Basic nutrition and Diet Therapy 4.

Responsible for basic nutrition education in

hospitalized clients with low to mild
Introduction to Nutrition
nutritional risk.

Nutrition in your life

FOOD
• Food is lifer
- Any substance taken into the body that will
help meet the body’s needs for energy,

Maslow’s Hierarchy of needs maintenance, growth, and repair.

Food choices are influenced by:

Nutrition in your life ✓ Personal preferences

✓ Habit
• Food and nutrition ranks on the same level as
✓ Ethnic heritage or tradition
the basic necessities of life based on
✓ Social interactions
Maslow’s hierarchy of needs.
✓ Availability, convenience, economy
• Food do much more than just sustain life.
✓ Positive or negative associations
• Food is loaded with personal, social, and ✓ Emotional comfort
cultural beliefs, and customs.
✓ Values
• Food nourishes the mind as well as the body. ✓ Body weight and image
• Nutrition is not simply a matter of food or no
food but rather a question of what kind, how
much, how often, and why. NUTRIENTS
• Merging want with need and pleasure with
- A chemical substance obtained from food and
health are keys to feeding the body, mind,
needed by the body for growth, maintenance,
and soul. (wellness)
or repair of tissues.

3 categories of nutrients:
Primary importance of studying nutrition:
1. Essential nutrients
1. It is fundamental for our own health 2. Nonessential nutrients
2. It is essential for the health and well-being of 3. Energy-yielding nutrients
our patients and clients.

NUTRITION
Nurses role in Nutrition Care:
➢ The sum of processes involved with the
1. Screens hospitalized patients to identify intake of nutrients as well as assimilating and
patients at nutritional risk. using them to maintain body tissue and
2. Serves as liaison between dietician and provide energy.
physician as well as with other members of ➢ Is the food people eat and how their bodies
health-care team. use it.
3. Reinforces nutrition counselling provided by ➢ A foundation for life and death.
the dietician.
DIET DIGESTIVE SYSTEM

a. The food that a person eats most frequently ▪ Esophagus – carries food from the mouth to
b. Food considered in terms of its qualities and the stomach
effects on health. ▪ Stomach – the organ where digestion of
c. A particular selection of food, usually protein begins
prescribed to cure a disease or to gain or lose ▪ Pancreas – a gland that makes enzymes for
weight. digestion and the hormone insulin (which
helps the body turn food into energy)
▪ Small intestine – the organ where most
HEALTH AND WELLNESS digestion occurs.

- Health is a state of optimal physical, mental, ▪ Rectum – the lower end of the large intestine,

and social well-being, not merely the absence leading to the anus

of disease or disability. ▪ Anus – the opening at the end of the digestive

- Wellness is a way of life that integrates body, tract where bowel movements leave the body.

mind, and spirit. It implies a balance between ▪ Liver – the largest organ in the body. Makes

activities and goals; work and leisure; bile (fluid that helps break down fats and gest

lifestyle choices and health risks, and rid of wastes in the body); changes food into

personal needs versus other’s expectations. energy; and cleans alcohol, some medicines,
and poisons from the blood.
▪ Gallbladder – stores the bile made in the liver,
TRADITIONAL AND PREVENTIVE then empties it to help digest fats.
APPROACHES TO HEALTH ▪ Large intestine – also called colon. It absorbs
water and sodium from stool.
- The traditional approach to health only
▪ Appendix – a pouch attached to the first part
attempts change when symptoms of illness or
of the large intestine. No one knows its
disease already exist, at which point those
function.
who are ill seek out a physician to diagnose,
treat, and “cure” the condition.
- This has little value for lifelong positive
ESSENTIAL NUTRIENTS
health. Major chronic problems (e.g., heart
disease or cancer) may be developing long - Nutrients a person must obtain from food

before overt signs become apparent. because the body cannot make them for itself

- The preventive health care approach in sufficient quantity to meet physiologic

involves identifying risk factors in advance needs.

that increase a person’s chances of 1. Carbohydrates

developing a particular health problem. 2. Proteins

- Knowing these factors, people can choose 3. Fats

dietary and lifestyle behaviors that will 4. Vitamins

prevent or minimize their risk for disease. 5. Minerals

- Less costly and offer a better quality of life. 6. Water

 - Nutrients can be manufactured in the body by interact as a dynamic whole to produce and
means of other nutrients maintain the body.
- It is not essential that you consume these
nutrients regularly
o Biotin ENERGY SOURCES

o Vitamin K CARBOHYDRATES
o Cholesterol
• Provide the body’s primary and preferred
o Dietary fibers etc.
source of fuel for energy.
• Maintain the body’s reserve tore of quick

ENERGY-YIELDING NUTRIENTS energy as glycogen

• One gram = yields 4kcal of body energy.
- Nutrients that break down to yield energy
within the body.

FATS

FUNCTIONS OF NUTRIENTS IN FOOD • From both animal and plant sources

• Provide the body’s secondary or storage form
1. Provide energy
of energy that is more concentrated
2. Build tissue
• One gram = yields 9kcal
3. Regulate metabolic process
• In a well-balanced diet, fats should provide
about 20% to 35% of the total kilocalories.
METABOLISM • 2/3 should be from plant sources.

- Refers to the sum of all chemical changes that PROTEINS

take place in the body by which it maintains
• Ideally protein would not be used for energy
itself and produces energy for its functioning.
by the body, rather it should be preserved for
- Close metabolic relations exist among all
other critical functions such as structure,
nutrients and their metabolic products, and
enzyme, and hormone production, fluid
this is the fundamental principle of nutrient
balance and so on.
interaction.
• One gram = yields 4 kcal
• In a well-balanced diet, protein should
provide approximately 10% to 35% of the
CONCEPTS OF NUTRIENT INTERACTION
total kilocalories.
1. Individual nutrients have many specific • The primary function of protein is tissue
metabolic functions including primary and building
supporting roles.
• Amino acids is the building blocks of protein
2. No nutrient ever works alone.
that are necessary for constructing and
Remember: repairing body tissues.

◼ Nutrients do not exist separately in the human

body or in the food that we eat. They always
TISSUE BUILDING

Other Nutrients:
VITAMINS AND MINERALS carbohydrates, fats, proteins, minerals, vitamins, and
water.
• Help regulate many body processes
• Vitamin C in developing collagen The desired amount of each essential
• Calcium and phosphorus participate in nutrients should be balanced to cover variations in
building and maintaining bone tissue health and disease and to provide reserve supplies

• Iron contributes to building in red blood cells. without unnecessary excesses.

REGULATION AND CONTROL MALNUTRITION

VITAMINS Refers to the condition that is caused by an

improper or insufficient diet. Consuming more
➢ Functions as coenzyme factors, which are
undesirable components such as fat, alcohol, added
components of cell enzymes, in the
sugars and consuming less of the recommended
governing of chemical reactions during
intake levels of more desirable components such as
metabolism (esp Vit B complex)
fruits and vegetables does not necessarily mean these
people are undernourished. But it does indicate poor
dietary choices and suboptimal nutritional intake.
MINERALS
On average, someone who is receiving less
➢ Also serve as coenzyme factors
than the desired amounts of essential nutrients has a
➢ Ex: Cobalt
greater risk for physical illness and compromised
immunity as compared with someone who is
WATER receiving optimal nutrition.

➢ Fundamental agent for life, providing the This state may result from many situations
essential base for all metabolic processes including poor eating habits, a continuously stressful
➢ Functions as regulatory agents environment with little or no available food, or a
➢ Body is approximately 50% to 70% water disease state.

DIETARY FIBERS Undernutrition

➢ Helps to regulate the passage of food material A subcategory in malnutrition, appears when
through the GI tract and influences the nutritional reserves are depleted and nutrient and
absorption of nutrients. energy are not sufficient to meet daily needs or added
metabolic stress.

Sometimes occur in hospitalized patients as well. Ex:

acute trauma or chronic illness.
NUTRITIONAL STATES:

OPTIMAL NUTRITION
Overnutrition
Means that a person receives & uses adequate
nutrients obtained from a varied & balanced diet of A result of excess nutrient and/or energy
intake over time.
 Another form of malnutrition especially - This is the intake level that meets the needs
when excess caloric intake produces harmful body of half of the individuals in a specific group.
weight (morbid obesity). - This quantity is used as the basis for the
development of the RDA.
Harmful overnutrition can also occur among
3. ADEQUATE INTAKE
people who consistently use excessive amounts of
- This is used as a guide when insufficient
dietary supplements, which can result in vitamin or
scientific is available to establish the RDA.
mineral toxicities.
4. TOLERABLE UPPER INTAKE LEVEL
- This indicator is not a recommended intake.
NUTRITION AND FOOD GUIDES FOR Rather, it sets the maximal intake that is
HEALTH PROMOTION likely to pose adverse health risk to almost all
healthy individuals
Nutrient Standards
- Refers to the daily intake from food, fortified
Serves as a guide for intake levels of the food, and nutrient supplements combined.
essential nutrients to meet the known nutrition needs
of most healthy population group.
FOOD GUIDES AND RECOOMMENDATIONS

▪ To interpret and apply nutrient standards,

RECOMMENDED DIETARY ALLOWANCES
health care workers need practical food
(RDAs)
guides to use for nutrition education & food
➢ Published by the National Academy of planning with individuals and families.
Sciences since 1941.
Other recommendations:
➢ RDAs have been authoritative source for
setting standards for the minimum amounts - Organizations such as American Cancer
of nutrients necessary to protect almost all Society, American Heart Association have
people against the risk of nutrient deficiency. their own independent dietary guidelines.

4 INTERCONNECTED CATEGORIES OF
NUTRIENT RECOMMENDATION BY THE
DRI:
DIETARY GUIDELINES FOR AMERICANS
1. RECOMMENDED DIETARY
➢ A document developed by nutrition experts
ALLOWANCE
to promote health and gain awareness.
- This is the daily intake of a nutrient that meets
➢ Developed by US Department of Health and
the needs of almost all healthy individuals of
Human Services.
a specific age & gender.
➢ Provide science-based advice to promote
- Use as a guide to achieve optimal nutrient
health and reduce the risk for chronic diseases
intake
through diet and physical activity.
- established with enough scientific evidence

2. ESTIMATED AVERAGE
DIETARY GUIDELINES FOR AMERICANS
REQUIREMENT (EAR)
TOPICS COVERED:
 - Adequate nutrients with calorie needs
- Weight management
- Physical activity
- Food groups to encourage NUTRITIONAL LABELING

- Fats Primary means of communication between producer

- Carbohydrates or manufacturer and the consumer.
- Sodium and potassium
2 components:
- Alcoholic beverages
- Food safety 1. Nutrient Declaration – a standardized
statement or listing of the nutrient content of
food.
MYPYRAMID 2. Nutrient Claim – representation which
states or implies that a food has some
- Outline for daily food choices based on the
particular nutritional proponents.
dietary guidelines
- Released in 2005

NUTRIENT DENSITY

MYPLATE 1. A measure of the nutrients a food provides

compared to the calories it provides.
- The goal of this tool/food guide is to promote
2. Nutrient Dense – foods low in calories and
variety, proportionality, moderation, gradual
high in nutrients.
improvements, and physical activity.
3. Nutrient Poor – foods high in calories and
- Personalize their own plans via the public
low in nutrients.
website www.choosemyplate.gov by creating
a profile.

