WMSU-ISMP-GU-002.

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ACTIVITY VI-I
NUTRITION IN HEALTH AND ILLNESSES
Introduction
Nutrition is a fundamental pillar of human life, health and development across the entire life span.
From the earliest stages of fetal development, at birth, through infancy, childhood, adolescence,
and on into adulthood and old age, proper food and good nutrition are essential for survival,
physical growth, mental development, performance and productivity, health and well-being. It is
an essential foundation of human and national development.
Human nutrition is a scientific discipline, concerned with the access and utilization of food and
nutrients for life, health, growth, development, and well-being. The scope of human nutrition is
vast, ranging from biological and metabolic nutrition, through whole-body and clinical nutrition,
to the massive public health nutrition issues of national nutrition programmes and the global
prevention, control, and elimination of malnutrition and nutritional disorders.
Objectives
At the end of this activity, you can:
1. Recognize the importance of nutrition in health and illnesses.
2. Identify different nutrition guidelines for different chronic disease.
3. List different food allowed and avoid for each chronic disease.
Concepts/Explanation
NUTRITION IN HEALTH AND ILLNESSES
Nutrition is coming to the fore as a major modifiable determinant of chronic disease, with scientific
evidence increasingly supporting the view that alterations in diet have strong effects, both positive
and negative, on health throughout life. Most importantly, dietary adjustments may not only
influence present health, but may determine whether or not an individual will develop such
diseases as cancer, cardiovascular disease and diabetes much later in life. However, these concepts
have not led to a change in policies or in practice. In many developing countries, food policies
remain focused only on undernutrition and are not addressing the prevention of chronic disease.
Nutrition and Chronic Disease
Obesity and overweight is a risk factor for many chronic diseases such as diabetes, stroke, cancer
and heart disease. Importance of nutrition, physical activity and a healthy weight.
Heart Disease
 Also called as coronary heart disease and cardiovascular disease.
 Describes several problems related to plaque buildup in the walls of arteries
(atherosclerosis)

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 Risks factors includes, high LDL (bad) cholesterol, Low LDL (good) cholesterol, high
blood pressure, family history, diabetes, smoking, men over 45, post-menopausal women
and obesity.
To promote healthy heart
1 Don’t smoke
2 Maintain a healthy weight
3 Engage in regular physical diet
4 Eat healthy diet
5 Manage blood pressure
6 Take charge of cholesterol
7 Keep blood sugar (glucose) at healthy level
8 Eat better for healthy heart
9 Fruits and vegetable are high in vitamins, mineral and fiber and low in calories.
10 Fish which contains omega-3 fatty acids that can help lower risk of death from coronary
artery disease.
11 Fiber-rich whole grains which helps during weight loss and can help lower cholesterol.
Nut, legumes, seed are good sources of fiber.
12 Consume less sodium rich food.
13 Consume less sugar-sweetened beverages.
Diabetes
 A disease in which the body has a shortage of insulin, decreased ability to use insulin or
both.
 Insulin allow sugar (glucose) to enter cells, where it is turned into energy.
 Everyone needs some glucose, it’s the brain’s main source of energy.
 Different types of diabetes include, type 1 (body doesn’t produce insulin), Type 2 (shortage
or low level of insulin), and gestational (occurs during pregnancy).
 Carbohydrates raise blood sugar
 Protein, fat and fiber can affect how fast your blood sugar increases.
 To manage blood sugar there should be a balance of carbohydrate, protein and fat intake.

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 Choose healthy food choices as these won’t raise blood sugar as fast and also help to
maintain a healthy weight.
Stroke
 Medical factors include, High blood pressure, atrial fibrillation, high cholesterol, diabetes,
atherosclerosis, circulation problems.
 Lifestyle factors include, smoking, alcohol use, physical inactivity and obesity.
 Low in saturated fat to limit calories
 High intake of omega-3 fatty acids
 High intake of fruits and vegetables
 Limit sugary beverages
 Low in sodium/salt to help prevent and control high blood pressure. Sodium attracts and
hold water, increases the volume of blood, making your heart work faster to move blood
through your body thus increase in blood pressure as a result.

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WORKSHEET VI-I
Nutrition in Health and Illnesses

Name: ________________________________________
Course, Year and Section: _______________________
Class Schedule: ________________________________
Date of Submission: ____________________________
Instructions: List the different foods allowed and avoided for the different chronic diseases.
CHRONIC DISEASE FOODS ALLOWED FOOD AVOIDED

Heart Disease

Stroke

Diabetes

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CONCLUSION:
_____________________________________________________________________________________
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_____________________________________________________________________________________
_____________________________________________________________________________________
_____________________________________________________________________________________

RECCOMENDATIONS:
_____________________________________________________________________________________
_____________________________________________________________________________________
_____________________________________________________________________________________
_____________________________________________________________________________________
_____________________________________________________________________________________

LABORATORY CHECKLIST:

Checklist of task to be accomplished during laboratory activity. (√)

1. List the different foods allowed and avoided for the different chronic
diseases

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ACTIVITY 7.1
INTRODUCTION TO DIET THERAPY (THE ROUTINE HOSPITAL DIETS) PART 1:
REGULAR OR FULL DIET, FULL LIQUID DIET, CLEAR LIQUID DIET AND COLD
LIQUID DIET
Introduction
Food is an important part of nutrition care. Attempts should be made to honor patient
preferences. Imagination and ingenuity in menu planning are essential when planning meals
acceptable to a varied patient population. Attention to color, texture, composition, and temperature
of the foods, coupled with a sound knowledge of therapeutic diets, is required for menu planning.
However to the patient, good taste and attractive presentation are the most important elements.
When possible, patient selection of menus results in the delivery of food that will most likely be
consumed. The ability to make food selections gives the patient an option in an otherwise limiting
environment.
All hospitals or health care institutions have basic, routine diets designed for uniformity
and convenience of service. These standard diets are based on the foundation of an adequate diet
pattern with nutrient levels as derived from the Recommended Nutrient Intake. The diets should
be as realistic as possible yet ensure that nutrition needs of patients are met. The most important
consideration of the type of diet offered is providing foods that the patient is willing and able to
eat and that fit in with any required dietary restrictions. Shortened lengths of stay in many health
care settings result in the need to optimize intake of calories and protein and this often translates
into a relatively liberal approach to therapeutic diets. This is especially true when the therapeutic
restrictions might compromise intake and subsequent recovery from surgery stress, or illness.
Objectives
At the end of this activity, you can:
1. Familiarize different routine diet therapy.
2. Understand clear liquid, full liquid and cold liquid diet.
3. Identify foods allowed and foods to avoid for clear liquid, full liquid and cold liquid
diet.
4. Plan a diet for clear liquid, full liquid and cold liquid diet.
5. Discuss the indication for use.
6. Modify regular diet into clear liquid, full liquid and cold liquid diet.

