What Is Medical Nutrition Therapy?

The goal of medical nutrition therapy is to help you get the best possible nutrition, even when you have a
gastrointestinal disorder.

The diet is the sum of food consumed by other person or other organism.
Side notes:
3 Principles of Dietary Management
1. Liberalization- the diet should meet the body’s requirement for essential nutrients generously as the
disease condition permits
2. Individualization- the diet regime should take cognizance of the patient’s food intake, habits,
preferences, economic status, religious practices and any environmental factor which has bearing on
the diet, such as where the meals are eaten and who prepares them.
3. Simplification- the therapeutic diet should vary from the adequate normal as possible.

Diet therapy is concerned with recovery from illness and prevention of disease.

WHAT IS THERAPEUTIC DIET?

 Planned diet  Removing or adding foods
 Modification of normal diet  Change nutrients, caloric content and/or
 Used to supplement the medical or surgical texture
treatment  Increase or decrease bulk in the diet e.g.
 Prescribed by doctor and planned by High or low fiber diets
dietician  Increase or decrease the energy values

Purposes of therapeutic diets Types of Diets in the Hospital

 Regulate amount of food 1. Regular Diet
 Assist body organs to maintain normal 2. Liquid Diet
function a. clear liquid
 Aid in digestion b. full liquid
 To improve specific health conditions c. pureed
 Increase or decrease body weight 3. Soft Diet
 Modify the intervals of feedings. 4. Restricted Diet
5. Therapeutic Diet

A. Regular Diets
 also called normal or house diets

Are used to maintain or achieve the highest For example, a pregnant woman may require
level of nutrition in patients who do not have more calories and different nutrients than a young
special needs related to illness or injury. child would need.
 It is most frequently used in all hospitals.
 While regular diets do not have portion or  It is used for ambulatory and bed patients.
choice restrictions, they are altered to meet the  Whose condition does not give a special diet of
needs of the patient's age, condition and personal one or the routine diets. Many special diets
beliefs. progress ultimately to a regular diet.

 PRINCIPLE:
 The diet should be well balanced one and nutritionally adequate. It should provide 1500 to
2000 kcal, 40 to 45 gram of protein and adequate vitamins and minerals.

B. Liquid Diets
The three types of liquid diets are clear liquid, full liquid and pureed.
 Nutritionally inadequate and should only be used for short periods of time
Uses:
o After surgery or a heart attack
o Patient with acute infections or digestive problems
o To replace fluids lost by vomiting or diarrhea
o Before some Xrays of digestive tract liquid diet
 a. CLEAR LIQUID DIETS
 is made up of clear fluid liquids
 is non residue FREE FROM FIBROUS or presence of any food particles. It is a non-residual diet.
 include water, broth, clear juices
such as apple or grape, popsicles and gelatin.

 PRINCIPLE:
o Non residue diet, non gas forming, non irritating, non stimulating diet.
o Clear fluid 30 to 60 ml of feed should be given at an interval of 2 hours.
o Given for acute infections when there is intolerance for food either as nausea,
vomiting, anorexia, distention and diarrhea.
o In acute inflammatory conditions of intestinal tract during post surgical conditions.

b. FULL LIQUID DIETS

 allow all the liquids in a clear liquid
diet PLUS THICKER FLUIDS such as milk, pudding and vegetable juices.
 In this diet, foods which are liquid or which readily becomes liquid on reaching stomach were
given.
 This diet bridges the gap between the clear fluid or soft diet.
 clear liquid diet plus strained soups and cereals, fruit and vegetable juices, yogurt, hot cocoa,
custard, ice cream, pudding, sherbet, and eggnog

 PRINCIPLE:
A non gas forming, non irritating, non stimulating full fluid diet.
 30 to 60 ml of feed at an interval of 2 to 4 hours.
 It is recommended for pre and post operative acute infections, diarrhea
 it is suggested for convolving patients and patients.

c. PUREED DIET
allows all foods as long as they are converted to a liquid form in a blender.

