HFN 067 DIET Therapy. PDF

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KENYATTA UNIVERSITY INSTITUTE OF OPEN DISTANCE & e-LEARNING IN COLLABORATION WITH

SCHOOL: SCHOOL OF APPLIED HUMAN SCIENCES DEPARTMENT: FOOD NUTRITION AND DIETETICS DEPARTMENT

UNIT CODE &NAME:FND 027:INTRODUCTION TO DIETETICS

COURSE AUTHOR’S NAME DR. WINFREDA NYAMOTA MAOGA

Reviewed/Edited by: NAME MS.REGINA KAMUHU

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Copyright © Kenyatta University, 2009 All Rights Reserved Published By: KENYATTA UNIVERSITY PRESS

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1. INTRODUCTION The study of dietetics prepares students to apply the principles of food, nutrition, and food service management to caring for the health of individuals and groups of people. Individuals who graduate from an approved dietetics program are eligible to be registered as dietician with the Kenya Nutrition and dietetics Institute (KNDI). The goal of the diploma dietetics program is to introduce students to the many overlapping domains in nutrition which form the core of dietetics practice. Dietetics is the science of applying nutritional principles to the planning and preparation of foods and regulation of the diet in relation to both health and disease. Dietetics touches on the feeding patterns and practices of individuals and groups. It is the art and science of feeding people.

2. OBJECTIVES 

To equip the students with the knowledge and skills in the practice of nutrition and dietetics

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To link the students with the relevant institutions in the field of nutrition and dietetics

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TABLE OF CONTENTS Contents INTRODUCTION............................................................................................................3 OBJECTIVES...................................................................................................................3 TABLE OF CONTENTS...................................................................................................4 LECTURE 1: INTRODUCTION TO DIETETICS...........................................................5 LECTURETWO:INTRODUCTION TO DIET THERAPY AND DIET MODIFICATIONS..........................................................................................................10 LECTURE THREE: INTRODUCTION TO THERAPEUTIC DIETS............................15 LECTURE FOUR: PRINCIPLES OF DIET PLANNING...............................................31 LECTURE SIX: INTRODUCTION TO DIETARY ASSESSMENT...............................51 LECTURE SEVEN: INTRODUCTION TO SPECIALIZED NUTRITION SUPPORT. 57 LECTURE EIGHT: INTRODUCTION TO FOOD ALLERGIES...................................68 LECTURE NINE: DIETARY SUPPLIMENTS...............................................................74 LECTURE TEN: INTRODUCTION TO FOOD FADDISM...........................................79

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LECTURE 1: INTRODUCTION TO DIETETICS

Introduction Dietetics is the branch of nutrition that deals with the study of diets. Diet comprises of the foods and drinks that we consume. Dietetics touches on the feeding patterns and practices of individuals and groups. It is the art and science of feeding people. Good nutrition requires an appropriate diet. An ‘appropriate diet’ is the one that is able to provide for all the nutritional needs of an individual at any given time whether in normal health state or in illness. An appropriate/ balanced diet not only meets our-day-today nutrient requirement, but also provides for an extra allowance of nutrients to be stored in our body which can be used in conditions of stress. Dietetics is the integration and application of principles derived from several disciplines—including nutrition, biochemistry, physiology, food science and composition, management, food service, and the behavioral and social sciences—to achieve and optimize human health. Dietetic professionals translate the scientific evidence regarding human nutrition and use that information to help shape the food intake or choices of the public (ADA, 2002).

Lecture Objectives By the end of this lecture the learner should be able to; 1. Define the practice of dietetics 2. Discuss the role and scope of the dietetic professionals