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Concepts/Explanation
REGULAR OR FULL DIET, FULL LIQUID DIET, CLEAR LIQUID DIET AND COLD
LIQUID DIET
The routine hospital diets, sometimes referred to as the “house” diet, constitute the majority
of the diet orders in a general hospital. These are: the regular diet, the soft diet and liquid diets.
Being the most frequently served, the routine hospital diets are the basis for special or therapeutic
diets. To ensure dietary adequacy of all hospital diets, the use of a food plan and meal pattern is
recommended.
REGULAR DIET OR FULL DIET
This is the most frequently ordered among the house diets. It is also called general, house,
full hospital diet. It is a normal diet planned to provide the recommended daily allowances for the
essential nutrients and to meet the caloric needs of a bedridden or an ambulatory patient whose
general condition does not require general modification or dietary restrictions. The diet is designed
to maintain and attain optimal nutritional status. All foods are allowed but it is sound practice to
serve simply prepared foods.
Characteristics of the Diet:
 To bring and maintain a person in a state of nutritive sufficiency.
 Used as a · basis for planning therapeutic diets and it should be practiced to serve· simply
prepared foods.
 Designed to maintain optimal nutritional status and follows the principles of good meal
planning and permits the use of all foods.
 May be used in educating the patient in the principles of nutrition by example and basis in
providing food the patient is willing and able to eat.
 The quantity of food selected from each food group should vary depending on the energy
needs and preferences of the patient.
 Serves as a basis for the modification of therapeutic diets in the hospital.

Indication for Use:

 For ambulatory or bed patients whose conditions do not necessitate a modified for
therapeutic purposes.
Feeding Administration/ Interval of Feeding:
 About 5 to 6 feeding a day which · includes Breakfast, Lunch, and Supper with 2
snacks (a.m/p.m.) or 1 evening snacks.
Food Allowed:
 All food are allowed but is sound practice to serve simply - prepared foods.
Foods Avoided:
 Those foods that are highly spicy, rich-fatty, and gas-forming foods.
Food Plan for 1800 Calories

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FOOD GROUP AMOUNT

Vegetables At least 3 servings; 1 ½ cup cooked per serving; one should be
leafy green or yellow.

Fruits 3 servings; one should be vitamin C rich.

Milk (evaporated) ½ cup

(non-fat milk) 4 tablespoons

Rice or substitute 8 exchanges or 4 cups cooked rice

Meat, fish or substitute 4-5 exchanges; liver or glandular organs once a week; ½ cup
cooked dried beans maybe used in place of one meat and fish
exchange
Egg
2 times a week
Fat
5-6 teaspoon
Sugar or sweets
5-8 teaspoon
Suggested Meal Pattern and Sample Menu

BREAKFAST SAMPLE MENU

Fruit or Juice Fresh fruit in season
Egg or substitute Scrambled egg
Rice or Bread Rice or bread with butter/margarine or jam
Hot beverage Coffee, tea or chocolate
LUNCH
Soup Chicken sotanghon soup
Meat, fish, poultry, or Fried Bangus
substitute Sayote Guisado
Vegetable Rice
Rice or substitute Ripe Mango
Fruit or dessert
SUPPER
Same as lunch Beef nilaga
Rice
Leche flan
SNACKS
As desired, if necessary As desired

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LIQUID DIETS
A liquid diet consists of foods that will pour or are liquid at body temperature. The nutritive
value of liquid diets is low and, consequently, such diets are used only for very limited periods of
time. Liquid diets may be clear-liquid or full-liquid. They are standard hospital diets. The liquid
diet is used for various reasons. One objective is to keep fecal matter in the colon at a minimum.
The clear-liquid diet may be used after surgery. The diet can replace fluids lost from vomiting or
diarrhea. The clear-liquid diet is composed mainly of water and carbohydrates. It is only a
temporary diet, since it is nutritionally inadequate. Its use is typically limited to 24 to 36 hours.

 Full Liquid Diet

Aims:
To provide oral nourishment to the patient who cannot tolerate solid foods, prevent
dehydration and alteration in nutrition. It is often used after surgery or fasting, which require least
effort for digestion and absorption.
Characteristic:
Intermediate between clear liquid and soft diet. Consist of liquid or strained semi- liquid
foods and foods that liquefy at room and body temperature, free from cellulose and irritating spics
and condiments. When carefully planned, the diet may be made adequate in energy value and
protein and can be used for several days. A termination diet from clear liquid to soft and regular
diet and nutritionally adequate diet by proper planning.
Indication for Use:
Post-operative cases with normal gastro-intestinal function, fevers and infection,
difficulty in swallowing as fractured jaw and after oral surgery, patients too ill to eat solid
or semi-solid foods, face lifting and lesions in the mouth and G.I. disturbances.
Feeding Administration/Intervals of feeding:
The diet is given is 6 or more feeding and can be used for several days. Given
every 2 to 3 hours feeding interval but not more than 300 ml. per feeding.
Foods Allowed:
Those foods that are included in the clear liquid diet plus strained cream soups,
pureed strained meat and fish, vegetable pureed and juices, strained lugao and oatmeal,
strained fruit juices, plain ice cream, plain gelatin, custard or cornstarch pudding, milk
and milk drinks, cocoa, cream, melted butter or margarine.
Foods Avoided:
All solid foods, breads and other cereals, cheese, all raw and cooked vegetables,
all frozen/fresh or canned foods or fruits.

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FOOD EXAMPLE
Meats Pureed meat in soup, liver spread, potted meat, soft cooked egg

Milk Whole milk, evaporated milk, low-fat milk, milk drinks, milk shake,
malted milk, plain yogurt

Rice or substitute Pureed strained lugao, cooked cereal

Vegetables All juices, pureed vegetables such as chayote, carrots, green papaya

Fruits Citrus and other fruits juices

Soup Broth or strained cream soup, bouillon

Sugar or sweets Sugar, honey, syrup, plain and unflavored gelatin, pudding, soft
custards, plain ice cream, popsicles, sherbet

Fluids Coffee, tea, carbonated beverages, cereal beverage, fruit drink

Suggested Meal Pattern and Sample Menu

BREAKFAST SAMPLE MENU

Fruit juice Mango juice
Gelatin Jello
Milk or milk beverage Sherbet
LUNCH
Soup Cream of onion soup
Meat Liver spread
Rice Pureed strained lugao
Pureed fruit or juice Orange juice
Dessert Jello
Milk or milk beverage Milk shake
SUPPER
Soup Cream soup or Strained cereal with milk
Dessert Soft Custard
Milk or milk beverage Milk
SNACKS
Milk or milk beverage Shake
Fruit juice Fruits in season
Yogurt Plain yogurt
Nutritional supplement As recommended

 Clear Liquid Diet

Aims:
To provide an oral source of fluids and small amounts of calories and electrolytes,
relieve thirst, maintain water balance, and reduce caloric residue to a minimum.
Characteristics:
It is used as a transition from NPO to a full or soft diet. Inadequate in nutritional essentials.
Foods included are liquid or become liquid at body temperature, leaves no residue, non-

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distending, non-irritating and non-stimulating to peristaltic action. This diet is also called non-
residue diet which made of clear liquid foods which leaves no residue in the G.I. tract.
Indication for Use:
Illness or surgery accompanied by marked intolerance to foods, acute inflammatory
conditions of the G.I. tract, in conditions when it is necessary to minimize fecal material, pre-
operative and post- operative cases, acute diarrhea, vomiting and intestinal obstruction.
Feeding Administration/Intervals of feeding:
It should be used for 1to 2 days or 24 to 48 hours only. Given every 2 to 3 hours, when
it is necessary, not more than 300ml. per feeding.
Food Allowed:
Clear, fat -free broths, strained juices, tea, black coffee, salabat, plain gelatin, plain
sugar, hard candies, ginger ale, non-carbonated soft drinks, honey, corn syrup, egg white.
Foods Avoided:
All solid foods, milk & milk products, fruit shakes, soup cooked with fat and creams,
fruit juices with residue.
FOOD EXAMPLES
Fruits Strained fruits juices