C. Soft diets
 transition patients from a liquid diet to a
regular diet.
 The diet should be most frequently to hospital patient. It bridges gap between ACUTE ILLNESS AND
CONVALESCING PATIENTS.
 Patients prescribed a soft diet are restricted to foods that can be mashed well.
This includes cooked fruits and vegetables, bananas, soft eggs and tender meats.
A mechanical soft diet allows most foods as long as they can be chopped, ground, mashed or pureed
to a soft texture.
 This excludes most raw fruits and vegetables or foods containing seeds and dried fruits.
 Similar to regular diet but foods must require little chewing and be easy to digest
 Avoid meat and shellfish with tough connective tissue, coarse cereals, spicy foods, rich desserts,
fried foods, raw fruits and veggies, nuts, and coconuts

 PRINCIPLE:
 The diet must be nutritionally adequate. It should be a bland diet and should made
up simple easy to digest food without harsh fibre at seasonings.
 Patients with dental problems.
 It may be used in acute infections following surgery and those find it difficult to chew.
 It is often modified for certain pathologic condition.

D. Restricted diets
encompass a variety of special diets that limit the amount of calories, fat, salt and
other substances based on the patient's medical needs
 For example, a restricted-fat diet allows only low-fat versions of milk, cheese, cereal and ice cream
but does not place limits on the amount of fresh fruits and vegetables a patient may consume.
  A restricted diet can also modify the other types of diets.
For example, a post-operative patient with heart disease may be prescribed a low-fat full liquid diet.

E. Therapeutic diets
are used to treat disease or illness.
 Like restricted diets, they can also be used to modify another type of hospital diet.
 Types of therapeutic diets include modification of calorie intake, such as with patients that need a
high calorie diet to promote weight gain, modification of certain nutrients including protein and
carbohydrates; or diets that encourage an
increased fluid intake

DIETARY MANAGEMENT OF GASTRTOINTESTINAL TRACT

Dysphagia
 Position the patient in a comfortable with  Foods should be close to room
the head in an upright position, slightly temperature. Avoid acid or bitter flavors
tilted forward and sticky foods (e.g. soft bread, bananas,
 Textured foods that require chewing or peanut butter).
stimulate a better swallow,  Make consistency adjustments according to
e.g. toast instead of bread or boiled the patient’s tolerance. Liquids can be used
potato instead of mashed potatoes. to moisten foods for individuals with
 Offer juices diluted with water at first, and decreased saliva production
use flexible straws if the patient has  Adapt the diet to the patients’ need and
suckling capabilities gradually upgrade it as feeding skills
 Mildly sweetened and salted foods are improve.
generally favored.

Gastroesophageal Reflux
 Achieve and maintain ideal body weight to  Avoid foods that may irritate and cause
improve mechanical and postural status spasms: citrus juices, tomatoes, and tomato
(except pregnant women, who should not sauce.
try to lose weight).  Stop smoking, if that is a habit.
 Increase protein and reduce fat intake to  Eat small meals four times a day.
increase sphincter pressure.  Eat large meal at noon with a lighter meal
 Avoid foods like chocolate, alcohol, in the evening.
peppermint, coffee, and carbonated drinks.  Finish the evening meal at least two to four
hours before bedtime. Avoid late evening
snacks.
Peptic Ulcer
 Individualized-approach
- A trend in nutritional therapy of peptic ulcer based on the individual patient’s tolerance for specific
foods.
 To reduce or neutralize gastric acid secretion:
o Eat three meals daily; avoid skipping o Some fibers, especially the soluble
meals. forms, are beneficial.
o Avoid stomach distention with large o Citric acid juices may induce gastric
quantities of food at a meal. reflux and discomfort in some patients.
o Avoid drinking milk frequently. o Avoid bedtime snacks to prevent acid
o Limit caffeine intake by reducing secretion if symptoms often occur in the
consumption of coffee, tea, cola, middle of the night.
chocolate and other foods and o Avoid cigarette smoking, which may
beverages that contain caffeine. increase gastric acid secretion and
o Limit alcohol intake and avoid drinking delay the healing process and is also
on any empty stomach. associated with an increased frequency
o Limit intake of spicy, fatty or otherwise of duodenal ulcers.
bothersome foods and beverages.
GASTRITIS
 The aim is to rest the stomach and reduce further irritation of the mucosa.
 Acute type: NPO for 24 to 48 hours: give glucose parenterally, followed by liquids, then soft to full diet
as tolerated.
 Chronic type: Bland, low fiber diet.
 Correct faulty food habits.