NUTRIENT GUIDELINES FOR FILIPINOS

FOOD EXCHANGE LISTB PHILIPPINE DIETARY REFERENCE

INTAKE (PDRI)
A classification or grouping of common
foods in terms of equivalent amounts of ▪ This is for planning and assessing diets of
carbohydrates, protein, fat, and calories. healthy groups and individuals
▪ Latest is the PDRI 2015
The word exchange refers to the fact that each
▪ Launched by Food and Nutrition Research
item on a particular list in the portion listed may be
Institute of the Department of A and
interchanged with any other food item on the same
Technology (FNRI-DOST)
list. An exchange can be explaining as substitution,
▪ Adopts the multi-level approach for setting
choice or serving.
nutrient reference values to meet the needs of
various stakeholders for appropriate nutrient
reference values.

COMPONENTS OF PDRI
 1. Estimated Average Requirement (EAR) • Breastfeed infants exclusively from birth
- Daily nutrient intake level that meets the up to six months and then give
median or average requirement of healthy appropriate complementary foods while
individuals in particular life stage and sex continuing breastfeeding for two years
group, corrected for incomplete utilization or and beyond for optimum growth and
dietary nutrient bioavailability. development.
2. Recommended Energy/Nutrient Intake • Eat more vegetables and fruits to get the
(REI/RNI) essential vitamins, minerals, and fiber for
- Level of intake of energy or nutrient which is regulation of body processes.
considered adequate for the maintenance of • Consume fish, lean meat, poultry, egg,
health and well-being of healthy persons in dried beans or nuts daily for growth and
the population. repair of body tissues.
3. Adequate Intake (AI) • Consume milk, milk products, and other
- The Adequate Intake is used as a guide when calcium-rich food such as small fish and
insufficient scientific evidence is available to shellfish, every day for healthy bones and
establish the RDA. Both the RDA and the teeth.
Adequate Intake may be used as goals for • Consume safe foods and water to prevent
individual intake. diarrhea and other food-and-water-borne
4. Tolerable Upper Intake Level or Upper diseases.
Limit (UL) • Use iodized salt to prevent Iodine
- Highest average daily nutrient intake level Deficiency Disorders.
likely to pose an adverse health effect to • Limit intake of salty, fried, fatty, and
almost all individuals in the general sugar-rich foods to prevent
population. cardiovascular diseases.
• Attain normal body weight through
proper diet and moderate physical
THE NUTRITIONAL GUIDELINES FOR
activity to maintain good health and help
FILIPINOS
prevent obesity.
NGF is a set of dietary guidelines based on • Be physically active, make healthy food
the eating pattern, lifestyle, and health status of choices, manage stress, avoid alcoholic
Filipinos. beverages and do not smoke to help

It contains all the nutrition messages to prevent lifestyle-related non

healthy living for all age groups from infants to communicable diseases.

adults, pregnant and lactating women, and the

elderly.
PERSON-CENTERED APPROACH

Regardless of the type of food guide or

2012 NUTRITIONAL GUIDELINES FOR recommendations used, health care professionals
FILIPINOS must remember that food patterns vary with

• Eat a variety of foods everyday to get the individual needs, tastes, habits, living situations,

nutrients needed by the body economic status, and energy demands.

 Food is a basic enjoyment of life, and this
should always be considered when implementing
dietary changes for oneself or for a patient.

Use the food guides to identify healthy food

groups to choose from and then use a person-
centered approach to more specifically select suitable
foods within those food groups to meet the patient’s
needs.
NUTRITION THROUGHOUT THE LIFE FOR WOMEN WHO ARE PREGNANT OR
CYCLE BREASTFEEDING

- Pregnancy and Lactation • Women who are pregnant are encouraged to

- Infancy, Childhood and Adolescence gain weight within the gestation weight gain
- Early, Middle, and Late Adulthood guidelines.
• Consume 8 – 12 ounces of seafood per week
from a variety of seafood types that are lower
Nutrition during Pregnancy and Lactation in methyl mercury
Characteristics of pregnancy • Do not drink alcohol while pregnant.

- Pregnancy or gestation is the period when the

fertilized ovum implants itself in the uterus,
NUTRITIONAL DEMANDS OF PREGNANCY:
undergoes differentiation and grows until it
ENERGY NEEDS
can support extra-uterine life
- Last for a period of 266 to 280 days Reasons for Increased Need
- Consist of three trimesters:
During the 2nd and 3rd trimester of pregnancy, the
1. First – Implantation
mother needs more kilocalories for 2 general reasons:
2. Second – organogenesis (formation of
organs) - To supply the increased fuel demand by the

3. Third – growth metabolic workload for both the mother and

the fetus.
- To spare protein for the added tissue –
DIETARY GUIDELINES FOR AMERICANS, building requirements.
2015 – 2020 FOR SPECIFIC POPULATIONS
For these reasons, the mother must consider the
REGARDING PREGNANCY AND
nutrient and energy density of the food in her diet.
LACTATION
• The exact amount of energy needs will vary
FOR WOMEN WHO ARE CAPABLE OF
depending on her pregnancy weight, health
BECOMING PREGNANT
status and activity level.
• Before becoming pregnant, women are
encouraged to achieve and maintain a healthy
weight. Amount of Energy Increase

• Choose foods that supply heme iron, which is • 1st trimester – remain the same as their
more readily absorbed by the body; kilocalorie needs before conception
additional iron sources; and enhances of iron • 2nd trimester – an increased need of 340
absorption, such as vitamin C – rich foods. kcal/day
• Consume 400 micrograms per day of • 3rd trimester – approximately 452 kcal/day
synthetic folic acid from fortified foods or an increased or about 15 – 20% over the
supplements in addition to food forms of energy needs of non-pregnant women.
folate from a varied diet.
• Active, large, teenage, or nutritionally
deficient pregnant women may require more
energy than the DRI guidelines.
 • The emphasis always should be an adequate - Many nutrients are needed in higher
kilocalorie to secure the energy and nutrient education during pregnancy to meet the
needs of a rapidly growing fetus. greatest structural and metabolic
requirements of gestation
- The nutrient needs of the mother must be met
Protein Needs: Reasons for increased need before the nutrient needs of the placenta will

Protein serves as the building blocks for the be met and finally, before the needs of the

tremendous growth of body tissues during fetus are fulfilled, thus all nutrients are of

pregnancy. Sufficient protein is required to meet the great importance in the mother’s diet

growth needs in the following ways: - Teratogenic effects may develop as a result of
a maternal diet that is deficient in minerals.
- Development of the placenta
- Growth of the fetus
- Growth of maternal tissues COMMON MINERAL CONCERN:
- Increased maternal blood volume
CALCIUM
- Amniotic fluid
- A good supply of calcium – along with the
phosphorus, magnesium, and vitamin D is
Amount of protein increase essential for the fetal development of bones

- The protein DRI for non-pregnant women is and teeth as well as for mother’s own body

= 46g/day needs

- The DRI for pregnant women is = 71g/day - Calcium is also necessary for blood clotting

- This represents an increase of 25g/day more - Food source: at least 3 cups of milk

than the average woman’s protein substitute, generous amount of green

requirement. vegetables, & enriched ow whole grain

provides enough calcium
- During pregnancy, calcium and zinc
Food sources absorption is enhanced
- Calcium supplement may be indicated for
Comple protein foods of high biologic value include:
cases of poor maternal intake of twin
1. Eggs pregnancy
2. Milk - A diet sufficient in calcium also provides
3. Beef enough phosphorus.
4. Poultry
5. Fish
6. Soy IRON
7. Cheese
◼ Essential for the increased hemoglobin
8. Other animal products
synthesis that is required for the greater blood
volume as well as for the baby’s necessary
prenatal storage of iron
Key vitamin and mineral needs
◼ The average intake of iron for women of
childbearing age is 14.5 g/day. While the
 current DRIs recommend a daily iron intake
of 27 g/day during pregnancy
VITAMIN D
◼ Food sources: meat, poultry, fish, fortified
cereals, beans and spinach. - Vitamin D deficiency during pregnancy may

◼ Iron occurs in small amounts in food sources be associated with adverse outcomes for the

and is not in readily absorbable form, thus mother and the fetus, including preeclampsia,

iron supplements are recommended. gestational diabetes, and preterm birth.

◼ Consuming foods that are high in vitamin C - Although causality has not been yet

along with the dietary sources of iron determined. Research between vitamin D and

enhances the body’s ability to absorb and use pregnancy complications are contradictory

iron - The current DRIs recommend pregnant and

◼ Also, avoid foods that inhibit iron absorption lactating women consume 15mcg/day

like whole – grain cereals, unleavened whole (600IU) to ensure absorption and use of

breads, legumes, tea, and coffee. calcium and phosphorus for fetal bone

◼ To prevent iron deficiency anemia, growth.

supplement with 20 to 80 mg/day - Sources includes fortified milk (3 cups),

exposure to sunlight.

FOLATE
WEIGHT GAIN DURING PREGNANCY
- Folate is important for both the mother and
the fetus throughout pregnancy AMOUNT AND QUALITY

- Tetrahydro folic acid (TH4) participates in - Weight gain during pregnancy is natural and
DNA synthesis, cell division and hemoglobin necessary for the infant to develop normally
synthesis. and the mother to retain her health.
- It is particularly relevant during the early - In addition to the developing infant, the
periconceptional period (2 months before mother’s uterus, breast, placenta, blood
conception to 6 weeks of gestation) to ensure volume, body fluids, and fat must all increase
adequate nutritional availability in the to accommodate the infant’s needs.
endometrial lining of the uterus for
Component Amount of gain
embryonic tissue development.
Fetus 7.5 pounds
- The current DRIs recommend daily folate
Placenta 1 pounds
intake of 600 mcg/day during pregnancy and
Amniotic fluid 2 pounds
400 mcg/day for nonpregnant women during
Uterus 2 pounds
their childbearing years
Breasts 1 – 3 pounds
- Natural sources of folate include but not
limited to liver, legumes (beans), orange Blood volume 4 pounds

juice, asparagus, and broccoli. Maternal fat 4+ pounds

- Spina bifida and anencephaly are the two

most common forms of neural tube defects
known to be associated with folate RATE OF WEIGHT GAIN
deficiency.
1. 1st trimester – approximately 1 to 2 kg
 2. 2nd trimester onwards – the rate of ALTERNATIVE FOOD PATTERNS
weight gain should be reflective of a
▪ Specific nutrients (not specific foods) are
woman’s pregnancy BMI
required for successful pregnancies, and
3. Unusual patterns of weight gain should be
these may be found in variety of foods.
monitored closely
▪ Wise health care providers encourage
4. No one should lose weight during
pregnant women to use food that serve both
pregnancy, because it could cause
their personal and their nutritional needs.
nutrient deficiencies for both mother and
infant BASIC PRINCIPLES OF DIET AND

