CLINICAL NUTRITION WEEK FOR UNDERSTANDING NUTRITIONAL REQUIREMENTS

Clinical nutrition document aided to understand the nutrition requirements for normal and healthy life

1. CLINICAL NUTRITION NCN 318

2. DIET THERAPY Is the use of diet as a tool in Tx, mgt and prevention of disease Complements medical therapy for better health outcomes Relationship between disease and nutrition Diseases increase metabolic rate Repair of tissues Malabsorption Nutrient losses Nutrient inadequacies Drug nutrient interaction

3. Objectives of diet therapy Restores health Prevents dx progression Mgt and Tx of disease Enhancing quality of life

4. Dietary modification The qualitative + quantitative adjustments of a person's normal diet with the aim of meeting a specific health need Determined by Dx symptoms Dx severity Nutritional status Metabolic changes involved Physiological state

5. Types of modification in diet therapy Modification in consistency Clear liquid Transparent/clear, liquid at room temperature, leave no residue in the gut Used short term 24-48 h as they are nutritionally inadequate Indications Pre-op , acute GI diseases, post op, transitional diet after npo examples Black tea, water, ice cubes/popsicle, clear broth, clear fruit juices

6. Advantages Keeps the body hydrated. Provides electrolytes and some energy. Reduces digestive system workload. Prepares the gut for procedures. Disadvantages Nutritionally inadequate (low in calories, protein, vitamins, minerals). Cannot be used for more than 2–3 days without supplementation. Prolonged use may lead to malnutrition

7. Full liquid diet includes all foods that are liquid or turn liquid at body temperature. Nutrient rich opaque fluids t is more nutritionally complete than a clear liquid diet, since it provides more energy, protein, vitamins, and minerals

8. Characteristics includes opaque and thicker fluids (unlike clear liquid diet). Can be strained or blended to remove solid particles. Still easy to digest and swallow. Can be enriched with milk, eggs, or protein powders to improve nutrition.

9. Indications Cannot tolerate solid food but need more nutrition than clear liquids provide. Are transitioning from clear liquid diet → soft/regular diet .Have difficulty chewing or swallowing (dysphagia, oral surgery recovery). Are recovering from illnesses, infections, burns, or malnutrition where extra protein and calories are needed. Need nutrient-dense but easily digestible food (elderly, frail patients).

10. Milk and milk products: milk, milkshakes, yogurt (without fruit pieces), custards, puddings. Smooth strained soups: cream soups (no chunks). Fruit juices and nectars: strained juices without pulp. Vegetable juices: tomato juice, vegetable blends (strained). Ice cream, frozen yogurt (no solid toppings). Smoothies: blended without seeds/skins. Egg-based liquids: eggnog, cooked egg blended into liquids. Nutritional supplements: protein shakes, fortified beverages

11. Foods Not Allowed Solid foods of any kind (bread, cereals, meat pieces, raw fruits/vegetables). Foods with chunks, seeds, skins, or fibers. Cheese or yogurt with fruit pieces. Carbonated drinks with pulp/fiber

12. Advantages Provides more protein, energy, vitamins, and minerals compared to clear liquid diet. Easy to swallow and digest. Can be fortified with supplements for higher nutrition.Useful in healing and recovery.

13. Clear Liquid Diet vs Full Liquid Diet Feature Clear Liquid Diet Full Liquid Diet Definition Only liquids that are transparent (see-through) at room temperature and leave no residue. Includes all fluids (clear + opaque) and foods that turn to liquid at body temperature. Nutritional value Very low in calories, protein, vitamins, and minerals . Higher in calories, protein, and nutrients compared to clear liquid diet. Still not fully adequate long-term. Purpose Used short-term (24–48 hrs) to rest the GI tract, hydrate, and prepare for/after surgery or medical procedures. Used when patients can’t chew/ swallow solid food but need more nutrition than clear liquids (e.g., transition to soft diet).

14. Thick liquid/blended A thick liquid or blended diet consists of foods that are liquefied or pureed to a smooth consistency and are often thickened to make them easier and safer to swallow. Sometimes called pureed diet or modified texture diet. Designed for patients with dysphagia (difficulty swallowing) or those unable to chew solid foods. Can be nutritionally adequate if well-planned

15. Characteristics All foods are blended or pureed to a smooth, homogenous texture. Liquids may be thickened to different levels (nectar-thick, honey-thick, pudding-thick) depending on swallowing ability. Can include both sweet and savory foods. Easy to digest, swallow, and absorb.