Diarrhea
Clinical Implications
 Fluids must be replaced to avoid dehydration, solids should be gradually added as tolerated.
 A low-residue diet may be in order to decrease the intake of fibrous materials.
 Evaluate the use of foods that may contribute to diarrhea, especially those high in fiber, caffeine, and
alcohol.
 Encourage juices high in potassium
 Remove milk products from the diet if there is a possibility of lactose intolerance.
 Bananas, grated raw apples, or cooked apple-sauce contain pectin, which helps bind the fluid and
retard its transit time.
 Extremely hot or cold foods increase peristalsis and may aggravate diarrhea.

Constipation
Clinical Implications
Ask patients about their use of cathartics or laxatives.
 Gradually increase the amount of fiber or bulk in the diet (raw vegetables and fruits, whole-grain
breads, and cereals).
 Force fluid intake; drink at least the equivalent of six to eight glasses of water a day.
 Dried fruits, especially prunes, contain natural laxatives.
 Any hot beverage upon arising, such as coffee, tea, or lemon water, may stimulate peristalsis because
duodenal-ileal or gastric colic is strongest in the morning. Breakfast is also important and should
contain some fiber.
 Encourage activity and relaxation as much as possible allow sufficient time for bowel habits

Crohn’s Disease (Regional Enteritis)

Clinical Implications
 During bouts with diarrhea, sources of potassium intake should be increased.
 Multivitamin and mineral supplements are frequently recommended.

Ulcerative Colitis
Clinical Implications
 Patients with severe diarrhea or steatorrhea should be monitored for magnesium, which is usually
deficient in chronic inflammatory bowel disease (Philips & Garnys, 1981).
 Low serum zinc levels are prevalent among children with chronic inflammatory bowel disease.
 Response to zinc intake is abnormal and growth is retarded (Nishl et al, 1980).
 The use of azulfidine requires a daily intake of eight to ten cups of fluid.

Irritable Bowel Syndrome (IBS)

Clinical Implications
 Patients with irritable bowel syndrome must be tested for lactose intolerance or malabsorption before
further treatment (Goldsmith & Patterson, 1985).
 Hydrophilic mucilloids necessitate large amounts of fluid intake.

Hepatitis
 During acute phase, 5-10% dextrose intravenously and/or protein parenterally
 To minimize protein losses, prevent ketosis, to replace fluids and electrolytes.
 High calories
To counteract weight loss and for maximum protein utilization.
 High CHO:
 To spare protein: Ensure glycogen reserve and maintenance of hepatic function.
  High protein:
 To repair hepatic cells; from cholic and other bile acids; to prevent hypothermia;
supply lipotropic factors which mobilize liver fat.
Side notes:
Hepatitis is when inflammation of the liver tissue occurs.
Causes: alcohol toxicity, virus, medication, fat deposition.
Types: Acute (viral, drug-induced toxic)
Chronic (active or persistent)
There are several viruses, A,B,C,D,E. Hepatitis is considered acute during the first 6 months. If not resolved by
6 months, it is considered to have developed into a chronic disease.

Cirrhosis
Action:
Moderate fat, MCT preferred over LC (restrict fat if there is biliary obstruction)
 To meet high energy needs, at the same time preventing fatty liver.
High vitamins
 To maintain liver function.
Frequent small feeding in cases:
 For better tolerance of anorexia
Consistency
 liquid to soft in acute attacks
Low sodium (<2,000mg.)
 In cases of ascites.
Alcohol prohibited
 Detoxification function of the liver is impaired by alcohol.
Side notes:
Chronic disease of the liver can cause fibrosis, which can proceed to permanent scarring of the liver known as
cirrhosis or end stage of liver disease.
Etiology:
• Alcoholism w/ long standing malnutrition: Laennec’s cirrhosis
Time to develop alcohol disease:
Men: 60-80g/day of alcohol for 10 years
Women: 20-40 g/day of alcohol for 10 years
• post necrotic cirrhosis-viral hepatitis
• Biliary cirrhosis
• Hemochromatosis-increased iron absorption