5. On average, a pregnant adult requires no EXERCISE

additional calories during the first ▪ Pregnant women should eat a sufficient
trimester of pregnancy and only and quantity of high-quality food.
additional 300 calories a day during the ▪ Pregnant women should eat regular meals
nd rd
2 and 3 trimesters and snacks to avoid fasting or skipping meals.
▪ In addition, pregnant women are encouraged
to participate in at least 150 mins of
INAPPROPRIATE WEIGHT GAIN
moderate-intensity aerobic activity spread
• Underweight throughout the week or 30 mins of
- High risk of having low birth weight infants moderately intense exercise on mis, if not all,
and days of the week.
- Higher rates of pre-terms deaths and infant
deaths.
GENERAL CONCERNS OF PREGNANCY:
• Overweight and obesity
GASTROINTESTINAL PROBLEMS
- High risk complications like hypertension,
gestational diabetes, and post-partum NAUSEA AND VOMITING
infections
▪ Nausea and vomiting affect 69% of pregnant
- Complications of labor and delivery
women during early pregnancy
- Large newborns increase likelihood of a
▪ The following dietary actions may help with
difficult labor and delivery, birth trauma, and
the relief of symptoms:
caesarian section
• Avoid empty stomach by eating
- May double the risk of neural tube defects.
small, frequent meals and snacks that
are fairly dry and bland with low fat
and low fiber.
DAILY FOOD PLAN
• Drink liquids between meals
GENERAL FOOD PLAN
• Avoid odors, foods or supplements
▪ Ideally, a food plan will be established for the that triggers nausea
pregnant woman on an individual basis to • Try ginger (125-250mg) or vitamin
meet her nutrition needs. B6 supplements
▪ The core food plan should be varied well ▪ If nausea and vomiting persist pregnant
rounded diet including all food groups women should be evaluated for hyperemesis
designed to supply the essential nutrients. gravidarum
 ▪ Sufficient rest during the latter pat of the day
may help relieve the downward pressure
Hyperemesis gravidarum
▪ Usually resolves spontaneous after delivery
▪ Approximately 1% pregnant women are
affected
▪ Possible recurrence during additional Heartburn
pregnancies
▪ Pregnant women sometimes have a heartburn
▪ Should be closely monitored and followed for
or a “full” feeling
hydration, electrolyte balance, and
▪ It is caused by the pressure of the enlarging
appropriate weight gain
uterus crowding the stomach
▪ Pregnancy outcome and fetal growth are
▪ Relieving measures includes dividing the
compromised
day’s food intake into small meals and
▪ Antiemetic may benefit some women.
wearing of loose-fitting clothing.

Constipation
Anemia
▪ This may occur as a result of increasing
▪ Iron deficiency anemia is the most common
pressure of the enlarging uterus and the
nutritional deficiency worldwide and is the
muscle-relaxing effect of progesterone on the
risk factor for delivering low birth weight
gastrointestinal tract, thereby reducing
infants
normal peristalsis
▪ Approximately 42% of pregnant women
▪ Helpful remedies
worldwide
▪ Adequate exercise
▪ More prevalent in underdeveloped countries
▪ Increased fluid intake
and poor women of low socioeconomic group
▪ High fiber diet (whole grains, vegetables,
▪ Dietary intake should be improved and use
dried fruits, fruits, and juices)
supplements as necessary
▪ Pregnant women should avoid artificial and
▪ WHO recommends an intermittent (1-3x a
herbal laxatives.
week) iron and folic acid dietary supplement
as a safe, effective and inexpensive way to
prevent anemia during pregnancy for women
Hemorrhoids
living in areas with high risk for anemia.
▪ Enlarged vein in the anus that often protrude
through the anal sphincter
▪ Usually caused by the increased weight of the Intrauterine Growth Restriction (IUGR)
baby and the downward pressure that this
▪ A fetus with IUGR is at risk for preterm birth
weight produces
and increased infant morbidity and mortality
▪ May cause discomfort, burning, and itching,
▪ Factors contributing to IUGR:
may even rupture and bleed under pressure of
- Low pre-pregnancy weight
a bowel movement
- Inadequate weight gain during pregnancy
▪ May be controlled by the dietary suggestions
- Inadequate folate and iron status
given for constipation
- Use of cigarettes, alcohol, and other drugs
 ▪ Infants who suffer from IUGR are at higher ▪ With high-risk for caesarian delivery and
risk for the developmental or chronic diseases fetal damage such as birth defects, stillbirths,
as adults, including CVD and HPN. macrosomia, and neonatal hypoglycemia.

Hypertensive Disorders of Pregnancy LACTATION

▪ Etiology is unknown, but it is the leading ▪ Lactation is the production and secretion of
cause of pregnancy-related deaths worldwide breast milk for the purpose of nourishing an
▪ HPN: blood pressure of > 140 mmHg systolic infant
or > diastolic ▪ It is facilitated by and interplay of various
▪ Called the silent diseases because it has no hormones after delivery of the infant
symptoms ▪ Oxytocin and Prolactin: instigate the process
▪ Indications of HPN: severe headaches. ▪ Prolactin is responsible for milk production
Blurred vision, chest pain, nausea, or sudden ▪ Oxytocin is involved in milk ejection from
weight gain. the breast
▪ Treatment varies but optimal nutrition is ▪ Let-down reflex – the infant’s sucking
important, and prompt medical attentions is initiates the release of oxytocin which causes
required the ejection of milk into the infant’s mouth. It
is a supply-and-demand mechanism. The
more an infant nurse, the more milk the
Classification of Hypertensive Disorders: mother produces.

a. Chronic hypertension – preexisting HPN,

appeared before 20 weeks
BREASTFEEDING
b. Gestational hypertension – HPN diagnosed
after 20 weeks, BP returns to normal within 6 ▪ Breastfeeding is “an unequalled way of
weeks postpartum providing ideal food for the healthy growth
c. Preeclampsia – gestational HPN plus and development of infants”
proteinuria (> 300mg/d of protein) ▪ It is the optimal method of feeding and
d. Eclampsia – preeclampsia plus seizure nurturing the infants
e. Preeclampsia superimposed on chronic ▪ WHO recommends be exclusively breastfed
hypertension – preexisting HPN with the for the first 6 months of life
development of proteinuria during gestation ▪ At about 6 months of age: slowly introduce
complimentary foods as breastfeeding
continues up to 2 years and beyond
Gestational Diabetes ▪ Breastfeeding is an important public health

▪ Glucose tolerance with onset during strategy for improving infant and child

pregnancy morbidity and mortality and improving

▪ The treatment follows that for type 2 DM, maternal morbidity (American Dietetic

with diet and exercise of paramount Associations, 2008)

importance as first-line treatment plan

BREASTMILK
 ▪ There are many positive reasons to breastfeed h. Improves bone density and reduces risk for
▪ The primary benefit of breastmilk is hip fracture
nutritional i. Reduces the risk of postpartum depression
▪ Breastmilk contains just the right amount of j. Enhances self-esteem as a competent mother
lactose: water, essential fatty acids; and
amino acids for brain development, growth,
and digestion BENEFITS OF BREASTFEEDING TO THE

▪ No babies are allergic to their mother’s milk, INFANT

although they may have reactions to k. Increases bonding with mother

something their mother eats. l. Optimal “natural” nutrition that contains no
▪ Human milk contains at least 100 ingredients artificial colorings, flavorings, preservatives,
not found in formula. or additives
▪ The breastmilk can stay: m. Safe and fresh
a. 8 – 10 hours at room temperature n. Reduces risk of acute otitis media,
b. 8 days in the refrigerator nonspecific gastroenteritis, severe lower
c. 3 – 4 months in the refrigerator freezer respiratory tract infections, and asthma
d. 12 months in deep freezer o. Enhances immune system
▪ Previously frozen milk must be used within p. Protect against allergies and intolerance
24 hours after defrosting in the refrigerator q. Promotes better tooth and jaw development
▪ Breastmilk should not be heated in the that the bottle feeding because the infant has
microwave or directly on the stove. Those to such harder
methods of heating breast milk will kill its r. Associated with higher IQ and school
immune – enhancing ability performance through adolescence
s. Reduces the risk of chronic diseases, such as
obesity, type 1 and 2 diabetes, heart diseases,
BENEFITS OF BREASTFEEDING TO THE
hypertension, hypercholesterolemia, and
MOTHER
childhood leukemia
a. Promotes optimal maternal – infant bonding t. Reduces risk for infant morbidity and
b. Stimulates uterine contractions to help mortality.
control postpartum bleeding and regain
prepregnant uterus size
c. Is readily available and requires no mixing or NUTRIENT REQUIREMENTS DURING

dilution LACTATION

d. Is less expensive than purchasing bottles, ▪ Most nutrient requirements are increased
nipples, sterilizing equipment and formula during lactation
e. Decreases the risk of breast and ovarian ▪ The amounts depend on the age of the mother
cancer and type 2 diabetes ▪ Protein is of particular importance because it
f. Reduces postpartum bleeding and delays is estimated that 10 grams of protein are
resumption of menstruation, although not secreted in the milk each day
reliable for birth control ▪ Be sure to include sufficient fruits and
g. Conserves iron stores by prolonging vegetables, especially those rich in vitamin C
amenorrhea
 ▪ Extra fat-free milk will provide many of the - Allowances of 1.5 to 2.5 gm of protein per kg
additional nutrients and calories required in the body weight from 0-6 months of age,
during lactation and 1.5 to 2 gm per kg in the body weight
▪ Chips, sodas, candles, and desserts provide from 6 to 12 months of age are recommended
little more than calories by the WHO expert group.
▪ It is important to have sufficient fluids to - One and a half oz. of cow’s milk per pound
replace those lost in the infant’s milk. Water body weight equals 1.5 gm of protein per
and real fruit juice are the best choices. pound

INFANCY

Infant Fat

- Refers to a person not more than 12 months - Whole cow’s milk contains satisfactory
of age levels of the essential fatty acids, linoleic and
- A healthy full term infant weighs 2.7 to 3.2 arachidonic acids required by the infant.
kg (6 – 7 lbs.)
- Measures 48 to 50 cm (19 to 20 inches)
- Head circumference average 35 cm (14 Carbohydrates

inches) - An allowance of 1/10 ounce per lb. of body

- Skin is moist and not wrinkled weight equals 1 ounce per 10 oz. of milk is
prescribed

Nutritional Objectives

- Provide nutritional base for rapid growth and Vitamins

development of the child during the first year - If the diet of a nursing mother is nutritionally
of life. adequate, the vitamin necessary for the infant
- Establish the foundation for good habits and will be contained in the milk, with the
attitudes. exception of vitamin D and possibly ascorbic

Nutritional Requirements acid

- It is desirable to administer tomato juice or
• Birth – 350 to 500 calories
orange juice very early in life, regardless of
• 1 year – 800 to 1200 calories whether the baby is breastfed or formula fed.
• nd th
(120 calories/kg for 2 to 7 month
• 100 calories/kg for 7th to 12th month)
- The average requirement for the growth in the Water
1st year is 50 calories per pound of expected
- The daily fluid needs of the infant are
weight (2/3 calories from milk and 1/3 from
approximately 2.5 ounces per pound of body
added carbphydrates)
weight
- The requirement of water varies from 10 too
15 % of the body weight, or 1 ½ or 2 ½
Proteins
ounces per pound of the body weight.
Feeding the Infant - Supplemental feeding – when the bottle is
used to replace one or more breast feeding as
- Infant feeding is dynamic in nature
when the mother is away from home for
- It has nutritional, psychological, and
periods longer than feeding intervals
biological interaction
v. Mix feeding is not encouraged as it may lead
- An infant may be breast-fed, bottle-fed, or
to lactation failure.
given combined breast and bottle feeding.