Soup Fat-free clear broth and bouillon

Sugar or sweets Flavored and unflavored gelatin, popsicles, fruit ices (made without
milk), sugar, honey, syrup, hard candy

Fluids Coffee, tea, carbonated beverages, fruit beverage drinks

Suggested Meal Pattern and Sample Menu

SAMPLE MENU
BREAKFAST Fruit juice and/or broth
Gelatin
Tea or coffee
LUNCH Fruit juice
Broth
Gelatin
Tea or coffee
SUPPER Same as lunch
BETWEEN-MEAL- Fruit juice
NOURICHMENTS Popsicle
Gelatin
Clear liquid nutritional support

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 Cold Liquid Diet

Aims:
To rest the organ included and avoid irritation at the side of the resection. Also, to minimize
pain in oral cavity and avoid bleeding of operated area. To promote rapid wound healing
and replaces nutrient losses. It also provides on oral source of fluids for individual who are
capable of chewing, swallowing, or digesting solid foods.
Characteristics:
Cold liquid diet is sometimes referred to as T and A diet after tonsillectomy and
adenectomy. Cold fluids given to prevent bleeding of the operated area which consist of food or
iced smooth liquids. All liquids are served cold or iced or foods that have been allowed to cool
may also be given.
Indication for Use:
Tonsillectomy, dental extraction, other minor operation on the mouth or throat and
adenoid surgery.
Feeding Administration/Intervals of Feeding:
 Cold liquid diet is given on the first day after surgery.

 Day 1 – i c e chips or sips of cold water are given progressing with cold milk and non-
irritating fruit juices.
 Day 2 - Cold liquids, gels, and ice are added for example like ginger ale, gelatin, bland
strained fruit juice, plain ice cream and weak iced tea or coffee. For some other patients
who can tolerate plain pudding, custard and 3-minute egg is given before the 3rd day.
 Day 3 & 4 - strained warm cream soups, fruit and vegetable puree, soft - cooked eggs,
strained warm cereals, milk, cheese, butter, lugao or gruel and mashed potatoes are
added to the cold liquid diet.
 Day 5 - soft to liquid diet is prescribed.

Foods Allowed:
Plain ice cream, add milk, iced tea, iced coffee, soft drinks, cooked soft and bland foods
which have been cooled are allowed.
Foods Avoided:
Acidic or sour fruit juices and hot soups or foods are avoided.

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WORKSHEET VII_A
Introduction to Diet Therapy (The Routine Hospital Diets) Part 1:
Regular or Full Diet, Full Liquid Diet, Clear Liquid Diet and Cold Liquid Diet

Name: ________________________________________
Course, Year and Section: _______________________
Class Schedule: ________________________________
Date of Submission: ____________________________

Work Exercise No. 1. Consider the images on the next page. These images are examples of routine
hospital diets. Can you identify which tray should be served as regular diet, clear liquid diet and
full liquid diet? Enumerate some of the characteristics of each picture

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Work Exercise No. 2. Plan a regular diet and modify it to full liquid diet, clear liquid diet and
cold liquid diet.
REGULAR DIET FULL LIQUID CLEAR LIQUID COLD LIQUID
DIET DIET DIET
Breakfast:

AM Snack:

Lunch:

PM Snack:

Supper:

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Work Exercise No. 3. How did you modify the regular diet into full liquid diet, clear liquid diet
and cold liquid diet?

REGULAR DIET TO FULL LIQUID DIET

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REGULAR DIET TO CLEAR LIQUID DIET
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REGULAR DIET TO COLD LIQUID DIET
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Work Exercise No. 4. What are the limitations of full liquid diet, clear liquid diet and cold liquid
diet?
FULL LIQUID DIET
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CLEAR LIQUID DIET

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COLD LIQUID DIET
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Work Exercise No. 5. What foods can you add to make full liquid diet, clear liquid diet and cold
liquid diet high in protein content?
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Work Exercise No. 6. What foods can you add to make full liquid diet, clear liquid diet and cold
liquid diet high in calories?
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CONCLUSION:
_____________________________________________________________________________________
_____________________________________________________________________________________
_____________________________________________________________________________________
_____________________________________________________________________________________
_____________________________________________________________________________________

RECCOMENDATIONS:
_____________________________________________________________________________________
_____________________________________________________________________________________
_____________________________________________________________________________________
_____________________________________________________________________________________
_____________________________________________________________________________________

LABORATORY CHECKLIST:
Checklist of task to be accomplished during laboratory activity. (√)
1. Enumerate characteristics of different therapeutic diets.
2. Plan a regular diet and modify it to full liquid diet, clear liquid diet
and cold liquid diet.
3. List limitations of different therapeutic diets
4. Enumerate foods that are appropriate for the different therapeutic
diets

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ACTIVITY 7.2
INTRODUCTION TO DIET THERAPY (THE ROUTINE HOSPITAL DIETS) PART 2:
SOFT DIET AND TUBE FEEDING
Introduction
During illness, many patients can meet energy and nutrient needs by following a standard
diet. Other patients may require a modified diet, which is altered by changing food consistency or
nutrient content or by including or eliminating specific foods. Diets with altered texture and
consistency are often prescribed for individuals with chewing and swallowing difficulties. Diets
with modified nutrient or food content are frequently used to relieve disease symptoms or reduce
the risk of developing complications. Some patients may have several medical problems and need
a number of dietary changes. Keep in mind that modified diets should be adjusted to satisfy
individual preferences and tolerances and may also need to be altered as a patient’s condition
changes.
Objectives
At the end of this activity, you can:
1. Familiarize different routine diet therapy.
2. Understand soft diet and tube feeding.
3. Identify foods allowed and foods to avoid for soft diet and tube feeding.
4. Plan a diet for soft diet and tube feeding.
5. Discuss the indication for use.
6. Modify regular diet into soft diet and tube.

Concepts/Explanation
SOFT DIET AND TUBE FEEDING
Mechanically altered diets are helpful for individuals who have difficulty chewing or
swallowing. Chewing difficulties usually result from dental problems. Impaired swallowing, or
dysphagia, may result from neurological disorders, surgical procedures involving the head and
neck, and various physiological or anatomical abnormalities that restrict the movement of food
within the throat or esophagus. Dysphagia diets are highly individualized because swallowing
problems can vary greatly. Furthermore, patients must be monitored regularly because swallowing
ability can fluctuate over time.

 Soft Diet

Aims:
To provide dietary and nutritional needs to the patient who is psychologically and
physically unable to tolerate regular diet.
To supplement foods that is modified in consistency and easily digestible to facilitate
mechanical case in eating. And therefore reduce the work load of the digestive system.

