Nutritional therapy in systemic diseases

Nutrition: It is defined as the science of food and its relationship to health.

Dietetics: It is the practical application of the principles of nutritions ,it includes the planning of meals for the well and the sick.

What is a Nutrient?

What are nutrients?

Essential substances that your body needs in order to grow and stay healthy.

Six categories of nutrients:

Macronutrients Water Amino Acids and Proteins Lipids Carbohydrates

Micronutrients Vitamins (B, C, A, D, E, K) Minerals (Fe, Ca, P, Na, K)

A balanced diet is one which contains different types of foods in such quantities and proportions, so that the for calories , proteins ,minerals and vitamins and other nutrients is adequately met and a small provision is made for nutrients to withstand short duration of leanness.

Guidelies to good diet

Reach and maintain ideal body weight Be careful of serving sizes Avoid skipping meals Increase your daily activity Preserve lean body mass

Diet in liver diseases

Infective hepatitis: A high protein ,high

carbohydrate,moderate fat is recommended.

Small attractive meals regular intervals are better.

Overfeeding should be avoided.

Proteins :1.5 – 2g/kg bw.

High carbohydrate diet (appox 300-400g/day).

Moderate amount of fat in the diet to make food palatable,no need to totally avoid dietary fat.

Vitamins to regenerate liver cells,500 mg of vit c,10 mg of vit k,and supplements of b complex for daily needs.

No alcohol intake.

jaundice

Energy:35-40 kcals/kg IBW. Carbohydrates:65-70% more of simple

carbohydrates,complex sugar to be avoided.

Proteins:1.2-1.5 gm/kg IBW. Fats:mild to moderate fats are given. Fibre:avoid roughage,give soft cooked

vegetables and non citrus fruits. No restriction of salt

Cirrhosis of liver

Energy of 2000-2500kcals Proteins 1.2 g/kg of body weight Fat:20g of fat is given, Low sodium diet,400-800mg/day Carbohydrates should be given liberally

so that liver may store glycogen

RENAL DISEASES

glomerulonephritis

Fluids:during the first stage ot treatment fluid should be decreased,to allow disperal of oedema.

In later stage fluid replacement should be 500 ml plus daily amount excreted in urine.

Energy: 1800-2000 kcals are given like sugar,honey,glucose,sago,and starchy foods.

Protein:if the blood urea nitrogen is elevated and oliguria is present dietary proteins are restricted.rice is preferable as it have low amount of protein than wheat.

Sodium:restrition of sodium varies with the degree of oliguria and hypertension,if renal function is impaired ,sodium will be restricted 500-1000 mg/day.

Nephrotic syndrome

As the patient in nephrotic syndrome are often malnourised and wasted, have poor appetite.

Calorie is high 2000kcals Protein is 0.8g/kg of high biological

value.and 1 gm of protein per gram of protein loss is advocated.

Salt intake should be restricted to 500-750 mg per 24 hours.

Restriction of fluid is necessary if oliguria is present.

Potassium supplements is essential with vitamin c supplements

Sample diet

Arf

Energy:minimum of 600-1000kcal is necessary.

Protein :all foods containing protein are stopped if the patient is under conservative treatment and blood urea nitrogen is rising.

Carbohydrates: minimum of 100g/day is essential to minimise tissue breakdown.,if patient is not fed by mouth,a nasogastric tube feeding is done 700ml of 15 % glucose.

Potassium : its intoxication occurs with a daily rise of 0.7 mEq serum potassium.potassium rich sources like tomato juice,coffee,tea,cocoa are avoided.

crf

Energy:it is important to provide calories to enhance positive protein metabolism,in adults 35-50 kcal/kg is given.

Protein:falling kidneys need to be given rest protein intake is reduced to 0.5g/kg body weight per day.

Fluids:volume of daily urine plus 500ml. Potassium:has to be restricted to

1mmol/kg of body weight.

Renal calculi

Adequate fluid intake to ensure urine output of 2 litre or more per day

Restrict foods rich in calcium and oxaltes Calcium rich foods

are:beans,caulliflower,milk,and milk products.

Oxalates:chickoo,spinach,tea,tomato,beef,chocolates,cashew nut

CARDIAC

Ischemic heart disease

proteins- normal diet Fats :dietary cholesterol needs to be

reduced in the presence of hypercholesterolemia ,the total allowance of dietary fat remains unchanged.

It should between saturated ,polyunsatrated and monounsaturated fatty acids(30,40,30%)

Rich dietary sources of saturated fat,high in cholesterol: animal fats:beef,meat,pork organ meat fats milk,cream ,butter,ghee,egg yolk.

Hydrogenated vegetable oil eg: margarine and vegetable ghee.

Diets containing unsaturated fats(low cholestrol diet are not restricted,vegetable oils high in polysaturated faaty acids are safflower,sunflower,groundnut,cottonseed oils.

HYPERTENSION

Calories –about 20 kcal/kg of ideal body weight for sedentary worker,and 25 kcal/kg moderately worker.

Protein:normal protein 50-60g are required for a person with optimum weight and mild hypertension,in severe hypertension with renal insufficiency protein should be restricted to 20g.

Fats:high intake of animal and hydrogenated oils are discouraged.about 20 g of vegetables oil is permitted.

Carbohydrates should constitute the major bulk of calories.