Formula Preparation
Breastfeeding
Aseptic method
f. Has a physiologic and psychologic effect for
mother and infant - The equipment and ingredients are sterilized
g. Meets nutrients need of early months separately either by steam or by boiling water
h. Provides immunity factor and reduces for at least 25 minutes
chances for infection
i. Breastmilk is clean
j. Breastmilk is easily digested Terminal method

- Protein in the form of whey sugar is superior - The formulas are poured into clean
to casein and is readily digested unsterilized bottles and are sterilized
k. Breastmilk is non- allergic together. Disadvantage: scum formation can
clog the nipple holes

Bottle-feeding

e. Formula designs to match nutritional ration Feeding time

of breastmilk composition, water dilution to - A 2.5 to 2.7 kg usually feed every 3 hours
reduce protein and mineral concentration, - A 3.6 to 4 kg baby usually feeds every 4 hours
added carbohydrate to increase energy - At 2 months old, the baby sleeps through the
f. May meet needs of working mother night after the 10 pm feeding
g. Must be prepared under clean conditions ad - Between 2 – 3 months old, the baby is on a 2-
sterilized to prevent contamination 4 feeding schedule.
h. Only recommended when breast feeding is
contraindicated
i. Artificial feeding is costly Supplementary foods
j. Artificial feeding is associated with infantile
2nd month
obesity or “protein-calorie malnutrition plus”
- Liquids like rice, water, vegetables water or
“calamansi” juice may be introduced
Mixed Feeding depending upon infants’ acceptance and
tolerance
u. A combination of breast and bottle feeding
- Complemented feeding – when the bottle is 4th month
given to complete a single breast feeding
because of insufficiency of mother’s milk
 - Scraped banana or papaya or thin “lugaw” or ▪ Include also other cerals like oatmeal,
commercial cereal pop like “cerelac” and biscuits, and boiled root crops like
“ceresoy” mashed kamote and gabi.

5th – 6th month

- Full diet consisting of pureed meat, egg, fruit, Tips on Giving New Foods
vegetables and even cereals.
1. After the 3rd month, test the readiness of the
- Weaning should take place
baby to accept new foods by placing a
- Chewy foods are also started when teething
teaspoon between his lips. If he tends to close
begins.
his lips or push the teaspoon away
7th – 8th month continually then he is not ready.
- If he accepts – give liquid or semi-liquid food
- Foods are chopped finely, not strained to
first. Begin with lugaw, move on to thicker
teach mastication. Ex: soft cooked egg with
lugaw, and then add step-by-step mashed
rice porridge, soft cooked rice with boiled
chopped and thinly sliced food as your baby
fish, misua soup.
grows older.
9th – 12th month 2. Start any new food with ½ teaspoon on the

- Whole tender foods or foods chopped first day and add as your baby takes to the

coarsely are given. new taste.

3. Never start two foods at the same time.
4. Show pleasure when giving food.
Foods for Infants (3 – 12 months) 5. Give water between feeds to provide enough
liquid to remove waste from his body.
- Simple tips on how to help infants eat better.
6. At about 7 months of age, teach your baby to
1. Beware of baby dinners or creamed products
drink water and other liquids from a cup.
that contain nutritionally incomplete refined
7. Offer bland foods to your baby.
starches.
a. Highly salted foods may injure his
2. Ore Drain off syrup from canned fruits before
kidneys.
serving.
b. Too much sugar and sweets may develop
3. Watch the number of egg yolks the child
in the baby a strong liking for these foods
consumes per week (3 – 4 is plenty)
which may lead to tooth decay and
4. If the doctor says its okay, give him 2% low
obesity.
fat milk instead of whole milk
5. Make lugaw, it is good for your baby. Add
these foods one at a time:
Health Concerns of Infancy
▪ Banana, ripe papaya, mango, tiesa
▪ Eggs, fish, meat, liver, munggo, 1. Milk allergy

soybeans, gabanzos, peanut - Soybean preparations are used

▪ Green leafy and yellow vegetables 2. Overfeeding resulting to obesity

like kamote tops, kangkong, - Common in bottle-fed infants

malunggay, petsay, carrot and squash. - Delay introduction of solid foods

- Do not add sugar to food
 - Not offering formula to fully fed child - Provide basis of support of psychosocial
3. Iron deficiency anemia development in relation to food patterns,
4. GI upsets: diarrhea, vomiting, constipation, eating behavior, and attitudes.
colic - Provide sufficient calories for increasing
When such conditions arise: physical activities and energy needs.
- Determine the underlying cause
- Maintain water and electrolyte balance
- Modify milk formula to suit digestive Good nutrition may be established by families

capacity. through:

- Practicing a good eating habit

- Providing wholesome, acceptable foods that
Responsibilities of Health Personnel
promote good health
If bottle feeding, the caregiver should be counseled - Establishing eating patterns that are socially
to: enjoyable and satisfying

1. Follow the directions exactly Pre-schooler

2. Not force the baby to drink every drop
Nutritional needs of the pre-school child differ from
3. Practice aseptic technique when making
that of an adult:
formula
4. Recognize developmental stages indicating - There is a larger requirement for growth so

when an infant should be started on solid there is a greater need for protein, vitamins,

foods and minerals

5. Follow reliable guide for addition of solid - The preschooler’s activities are

foods proportionally higher than those of the adults

6. Offer single foods and note any allergies. - Selection of foods requires some

7. Introduce a variety of food modifications especially for young children

8. Reintroduce once-rejected food items at - Childhood presents period of rapidly

another time changing attitudes and emotional

9. Avoid allowing the child to drink more than development – a period when food habits can

one quart of milk a day, to prevent refusal of be most favorably channeled

other foods.
10. Make mealtimes for the infant a pleasurable,
Functions of a diet for a child
special time.
- Provide fuel for mascular activity
- Supply necessary chemical elements and
CHILDHOOD compounds that the child’s body requires for

- A period of life building materials and repairing worn out

tissues
Nutritional Objectives

- Provide adequate nutrient intake to meet

continuing growth and development needs. Nutrient Allowances

Calories
 - The energy need of the pre-school child is - Put the child in a well- ventilated v=bright
determined by his age, activity, and basal clean room
metabolism. - Provide colorful plate and utensils
- About 55% of his total caloric needs go to
Child has aversion towards some foods
metabolic activities, 25% to physical growth,
12% to growth needs, and 8% to fecal loss. - Give fruits as substitutes of some vegetables
- Mix vegetables with familiar foods
Protein
- Give milk through “halo-halo”, leche flan,
- About 1.5 to 2.0 mg/kg of body weight is gulaman, “mais con yelo”
required
Child has allergies
Vitamins and Minerals
- Monitor nutrient intake
- Essential for normal growth - Make some food substitutes

Fluids

- The total fluid requirements of a healthy child SCHOOL AGE CHILDREN

are 4 to 6 glasses, one to one and half quarts
- The period between 7 – 12 years is
or 1000 – 1500 ml.
characterized by a slow steady, growth,
increased body proportions, enhanced mental
capabilities, and more mind and body
Feeding Problems
coordination.
Child is eating too little

- Remedies – go slow in adding new foods

How to prepare packed lunch
- Start the meal with foods he/she likes best
- Serve less than what he/she will eat - Plan the meals that are cheap and easy to
- Prepare simple dishes like “sinigang” or prepare.
“tinola” - Prepare sandwich fillings the day or night
before, if preferred.
Child is eating too much
- Include foods like milk and fruit juice for
- Refrain from serving rich foods like cakes, beverage, if possible.
pastries, pies, and ice cream.

Child is dawdling during mealtime

Health concerns in Childhood
- Have the child regularly check by a
Childhood Obesity
pediatrician
- Avoid fussing over him/her - Overweight is defined as a child at or above
- Let the child enjoy eating the 95th percentile of Body Mass Index by sex
and age.
Child is gagging especially when fed with course
- Children are considered obese when their
foods
body fat exceeds lean muscle mass
- Encourage self-feeding - The result of an imbalance between the
calories a child consumes as food and
 beverages and the calories a child extends for - Overweight is defined as a child or above the
normal growth and development, 95th percentile of Body Mass Index by sex
metabolism, and physical activity. and age.
- Children are considered obese
Factors contributing to obesity:

1. Energy intake of large portions of food and

beverages Factors contributing to Obesity:
2. Eating meals away from home
1. Energy intake of large portions of food and
3. Frequent snacking o energy-dense foods
beverages
4. Consuming beverages with sugar
2. Eating meals away from home
5. Minimal physical activity.
3. Frequent snacking on energy-dense foods
4. Consuming beverages with sugar
5. Minimal physical activity
Childhood Type 2 Diabetes

- As a result of the increase of childhood

obesity, there is a parallel; increase in What can parents do to help?
diabetes, particularly type 2
- Provide only healthy, nourishing food for
- Most obese children will develop type 2
meals and snacks. If it is not available a child
diabetes between the ages of 10 and 14
cannot eat it.
- Children with type 2 diabetes should see a
- Limit Tv and computer time. Remove TV
certified diabetes educator to learn what o eat
sets from your child’s bedroom
to control their diabetes. The diabetes
- Get moving yourself exercise benefits
educator will also prescribe daily exercise
everyone
and attention to fiber intake, both of which
- Never tell a child he cannot have a food
help control blood glucose.
because “he is too fat”
- Learn correct portions, even if this means
weighing and measuring
Feeding the School Child
- Remember, there is nothing a child cannot
- Psychological factors eat; it is just how often and how much will be
- School environment consumed of a particular food. There is no
- Food preferences good or bad foods.
- Eat only at the table at designated times
- Give water to drink rather than calorie-laden
Feeding Problems
fruit juices. If a child won’t drink water, then
- Inadequate meals a small amount of juice can be mixed with
- Poor appetite water to give flavor. Use ¼ cup juice to 8-12
- Sweet tooth ounces of water. This glass of water-juice
will contain about 30 calories versus 120 –
180 for 100% juice.
CHILDHOOD CONCERNS IN CHILDHOOD
- Eat slowly – it takes 20 minutes for the brain
CHILDHOOD OBESITY to get the message that the stomach is full.
 Make it a game – set a timer and see who can - Boys greater than girls
make the meal last for 20 minutes
- Use the 20-minutes technique. If your child
Minerals
wants a calorie-dense snack such as cookies,
chocolate, candy bars, or other calorie-dense - 13-15 age group is increased compared to the

controlled serving, pay attention to the treat 16-19 age group.

