OF DIET INDICATIONS CHARACTERISTICS FOOD SELECTION
1. Liquid Diet:
a. Clear Liquid Diet Illness or surgery accompanied by marked Provides no nutritional essential; foods FOODS ALLOWED: Clear fat free broths, strained
intolerance to foods; acute inflammatory included are liquid at body temperature, leave juices, tea, black coffee, salabat, plain, hard candies.
conditions when it is necessary to minimize no residue, non‐distending, non‐irritating and Give small amounts every 1‐2 hours
fecal material. non‐stimulating to peristaltic action; should be
used for 1‐2 days only.
b. Full Liquid Diet Post‐operatively; acute infections, acute Intermediary between clear liquid and soft diet; FOODS ALLOWED: Those included in the clear
inflammatory conditions of the GIT; for patients consists of liquids or strained semi‐liquid foods liquid diets plus strained cream soups, pureed
too ill to eat solid or semi‐solid foods; impaired and foods that liquefy at room temperature, free strained meat and fish, strained vegetables purees
chewing and swallowing ability, face lifting, from cellulose and irritating spices and and fruit juices, strained lugao and oatmeal, plain ice
radical mouth surgery condiments. cream and gelatin, custard or cornstarch pudding,
milk and milk drinks, cocoa, cream in moderation,
melted margarine or butter, 6‐8 small feedings
recommended.
c. Cold Liquid Diet or sometimes Tonsillectomy, dental extraction, adenoid Cold fluids given to prevent bleeding of the FOODS ALLOWED: Plain ice cream, cold milk,
referred to as T &A diet (after surgery and other minor throat and mouth post‐operative area; cooked soft and bland iced tea, iced coffee, soft drinks, cooked soft bland
tonsillectomy and adenoidectomy) operations. foods which have been all allowed to cool may foods which have been cooled.
also be given; use only for a limited period of
time.
d. Tube Feeding (blenderized or Esophageal obstruction, surgery of the mouth Composed of food in the soft and liquid diet FOODS ALLOWED: All foods included in the soft
osteorized) and stomach, severe burns, coma, insanity, blended and liquefied to enable the mixture to and liquid diet which are easily blended, 100‐200 cc
severe malnutrition, paralysis of swallowing pass thru a polyvinyl tube. Pectin or apple of diluted formula given 2‐3 hours is recommended.
muscles, acute and chronic infections, face sauce may be included to prevent diarrhea.
lifting; with functioning GIT but unable to Ideally 1cc=1kcal.
swallow/eat per orem.
2. Soft Diet:
a. Minimum Residue Diet Disease condition involving the bowel like: Made up of foods which forms the least amount FOODS ALLOWED: Plain and strained soups; lean
dysentery and diarrhea, pre and post‐op periods of fecal matter; inadequate in Vitamins and and tender beef, liver, skinless chicken, fish and
when it is desired to reduce fecal residue as in minerals therefore should be supplemented; other sea foods, soft cooked eggs, well-cooked
cases like: colostomy, ileostomy and bowel should be used for limited time only. strained vegetables, strained fruit juices, rice and
resection. other cereals, plain cakes and gelatins, refined
sugars, black coffee and tea.
NUDIET HANDOUTS 2019 Page 4 of 7

FOODS THAT MUST BE AVOIDED: Milk and


Milk drinks, cheese, raw eggs, vegetables and fruits
(except those that are strained) coarse breads, tough
meat, fried foods and rich desserts.
b. Low Residue Diet If this diet is ordered, a soft diet is given
c. Bland Diet Gastric and duodenal ulcers, gastritis, ulcerative An allowance of food and drinks which is FOODS ALLOWED: Those which are mild in
colitis, in some cardiac cases in order to provide chemically, mechanically, and non‐irritating; flavors, no coarse fibers and tough connective
rest to the heart. Foods more likely to cause dyspepsia are tissues, and non‐stimulating food that is tolerated by
omitted; Regularity as well as frequency of the patient.
meals is advised FOODS AVOIDED: Black pepper, chili powder,
strong coffee and alcohol.
d. Mechanical Soft Diet Poor dentures, lack of teeth, presence of sores Foods given requires little chewing FOODS ALLOWED: Foods included in the full diet
and lesions in the mouth maybe given but reduced to small portions by
grinding, chopping, mincing, etc.
e. Low Fiber Diet Spastic constipation, diverticulitis and other Contains a minimum of indigestible FOODS AVOIDED: Gristle and tough connective
gastro‐intestinal disturbances carbohydrates and tough connective tissues tissues in meats, seeds and skins of fruits, vegetables,
whole grains, cereals and coarse breads
2. High Fiber Diet Constipation; Atherosclerosis, diverticulosis, Normal diet with fiber increased to more than 6 FOODS INCLUDED: Those in the full diet with
diabetes g daily; Concentrated foods replaced by those emphasis on long fibered vegetables; raw fruits and
of greater bulk vegetables, whole grain cereals, coarse breads.

