DIETARY

MODIFICATION &
DIET THERAPY
 Diet Modification
Dietary modifications are changes made during
food preparation, processing and consumption to
increase the bioavailability of micronutrients and
reduce micronutrients deficiencies in food at the
commercial or individual household level.

Diets are typically modified for therapeutic

reasons including treatment of high blood
pressure, low body weight or vitamin and mineral
deficiencies.
 Dietary Modifications
Standard Diet- a diet that includes all foods
and meets the nutrient needs of healthy
people; also called a regular diet.
Modified Diet- a diet that is altered by
changing food consistency or nutrient content
or by including or eliminating specific foods;
also called a therapeutic diet.
Types of Diet Examples Description of Diet Appropriate Uses Example
Pureed diets are used
Contain foods that
for people with soft bananas,
are modified in
swallowing difficulty, pureed fruits,
texture. Pureed
poor lip and tongue soups with easily
diets include only
control, or oral
Mechanically pureed foods;
hypersensitivity.
chewed pieces
mechanical
Altered Diet soft diets may
Mechanical soft diets
are appropriate for
include solid foods
people with limited
that are mashed,
chewing ability
minced, ground, or
or certain swallowing
soft
impairments
Types of Diet Examples Description of Diet Appropriate Uses Example
plain water, soup
broth, gelatin,
For bowel surgery or
Contains clear fluids fruit juices
colonoscopy, for.
or foods that are (without pulp),
acute GI disturbances
liquid at room tea or coffee
Clear Liquid
(such as after GI
preparation for (with no cream
surgeries), or as a
temperature and and milk added)
Diet leave minimal residue
transition diet after
intravenous feeding.
in the
For short-term use
colon
only.
Types of Diet Examples Description of Diet Appropriate Uses Example

blended
Contains fluids For people who fruits, oats,
and foods that cannot chew,
Blenderized are swallow easily, squash
blenderized to or tolerate solid
Liquid Diet liquid diet liquid foods.
form.
 Diet Therapy
Diet therapy is the branch of dietetics concerned with the use of foods
for therapeutic purpose. It is method of eating prescribed by a physician
to improve health.
usually involves the modification of an existing dietary lifestyle to
promote optimum health.

Diet is a very important aspect of the therapy for many disease states,
complementing and even replacing drug therapy in some cases. A useful
schema of therapeutic diets breaks the general diet into its basic
components (water, carbohydrate, fiber, protein, fat, vitamins, minerals,
and other substances such as alcohol) and consistencies (liquid, soft, or
solid). It is possible to alter (restrict or increase) each of these to form
therapeutic diets as shown by the following examples:
 Fluid Modified Diets- restricted fluid intake for treating heart or
kidney disease.
Carbohydrate Modified Diets- for treating diabetes or
hypertriglyceridemia

Protein Modified Diets- low protein for unstressed patients with

chronic kidney disease; high protein for stressed patients

Fat Modified Diets- low total and saturated for teating

hypercholesterolemia; low total fat for treating malabsorption
syndromes

Mineral Modified Diets- low sodium, potassium and phophorus for

treating kidney disease
Modified Consistency Diets- soft diets for treating patients without teeth;
high fiber diets for treating constipation

Other Substances- restricted alcohol for treating hypertriglyceridemia

Objectives of Diet Therapy
To increase or decrease body weight
To rest a particular organ
To adjust the diet to body's ability to use certain foods
To produce a specific effect as a remedy e.g. regulation of
blood sugar in diabetes
To overcome deficiencies by the addition of food rich in
some necessary element e.g. supplementing the diet with
iron in treating macrocytic anemia
To provide ease of digestion by omitting irritaating substances
such as fiber, spices or high fat foods
Factors to consider in Planning
Therapeutic Diets
This underlying diseased condition which requires a
change in diet
The possible duration of the disease

