NCM 105 A | NUTRITION & DIET THERAPY LECTURE

PRELIM PERIOD ENZYMES

NUTRITION & DIET THERAPY  Organic catalysts that are protein in nature and are
 This course will introduce how our body makes use of produced by living cells.
food. You will learn not only the quantity and quality  Catalysts means substance that makes a chemical
of food consumed but also the process of receiving reaction happen more quickly, w/o being changed
and utilizing it for the growth and renewal of the body itself
and for the maintenance of the different body  Most enzymes are recognized by the ending “ase”
functions. like Amylase, Protease: Renin/ milk and Pepsin/ meat
 Also, it will include discussions on how illness affects products, Lipase (Digestive Enzymes)
the body’s ability to use nutrients and modifications
in the diet in such conditions.
 First, let’s have a glimpse of some of the common
terms use related to nutrition and diet therapy.

NUTRITION
 The science of foods and nutrients and other
substances they contain, and of their actions within
the body
 Including ingestion, digestion, absorption, transport,
metabolism and excretion
 A broader definition includes the social, economic,
cultural and psychological implications of food and HORMONES
eating  Organic substances produced by special cells of the
 Study of food in relation to health of an individual, body
community, society  Discharged into the blood to be circulated and
 The process through which food is used to sustain life brought to specific organs or tissues
and growth  They regulate vital processes which are highly
specific
FOOD
 Most hormones are produced by endocrine or
 Products derived from plants or animals that can be
ductless gland
taken into the body to yield energy and nutrients for
Eg. Insulin, Adrenaline/Epinephrine,
the maintenance of life and the growth and repair of
Progesterone
tissues
 Food is any substance, organic or inorganic, when NUTRITIONAL STATUS/ NUTRITURE
ingested or eaten, nourishes by the body building  Condition of the body resulting from the utilization of
and repairing tissues, supplying heat energy essential nutrients
 Food sustains life, second to oxygen  May be classified as having good, fair and poor
OPTIMUM NUTRITION nutriture
 The body has adequate supply of essential nutrients
that are efficiently utilized such as growth and good
health are maintained at the highest possible level.

MALNUTRITION
 A condition of the body resulting from a lack of one
or more essential nutrients (nutritional deficiency) or it
may be due to an excessive nutrient supply to the
point of creating toxic or harmful effects (e.g. METABOLISM
overnutrition and hypervitaminosis)
 Chemical process in
 It can be caused by a primary factor or secondary
your body that
factor.
changes food into
NUTRIENT energy you need.
 Chemical component needed by the body for one
or more of these three general functions
 To provide energy, to build and repair tissues,
regulate life processes

1
NCM 105 A | NUTRITION & DIET THERAPY LECTURE
ANABOLISM CARBOHYDRATES
 Balance between the building up of complex tissues  Are organic compounds (saccharides, starches and
with the consumption of energy sugars) composes of carbon, hydrogen and oxygen
 The creation of new compounds during metabolism  They provide the major source of energy for the body
or as much as 80 to 100%
 CARBOHYDRATES (“GO” Food)
 The main source of energy for man provides heat to
maintain body temperature
 Broken down into sugars during ingestion
 The cheapest among all food stuffs fiber
CATABOLISM  part of plant food which when eaten is the
 Breakdown of complex substance with the liberation indigestible part of food
of energy  Acts as a broom in our digestive tract to prevent
 The breakdown of compounds during metabolism constipation

CLASSIFICATION OF CARBOHYDRATES
Carbohydrates are divided into three groups

A. MONOSSACHARIDE
or simple sugars is the simplest form of carbohydrates

1. Glucose (Dextrose)
 Abundant in fruits, sweet corn, corn syrup.
Moderately sweet sugar
DIGESTION  It Stores in the Liver 1/3 of body’s total glycogen
 The process of digesting food which is changing food  Muscle cells stores glucose as glycogen.
in the stomach into a form that your body can use  Only glucose can provide energy for the brain other
o Mechanically nerve cells and developing RBC.
o Chemically  Gluconeogenesis is the process where protein is
ABSORPTION converted to glucose.
 When the products of digestion pass through the  Ketones, also known as “ketone bodies,” are by
lining of digestive tract products of the body breaking down fat for energy
 Takes place largely in small intestines through villi that occurs when carbohydrate intake is low
 Villi are fingerlike projections lined in intestinal wall  Ketosis is a metabolic state in which some of the
body's energy supply comes from ketone bodies in
CALORIES the blood, in contrast to a state of glycolysis in which
 Unit for measuring the amount of energy a particular blood glucose provides energy. Ketosis is a result of
food can produce metabolizing fat to provide energy.

2. Fructose (levulose)
ENERGY  The sweetest of all simple sugars and can be
 The ability to do a lot of work or activities without converted in glucose in the body
feeling tired
3. Galactose
 Not found free in foods it is produced from lactose
FOOD GUIDE PYRAMID (milk sugar)
 Galactosemia Inability to metabolize galactose

B. DISACCHARIDES OR DOUBLE SUGARS

They must change to simple sugars by hydrolysis
before the can be absorb
1. Sucrose processed from cane and beet sugar, fruits,
vegetables syrups, sweet food production and is
converted to glucose and galactose upon digestion.
Compose of glucose in digestion.

2. Lactose (milk sugar) milk and milk products. It is

converted to glucose and galactose in digestion. It
remains in the intestine longer than other sugars

2
NCM 105 A | NUTRITION & DIET THERAPY LECTURE
3. Maltose It is produced by hydrolysis of starch and B. Stomach
converted to glucose. It occurs in the malt products. 1. Enzyme – none for the carbohydrates
It is less sweet compare to glucose and sucrose. 2. Action – none; above action by ptyalin may continue
to a minor degree.
C. POLYSACCHARIDES (Complex Sugars)
Are composed of many molecules of simple sugars C. Small Intestine
1. Enzyme - Pancreatin Enzyme- amylopsin –converts-
1. Starch starch to dextrins and maltose
 the most significant polysaccharide 2. Intestinal Juice – which contains three disaccharides
 It is converted entirely to glucose upon digestion and sucrose, lactose, maltose
are more complex than sugars
FUNCTIONS OF CARBOHYDRATES
2. Dextrin  To serve as a main source of energy and must be
 Are found free in foods. They are formed as supplied regularly
intermediate products in the breakdown of starch.  The amount of CHO is 365 gm. is stored in the liver and
present in circulating blood sugar
3. Cellulose
 Carbohydrate event is a protein sparing action. If
 Forms the framework of plants found in unrefined
insufficient carbohydrates are available in the diet
grains and vegetables and fruits
the body will convert protein.
 A non-digestible enzyme and provides important bulk
in the diet which helps move digestive food mass  Necessary for normal Fat Metabolism. If there is no
along and stimulates peristalsis sufficient CHO larger amounts of fats are used for
 Lowers blood glucose levels of people with diabetes energy. The amount of carbohydrates present
mellitus. determines how much fat will be broken down.
Therefore, it affects the formation and disposal rates
Classified into: of ketones and are intermediate of fat metabolism.
a) Soluble- found in fruits and legumes, barley and oats Which broken-down to fatty acids
which delay gastrointestinal transit, delay glucose  Cellulose and closely related soluble, indigestible
absorption. carbohydrates ain in normal elimination. They
stimulate the peristaltic movements of the
b) Insoluble – found in wheat bran, corn bran, whole gastrointestinal tract and absorb water to give bulk
grain bread, cereals and vegetables which to the intestinal content.
accelerates gastrointestinal transit. Increase fecal
 They also supply significant quantities of proteins,
weight, slow down starch hydrolysis and delay
mineral and B vitamins.
glucose absorption.
 Lactose remains in the intestine longer than other
4. Pectin are non-digestible, colloidal polysaccharides saccharide encourages the growth of the beneficial
having a gel quality bacteria. Resulting in the laxative reaction
 Its sources include mostly fruits and are often used as  Glucose has a specific influence. It is indispensable
a base for jellies. for the maintenance of the functional integrity of the
 Pectins are also used in the treatment of diarrhea. nerve tissue thus a constant supply of glucose from
the blood is essential.
5. Glycogen (animal starch) are formed from glucose
and stored in the liver and muscle tissue. Its food FUNCTIONS OF CARBOHYDRATES
sources are mainly meat and sea foods. It is 1. Whole grains rich in iron, thiamine, niacin and other
converted to glucose upon digestion. nutrients. Important in the manufacture of wheat flour
 The hormone glucagon helps the liver convert 2. Sweet potatoes and white potatoes, bananas and
glycogen to glucose some fruits are relatively high in CHO.
3. Sugar and sweets
DIGESTION OF CARBOHYDRATES 4. Milk
A. Mouth
1. Enzyme- amylase (an enzyme of the saliva secreted Health Effects
by the parotid glands, acts on starch to begin its  Weight Control
breakdown to its breakdown to dextrin and maltose  Heart Disease
 Cancer- protects in many types of cancer
2. Action – conveyed into the stomach mostly in starch  Diabetes
form.  Gastrointestinal health

3
NCM 105 A | NUTRITION & DIET THERAPY LECTURE
PROTEINS FUNCTIONS OF PROTEINS
 Came from a Greek word PROTOS meaning primary  Used in repairing worn out body tissue proteins
or prime importance (anabolism) resulting from continued wear and
 Consists of Nitrogen, Carbon, Hydrogen, and Oxygen tear (catabolism) going on in the body
 Function of building repairing cells and other  Proteins are built to new tissues by supplying the
specialized roles in metabolism that cannot be necessary amino acid building blocks.
accomplished or performed by other nutrients  Proteins are source of heat and energy.
 Proteins contribute to numerous essential body
CLASSIFICATION OF AMINO ACIDS secretions and fluids, enzymes and proteins
A. Essential Amino Acids
 Is The one that cannot be synthesized SOURCES:
(indispensable amino acid) by the body from  Meat
materials readily available at a speed to keep up  Fish
with normal growth rate.  Poultry
8 ESSESNTIAL AMINO ACIDS  Eggs
1. Histidine*  Milk products
2. Isoleucine  Cereals
3. Leucine  Beans
4. Lysine  Peas
5. Methionine  Nuts
6. Phenylalanine
7. Threonine
8. Tryptophan
9. Valine
10. Arginine*

B. Non-Essential Amino Acid

 Can be manufactured by the body and
therefore are not necessary for consideration in
the diet.
EXAMPLES:
1. Glycine
2. Alanine
3. Glutamic acid
4. Proline
5. Hydroxyproline
6. Cystine
7. Tyrosine
8. Serine
9. Arginine
10. Histidine

