MNT-Notes Pt. 2
MNT-Notes Pt. 2
MNT-Notes Pt. 2
Diet Therapy - Branch of dietetics that is concerned with the use of food for therapeutic
purposes. It is also the modification of the normal diet to meet the physiological requirements of
the sick individual.
Nutrition Therapy - This refers to interventions used in the treatment of a disorder or illness and
includes diet therapy, nutrition counseling and/or the use specialized nutrition therapies.
Clinical Nutrition - Branch of health science having to do with the diagnosis, treatment, and
prevention of human disease caused by deficiency, excess or metabolic imbalance of dietary
nutrients.
Health - A state of complete, physical, mental, and social well-being and not merely the absence
of disease and infirmity.
Illness - Deviation of bodily functions from the normal or usual well-feeling and its perception is
both physiological and psychological
Diet History - A record of the usual day-to-day food intake of an individual . It is part of the
nutritional history and can be taken by means of recall or food records.
Nutritional Status - The condition of the body resulting from the utilization of the essential
nutrients available to the body.
NOTE:
Infant’s weight:
Doubles at 5 to 6 months
Triples at 12 months
Quadruples at 24 months
Infant’s height:
Increases by 24, 12, and 8 cm during the first, second, and third year of life, respectively,
then by 4 cm every year thereafter up to the eighth year.
TER of Infants
0-6 months: TER/day = 95 kcal/kg DBW
7-12 months: TER/day = 80 kcal/kg DBW
DBW of Children
DBW (Kg) = (no. of years x 2) + 8
TER of Children
Children (1-12 yrs old): TER/day = 1000 + (100 x age in years)
DBW of Adolescents
Tannhauser Method
Hamwi Method
TER of Adolescents
2002 RENI
Age Range Kcal/KDBW
13-15 55 (Boys)
45 (Girls)
16-18 50 (boys)
40 (girls)
DBW of Adults
Tannhauser’s Method
DBW = (height in cm – 100) – [10% (height-100)]
Hamwi Formula
Women Men
100 lbs for the first 5 ft of height 106 lbs. for first 5 ft
+5 lbs for each additional inch +6 lbs for each inch
Adopted Method
DBW: 5ft = 105lbs
Add/Subtract 5lbs for every inch above/below 5ft
Ador Dionisio
DBW: 5ft = 110lbs (men)
DBW: 5ft = 100lbs (women)
Add 2lbs for every extra inch
Add 2 for every 5 year interval between 25-30 years
NDAP
DBW for men, 5 ft is 112 lbs.
DBW for women, 5 ft is 106 lbs.
Add/subtract 4lbs for every inch above/below 5 ft
Oxford
18 - 30 years old
Men: (16.0 x weight in kg) + 545
Women: (13.1 x weight in kg) + 558
30 - 60 years old
Men: (14.2 x weight in kg) + 593
Women: (9.74 x weight in kg) + 694
Example of Activities
Sedentary – secretary, clerk, typist, administrator, cashier, bank teller
Light – teacher, nurse, student, lab technician, housewife with maids
Moderate – housewife without maids, vendor, mechanic, jeepney and car driver
Heavy – farmer, laborer, cargador, coal miner, fisherman, heavy equipment operator
Adjusted Body Weight
For weight (TER)
Underweight – use DBW
Normal – Actual
Overweight/Obese – Adjusted Body Weight
Adjusted Body Weight = (Actual Weight – DBW) x 0.25 + DBW
I. Distribution of TER
A. Method I (percentage)
1. CHO 50-70% or average of 60%
2. CHONs 10-20% or average of 15%
3. FATs
Normal adults, moderately active 20-30% or average of 25%
Children, adolescents, very active individuals 30-35%
B. Method II (NPC)
Determine the protein calories (PC) first according to the normal allowance in gm/kg
DBW and divide the non-protein calores (NPC) into
CHO : 55-80% or an average of 70%
FAT : 20-45% or an average of 30%
ADDITIONAL INFO:
General Formula is used for the unknown birth weight.
Midpoint is 25 and 75 for rounding up and down
Use whole number in kg for adults
Use TER for Adolescent
In a clinical setting, usually use 30 in NDAP formula for TER
HBEE use DBW. HBEE is used for seniors and critical care. HBEE PA lower range is for females and upper
range is male.