16. Dysphagia (stroke, neurological disorders, Parkinson’s disease, dementia). Oral/dental issues (jaw surgery, no teeth). Head, neck, or esophageal surgery recovery. Severe weakness or frailty (elderly, critically ill patients).Transition from full liquid diet to soft/normal diet when chewing is still a problem

17. Anything that can be blended or thickened smoothly, such as: Cereals & starches : oatmeal, rice porridge, mashed potatoes (thinned with milk or broth). Proteins : pureed meats, chicken, fish (blended with gravy/broth); scrambled or pureed eggs; smooth beans/lentils. Fruits : mashed banana, pureed applesauce, strained fruit smoothies. Vegetables : pureed carrots, peas, pumpkin, spinach (well-cooked, blended). Dairy : yogurt (plain or blended), pudding, custards, smooth cheese sauces. Soups : blended vegetable or cream soups. Thickened beverages : fruit juices, milk, tea, coffee (with thickener if needed).

18. Foods Not Allowed Foods with chunks, seeds, or skins (e.g., grapes, tomatoes with skin, corn). Hard, crunchy foods (nuts, raw vegetables, granola). Bread or pastries unless fully blended into smooth consistency. Stringy foods (pineapple, celery).

19. Advantages Safe swallowing (prevents aspiration). Can be nutritionally balanced if fortified with protein, vitamins, and minerals. More variety and flavor compared to clear/full liquid diets. Useful in rehabilitation of swallowing difficulties.

20. Learners to read on disadvantages

21. Modification in nutrient content tailoring nutrients : Energy → high or low calories. Protein → high (healing, growth) or low (renal/hepatic disease). Carbohydrates → regulated in diabetes, GI disorders. Fats → type and amount adjusted (heart disease, malabsorption). Fiber → high (constipation) or low (diarrhea, GI surgery). Electrolytes → sodium, potassium, phosphorus as per disease. Vitamins & minerals → supplemented or restricted depending on deficiency/toxicity.

22. Modification in frequency Changing the number of meals or feeding intervals to match the patient’s disease condition, digestion capacity, metabolism, or appetite. i )Small, Frequent Meal-5-6/3 easier digestion, prevents overloading the stomach, stabilizes blood sugar. ii)Frequent feeding with nutrient dense iii) Night Feeding / Continuous Feeding iv) Timing-Based Modifications Resticted meal

23. Therapeutic modification Specialized diets prescribed for medical conditions. Diabetes mellitus → controlled carbs, balanced calories. Renal disease → controlled protein, sodium, potassium, and fluid. Cardiovascular disease → low-sodium, low-cholesterol, low-saturated fat. Liver disease → high-carb, moderate protein, restricted fat.GI disorders → bland diet, lactose-free, gluten-free, low-residue (for IBD).

24. Modification in method of feeding Occurs when oral intake is inadequate Are normally 2 Enteral parenteral

25. MODES OF FEEDING 1 ORAL Normal and preferred way of taking in fluids and food. Natural and physiological method. Provides pleasure, satisfaction, and psychological comfort. Uses all parts of the digestive system normally. Economical and convenient. Helps maintain chewing and swallowing function

26. Challenges Not suitable if patient has difficulty swallowing (dysphagia), unconsciousness, severe nausea/vomiting. Limited in very sick patients who cannot eat adequate amounts. Risk of aspiration in patients with swallowing problems.

27. ENTERAL Feeding via a tube directly to the stomach or intestines Functional gut but intake orally inadequate Nasogastric NGT Nasadeudenal / nasojejunal Gastrostomy Jejunostomy

28. Maintains normal gut function (“if the gut works, use it”). Prevents gut atrophy and maintains gut immunity. Safer and cheaper than parenteral feeding. Can provide full nutritional requirements. Flexible (can be short-term or long-term).

29. Challenges Insertion can be uncomfortable (especially NGT). Risk of aspiration pneumonia if tube dislodges. Can cause diarrhea, bloating, or nausea. Requires monitoring and skilled care. Not possible if gut is non-functional (e.g., obstruction, severe vomiting).

30. 3. parenteral feeding Aka intravenous feeding Non functional gut 2 types available Partial parenteral Total parenteral

31. Advantages: Useful when the digestive system cannot be used (e.g., bowel obstruction, severe pancreatitis, short bowel syndrome). Provides precise control of nutrients. Life-saving in critically ill patients

32. Expensive compared to oral/enteral feeding. Requires strict sterile technique (risk of infection/sepsis). Can cause complications: Catheter blockage or infection. Electrolyte imbalances. Liver dysfunction with long-term use. Does not maintain gut function → may lead to intestinal atrophy.