L12-Therapeutic diets (1).pptx

Diet sources

1. THERAPEUTIC DIETS 24-NOV-2019 1 Dr.R.KalavaThy Adjunct Associate professor GMU

2. Objectives At the end of the session, students will be able to- Identify the therapeutic diet Explain about the daily requirements for each food group

3. What is a therapeutic diet? A therapeutic diet is a meal plan that controls the intake of certain foods or nutrients. It is part of the treatment of a medical condition and are normally prescribed by a physician and planned by a dietician. A therapeutic diet is usually a modification of a regular diet. April 25, 2021 3

4. What is a therapeutic diet? It involves removing or adding some foods. Changing nutrients/calorie content and texture of foods Increase or decrease the fibre in the diet April 25, 2021 4

5. Purpose of therapeutic diets Regulate the amount of food. Assist body organs to function normally Aid in digestion To improve specific health conditions Increase or decrease body weight Modify diet patterns These diets are useful in managing diseases, improves immunity, act as prevention or supplemental treatment. April 25, 2021 5

6. Types of therapeutic diets Clear liquid diet Liquid diet Full fluid diet Soft diet Pureed diet April 25, 2021 6

7. Regular diet : Balanced diet usually used for ambulatory patients with no serious chronic disorders. Liquid diet: Nutritionally inadequate. Used for short period of times after surgeries. Full fluid diet : Includes liquids along with smooth textured fluids at room temp such as custards, eggnog, thick soups, pudding etc. Generally used for grade 1 dysphagia, dehydration,etc. April 25, 2021 7

8. Clear liquid diet : water, apple juice, plain gelatine, fat free broth, ginger ale, tea, coffee, etc. Soft diet: Similar to regular diet but most foods required little chewing and be easy to digest. Avoid tough meats, shell fish, raw fruits and vegetables, nuts, coconuts and spicy foods Low residue diet : used for patients with digestive diseases and rectal diseases such as colitis and diarrhoea. Eliminates or limits high bulk foods such as raw veg, fruits, nuts, coconut, tough meats, fried foods, beans , seeds, whole grains. April 25, 2021 8

9. Diabetic diet : Diet for hyperglycaemia. Diet contains exchange lists to match carbohydrate intake as per pts. needs Low calorie diet: Diet for patients with overweight. Avoids fatty foods, sugars, high fat meats, etc. High Calorie diet : Diet for patient’s with underweight, anorexia, hyperthyroidism, cancer etc. Includes calorie dense foods and avoids high bulk foods which reduce appetite. April 25, 2021 9

10. Low Cholesterol diet : Diet for pts. With atherosclerosis and heart diseases. Diet limits foods rich in saturated fats. Low Sodium diet: used for patients with cardiovascular diseases, hypertension, oedema and renal diseases. Avoids or limits salt in food along wit restriction on processed foods, preserved foods, fried items, pickles and processed cheese. April 25, 2021 10

11. High protein diet : Regular Diet with added protein rich foods like milk, eggs, etc. Used for growing age groups, pregnancy and lactation, pre and post surgery, pts. With burns, infections and fever. Low Protein diet: Diet for patients with certain kidney diseases, allergies. Avoids high protein foods. Bland diet : Diet for patient’s with ulcers and other digestive diseases. Avoids foods that irritate GI tracts. Avoid coarse foods, highly seasoned foods, tea, coffee, oily foods, spicy foods, salted meats and fish April 25, 2021 11

12. ROLE OF NURSE IN NUTRITIONAL CARE Coordinator Communicator Counselor Teacher Motivator April 25, 2021 12

13. THE ROLE OF THE NURSE IN IMPLEMENTATION OF THERAPEUTIC NUTRITION April 25, 2021 13 Reinforce the importance of therapeutic diet. Identify and communicate needed changes in the patient’s diet. Identify and implement changes in method of feeding & time of feeding. Reinforce the meal plan with the patient and the patient's family.

14. The role of the nurse in implementation of therapeutic nutrition April 25, 2021 14 Encourage the patient to depend on himself (the restorative approach). Encourage the patient to eat, provide adaptive equipment, and right atmosphere. Make sure that all health care professionals are consulted with respect to diet plan and implementation.