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Characteristics:
This diet follows the regular pattern but · is designed for patients who are
psychologically or physically unable to tolerate the regular diet. This diet serves as a transition
from full liquid to the regular or full diet. It is a nutritionally adequate diet, modified in
consistency and texture. These foods that are easily digestible with low cellulose content and
with little or no tough connective tissues like elastin and are generally bland in flavor. The foods
were prepared through cooking, washing, cutting, and removal of skin and seeds from fruits
and vegetables, gristle and elastin from meat can improved the digestibility of these foods.
Indication for Use:
Post - operative cases - when patientcan tolerate solid food but not a full diet, fevers
and infections, G.I. · disturbances, convalescence and patient who are unable to chew, swallow
or digest foods included in the full diet.
Feeding Administration/ Intervals of feeding:
5 · feeding a day which i n c l u d e s breakfast, lunch, and supper, 2 snacks (a.m./p.m.)
and 1 evening snacks.
Food Allowed:
The food selection guide includes low in cellulose content, low in fiber, .free from
tough connective tissue and strong flavors, simple and easily digested foods.
·Foods Avoided:
Those foods that were not included on the foods allowed lists were avoided.
FOOD EXAMPLES
Vegetable Cooked mild-flavored vegetables, asparagus tips, young tender beans,
carrots, mushroom, squash, tomato juice, chayote, green papaya, peas,
spinach

Fruit Citrus fruits without membranes and all fruit juices; cooked or canned
low fiber fruits such as banana

Milk Whole milk, evaporated milk, low-fat milk, milk drinks, milk shake,
malted milk, plain yogurt

Rice/Substitutes Rice gruel, bakery products made from white, refined wheat, refined
cereals

Meat/Substitutes Any tender meat, fish or fowl, all without tough connective tissues,
eggs; cottage cheese, mildly flavored cheese; yogurt, cheesy-style
peanut butter

Soup/Fluids Broth, cream soup, strained vegetable soup; coffee, tea, carbonated
beverages, cereal beverages

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Sugar or sweets Sugar, honey, syrup, plain and unflavored gelatin, soft custards,
pudding, plain ice cream, popsicles, sherbet, chocolate, cakes and
cookies without nuts

Oils/Fat Fortified margarine or butter, mayonnaise, gravy, cream vegetable oil

Salt, pepper, vinegar, soy sauce, catsup, mild spices, chopped or

Miscellaneous ground leaf herbs
Food Plan for 1800 Calories

FOOD GROUP AMOUNT

Vegetable At last 3 servings; 1 ½ cup cooked per serving; one should be leafy
green or yellow

Fruits 3 servings; one should be vitamin C rich

Milk (evaporated) ½ cup

(non-fat milk) 4 tablespoons

Rice/Substitutes 8 exchanges or 4 cups cooked rice

Meat, fish or Substitutes 4-5 exchanges; liver/glandular organs once/week, ½ cup cooked dried
Egg beans maybe used in place of one meat and fish exchange
2 times a week

Oils/Fat 5-6 teaspoons

Sugar or sweets 6-8 teaspoons

Suggested Meal Pattern and Sample Menu

BREAKFAST SAMPLE MENU

Fruit or Juice Fresh fruit in season
Egg or substitute Scrambled egg
Rice or Bread with Rice or bread with butter/margarine or jam
butter/margarine or jam
Hot beverage Coffee, tea or chocolate
LUNCH
Soup Chicken sotanghon soup
Meat, fish, poultry, or substitute Baked fish
Vegetable Sayote Guisado
Rice or substitute Rice
Fruit or dessert Ripe Mango
SUPPER
Same as lunch Beef nilaga
Rice
Leche flan
SNACKS
As desired, if necessary As desired

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 Tube Feeding
A form of enteral nutrition support designed to provide adequate nutrition in a form that can
be administered through a tube, used for persons that are unable to tolerate an oral diet or
who have inadequate oral intake and have functioning gastrointestinal tract.
Aims:
To provide a source of complete nutrition in a form that will easily pass through a tube in
patients in whom oral feeding methods are contraindicated or not tolerated or whose condition
warrant supplementation in the form of natural foods.
Characteristics:
Composed of foods included in the soft and liquid diet, blended, and liquefied to enable
the mixture to pass thru a polyvinyl tube.
May be administered through a gastrostomy or jejunostomy. A satisfactory tube feeding
formula must be nutritionally adequate except for prescribe modifications for specifies
nutrients. It must be inexpensive, easier, prepared, and stored
Types of Tube Feeding:
Homogenized or blenderized mixture of foods selected from a normal diet.
Indication for Use:
When patient is unable to chew or swallow due to deformity or inflammation of mouth
or throat, corrosive poisoning, coma, unconsciousness, paralysis of throat, muscles, surgery of
the head and neck, esophageal obstruction, surgery of the GIT, in severe burns, mental
disturbances, anorexia nervosa, mandibular fractures, strokes, or trauma to the oral pharyngeal
cavity.
Feeding Administration/I ntervals of Feeding:
Tube feeding may be given as continuous drip or at intervals throughout the day. The
regimen should be adjusted to the patient's condition, nutriture, and dietary prescription by the
doctor. To initiate tube feeding used dilute mixture at first, about half the required concentration.
Try 50 ml of the mixture at hourly interval then gradually increase the concentration and
volume until patient can tolerate 300 ml at 2-3 hourly intervals. Do not exceed 300 ml per
feeding.
For continuous drip method, the flow of the tube feeding should be very slow at first
then increases gradually but kept at constant, steady rate. Total volume should not exceed 100
ml/hr. with a dilution of 1kcal/ml.
Additional water should be given as needed to make fluids requirement as patient's
condition improve, whenever possible food should be given orally.
Again, small amount of liquid food is introduced, gradually, increasing the volume and
consistency until part of the days feeding is by normal route.

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Food Allowed:
Well-cooked meat, ripe fruit, cooked vegetable whole or non-fat dry milk, cooked eggs,
sugar, oil, homogenized milk, and low fibrous fruit.
Foods Avoided:
Plain pasteurized milk, course fibrous food that tend to clog the blender.
TUBE FEEDING STANDARD FORMULA

Diet prescription: 1,800 kcal CHO g: 270 CHON g: 67.5 Fat g:

50

Food group No. of exchange Household measure

Vegetable 2 ex. 1c cooked

Fruit 3ex.

Milk 1 ex. 4 tbsp.

Sugar

Rice and Rice Equivalent 9 ½ ex. 7 ½ C lugao + 8 slice bread

MEAT

Low fat 4 ex. 120 g. cooked

Medium fat 1 ex. 1 pc. Egg

Fat 6 ½ tsp. 6 ½ tsp.

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TUBE FEEDING STANDARD FORMULA (60-15-25%)

Rice and
Energy
CHOg CHONg Fats g Veg Fruit Milk Rice Meat Fat
kcal
Equivalent
500 75 18 13 2 ex 3 ex ½ ex. 2 1 ex L.F. 1 ex
600 90 23 17 2 ex 3 ex 1 ex 2 ex 1 ex L.F. 1 ex
1 ½ ex
700 105 26 19 2 ex 3 ex 1 ex 2 ½ ex 2 ex
L.F.
800 120 30 22 2 ex 3 ex 1 ex 3 ex 2 ex L.F. 2 ½ ex
900 135 34 25 2 ex 3 ex 1 ex 4 ex 2 ex L.F. 2 ½ ex
2 ½ ex
1000 150 38 28 2 ex 3 ex 1 ex 4 ½ ex 3 ex
L.F.
1,1000 165 41 31 2 ex 3 ex 1 ex 5 ex 3 ex L.F. 3 ½ ex
1,200 180 45 33 2 ex 3 ex 1 ex 6 ex 3 ex L.F. 4 ex
1,300 195 49 36 2 ex 3 ex 1 ex 6 ½ ex 3 ex L.F. 5 ex
1,400 210 52.5 39 2 ex 3 ex 1 ex 7 ex 4 ex L.F. 5 ex
1,500 225 56 42 2 ex 3 ex 1 ex 7 ½ ex 4 ex L.F. 6 ex
1,600 240 60 44 2 ex 3 ex 1 ex 8 ½ ex 4 ex L.F. 6 ex
4 ½ ex
1,700 255 64 47 2 ex 3 ex 1 ex 9 ex 6 ½ ex
L.F.
1 ex M.F.
1,800 270 67.5 50 2 ex 3 ex 1 ex 9 ½ ex 6 ½ ex
4 ex L.F.
2 ex M.F.
1,900 285 71 53 2 ex 3 ex 1 ex 10 ex 6 ½ ex
3 ex L.F.
1 M.F.
2000 300 75 56 2 ex 3 ex 1 ex 11ex 4 1/2 ex 7 ex
L.F.
1 M.F.
2,100 315 79 58 4 ex 3 ex 1 ½ ex 11 ex 7 ½ ex
4L.F.
2 M.F.
2,200 330 82.5 61 4 ex 4 ex 1 ½ ex 11 ex 7 ½ ex
4 L.F.
2 M.F.
2,300 345 86 64 4 ex 4 ex 2 ex 11 ex 7 ex
4 L.F.
2 M.F.
2,400 360 90 66 4 ex 4 ex 2ex 12 ex 7 ex
4 L.F.
2 M.F.
2,500 375 94 68 4 ex 4 ex 2ex 12 ½ ex 7 ½ ex
5 L.F.

