1. بسم بسم الله الله الرحمن الرحمن الرحيم Community Medicine Lec-8-

2. Learning objectives At the end of this lecture student would be able to : 1-Outline the aims of diet therapy. 2-Determine principles of diet therapy. 3-Mention types of modifications in food pattern. 4-Discuss planning of diet therapy & dietary assessment. 5-Enumerate the determinants of qualitative assessment. 6-Identify food regimen characteristics. 7-Describe different types of diet consistency modifications. 8-Specify dietary considerations in diabetes & GIT diseases. To a level accepted to the accreditation standard of the College.

3. Diet Therapy Aims of diet therapy:- 1.To prevent or treat malnutrition. 2.To control diet - related manifestations of disease. 3.To delay progression of chronic disease. 4.To provide support for other medical or surgical treatment. 5.To play rehabilitative and palliative role e.g. maintaining or enhancing quality of life in terminally ill patients. 6.Dietary advice is useful for health promotion, disease prevention, nutritional support and rehabilitation.

4. Note:- Nutrition therapy may involve slight modifications of usual food intake, use of special purpose oral supplements or feeding by enteral or parenteral routes. Principles of diet therapy:- 1.A 1.A nutrition - related problem must be present for which an accepted diet therapy exists. 2.Diet therapy must be based on a solid scientific rationale. Ideally, documentation of the effectiveness of the therapeutic diet in ameliorating symptoms,slowing progression,lessening secondary problems or offering other positive effects on function should be available.

5. 3.Patient must be able and willing to eat and must have a functional gastrointestinal tract. Note :- Little effort is required for a patient to consume a diet in the hospital since appropriate meals are served and no other food choice may be available,but a great deal of motivation is needed to prepare and eat therapeutic diets after discharge. 4.Patient must adhere to the diet.

6. Types of modifications in food pattern:- 2.Qualitative modifications or changes might required e.g. in congestive heart failure, sodium restricted diet. 3.Changes in diet consistency e.g. liquid, soft & bland diet in certain GIT disorders. 1.Quantitative modifications in normal diet pattern (quantitative nutritional requirements) of individual may be altered as in febrile illnesses. Planing diet therapy:- Dietary assessment:- Dietary assessment attempts to discover what is eaten.

7.  It requires cataloging what the individual usually eats and the nutritional quality and adequacy of that pattern.  It helps in determining nutritional status, establishing or defining differential diagnosis and furnishing the background information on food intake and preferences that are needed for implementing diet therapy.  Nutritional status assessment measures the interaction of diet, disease and nutritional requirements by integrating information on food intake and clinical, biochemical and anthropometric measurements.

8.  Both dietary assessment and nutritional status assessment are needed to identify nutrition-related problems and plan therapeutic diets. Determinants of qualitative assessment:- 1.Whether patient is currently eating and following following a specific diet. If so, the number of meals per day, any use of nutritional supplement, special dietary preferences or dietary practices, or modifications that may influence nutritional status.  Dietary assessment can be performed at qualitative or quantitative levels.

9. 2.Whether there has been recent weight loss or gain. 3.The physical state including chewing problems, dysphagia, diarrhea, ability to shop and cook & feed oneself. 4.Social circumstances that may influence intake e.g. economic resources, social isolation and social support systems.  If qualitative assessment suggests that nutritional problems may exits, more quantitative approaches may be in order.

10. Food regimen characteristics 1.Diet should provide all essential nutrients. 2.Food regimen should be patterned as much as possible after normal diet. 3.Diet should be flexible (according to patients habit, preferences, economic status,and religious rules). 4.Diet should be adapted according to patient work and degree of exercise. 5.Food must be agreed with patient. 6.Diet should emphasize natural,commonly used foods that are readily available and easily prepared at home.

11. 7.Prescribed food regimen must accompanied by clear simple explanation of purpose for both patient and family. 8.Except for cases adhered to for life maintenance diet, patients should be taken off special diets as soon as possible. 9.Diet regimen should be absolutely justifiable and defensible for patient & family.

12. Modifications in diet consistency  Usually a short term diet.  Its purpose is to supply fluid and some energy in a form that requires minimal digestion after surgery, trauma, or in acute illness.  It is used as initial feeding after surgery or intravenous feeding to relieve thirst and hydrate,while minimizing the need to chew and GIT stimulation.  Nutritionally, it is inadequate diet thus if to continue beyond 3-5 days, nutritional support is necessary.  It produces few or no feces. A.Clear liquid diet:

13. B.Full liquid diet: Foods that are liquid at body temperature.  Its purpose is to supply fluid & meet energy & other nutrients need.  Usually higher in calories than clear liquid diet.  It is used as transition between clear liquid and solid foods, after surgery and in acute illnesses ; in esophageal or stomach disorders with strictures or anatomical irregularity ; and for inability to chew or swallow solid foods.  Nutritionally, it may be inadequate in niacin, folacin and iron. Nutritional adequacy may be improved by using high-protein, high-calorie supplement or the addition of multivitamin supplement.

14.  It is more complete than clear liquid diet. It is beneficial as a transitional feeding for weak patients who cannot adequately chew food.  It is greatly different from usual diet. C.Soft diet:-  Its purpose is to provide food that can be swallowed with little or no chewing.  It is used for patients who are alert or acutely ill with difficulty in chewing /swallowing,or who are too ill or weak to tolerate a usual diet.  Indicated in patients with head and neck surgery, those with esophageal stricture or poor dentition. Also useful in those with inflammatory ulcerations, neurological changes, or anatomic alterations.

15.  Nutritionally, it can be adequate in all nutrients based on menu selection.Oral nutritional supplements may be helpful. Dietary considerations in diabetes  Its texture can range from blenderized smooth food to ground,chopped or soft solids. A*Dietary requirements differ according to:- 1.Severity of disease. 2.Type & extent of insulin therapy. 3.Exercise performed. B*Patient’s weight and desirable weight. Ideal weight is 10% lower than desirable weight specially in non-insulin dependant diabetes.

16. C*Patients require regular spacing of food intake to prevent intermittent periods of hypoglycemia specially insulin dependant diabetes. Diet in GIT diseases:- D*Nutritional requirements are greater in any growing child or those patients who are physically active persons. I.Bland diet:- It is that diet which has smooth and bland consistency or texture. It has a bland taste and considered chemically, physiologically and thermally non-irritating.

17. II.Low residue diet:-  It is that diet which leave a small or minimal amount of residue in lower intestinal tract after digestion and absorption have taken place proximally.  It is desirable in conditions where the bulk of fecal material presents a strain, particularly after surgery involving lower intestine.  It is used in preparation of patients for intestinal surgery.  Also used to rehabilitate organ obstruction, distension, edema and inflamed bowel wall.

18. The End