Hepatic Encephalopathy (Hepatic Coma)

Protein Intake
 Initially: non-protein diet (Borst Diet)
 Progress to 20-30 gm/day (Giordano-Giovanetti Diet) if condition improves until the normal protein
allowance is tolerated:
 To eliminate completely a source of nitrogen for ammonia synthesis.
 Calories: 1500 to 2000 a day to come mostly from CHO and fat
Minimize tissue protein breakdown which is a source of ammonia.
 Liberal vitamins and minerals:
 For adequate nutrition.
 Low sodium
Prevent ascites.
 Tube feeding: when oral feeding is not possible.
Hepatic coma- a complex organic brain syndrome secondary to liver diseases characterized by:
• Disturbances of awareness and mental function: forgetfulness and confusion-stupor- coma
• Neuroligacal changes, rigidity, flapping tremor (asterixis)
• Fetor hepaticus: (fecal odor breath)
Effects of increased blood ammonia level:
• Ammonia intoxication due to failure of the liver to convert ammonia to non toxic urea
• Failure of glutamic acid to function in the normal brain metabolism due to its combination with
ammonia
Sources of ammonia:
• Protein deamination
• Massive hemorrhage from esophageal varices
• Intake of ammonia containing drugs
Etiology: cirrhotic changes in the liver bring about diminished portal blood circulation and development of
collateral circulation, bypassing the liver and its urea cycle for the removal of ammonia
 Use of Vegetable-derived protein
Less ammoniagenic and contains smaller amounts of methionine and aromatic amino acid
 source of fiber which alters bacterial Nitrogen metabolism.
 Use of branched chain amino acids
 These are not catabolized by the liver but are taken up preferentially by extra hepatic
tissues;
 improve plasma levels of valine, isoleucine and leucine.
 Parenteral or oral potassium
 100 to 200 mEqK if renal function is normal: Hypokalemia increases renal vein ammonia due
to increased renal ammonia production and increased back diffusion of ammonia from alkaline
urine.

CHOLECYSTITIS
 IV fluids and electrolytes; progress to clear liquid
 To rest inflamed gallbladder, prevent and correct dehydration, volume depletion and
electrolyte abnormalities.
 Low fat
 Reduce discomfort by preventing stimulation of sphincter of Oddi, and contraction of Gall
Bladder.
 Bland low fiber
 Decrease mechanical and chemical stimulation.
 Low calorie for obese patients
 For weight loss, obesity is predisposing factor.
 Small frequent feedings
To prevent dyspepsia.

PANCREATITIS
 Acute attack: NPO
 To rest the organ.
 Low fat
To control steatorrhea and prevent stimulation for bile production.
 Moderate CHO and protein
 Prevention of hypoglycemia and creatorrhea.
 Plus enzyme supplements
 Utilization of nutrients.
 Six small feedings, bland
Avoid undue distention and stimulation.
 Avoidance of alcohol
Alcohol may precipitate attack.
 Supplements of fat-soluble vitamins and calcium
To prevent deficiencies.
 MCT oil
Better absorbed than LCT.

Pre-operative
 To improve the nutrition of the patient.
 To prepare the patient for nutrient losses during surgery.
 To hasten post-operative recovery.
 To build up glycogen reserves.
 To strengthen bodily resistance to infections.
Pre-Operative Dietary Management in: Emergency Operation
 If patient is in good nutritional status = NPO 8 hours prior to surgery
 If patient is in poor nutritional status (protein deficient)= parenteral administration of whole blood or
plasma.
 In addition, 5% glucose in water, saline solution, vitamins and potassium.
 To avoid vomiting during anesthesia or recovery from anesthesia, and decrease the risk of post-
operative gastric retention since peristalsis is stropped
 For adequate stores of serum protein to prevent hypoproteinemia and shock.
 For adequate nutrition

Pre-Operative Dietary Management in: Elective Surgery

 High calorie for underweight  Low to adequate calories for others to build up any weight deficit
 If patient is overweight  weight reduction is indicated to reduce surgical risks.