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TUBE FEEDING INSERTION METHOD AND FEEDING SITES

INSERTION
METHOD & ADVANTAGES DISADSVANTAGES
FEEDING SITE

Easy to remove by disoriented clients; long-

Does not require surgery or
Trans–nasal term use may irritate the nasal passages,
incisions for placement.
throat, and esophagus.

Easiest to insert and confirm

placement; feedings can often be Highest risk of aspiration in compromised
Nasogastric
given intermittently and without clients.
an infusion pump.
Allow lower esophageal
May require general anesthesia for insertion;
sphincter to remain closed,
require incisions; greater risk of complications
reducing the risk of aspiration;
Tube Enterostomies from the insertion procedure; greater risk of
more comfortable than transnasal
infection; may cause skin irritation around the
insertion for long-term use; site
insertion site.
is not visible under clothing.
Feedings can often be given
intermittently and without a Moderate risk of aspiration in high-risk
Gastrostomy
pump; easier to insert than a clients.
jejunostomy.

Lowest risk of aspiration; allows

for enteral nutrition earlier
following severe stress; may Most difficult to insert; feedings require an
Jejunostomy allow for enteral feeding when infusion pump for administration; may take
partial obstructions, fistulas, or longer to reach nutrition goals.
medical conditions prevent
gastric feeding.
TUBE FEEDING ROUTES

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BLENDERIZED TUBE FEEDING COMPUTATION

Steps in the formulation of a food plan for a blenderized formula are as follows:
1. Convert the dietary prescription into grams CHO, PRO, Fat.
Ex. 1,800 Kcal C-60% P-15% F25% or C-270g P-70g
F- 50g
2.Distribute into food item:
Food items # Ex C P F Kcal
Veg. B 2 6 2 - 32
Friuts 3 30 - - 120
Milk WM 1 12 8 10 170
Rice 9 209 18 - 900
Meat: MF 1 - 8 6 86
LF 4 - 32 4 164
Fat 6 - - 30 270
Sugar 3 15 - - 60

Total 270 68 50 1802

3. Compute for the total fluid volume using the formula

Cal Dx = Volume
Cal Density
Volume= 1800 cal_= 1800ml
1cal/ml
4. Convert the ml into cups
Ex. Dx 1800 kcal with calorie density = 1kcal/ml

Volume= 1800 cal = 1800 ml or 7.5 cups

1 cal/ml

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5. Translate into household measure. Compute fluid content.

Food Group Food Exchanges Household Meas. Fluid (ml)

Veg. B Boiled squash 2 1 cup -
Sugar Sugar 3 3 tsp. -
Egg Soft-cooked 1 1 pc. 50
Meat Boiled chicken 4 8 tbsp. -
Breast
Oil Corn oil 6 6 tsp. 30
Fruit Banana 3 3 pcs. -
Milk Evap milk 1 ½ cup 120

Total Fluid 200

Total Fluid Rx- Sub total = 1800ml—200ml= 1600 ml

Cups of thick lugao = 1600 ml/240ml/cup = 6.7 cups
Rice lugao = 6 cupsx240 ml = 1440; 6 cups thick lugao = 4 exchanges rice
Slice bread = 5 exchanges = 10 slices
Sub-total fluid = 200ml + 1440ml = 1640ml
Water to be added = Rx Fluid – sub-total fluid
= 1800 – 1640 = 160 ml.

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WORKSHEET VII_B
Introduction to Diet Therapy (The Routine Hospital Diets) Part 2:
Soft Diet and Tube Feeding

Name: ________________________________________
Course, Year and Section: _______________________
Class Schedule: ________________________________
Date of Submission: ____________________________

Work Exercise No. 1. Consider the images. These images are examples of routine hospital diets.
Can you identify which diet should be given to a patient with sore and lesions in the mouth; and a
patient with neurological disease? What do you think is the difference between the two diet why
one diet is preferable than the other?

____________________________________________________________________________
____________________________________________________________________________
____________________________________________________________________________
____________________________________________________________________________
____________________________________________________________________________
____________________________________________________________________________
____________________________________________________________________________
____________________________________________________________________________

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Work Exercise No. 2. Plan a regular diet and modify it to soft diet.

REGULAR DIET SOFT DIET

Breakfast:

AM Snack:

Lunch:

PM Snack:

Supper:

Work Exercise No. 3. How did you modify the regular diet into soft diet?
____________________________________________________________________________
____________________________________________________________________________
____________________________________________________________________________
____________________________________________________________________________
____________________________________________________________________________
____________________________________________________________________________

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Work Exercise No. 4. What are the limitations of soft diet?

_____________________________________________________________________________________
_____________________________________________________________________________________
_____________________________________________________________________________________
_____________________________________________________________________________________
_____________________________________________________________________________________
_____________________________________________________________________________________
_____________________________________________________________________________________
_____________________________________________________________________________________
_____________________________________________________________________________________
_____________________________________________________________________________________

Work Exercise No. 5. Plan a 2000 kcal blenderized tube feeding.

 Convert the dietary prescription into grams CHO, PRO, Fat.

CHO =
PRO =
Fat =
 Distribute into food item:

Food items # Ex C P F Kcal

Veg. B
Friuts
Milk WM
Rice
Meat: MF
LF
Fat
Sugar

Total

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 Compute for the total fluid volume using the formula

Volume (ml) =

 Convert the ml into cups

Volume (cups) =

 Translate into household measure. Compute fluid content.

Food Group Food Exchanges Household Meas. Fluid (ml)

Veg. B
Sugar
Egg
Meat

Oil
Fruit
Milk

Total Fluid

 Compute for the following:

 Fluid volume and No. of Exchanges for lugao

 No. of Exchanges for Slice bread (if needed)
 Sub-total fluid
 Water to be added

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CONCLUSION:
_____________________________________________________________________________________
_____________________________________________________________________________________
_____________________________________________________________________________________
_____________________________________________________________________________________
_____________________________________________________________________________________

RECCOMENDATIONS:
_____________________________________________________________________________________
_____________________________________________________________________________________
_____________________________________________________________________________________
_____________________________________________________________________________________
_____________________________________________________________________________________

LABORATORY CHECKLIST:

Checklist of task to be accomplished during laboratory activity. (√)

1. Differentiate soft diet and tube feeding diet.
2. Modify regular diet to soft diet.
3. Compute and plan tube feeding diet.