The factors in the diet which must be altered to

overcome these conditions

The patient's tolerance for food by mouth

 General Diet
What is Regular Diet?
A regular diet is a healthy meal plan that
includes a variety of healthy foods from all the
food groups. Follow this meal plan if you do not
have any health conditions that require a special
diet. A healthy meal plan is low in unhealthy fats,
salt, and added sugar. It may decrease your risk
of heart disease, osteoporosis (brittle bones),
and some types of cancer.
 What is a Healthy Meal Plan?
My Plate is a model for planning healthy meals. It
shows the types and amounts of foods that should go
on your plate. Fruits and vegetables make up about
half of your plate, and grains and protein make up the
other half. A serving of dairy is also included.
The amount of calories and serving sizes you need
depends on your age, gender,
weight, and height. Examples of healthy foods are
listed below:
 Eat a variety of Vegetables such as dark green, red, and orange vegetables. You can also
include canned vegetables low in sodium (salt) and frozen vegetables without added butter
or sauces.
Eat a Variety of Fresh Fruits canned fruits in 100% juice, ffrozen fruit, and dried fruit.
Include Whole Grains At least half of the grains you eat should be whole grains.
Examples include whole wheat bread, wheat pasta, brown rice, and whole grain cereal
such as oatmeal.
Eat a Variety of Protein Foods such as as seafood (fish and shellfish), lean meat, and
poultry without skin (turkey and chicken). Examples of lean meats include pork leg,
shoulder, or tenderloin, and beef round, sirloin, tenderloin, and extra lean ground
beef. Other protein foods include eggs and egg substitutes, beans, peas,
soy products, nuts, and seeds.

Choose Low Fat Dairy Products such as skim or 1% milk or low-fat yogurt, cheese an
cottage cheese.
What Food Should I Limit?
Vegetables with added fat
Fruits with added sugar
Carbohydrates high in fat and sugar
Protein foods with added fat
High fat protein foods
High fat dairy products
 Diet Modified in Consistency
A modified consistency diet involves the
consumption of foods that have oundergone
a change in their consistency.

examples of modifications include

chopped, ground up and pureed foods.
A modified consistency diet includes foods from all
food groups and should adequately meet your
nutrient needs.
These diets are used in the treatment of gastro
intestinal tract.
They can be from a very low residue diet to a very
high fiber diet.
Method of feeding is by mouth, unless otherwise
indicated
 Liquid Diet/Non-Solid Diet
Liquid Diets
Liquid diets consists of a variety of foods that are liquid or liquify
at room temperature.

These diets are used in:

Febrile States
Post operative conditions
Wherever the patient is unable to
tolerate solid food
 There are two types of liquid diet
Clear fluid diet
Full fluid diet
Clear Fluid Diet
This diet is designated for people who have/had:
Acute illness
Surgery
Gastrointestinal disturbances
A clear fluid diet is usually used for 1 or 2 days.
After that a more liberal liquid diet is given.
The amount per feeding is 30-60 ml/hour. As the patients tolerance
improves the amounts can be increased.