C. SIMPLE PROTEINS
 Are those which yield only amino acids upon
hydrolysis
EXAMPLES:
1. Albumins which are soluble in water
2. Globulins which are insoluble in water, soluble in
dilute salt solution coagulated by heat
3. Glutelins
4. Prolamines
5. Albuminoids
6. Histones and Protamines

D. Compound Proteins
 Conjugated Proteins or Proteids combinations of
simple proteins and other non-protein
substances.

4
NCM 105 A | NUTRITION & DIET THERAPY LECTURE
2. Glycerol
FATS / LIPIDS
 Is a water-soluble component of Triglycerides and is
FATS
inconvertible with CHO
 Are organic compounds composed of Carbon,
 10 % of FAT After broken off in digestion
hydrogen and oxygen.
 Available for the formation of glucose in the diet
 Triglycerides, fats, oils, are fatty acid esters of glycerol
 Some fats deposits are not used and are considered 3. Steroids
structural fat. They hold the body organs and nerves  Contains sterols
in position and protect them against shock and injury  Cholesterol
found in all body tissues especially in the brain and
CLASSIFICATION OF FATS nerve tissues
A. Simple Lipids and Neutral Fats
Foods rich in Cholesterol
 Waxes are esters of fatty acids
 egg yolk,
 organ meats
B. Compound lipids
 butter
1. Phospholipids  cream
 Lecithin from oils, cheese, margarine  whole milk
 Glycolipids - Thromboplastin for the blood  cheese
clotting process  Ice Cream
 Sphingomyelin – found in the brain, myelin
sheath insulators around nerve fibers. From The Omega-6/Omega-3 Ratio
Egg yolk, liver is good source.  Vegetable Sardines
 Cod liver oil Crab
2. Glycolipids are compounds of fatty acids combined  Mackerel Oyster
with carbohydrates and nitrogenous base.  Salmon
3. Lipoproteins are lipids in combination with protein.
Found in liver and are found in the cell FUNCTIONS OF FAT
1. Important source of calories
C. Derived Lipids 2. Fat is a sparing protein because its availability
 Are simple derivatives from fat digestion or other reduces the need to burn protein for energy.
more complex products. Fat substances produced 3. Fat is essential to maintain body temperature
from fats and fat compounds during digestive 4. Fat cushions vital organs such as the kidney against
enzyme. injury.
1. Fatty Acids are the refined fuel forms of fat that the cell 5. Fat facilitates the absorption of the fat-soluble
burns for energy. They are basic structural units of fata vitamins ADEK
and may be saturated or unsaturated in nature. 6. Fat provides satiety and delays the onset of hunger
Sources of Fatty Acids 7. Fat contributes flavor and palatability to the diet.
a. Saturated Fats are those into which no hydrogen can
be added. they are abundant in animal fats FOOD SOURCES
including beef. A. Visible Fats include lard, butter. Margarine.
Shortenings. Salad oils, visible fats of meat
b. Monounsaturated fatty Acid B. Invisible fats are those available in milk, cheese, eggs,
 Oleic Acid is the most abundant monounsaturated nuts, and meat.
fatty acid, Olive and peanut oils are especially high High Saturated Fatty Acids
in Oleic acid.  Whole Milk, cream, ice cream
c. Polyunsaturated fatty acid  Medium fat or fatty meats beef, lamb, pork and ham
 Linoleic Acid the most common Polyunsaturated  Bacon, butter, coconut oil, lamb fat, lard, regular
fatty acids. Abundant in vegetable oils margarine. Salt pork, hydrogenated shortenings.
 Chocolates, chocolate candy, cakes, cookies, pies,
Saturated (Animal Fat) Unsaturated (Plant Oil) rich pudding
 Beef  Vegetable Oil
 Seafood  Peanut High in Polyunsaturated Fatty Acids
 Red meat  Soy bean  Vegetable oils, safflower, corn, cotton seed,
 Dairy  Cauliflower soybean, sesame, sunflower
 Egg  Corn  Salad dressings made from the above oils;
 Poultry  Cotton mayonnaise,
 Olives  French dressings and others
 Olive oil  Special margarine; liquid oil listed first on label
 Fatty Fish; salmon, tuna, herring.

5
NCM 105 A | NUTRITION & DIET THERAPY LECTURE
VITAMINS  Various infections, male infertility, birth defects, slower
 Vitamins are organic components in food that are wound-healing, joint and muscle aches and rash on
needed in very small amounts for growth and for the legs are led by Vitamin C deficiency over a long
maintaining good health. period of time.
 A compound is called a vitamin when it cannot be
synthesized in sufficient quantities by an organism,
and must be obtained from the diet

CLASSIFICATION OF VITAMINS
A. Water-soluble vitamins
 Dissolve easily in water and, in general, are readily
excreted from the body, to the degree that urinary
output is a strong predictor of vitamin consumption.
Because they are not readily stored, consistent daily
intake is important.
 This includes Vitamins C and B Complex Family
 All raw fruits and vegetable contain Ascorbic Acid.

B. Fat-soluble vitamins
 are absorbed through the intestinal tract with the
help of lipids (fats). Because they are more likely
to accumulate in the body.
 Because they can build up over long periods of
time, it's possible to develop a toxicity from too
much.
 Soluble in fat solvents and are absorbed along CHEILOSIS
with dietary fats; they are not normally excreted  The symptoms are exactly the same, cracked and
in the urine and tend to be stored in the body in sore lesions on the mouth corners, difficulty eating or
moderate amounts. drinking and an overall feeling of ill health
GLOSSITIS
Water Soluble Vitamins  A painful tongue which appears smooth due to loss
of the filiform and sometimes the fungiform papillae
secondary to certain nutritional deficiencies,
especially B-vitamin deficiencies, as seen in pellagra,
thiamin deficiency, and disorders such as pernicious
anemia

Vitamin C deficiency
 is caused by not eating sufficient fruits and
vegetables. During cooking due to water solubility,
heat, exposure to air and the use of copper
cookware, the vitamin C contained within food can
be lost.
 Vitamin C is necessary for the formation, growth and
repair of bone, skin, and connective tissue. Vitamin C
assists to maintain healthy teeth and gums. It also
helps the body to soak up iron, which is required to
make red blood cells.
 Vitamin C helps for burns and wounds heal. Vitamin
C is an antioxidant like vitamin E. A person with an
)
eating disorder like anorexia is at high risk for vitamin
C deficiency.
 Alcoholics are also at risk as they get calories from
their drinks that they frequently neglect eating
healthy food.
 Nose bleeding, weakness, swollen gums and
lassitude are the symptoms of mild deficiency.

6
NCM 105 A | NUTRITION & DIET THERAPY LECTURE

FAT-SOLUBLE VITAMIN

VITAMIN E DEFICIENCY
Vitamin E Deficiency in Infants
 Buphthalmos retrolental fibroplasia.
 Close-up of the face of a child with Buphthalmos
retrolental fibroplasia, a cause of blindness in
premature infants.
 The affected eye (at right) is noticeably enlarged,
cloudy and lacking a distinct pupil. Buphthalmos is a
VITAMIN A DEFICIENCY type of congenital glaucoma, where fluid build-up
 Keratomalacia is also known as Night Blindness, within the eye damages internal structures.
Retinol Deficiency, Vitamin A Deficiency,
 Here, it has caused retrolental fibroplasia: damaging
Xerophthalmia and Xerotic Keratitis. It is an ocular
blood vessels in the developing retina leading to
condition when the cornea becomes dry, soft and
abnormal growth of fibrous scar tissue inside the eye.
thin, and then ulcerates, usually affecting both eyes.
 This condition can lead to detached retina as well as
damaged vision, and can be treated with lasers.

An early sign of vitamin E deficiency

are lipofuscin or age spots.

Rickets. Drawing of three pairs of legs (labelled 'a', 'b', 'c'). Pair
'a' and 'b' show the effect of rickets. Pair 'c' show the legs of a
rickets sufferer after undergoing an osteotomy. An osteotomy
is a surgical operation whereby a bone is cut to shorten,
lengthen, or change its alignment.

There are three different types of vitamin K:

1. Vitamin K1 (phylloquinone) is the type that comes
from the diet, especially green leafy vegetables but
also dairy products and vegetable oils. K1 is also
produced commercially to use as an oral or
injectable treatment for some conditions associated
with excess bleeding.

7
NCM 105 A | NUTRITION & DIET THERAPY LECTURE
2. Vitamin K2 (menaquinone) is made by bacteria, the MINERALS
normal flora in the intestines. It supplements K1, but  An inorganic element that remain an ash when food
there is not enough of it to meet the body's is burned
requirements.  important part in the vital processes of the body

3. Vitamin K3 (menadione) is a synthetic water-soluble CLASSIFICATION

form of vitamin K that is used as a treatment for adults. a. Macro nutrient mineral –essential for human nutrition
It is no longer given to infants in the United States as it present in amounts greater than 5grams
can cause hemolytic anemia. e.g. Calcium, Sodium, Phosphorous,
Potassium, Chlorine, Magnesium
Signs and Symptoms of vitamin K deficiency may include:
 easy bruising b. Micro nutrient mineral
 oozing from nose or gums – essential for human nutrition
 excessive bleeding from wounds, punctures, and – Present in amounts less than 5 grams
injection or surgical sites e.g. Iron, Iodine, Zinc, Manganese, Copper,
 heavy menstrual periods Cobalt Chromium
 bleeding from the gastrointestinal (GI) tract
 blood in the urine and/or stool Dietary minerals (also known as mineral nutrients) are the
chemical elements required by living organisms In general,
functions of dietary minerals are:
1. as constituents of bones and teeth
2. as salts regulating body fluids
3. as components of enzymes and hormones

GOOD SOURCE OF DIETARY MINERALS

The dietary minerals needed for our body come from the
following sources:
 Dairy products and green leafy vegetables for
Calcium
 Nuts, soy beans, and cocoa for Magnesium
 Table salt (sodium chloride, the main source), milk
and spinach for Sodium
 Legumes, whole grains, and bananas for Potassium
 Red meat, leafy vegetables (especially spinach) for
iron

Calcium deficiency
 Is a condition in which the body has an inadequate
amount of calcium. Calcium is a mineral that is
essential for many aspects of health, including the
health of bones and teeth, and a normal heart
rhythm.
 This mineral is also required for muscle contractions
and relaxation, nerve and hormone function, and
blood pressure regulation.
 High dietary calcium intake is necessary for infants,
children and adolescents in order to promote bone
growth and formation. Pregnant women also have
higher calcium needs, because it is required for the
normal development of fetal bones. In addition,
women who have reached menopause need to
ensure an adequate amount of calcium intake to
reduce the risk of osteoporosis.