Role and Scope of Dietetic Practitioners Dietetic practitioners translate the science of nutrition into practical applications for individuals, groups, and communities. This requires a solid foundation in cultural competency, including knowledge of food composition, preparation methods and cultural values associated with particular foods, and skills in the culinary arts as well as in nutrition, science, social sciences, management, and communications. Dietetic practitioners will continue to provide nutrition therapy to individuals and groups, manage the feeding of individuals and groups, provide public education, and contribute to research about the links between food, 5

nutrition, and health. Dietetic practitioners have a major contribution to make in the public-policy debate on issues such as obesity and its prevention and management, hunger and its prevention, and genetic modification of foods. The role of dietetic professionals will expand as nutrition becomes a major focus in addressing health issues in the nation and the world. Dietitians supervise the preparation and service of food, develop modified diets, participate in research, and educate individuals and groups on good nutritional habits. The goals of dietitians are to provide medical nutritional intervention, and to obtain, safely prepare, serve and advise on flavorsome, attractive, and nutritious food for patients, groups and communities. Dietary modification to address medical issues involving dietary intake is a major part of dietetics (the study of nutrition as it relates to health. For example, working in consultation with physicians and other health care providers, a dietitian may provide specific artificial nutritional needs to patients unable to consume food normally. Professional dietitians may also provide specialist services such as in diabetes, obesity, oncology, osteoporosis, pediatrics, renal disease, and micronutrient research. Dietetic professionals work with individuals and groups of all ages to assess nutritional health and provide recommendations and therapies to assist individuals, groups, and populations in achieving a diet based on scientific evidence. The diet is generally a variety of foods but may include supplements and tube or parenteral feedings. Nutrient needs vary based on age, genetics, body composition, health status, and lifestyle. Dietetic professionals specialize in different aspects of care: They serve as translators of nutrition science to the public, as specialists in business and industry, as advocates to change food policy, as managers of food operations, as educators and researchers, and as clinicians in many different settings. The practice of dietetics is continuously changing as more research is conducted on foods and on the role of food in human health. Many dietitians work in hospital settings, either in clinical management or nutrition therapy as clinical dietitians. Clinical dietitians who work in nutrition therapy assess the nutritional needs of patients, plan menus, recommend or prescribe diets and nutritional support for patients, consult with physicians and direct educational programs on nutrition and special diets. They are members of the interdisciplinary team both in healthcare and wellness facilities. Different professional terms are used in different countries and employment settings, for example, clinical dietitian, community dietitian, dietetic educator, foodservice dietitian, registered dietitian, public health dietitian, therapeutic dietitian, or research dietitian. In many countries, only people who have specified educational credentials and other professional requirements can call themselves "dietitians" — the title is legally protected. The term "nutritionist" is also widely used; however, the terms "dietitian" and "nutritionist" should not be considered interchangeable — the training, regulation and scope of practice of the two 6

professional titles can be very different across individuals and jurisdictions. In many countries, the majority of dietitians are clinical or therapeutic dietitians, such as the case of the United States, the United Kingdom, and much of Africa. In other countries they are mostly foodservice dietitians, such as in Japan and many European countries. Duties and Responsibilities of a Dietician Summarized 1. Nutritional Assessment Typical tasks: consults medical, nursing, and social service staffs concerning problems affecting patients' food habits and needs; interviews patients to obtain dietary history, food tolerances and allergies, and social information such as food preparation habits and cooking facilities; inquires about food preferences and chewing or swallowing difficulties; reads patients' charts and medical records to obtain medical information such as height, weight, laboratory test values, diagnosis, medications, medical history, and diet order; analyzes data to determine nutritional status of patients. 2. Nutritional Care Plan Development. Typical tasks: assesses physician's diet order and meets with physician as necessary to discuss revisions or augmentations such as vitamin therapy; selects types and amounts of food for therapeutic diets based on indicated physiological and psychological needs of patients; integrates patient's needs with basic institutional menus and patient food preferences; indicates mode of feeding for infants or patients with chewing or swallowing difficulties; prepares home diet plans for outpatients or patients leaving the institution.

3. Nutrition Care Plan Follow-up. Typical tasks: inspects meals served for conformance to prescribed diets and standards of palatability and appearance; visits patients on ward or specialty rounds and during clinical appointments to note patients' responses to diet program; calculates and records dietary intake of patients on medical records; modifies nutrition care plan as necessary; provides patient with follow-up training on such topics as nutrition, food preparation, and record keeping; may assign food inspection, nutrition calculation, and record keeping duties to dietetic technicians. 4. Nutrition Instruction.