and make it last for 20 minutes. Holding it in - Increase in iron intake and iodine

the mouth and rolling it around on the tongue

will satisfy the taste buds quicker than Vitamins
swallowing immediately and may contribute
- Increased than that of females.
to satiety sooner.
- Learn to determine whether your child is
really hungry or just bored, tired, or lonely. It
Food habits
takes 3 to 4 hours for a stomach to completely
empty after a significant meal, so if that - Typically have enormous appetites, esp boys

amount of time has elapsed, then your child - They usually their peers and do what is

is truly hungry. popular

- Make sure your child gets enough sleep (8 – - Usually busy with a lot of activities

10 hours - Has natural desire for independence and may

resent being told what to do

ADOLESCENTS
Meal planning for Teenagers (13 – 19 Y/O)
- A person between the ages of 13 and 20
- A transition period oof human development Use the family menu, but add more foods rich in:

that occurs between childhood and - Protein

adulthood. Girls go through this period - Calories
earlier than boys do. - Iron
- Vitamin C

Nutritional Objectives

- Provide optimum nutritional support for Possible Nutritional Problems

demands of rapid growth and high energy - Low intakes of Calcium, Vitamin A and C
expenditure. - Low intake of iron in girls
- Support development of good eating habits - Anemia
by providing a variety of foods through a - Obesity or underweight
regular pattern. - Skin problems
- Nutritional deficiencies related to:
o Psychological factors
Nutrient Allowances
o Fear of overweight or crash diets
Calories o Food diets
o Poor choice of snack foods
- Increased due to physical activity
 o Irregular eating problems - Bulimics are said to fear that they cannot stop
o Additional stress of pregnancy eating
- They tend to be high achievers who are
perfectionistic, obsessive, and depressed
Special considerations for the Adolescent related - They generally lack a strong sense of self and
to Nutrition Concerns: have a need to seem special.
Anorexia Nervosa

- A psychological disorder more common to

women than men
Overweight
- It can begin as early as late childhood, but
usually begins during the teen years or the - Being overweight during adolescence is
early twenties. particularly unfortunate because it is apt to
- It can cause the client to drastically reduce diminish the individual’s self-esteem and,
calories, causing altered metabolism, which consequently, can exclude her or him from
results in hair loss, low blood pressure, the normal social life of the teen years, further
weakness, amenorrhea, brain damage, and diminishing self-esteem
even death. - Also, it tends to make the individual prone to
overweight as an adult.
Treatment requires the ff:
- The problem of being overweight during
1. Development of a strong and trusting adolescence is especially difficult to solve
relationship between the client and the health until the individual involved makes the
care professionals involved in the case independent decision to change lifestyle
2. That the client learns and accept that weight habits.
gain and a change in body contours are
normal during adolescence
3. Nutritional therapy so the client will Fast-food
understand the need for both nutrients and
- Include hamburgers, cheeseburgers, French
calories and how best to obtain them
fries, milkshakes, pizza, sodas, tacos, chili,
4. Individual and family counseling so the
fried chicken, and onion rings
problem is understood by everyone
- Fast foods are excessively high in fat and
5. Close supervision by the health care
sodium, as well as calories, and contain only
professional
limited amounts of vitamins and minerals
6. Time and patience from all involved.
(other than sodium) and little fiber.
- Teens often use fast foods as a snack to hold
them over until dinner, and this results in
Bulimia
consumption of many extra calories.
- A syndrome in which the client alternately
binges and purges by inducing vomiting and
using laxatives and diuretics to get rid of Alcohol
ingested food.
- Alcohol is typically made from fruit, corn,
rhy, barley, rice or potatoes
 - It provides 7 calories per gram but almost no
nutrients
Middle Adults
- It initially lowers inhibitions thus the drinkee
feel “happy”. This feeling affects the - This is a time when the physical activities of

drinker’s judgment and can lead to accidents young adulthood typically begin to decrease,

and crime resulting in lowered caloric requirement for

- Ultimately, alcohol is a depressant; continued most individuals

drinking leads to sleepiness, loss of - May tire more easily

consciousness, and, when too much is - May not get as much exercise as they did in

consumed in a short period, death. earlier years

- It affects absorption and normal metabolism

of glucose, fats, proteins, and vitamins.
Nutrient Allowances
- Excessive use may result to:
◼ Liver cirrhosis Calories
◼ High blood pressure - Reduction of calories is needed
◼ Damage heart muscle Protein
◼ Kidney disease - Allowance of 11.1gm/kg body weight is
required.
Vitamins and Minerals
ADULTHOOD - Supplements of calcium, iron, vitamins A
- The period of life when one has attained full and C is needed.
growth and maturity. Water and Fiber
- About 6 to 8 glasses should be consumed
daily.
3 Stages of Adulthood

➢ Young Adulthood – 20 to 40 years old How to Live Longer

➢ Middle Adulthood – 40 to 65 years old
- Avoid red meat and substitute fish whenever
➢ Older Adulthood – 65 years old and older
possible in diet
- Eat vegetables rich in beta-carotene

Young Adults - Eat vegetables more frequently than red

meats and dairy products
- A time of excitement and exploration
- Adhere to low-fat, low-calorie diet
- Individuals are alive with plans, desires, and
- Avoid preserved foods, especially those
energy as they begin searching for and
preserved with nitrates
finding their places in the mainstream of
- Cut smoked meats out of diet
adult life.
- Take vitamin supplements daily
- They appear to have boundless energy for
- Don’t smoke
both social and professional activities.
- They are often interested in exercise for its
own sake and may participate in athletic Common problems among the Elderly
events as well
Difficult in chewing due to loss of teeth and not ◼ Cabbage, broccoli, Brussel sprouts, and
getting used to dentures: cauliflower reduce the risk of GI and
respiratory tract cancer
- Chop meat or flake fish
◼ Fruits, vegetables, and whole grain
- Slice or chop vegetables into small bite-sized
cereals
pieces for easy chewing
◼ Moderate intake of foods high in fats,
Lack of appetite salts, nitrite-cured foods

- Do light exercise like walking and gardening ◼ Milk to ward off colon cancer

to improve appetite and keep the body fit ◼ Drink too much of alcoholic beverages

- Eat in pleasant surroundings to make your

meal enjoyable
Family Nutritional Needs and Costs
- Make the food attractive by varying color,
shape, and size Nurse’s role in nutritional counselling

Poor digestion leading to constipation, gas pains, or ◼ Establish rapport

diarrhea ◼ Identify nutrition problems
◼ Collect pertinent information concerning
- Include fruits and vegetables in your daily
influences o food habits and patterns
meals to prevent constipations
◼ Take nutritional history
- Have 4 light meals. Eat the heaviest meal at
◼ Evaluate nutritional intake based on
noon
standard of nutrition
- Drink 6 to 8 glasses of water and fruit juices
◼ Plan follow-up visits for continued
everyday
support, education, and encouragement
- Help digestion and keep normal flow of body
◼ Use available resource persons and
fluids
materials.
- If with diarrhea – eat crackers, banana, lugaw
or toast.

Difficulty in sleeping Economic considerations in Food Planning

- Drink warm milk just before going to bed to - Plan menus and market lists in advance
assure a restful night - Select most economic market
- Avoid tea or coffee late in the day if any of - Take advantage of food discounts/bargains
these affect your sleep. - Purchase foods in season
- Purchase food sizes and amounts in grades
most suitable
Common Disorders - Compare prices according to method of

- Arthritis preserving freshness, edible portion, etc.

- Osteoporosis - Compare nutritive return in relation to cost.

- Sarcopenia
- Cancer
NUTRITION IN WEIGHT MANAGEMENT
◼ Carotene
Learning objectives:
 6. At the end of the discussion, the students will 8. A BMI between 25 and 30 indicates
be able to: overweight, whereas a BMI over 30 indicates
1. Be more aware on weight management obesity.
2. Maintaining ideal body weight
Distribution of Fat
3. Importance of high fiber and fluids in our diet
4. Grocery planning, selection and management 9. Another indicator of possible health
problems.
10. Fat in the abdominal cavity (visceral fat) has
Definition: been shown to be associated with greater risk
for hypertension; coronary heart disease; type
Normal Weight: can mean average, desired or
2 diabetes; and certain types of cancer than
standard which is a appropriate for the maintenance
has fat in the thigh, buttocks, and hip area. A
of good health for a particular individual at a
pear-shaped body has a lower risk for disease
particular time.
than does the apple-shaped body.
Overweight: defined as weight 10% to 20% above
Body weight – is composed of fluids, organs, fat.
average. Obesity can be defined as excessive body
Muscles, and bones, so large variation exists among
fat, with weight 20% above average.
people.
Underweight: is defined as weight 10% to 15%
In addition to height, one needs to consider age,
below average.
physical condition, heredity, gender, and general
frame size (small, medium, or large) in determining

The Rule of Thumb Method: desired weight.

A. Males assume 106 pounds for the first For example: a 6-foot 2-inch man: with a 44-inch

5 feet (60 inches) and add 6 pounds for each chest, 36-inch-long arms, and 81 2/inch wrists

inch over 60. Will weigh more than

B. Females assume 100 pounds for the
A 6-foot 2-inch man with a 40-inch chest, 35-inch-
first 5 feet (60 inches) and add 5 pounds for
long arms, and 71 2/inch wrists because he has more
each inch over 60.
body tissue.
C. Large-boned individuals of both
sexes increase the first sum by 10%. “Nutrition is probably the single most important
D. Small-boned individuals of both factor in weight loss management and health
sexes decrease the first sum by 10%. maintenance. Most of us love to eat, and in our
convenience-filled world, we have no lack of
Body Mass Index
choices.”
The medical standard used to defined obesity
“Sometimes, when trying to think about healthy
It is used to determine whether a person is at eating, it helps to think about the environment in
health risk from excess weight. which our bodies were originally intended to live.”

The BMI is obtained by dividing weight in “Just in case our bodies weren’t able to use the
kilograms by height in meters squared. energy e take in each through food, we came

7. Fewer health risks are associated with a BMI equipped with a wonderful energy storage system

below that range. called fat.”

“Some body fat is essential for keeping us healthy, so with age. Consequently, weight accumulates
no one should be striving for 0 percent body fat, but unless calorie intake is reduced.
most of us retain a few more layers than we need.”
Two Popular Theories about weight loss
“All healthy weight loss comes from a calorie deficit,
1. Fat Cell Theory
or burning more energy from food than you take in.
2. Set-Point Theory
It takes a deficit of 3500 calorie deficit of 500
calories per day, and over the course of a week, they Fat-cell theory

can easily lose a pound.” • According to the fat cell theory, obesity

“In nutrition, as with many parts of life, baby steps develops when the size of fat cells increased.

are easier to adjust to than enormous, large-scale life When their size decreases, as during a

changes.” reducing diet, the individual is driven to eat

in order for the fat cells to regain their former
Overweight and Obesity
size. Therefore, it is difficult to lose weight
11. Obesity and overweight have become and keep it off.
epidemic
Set-Point Theory
12. 64% of Americans are overweight or obese
13. Overweight puts extra strain on the heart, • According to the set-point theory, everyone
lungs, muscles, bones, and joints, and it has a set point or natural weight at which the
increases the susceptibility to diabetes body is so comfortable that it does not allow
mellitus and hypertension. It increases for deviation. This is said to be the reason
surgical risks, shortens the life span, causes why some people cannot lose weight below a
psychosocial problems, and is associated “set-point” or why, is they do they quickly
with heart disease and some forms of cancer. regain to that “set point”. The only way to
lower a set point is through exercising three
Cause of Obesity
to five times a week.
There is no cause for excess weight:
Dietary Treatment of Overweight and Obesity
• Poor diet
Obviously, is a significant cause of
• Inactivity appear
overweight is overeating, the solution is to reduce
• Genetic
portion size and calorie intake. This is seldom easy.
• Physiological
To accomplish it, one must undertake a weight
• Metabolic reduction (low-calorie diet. For the diet to be
• Biochemical effective, one must have a genuine desire to lose
• Psychological weight.