8
NCM 105 A | NUTRITION & DIET THERAPY LECTURE
Types of calcium deficiency  Should a child start consuming junk food exclusively,
There are two types of calcium deficiency: as opposed to having a balanced diet, their intake
 Dietary calcium deficiency is a condition in which of high-protein-vitamins-roughage diet would
there is an inadequate calcium intake, which can substantially decrease and intake of milk and healthy
lead to depleted calcium stores in the bones, fruit juices would likely be replaced by soft drinks.
thinning and weakening of the bones, and
osteoporosis.  This would potentially lead to a deficiency of
 Hypocalcemia is a low level of calcium in the blood. calcium, since milk is rich in calcium. Calcium
It can occur from taking medications, such as deficiency, in turn, results in weakening of bones
diuretics; medical treatments; or disease processes, (osteoporosis).
such as renal failure
 Untreated calcium deficiency can lead to serious People who are at risk:
complications, such as osteoporosis, hypertension 1. Menopausal women. Women who undergo such
(high blood pressure), and cardiac arrhythmias (An stage from age 45 to 55, double their risk because
arrhythmia (also referred to as dysrhythmia) is an estrogen produced is fewer now and can no longer
abnormal rhythm of the heart that can cause the equal to bone loss.
heart to pump less effectively. 2. Smokers. Cigarettes and tobacco usage decreases
bone density. There is also a remarkable difference in
Symptoms of dietary calcium deficiency weight between most smokers and non-smokers.
There are generally no symptoms of dietary calcium Smokers tend to be thinner.
deficiency until bone thinning occurs and fractures develop
in weakened bones. Symptoms can be vague, take years to 3. Underweight people. Anorexics Being sickly thin
develop, and may not be noticeable until advanced increases their chances of breaking their bones more
osteoporosis has developed. Symptoms can include: than those who are overweight due to low levels of
 Back or neck pain, which can be severe estrogen in their bodies.
because of spinal bone fractures 4. Lack of exercise. Under, over and the right weight
 Bone pain or tenderness people run the risk of osteoporosis when they don’t
 Fracture that occurs with little or no trauma exercise regularly because it stretches your bones
 Loss of height and makes it sturdier.
 Stooped posture due to kyphosis (abnormal
curving of the spine and humpback) 5. People with Poor diet. Calcium deficiency happens
and bone loss occurs when there is not enough
Symptoms of hypocalcemia, or low levels of calcium in the supply of calcium and Vitamin D in your body. Drink
blood, are generally different from symptoms of dietary milk, eat cheese and take Vitamin D to help absorb
calcium deficiency. Some people may have no symptoms of all those necessary nutrients and feed your bones as
hypocalcemia, while others may experience the following early as possible.
symptoms:
6. Excessive coffee, tea, sodas and alcohol drinkers.
 Muscle cramps
Everything taken in excess is harmful more than
 Numbness
beneficial. These drinks take up calcium in your body,
 Paresthesia (burning or prickling sensations)
thereby decreasing your bone density over time.
 Petechiae (bleeding under the skin forming tiny
Caffeine erases the calcium in your body.
red dots)
 Poor appetite 7. Those who have family members with osteoporosis.
8. Those who take up medications that take up body
calcium. Medicine like Depo-Provera takes the
calcium out of your body, thereby, increases your risk
for osteoporosis.

Osteoporosis may not seem a big deal yet when you are still
in your 20s and 30s but when you reach 40s, it becomes big.
Regrets of not having taken that glass of milk or taken care of
health better before …pain – back, hip, neck, fingers and
knee – pain start showing up in our bodies.

9
NCM 105 A | NUTRITION & DIET THERAPY LECTURE
 The normal potassium level is 3.5-5.0 mEq/L (mEq/L stand
for mill equivalents per liter of blood and this is a measure
used to evaluate the level). Low potassium is defined as
a potassium level below 3.5 mEq/L.

 What is Potassium Deficiency (Hypokalemia)?

A medical condition in which our body fails to retain
minimum necessary amount of Potassium required for
its day to day functioning is called as Potassium
deficiency or hypokalemia.

 Potassium deficiency (hypokalemia) can be fatal at

times if not taken care of. A person may also develop
Potassium deficiency due to extra excretion of
Potassium or lower quantity of Potassium in daily

Symptoms of Hypokalemia:
Hypokalemia ranges from very ornate to severe level. A
person suffering from simple/harmless/primary staged
hypokalemia may experience no symptoms at all, but
general symptoms of hypokalemia are:
 Fatigue
 Patient may experience problems such as Iron deficiency anemia (IDA)
Myalgia and muscular weakness  is an ailment when there is not enough hemoglobin
 Patient may experience hyponatremia and also produced by the body to meet its requirement.
may experience confused i.e. anxiety.  The benchmark for its diagnosis is marked by below-
 Acne problem normal total body iron
 Skin related problems such as blistering, skin Etiology:
eruptions, dryness of skin etc.  It is caused by inadequate intake of iron-rich foods or
 Temporary memory loss or problems such as inadequate absorption of iron. Some of the known
weak memory etc. could be due to:
 Patient is prone to heart related problems, such a. chronic diarrhea
as heart deterioration. b. malabsorption syndromes
 Digestive system also may get affected due to c. high cereal intake with low animal protein ingestion
potassium deficiency leading to hypertension, partial or complete gastrectomy
improper sleep, nervous system deterioration,
depression, constipation etc.
 In some cases, patient may experience
ringing/noise in ear.

What are the causes of hypokalemia?

 There can be more than one reasons of potassium
deficiency (hypokalemia) in a person such as lower level
of Potassium in daily diet (i.e. insufficient potassium
consumption), excess potassium excretion through bowel
motions or urine, if a person is undergoing medication
that as a side effect causes lowering in Potassium level in
body
 Treatments available for hypokalemia:
Hypokalemia is generally treated by treating the
symptoms a patient is experiencing i.e. if a person is
suffering from diarrhea or constipation then he/she is
treated for the problem so as to stop/regulate Potassium
loss from his/her body. Your physician may also suggest
your medication to improve Potassium level in your body.
The patient is generally asked to take balanced diet for
days in order to restore the physical health pertaining
Potassium level and its role in metabolism.

10
NCM 105 A | NUTRITION & DIET THERAPY LECTURE
GOITER OR GOITRE
SIGNS AND SYMPTOMS
 Also known as Bronchocele swelling of the neck and
Main symptoms include:
larynx
 A swelling, ranging in size from a small nodule to a
 Goiter is an enlargement of the thyroid gland. The
massive lump, in the front of the neck just below your
thyroid gland is a small, butterfly-shaped gland
Adam’s apple
located in the neck, below your Adam’s appl
 A feeling of tightness in the throat area
 The thyroid gland produces the hormones thyroxine
 Hoarseness
(also called T4) and a small amount of
 Neck vein distention.
triiodothyronine (also called T3). Most of the T4 is
 Dizziness when the arms are raised above the head
converted to T3 outside of the thyroid. These thyroid
 Difficulty breathing (shortness of breath), coughing,
hormones influence such bodily functions as a
wheezing (due to compression of the windpipe) are
person’s body temperature, mood and excitability,
rare symptoms
pulse rate, digestive functions, and other processes
 Difficulty swallowing (due to compression of the
necessary for life.
esophagus) is also rare
CAUSES
Other symptoms of goiters can include:
 Goiters have different causes depending on their
 An increased resting pulse rate
type. Goiters can be classified as simple, hereditary,
 Rapid heartbeat
or due to other causes. Simple goiters are further
 Diarrhea, nausea, vomiting
classified as endemic (associated with iodine
 Sweating without exercise or increased room
deficiency) or sporadic.
temperature
 Simple goiters develop when the thyroid gland does
 Shaking
not make enough thyroid hormone to meet the
 Agitation
body’s needs. The thyroid gland tries to make up for
this shortage by enlarging.
 Endemic goiters occur in people within certain
geographic areas who do not get enough iodine in
their diet (iodine is necessary to make thyroid
hormone). Lack of enough iodine in the diet is still
common in parts of central Asia and central Africa.
The use of iodized table salt in the United States and
other countries has limited the development of this
type of goiter.
 Another type of simple goiter (sporadic goiters), in
most cases, has no known cause. In some cases,
though, certain types of drugs can cause this type of
goiter. Lithium (e.g., used in many mental health
conditions [bipolar disorder, major depression,
schizoaffective disorder]) as well as other medical
conditions, can cause this type of goiter.
Aminoglutethimide, a drug approved to treat tumors
in the adrenal glands, can also cause this type of
goiter.
 Hereditary factors also may cause goiters. A family
history of goiter, female gender and age over 40 are
all risk factors for the development of goiters.

Hypothyroidism
 is a condition in which the thyroid gland does not
make enough thyroid hormone.

Hyperthyroidism
 often referred to as an 'overactive thyroid', is when
the thyroid gland produces and secretes excessive
amounts of the free - not protein bound and
circulating in the blood

11
NCM 105 A | NUTRITION & DIET THERAPY LECTURE
MIDTERM PERIOD NOTES:
FOOD GUIDE PYRAMID FOR PREGNANT WOMEN

Source: Pinterest

Table 2
Table 1
RECOMMENDED WEIGHT GAIN DURING PREGNANCY
MATERNAL WEIGHT GAIN
WEIGHT GAIN
TISSUE WEIGHT (POUNDS) PRE-PREGNANCY RECOMMENDED PATTERNS
Fetus 7.5 WEIGHT WEIGHT GAIN 1st thereafter
Uterus 2.0 Trimester
Placenta 1.5 Underweight BMI 28.40 lbs 5 lbs 1 lb. per
Amniotic fluid 2.0 <18.5 week
Extracellular fluid 3.0 Healthy BMI 25-35 lbs 3 ½ lbs 1 lb. per
<18.5 week
Breast tissue 1.0
-24.9
Blood volume 3.0 Overweight BMI 15-25 lbs 2 lbs 2/3 lb. per
Fat 9.0 25.0 - week
Total: 28.0 29.9
Obese BMI 15 lbs
>30

12
NCM 105 A | NUTRITION & DIET THERAPY LECTURE
INFANCY TODDLERS
NUTRITIONAL REQUIREMENT FOOD GUIDE PYRAMID: TODDLERS
 WEANING – it signifies the gradual change from all The new Dietary Guidelines on which MyPyramid is based,
milk diet to one including a wide variety of foods. promoted fruits and vegetables and whole grains.