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REFERENCES:
BOOKS
 Caudal, ML.., 2019. Basic Nutrition and Diet Therapy, 2nd edition.
 De Guzman, MA P. E. et al (1998). Basic Nutrition for Filipinos. Merriam &Webster
Bookstore, Inc.
 Garvilles, R. (2017). Nutritional Biochemistry, WMSU NDLE Review
 Jamorabo, A. et al. (2013). Basic Diet Therapy for Filipinos. Merriam &Webster
Bookstore, Inc.
 NDAP (1994). Diet Manual. Recommended For use in the Philippines.
 Rolfes, S.R., Pinna, K., & Whitney, E. (2009). Understanding Normal & Clinical Nutrition
(8th ed.). Wadsworth, Cengage Learning. USA.
 Roth, R. (2011). Nutrition and Diet Therapy (10th ed.). Delmar, Cengage Learning. USA.
 Ruiz, A.J., Claudio, V., & de Castro E. (2011). Medical Nutrition Therapy for Filipinos
(6th ed.). Merriam & Webster Bookstore, Inc. Manila, Philippines.
 Santos, L., de Leon, S., Ahari, S., & Unga, N. (2019). Readings & Laboratory Manual in
Nutrition & Diet Therapy. NCM 105: Nursing Care Management. Western Mindanao State
University. Zamboanga City, Philippines.
 Stanfield, P., & Hui, Y. (2010). Nutrition and Diet Therapy: Self-Instructional Approaches
(5th ed.). Jones and Bartlett Publishers, LLC. London, United Kingdom.
 Tanchoco, C., & Ruiz, A.J. (2010). Diet Manual: Recommended for Use in the Philippines
(5th ed.). The Nutritionist-Dietitians’ Association of the Philippines. Makati, Metro Manila,
Philippines.
 Zimmerman, M., & Snow, B. (2012). An Introduction to Nutrition (V 1.0).
https://2012books.lardbucket.org.

INTERNET SOURCE
 Aryal,S., February 24, 2020. Microbe Notes. Carbohydrates- Definition, Structure, Types,
Example, Functions. Retrieved From https://microbenotes.com/carbohydrates-structure-
properties-classification-and-functions/#classification-of-carbohydrates-types-of-
carbohydrates
 Atassi H., March 11, 22019. Medscape. Protein-Energy Malnutrition. Retrieved From
https://emedicine.medscape.com/article/1104623-overview
 Biology Dictionary. October 4, 2019. Disaccharide Definition. Retrieved From
https://biologydictionary.net/disaccharide/
 Biology Dictionary. October 4, 2019. Polysaccharide. Retrieved From
https://biologydictionary.net/polysaccharide/
 Butler Natalie. July 1, 2020. Healthline.6 Essential Nutrients and Why Your Body Needs
Them. Retrieved From https://www.healthline.com/health/food-nutrition/six-essential-
nutrients.
 Eufic. January 14, 2020/ The Functions of Carbohydrates in the Body. Retrieved From
https://www.eufic.org/en/whats-in-food/article/the-basics-carbohydrates
 Harvard T.H. Chan, School of Public Health. The Nutrition Source. Carbohydrates.
Retrieved Fromhttps://www.hsph.harvard.edu/nutritionsource/carbohydrates/
 Lagua, et al.(1974). Nutrition and Diet Therapy Reference Dictionary

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 Mahan, L.K., & Stump, S. (2004). Krause’s Food, Nutrition & Diet Therapy (11th ed.).
Elsevier. USA.
 MedlinePlus. Carbohydrates. June 18, 2018. Retrieved From
https://medlineplus.gov/carbohydrates.html
 PCRM’s Nutrition Guide for Clinicians. February 20, 2018. Protein-Energy Malnutrition.
Retrieved From
https://nutritionguide.pcrm.org/nutritionguide/view/Nutrition_Guide_for_Clinicians/1342
068/all/Protein_Energy_Malnutrition
 Romito, Kathleen. Agusut 21, 2019.Michigan Medicine. Minerals their Functions and
Source. Retrieved From https://www.uofmhealth.org/health-library/ta3912
 Sheehan, Jan. December 07. 2018. SFGATE. What can Happen From a Lack of
Carbohydrates? Retrieved From https://healthyeating.sfgate.com/can-happen-lack-
carbohydrates-5999.html
 Thorpe Matthew. September16, 2017. Healthline. Maltose: Good or Bad? Retrieved From
https://www.healthline.com/nutrition/maltose
 West Helen. June 24, 2017. Healthline. Lactose Intolerance 101-Causes, Symptoms and
Treatment. Retrieved From https://www.healthline.com/nutrition/lactose-intolerance-
101#section1

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APPENDICES
Anthropometric Measurements
Different Methods of Computing Desirable Body Weight

Method Formula
Data Needed: Height, Body Frame
Step I- convert feet to inches
Step II- Convert to inches to centimeter
Step III- step 2 minus 100
Step IV- step III – 10 % for small frame, or minus 5% for medium frame
or as is for large frame.
#1 – Tannhauser’s
Method The answer is the DBW in Kilogram
Example Height- 6’1”
Step I- 6’ x 12” = 72 inches + 1 = 73 inches
Step II- 73 inches x 2.54 cm / inch = 185.42cm
Step III- 185.42 – 100 (constant factor) = 85.42
Step IV- 85.42- 10% (small frame) 8.542= 76.878
DBW= 76.78 kilogram or 169.1316 pounds

Height Male Female

5ft 106 lbs 100 lbs
 For every inch increase in height add 6 lbs for male and 5 lbs for female
 For large frame add 10%
 For small frame subtract 10%
#2 – Dr. Fernando’s
Method Ex. Male 5’9” height, large frame
Male = 106 lbs 9 x 6 = 54 lbs
+ 54 lbs
160 lbs or 72.73 kilogram

16 lbs 7.273
DBW = 176 lbs or 80.003 kilograms

Height Male Female

5ft 110 lbs 100 lbs
 For every inch increase add 2 lbs
 For additional inch- allow 2 lbs for each 5 years complement between 25
#3 Ador Dionisio’s and 50
Method Ex. A 35 years old female – 5’8 height
5ft = 100 lbs (35 years ÷ 5 years = 7 x 2lbs = 14 lbs)
8 inches x 2lbs = 16 lbs
100 + 16 = 116 lbs
+ 14 lbs
130 lbs or 59.09 kilograms

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 For 5 ft allow 105 lbs

 For every inch above 5ft add 5 lbs
 Age and gender are not specified
#4 ADOPTED
METHOD Ex. 5’8”
DBW= 5 ft = 105 lbs
8’ x 5lbs = + 40lbs
145 lbs or 65.91 kg

 DBW ( male) = 106 lbs for every 5 ft + 6 lbs for every inch over 5 ft.
(female)= 100 lbs for 5 ft + 5 lbs for every inch over 5 ft.
#5 HAMWI’S
Add 10 % for large frame
METHOD
Subtract 10 % for small frame