Vitamins in normal amount. Minerals sodium is restricted to 4 to 6 /

day.

Sample diet

Morning 1 cup tea with 1 tea spoon sugar and 2 table spoon milk

Breakfast:4 slices bread ,1 cup milk,no sugar,1 glass buttermilk.

Lunch:2 medium size chapatis,or 1 medium katori rice ,1 medium katori dal ,1 medium katori vegetables

16.00 hours 1 cup tea with 1 teaspoon sugar,2 toasts.

Dinner:2 medium size chapatis,1 medium katori vegetables,1 medium katori dal.

Bedtime 1 cup skimmed milk ,no sugar . Allowance of fats and oils per day:20 g

this diet provides 1320 calories , carbohydrates 198 g protein,protein 51g fats 40 g.

Cancer

Energy:adult with a good nutritional status needs about 2000kcal,a malnourised patient may require 3000-4000 kcal depending on degree of malnutrition.

Protein: A protein amount of 80-100 g to meet maintenance needs to ensure anabolism.

Vitamins:vit A, vit C and vit E, Fibre diet should be increased Fats :less than 30% of total calories,avoid

saturated fats.

Obesity

A low calories and fat,high in fibre is recommended.

Some guidelines for obese patients :1)Set realistic short term and long term goals.2)Avoid fasting or feasting/skipping of meals.3)Always eat breakast with good choice of

cereals.

Do not sleep,immediately after eating. Thoroughly chew each and every morsel

of food. Avoid alcohol and follow dietary

recommendations. Physical exercise is a must to burn away

excessive fat.

Energy:a low calorie diet of atleast 1,200 kcal/day is considered safest and most effective.

Proteins:intake of 1g/kg of ideal body weight.

Fats:a minimum level of 15-20g visible fat should be maintained in diet to provide palatability and essetial fatty acid requirement.

Carbohydrates:high carbohydrates foods contents like potatos , rice are restricted. fruits rich in carbohydrates are avoided.

Vitamins:with prolonged restriction of fats,there is restricted fat soluble vitamin A and vitamin D which may be supplemented.

Minerls:restriction of sodium as comman salt is helpful.

High fibre diet: high fibre low calorie foods like green leafy vegetables,fruits,vegetable salads,whole grains cereals and pulses can be included in the diet.

Sample diet

Peptic ulcer

Diet to restrict foods,beverages that may cause gastric irritation or stimulate excesssive gastric acid secretion.

Energy:35 to 40 kcal/kg is given. Proteins :it have buffering effect.milk proteins

considered better and do not irriatate gastric mucosa.1.2gm/kg IBW is provided.

Fats:it delays gastric emptying and help in meeting the caloric requirement.avoid fried snacks.

Vitamins and minerals:adequate vitamin c and iron is necessary for proper healing.

Fibres:raw vegetables,leafy vegetables,fruits(peel) irritates mucosal lining.

Foods to avoid:alcohol,coffee,spies,caffeine,spies,pickles,vinegar,garlic,onions.

GOUT

A low in fat and purine,high carbohydrate diet is advised to decrease elevated blood uric acid level.

Energy:ajusted to 500kcal Carbohydrates:liberal use of fruits and

vegetables and soluble fibre is helpful. Protein:skimmed milk and its products should

be used. Fats :a low fat diet will promote weight reduction

Fluids:liberal intake in the form of thin buttermilk,vegetable soup, will facilitate urinary excretion of accumulated uric acid and prevent formation of calculi.

Foods to avoid:alcohol,sweet breads,sardines,liver,chicken,ham,musroom.meat,custard apple.

DIABETES MELLITUS

The diet is designed to improve blood glucose and lipid levels,to encourage healthy eating pattens,promote consistent food intake and avoid undue starvation or overeating.Out of the total calroies provided 60% from carbohydrate,20% proteins,20%fats

Energy:calories by IBW ideal body weight,and waist-hip ratio.

For overweight 20kcal/kg/day IBW For underweight 40kcal/kg/day IBW For ideal weight: 25kcal/kg/day IBW

For pregnant diabetic woman:30-35 kcal/kg/day IBW.

Small , frequent meals, avoiding load to the pancreas.

Carbohydrates:the daily intake of carbohydrates should range from 100g to 240-260g.Avoidence of simple cabohydrates like sugar,jaggery,honey.

And complex carbohydrates can be given as they do not raise sugar quickly.

Proteins:1 gm/kg is the recommended dietary allowance,skimmed milk amd milk products except (cream,butter),dals,pulses,nuts,fish, are good sources of proteins.

Fats:A diet of 15-20 gms of visible fats in limited quantities are given.vegetables fats such as sunflower oil,safflower oil, corn oil,contains a high proportion of polyunsaturated fatty acids which are helpful in controling cholestrol levels.

Fibre: dietary fibre is beneficial in type 1 and type 2 DM. fibre present in vegetables,certain fruits,legumes,fenugreek seeds are effective in controlling blood sugar and serum lipid levels.

Patients with insulin dependent diabetes must eat multiple meals to avoid hypoglycemia.

Lung diseases copd

Frequent, Small Meals are given.

A high energy, high protein and low carbohydrate is given in COPD.

vitamins : vitamin A and vitamin E are recommended as they are good source of antioxidants.