B. MODIFICATION IN COMPOSITION:
TYPE OF DIET INDICATIONS CHARACTERISTICS FOOD SELECTION
1. Calorie:
a. High Calorie Underweight, PEM, Fever and infections, Contains greater amount of total energy to FOODS INCLUDED: All foods in the normal diet
hyperthyroidism, burns, growth, pregnancy and effect a positive energy balance; Minerals and with increased amount of cereals, breads, butter,
lactation Vitamins remains at or above recommended cream and other fats and sugars.
level; Gradual rather than drastic increase in FOODS AVOIDED: Excessive amount of bulky low
the amount of food given; 3 meals with calorie foods, fried foods or those which may hinder
in/between feedings with appetite.
b. Low Calorie Obesity and those cases where excess weight is Contain a reduced amount of total energy to FOODS INCLUDED: Protein foods emphasized;
a complicating factor as Diabetes Mellitus, effect a negative energy balance; Protein, sufficient bulk, low in calories for a satisfied feeling.
CVD, Renal Diseases, HTN, Gout, Gall bladder Minerals and Vitamins remain at or above FOODS AVOIDED: High fat foods, high CHO
disease and preceding surgery recommended levels; Distribution of CHO and
fats may follow a normal pattern as long as
total calories are reduced; Drastic reduction
should be avoided
NUDIET HANDOUTS 2019 Page 5 of 7

2. Carbohydrates:
a. High CHO Renal and liver disturbances, Toxemia or CHO in the diet are increased by 50% above FOODS INCLUDED: Emphasis on rice and other
pregnancy, Addison’s disease, preparation for the normal cereals, breads and bakery products, root crops,
surgery, hyperthyroidism noodles, sugars and sugar products, native cakes and
the like, fruits, dried beans and legumes.
b. Low CHO Hyperinsulinism, dumping syndrome, obesity, CHO in the diet are reduced by 50%. Proteins FOODS INCLUDED: Foods high in proteins;
epilepsy, celiac disease and/or fats are increased. adequate to high fat foods in certain conditions
3. Proteins:
a. High CHON Growth, pregnancy, lactation, PEM, burns, A regular diet with proteins increased by 50‐ FOODS INCLUDED: All foods in the regular diet
surgery, fractures, fever, debilitating conditions, 100% above the normal allowance; about 1/3‐ with emphasis on milk, eggs, cheese, meat, poultry
pernicious anemia, nephrotic syndrome, renal 1/2 and and fish
disease without Azotemia, hepatitis, cirrhosis ½‐2/3 of the total protein in diets of adults and
w/o impending coma, hyperinsulinism, dumping children, respectively, should come from
syndrome, celiac disease protein of HBV; enough CHO and fats should
be provided for protein sparing effect
b. Low CHON Acute glomerulonephritis, uremia, hepatic coma, Protein restricted to 50% below the normal FOODS INCLUDED: Fruit juices if K+ is not
chronic glomerulonephritis with nitrogen allowance or about 20‐30 g per day; about 2/3 restricted; sugar‐mixtures as buttered‐balls, butter
retention of the total protein prescribed should come soups, butter pudding, etc…
from HBV proteins adequate CHO and fats to
spare protein; and Na and K may be restricted
c. CHON free or Zero CHON Hepatic coma, acute anuria Used only as emergency measures; high CHO FOODS INCLUDED: Fruit juices if K+ is not
and fats to prevent tissue breakdown restricted; sugar‐mixtures as buttered‐balls, butter
soups, butter pudding, etc…
4. Fats
a. Low Fat Diet Malabsorption, Steatorrhea, acute attacks of Severely restricted fats diet allows from 10‐ FOODS INCLUDED: Skimmed milk, eggs, lean
Pancreatitis and Cholecystitis in Type I 15% of TEA as fat calories or approximately meat, cottage cheese, cereals, fruits, vegetables,
Hyperlipoproteinemia, Celiac disease 20‐30 g fats/day; all foods rich in fats not sugars
allowed or restricted; Foods cooked by method FOODS AVOIDED: Fatty meat, rich desserts, fried
not requiring addition of fat; Emphasis in foods
Vitamin A‐rich foods
b. Modified Fatty Acid Ratio CAD, DM, hypercholesterolemia, Calories from fats approximately of normal FOODS AVOIDED: Fats of meat; butter,
hypertriglyceridemia, atherosclerosis, type II‐V level but food sources of PUFA are hydrogenated margarine, whole milk, cream cheese,
hyperlipoproteinemia emphasized; intake of SFA reduced; Maintain coconut oil
P/S ratio of 1:1 to 2:1
NUDIET HANDOUTS 2019 Page 6 of 7