 DBW Male= 112 lbs for every 5ft

 Female = 106 lbs for every 5ft
 Add 4 lbs for every inch over 5 ft/ Subtract 4 lbs for every inch below 5
#6 NDAP ft.
METHOD
Ex. Female 5’7”
DBW= 106 lbs + (7) (4)= 28lbs
106 lbs + 28 lbs = 134 lbs or 60.9 kg

 BODY MASS INDEX – also known as QUETELET INDEX

 Is the ratio of weight (in kilograms) over height squared (in meters)
 To estimate BMI using the formula: BMI = Act Wt.
Ht (m)2

 BMI Classification World Health Organization (WHO)

BMI CLASSIFICATION BMI RANGE

CED Grade III Less than 16
CED Grade II 16.0 – 16.9
CED Grade I 17.0 – 18.4
Low Normal 18.5 – 19.5
Normal 20.0 – 24.9
Obese Grade I 25.0 – 29.9
Obese Grade II 30.0- 39.9
Obese Grade III 40 and above

BMI Implications : >23 KG/m2 – increase prevalence of obesity

>30 kg/m2 - increased risk of mortality
>27 kg/m2 – increased risk for morbidity
Example Calculation of BMI: Ht – 5’2” Act. Wt = 55kg
 Convert first the feet into inches and inches to centimeter;

1ft= 12 inches, 1 inch = 2.54 cm

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Ht= 5ft x 12 inches= 60 inches + 2 inches = 62 inches

62 inches x 2.54 cm = 157.48 cm
 Convert centimeter to meter = 1m = 100cm

157.48 cm ÷ 100 cm = 1.5748 then multiply it by itself = 1.5748 x 1.5748 = 2.47

BMI= 55kg ÷ 2.47= 22.26 Normal
Note: Do not round off the answer of the BMI
Computation of Total Energy Requirement
Physical Activity Kcal/kg DBW/day
Bed Rest but mobile ( hospital patients) 27.5
Sedentary ( mostly sitting) 30.0
Light ( tailor, nurse, physician, jeepney driver) 35.0
Moderate ( carpenter, painter, heavy house work) 40.0
Very Active (swimming, lumberman) 45.0


TER= DBW x Physical Activity - if the BMI is normal

TER= Actual Weight x Physical Activity + 500kcal – if the BMI is below
Normal
 TER = Actual Weight x Physical Activity – 500 Kcal – if the BMI is above
normal
Percentage Distribution: Physiological Value Fuel
Carbohydrates = 55 – 70 % of the TER Carbohydrates = 4 cal / gram
Protein = 10 – 15 % of the TER Protein = 4 cal / gram
Fats = 20 – 30 % of the TER Fats = 9 cal / gram

Examples:
Problem: Compute for C, P, F of a school teacher.
DBW 52 Kg. Total Energy Requirement 1800 Kcal.
1. Percentage Distribution Method
Procedure:
Carbohydrate: 1,800 kcal x .60=1,080 kcal/ 4 kcal/gm = 270 gm
Protein: 1,800 kcal x .15= 270 kcal/ 4 kcal/gm = 67.5 or 7O gm
Fats: 1,800 kcal x .25= 450 kcal/ 9 kcal/gm = 50 gm
Diet Prescription: Calorie: 1,800 kcal C 270 gm P 70 gm F 50 gm

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2. Non Protein Calorie (NPC) Method:

CHO allow 60 - 80 % (Average 0f 70%)
FAT allow 20 - 40 % (Average of 30%)
Procedure:
Protein Rqt. = 52 Kg x 1.1g/Kg = 57.2 or 60 gm.
Protein Cal. = 60 gm x 4 cal/gm = 240 Kcal.
Non-Protein Cal = 1800 Kcal - 240 Kcal = 1560 Kcal

Carbohydrate = NPC x 70% = 1560 Kcal x .70 = 1092 kcal

Carbohydrate in gm = 1092 Kcal / 4 Kcal/gm = 273.5 or 275 gm

Fat = NPC x 30% = 1560 x .30 = 468 Kcal

Fat in gm = 468 Kcal / 9 Kcal/gm = 52 or 50 gm

Diet Prescription: Calorie: 1,800 kcal C 275 gm P 60 gm F 50 gm

ESTIMATING DESIRABLE BODY WEIGHT CALORIE ALLOWANCES

1. INFANTS
(0 – 6 months)
DBW(g) = Bw(g) + (age in mos × 600) TER = DBW (kg) × 95 kcals/(kg)DBW

(7 – 12 months)
a. DBW(g) = Bw(g) + (age in mos × 500) TER = DBW (kg) × 80 kcals/(kg)DBW
b. DBW(kg) = (age in months) + 3
2
NOTE: If BW is unknown used 3000g.

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2. CHILDREN a. TER = 1000 + (100 × Age in yrs.)

DBW(kg) = (Age in yrs. × 2) + 8 b. TER = DBW (kg) × kcals/(kg)DBW
Age Range:
Age kcals/kgDBW 2002 RENI
1–3 80 82.3
4–6 75 74.2
7–9 65 66.6
10 – 12 65 (boys) 62.9
55 (girls) 54.9

3. TEENAGERS TO ADULT ADOLESCENTS

(13 – above) TER = DBW (kg) × kcals/kgDBW
NDAP FORMULA TER = DBW (kg) × P.A.
Male – allow 112 lbs. + 4 lbs. for each inch over Age kcals/kgDBW 2002 RENI
5ft.
13 – 15 55 (boys) 56
allow 112 lbs. - 4 lbs. for each inch below
45 (girls) 45.9
5ft.
16 – 18 50 (boys) 49
Female - allow 106 lbs. + 4 lbs. for each inch over
5ft. 40 (girls) 41
allow 106 lbs. - 4 lbs. for each inch below NOTE: average for both sexes is 45 kcals/kg
5ft. DBW.

REMINDERS: ADULTS (19 and above)

Pregnant TER = DBW (kg) × P.A.
1st trimester – add 1kg/mo. KRAUSE METHOD
NDAP
2nd trimester – add 1.16kg/mo.
M
3rd trimester – add 1.5kg/mo.
F
Bedrest 27.5 Bed in mobile 35
30
Sedentary 30 Light 40
35
Light 35 Moderate 45
40

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Moderate 40 Heavy 50
50
Heavy 45
REMINDERS:
Pregnant TER = NTER + 300 kcals (2ND &
3RD tri)
Lactating TER = NTER + 500 kcals
Age deduction
30 – 39 3% 60 – 69 7.5%
40 – 49 5% 70 – 74 10%
50 – 59 7.3% > 75 20 – 25%

BMI Classification (NDAP)

Classification BMI (kg/m²)

Obese 30 and ↑
Overweight 25.0 – 29.9
Normal 18.5 – 24.9
Underweight 18.4 and ↓

BMI Classification of UNDERWEIGHT in Adults (WHO 1998)

Classification BMI (kg/m²)

Normal >20
Marginal 18.5 – 20
Mild 17 – 18.5
Moderate 16 – 17
Severe <16

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DISTRIBUTION OF TOTAL ENERGY REQUIREMENT

METHOD I. PERCENTAGE DISTRIBUTION

Other distributions:
a. C, P = TER × Percentage Dist
DM
4 cals/g
60, 15, 25 – no complications
60, 20, 20 – if underweight
b. F = TER × Percentage Dist
65, 15, 20 – age ↑ 65 (kidney condition)
9 cals/g
55, 20, 25 – with neuropathy