 High carbohydrates For glycogen stores and to spare protein for tissue synthesis.
 Stores of glycogen exert a protective action on the liver and help to prevent post-operative ketosis
and vomiting.
 High proteinTo build reserves for anticipated blood losses during surgery and increased tissue
catabolism, to reduce the possibility of edema at the site of the wound which is a hindrance to wound
healing.
 Increased vitamins, especially ascorbic acid, vitamin K; B- complexFor wound healing and
prevention of hemorrhage
 increased minerals, especially phosphorus and potassium; Na and chlorideTo replace electrolyte
losses due to the break-down of body tissue; and due to vomiting, diarrhea, perspiration and diuresis.
 Ironto correct anemia
 Increased fluids  to replace losses due to vomiting and diuresis

Post-operative Dietary Management in: Major Surgery

 NPO 24 - 48 Hours GI tract not yet functioning normally. To allow for recovery from anesthesia;
prevent aspiration.
 Nutrition support: type and duration depends on recovery of GIT function
o As soon as activity of GIT is restored
 Conventional intravenous administration of amino acid solution
 Patient is expected to tolerate an enteral diet within a few days.
 Total parenteral nutrition (TPN)to meet nutritional needs for extended periods when enteral
feeding is not possible

GASTRECTOMY
 NPO first 24-48 hours; intravenous feedings
 Day 2 to 4: iced water with intravenous feedings
 Day 5: 1 to 2 oz. water every even hour, and 1 to 2 oz milk every odd hour between.
 Day 6: Soft low fiber foods are used – eggs, custards, thickened soups, cereals, crackers, milk and
fruit purees are suitable.
 Day 7: Tender meats, cottage cheese, and pureed vegetables are the next foods added to all the
foods allowed in the previous days.
 Meats are divided into 5 or 6 small feedings daily with emphasis on foods high in protein and fat.
 CHO is kept relatively low. If not liquids are taken with meals, and the diet continues to be low in CHO,
especially the simple sugars, many patients progress satisfactorily.

DUMPING SYNDROME: MAJOR SURGERY

 Small frequent feedings (5 or6) fed in supine position.  To prevent dumping of food into the
intestines.
 High protein Better tolerate because proteins are hydrolyzed into osmotically active substances
more slowly; needed to rebuild tissues and gain strength.
 High fatTo meet energy needs
 High calories  For strength
  Simple CHO (sugar, sweets or desserts, restricted)Simple CHO increases osmolarity of jejunum
contents * “dumping syndrome.”
 Dry solid diet  Better than liquids as they enter the jejunum less rapidly.
 Low fiber, low residue dietTo prevent rapid dumping of food into the intestines.
 Avoid alcohol or sweet carbonated beverages

RECTAL SURGERY (HEMORRHOIDECTOMY)

 NPO – 1ST 24 to 48 hoursDue to anaesthesia
 Clear liquidInitial Feeding
 Low fiber-low residue: Fruits and vegetables are omitted except for strained fruit juices To
discourage early bowel movements

ALLERGY
 Avoidance diet: An adequate diet which excludes the food(s) causing allergic reactions (e.g. milk-free,
egg-free diet, wheat-free diet, etc.)
 Desensitization: The allergenic food is given in gradually increasing amounts over a long period of
time.
Definition of terms
1. Adverse reaction to foodclinically abnormal response believed to be due to an
ingested food or food additive.
2. Antibodiesproteins in the bloodstream or other body fluids that are produced in
response to foreign materials that enter the body
3. Anaphylaxisa severe systemic allergic reaction that is potentially fatal
4. Food Sensitivity a general term for an adverse reaction to an ingested food or food
additive
Most Common Food Allergens
o Chicken o Wheat o Soy products
o Cow’s milk o Peanuts/nuts o Fish, shellfish

DIABETES MELLITUS (DM)

