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Physical Health

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Nutritional Considerations



Nutritional Requirements



Dietary Guidelines



Potential Shortfall



Methods of Assessment



Dietary Management



Food Pyramid



Preparation a Simple diet



A guide to Healthy eating



Nutrition

Dietary Management in Specific Diseases
Disease Diet Therapy Remarks
Hyperlipidemia Low fat, High fibre
  • Calories should be sufficient to maintain appropriate body weight for a given height.
  • Carbohydrate should constitute 55-75% of calories.
  • Proteins around
  • 10-15% of the total calories (min. 1 gm per kg of ideal body weight)
  • Total fat intake between 15-35% of total calories.
  • Cholesterol should not exceed 300mg/day in the diet.
  • Saturated fat should be less than 10% of the total calories
  • Polyunsaturated fat should not exceed 8% of the total calories
  • MUFA (10 – 15 % of total calories)
  • P/S ratio between 0.8-1.0
  • Trans Fatty acids should be avoided
  • Linoleic acid(n6) between 3-7% of the calories
  • Alpha-Linoleic acid(n3) not less than 1% of calories.
  • LA/ALNA ratio between 5-10
Hypercholesterolemia Low saturated fat, low cholesterol,
high fiber
 
Hypertension Sodium Restriction Emphasize fruits and vegetables, low fat dairy products, whole grains, nuts.
Restrict Sodium intake to < 2.4 g ( 6g salt /day)
Hypertriglyceridemia Moderate restriction in total fat; sucrose and alcohol-restricted, calories to achieve or maintain ideal body weight 30% of calories from fat increase intake of complex carbohydrates Restrict concentrated sweets Restrict alcohol
Mycocardial infarction Restrict sodium and saturated fat If CHF is present, fluid restriction may be necessary Fat similar to Hypercholesterolemia
Congestive Heart Failure (CHF) Restrict-sodium Low saturated fat Acute CHF-2-3g sodium/day Severe restriction- 0.5-1.0g/day
Diabetes Mellitus, Type-2, non-insulin dependant Low fat, low cholesterol, high fiber diet Specify the calorie level Include whole grains, fruits, vegetables & low fat dairy. For glycemic control, total amount of carbohydrate is more important. Low glycemic index diet s may be considered Dietary fiber-12-14g/1000kcal
Gout Purine restricted Avoid intake of organ meats, liver, kidney & certain sea foods, mushroom, dried fruits & nuts Consume liberal amounts of fluids
Obesity Weight reduction Specify calories to achieve 1-2lb of weight loss per week. Less than 1000 kcal for women & 1200 kcal for men is generally not recommended because of difficulty in achieving nutritional adequacy.
Lifestyle modification & exercise programs are recommended
Celiac Disease Gluten free Omit foods containing wheat, rye, barley. Substitute with oats,corn, rice, tapioca, soybean, arrowroot & potato flours
Constipation, Diverticulosis, hemorrhoids High fiber (21-38g/day) Dietary sources of fiber should be tried before supplements
Excessive intake may reduce absorption of calcium, copper, iron, magnesium,
selenium & zinc.
Ulcerative colitis Individualised Avoid highly spiced foods, highly osmotic fruit juices, alcohol & caffeine
Lactose intolerance Lactose restricted/free Severe lactase deficiency-avoid all milk containing foods
Moerate lactase deficiency-
Curd, butter-milk, cottage cheese, pro-biotic curd often tolerated.
Lactase enzymes for pre-treatment of lactose containing foods may be used
Acute renal failure (ARF) Individualized for the degree of renal failure
Consider sodium, potassium, phosphorous and fluid restrictions if necessary
ARF with dialysis- 0.8g/kg/protein/day
Chronic kidney disease without dialysis
Consider for protein, sodium, potassium & fluid restrictions
Energy- 20-35kcal/kg/ ideal body weight/day
With hypertension and edema, restrict sodium (1-3g/d) & fluid.
Protein-0.8-.1.0g may be helpful
End Stage renal disease (ESRD) with dialysis
Individualised restriction of
sodium, potassium, phosphorous & fluid restrictions
Adjust energy for activity level and body weight
For weight maintenance-
20-35kcal/kg/ ideal body weight/day
For weight reduction-
20-55kcal/kg/ ideal body weight/day
Protein-
Hemodialysis-
1.1-1.4g/kg/ ideal body weight/day
Peritoneal dialysis-
1.2-1.5g/kg/ ideal body weight/day
Phosphorous- Hemodialysis
& Peritoneal dialysis<
17mg/kg/ ideal body weight/day
Potassium-
Hemodialysis-
About 40-70meq/day
Peritoneal dialysis-
About >75meq/day
Fluid –according to urine output & patient’s condition
 
Dental impairment
Ground pureed or full liquid
Patients with fresh dental sutures should not use straws
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