START OF WEANING  Fruit Group should provide 4 daily servings, or 2 cups

 6 months -Introduction of solid foods  Vegetable Group should provide 5 servings, or 2.5
 4-5 months- solid foods should not be given to a child cups.
 Grain Group should provide 6 ounce-equivalents (1
How to introduce new foods ounce-equivalent means 1 serving), half of which
1. Give half teaspoonful of the prepared new foods on should be whole grains.
the first occasion  Meat and Beans Group should provide 5.5 ounce-
2. Give the new food before breast or bottle feeding. equivalents or servings.
3. The second trial of the new food should be given a  Milk Group should provide 3 cups/servings.
Day or so later and the quantity increased to one  Oils should provide 24g or 6 teaspoons.
teaspoonful.
4. The amount and the variety of new foods should be ADULT
increased slowly until accustomed to their flavor and FOOD GUIDE PYRAMID: ADULT
consistency.
5. New foods should be introduced one at a time,
waiting several days before another is added.
6. Once the child has acquired a taste for a new food,
it should be given fairly frequently.
7. Food must be given in a natural state as much as
possible.

MEAL PLANNING
FOODS TO AVOID:
a. Strong flavored vegetables (such as onions, radish
and cabbage)
b. Very hot or very cold meals
c. Fried foods
d. Excessive spices and seasoning
Monosodium glutamate, salt and pepper
Coffee, teas, carbonated beverages
Foods that may choke the child (such as fruits with
seeds
Reminder:
1. Follow formula feeding schedules and directed by
the physician. ELDERY
2. We must ensure that supplements are either FOOD GUIDE PYRAMID: ELDERLY
SCRAPPED (fruits), MASHED, vegetables) STRAINED Choose the number of servings for each food group daily
(cereals and meats) all food types. Water equivalents
3. We must keep a diary of foods given to the child in  Choose 8 servings of water or decaffeinated, diluted
order to have a trace system by which reactions to drink. Water, Mineral Water and herbal teas.
foods may be determined. Bread, Cereal, Rice, Pasta Group
 Choose 8 or more servings
FOOD GUIDE FOR INFANTS
1 slice of bread (whole-grain)
ORDERS OF FOOD FOR WEANING INFANTS
o - ½ English muffin
1. Cereal
o small biscuit or muffin
2. Fruit
o ½ cup cooked cereals, rice or pasta
3. Juice
o 1 ounce ready to eat cereals
4. Vegetables/Greens
Vegetable group
5. Soups
 Choose 3 or more servings from vegetable A group
6. Legumes
o ½ cup cooked vegetables
7. Rice
o ½ cup chopped raw vegetables
8. Cooked Food
o 1 cup leafy raw vegetables such as lettuce
9. Eggs
or spinach
10. Animal Protein/Meat
o ¾ cup vegetable juice

13
NCM 105 A | NUTRITION & DIET THERAPY LECTURE
Fruit Group NUTRITION FOR DIFFERENT AGE GROUP
 Choose servings from the fruit group NUTRITION IN INFANCY
o whole fruit such as medium apple, banana Infancy is characterized by rapid physical growth and
or orange development and maturation of oral, fine and motor skills.
o half of a grape fruit Adequate supply of all essential nutrients such as proteins,
o a melon wedges vitamins, minerals and energy.
o ¾ cup of juice Factors to determine individual needs
o ½ cup berries 1. Gender 3. rate of growth
o ½ chopped cooked or canned fruit 2. Body Size 4. physical activity

Meat, Poultry, Fish, Dry Beans, Eggs and Nut group Infants need smaller total amounts of nutrients than adults
 Amounts should total 5 or more ounces of cooked do because of their body size.
lean meat, poultry without skin or fish per day. Count
1 egg, ½ cup cooked beans or 2 tablespoons peanut METHODS OF FEEDING THE INFANT
butter as 1 ounce of meat. 1. BREAST FEEDING – when mother gives her breast to
the infant. The best and most natural way of feeding
Milk yogurt and Cheese Group
the infant.
 Choose 3 or more servings of nonfat or low-fat dairy.
A serving is 2. WET NURSING – Substitute for breast feeding due to
o 1 cup of milk maternal death or the mother’s unwillingness or
o 8 ounces of yogurt inability to breastfeeds an infant deprived of his own
o 1 ½ ounces processed cheese mother’s milk.
3. MIXED FEEDING – Feeding the infant partially from
Fats, Oils and Sweets
both the breast and the bottle.
 Use sparingly, these provide many calories often with
few important nutrients ADVANTAGES OF BREASTFEEDING
Supplements 1. COLOSTRUM - gives greater immunity to the infant, a
small amount of thick yellowish fluid secreted by the
 Extra calcium, vitamin D and Vitamins B12
mammary glands in the first few days after the birth.
supplements may be necessary to help prevent
It has a high carotene content, more protein less
o Bone thinning sugar and fat than milk produced thereafter high ash
o Maintain nerve function and content as well as greater concentration of sodium
o Reduce incidence of dementia potassium and chlorine.
2. Provides adequate nutrition.
3. Provides satisfactory growth and development
4. Low incidence of allergy.
5. Psychological Development
6. Economical Sanitary and convenient.
WEANING – it signifies the gradual change from all milk diet
to one including a wide variety of foods.
START OF WEANING
 6 months - Introduction of solid foods
 4-5 months - solid foods should not be given to a
child
How to introduce new foods
1. Give half teaspoonful of the prepared new foods on
the first occasion
2. Give the new food before breast or bottle feeding.
3. The second trial of the new food should be given a
Day or so later and the quantity increased to one
teaspoonful.
4. The amount and the variety of new foods should be
increased slowly until accustomed to their flavor and
consistency.
5. New foods should be introduced one at a time,
waiting several days before another is added.
6. Once the child has acquired a taste for a new food,
it should be given fairly frequently so that the liking is
not bad.
7. Food must be given in a natural state as much as
possible.

14
NCM 105 A | NUTRITION & DIET THERAPY LECTURE
FOODS TO AVOID: COMMON PROBLEMS AND DISORDERS IN INFANCY:
a. Strong flavored vegetables (such as onions, radish 1. REGURGITATION – the effortless expulsions of gastric
and cabbage) contents caused by gastrointestinal reflex. The result
b. Very hot or very cold meals of the decrease pressure on the lower esophageal
c. Fried foods sphincter.
d. Excessive spices and seasoning
2. COLIC – Acute abdominal pain which results to crying
e. Monosodium glutamate, salt and pepper
and being irritable. Food allergy or intolerance is one
f. Coffee, teas, carbonated beverages
of the causes of colic. This maybe resolve to a
g. Foods that may choke the child (such as fruits with
hypoallergenic formula.
seeds
3. DIARRHEA – characterized by frequent passage of
When the mother needs to be aware of when introducing
loose watery and unformed stool. Breast feeding
supplementary foods;
should continue. Plenty of liquids are needed for oral
1. The baby spit out the new food during first
re hydration.
experience.
2. Some babies are slow to accept new innovations, 4. FOOD ALLERGY – Hypersensitive state resulting from
some have general dislike or even minor variations the interaction of an allergens with an antibody. Any
from the regular routine of feeding. food is potentially allergenic but egg, milk and
3. The baby may refuse the new foods or may not take chicken are listed as common food allergens among
the full amount offered. infants.
4. Forcing the baby to eat may cause him to reject the
food altogether, or not to take the full amount
offered.
The child should be encouraged by:
a. Letting him see the new food
b. Allowing him to handle the feeding bowl to see
what it is like and how it feels.
c. Giving him a spoon and encouraging him to feed
himself by the eighth or ninth month.
d. Not discouraging his early messy efforts,
recognizing that this helps the baby to be able to
manage his feeding sooner by himself.
FOOD HYGIENE
1. Always give cooked foods, fruits freshly peeled e.g.
banana
2. Feed freshly cooked foods
3. Protect the food from flies
4. left-over foods should not be given to babies
5. Cleanliness of hands and utensils.
a. Wash hands with soap before preparing foods
and baby’s hands too.
b. Utensils should be separated from the general
use.
c. Keep utensils in a clean place
d. Boil utensils for at least three minutes after each
use keep then dry and covered.
NURSE’S ROLE:
1. Caregiver has to follow formula feeding schedules
and directed by the physician.
2. Caregiver must ensure that supplements are either
SCRAPPED (fruits), MASHED, vegetables) STRAINED
(cereals and meats) all food types)
3. Caregiver must keep a diary of foods given to the
child in order to have a trace system by which
reactions to foods may be determined.

15
NCM 105 A | NUTRITION & DIET THERAPY LECTURE
NUTRITION IN TODDLERS AND PRESCHOOLERS GUIDELINE TO PREVENT CHOKING
NUTRITIONAL REQUIREMENTS 1. Children should eat sitting down so they can
1. Energy concentrate on chewing and swallowing.
2. Protein 2. An adult should supervise children while they eat.
3. Vitamins and Minerals 3. Foods on which preschooler (age less than 3 years)
often choke as listed above should be avoided.
It is the period between 1 to 3 and 4 to 6 years, the most
4. Well-cooked foods modified so that children can
critical and dangerous in the growth of the child. Food likes
chew and swallow without difficulty
and dislikes begin to be established some are temporary but
5. Eating in the car should be avoided for if the child
many of which form the basis for a lifetime of food intake.
chokes it would be difficult to get to the side of the
road safely.
Nutrition plays a critical role in the development and growth
of children. Environmental influences and parental behavior SIGN OF GOOD NUTRITION
may reinforce or extinguish food related behaviors. 1. Alert, vigorous and happy
1. Toddlers are very active due national curiosity so they 2. Endurance during activity
need foods rich in nutrients to ensure that growth, 3. Sleeps well
process is enhanced and supported. 4. Normal weight and height for age
2. If the physician directed vitamin supplements, the 5. Stands erect arms leg straight
nature and quality of foods sources must be 6. Clear bright eyes, smooth and healthy skin lustrous
monitored carefully. hair
7. Firm and well-develop muscles
3. Foods must be prepared attractively and simply (with 8. Good attention
little sauces only)
Feeding Problems and Disorders
4. To eat his/her veggies first then the main then main 1. Food Jagging (eating too little and very limited
dish and dessert to ensure balanced intake of food. number of foods). Encourage the use of variety of
5. The pre-school child’s diet is best taken equally foods.
divided between the three meals. 2. Dawdling (the children Lingers or plays with his food
during meal times). Check on the child, he might not
6. Pre-school children prefers mildly flavored. Plain food be feeling well and the food given to him is too large.
rather the mixed dishes, soft textured rather than dry 3. Gagging (the child feels like vomiting). Encourage
or tough foods, warm foods, rather than very hot or the child to feed himself in a well-ventilated place.
very cold foods. 4. A pre-school child is a difficult child his appetite is
7. Fruits are well-liked, although simple desserts may be variable and his behavior capricious.
given. Candies and sweets should be in moderation.
The following recommendations to assist children in
8. Snacks should be given long before regular meals developing desirable food patterns:
1. All foods should be well prepared and attractive in
9. Avoid too much fried foods, high fiber foods or foods color, flavor and texture.
inadequately chewed such as nuts. 2. The environment for eating should be suitable for the
10. Satisfy the curiosity by giving him an opportunity to ability and comfort of the child appropriate tables
handle ingredients and acquainting him with names and chairs and suitable dishes.
and pictures of food stuffs. 3. Feeding should occur in a relaxed and pleasant
environment that fosters healthy digestion and pro-
11. Adults should set a good example of eating the right social behavior.
food. 4. The child is expected to have a good appetite and
12. Associate food with love and understanding to be hungry.
13. Preschool children do best with small servings of food 5. A child is expected to have a good appetite and to
offered several times during the day because of their be hungry and happily excited over the fact that is
smaller capacity and variable appetite. meal time.
14. Children are at risk on choking on food. Foods must
often responsible for deaths due to food asphyxiation 6. Pleasant associations with the food are fostered if the
are hotdogs, candy and grapes. In reality children meal can be eaten successfully with reasonable
can choke on any foods but they are most likely to effort.
have trouble with foods are hard or slippery.
Common Problems and Disorders
15. Caregiver must prepare meals that offer high sources
1. Diarrhea
of energy
2. Constipation
3. Food Allergy
4. Hyperactivity
5. Dental Caries
6. Protein Energy Malnutrition
7. Pica

