Chapter-19 Diet and Nutrition [chapter]

Harpreet Kaur
2008 Medical Biochemistry for Physiotherapy Students  
This chapter is concerned with the nutritional requirements for the healthy person, and for the sick, wounded, and convalescing patient. Research has confirmed that good health depends in part upon the availability of essential nutrients the body requires throughout life. The well-nourished individual is usually mentally alert, is at a maximum of physical capability, and has a high resistance to disease. The daily basic minimum nutritional requirements must be met and often supplemented during
more » ... eriods of illness to meet the changing needs of the body and its ability to use foods. Therefore, the diet is an important factor in the therapeutic plan for each patient. The soft diet includes all liquids other than alcohol, and foods that may be incorporated into a soft 9-7 diet include well-cooked cereals, pastas, white bread and crackers, eggs, cottage cheese, tender meat, fish, poultry, and vegetables (including baked, mashed, and scalloped potatoes). Vegetables can be puréed and meats ground for dental patients. Permitted desserts are custards, gelatin puddings, soft fruits, and simple cakes and cookies. Foods prohibited in a soft diet include fried foods, raw vegetables, and nuts. LIQUID DIET.-A liquid diet consists of foods that are in a liquid state at body temperature. This type of diet is indicated in some postoperative cases, in acute illnesses, and in inflammatory conditions of the gastrointestinal (GI) tract. It is important that feedings consisting of 6 to 8 ounces or more be given every 2 to 3 hours while the patient is awake. Liquid diets are usually ordered as clear, full, or dental liquid. A clear liquid diet includes clear broth, black tea or coffee, plain gelatin, and clear fruit juices (apple, grape, and cranberry), popsicles, fruit drinks, and soft drinks. This diet is inadequate in all nutrients. A full liquid diet includes all the liquids served on a clear liquid diet, with the addition of strained cream soups, milk and milk drinks, ice cream, puddings, and custard. The full liquid diet is inadequate in iron, niacin, and possibly Vitamin A and thiamin. A dental liquid diet includes regular foods blended and strained in liquid form and all foods allowed on clear and full liquid diets. Vitamin and mineral supplements may be necessary with the dental liquid diet if the recommended amounts of food are not tolerated. HIGH-CALORIE DIET.-The high-calorie diet is of a higher caloric value than the average patient normally requires. A high-calorie diet is indicated when an increase of total calories is required by malnourished, underweight, postsurgical, or convalescing patients, especially those recovering from acute illnesses such as infections, burns, and fevers. The increase in calories is obtained by supplementing or modifying the regular diet with high-calorie foods or commercial supplements, by giving larger portions, or by adding snacks. It is given to meet a need for energy caused by the more rapid metabolism that accompanies certain diseases (especially fever, hyperthyroidism, poliomyelitis, and tuberculosis). In the liquid or soft diet, adding fats and carbohydrates increases the caloric value. The high-calorie diet is often ordered along with high protein. Proteins are added to prevent depletion of proteins in the plasma (a condition known as hypoproteinemia). As the patient progresses, a more solid diet is given. Good sources of high-calorie foods are whole milk, cream, sweets, butter, margarine, fried foods, gravy, sauces, and ice cream. Between-meal feedings consisting of milk, milkshakes, cheese, cookies, or sandwiches are recommended, but these feedings should not interfere with the patient's appetite at mealtime. LOW-RESIDUE DIET. -The low-residue diet is indicated in ulceration, inflammation, and other 9-9 gastric disorders (such as partial intestinal obstruction or diverticulitis). It is also used in certain postoperative states that affect any part of the GI tract, e.g., a hemorrhoidectomy. Low-residue diets are also used in treating dysenteries of long duration. The purpose of this diet is to provide nonstimulating, non-irritating, and easily digested material that leaves little residue, thus avoiding mechanical irritation of the GI tract. Various commercially prepared low-residue elemental diet supplements may be given to provide complete nutrition. LOW-SODIUM DIET.-A low-sodium diet consists of foods containing a very small percentage of sodium, with no salt added in preparation or by the patient. It is impossible to prepare an absolutely sodium-free diet. The low-sodium diet is indicated when edema is present, in renal diseases, hypertension, and certain cardiac conditions. The nephrotic patient is often unable to excrete sodium in a normal manner because the kidneys' retention of sodium leads to edema. A low-sodium diet is thus indicated, with no restriction on salt-free liquids. Such patients should be encouraged to drink 2,000 to 3,000 milliliters (ml) of low-sodium fluids daily. The allowance of sodium in a strict low-sodium diet is 250 to 1,000 mg daily. The allowance of sodium in a moderate low-sodium diet is 2,000 mg or 2 g. Regular diets with no salt added contain 2.4 to 4.5 g of sodium. Any diet in which the amount of sodium is drastically reduced has possible side effects. The patient who is on this diet regimen must be constantly observed-particularly in warm climates-for lassitude, complaints of weakness, anorexia, nausea and vomiting, mental confusion, abdominal cramps, and aching skeletal muscles. Electrolyte imbalances can have serious consequences. If you observe symptoms such as those described above, notify a medical officer. BLAND DIET.-A bland diet may be helpful for gastritis, hyperacidity, hemorrhoids, peptic ulcers, and other GI disorders. Dietary management of patients with chronic ulcer disease has been the subject of much controversy. Bland diets have traditionally been used for these patients. However, experiments show that there is no significant difference in the response of patients with an active duodenal ulcer to a bland diet. Known irritants to the gastric mucosa include alcohol, black pepper, caffeine, chili powder, cocoa, coffee, certain drugs, and tea.
doi:10.5005/jp/books/10512_19 fatcat:xzkindb45rd23e26h7atptofma