15. NUTRITION IN CARDIO VASCULAR DISEASES April 25, 2021 15

16. Objectives of dietary management To relieve strain to the heart To prevent further damage to the heart To restore the damaged heart April 25, 2021 16

17. Recommended foods Skimmed milk Cottage cheese Whole grains Fruits and vegetables High fiber and soluble fibers like pectin and gum Lean meat, egg whites, fish Honey, jaggery April 25, 2021 17

18. Foods to be Avoided/ to limit Cholesterol rich foods Whole cream, butter, cream cheese Heavy sweets, bakery products Organ meat Fried foods Alcohol High sodium processed foods High fat convenience meals April 25, 2021 18

19. Prevention and Treatment of CVD HTN: DASH Diet Individuals should adopt the Dietary Approaches to Stop Hypertension (DASH) dietary pattern which is rich in fruits, vegetables, low-fat dairy, and nuts; low in sodium, total fat, and saturated fat; and adequate in calories for weight management. The DASH dietary pattern reduces systolic blood pressure by 8-14 mmHg.

20. DASH: Major Food Groups Fruit: Melons, bananas, papaya, prunes, oranges (Mg, K), fortified juices (Ca), fiber 4-5 servings per day Vegetables: broccoli ( vit A), Soy (Ca, K), beets, mushrooms, potatoes (B6), green leafy/spinach ( vit A, Mg, Ca), tomatoes, (K, Mg) (fiber) 4-5 Servings per day

21. NUTRITION MANAGEMENT IN DIABETES April 25, 2021 21

22. Objectives of dietary management To improve glycemic control To prevent diabetes related complications such as retinopathy, nephropathy To improve nutritional quality of life and reduce morbidity and mortality April 25, 2021 22

23. Nutrition Intervention options for Diabetes Reduce energy and fat intake Carbohydrate counting Simplified meal plans Healthy food choices Individualized meal planning strategies Exchange lists Insulin-to-carbohydrate ratios Physical activity and behavioral strategies

24. Prevention and Treatment of CVD & Diabetes Recommendations: Very High Triglycerides (>500) Very low-fat diet less than or equal to15% fat), Weight management Physical activity Alcohol restriction Elevated Triglycerides ( ≥ 150) and Macronutrients Calorie controlled Complex Carbohydrates Limit refined sugar Limit Alcohol Weight loss of 7 to 10% of body weight Physical Activity

25. CHOLESTEROL PROFILE IMPROVEMENT STRATEGY Foods to increase 1 bowl of oat bran at breakfast with oatmeal. (Note that Psyllium also decreases total cholesterol) Fresh vegetables, avocados (rich in good fat), artichokes, lentils and beans, chick peas (high in isoflavones), rice bran, citrus fruits, strawberries, apples (rich in pectin) and apple pulp (rich in soluble fiber) Mulberries, raspberries (rich in resveratrol) Almonds, pecans, walnuts, hazelnuts, macadamia, pistachios, peanuts. Almonds can reduce the ratio LDL to HDL up to 12% after 4 weeks (Journal of the American Heart Association). Eat them natural or “dry roasted” without added oils or salts. Most of their fat is polyunsaturated or mono-unsaturated.

26. Glycemic Index A scale that ranks carbohydrates by how much they raise blood glucose levels compared to a reference food. Low 0 – 55 Moderate 56 – 69 High 70 or more

27. Pictures of Low/High GI Meals & Snacks GI = 60 GL = 48 GI = 42 GL = 31

28. Pictures of Low/High GI Meals & Snacks GI = 85 GL = 48 GI = 39 GL = 22

29. NUTRITION ACTION PLAN FOR CVD & DM Eat meat sparingly Add fish to your diet Eat fruits and vegetables Go for nuts Increase complex carbohydrates and fiber Opt for low-fat dairy products Cut down on saturated fat in cooking Avoid palm and coconut oils Avoid trans fats Reduce dietary cholesterol Reduce salt and sugar intake Watch the snacks Drink alcohol only in moderation Read labels carefully

30. References Mann J, Truswell S, editors. Essentials of human nutrition. 5th ed. London, England: Oxford University Press; 2017. Chapter - 43, pp – 670-678 Bender DA. Introduction to nutrition and metabolism, fourth edition. 4th ed. Boca Raton, FL: CRC Press; 2007. Chapter - 6, pp- 178-186

31. THANK YOU April 25, 2021 31