NUTRITION MODULE Final

TOPIC 1
BASIC CONCEPTS IN NUTRITION AND DIET THERAPY
Introduction
Achieving wellness that integrates body, mind, and spirit should be the main
goal in life. This can be accomplished through lifestyle changes such as focusing
on healthy food choices, not smoking, participating in regular physical activity, and
maintaining a healthy weight. Expanding one’s mind through continued education,
in both nutrition and other areas, and finding a source of inner strength to deal with
life changes will all contribute to one’s sense of wellness.
Nutrition is a vital component to overall wellness and health. Diet affects
energy, wellbeing and many disease states. There is a connection between
lifetime nutritional habits and the risks of many chronic diseases such as cardio
vascular diseases, diabetes, and cancer. A well-balanced diet can prevent such
conditions and improve energy levels and overall health and wellness. The basis
of nutrition is FOOD.
Learning Outcome
At the end of the lesson, the students should be able to:
Understand the basic concepts in nutrition and diet therapy.
Learning Content
1. Definition of terms:
Nutrition
Food
Nutrients
2. Basic concepts in nutrition.
3. Classifications of nutrients.
4. Six essential nutrients, functions and examples of nutrients.
Carbohydrates
Protein
Fats
Vitamins
Minerals
Water
5. Health effects of each nutrients.
NUR 212 Nutrition and Diet Therapy

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Definition of Terms
Cells are made up of water, inorganic ions and carbon containing molecules.
Water is the most abundant molecules in cells, making up 70% or more of total
cell mass. As a result, the interactions between water and other constituents of
cells are of vital importance in biological chemistry. The significant property of
water is that is a polar molecule can form hydrogen bonds with each other or with
other polar molecules, as well as interact with positive or negative ions.
Hydrophilic ions and polar molecules are readily soluble in water
Hydrophobic non polar molecules, that cannot interact with water, it is poorly
soluble in an aqueous environment.
Human body cells have similar features:
1. Cell Membrane is also known as plasma membrane, is selectively
permeable and made up of phospholipids, cholesterol, and proteins.
The proteins in the cell membrane form pores or openings to permit
passage of materials by:
 Acting as enzymes to help substances enter the cell.
 Acting as antigen markers to identify the cell as “self”
 Serving as receptor sites in hormones
2. Cytoplasm is a watery solution of minerals, gasses, and organic molecules
found between the cell membrane and the nucleus and is a location of
chemical reactions.
3. Cell Organelles are intracellular structures that are bound by their own
membranes, each having a definite function. It is made up of:
a. Endoplasmic reticulum (ER) is a passageway for the transport of
materials within the cell.
 Rough ER has ribosomes attached to the membranes in order
to synthesize secretory proteins.
 Smooth ER has no ribosomes attached and synthesizes lipids
and carbohydrates.
b. Ribosomes is a tiny structure of protein and rRNA that are sites of
protein synthesis.
c. Golgi apparatus is a string of flat membranous sacs that synthesize
carbohydrates. They package material for secretion from the cell by
breaking off some of their small sacs and fusing with the cell
membrane in order to release the contained substance to the outside
cell.
d. Mitochondria organelles inside the cytoplasm that is the site of
energy production (ATP). They are bound by a double membrane and
have an inner layer with folds called cristae.

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e. Lysosomes single membraned structures inside the cytoplasm that
contain digestive enzymes that destroy engulfed bacteria and other
cellular debris.
f. Centrioles is a pair of rod-shaped structures that lie perpendicular to
one another and located just outside the nucleus. Their function is to
organize the spindle fibers during cell division.
g. Cilia and Flagella mobile thread- like projections through the cell
membrane. Cilia are shorter than the flagella. They sweep materials
across the cell surface.
h. Nucleus the control center of the cell that contains chromosomes. The
forty- six chromosomes of the human cells are long threads called
chromatin that is made of DNA and protein.
Prokaryotic and Eukaryotic Cells

Organisms are divided into two types:
Prokaryotic Organisms are those that do not have true nucleus and
membrane-bound cell organelles and are simple and small cells.
Eukaryotic Organisms are those that have true nucleus and nucleolus and
also contain all also contain all membrane bound cell organelles. This are the
complex, large structured and are present in trillions which can be single-celled or
multi-cellular celled.
PROCESS OF DIGESTION
Digestion is defined as the process of breaking down food into substances

like carbohydrates, proteins, fats, and vitamins that aid the body in its different
functions.
 The digestive system is made up of the gastrointestinal tract also called
as the GI tract or digestive tract, liver, pancreas and the gallbladder.