Understanding where you are

H. Energy imbalance is a significant One of the best ways to start a weight loss
cause of overweight. plan is to get an accurate idea of where you are now.
I. People eat more than they need. Look at what you’re doing and eating as compared to
J. Excess weight can accumulate during some basic guidelines.
and after middle age because people reduce
their level of activity and metabolism slows
“Keeping a food journal for a few days or a week, in ● Fluids- drink less caloric fluid like water, and
which you write down everything you eat. You can also essential for all the functions of life.
use online calculators and nutritional labels on foods ● Make a grocery list- to prevent impulse
to get an accurate idea of calories in the food you buying of unhealthy products and also helps
eat.” save money.
● Eating in- gives control of what you eat and
Remember, if you eat 250 calories less and spend 250
is less expensive.
calories more in the form of exercise, you will loss a
● Dump the junk food
pound a week. After a few weeks, then you can find
● Go meatless a few night a week- helps
another high-calorie favorite that you can exchange
lighten budget and diet
painlessly for a healthier alternative.
● Keep healthy snacks at hand.
Food journals are wonderful tools, but only if you are
willing to use them to make real changes. In order to
EATING DISORDERS
do that, once you have tracked all the food you’ve
eaten for a few days, take a serious look at your - A range of psychological conditions that
journal, and at the calorie and fat counts. cause unhealthy eating habits to develop.
They might start with an obsession with food,
Handling Hunger
body weight or body shape.
• One of the reasons a lot of people cringe at - A mental health condition marked by an
the word “diet” is the idea of feeling hungry obsession with food or body shape.
and grumpy all the time. Starving yourself is - Can cause serious consequences and may
absolutely the wrong way to go. The even lead to death if left untreated.
importance of not skipping meals. “Make - Symptoms include severe restrictions of
sure you’re eating at least three meals a day, food, food bingers, or purging behavior like
if not more often.” vomiting or over exercising.
• Eat your vegetable, and breakfast is the most - Most often reported in adolescents and young
important meal of the day. If you are one of women.
those people who often feels hungrier on days
you do eat breakfast, consider trying a
CAUSES OF EATING DISORDERS
breakfast with more protein and whole
grains. ● Genetics
• Simple carbohydrates like those in a plain ● Personality traits like neuroticism,
white bagel or sugary cereal will burn off perfectionism, impulsivity
quickly but an egg-white omelet, or bowl of ● Differences in brain structure and biology
oatmeal with bananas and a tablespoon of ● Cultural ideals
chopped almonds, will take longer to digest
• Some can be dangerous if you do have certain
medical conditions. For example, some of the
6 COMMON EATING DISORDERS
fasting diets and fluid diets can be dangerous
for people with diabetes or a blood sugar
control issue.
1. ANOREXIA NERVOSA
- Being considerably underweight compares - Feels distress, shame and guilt when thinking
with people of similar age and weight. about the binge eating behavior.
- Very restrictive eating pattern - Often overweight or obese. Increased risk of
- Intense fear of gaining weight or persistent heart disease, type 2 diabetes, stroke.
behaviors to avoid gaining weight, despite - Begins during adolescence and early
being underweight adulthood.
- Relentless pursuit of thinness and
unwillingness to maintain a healthy weight
4. PICA
- Distorted body image, including denial of
- Eating things that are not considered foods.
being seriously underweight.
(craves non-food substance)
- Can result in heart, brain, or multi-organ
- To be considered pica, eating non-food
failure and death.
substances must not be a normal part of
someone’s culture or religion and must not be
2. BULIMIA NERVOSA considered a socially acceptable practice by a
- Eats unusually large amounts of food in a person’s peers.
specific period of time - Increased risk of poisoning, infections, gut
- Each binge episode usually continues until injuries and nutritional deficiencies.
the person becomes painfully full.Feels like Depending on the substance ingested, it may
they cannot stop eating or control how much be fatal.
they eat. - Observed with children, pregnant women,
- Purging behavior includes forced vomiting, and persons with mental disabilities.
fasting, laxatives, diuretics, enemas and
excessive exercise
5. RUMINATION DISORDER
- They usually maintain a relatively normal
- Person regurgitates food they have
weight, rather than being underweight.
previously chewed and swallowed, re-chews
- Can cause an imbalance in electrolytes, such
it and either re-swallows it or spits it out.
as sodium, potassium, and calcium. May
- Happens within the first 30 mins of after the
cause stroke and heart attack.
meal and fully voluntary.
- Develops during adolescence and early
- May develop during infancy (3-12 months
adulthood and is more common among
and then disappears on its own), childhood,
women.
or adulthood.

3. BINGE EATING DISORDER

6. AVOIDANT/ RESTRICTIVE FOOD
- They do not restrict calories or use purging
INTAKE DISORDER (ARFID)
behaviors.
- Replaced what was known as a “feeding
- Eating large amounts of foods rapidly, in
disorder of infancy and early childhood” a
secret and until uncomfortably full, despite
diagnosis previously reserved for children
not feeling hungry
uner 7 years old
- Lack of control during episodes of binge
- Experience disturbed eating either due to a
eating.
lack of interest in eating or distaste for
 certain smells, taste, colors, textures or sedentary lifestyle, some of us may need energy that
temperature. the standard energy requirement charts recommend.
- Weight loss and poor development for age In contrast, the series competitive athlete’s energy in
and height. intake must support a training and competition
- Nutrient deficiencies or dependence on schedule that allows the athlete to achieve his or her
supplements or tube feeding. personal best.

Individuals who are acutely ill or hospitalized or

OTHER EATING DISORDER adapting to chronic disorders may require energy
intake levels specifically calculated to meet their
changing physiological needs.
PURGING DISORDER
Components of total energy expenditure: –
- Often use purging behaviors, such as
vomiting,laxative, diuretics or excessive - Basal metabolism;
exercising, to control their weight or shape, - Physical activity;
however they DO NOT BINGE. - Thermic effect of food;
- Adaptive thermogenesis.

NIGHT EATING SYNDROME

Basal metabolism Rate (BMR) represents the
- Frequently eat excessively, often after amount of energy required to maintain life-sustaining
awakening from sleep. activities, for example breathing, circulation,
OTHER SPECIFIED FEEDING OR EATING heartbeat, secretion of hormones for a specific
DISORDER (OSFED) period. Several factors affect BMR, including age,
body size, body temperature, fasting/starvation,
- Includes any other conditions that have
stress, menstruation, and function. BMR varies with
symptoms similar to those of an eating
the amount of lean tissue in the body higher; levels
disorder but don’t fit into any of the
of lean body mass increase BMR. For example, men
categories above.
have higher BMRs than women because of larger
- ORTHOREXIA- obsessive focus on healthy
body size and more lean body tissue.
eating, to an extent that disrupts their daily
lives. The BMR of adults slowly lowers after age of 35
- because of decreases in lean body tissues associated
with aging. As a physically fit person ages, the BMR
NUTRITION FOR HEALTH AND FITNESS
may not slow down as much as that person was
C. Nutrition exercise and sports physically unfit.

D. Nutrition and bone health PHYSICAL ACIVITY

E. Nutrition for oral and dental health

The second largest component of energy expenditure
after REE is physical activity

Nutrition exercise and sports Physical activity is any body movement produced by
skeletal muscles that results in energy expenditure. It
To maintain a healthy weight, or energy
demands about 20% to 30% of our total energy
intake should equal energy expended. Because of our
needs. Of all of the components, it varies the most - Flexibility is the ability to full extent without
among people. injury.
- Muscular strength endurance describes the
The amount of energy we expand depends on the
ability of the muscles to perform hard or
intensity and duration of the activity.
prolong work.

Thus, even moderate activity can become high - Cardiovascular endurance is the ability of

energy if it is carried on for a long time. the body to take in, deliver, and use oxygen
for physical work..
Body size of expenditure more than any other single
factor. A heavier person uses more energy to perform Adult (aged 18 to 64)

a given task than a lighter person.

Moderate intensity aerobic activity: two
THERMIC EFFECT OF FOOD hours and 30 minutes a week, or vigorous intensity
or aerobic one hour and 15 minutes a week or
The third component of energy output is the energy equivalent combination of moderate and vigorous-
required for our body to digest, absorb, metabolize, intensity aerobic physical activity. Complete in
and store food. When we eat, the body‘s cells intervals of at least 10 minutes, best distributed over
increase their activities. This increases the cellular the week.
activity is called the thermic effect of food or diet
induced or thermogenesis. The Thermic effect of Additional health benefits: Moderate intensity

food is relatively small, accounting for aerobic physical activity increased to five hours a

approximately 7% to 10% of a person’s total energy week or two hours and 30 minutes of vigorous-

needs. intensity physical or equivalent combination of both.

ADAPTIVE THERMOGENESIS Muscle strengthening activities: two or more days a

week all major muscle groups.
Is the energy used by our bodies to adjust to changing
physical and biologic environmental situations. This Older adults (aged 65 and older)

includes energy used to adapt coldness, extreme

● Follow adult guidelines: if movement is
changes in calorie intake of several days duration,
limited due to chronic conditions, adults can
and physical and emotional trauma.
be as physically active as possible;

This category of energy need incorporate the ● Avoid an activity;

additional demands caused by illness in the presence ● Focus on activities that sustain or increase

of recovery. Because the expenditure depends on balance.

individualized variables, it is not calculated in the

Sedentary individuals
average energy requirement.
- Generally, sedentary people can do little
FITNESS
activity without early onset of fatigue or

Physical fitness consists of three major components: discomfort.

flexibility, muscular strength and endurance, and

Moderately Active individuals
cardiovascular endurance.
- are those people who can participate in 30
minutes of physical activity with minimal
 fatigue. They are generally interested in exercise intensity. Depending on the
improving cardiovascular health; however, frequency and intensity of exercise, levels of
many of these may wish to decrease body fat indications may need adjustment.
or increase muscle mass.
STRENGTH TRAINING
Vigorously active individuals
Strength training has become a popular way to stay
Generally includes recreational athletes, in shape. It is an integral part of an overall exercise
competitive athletes, an elite and olympic-level. program. Strength training involves lifting various
These individuals not only want to develop types of weights to build muscle strength and
cardiovascular fitness but also look to enhance their endurance. It may differ from weightlifting.
performance and move to the next level in your
With different training, improvement is gauged by
sports.
increased muscle mass. In contrast, weightlifting
Special populations may be a competitive sport in which individuals lift
weights in specific body weight divisions.
Adults with physical disabilities can follow the adult
guidelines. If necessary, activity can be adopted. BODYBUILDING
Inactivity should be avoided.
In recent years there has been an increase in interest
and participation in bodybuilding.