PA Light - Normal day to day activities
PA Moderate - longer periods of time working out; heavy works
Normal TER for Woman is 1600 (Light)
Round off to the whole number each macronutrient.
HF Meat should not be used in MNT; only in healthy individuals.
CHO CHON FAT - only ± 5; KCAL - only ± 50
No need for BMIs: Edema (fluid retention), Pregnant, and 1st 6 months of lactation
2nd and 3rd trimester = +300kcal
Lactating = +500
Lactating mothers should not solve for BMI in the first 6 months. It is not appropriate to determine if they
are nutritionally at risk due to the additional weight from pregnancy.
Nutrition inadequacy - compute the total 24hr recall divided by TER/day times 100 to get percentage (This
is also a way we can determine for our PES)
o More than 125% - excessive energy intake
o 75% - 125% adequate
o 74% or less is inadequate
Nutrition Diagnosis - food and nutrition professional's identification and labelling of an exisitng
nutrition problem that the food and nutrition professional is responsible for treating
independently
Nutrition Intervention - is a purposefully planned action(s) designed with intent of changing a
nutrition - related behavior, risk factor, environmental condition, or aspect of health status.
Nutrition Monitoring and Evaluation - identifies the amount of progress made and whether
goals/expected outcomes are being met. This identifies outcomes relevant to the nutrition
diagnosis and intervention plans and goals.
Objectives
1. To help the patient/client understand and follow the physician's diet prescription in terms
of the kind and amounts of food prepared in specific ways.
2. To advise the patient/client on lifestyle changes needed to support medical and nutritional
management, particularly of chronic ailments
3. To motivate the patient/client to make necessary modifications in diet and lifestyle.
Soft Diet
Diet consists of food that are tender but not ground or pureed
Diet follows the pattern of the regular diet with modification in consistency and texture
Transition diet from liquid diet
Helps ease gastric distress
Dysphagia Diet
Dysphagia is defined as difficulty in swallowing and as symptom of a disease or
dysfunction that results from neurological, mechanical, structural or behavioral disorder.
Purpose of nutrition care is to provide adequate energy, nutrients, and fluids in a
consistency tolerated by the patient
Vegetarian Diets
Vegan or Total Vegan - all animal-based foods and products are avoided
Lacto-vegetarian - milk and milk products are allowed
Ovo-vegetarian – eggs and egg products are allowed
Lacto-ovo-vegetarian - eggs and milk products are allowed
Semi-vegan - plant origin, milk, eggs, fish and chicken are consumed
Pesco-vegetarian - fish and fish products are included
Foods to Avoid:
Fruits: rhubarb, kiwis, dates, raspberries, oranges, tangerines
Vegetables: spinach, chard, potatoes, beets, turnips, yams, okra, carrots Legumes: navy beans,
fava beans, kidney beans, refried beans
Nuts: almonds, walnuts, pistachios, macadamia nuts, cashews
Seeds: sunflower seeds, pumpkin seeds
Chocolate and cocoa
Grains and starches: brown rice, couscous, millet, bulgur, cornmeal, corn grits
Beverages: chocolate milk, hot chocolate, tea, tomato juice
Soy products: tofu, soybeans, soy burgers
So, basically a neutropenic diet is similar from a regular diet; however, preparation and handling
of food items should be more cautious and must be cooked through.]
LOW POTASSIUM DIET
LOW PHOSPHORUS DIET
More Notes about Diet Modifications:
2gNa - low sodium
Renal patients - 4gNa
1tsp of salt throughout the day
Paleo is adopted in Paleolithic era. Humans were hunter gatherers.
Clear soup - fat-free strained soup
Low residue: From clear diet to general liquid to soft
Concentrated source: Vitamin c food supplements not allowed in low oxalate diet
Purine breaks down into uric acid which can form into crystals that deposit in your joints
and cause pain and inflammation. Joint pain is referred to as gout or gout attack.
o Mediterranean diet lowers the risk of developing high uric anti-inflammatory and
antioxidant.
o Avoid: red meat, shellfish, fast-food,
o Foods allowed: Purine-free foods: breads, cereals, milk / milk product,
o White meat or flesh meat to recommend on purine diet; avoid red or bloody
fishes, darker color in purine;
o A byproduct of purine is uric acid
o Substitute beer to wine because of malt
In a hospital, when you see hypoallergenic, no need to ask the patient what specific.
o Hypoallergenic is in general to avoid the major 8 allergens. This law identified
eight foods as major food allergens: milk, eggs, fish, Crustacean shellfish, tree
nuts, peanuts, wheat, and soybeans.
o Itchy Vegetables with seeds irritating asthmatic reaction
o When a specific allergy is specified, make sure
o Allergies - immunological; reactions from immune system
o Intolerances - associated to digestive system.