16
NCM 105 A | NUTRITION & DIET THERAPY LECTURE
NUTRITION IN SCHOOL AGE NUTRITION FOR ADOLESCENCE
 The school age years is generally considered to be 7- Characterized by:
12 years, 1. Accelerated growth and development
 Characterized by more quiet, stable changes with 2. Changes in food habits
the extreme of growth and development seen in 3. Involvement is social and physical activities
infancy and adolescence. 4. Emotional problems associated with increased
 School age children show consistent but slow rate of personal and academic responsibilities and
physical growth, continuing maturation of the fine psychological concerns.
gross motor skills and gains in cognitive and social- 5. Problems with some teen-agers that demand special
emotional growth. nutritional needs, such as smoking drug and abuse
and eating disorders.
Nutritional Allowances
Children need more nutritious foods in proportion to their Psychological Changes during Adolescents
weight than do adults because of developing bones, teeth,  10-12 years old – the adolescence is aware of peer
muscles and blood relationship, starts to conscious of the body parts.
1. Energy  13-15 years old – there is more peer pressure, more
2. Proteins independence from parents and less trustful for adults
3. Vitamins and Minerals and significant cognitive development.
4. Fluids
 16-19 years old – he/she established a body image;
Factors Influencing food Intake: definitely shows independence; makes plans for the
1. Family – The family continues to have a strong future.
influence on food habits.
Nutritional Needs of Adolescence
2. Peers – Food attitudes and choices are beginning to The different between males and females of the same age
be more influenced by those outside the home. group to their growth and body composition changes as
3. Schools – Play a big role in education the child on describe earlier. There is also higher energy expenditures for
good eating habits. physical activities of males.
1. Proteins
4. Societal Trends – Includes mother who are employed. 2. Carbohydrates
5. Media – Television, is the media that influence of all 3. Vitamins
ages, they have an increasingly sophisticated 4. Water
advertising aimed at children to which kids are
responsive.  More calcium and iron on diet must be supplied.
Feeding tips Calcium is important in bone formation and iron is
1. Give liberal amounts of body-building energy giving important in maintaining a constant concentration of
and regulating foods in each meal. hemoglobin in the blood.
2. Every food eaten must carry, some proteins, minerals,  More iodine must also be supplied in the diet in the
vitamins and energy. form of iodized salt to compensate for the increased
3. Provide for nutritious snacks. thyroid activity associated with growth.
4. home packed lunches should be well-planned
5. The child should be given experience in food  They also need more body building and energy
selection but the parents should provide guidance to giving-foods due to higher energy expenditure.
ensure nutrient adequacy.  Fatty/sweet junk foods to acne and pimples.
6. Incorporate milk in other foods such as custard,
pudding, ice cream. Feeding Problems during Adolescence
7. Child at this stage has marked Like and Dislikes. More Irregular meals and snacking
often than not they Dislikes food that are rich in 1. Omitting breakfast
nutrients. 2. Junk foods
8. Caregiver must put emphasis on natural sources of 3. Frequent snacking of foods-follow food fads
supplement in order to enliven the diet of the child.
9. Schoolers must have a good breakfast because a  Anorexia Nervosa
hungry child is weak and less attentive.  Bulimia Nervosa
Signs of Good Nutrition  Weight Disorders
1. A well-develop body
2. Good posture
3. Healthy skin
4. Smooth and glossy hair
5. Clear eyes
6. Alert facial expression
7. Good digestion and elimination
8. Food appetite.

17
NCM 105 A | NUTRITION & DIET THERAPY LECTURE
NUTRITION FOR ADULTS AND ELDERLY 9. Poor oral hygiene or loose-fitting dentures will
Adulthood contribute to poor nutrition.
 Adulthood is the period of life when one has attained 10. Loss of taste sensation makes food less appealing
full growth and maturity. thus the elder will eat less.
 Adulthood pertains to the years between ages 21-50 11. Elderly people take drugs for various age-related
years without stresses. problems.
12. Inability to chew and swallow deters from eating
Proper nutrition needs emphasis in adulthood, since it is the properly.
longest period of life and possibly the peak productive years. 13. Loneliness, depression and loss of independence
will affect their appetite.
Nutritional Management 14. Caregiver must remember these elderly folks don’t
1. Maintenance of the desirable body weight have healthy and regular digestive system, so care
2. Overweight and obesity increases the chance of and thought must be observed to prevent disease
developing chronic disorders associated with aging caused by improper practices.
like, high blood pressure. 16. Fiber of tender vegetables, fruits and whole grains will
promote normal defecation in addition to their being
Factors Affecting Adequate Feeding good sources of vitamins and minerals.
I. Psychological Factors 17. Milk is important in the diet of the aged. A glass of hot
1. The loss of one’s spouse, close friends and relatives set milk before going to bed may induce sleep.
up a feeling of loneliness and insecurity in the aged 18. Avoid fatty meats and fish, dried foods, gravies,
to poor appetite. sauces and rich desserts.
2. Loss of one’s job, social position
3. Sexual Attractiveness
4. The threat of death creates a fear of being, lied to
5. Loss of vision and hearing

 Anxiety
 Depression
 Suspicion
 Confusion
 Loss of Memory
 Dementia
- Trouble learning new tasks
- Social withdrawal
- Neglect of hygiene of appearance,
inappropriate
- Poverty of speech for example gives “I don’t
know” answers.

II. Cultural Factors

III. Physical Factors
IV. Socio-Economic Factors (budget)
V. Health Factor
VI. Religion

Guideline in Feeding the Elderly

1. This age group needs the same basic “protective
foods”
2. No teeth or Poor Dentures
 Restrict foods that are mashed and chopped,
tender vegetables, fruits and whole grain
cereals, good sources of vitamins and minerals.
3. Milk as such an ingredient in recipes (breakfast
cereal)
4. Small frequent feedings of easy to digest foods are
more tolerable by some rather than 3 big meals
5. Consider the weather
6. Finger foods or eating out in the patio or park
7. Avoid highly seasoned foods, unless person is used to
spices.
8. Serve and encourage plain drinking water.
Dehydration is a big problem in the elderly

18
NCM 105 A | NUTRITION & DIET THERAPY LECTURE
TYPES OF HOSPITAL DIETS SOFT DIET
THERAPEUTIC DIET
 Also known as Clinical Diet Description: it includes easily digestible foods there are
 Is a modification of normal diet that designed to low fiber, mildly seasoned, and tender. Most raw fruits and
meet the requirement of a given situation? vegetables, nuts, seeds, coarse bread, and cereals are
 modification of regular diet to meet the needs of a voided. Milk, lean meats, fish, most forms of potatoes and
particular person. white breads are served on this diet plan. Caffeine is
Modified for discouraged. Field and highly seasoned foods are
a. Nutrients discouraged since they may be difficult to digest
b. Texture Purpose: serves as a transition diet between full liquid diet
c. Food Allergies and regular diet post surgeries. To decrease peristalsis and
d. Abdominal procedure limit situation of the GI tract

TRANSITIONAL DIET Remarks: the portions in this type of diet are usually small,
 Usually used after surgeries and procedure, to start because reintroduction of any food following surgery is
gradually with feeding and monitor tolerance to food best tolerated in small portions.
provided.
 Foods that are soft in texture REDULAR DIET
 The goal is to decrease nausea, diarrhea and gas Description: it is served based on the dietary guidelines
bowel movement that may cause abdominal pain and it incorporates a wide variety of foods and adequate
and discomfort. caloric intake. It has no food restrictions

Purpose: its purpose is to provide a well-balanced diet

CLEAR LIQUID DIET and ensure that individuals who do not require dietary
Description: foods that are liquid at room temperature modifications receive adequate nutrition.
such as clear juice, clear fruit flavored beverage, broth,
Remarks: it can also be referred to as general or normal
tea, and gelatin dessert. This diet does not include milk-
diet.
based liquids

Purpose: this diet is used to pre- and post – operatively for TEXTURE MODIFICATION
acute episodes of nausea and vomiting to promote  These types of diets are given for people who have
bowel rest, and when other liquids and solid foods are not difficulty in chewing or swallowing the food
tolerated  Usually given to elderly patients, or patient following
It helps prevent dehydration and relieves thirst oral surgeries.
Remarks: intended for a very short durations (3 days or
less) due to nutritional inadequacies MECHANICALLY SOFT DIET
Description: foods soft in texture, moderately low in fiber,
and processed by chopping, grinding or mincing to be
FULL LIQUID DIET easier to chew, according to individual need
Description: composed of foods that are liquid or that More milk products, tender meats, mashed
liquefy at room temperature. It also includes everything potatoes, tender vegetables and fruits and their juices are
allowed on the “clear liquid diet” plus strained cream included in the diet.
soups and ice cream. It uses milk and milk-based products
Purpose: it is indicated for individuals who have difficulty
as sources of protein. If patient is lactose and tolerant, the
w/ mastication due to conditions such as absence of
dietitian will recommend lactose-free products
teeth, loose dentures, and sore gums. It may be useful for
Purpose: this diet is used to as a transition between clear individuals’ w/ varices, inflammation or strictures of the
liquids and solid foods. It is prescribed when there are esophagus, and following radiation therapy to the oral,
problems w/ chewing and swallowing and following oral pharyngeal, or laryngeal areas.
surgery or surgery of the head and neck. This diet may also
Remarks: meals usually include sauces and dressings to
be used when your mouth or throat is sore.
make food easier to chew.
Remarks: it is temporary diet because it is deficient in
some vitamins and minerals. However, liquid
protein/calorie supplements may be included if you need
to follow a full liquid diet for extended periods of time.