 Carbohydrate – 50% - 70%

70,15,15 - ↓ salt, ↓ fat ( non DM)
1.) Protein – 10% - 15%
2.) Fat - 20% - 30% 70, 10,20 - ↓ salt, ↓ fat, ↓ protein
70, 15, 15 -↓ purine

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METHOD II. NPC (NON PROTEIN RENAL COMPUTATION

CALORIE)

 .6 - .75 g/ kgDBW – pre dialysis

 Carbohydrate – 55% – 80% or ave. 70% 1. .8 g/kgDBW - DM nephropathy,+
1. Fat - 20% - 45% or ave. 30% urine
2. Protein Requirement (g/kgDBW) 2. 1.2 g/kgDBW - Hemodialysis
Infants 1.5 3. 1.3 g/kgDBW - Peritoneal
Children 2.0 dialysis
Adolescents 1.3 4. 1000 –3000mg Na - ↓ salt or ave.
Adults 1.1 2000mg
3. a. Pregnant - 10g/kgDBW 5. 2g - potassium
b. Lactating - 20g/kgDBW 6. 800mg - phosphorus
7. 1000 ml/day - dialysis
8. 60 – 100mg/day - vit. C
9. 20 – 25g/day - Fiber
10. ½ ex - milk
11. ENERGY a. 35 kcal/kg - for
maintenance
b. 20 - 30 kcal/kg - for
reduction
c. 40 – 45 kcal/kg - for
repletion

FORMULA:
1. a. Adjusted Edema Free Body weight (dialysis
patient)
aBwef = Awt + [(DBW – Awt) ×.25]

1.b. Estimating Dry Weight or used Height (pre –

dialysis)

EDW = 142mEq/L × Liters of NTBW

Pre- Dialysis Serum Na (mEq/L)

2. TER = aBwef (kg) × P.A. (if N used 35 kcals)

3. Protein = aBwef × Prqt.
a. HBV (2/3)
b. LBV (1/3 )

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4. NaCL equivalent in tsp.

1 tsp. – 1.0
3/4 tsp. - .9 - .8
2/3 tsp. - .7 - .6
1/2 tsp. - .5
1/3 tsp. - .3 - .4
1/4 tsp. - .2
1/5 tsp. - .1

tsp. NaCL = Na Rx.(mg) – Inherent Na (mg) ÷

5mg/tsp
400mg

Courtesy of: Zamboanga City Medical Center, Nutrition and Dietetics Services

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Determination of Nutrient Requirements

I. Estimating Energy Requirements of Adults
A. Short method for Estimating Energy Requirements
1. Activity level kcal/kg BW
Bed rest but mobile (hospital patients) 27.5
Very light or sedentary (mostly sitting down) 30.0
Light (tailor, nurse, physician, jeepney driver) 35.0
Moderated (carpenter, painter, heavy housework) 40.0
Very active (swimming, lumberman) 45.0
2. Stress Condition
Overweight/weight reduction 20
Non-stress, bed rest 25
Mild Stress, bed rest ambulatory 35
Moderate stress, bed rest, ambulatory 40
Severe stress, polytrauma, hypermetabolic, sepsis 45
Surgery; elective/ minor 32
Surgery; major, bed rest, 35
ambulatory 38
Burn, major, bed rest, 45-50
Ambulatory 55-60
Cancer 35-45
Pre-dialysis 40-50
Hemodialysis 35
Peritoneal dialysis 30
Method II. Harris-Benedict Equation
1. Males
BEE = 66.47+ [13.75 x weight (kg)] + [5.0 x height (cm)] – [6.76 x age (years)
=_______kcals/day
1. Females

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BEE= 655. + [9.56 x weight (kg)] + [1.85 x height (cm)] – [4.68 x age (years)]
=_______kcals/day
To estimate total energy requirements, the BEE (as calculated above) must be multiplied by an activity factor
(AF) and an injury factor (IF) [i.e. TER=BEE x AF x IF]
Activity and Injury Factors
Activity Factors Bed rest 1.0-1.1 Moderate 1.6-1.7
(AF) Very light 1.2-1.3 Heavy 1.9-2.1
Light 1.0-1.5 Strenuous or exceptional 2.2-2.4
Note: Use lower factor for females; higher factor for males

Injury factors No illness/non-stress 1.0

(IF) Convalescence, mid malnutrition, 1.1
post-operative (no complication)
mild-illness, non-catabolic
Confined to bed 1.2
Ambulatory/ out of bed 1.3
Infectious and stress, catabolic
a. Mild 1.2-1.3
b. Moderate 1.4-1.5
c. Severe, hyper catabolic 1.6-1.8
Sepsis 2.0-2.2
Burns: <20% body surface 1.2-1.4
20-40%body surface 1.5-1.7
>40% body surface 1.8-2.0
Fracture (long- bone) 1.2-1.3
Respiratory/failure 1.4-1.5
COPD 1.4-1.8
Cancer with chemotherapy or
radiation, cardiac cachexia 1.5-1.6
Surgery, minor/elective 1.1-1.2

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Surgery, major 1.2-1.3

Trauma 1.3-1.4
Trauma, multiple/ head injury 1.5-1.6

II. Estimating Energy Requirements of Infants and Children

1. Infants
Age (months) Kcal/kg DBW
0-6 120
7-12 110
2. Children
TEA/day=1000 + (100 x age in years)
III. Estimating Energy Requirements of Pregnant and Lactating Women
1. Pregnant women (2nd 3rd trimester)
TEA day Normal requirement + 300 kcal

2. Lactating women
1st 6 months TEA/ day = normal requirement + 500 kcal
Next 6 months TEA/ day = Normal requirement = 440 kcal

Caloric Expenditure For Various Activities

ACTIVITY kcal /hr. ACTIVITY Kcal/hr.
Sleeping 72 Pool or billiards 108
Resting in bed 78 Volleyball
Sitting in normally 78 Recreational 210
Sitting, reading 78 Competitive 528
Lying quietly 78 Golf
Sitting eating 90 Foursome 222
Sitting playing cards 90 Twosome 300
Standing normally 90 Baseball (except pitcher) 282
Personal toilet needs 120 Table tennis 294-420

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Sitting, writing 156 Calisthenics 300-720

Standing, light activity 156 Cycling: 5-15mp 300-720
Walking indoors 186 Skating
Dressing 204 Recreation 300
Showering 204 Vigorous 900
Listening to lecture 102 Badminton
Conversing 108
Basketball
Half-court 360
Full-court 540
Bowling 420
Tennis 420-660
Soccer 540
Mountain climbing 600
Skipping rope 600-90
Judo and karate 780
HOUSEWORK kcal/hr Football 798
Washing and Dressing 156 Swimming
Washing and shaving 156 Pleasure 360
Driving a car 156 Crawl (25-50 yd/min) 630-750
Washing clothes 186 Butterfly (50 yd/min) 840
Making bed 204 Backstroke 360-750
Painting house 210 Sidestroke 660
Cleaning windows 222 Dancing
Carpentry 228 Square 462
Sweeping floors 234 Modern 252-342
Ironing clothes 252 Ballroom 342-420
Mapping floors 294 Walking
Gardening, weeding 336 Road to field 336-420

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Gardening, digging 516 Uphill: 5%-10%-15% 480-660-

900
Running
12-min mile (5mph) 600
8- min mile (7.5 mph) 900
6- min mile (10pmh) 1,200

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Child Growth Standards Table Courtesy of WHO and FNRI-DOST acquired through National Nutrition
Council and Department of Education.

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