Gluten is a protein mostly found on grains like wheat barley and rye
o Celiac diseases - body mistakes it as a foreign substance and overreacts to the
protein which damages the small intestine.
o NCGS - feel uncomfortable with food with gluten but no celiac disease
o gluten ataxia - like celiac, immune attacks nervous system can cause neurological
symptoms
o wheat allergy
Low fat dairy products, fruits, and vegetables,
WARFARIN DIET: avoid green leafy vegetables and other food that are vitamin K rich
Level 7 - Regular
Normal, everyday foods of various textures that are developmentally and age appropriate
Any method may be used to eat these foods
Foods may be hard and crunchy or naturally soft
Rationale:
o Ability to bite hard or soft foods and chew them for long enough that they form a soft
cohesive ball/bolus that is ‘swallow ready’
o An ability to chew all food textures without tiring easily
o An ability to remove bone or gristle that cannot be swallowed safely from the mouth
Introduction
Definitions
Infection - result of successful invasion, establishment, and growth of pathogenic
microorganisms in host.
There are five major categories of infectious agents are viruses, bacteria, fungi, protozoa,
and helminths
Fever - medically termed as pyrexia, is a rise in body temperature above normal of
98.6°F. You have a low grade fever if you have an internal body temperature of 37.2°C-
38.1°C. A high-grade fever above 38.2°C and a very high fever above 40°C.
Sepsis occurs when infection has spread from one part of the body to other areas via the
circulatory system
Classification of Infection
Infections can be classified as:
Acute Infection - usually short duration, with sudden onset and rapid progression. Seen in
colds, influenza, tonsillitis, pneumonia, measles, chickenpox, etc.
Chronic Infection - last for weeks, months, or years. Seen in tuberculosis, hepatitis, etc.
Recurrent Infection - occur at periodic intervals
Nutrition Therapy: a soft to regular diet with adequate calories is given. Increase fluid intake
will help keep the lining of the nose and throat moist and help prevent dehydration.
3. Measles: An acute highly infectious communicable disease usually recognized by
presence of fever, rashes, and symptoms in the upper respiratory tract. It is preceded by
grayish pecks (Koplik spots) of the cheeks and rashes in the face and body.
a. Nutrition Therapy: A liquid to soft consistency and in increasing amounts. Some
cases may require tube feeding
4. Cholera: A self-limiting, acute dehydrating disease of the intestines particularly the small
intestines caused by Vibrio cholerae. This causes hypersecretion of sodium and water in
the gut leading to diarrhea.
a. Nutrition Therapy: Patient is placed at NPO for 12 hours with IVF and
electrolytes. Oral Rehydration Therapy with addition of resistant starch is
advisable to reduce fecal fluid loss and shorten duration of loose bowel
movement.
5. Dengue: An acute infectious mosquito-borne fever in which it is a major international
public health concern. It results in a severe, flu-like illness which affects infants, children,
and adults. Some cases may lead to dengue hemorrhagic fever.
a. Nutrition Therapy: A high calorie liquid diet with ample amount of water and
fruit juices. As tolerance progresses, diet can be modified to high calorie diet.
b. NCCF (no choco color food) may alter the stool color.
c. Anything processed with red not allowed to observe if the digestive tract has any
hemorrhage.
d. Red – bleeding from intestine
e. Black – bleeding from stomach
6. Diptheria: An acute infectious and communicable disease caused by Corynebacterium
diphtheriae. It affects the respiratory system. Symptoms include moderate temperature,
malaise, sore throat.
a. Nutrition Therapy: a fluid diet consisting of warm milk, broth, fruit juices, and
gelatin to ease sore throat. Soft diet may be given.
7. Mumps: An acute generalized viral infection usually diagnosed by the sudden onset of
painful swelling in one or both parotid glands.
a. Nutrition Therapy: a liquid diet is given and gradually progressing to soft bland
diet to minimize discomfort.