19
NCM 105 A | NUTRITION & DIET THERAPY LECTURE
MASHED DIET LACTOSE-FREE DIET
Description: it refers to very soft food that requires minimal Description: it similar to the regular diet, but excludes milk
chewing. It can be easily mashed w/ a fork and may be and milk products and they are replaced w/ lactose free
moistening w/ a sauce. milk products, and milk alternatives, such as soy milk.

Purpose: it is indicated for patients whose swallowing Purpose: it is for individuals who are lactose intolerance or
muscles are not working properly and there is a risk of whom lactose is temporarily restricted for GI related issues
choking. Also, if the muscles in the mouth are weak, they
Remarks: lactose is a sugar found in milk and milk
may get tired before they have managed to eat enough
products
Remarks: serve w/ thick sauces or gravies. Puree all food
that cannot be mashed GLUTEN-FREE DIET
Description: It is a diet free form product containing
MODIFICATION FOR GASTROINTESTINAL DISORDER
gluten (wheat, barley, and rye), which include bread,
 Many digestive problems can be prevented by
pasta, cereals, biscuit and cakes and these can be
eating a healthy, balanced diet, such as
replaced w/ gluten free products, such as gluten free
constipation, diarrhea, and irritable bowel syndrome
bread or pasta or rice crackers

GASTRIC SOFT DIET (BLAND DIET) Purpose: it is for individuals who’s sensitive in gluten or
those individuals diagnosed as having Celiac disease
Description: it consists of foods that are easily digestible
and mildly seasoned. Fried foods, highly seasoned foods Remarks: Gluten-free products are available in the
and most raw or gas-forming fruits and vegetables are hospital, such as gluten free bread and pasta. They should
eliminated be ordered once the patient is admitted to the hospital
and they will be provided w/ 24 hrs. of admission.
Purpose: it is designed to avoid irritation of the
Gluten free snacks are also available, such as rice
gastrointestinal tract.
crackers
Remarks: it can also refer to as Bland diet.
MODIFICATION BASED ON MEDICAL CONDITION
ANTIDIARRHEAL DIET  These diets are ordered based on patient’s medical
condition, such as having diabetes, renal diseases, or
Description: it does not allow foods high in sugar and
cardiac problems, and they are modified according
smaller, more frequent meals are encouraged
to patient’s needs
Purpose: it is typically used for controlling diarrhea and
provides low fiber, low residue foods that are easier for the DIABETIC DIET
intestines to digest Description: it includes 3 meals and 2 snacks that are
served at 4pm and 10pm
Remarks: it is intended for a short duration due to
It contains restricted amount of CHO from milk food
nutritional inadequacies
group, starch, and fruit. The diet is rich in fiber from whole
grains, vegetables and fruits. Protein portion is doubled
HIGH FIBER DIET foe all diabetic patient unless contraindicated. It is also
Description: it focuses on whole grains, beans, vegetables low in fat, therefore all food items served should be low
and fruits to increase fiber content of diet. The diet might fat
include extra fruits, or brown bread, and/or two types of
Purpose: it is ordered for diabetic patients to help control
salads
blood sugar levels and avoid complications associated
Purpose: used for certain GI conditions to promote gut w/ diabetes
health, such as constipation
Remarks: this diet includes snacks such as, yoghurt,
Remarks: it should be introduced gradually as the high Laban, muhalabiya (milk pudding) or fruit.
fiber content in foods might cause some uncomfortable
symptoms for the patient such as abdominal distention or CARDIAC DIET
gas.
Description: it limits red meat, cheese, whole milk, butter,
and egg yolks, as well as high sodium foods and
FOOD INTOLERANCE condiments. It promotes whole grains, bean, vegetables
 Food intolerance is a chemical reaction and fruits
 Some common food intolerances include lactose Purpose: it is ordered for patients w/ cardiovascular
intolerance and gluten intolerance illnesses. Its purpose is to reduce serum cholesterol and
lipid lvl, to avoid and prevent excessive sodium intake

20
NCM 105 A | NUTRITION & DIET THERAPY LECTURE
and to reduce heart disease risk. This diet controls for total SPECIAL DIETS
dietary fat, saturated fat, cholesterol and salt DIABETES
Diabetes Mellitus is a disease in which the body does not
produce or properly use insulin to regulate the amount of
UREMIC DIET
glucose or sugar in the blood
Description: the RENAL DIET includes individually tailored
dietary protein, and certain other nutrients (potassium, Type 1 Diabetes: Insulin-dependent diabetes
phosphorus, and sodium) to help slow or prevent Insulin Dependent Diabetes mellitus (IDDM) or
progression of illness. Usually this diet will omit whole grain formerly called juvenile-onset diabetes accounts for
products because they are rich in potassium and about 5 to 10 percent of all diagnosed diabetes.
phosphorus, and milk products will be restricted to a Normally affect children and young adulthood but
certain quantity. Fruits are also chosen according to their can occur at any age.
nutrient content. Patient with Type 1 diabetes must have daily injection
to survive.
Purpose: it is specifically designed for patients who have
kidney diseases, whether patient is on dialysis or pre- I. Risk Factor
dialysis. The nutrient needs are ordered by a clinical The main risk factors include the following:
nutritionist  Family Health History
Remarks: this diet is considered important component of  Autoimmune Conditions
 Birth and Early Childhood Condition
the medical treatment for kidney diseases
 Born to an older mother
LOW POTASSIUM MEDIUM HIGH POTTASIUM  Born to a mother with preeclampsia during
VEG. POTASSIUM VEG. VEG. pregnancy
Cabbage Asparagus Artichokes  Early introduction of formula milk to infants.
Carrots Broccoli Avocado  Ethnic Background
Cauliflower Celery Beets
Corn Peas Okra II. Signs and Symptoms
Cucumber Peppers Potatoes  Weight loss
Eggplant Zucchini Pumpkin  Increased urination night time
Onions Summer squash Spinach  Extreme thirst
Mushrooms Tomatoes  Hunger
Lettuce Sweet potatoes  Fatigue, weakness
 Blurry vision
LOW POTASSIUM MEDIUM HIGH POTTASIUM  Irritability
FUITS POTASSIUM FRUITS FRUITS  Skin infections
Apple Cherries Apricots  Wounds that don't heal
Apple juice Grapefruit Banana
Blackberries Papaya Dates III. Treatment
Grapes Figs Nectarines There isn't any cure for diabetes yet. The only thing patient
Peach (canned) Prunes Orange
can do is to control and maintain their blood sugar level within
Pear (canned) Raisins Orange juice
a healthful and ideal range. This can be done by a
Pineapple Mango nectar
Strawberries combination of insulin therapy, diet, and exercise.
Watermelon
Type 2 Diabetes: Non-insulin-dependent diabetes
TONSILLECTOMY DIET Type 2 diabetes - Non-insulin dependent diabetes
Description: immediately post the surgery the patient will mellitus (NIDDM) or formerly called adult onset
account for more than 90 percent of all diabetes
drink only clear liquids, which are easier to swallow and
cases. It normally affects adult which is age 40 and
less irritation. Gradually add soft foods as desired. Good
above, and people which is overweight.
choices include: ice cream, cooked cereals, mashed
potatoes, pureed vegetables, puddings, warm soups, Type 2 diabetes is characterized by high level of
gelatin, yogurt, cottage cheese, soft-cooked or glucose in the blood. Glucose is the main energy
scrambled eggs, custards, and ground beef in gravy or source used by the body to fuel almost every action
sauce it performs. Insulin is produced by pancreas to
control the amount of glucose circulating in the
Purpose: it is ordered because some patients experience body by controlling the uptake of glucose into the
some pain on swallowing for at least the first 7-10 days body cell.
after surgery.

Remarks: avoid citrus juices or spicy foods that may irritate

your wounds. It’s important to get plenty of fluids after
surgery
21
NCM 105 A | NUTRITION & DIET THERAPY LECTURE
I. Risk Factors I. Risk Factors
A major advance for people at risk of developing type 2 Women most at risk for gestational diabetes are
diabetes: obese or over 30 years of age, have a family history
 Family Health History of diabetes and/or have previously given birth to a
 Obese or Overweight baby over 9 pounds.
 Sedentary or Inactive lifestyle
 Carrying fat around the waist and stomach II. Treatment
It is important to get early treatment for gestational
II. Complication
diabetes as it imposes danger on both the baby and
Without effective intervention to limit this strain can mother. Treatments include diet with a special meal
cause significant, severe complications such as
plans and scheduled physical activity, insulin
heart disease, kidney disease, blindness and loss of
injections, monitoring blood sugar and urine ketones.
limbs through amputation.
The goal of gestational treatment is to keep blood
III. Treatment glucose level equivalent to those pregnant women
 Proper treatment and glucose control enable who don't have gestational diabetes.
people with type 2 diabetes to live normal,
DIABETIC DIET
productive lives.
Diabetic Diet
 Treatment differs at various stages of the condition.  Maintain DBW
In its early stages, many people with type 2  Simple balanced healthy meal
diabetes can control their blood glucose levels by  Balance food with exercise
losing weight, eating properly and exercising.  Eating enough calories
 Many may subsequently need oral medication,  Recommendations of diabetic diet differ for person
and some people with type 2 diabetes may to person, based on their nutritional needs, lifestyle,
eventually need insulin shots to control their and the action and timing of medications
diabetes and avoid the disease's serious  Type 1 diabetic, focus mostly on matching food
complications. intake to insulin whereby one needs to know when
insulin peaks and how fast the body
Metformin, which is usually thought of as a treatment of  Type 2 diabetic the concern may be more oriented
diabetes, increases the body’s response to insulin. This not only to weight loss in order to improve the body's ability
to utilize the insulin it does produce.
regulates blood sugar, but has also been shown to increase
ovulation in women who were previously anovulatory.
Diabetes Guidelines
Whether it is Type I, Type II diabetes or Gestational
diabetes, the goals of achieving control of blood
Gestational Diabetes glucose levels are similar: to keep blood glucose as
Gestational diabetes is a form of diabetic which affect near as possible to that of a person without
diabetes.
non-diabetic pregnant women with high blood glucose
during pregnancy. The following table show the desirable blood sugar level
supply by The American Diabetes Association
 Begins between 24th and 28th weeks of pregnancy
and is consider as a temporary form of diabetes Blood Glucose Goals - Desirable Blood Sugar Levels
because it usually dissolves after delivery. However, in Time of test Person w/o Person w/
some instances, gestational diabetes patient might diabetes diabetes
subsequently develop type 2 diabetes. Before < 115 mg/dl 80 – 120 mg/dl
meals
Gestational diabetes happens when body not produce
Before < 120 mg/dl 100 – 140 mg/dl
or properly use insulin to regulate the amount of glucose bedtime
in the blood.  Recommended daily food portion:
This condition is known as insulin resistance. The result,  Daily calories count:
carbohydrates - 50% to 60%
glucose level in the bloodstream rise. During pregnancy
protein - 12% to 20%
there is normally an increase in the amount of insulin
fat - not more than 30%
produced by the pancreas. This occurs because
hormones during pregnancy make it difficult for your  Spacing meal throughout the day, help a person
body to use insulin. When a woman has gestational avoid extremely high or low blood glucose levels.
diabetes, pancreas can't cope with the demand and  Diet undertaken with the supervision of a doctor.
blood glucose levels rise.  Intake of food which help lower blood cholesterol.
 Use Exchange lists in planning diabetic diet.