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Typical tasks: educates patients and families in how to choose meals from a modified therapeutic selective menu; provides and explains materials and publications which are given to patient in support of the nutrition care plan; participates in in-service training programs demonstrating and explaining topics such as feeding methods and nutrition assessment methods to physicians, interns, and nursing staff; some employees in this class provide on-the-job training giving clinical experience to dietetic interns or nutrition fellowship students; may assist chief clinical dietitian and internship director with development of curriculum and study guides; may conduct classroom training sessions for interns and students. Summary In this lecture we have learnt that dietetics is the science of applying nutritional principles to the planning and preparation of foods and regulation of the diet in relation to both health and disease. We have also learnt that dietetic professionals specialize in different aspects of care: They serve as translators of nutrition science to the public, as specialists in business and industry, as advocates to change food policy, as managers of food operations, as educators and researchers, and as clinicians in many different settings.

Questions 1. Define the practice of dietetics 2. Discuss the role and scope of the dietetic professionals 3. Define the duties and responsibilities of a dietician

Further Reading 1. GOK/Ministry of Medical Services (2010) Kenya National Nutrition and Dietetics Bibliography 2. American Dietetic Association (ADA). Commission on Accreditation for Dietetics Education Accreditation Handbook. Chicago: The American Dietetic Association, 2002. 3. American Dietetic Association (ADA). Definition of Dietetics. January 2002. 4. Am J Occup Ther. (1999). The Guide to Occupational Therapy Practice.; 53:3. 8

5. Available at http://nweb.pct.edu/homepage/student/NUNJOL02/ot%20 process.ppt. Accessed April 2010. 6. ACADE Accreditation Handbook. Available http://www.eatright.com/cade/standards.html. Accessed April 2010.

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7. The American Dietetic Association, 1988, Manual of Clinical Dietetics 8. Sue Rodwell Williams, 1989 Nutrition and Diet Therapy., C.V. Mosby Company. 9. Sue Rodwell Williams, 1990 Essentials of Nutrition and Diet Therapy. 5 th ed., C.V. Mosby Company. 10. Robinson, C.H; Lawler, M.N.; Chenoweth, L.W. and Garwick, E.A 1986. Normal and Therapeutic Nutrition. 17th ed. Macmillan Publishing Company. 11. Zeman, J.F., Ney, D.M., 1988. Applications of Clinical Nutrition., Prentice Hall. 12. Kenyatta National Hospital, 2002. Nutritional Management Guidelines, Jomo Kenyatta Foundation. 13. Kumud, K., Sharda, G., Santosh, J.P., Rama, S., Ranjana, M., Seema, P., 1997. Text book of Nutrition and Dietetics., Phoenix Publishing House LTD. New Delhi.

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LECTURE TWO: INTRODUCTION TO DIET THERAPY AND DIET MODIFICATIONS Introduction Diet therapy is the use of diet in the treatment, prevention and management of diseases and disorders. Diet plays a significant role in the treatment, prevention and management of diseases and disorders. The normal diet is sometimes altered in certain aspects so as to meet the modified nutrition needs during illness. A well-planned diet providing all the specific nutrients to the body helps to achieve nutritional homeostasis in a normal, healthy individual. However, in disease conditions, the body tissues either do not receive proper nutrients in sufficient amounts or cannot utilize the available nutrients owing to faulty digestion, absorption or transportation of food elements, thus affecting the nutritional homeostasis of sick person. The diet therefore will need to be suitably modified. However, it is imperative that the basis of planning modified diets (therapeutic diets) be the normal diet and should be in line with the principles of normal nutrition. The normal diet may be modified qualitatively or quantitatively.

Lecture Objectives By the end of this lecture, the learner should be able to; 1. Explain the role and objectives of diet therapy 2. Describe the types of diet modifications 3. Explain the factors that determine the type of modification to be done in a normal diet.