8. Pertussis: An acute serious communicable disease involving the respiratory tract. It is
caused by Bordatella pertussis and B. parapertussis and can spread by droplet infection.
a. Nutrition Therapy: a soft diet is given when oral feedings are tolerated to prevent
mucus secretions
9. Poliomyelitis: a disease cause by infection with the poliovirus. Transmitted via direct
personal contact by eating contaminated food or drink. It affects the nervous system and
may cause paralysis.
a. Nutrition Therapy: for patient with acute paralysis, provide high calorie, high
protein liquid diet or tube feeding. It may progress to a soft, bland diet.
10. Rheumatic Fever: An auto-immune disease-causing inflammatory conditions affecting
the connective tissue and causing joint pain, swelling, fever, rash, jerky movements, and
carditis. This is caused by untreated streptococcal infection. Long term effect may lead to
Rheumatic Heart Disease
a. Nutrition Therapy: high calorie, high protein, full liquid diet is indicated during
acute infection. As treatment progresses, gradually change to soft to regular diet.
11. Malaria: A recurrent infection caused by the genus Plasmodium, a parasitic protozoa
found in mosquitoes. Main symptoms are intermittent fever, chills, swelling of the liver
and spleen
a. Nutrition Therapy: the diet aims to counteract losses during the attack of fever
and chills. A high calorie diet, a high protein diet, moderate fat is recommended.
12. Pneumonia: An acute infectious disease of the respiratory tract typically caused by the
pneumococcus bacteria resulting in the inflammation of the alveolar spaces of the lungs.
Signs and symptoms include difficult, painful respirations, shortness of breath, chills,
fever, malaise, productive cough, and anorexia.
a. Community acquired Pneumonia (CAP) – certain risk factors
b. CAP MR (moderate risk) – has different risk level of pneumonia
c. Nutrition Therapy: High calorie soft diet is given to prevent weight loss from
hypermetabolic state. Prevention and correction of dehydration is done by giving
3-3.5 liters of fluid per day
13. Tuberculosis: a highly infectious chronic disease caused by the tubercle bacillus
(Mycobacterium tuberculosis) characterized by the formation of tubercles and caseous
necrosis in the tissue. Most TB cases affect the lungs, but it can also spread in other parts
of the body
a. TB can affect the brain, spine, and digestive tract
b. Pulmonary TB – main infection in the lungs
c. Active TB – have tb bacteria, has symptoms (productive cough and fever), and
contagious
d. Laten TB – have TB bacteria but do not manifest the symptoms and not
contagious.
e. Nutrition Therapy: Adequate nutrition is important because many patients with
TB are debilitated by the disease and malnutrition can contribute to weakened
immune system.
14. Severe Acute Respiratory Syndrome (SARS): SARS is respiratory illness that is caused by
coronavirus. SARS was first reported in Asia in 2003. It is spread through respiratory droplets
which may enter in another person through eyes, nose, or mouth.
a. Nutrition Therapy: a high calorie high protein diet is given. Usually, a soft diet in
small frequent feedings is better tolerated.
Major surgery involves opening a major body cavity, such as the abdomen (laparotomy)
or the skull in a craniotomy. General anesthesia, a surgical team, and a hospital stay are
required.
Minor surgery may be done in an outpatient or emergency room setting, often with
minimal anesthetic treatment.
Surgery Process
1. Pre-operative Evaluation
2. Main surgery
3. Post-operative care
Pre-operative Diet
Aims to improve nutritional status of the patient
Help hasten post-operative recovery
Build up glycogen stores
Strengthen bodily resistance to infections
A. Emergency Operation
1. If patient is in good nutrition status NPO 6-8 hours prior to surgery. To avoid vomiting during
anesthesia, and decrease irks of post-operative gastric retention
2. If patient is in poor nutrition status parenteral administration of whole blood. For adequate stores
of serum protein to prevent hypoproteinemia.
3. In addition, 5% glucose (dextrose) in water, ACL saline solution, and potassium. For adequate
nutrition
B. Elective Surgery
1. High calorie for underweight. To build up any weight deficit
2. Low to adequate calories for others. If patient is overweight, weight reduction is indicated to
reduce surgical risks
3. High carbohydrates. For glycogen stores and to spare protein for tissue synthesis. Glycogen is
stored in the liver.
4. High protein. To build reserves for anticipated blood losses during surgery and increased tissue
catabolism.
5. Increased in vitamins C & B for wound healing and prevention of hemorrhage (K).
6. Increased minerals, especially phosphorus, potassium and chloride, iron to replace electrolyte
losses and correct anemia.