- Pregnant woman and those individuals with Bodybuilders work to develop muscle mass,
physical disabilities or health problems such strength, and muscle definition through a
as diabetes, hypertension, or cardiovascular combination of diet, weight training, and aerobic
disease can follow the same principles of exercise.
prescribing intensity with the pew adaptation:
Unlike weightlifting and other traditional sports that
- The more severe the condition to lower the
involve strength, bodybuilders exercise to improve
intensity of exercise.
their physique as a form of athletic performance.
- Women who are healthy during pregnancy
and postpartum can do moderate intensity FOOD AND ATHLETIC
aerobic activity for at least two hours and 30
Food and athletic performance physical activity in
minutes a week. Those with that in
attrition have been associated with health since the
established vigorous-intensity aerobic
time of ancient Greece
activity can continue as long as their
conditions remain consistent.
All parts of the body which have a function, if used
- Activity levels should be discussed with the
in moderate exercise and laborers in which each is
healthcare providers. Pregnant women
accustomed, become thereby healthy, well
should not participate in high intensity
developed, and H more slowly, but if a news and let
exercise after their first trimester because of
you know they become liable to disease, defective
the increase in body temperature.
in growth and age quickly.
- Individuals who have diabetes or
hypertension need to be more aware of their
A diet that provides a variety of food supply in 45%
conditions and carefully monitor their
to 65% of kilocalorie intake from carbohydrates;
20% to 35% of kilocalorie intake from fat; and 10% When the water loss via sweat is not replaced, blood
to 35% of 0 cal intake from protein is recommended volume Falls and body temperature rises, causing
for health and performance. confusion and loss of coordination. To replace the
lost water, athletes must give you extra fluids.
However, some forms of training increase the
requirement for certain nutrients. For example, The following guidelines by the American College
carbohydrates are important source of energy during of sports medicine ensures adequate fluid
insurance exercise, and therefore runners, cyclist, replacement, leading to optimal performance.
and swimmers may need more carbohydrates (60%
to 70% of their total calorie intake) than other
individuals • Eat a nutritionally balanced diet and drink
adequate fluids during the 24 hour period
Kilo calorie requirements before an event.
• Could see you in 2 cups (16 on sis) fluid two
Some sports demand high energy expenditure, hours before exercise, followed by another 2
whereas others do not. Ask you to decrease calorie cups 15 to 20 minutes before exercise and 4
intake, so does nutrient intake. to 6 ounces of fluids every 10 to 15 minutes
during exercise.
A minimum requirement for college athletes is 1800
to 2000 kg calories a day. Eating less than this
amount can leave the athlete feeling weak and • Drink cool beverages to reduce body core
listless and may lead to iron deficiency, stress temperature. Cool Debridge are best for
fractures, and, for women, amenorrhea (lack of activities lasting less than one hour.
menstruation) and osteoporosis. •

• Consume sports drinks to enhance fluid

Water intake and absorption and help delay fatigue
and endurance events lasting longer than one
The essential ingredient water is the nutrient most hour.
critical to athletic performance. Without adequate • After exercise, consume sports drinks to
water, performance can suffer in less than an hour. enhance palatability and further promote
Water is necessary for the body's cooling system. It fluid replacement.
also transports nutrients throughout the tissues and
maintains adequate blood volume. Sport drinks athletes often wonder which is better
for replacing fluids during exercise Dash water or
During exercise there is always the risk of sports drinks. The number one goal is to remain
becoming dehydrated (fluid volume deficit), well hydrated. Whether the athlete drinks water or a
especially when the temperature is hot. Although sports drink is his or her choice. Cool water is what
sweat rates vary among people, losing as little as the body really needs during activities lasting less
2% to 3% of eight via sweat can impair than one hour. However, athletes participating in
performance. endurance events requiring more than 90 minutes of
continuous moderate to have the exercise, such as
distance for a name or cycling, may benefit from
sports drinks that contain carbohydrates and You may hear of other nutrients when it comes to
electrolyte (sodium and potassium). bone health, like boron, copper and silicon. These
nutrients are found in many foods and are only
A major consideration and fluid replacement is how needed in trace amounts. Deficiency rarely occurs
quickly the fluid empties from the stomach. To unless you have intestinal absorption problem
hydrate the total body, the fluid needs to leave the
stomach quickly to be distributed throughout the People who might need supplements
body. Although larger volumes of fluid empty more
rapidly from the stomach, many athletes cannot Supplements are not designed to replace food. If
exercise with a full stomach. you had intestinal bypass surgery or have other
malabsorption problems like celiac or Crohn's
Cool fluids empty faster from the stomach then disease, your healthcare provider will likely suggest
warm fluids kilocalorie content is also important. supplements to stay healthy.
The greater the kilo calorie content of the beverage,
the slower the emptying rate. Ask your healthcare provider, you should have the
test to see whether you need a vitamin D
Nutrition and bone health supplement. If you cannot tolerate any dairy
products, you may need a calcium supplement.
Calcium, vitamin D and magnesium help nutrients
that require special attention to ensure that you meet Nutrition for oral and dental health
your daily requirement.
The health concerns regarding sugar consumption
There are food sources of vitamin D, but it is include nutrient replacement, dental caries, and the
difficult to get adequate amounts from food alone; related issues of obesity and diabetes.
therefore, many people benefit from a supplement.
People who consume even a moderate amount of Cariogenic are foods are substances that cause tooth
alcohol or use proton pump inhibitors may have decay.
increased loss of magnesium in the urine and may
benefit from the supplement (approximately 200 to Ways to decrease the development of caries are to
250 mg per day). With magnesium is found in many eat sweets at the end of meals – rather than between
foods meals – and to monitor the quantity and frequency
of sugar intake. Sticky, sugary foods are more
Nutrients needed for bone health based on good cariogenic than sweet liquid’s. Optimal dental
evidence hygiene reduce his plaque formation and promoted
dental health
In healthy adults, nutrients can be readily found in a
balanced diet; rarely would a supplement be Sugar alcohols have several advantages when
required – unless directed by your healthcare replacing sugar. They are Less cariogenic than
provider. sucrose. In contrast to carbohydrates sugars, sugar
alcohols did not encourage the growth of bacteria in
Nutrients rarely causing bone health problems the mouth that leads to tooth decay.
In fact, xylitol may actually prevent cavities with prescription or over-the-counter drugs. Some
formation and be protective when used in chewing food can also interact negatively with prescription
gum. drugs.

Risk factors Restrictive diet/allergies

There are a number of factors that could put Those with food allergies or on restrictive diets, for
individuals at risk for poor oral and overall health example gluten free, as well as vegetarians,
such as an unhealthy diet, age, medications, particularly vegans may experience vitamins and
allergies, restrictive diet, chronic disease, lack of protein deficiency. This could put them at greater
vitamins (supplements), as well as social economic risk for tooth decay and gum disease. Choosing the
conditions. right foods and quantities can supply the nutrients
they need. Taking a multivitamin daily is also
Children and teens recommended.

Children need a balanced nutritious diet so that their Prevention and home care
teeth develop properly and are strong and decay
resistant. Eating patterns and food choices are
important factors that affect how quickly tooth • Limit consumption of food and beverage
decay develops and could put them at risk for that contribute to poor oral health
serious ailments, such as diabetes and also due • Eating sweets at meal time, not as a snack,
process, later in life. because they increase flow of saliva during a
meal protects the teeth by washing and
The elderly diluting sugar.
• If the sugar is the first ingredient listed on
Often the elderly are at higher risk for poor the product label, did the food has high
nutrition. Those on restrictive diets or undergoing sugar content. Look for other sugars on the
medical treatment may be too isolated, weak or lack labels: corn syrup, porn sweetener, dextrose,
the appetite, time, resources or money to eat fructose, glucose, honey, maple syrup,
attritional balanced meals. This could result in tooth Molasses and sucrose.
loss, gum disease, pain or a joint dysfunction such • Check to see if liquid medicines (such as
as temporomandibular joint (TMJ) disorder, which cough syrup) contain sugar. As a physician
can impair an individual‘s ability to taste, bite to eat or a pharmacist for sugar free medicine.
and swallow food. • Drink water between meals.
• Prepare food in healthy ways, such as
Medication stained, sautéed, poached or baked. Avoid
fried food and limit salt intake.
Some medications can cause dry mouth, making it • Maintain proper oral hygiene. Brush twice a
difficult to chew and swallow food. This can result day for two minutes with fluoridated
in poor nutritional state that could have a negative toothpaste and a soft toothbrush; Clean or
impact on oral health. Many herbal supplements floss between teeth and gums once a day;
contain active ingredients that may not safely mix clean or scrape the tongue daily.
 - Of great importance in a therapeutic sense.
Food/beverages that contribute to poor oral With satisfactory food intake, the body
health tissues are continuously maintained and there
is opportunity for repair from effects of
illness.
• Practice moderation when consuming the
following:
General diet may be modified for:
• chewy, sticky foods – raisins, granular bars,
jellybeans, Caramel and honey stick to teeth. • Consistency and texture

• Sugary snacks – candy, regular gum, • Flavor

cookies, cakes or other sweet treats contain a • Energy value
high amount of gravity – causing sugar. • Nutrient level such as fats, protein,
carbohydrates, sodium and other.
• Food categories such as types of fats or
• Carbonated soft drinks – regular pop elimination diet for allergens.
contains a high amount of sugar. Both • In modifying diets, the general diet should be
regular and diet pop also contain acids that used as the frame of reference.
wear away tooth enamel. • Aim should always be to keep as many
characteristics of the general/ normal diet as
possible.
• Fruit drinks – these tend to be high in sugar
and acid that can damage both tooth enamel
GOOD TRAY SERVICE
and lead to decay.
- Portions of food suitable for the patient’s
appetite

• Sports/Energy drinks – These drinks are - Food attractively arranged with appropriate

acidic and high in sugar. garnishes, meals served in time, hot food are

• Acidic food and beverage – acids that cause served on warm plate and kept warm ; cold

dental erosion our friend and you were food foods served on chilled dishes.

and drinks such as fruit juices, ice tea, - Trays promptly served to the patient so that

lemons, Pickles, salad dressing and wine. food is at its best.