Dietary Modification
 Current concepts
 There is no one “diabetic diet” that will suit the individual and special needs of a person with
diabetes.
 The diet for an individual with diabetes can only be defined as a “dietary prescription” based
on nutrition assessment and treatment goals.
 Goals of Nutrition Therapy of DM
 Maintenance of as near-normal blood glucose levels as possible
 Achievement of optimal serum lipid levels
 Provision of adequate energy to maintain/achieve reasonable body weight
 Prevention and treatment of the acute complications and of long-term complications
 Improvement of overall health through optimal nutrition

Recommended Dietary Modification

 Total calories – sufficient to maintain/achieve reasonable weight in adults, or meet increased needs
of children, adolescents, pregnant and lactating women and individuals recovering from catabolic
illness.
 Caloric distribution:
Carbohydrates: 50 – 70%
Protein : 10 – 20%
Fat : 20 – 30%
 Cholesterol – limit to 300 mg/day or less
 Carbohydrates sweeteners are permissible
 Sodium –limit to about 3000 mg/day; less for people with hypertension or renal complications.
 Alcohol – moderate amounts may be allowed, contingent on good metabolic control.
 Vitamins and mineral supplement – not usually necessary, but may be given to individuals, on
reduced calorie diets (1400 kcal/day or less).
HYPERTENSION
 Calorie level, depends on weight status or weight goal: Weight loss of 5-6% in over-weight/obese can
lower BP.
 Sodium– restricted:
 Excess sodium may increase cardiac output due to over-filling of vasculature
 Excess sodium may increase peripheral resistance to blood flow
 Fluids and roughage – adequate: Prevent constipation which hinders absorption of anti-hypertensive
drugs.

Risk Factors for CHD

Modifiable ● Nonmodifiable ● Dyslipidemia
- Age - Sex - Family history of CHD
 Smoking  Dietary factors
 Hypertension  Thrombogenic factors
 Diabetes mellitus  Sedentary lifestyle
 Obesity

CORONARY HEART DISEASE

 Total fat – not more than 30% of TER:
- avoid post-prandial hyperlipedemia and its possible adverse effect of coagulation.
- reduce plasma LDL cholesterol

 Saturated fatty acids (SFA) – approx 10% of TER period of time.

 Polyunsaturated fatty acids (PUFA)
 approx. 10% of TER consisting of omega-6 PUFA (e.g linoleic acid), promotes prostaglandin
synthesis, which in turn promotes arterial dilation and heart muscle contractility
 Long chain PUFA or omega 3 fatty acids
 monounsaturated fatty acids (MUFA) – approx. 10% of TER.
 as effective as PUFA in lowering serum total cholesterol, but has the advantages of not
lowering HDL cholesterol, less susceptible to oxidation, less thrombogenic potential, does not
raise serum triglycerides; also has less tumorigenic potential.
 Cholesterol – not more than 300 mg/day
reduce plasma LDL cholesterol
 Sodium – moderate intakecontrol blood pressure
 Carbohydrates  type and amount depends on lipid abnormality
 Alcohol – avoid high intake: control blood pressure
reduce fibrinogen
exessive intake can produce hypertriglyceridemia, elevated LDL cholesterol, arrhythmia, cardiac enlargement
and heart failure

ACUTE MI OR CORONARY OCCLUSION OR THROMBOSIS

 Acute phase: 500 – 800 cal liquid diet for 2-3 days
* to avoid gagging and aspiration of solid foods.
 No extremes in temperatureTo prevent possible precipitation of arrythmias.
 No coffee or tea maybe stimulating and increases heart rate.
 Parenteral feedingFor those unwilling to consume liquid diet
 Restriction of Nato prevent/correct edema
 Subacute phase
*1000 – 1200 cal: 20% Pro. 45% CHO 35% fat
To meet resting metabolism requirements.
 Cholesterol, 300 mg To control blood cholesterol possible precipitation level
 Soft, low fiber, free of gastric irritants To avoid indigestion and flatus
 Sodium restriction To prevent /correct edema
 Small frequent feeding To reduce possibility of post prandial dyspnea or pain.
Congestive Heart Failure
 Low calories
- reduce weight; decrease work of heart
 Moderate protein
- maintenance of N balance
 Sodium restriction – 500 mg initially, 1000 mg later
- to control edema.
 Small frequent feedings
- decreased circulatory load
 Fluid as desired