22
NCM 105 A | NUTRITION & DIET THERAPY LECTURE
DIABETIC FOOD PYRAMID HYPERTENSION
Medical Description
Hypertension, or high blood pressure, is characterized
by high blood pressure on the artery walls.

I. Risk Factors
 Heart failure: by imposing an additional workload on
the heart, hypertension can cause depletion of the
heart muscle;
 Of angina, myocardial infarction and stroke: high
blood pressure means that the blood exerts greater
pressure on the artery walls, making them fragile and
increases the risk that the artery Hangs by
atherosclerosis;
 Kidney problems (renal failure) and eyes (injury to the
retina can lead to blindness): Again, due to the
Fats (Limit to 1 serving per meal) A serving can be weakening of blood vessels.
 10 Peanuts.
 1 Tbsp Salad Dressing II. Prevalence
 2 Tbsp light salad dressing or sour cream. According to the World Health Organization, 30%
 1 Tsp margarine, Oil or mayonnaise. men and 50% of women aged 65 to 75 years suffer
 1/8 Avocado. from hypertension. Nowadays, hypertension affects
populations increasingly younger.
Sweets (Substitute for starch or fruit serving occasionally) A
serving can be: The types of hypertension and its causes
 2 Small Cookies.  The primary hypertension represents about 90% of
 1 Small Cupcake or Muffin cases. It depends on many factors related to age,
 ½ Cup Ice cream. heredity (especially for males) and harmful habits,
 1/3 Cup Frozen Yoghurt. the effects accumulate over the years. Obesity,
 ¼ Cup Sherbet. inactivity, smoking, alcohol abuse, stress and too
 1 tsp Syrup or Honey. much salt diet contributes to hypertension.
Milk (2-3 Servings per day) A serving can be:  A high intake of salt causes water retention.
 1 cup Milk. According to a survey conducted by Statistics
 1 Cup Low Fat. Canada, over 85% of men and 60% of women have
 1 Cup Artificially Sweetened yogurt (No sugar) an intake of salt or sodium than the recommended
upper limit of 2 300 mg per day1.
Meat / Fish/Chicken (2-3 Serving per day) A serving can be:
 2 oz Cooked Lean Meat/Poultry/Fish.  Secondary hypertension may result from another
 ½ - ¾ Cup Tuna or Cottage Cheese. health problem (a kidney problem or endocrine,
 1 Egg or 4 oz Tofu or 1 oz cheese. congenital deformity of the aorta) or the frequent use
 2 Tbsp peanut Butter. of certain drugs. For example, nasal decongestants,
because they contain ephedrine (a substance
Vegetables (3-5 Serving Per day) A Serving can be:
whose effect resembles that of adrenaline secreted
 1 Cup Raw Vegetables.
under stress), anti-inflammatory, which create the
 ½ Cup Cooked Vegetables.
retention of water and salt, and bronchodilators,
 ½ Cup Tomato or Vegetable Juice.
which have a stimulating effect on the heart.
Fruits (3 Serving per Day) A Serving Can be:
 70 gm small fruit III. Diagnosis
 ½ Cup canned fruit Doctors measure blood pressure several times during
 ¼ cup Dried Fruit successive visits, as figures can vary significantly from
 ½ Cup Fruit Juice. (No sugar) one time to another.
Grains, Starchy Vegetables and Beans. (6-11 Servings Per It is uncommon for tension rises significantly when a
Day) A Serving Can be: patient enters the doctor’s office, and tension begins
 1 Slice of 1 oz bread or ½ (1 oz) Bagel or 5 Crackers to decrease when it emerges. This is called the
or 1 Granola bar. “syndrome of the white coat.” To avoid this type of
 ½ Hamburger or Hot dog Bun or a tortilla of 6 inch or reaction, the doctor may suggest the patient to
2 tacos. measure his own blood pressure at home using a
 ½ Cup Cooked Cereal, Cooked beans, Lentils, Corn, monitor.
Peas, S. Potato, Potato or Pasta. Once reliable values found, the doctor may
 1 Cup winter Squash, 1 Cup Soup. diagnose a person whose pressure is equal to or
 1/3 Cup Rice or 3 Cup Plain Popcorn (Fat free) greater than 140/90 suffers from hypertension. Note

23
NCM 105 A | NUTRITION & DIET THERAPY LECTURE
that people with diabetes or renal disease should
 Americans of African descent.
ideally maintain a blood pressure that does not
 Individuals with a family history of early hypertension.
exceed 130/80.
VI. Risk Factor
Level of blood pressure  Obesity.
 Measurement of systolic pressure  Diet high in salt and fat and low in potassium.
 Measurement of diastolic pressure  Excessive consumption of alcohol.
OPTIMAL 115 / 75 mmHg  Smoking.
NORMAL < 120 / < 80 mmHg  Physical inactivity.
PREHYPERTENSION 120-139 / 80-89 mmHg  Stress.
HIGH Stage light  Regular consumption of black licorice or products
140-159 / 90-99 mmHg containing black licorice
Stadium moderate
160-179 / 100-109 mmHg DIET (DASH DIET)
Late stage (Dietary Approaches to Stop Hypertension)
180-110 mmHg
Grains: 4 daily servings
Note:
Vegetables: 4-5 daily servings
In the case where the measurement of the systolic and Fruits: 4-5 daily servings
diastolic blood pressure are two different levels, the physician
Low-fat or
takes into account the level corresponding to the higher Fat free dairy products: 2-3 daily servings
value for assessing the condition of blood pressure.
Meat, Poultry and Fish: 2 or less daily servings
Understanding the measurement of blood pressure Nuts, seeds and
Blood pressure consists of systolic and diastolic pressures, Dry beans: 4-5 servings per week
which are measured in millimeters of mercury or mmHg. Fat and Oils: 2-3 daily servings
Sweets: try to limit to less than
 Systolic pressure corresponds to the period of heart 5 servings per week
contraction and ejection of blood into the arteries. It
ensures a supply of blood around the body. Vegetarian Diet
Lower blood pressure and lower incidence of
 The diastolic pressure is the pressure exerted on the hypertension and other cardiovascular diseases,
arteries between each pulse when the heart relaxes. vegetarian diet contains more potassium, complex
It corresponds to the period of ventricular relaxation carbohydrates, polyunsaturated fiber, calcium
that allows the heart chambers to fill. This pressure magnesium, vitamin C and A.
tends to increase with age, but passed the sixties, it Fiber
gradually decreases due to the weakening of blood
Water soluble gel forming oat bran, apple pectin it
vessels in the body.
also reduces cholesterol and promote weight loss
Blood pressure depends on the amount of blood pumped Reduce Salt and Sodium in your diet
by the heart and resistance in the arteries. Excessive consumption of dietary sodium
chloride(salt)
IV. Symptoms
Coupled with diminished dietary potassium, induces
Hypertension is usually asymptomatic. However, a very high
an increase in fluid volume and an impairment of
blood pressure (moderate or advanced stage) can cause
the following symptoms: blood pressure regulating mechanisms. This results in
hypertension in susceptible individuals.
 Headache accompanied by fatigue (these
A high potassium-low sodium diet reduces the rise in
headaches are located in the neck and occur early
blood pressure during mental stress by reducing the
in the morning);
blood vessel constriction effect of adrenaline.
 Dizziness or ringing in the ears;
 Palpitations; Sodium restriction alone does not improve blood
 Nosebleeds; pressure control; It must be accompanied by a high
 Confusion or sleepiness; potassium intake.
 Numbness or tingling in the feet and hands.
Beneficial Vegetables and Spices to control hypertension
1. Celery
V. People at risk
 Eating a few as four celery stalks was found to be
 People over 55 years. Blood pressure tends to
beneficial in lowering blood pressure.
increase from that age.
2. Garlic
 Among young adults, the percentage of
 1 clove of garlic in 12 weeks- diastolic blood
hypertension is higher among men than women
pressure and cholesterol levels were significantly
among those aged 55 to 64 years, the percentage is
reduced.
roughly the same in both sexes among persons over
64 years, the percentage is higher among women. 3. Onion
 It has an essential oil that lowers the systolic levels