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 The GI tract is a chain of hollow organs connected in a long, twisting
tube from the mouth to anus.
 The hollow organs that make up the GI tract are the Mouth,
esophagus, stomach, small intestine, large intestine and anus.
 The liver, pancreas and gallbladder are the solid organs of the
digestive system.
PARTS OF THE DIGESTIVE SYSTEM

MOUTH digestion begins in the mouth where food is broken down into pieces.
By chewing. Food then mixes with saliva and broken down into form that the body
can absorb and use.
THROAT also known as the pharynx, transfers food from the mouth to the
esophagus and warm, moistens and filters air before food is moved into the trachea.
ESOPHAGUS it is muscular tube extending from the pharynx to the stomach.
Through a series of contractions known as peristalsis food goes to the stomach. A
“zone of high pressure”, known as the lower esophageal sphincter, prevents food
from passing backwards into the esophagus.
STOMACH it is a sac-liked organ with tough muscular walls. It holds, mixes
and grinds food. The stomach secretes acid and powerful enzymes that carry on the
process of breaking down of food. Food leaves the stomach in liquid or paste
consistency and moves to the small intestine.
SMALL INTESTINES is a long loosely coiled tube in the abdomen which
when spread out, would be more than 20 feet long. It is made up of three parts- the
duodenum, jejunum, and ileum.
 DUODENUM it continues the process of breaking down food.
 JEJUNUM and ILEUM are responsible for the absorption of nutrients
into the bloodstream.
The stomach and the small intestines are supported by 3 organs in digesting food:
1. Pancreas secretes the enzymes into the small intestine which breakdown
protein, fat and carbohydrates
2. Liver produces and secretes bile which helps in the digestion and absorption
of fats and fat-soluble vitamins. It also cleanses and purifies the blood that
comes from the small intestines which contains the nutrients absorb from
food.
3. Gallbladder is a pear-shaped reservoir located just under the liver. Bile made
in the liver travels to a gallbladder through a cystic duct for storage. During
meals, the gallbladder contracts and sends bile to the small intestines, wastes
are passed to the large intestines, or colon.
LARGE INTESTINES the colon is a muscular tube approximately 5-6 feet that
connects the caecum (the first part of the colon) to the rectum (the last part of
the large intestines).

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5 PARTS
1. CEACUM, the ascending (right) colon
2. Transverse (across) colon
3. Descending (left) colon
4. Sigmoid colon
5. Rectum
Stool from the digestive process passes through the colon by means of
contractions or peristaltic movements, first in liquid state and finally in solid form as
water is removed from the stool. The stool is kept in the sigmoid colon until a “mass
movement” empties it into the rectum once or twice a day. It normally takes about
empties 36 hours for the stool to get through the colon. The stool is made up of
mostly food debris and bacteria. These bacteria synthesize various vitamins and
processes waste products and food particles. The descending colon empties its
contents into the rectum when it becomes full of stool, or feces, and begins the
process of elimination.
RECTUM is an 8-inch chamber that connects the colon to the anus. It
receives stool from the colon and holds the stool until defecation. When gas or stool
comes into the rectum, sensors send a message to the brain which decides if the
rectal contents can be released or not. then the sphincters (muscles) relax and the
rectum contracts, expelling the contents.
ANUS the digestive tract end in the anus which consist of the pelvic floor
muscles and the two anal sphincters. The lining of the upper anus is specialized to
detect rectal contents. The pelvic floor muscles create an angle between the rectum
and the anus that stops stool from coming out when it is supposed to. The anal
sphincters provide control in the elimination of stool.
Nutrition is the study of food and how the body makes use of it. It deals not
only with the quantity and quality of food consumed but also with the process of
received and utilizing it for the growth and renewal of the body and for the
maintenance of the different body functions.

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The basic function of nutrition is to maintain life by allowing an individual to
grow and be in a state of optimum health.
The following are reasons why nutritional science is applied to nursing care.
1. The recognition of the role of nutrition in preventing diseases or illnesses;
2. The concern for adapting food patterns of individuals to their nutritional
needs within the framework of their cultural, economic, and psychological
situations and styles; and
3. The awareness of the need in specified disease states to modify nutritional
factors for therapeutic purpose.
Food when taken and digested nourishes the body. It is a vital need
without which a person cannot live. It is likewise culturally acceptable as it
supplies heat and energy, builds and repairs body tissues, and regulates body
processes.
Nutrients are chemical substances found in food. They perform diverse
roles in the body such as to provide heat and energy, to build and repair body
tissues, and to regulate body processes. Since nutrients are found primarily in
natural foods, adequate intake of these nutrients is necessary to carry out
physiological functions.
Nutrients are classified according to the following:
1. Function – Those that form tissues in the body are body-building nutrients
while those that furnish heat and energy are fat, carbohydrates, and
protein.
2. Chemical properties – Nutrients are either organic or inorganic.
3. Essentiality – Nutrients are classified based on their significant contribution
to the body’s physiological functioning.
4. Concentration – Nutrients are either in large amounts or in little amounts.
a. Macro Nutrients – are nutrients that the body uses in relatively large
amounts and needs daily. There are three micronutrients: proteins,
carbohydrates and fats.
b. Micro Nutrients – are chemical element or substance required in trace