c. Low Cholesterol Diet Atherosclerosis, hypercholesterolemia, type II‐V Eggs limited to 2‐3 per week; Dietary FOODS ALLOWED: Lean meat only or fish, 2‐3
hyperlipoproteinemia, cholelithiasis with cholesterol reduced to less than 300 mg/day egg yolks/week, egg white as desired, skimmed milk,
cholesterol esters, CAD cottage cheese, vegetables and fruits, corn starch or
rice pudding prepared with skimmed milk; Honey
sugar
FOODS AVOIDED: Glandular organs, oysters, roe,
caviar, animal fats, cream cheese, whole milk,
cream, butter, ice cream
5. Minerals:
a. Na++ restricted Restrictions depend on individual needs; less Diets where the Na content is limited to a FOODS ALLOWED: Special attention given to the
severe restrictions when diuretics are used specific level which may range to mild choice of foods which are naturally low in Na
restrictions to severe restrictions; provides an content
adequate diet with a prescribed level of Na FOODS AVOIDED: Canned, cured, processed foods
according to To individual needs which uses salt and Na containing flavoring agent
and preservatives; salts, patis (fish sauce), vetsin and
toyo (soy sauce) are omitted from the table or the
tray
Levels of Restriction
1. 200‐250 mg Na Severe hypertension intended primarily for Lowest level of Na restriction FOODS ALLOWED: Rice or oatmeal as substitute
(9‐11 mEq) hospitalized patient whose salt tolerance is low; for regular bread at breakfast. Ham used instead of
Caution is employed to avoid Na depletion, butter and margarine; Meat limited to 4 exchanges
Azotemia, Refractory heart failure per day, unsalted vegetables, oils for cooking; only
low Na milk.
FOODS AVOIDED: Butter, margarines, commercial
products. Other foods not stated above.
TYPE OF DIET INDICATIONS CHARACTERISTICS FOOD SELECTION
2. 500 mg Na Severe CHF; in renal disease with edema and in Strict Na restriction FOODS ALLOWED: Ordinary evaporated milk is
(20 mEq) cirrhosis with ascites and pulmonary edema used but no more than 2x/day. Include the food plan
in a 200mg Na diet plus two exchanges of butter and
margarine/day. Other foods not stated above.
3. 1000 mg Na Serious CHF; used as maintenance diet for Moderate Na restriction FOODS ALLOWED: Include the food plan in the
(43 mEq) Nephritis, toxemia of pregnancy; for patients 500 mg diet plus ¼ tsp. NaCl/day. In a Na restricted
who had a tendency to develop edema High protein diet, this additional salt is omitted
4. 2000‐3000 mg Na Patients with moderate heart damage, Mild Na restriction. Essentially normal diet; FOODS ALLOWED: May allow moderate use of
(87‐130 mEq) maintenance diet in renal diseases; steroid moderate use of salt in food preparation salt in preparation.
edema; edema of hepatic origin, premenstrual FOODS AVOIDED: Further addition of salt, toyo,
tension, mild CHF patis or other salty condiments at the table or on the
tray. Highly salted foods.
NUDIET HANDOUTS 2019 Page 7 of 7

b. K+ restricted Diet Renal Failure, Hyperkalemia, Addison’s The K+ content of the diet is reduced to about FOODS ALLOWED: Cereals and bread; sugars,
Disease, Oliguria, Anuria 1.0‐1.5 g/day fats, protein foods, fruits and vegetables in the
prescribed amounts.
FOODS RESTRICTED: Milk, cream, eggs, meat,
fish, poultry, fruits, vegetables
c. Ca++ restricted Diet Calcium stones, hypercalcemia, recurrent The calcium content of the diet is reduced to FOODS RESTRICTED: Milk, cheese, eggs, nuts,
pancreatitis, diagnostic test for approx. 150 and 350 mg/day in adults and meat, and other high Ca++ foods
hyperparathyroidism children respectively
6. Ash Content:
a. Acid Ash Diet Kidney stones, Ca++ and Mg++, phosphates, Acid ash foods are emphasized; neutral foods FOODS INCLUDED: meat, fish, poultry, eggs,
carbonates and oxalates used as desired. Usually formed by chlorine, whole grain cereals, bread, noodles, prunes, corn,
sulfur, and phosphates. NEUTRAL FOODS: Butter, sugar, plain candies, oil
and fats, coffee, tea
b. Alkaline Ash Diet Kidney stones, uric acid and cysteine calculi Alkaline ash foods are emphasized; acid ash FOODS INCLUDED: Large amount of fruits,
foods limited to those necessary for good vegetables, milk
nutrition. Neutral foods used as desired. NEUTRAL FOODS: Butter, sugar, plain candies, oil
Usually formed by Na, Ca, Mg, and K. and fats, coffee, tea
FOODS AVOIDED: meat, poultry, fish, cheese,
noodles, cereals bread, prunes and corn.

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