Role and Objectives of diet therapy A normal diet or a modified diet may play different roles in disease context:a) Preventive b) Curative c) Restorative d) Maintenance Hence the main objectives of diet therapy include; 10

1. To achieve and maintain good nutrition status 2. To correct nutrient deficiencies that may result from disease or disorder. 3. To adjust the dietary patterns so as to cope with the individual’s ability to metabolize nutrients. 4. To supplement medical treatment

An ‘appropriate diet’ An ‘appropriate diet’ or a balanced is the one that is able to provide for all the nutritional needs of an individual at any given time. An appropriate not only meets our-day-today nutrient requirement, but also provides for an extra allowance of nutrients to be stored in our body which can be used in conditions of stress. The fundamental factors or principles to be considered in providing an appropriate diet are as described below; 1. Adequacy in all nutrients An adequate diet provides all nutrients to meet the recommended nutrient intake of healthy people. The first prerequisite of a good diet is to meet the nutritional needs of the individuals. 2. Balance of foods and nutrients in the diet This means not over consuming any one food. The art of balance involves the use of enough but not too much or too little of each type of the seven food groups for example use some meat or meat alternatives for iron, use some milk or milk products for calcium and save some space for other foods. The concept of balance encompasses proportionality both between and among the groups. 3. Acceptability Acceptability of meals or diet is as important as meeting the nutritional needs. It is important to consider the likes and dislikes of individual and explore the possibility of nutritionally appropriate substitutes. 4. Availability and accessibility Food cost and economy are important factors to consider in diet planning. The underlying factors may include family income and family size. The type of foods consumed by individuals depends to a large extent on the money available for food. Diet planning should be done wisely so as to achieve maximum nutrition from the money spent. 5. Moderation in the diet

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This mainly refers to portion size. This requires planning the entire day’s diet so as not to under/over consume any one food. In planning the diets, the goal should be to moderate rather than eliminate intake of some foods. 6. Variety in food choice This means choosing a number of different foods within any given food group rather than eating the same food daily. People should vary their choices of food within each class of food from day to day. This makes meals more interesting, helps to ensure a diet contains sufficient nutrients as different foods in the same group contain different arrays of nutrients and gives one the advantage of added bonus in fruits and vegetables as each contain different phyto chemicals.

Diet Modification The normal diet is sometimes altered in certain aspects so as to meet the modified nutritional needs during illness. However, it is imperative that the basis of planning modified diets (therapeutic diets) be the normal diet and should be in line with the principles of normal nutrition. The normal diet may be modified qualitatively or quantitatively. Qualitative modifications affect aspects of the diet like the form of the diet. This can include changes in the texture, flavor consistency etc. Quantitative modifications affect the content of all or of some nutrients. This includes changes like reducing fat, increasing protein etc. The type of modification depends on certain factors: 1. The nature of illness/ disease 2. The severity of the disease/disorder 3. The metabolic changes involved and their implications 4. The nutritional status of the patient. In some illness, the dietary modifications involved may be minimal but in others, several alterations and adjustments may have to be made. Typical Diet Modifications 1. Change in consistency – this is done in order to provide a soft or liquid diet

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2. Change in the total Energy intake – in order to provide a low energy diet or high-energy diet. Depending on the metabolic changes and weight of the patient suitable alterations are made to either reduce or increase the energy intake. 3. Change in frequency of feeding – sometimes a patient may not be able to consume normal amounts of food. It is therefore to add the feeding times by providing small meals at frequent intervals. 4. Change to Bland diet – this is done to provide a diet that chemically, mechanically and thermally bland so as to avoid any kind of irritation to the GIT. Avoid strong spices, strongly flavored foods, and provide foods at a warm temperature. (Extremes of very cold or very hot should be avoided). 5. Exclusion of certain foods – in severe allergic conditions, certain foods to which the individual is allergic to is entirely excluded. However, suitable substitutes should be used. 6. Change in mode of feeding – for patients who are not able to ingest food orally or those whose Gastro intestinal functioning is impaired different feeding methods have to be used. This includes tube feeding and intravenous feeding.

Summary In this lecture we have learnt that diet therapy is the use of diet in the treatment, prevention and management of diseases and disorders. We have also learnt that the objectives of any diet therapy are based on principles of normal nutrition. We have also learnt about diet modification and the need to modify th...