24
NCM 105 A | NUTRITION & DIET THERAPY LECTURE
4. Tomato  Indications: Maybe required for a short period of time
 Are high in gamma-amino butyric acid (GABA) a or indefinitely in a variety of circumstances, surgery of
compound that can help bring down blood the mouth or GIT, paralysis of the jaw, severe burns,
pressure. anorexia nervosa, coma, ordinarily the feeding are
given by NGT.
5. Saffron
 Contains a chemical compound called crocetin 5. Soft diet
that lowers the blood pressures  To provide nutritionally adequate and the use of
simple and easily digested foods.
Tips to start DASH Diet  CHAR: Follows the regular diet pattern but modified
 Add a serving of vegetables at lunch and dinner in consistency and texture.
 Add a serving of fruit to your meals or as a snack  Foods Allowed: Easily digested and easily chewed
 Use only a half butter, margarine or salad dressing such as fruits, meat not tough
use low-fat or fat free condiments  Foods Avoided: Highly seasoned foods, fatty tough
 Drink low-fat or skim dairy products three times a foods and friend foods.
day
 Limit meat six ounces a day. Try eating some 6. Mechanical Soft Diet or Geriatric Soft Diet
vegetarian meals  To provide food with minimum chewing
 Add more vegetables, rice, pasta and dry beans to  CHAR: Follows food pattern regular diet but modified
your diet. by grinding, mincing, chopping and pureeing.
 Instead of typical snack (chips etc.) eat unsalted
pretzels or nuts, graham crackers low-fat free 7. Bland Diet
yogurt: unsalted plain popcorn with no butter and  To provide chemically, thermally and mechanically
raw vegetables non-irritating diet, to reduce the secretion.
 Read food labels carefully to choose products that  Food Avoided: Decaffeinated coffee, red pepper,
are lower in sodium. cola beverages, food gastric irritation, black pepper,
Chili powder, caffeine, coffee, tea. Cocoa, alcohol
THERAPEUTIC DIET  Indications: Duodenal Ulcers, Ulcer, Ulcerative Colitis
Is a modification of normal diet that designed to meet the  Gall Bladder disease.
requirement of a given situation?
TYPES OF DIET 8. Reducing Diet (low Calorie/Low fat)
1. Normal or Regular or Full Diet  CHAR: Normal Diet
 Use as a basis for planning therapeutic diet  Fat and CHO Restricted
 CHAR: It follows the principle of good meal planning  ↓CHO – Fruits and Vegetables are used and restriction
and permits the use of all foods
 AVOIDED: Highly spicy foods, rich fatty foods and gas
forming foods (apple, bread, camote, milk products
and citrus fruits)

2. Clear Liquid Diet

 To provide and oral source of fluid and small amount
of calorie and electrolytes in order to prevent
dehydration relieve thirst, maintain water imbalance
and reduce caloric residue.
 Indications: Diarrhea, inflammatory conditions of GIT

3. Cold Diet (Tonsillectomy)

 To minimize pain, in the oral cavity and avoid
bleeding of the operated areas.
 CHAR: consists of solid or iced smooth liquids and
foods (plain ice cream, sherbets, cold milk, ice tea,
bland fruits which have been cooled.
 Indications: Tonsillectomy and tooth extraction

4. Tube feeding or Blenderized or Osteorized diets

 To provide a source of complete nutrition in a form
that will easily pass through a tube.
 CHAR: Consist of Natural food that are liquid or a
liquefied by means of mechanical blender and
administered by NGT for patient unable to take food
by mouth, it is nutritionally adequate well tolerated by
the patient, easily digested, easily prepared and in
expensive.

25
NCM 105 A | NUTRITION & DIET THERAPY LECTURE
GOUT Treatment
Gout is a version of arthritis caused by too much uric acid in First, it is critical to stop the acute inflammation of
the blood stream. joints affected by gouty arthritis.
It is one of the most common and oldest forms of arthritis that Second, it is important to address the long-term
can cause extreme pain in the areas affected management of the disease in order to prevent
future gouty arthritis
The body either makes too much uric acid or it cannot
excrete it from the body in large enough quantities. The treatment of an acute attack of gouty arthritis
involves measures and medications that reduce
Uric acid is a byproduct of purines being broken down by the
inflammation. Preventing future acute gout attacks is
body's digestive and waste system, which in turn breaks down
equally as important as treating the acute arthritis.
and builds up body and food tissues through food intake.
Generally, the uric acid is dissolved in the blood and also Prevention of acute gout involves maintaining
flushed out through the kidneys. adequate fluid intake, weight reduction, dietary
changes, reduction in alcohol consumption, and
When the Uric acid levels are high, it is known as medications to lower the uric acid level in the blood
Hyperuricemia.
Drugs:
 Indomethacin - anti-inflammatory
 Acetaminophen - pain reliever
 Colchicine - decrease joint inflammatory

Recommended Food to Eat:

 Fresh Cherries, Strawberries, Blueberries
 Banana, Celery, Tomatoes,
 Vegetables including: Cabbage, Parsley, green
leafy vegetables
 Pine apple
 Foods high in Vitamin C
 Red Cabbage
 Red Bell peppers
 Mandarins
 Gout is considered a chronic and progressive disease  Oranges
 Potatoes
 It is often related to an inherited abnormality in the
 Drink fruit juices
body's ability to process uric acid. Uric acid is a
 8 glasses of water a day
breakdown product of purines that are part of many
 Carbohydrates such as Bread, cereals, pasta, rice
foods we eat.
 Low-fat dairy products
 Gouty arthritis is typically an extremely painful attack  Tuna
with a rapid onset of joint inflammation.  Salmon
 Tofu
 Gout is nine times more common in men than in
women. It predominantly attacks males after
(X) Food to Avoid
puberty, with a peak age of 75. In women, gout
 Bacon
attacks usually occur after menopause.
 Beer
 Red Meat
Risk Factors for developing gout:
 other alcoholic beverages.
1. Obesity
 Anchovies, sardines in oil, Yeast.
2. Excessive weight gain
 Organ meat (liver, kidneys, sweetbreads)
3. Alcohol
 Legumes (dried beans, peas)
4. High Blood Pressure
 Meat extracts, gravies.
 Mushrooms, spinach, asparagus, cauliflower.
Signs and symptoms
1. The small joint at the base of the big toe is the most
common site of an acute gout attack of arthritis.
2. Other joints that are commonly affected include the
ankles, knees, wrists, fingers, and elbows.
3. Acute gout attacks are characterized by a rapid
onset of pain in the affected joint followed by
warmth, swelling, reddish discoloration, and marked
tenderness.
4. Patients can develop fever with the acute gout
attacks

26
NCM 105 A | NUTRITION & DIET THERAPY LECTURE
KIDNEY STONE SIGNS AND SYMPTOMS
 people who have kidney stones often report the
sudden onset of excruciating, cramping pain in their
low back and/or side, groin, or abdomen.
 It may be so severe that it is often accompanied by
nausea and vomiting.
 If infection is present in the urinary tract along with the
stones, there may be fever and chills. Sometimes,
symptoms such as difficulty urinating, urinary urgency,
penile pain, or testicular pain may occur due to
kidney stones.

TREATMENT:
 Ketorolac (Toradol), an injectable anti-inflammatory
drug,
 Treatment is directed toward control of symptoms.
 A kidney stone is a hard, crystalline mineral material Home care in this case includes the consumption of
formed within the kidney or urinary tract. Kidney plenty of fluids. Ibuprofen (Advil) may be used as an
stones are a common cause of blood in the urine anti-inflammatory medication if there is no
(hematuria) contraindication to its use
 often severe pain in the abdomen, flank, or groin.  Surgical techniques have also been developed to
Kidney stones are sometimes called renal calculi remove kidney stones

RISK (X) FOODS TO AVOID

 Anyone may develop a kidney stone or those who 1. Foods Rich in Calcium
are taking certain medications are more susceptible Foods rich in calcium are obviously kidney stone
to their development. foods to avoid. It is not the calcium rich foods per se
 Most urinary stones develop in people 20-49 years of that leads to formation of kidney stones. However,
age, and those who are prone to multiple attacks of when our diet is too high in calcium, our body cannot
kidney stones usually develop their first stones during convert these calcium deposits into useful forms thus
the second or third decade of life. they become stagnant in our kidneys and clump to
become a kidney stone.
Most Common in Males than females
2. Food high in oxalate or salt of oxalic acid produce in
 A family history of kidney stones is also a risk factor for
the body’s metabolism excreted in the urine.
developing kidney stones. Kidney stones are more
Spinach, peanuts, chocolate and sweet potatoes
common in Asians and Caucasians than in Native
are oxalate-rich foods that a person prone to kidney
Americans, Africans, or African Americans.
stones should avoid eating.
 Uric acid kidney stones are more common in people
with chronically elevated uric acid levels in their 3. Foods High in Protein
blood. Meat, Egg, Nuts

4. Foods High in Sugar

Causes
Apart from those with diabetes mellitus, people with
 Kidney stones form when there is a decrease in urine
kidney stones should also consider sugary and sweet
volume and/or an excess of stone-forming
confections as kidney stone foods to avoid. What
substances in the urine.
happens with too much intake of sugar, it takes away
 The most common type of kidney stone contains calcium deposits from our bones and increases the
calcium in combination with either oxalate or amount of calcium in our blood. As such, calcium
phosphate. may be deposited inside our kidneys and may form
in calcium stones
 Dehydration from reduced fluid intake or strenuous
exercise without adequate fluid replacement 5. Diuretic Drinks
increases the risk of kidney stones Alcohol and caffeine are diuretics. When we say
diuretics, these foods and beverages increases our
Gout results in chronically increased amount of uric acid in urine output. When this happens, we may dehydrate
the blood and urine and can lead to the formation of uric ourselves and leave our kidneys with a high
acid stones. concentration of minerals and elements. With
dehydration, kidney stones may form. As such, it is
important to keep ourselves hydrated as much as
possible to dilute our urine and prevent these minerals
from turning into kidney stones.

27
NCM 105 A | NUTRITION & DIET THERAPY LECTURE
6. Sodium
Processed Foods

(/) Foods Allowed

 Eating whole foods like leafy vegetables, fruits,
vegetables, whole grains, legumes, brown rice and
soy makes the perfect diet for kidney stones.
Including foods containing Magnesium and other
minerals, high fiber like oats, wheat bran, barley etc.
proves to be beneficial in preventing kidney stones.
 magnesium (dry milk in homemade yogurt increases
the percent of magnesium content through food)

Different Cookery terms:

 Bake To cook food by dry heat in an oven, or as if in
an oven.
 Blanch To plunge a food into boiling water - then into
iced water to quickly stop the cooking. Often used to
loosen skins, set color, remove bitterness or reduce
salt in cured meats.
 Boil To cook food by heating liquid ingredients to
boiling point and maintaining at that temperature.
"Bring to the boil" heating a liquid until bubbles break
the surface.

Blend To use a spoon, beater or electric blender to evenly

combine two or more ingredients.
 Braising To gently fry meat, vegetables or other foods
by lightly browning in fat and then cooking slowly in
a covered pan with a small amount of flavorful liquid
such as stock or wine.
 Dash a seasoning measure indicating a scant 1/8
teaspoon or less.
 Fry to cook over direct heat in a hot oil of fat
 Garnish To decorate food with strips pf parsley,
tomato slices and other vegetables that are edible.
 Sauté To fry food quickly over high heat in a little fat
to seal and lightly brown. The food is moved
constantly to keep an even heat and avoid burning
on the outside before the inside is properly cooked.
 Simmer To cook food gently in a liquid at or just below
boiling point so that the liquid quivers rather than
bubbles.
 Stew To simmer in a small quantity of water

28