PROPER FOOD PREPARATION AND

SERVING CONSIDERATION
GENERAL DIET AND ITS MODIFICATIONS
1. Hand hygiene
2. PPE
General diet 3. Use of clean water and materials
4. Prevention and control of vectors
- Sometimes called regular, normal, house diet,
5. Prevention of hazards in cooking
healthy diet.
6. Proper food testing and eating etiquette
- A diet that includes variety of healthy foods
from all the food groups
IMPROVING APPETITE - Ensure not to compromise a balanced diet
while following a low calorie diet.
1. Provide familiar food that the client likes
- Purpose is for weight loss, especially for
2. Select small portions so as not to discouraged
people with diabetes who are overweight.
anorexic clients
- Low calorie diet kcal range is 800 kcal (very
3. Avoid unpleasant or uncomfortable
low calorie diet) up to 1,500 kcal.
treatments immediately before or after meal.
4. Provide a tidy, clean environment which is
free from unpleasant sight and odors Examples: low fat milk, all fresh or frozen
5. Oral hygiene before meal time vegetables, fresh or frozen fruit with no sugar added,
6. Relieve illness which depress the appetite whole wheat products, pasta , brown rice, boneless
7. Reduce psychologic stress. chicken, fish, shellfish, tea or coffee
8. If client cannot see, tell the client which food
is being given or identify the placement of the
food as you would describe the clock HIGH CALORIE DIET

9. Do not rush the client in chewing and eating - Usually composed of food high in CHON,
10. Offer liquids after every 3-4 mouthfuls of CHO, fat, vitamins and minerals.
solid food, using straw for clients who have - Calorie could amount to 4000 to 5000
difficulty in drinking or holding a glass. calories per day.
- Purpose: for people who likes to gain weight

MODIFIED CONSISTENCY or stop losing weight, do not feel hungry,

have higher need for calories such as burn
- Foods have been altered physically altered.
patients or patients with infection.
- Pureed- food prepared by straining or
blending and is usually a modification of the
soft diet. EXAMPLE: cheese, whole milk, whipped cream,

- Mashed- crushed food usually after cooking. milkshakes, butter, margarine, ice cream, cake,

- Grounded- to break or grind something into gravy, salad dressings, mayonnaise, mashed

small pieces or particles potatoes.

- Sauteed- To fry quickly in fat using a

shallow open pan.
HIGH PROTEIN DIET

- Purpose:may help with weight loss by

making one feel fuller.
LOW CALORIE DIET - High CHON diet with carbohydrate

- Also referred to as calorie-restricted diet or restriction can be harmful to health

weight loss diet. - High protein foods like red meat may

- It can be many different diets like low fat or increase risk for heart disease.

low carb diet as long as it meets the calorie - High CHON diet may worsen kidney

criteria function in people with kidney disease.

- Not designed to achieve rapid weight loss but EXAMPLE: soy beans, nuts, fish, skinless poultry,

to achieve success over a long period of time. lean beef, pork, low-fat dairy, eggs, oats, jackfruit,
prunes, broccoli
 ● Brains, kidney, liver
● Mackerel
LOW PROTEIN DIET
● Meat extracts/ gravy
- Purpose: for people with inherited metabolic ● Sardines
disorders, for people with kidney and liver ● Scallops
disease ( to reduce workload)
EXAMPLE: apples, bananas, pears, peaches, berries,
GLUTEN FREE DIET
tomatoes, asparagus, peppers, broccoli, leafy greens,
rice, oats, bread, pasta, barley - Currently the only treatment for people with
celiac disease (a serious autoimmune
disorder that can occur in generally
PURINE predisposed people where the ingestion of

- Substances naturally found in the body and in gluten leads to damage in the small intestine)

food. - this is also a diet fit for people living with

- When the body breaks down purines, uric non-celiac gluten sensitivity

acid is formed. - Good for some people with IBS, wheat

- High purines results to high uric acid which allergy, schizophrenia, autism, anad a disease

then causes gout and uric acid kidney stones. called gluten ataxis

UNRESTRICTED (0-15mg Purines/100g of: Gluten- A family of protein present in the

endosperm of cereal grains like wheat, rye
● Coffee, tea and sodas
and barley.
● Breads and cereals ( but if its whole wheat,
use in moderation) - When flour is mixed with water,

● Cheese, fats gluten proteins form a sticky network

● eggs (not more than 3x/ week) that has a do like consistency thus the

● Fruit and fruit juices name glu-ten

- All grains are considered high risk for
cross contact are considered high r
ALLOWED IN MODERATE AMOUNTS (50-
are considered high risk for cross
150mg Purines/100g of:
contact because they are often grown,
● Asparagus milled and manufactured near gluten-
● Cauliflower containing grains
● Dried beans EXAMPLE: fruits, vegetables, meats, poultry, fish
● Eel and seafood, bans, legumes, nuts, tubers, most dairy
● Fish (fresh and saltwater) products.
● Beef, pork, lamb, veal
● Mushrooms
● Oatmeal GLUTEN ALTERNATIVES- brown, white and wild
rice, coconut flour, corn, cornstarch, potato flour,
sorghum, millet, quinoa
RESTRICTIONS (150-825 Purines/100g of:

● Anchovies
LOW FAT DIET - Orogastric tube-Thin, soft tube passes thru a
client’s mouth, thru the Oropharynx →
- Less than a third (30%) or one-fifth (20%) or esophagus→ stomach
one-tenth (10%) of energy or calories comes - Nasogastric tube-thin, soft tube passes thru
the nose, down the back of throat, thru the
from fat.
esophagus→stomach
- Indicated for people with gallbladder disease,
diarrhea, hypertension, also for heart disease
prevention.
Though the quality of fat in the diet is important, for
this specific diet order, the most important thing is
the TOTAL AMOUNT OF FAT IN DIET.

TUBE FEEDING
In this chapter you will learn:

• Tube feedings indication, method,

contraindications, and complications
• Types of formulas used for tube feedings

➢ Enteral feeding- is a method of supplying

nutrients directly into the GIT
➢ Enteral Feeding tubes-nourish patients
Gastrostomy tube-inserted surgically or by means of
who are unable to feed themselves by means
endoscopy thru the abdominal wall→ stomach
of inserting tubes which ends directly at
(Note: G tube or temporary balloon devise is the
specific GIT sites
tube used for this) variations of gastrostomy tube:
➢ Feeds can be administered using syringe
(asepto-syringe or enteral syringes), gravity 1. Percutaneous endoscopic gastrostomy tube (PEG)
feeding set and feeding pumps - a gastrostomy tube which is held in place with an
internal fixator

ENTERAL FEEDING TUBES CAN BE USED

TO:
➢ Administer bolus, intermittent feeds and
continuous feeds
➢ Medication administration
➢ Facilitate free drainage and aspiration of the 2. Gastrostomy-Button (Mickey Button) – skin level
stomach contents button gastrostomy tube inserted into a pre-formed
➢ Facilitate venting/decompression of the stomach
stomach
➢ Stent the esophagus
BOLUS
 o Relies on gravitational pull only for neonates (NOTE: IF THE CHILD
o Use 50 ml syringe (with or without plunger) BELCHES IMMEDIATELY FOLLOWING
o Feed over 15-60 minutes (for feeds which is AIR INSUFFLATION, THE TIP OF THE
250-400ml or depending on institutions TUBE COULD BE IN THE
protocol) ESOPHAGUS).
✓ Flush the tube with water before and after
DISADVANTAGES:
feeding (for children 0.5-2ml, depending on
1. Bloating and diarrhea fluid restriction)
✓ When using pH to check placement of tube,
2. “Dumping” type syndrome- rapid gastric
note that pH of gastric acid is less than 3,
emptying (food moves too quickly from the
whereas bronchial secretions have a pH of
stomach to the duodenum) which results to a group
greater than 6-NEVER USE THIS TEST IF
of sx like diarrhea, nausea and light headedness or
PATIENT HAS MEDS WHICH
tiredness after a meal.
CONTROLS GASTRIC ACID
CONTINUOUS INFUSION ✓ Sitting position is preferred for bolus
feeding or continuous feeding, if not, use
o May help with diarrhea and prevent
30-45 degrees elevation of the HOB
dumping syndrome in some patients but it
✓ Keep clients HOB elevated for at least 30
results to higher intragastric pH level than
minutes after feeding
bolus which promotes bacterial growth
✓ Administer feed slowly to prevent
o Commonly used for very ill clients
abdominal cramping
o Consists of the total volume of feed
administered over 24-hours
o May be done with or without pump but it’s
CONTRAINDICATIONS FOR NG AND OG
better to administer it via pump
FEEDING
INTERMITTENT INFUSION
➢ Intestinal obstruction
o Will consist of 6 bolus feeds (one bolus ➢ Paralytic ileus
every four hours) ➢ Diffuse peritonitis
o May be done with or without pump (via ➢ Intractable vomiting
gravity) ➢ Severe diarrhea
o Provides moderate rates of feed ➢ Severe malabsorption
➢ Short bowel syndrome
PROTOCOL IN OGT/NGT FEEDING:
➢ Basal skull fractures
✓ Prior to each feed
COMPLICATIONS FOR NGT AND OGT
✓ Before each meds
✓ Before putting ANYTHING to the tube ➢ Discomfort
✓ After the client has vomited ➢ Traumatic injuries
✓ Every 4 hours if the patient is receiving ➢ Reflux
continuous feeds ➢ Inhalation problems
✓ Observe taping of NGT
PROTOCOL IN GASTROSTOMY TUBE
✓ Observe and document position marker of
FEEDING
NGT and OGT
✓ Observe for any signs of distress ▪ Prior to GT insertion, patient is at least 6
✓ WARNING: patients with history of liver hours NPO
failure and or suspected of having ▪ Check insertion site and assess for
esophageal varices should not have their abdominal pain or any discomfort
gastric aspirate removed from the OGT or ▪ If in doubt of the tubes position, refer to
NGT doctor
✓ For children, use a 10-20ml oral or enteral ▪ Check position of the tube before feeding:
syringe. taping, marker on the tubing
✓ For neonate, use a 5-10ml oral or enteral ▪ Flush the tube with 5-20ml water depending
syringe. on the viscosity of feeds or medications (2-
✓ For instilling air during checking of air, 1.5ml for children)
insufflate 1-5ml of air for child and 1-2 ml
 ▪ Continuous feeds should NOT be warmed.
Bring it out from the fridge 15-20 minutes
Prior to administration and hung/give for no
more than 4 hours to prevent spoilage
▪ Cleanse the site (5-14 days) with sterile
water and dress with dry dressing.
Subsequently, the site can be washed daily
with soap and water (no dressing is
necessary if the site is not draining heavily)
▪ Feeds should not be warmed in a microwave
or on jugs of boiling water
• Choice of feeds will depend on patients
▪ For gravity feeding, prime the tube as you
nutritional requirement, presence of any
would prime an IV set and hang the
abnormality in absorption, motility or
container in place. Count the drops per
diarrheal loss, liver and renal failure
minute (as a guide, 20 drops of feed is
• Most commercial fees contain 1 kcal/ml
approximately 1ml) per institutions policy.
with higher energy versions containing 1.5
For gravity feeding, you can use:
kcal/ml (available in fibre free and fibre
▪ (ml/hr)/3=drops per minute
enriched forms)
▪ for neonates, prime the giving set with feeds
immediately prior to feeding time • Producing feeds locally by using liquidizer
is not recommended due to high infective
risks and potentially poor nutritional quality
Contraindications for gastrostomy tube feeding
TYPE OF FORMULAS FOR TUBE FEEDING *Same with NGT and OGT except for basal skull
fractures +
1. Patient is unfit for surgery or endoscopy
2. Current chest infection
3. Ascites
4. Portal hypertension with gastric varices
5. Active gastric ulcer
6. Total gastrectomy
7. Blood clotting dysfunction
DIETAY COMPUATIONS