Foods permitted
Tea with lemon and sugar
Coffee
Fat free broths
Carbonated beverages
Cereal waters
 Full Fluid Diet
This diet is indicated when a patient is:
Acutely ill
Unable to chew or swallow solid food
 This diet includes all foods which are liquid
at room temperature
It is free from cellulose and irritating condiments.
Iron is provided at inadequate levels.
Six or more feedings can be given daily
The protein content of the diet can be increased by adding butter to
cereal gruels and soups, glucose in beverages and using ice creams,
dessert.
The calorie value of the diet can be increased by adding butter to
cereal gruels and soups, glucose in beverages and using ice
creams, dessert.
If decreased volume of fluid is desired, non fat dry milk can be
substituted for the part of the fluid milk
 Foods Allowed
Beverages- cocoa, coffee or tea
Cereal- Fine or strained gruels
Dessert- Soft custard, gelatin
Eggs- Raw in broth with fruit juices or milk
Fruit- All strained juices
Meat- strained in soups
Vegetables- Puree, soups
Miscellaneous- Butter, cocoa, sugar, salt
 Commercial Liquid Formulas
These are used to supplement other external
diets.
These formulas vary in composition and source of
nutrients
Most of the formulas are milk based.
For persons who cannot tolerate milk, protein
source is meat, soy or casein hydrolysate.
Fat and carbohydrate composition and proportions
also vary to accommodate persons with different needs and
restriction.
Criteria for Selection of Appropriate Formulas
The protein sources
The composition and proportion of fats and
carbohydrates
The osmotality
The platability
The cost
 Solid Diet
Soft and Low Fibre Diets
-Soft diet is between liquid diet and normal diet
-Soft diet includes both liquid and solid foods which contain restricted amount of
indigestible carbohydrates and no tough connective tissue
-The diet can be made mechanically soft by cooking, mashing, pureeing the foods
used in a normal diet. Further reduction in indigestible carbohydrate can be
achieved by the use of refined breads, cereals, immature vegetables and fruits.
-The skin and seeds of fruits have to be removed
-Soft fruits like banana can be used as it is.
-Tough connective tissue can be reduced, by selecting tender meat and cooking
very soft.
-Meat and meat broths have to be restricted because the non protein nitrogen
products such as creatine, creatinine, purines and other products which are present
in muscle tissue is extracted into the gravy which stimulates gastric juice.
-Strong flavoured vegetable such as onions, radish, dried beans, cabbage,
cauliflower have to be omitted if necessary.
-With proper cooking (short cooking time, vessel uncovered, serving immediately)
it is desirable to eliminate those vegtables which the individual patient cannot
tolerate.
-It is not necessary to eliminate all spices, only gastric irritants like black pepper,
chili pepper, cloves etc. can be eliminated.
-This diet is nutritionally adequate.
-It is soft in texture and bland in flavor.
-Meat should be tender or ground to reduce connective tissue.
 Low Residue Diets
The diet is made up of foods which can be completely absorbed,
thereby leaving little or no residue for formation of feces. This diet
provides insufficient minerals and vitamins.

It must be supplemented
Foods high in fibre should be omitted
Food which contain residue but not fibre such as milk are
also omitted or restricted
Two cups of milk may be permitted per day. Strained sruits and
vegetables without skin must be prevented.
 The Diets usually used in:
-Severe diarrhea to afford rest to the gastrointestinal
tract
-Acute phases of diverticulitis
-Ulcerative colitis in initial stage
-Operations
-Partial intestinal obstruction
-Whenever necessary to reduce bulk in
gastrointestinal tract
 High Fibre Diets
-Dietary fibre plays a significant role in colonic function
-High fibre diet is mainly used for atonic constipation and diverticulosis
-This is a normal diet with fibre increased to 15-20 gms daily
-Fluid intake is also increased
-Concentrate foods should be replaced by those of greater bulk
-Foods which can be included in the diet are plenty of long fibered vegetables,
salads, fruits and whole cereal grains
-Highly refined and concentrated food, excessive amounts of rough brans and
excessive seasoning should be avoided
-intervals of feeding should be three meals daily
 Soft Diets
In addition to helping people with chewing and swallowing
problems, the soft diet is also recommended for people as a
transitional diet from clear liquid to regular following surgery.
The soft diet includes that are low in fiber and soft in texture.
Foods are also mildly seasoned on a soft diet.
Food choices unclude canned fruits, bananas, soft melon, soft
cooked meats, potatoes, pasta, rice, bread, cooked vegetables
and lettuce.
 Mechanical Soft
-Foods on the mechanical soft diet are
chooped, ground or blenderized, and
moistened with liquids to make them easier
for chewing and swallowing
 Cut Up Food Consistency
-All foods must be cut into pieces no larger than 1/2"

Chopped Food Consistency

-Food is cut by hand or as directed by pea size pieces 1/4"
-Food must also be moist. No finger foods
 Ground Food Consistency
All foods must be ground in a machine to small curd cottage
cheese consistency
Foods must be moist and liquids may be added to get the
desired consistency
Pureed Diet
A pureed diet includes foods that are blended into a fine
paste
All foods are prepared to a smooth consistency by grinding
and then pureeing them.
Appearance is smooth like pudding