7. Increased fluids. Replace losses due to vomiting and diuresis
Immediate Pre-operative
A light meal is given the night prior to surgery, and nothing is given by mouth for at least 8 hours
before general surgery.
A. Minor Surgery
1. Provide liquids within a few hours after surgery and resume normal diet as soon as activity of
GIT is restored.
B. Major surgery
1. NPO 24-28 hours
2. Nutrition support if needed
3. Transition oral diet (liquid to full diet) clear liquid, full liquid, soft diet to full diet
Metabolic Changes:
1. Weight Loss
2. Protein Digestion is impaired
3. Impairment of fat utilization (biliary and pancreatic secretion for mixing and emulsifying)
4. Increased intestinal motility (most process is in the intestines)
5. Iron is less readily absorbed
6. Vitamin b12 deficiency (needs the intrinsic factor in the stomach)
Nutrition Therapy involves two Periods: (1) Immediate post-operative period & (2) Later period
involving Dumping Syndrome
o NPO first 24-48hrs
o Days 2-4 iced water with intravenous feeding
o Day 5: 2 oz of water and milk given alternately per hour
o Day 6: soft low fiber foods
o Day 7: tender meats, cottage cheese, pureed vegetables
o Meals are divided into 5 to 6 small feedings daily with emphasis on food high in protein
and fat.
o All food and drinks should have moderate temperature. Cold drinks tend to cause
increased gastric activity.
3. Dumping Syndrome
A complex physiological response to the presence of undigested food in the jejunum usually
associated with gastrectomy.
Characteristics:
Withdrawal of circulating fluid after partial gastrectomy
Decrease in plasma volume which can lead to palpitation, exhaustion and faintness
Intestinal distention which increases intestinal peristalsis
Hypoglycemia
Symptoms: abnormal cramping, abdominal pain, diarrhea, feeling warmth, dizziness, weakness,
tachycardia (more than 100bpm)
Nutrition Therapy:
Small frequent meals
High protein
High fat
Restricted simple sugars (decreases osmolarity of the jejunum)
Dry solid diet
Low fiber, low residue
Avoid alcohol and carbonated beverages
4. Intestinal Surgery
Surgical resection (removal of parts of intestine) of the intestinal will produce changes in
absorption, motility, and production of waste products.
Ileostomy: removal of the entire colon rectum and anus, an opening made from the ileum, is
brought through the abdominal wall for waste elimination. Bag is cleaned out every now and then
to prevent infections, foul smell.
Colostomy – involves the removal of only the rectum and anus and attaching the proximal end of
the resected colon to an opening in the abdominal wall. Some ability to absorb water is retained
so that the feces are formed. Only the rectum and anus still have the colostomy bag a whole in the
stomach wall
Jejunoileostomy - short segment of the jejunum is joined to the terminal ileum, effectively by
passing about 90% of the small bowel. Weight loss follows as a result of shortened transit time
and reduced surface area for absorption.
Nutrition Therapy:
supplementation for micronutrient deficiencies
Small frequent meals divided throughout the day
Avoiding spicy and oily foods
Drink 8-10 cups of fluids per day
Avoid gas-forming foods and high fiber foods
5. Rectal Surgery
hemorrhoidectomy: removal of either external or internal hemorrhoids
Dietary Management:
NPO for the first 24 hours
Clear liquid
Low fiber-low residue (fruits and vegetables are omitted unless strained fruit juices)
6. Fractures
Metabolic changes in fractures
Increased protein breakdown
Development of osteoporosis
Loss of fluids and electrolytes
Nutrition Therapy:
High calories
High protein
Increased electrolytes and fluids
Calcium from natural sources
7. Burns
First degree - erythema and cell necrosis above the basal layer of the epidermis
Second degree - erythema and blistering necrosis within the dermis (Body Surface Area 15% for
adults, 10% children)
Third degree - full thickness skin loss, including the fat layer (do not really feel pain because
nerves are destroyed)
Metabolic changes:
Loss of tissue
Dehydration
Protein loss
Electrolyte imbalance
Increased energy needs
Weight loss
TER:
Adults: 25 x preburn weight in kg + (40kcal x % BSA burned)
Children: 30 to 100kcal x preburn weight in kg + (40kcal x % BSA burned)
Burns: add for 50kcal for fast estimation