DIETARY PRINCIPLES
Objectives of nutritional therapy in chronic failure
 To maintain nutritional status
 To minimize uremic toxicity
 To prevent net protein catabolism
 To stimulate patient’s well-being
 To retard progression of renal failure
 To postpone initiation of dialysis

Renal Disorders-1
ACUTE OR CHRONIC GLOMERULONEPHRITIS
Controlled fluid intake = fluid output
Kcal
Controlled protein -according to laboratory data & renal function
Sodium
Potassium
Nephritis
Treat symptomatically when there is significant uremia, hyperkalemia or edema. Replace all lost fluids

Renal Disorders-2
UREMIA
 Adequate calories and controlled protein, fluid and electrolytes according to laboratory data and renal
function
Nephrotic Syndrome
Protein - 1.5 g/kg/day + 1 g Protein for each gram protein lost in urine
Kcal - increased kcal to spare protein
Sodium - low sodium (2 grams) to reduce edema

Renal Disorders-3
ACUTE RENAL FAILURE
Protein - not restricted below 1.0 – 2.0 g/kg DBW
Kcal - increased kcal to spare protein for a malnourished child, 1 ½ - 2 times normal requirements

Sodium- varies according to fluid retention and hydration states

Potassium - decreased due to hypercalcemia as a result of catabolic process

Renal Disorders-4
CHRONIC RENAL FAILURE
 Regulation of protein intake
 Balance of fluid intake and output
 Adequate calorie intake
 Regulation of sodium, potassium and phosphorus intake
 Supplementation of appropriate vitamins and minerals
*Restriction is not fixed dependent on patient’s clinical and biochemical status
THERAPEUTIC DIET FOR SPECIFIC DISEASE CONDITIONS
 Acne Low fat
 Acute gastroenterities (diarrhea) Clear liquid
 Acute glomerulonephritisLow Sodium, Low Protein
 Addisons’ diseaseHigh Sodium, Low Potassium
 AngiSodium pectoris  Low cholesterol
 Arthritis, goutPurine restricted
 ADHD Finger foods
 Bipolar disorderFinger foods
 Burn High calorie, High Protein

 Celiac’s disease Gluten free

 CholecystitisHigh Protein, High CHO, low fat
 Congestive heart failure Low Sodium, low cholesterol
 CretinismHigh Protein, High Calcium
 Crohn’s dse. High Protein, High CHO, low fat
 CusHighngs’ dse.  High Potassium, low Sodium
 Cystic fibrosis  High calorie, High Sodium
 CystitisAcid Ash (for alkaline stones)
 Calculi  Alkaline Ash (for acid stones)
 Decubitus ulcer (bedsore) High Protein, High vit. C.
 Diabetes mellitus Well balanced
 Diarrhea  High Potassium, High Sodium
 Diverticulitis  Low residue
 Diverticulosis  High residue with no seeds
 Dumping syndrome  High fat, High Protein, dry
 Hepatic encephalopathy  Low Protein
 Hepatitis  High Protein, High calorie
 Highrschprungs’ disease  High calorie, low residue, High Protein
 Hyperparathyroidism Low Calcium
 Hypothyroidism  Low Calorie, low cholesterol, low sat fat
 Kawasaki’s disease  Clear liquid
 Liver cirrhosis Average Protein
 Meniere’s disease  Low sodium
 Myocardial infarction  Low fat, low Chol, low Sodium
 Nephrotic syndrome  Low Sodium, High Protein, High cal
 Osteoporosis  High Calorie, High Vit. D
 Pancreatitis Low fat
 Peptic ulcer High fat, High Cho, low Protein
 Phenylketonuria  Low Protein/phenylalanine
 PIH  High Protein
 ReSodiuml colic  Low Sodium, low Protein
 ARF: Low Protein, High Cho, Low Sodium (Oliguric
phase),
High Protein, High Cal, & restricted fluid
(diuretic phase)
 CRF  Low Protein, low Sodium, low Potassium
 TonsillitisClear liquid; cold diet