Modification Of Therapeutic Diets

MODIFICATION OF THERAPEUTIC DIETS

 

Therapeutic diets can be modified in terms of quality and quantity.

Qualitative-

- Restriction of a Nutrient eg.; Sodium in hypertension

- Excess of a nutrient eg.; Tuberculosis where increased protein and energy are required

 

Quantitative

- Change in consistency eg.;clear liquid diet

- Rearrangement of meals eg: Increasing frequency of meals

- Omission of foods eg: Allergy, which  demands  complete exclusion of the allergic food.

Routine Hospital Diets

 

1. Clear liquid Diet

 

Clear liquid diet is a temporary diet of clear liquids without residue and is non - stimulating, non-irritating and non-gas forming.

 

Small amounts of fluids (usually 30-60 ml) are served at frequent intervals (2 hrs) to replace fluid and electrolytes and also to relieve thirst. Being composed mainly of water, carbohydrates and some electrolytes, a clear fluid diet can normally provide only 400-500 k.cal, 5 g protein, negligible fat and 100-120 g of carbohydrates.

It is nutritionally inadequate and therefore used for a very short period of time (24-48 hrs).

 

Disease conditions for its use

 

1.     Preoperative patients eg: preparation for bowel surgery.

 

2.     Prior to colonoscopic examination.

 

3.     Post operative patients eg: in the initial recovery phase after abdominal surgery or after a period of intravenous feeding.

 

4.     Acute illness and infections as in acute Gastro Intestinal (GI) disturbances such as acute gastroenteritis, when fluid and electrolyte replacement is desired to compensate for losses from diarrhoea.

 

5.     As the first step in oral alimentation of a nutritionally debilitated person.

 

6.     Temporary food intolerance.

 

7.     To relieve thirst.

 

8.     To reduce colonic fecal matter.

 

2. Full fluid diet

 

A full fluid diet includes all foods which are liquid or can be liquefied at room and body temperature. It is free from cellulose and irritating condiments and spices.

 

This diet can be properly planned and made nutritionally adequate for maintenance requirements. If used for more than two days, then a high protein, high calorie supplement may be necessary.

 

This diet is given in between a clear liquid diet and soft diet. The average nutritional composition of this diet is 1200 k.cal and 35 g protein. This should be given at 2-4 hr interval.

Disease condition for its use

 

1.     Most often used post operatively by patients progressing from clear liquids to solid foods.

 

2.     Acute gastritis and infections.

 

3.     Following oral surgery or plastic surgery of face or neck area.

 

4.     In presence of chewing and swallowing dysfunction for acutely ill patients.

 

5.     Patients with oesophagal or stomach disorder who cannot tolerate solid foods owing to anatomical irregularity.

 

3. Soft Diet

 

A soft diet is used as a transitional diet between full fluid and normal diet. It is nutritionally adequate. It is soft in consistency, easy to chew, made up of simple, easily digested foods, containing limited fibre and connecting tissues and does not contain rich or highly flavoured foods.

 

The average soft diet supplies around 1800 k.cal and 50 g protein. However the energy, protein and other nutrients are adjustable according to the individual's need, based on activity, height, weight, sex, age and disease condition.

 

It can be given as three meals a day with or without in between meal feedings.

 

Disease condition for its use

 

1.     Patients progressing from full fluid diet to general diet.

 

2.     Post operative patients unable to tolerate general diet.

3.     Patients with mild GI problems.

 

4.     Weak patients or patients with inadequate dentition to handle all foods in a general diet.

 

5.     Diarrhoea convalescence.

 

6.     Between acute illness and convalescence.

7.     Acute infections.

A soft diet can be modified as mechanical soft diet.

Mechanical soft diet

 

Many people require a soft diet simply because they have no teeth and such a diet is known as mechanical or a dental soft diet. It is not desirable to restrict the patient to the food selection of the customary soft diet and the following modifications to the normal diet may suffice.

1.     Vegetables may be chopped or diced before cooking

 

2.     Hard raw fruits and vegetables are to be avoided; tough skins and seeds to be removed.

 

3.     Nuts and dried fruits may be used in chopped or powdered forms.

 

4.     Meat to be finely minced or ground.

5.     Soft breads and chapattis can be given.

Disease condition for its use

 

1.     In cases of limited chewing or swallowing.

 

2.     Patients who have undergone head and neck surgery.

 

3.     Dental problems.

 

Anatomical oesophagal strictures.

4. Normal diet

 

A normal diet is defined as one which consists of any and all foods eaten by a person in health. It is planned keeping the basic food groups in mind so that optimum amounts of all nutrients are provided. As there is no restriction of any kind of food, this diet is well balanced and nutritionally adequate.

 

Since the patient is hospitalized or is at bed rest, a reduction of 10% in energy intake should be made and too many fatty foods and fried foods be avoided as they are difficult to digest. The proteins are slightly increased (+10%) to counteract a negative nitrogen balance. All other nutrients are supplied in normal amounts.

5. Cold semi liquid diets

 

This diet is given following tonsillectomy or throat surgery until a soft or general diet may be swallowed without difficulty. It contains more of cold beverages and luke warm preparations.

 

6. Blenderized liquid diet

 

This is adopted in conditions of

1.     inadequate oral control

2.     oral surgery with dysphagia

 

3.     wired jaws (blenderized foods can be consumed through small openings).

4.     Patients with reduced pharyngeal peristalisis.

 

Routine food is made into liquid pulp and can be prepared using a kitchen blender.