or small amounts for the normal growth and development of living
organisms.
The foods which we use daily include rice, wheat, dal, vegetables, fruits,
milk, eggs, fish, meat, sugar, butter, oils, etc. These different foods are made up of
a number of chemical components called nutrients. These are classified
according to their chemical composition.
Each nutrient class has its own function, but the various nutrients must act
in unison for effective action. The nutrients found in foods are — carbohydrates,
proteins, fats, minerals, vitamins and water. Fiber is also an essential component
of our diet. The functions of nutrients are given below.

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Nutrition Concepts
1. Food is a basic need of humans
2. Food provides energy, nutrients and other substances needed for growth
and health.
3. Health problems related to nutrition originate within the cells.
4. Poor nutrition can result from both inadequate and excessive levels of
nutrient intake.
5. Humans have adaptive mechanisms for fluctuation in nutrient intake.
6. Malnutrition can result from poor diets, disease states, genetic factor, or
combination of these causes.
7. Some people are at higher risk of becoming inadequately nourished than
others.
8. Poor nutrition can influence the development of certain chronic diseases.
9. Adequate, variety, and balance are key characteristics of a healthy diet.
10. There are no “good” or “bad” foods.
Six Essential Nutrients

1. Carbohydrates:
 Organic compounds (saccharides - starches and sugar) that contain
carbon, hydrogen and oxygen
 Represented by the formula CHO
 Provide the major source of energy for the body or as much as 80% to
100% of calories
Functions:
1. Provide the major source of energy for the body
2. Spare protein
3. Normal fat metabolism
4. Regulates the function of the GI tract
5. Supply sufficient quantities of proteins, minerals and B vitamins.
6. Enhance the growth of beneficial microorganism in the intestines
7. Sole source of energy for the brain. Thus a constant supply of glucose
from the blood is essential for the proper functioning.
Food sources:
1. Whole grain
2. Sweet potatoes and white potatoes
3. Milk

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4. Sugar and sweets
Health effects:
1. Weight control – fibers rich in complex CHO tend to be low in fat and
added sugars and can promote weight loss.
2. Heart disease – high CHO diets, rich in whole grains, may protect against
heart disease and stroke
3. Cancer – high CHO diets protects against many types of cancer
4. Diabetes – high CHO, low fat diets help control weight
5. Gastrointestinal health – dietary fibers enhance the health of the large
intestines
6. Dental caries – excess intake of sugar and improper dental hygiene
contribute to the development of tooth decay. Bacteria present in the
mouth ferment the sugars in the process produce an acid that dissolves
the tooth enamel
Deficiency:
1. Ketosis
2. Protein energy malnutrition
a. Kwashiorkor – CHON deficiency
b. Marasmus – Calorie deficiency
3. Low blood sugar
2. Fats:
 Organic compounds composed of carbon, hydrogen, oxygen
 Differ from carbohydrates in terms of the ration of oxygen to carbon and
hydrogen which is much higher compared to 1:2 in simple carbohydrates.
This lower amount of oxygen in relation to carbon and hydrogen accounts
for the fact that fats are more concentrated sources of energy than
carbohydrates.
 Include substances such as fats, oils, waxes, and related compounds that
are greasy to touch and insoluble in water
 Most concentrated form of energy
Functions:
1. Source of energy
2. Protein sparer
3. Insulation and padding
4. Carriers of fat-soluble vitamins
5. Provide satiety value
6. Enhances palatability of foods
Sources:

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1. Visible fats include lard, butter, margarine, shortenings, salad oils, visible
fats of meat
2. Invisible fats are those available in milk, cheese, eggs, nuts and meat
3. High in saturated fatty acids:
ex. - Whole milk, cream, ice cream, cheese made from whole milk, egg
yolk
4. Medium fat or fatty meats; beef, lamb, pork, ham
5. Bacon, butter, coconut oil, lamb fat, lard, regular margarine, hydrogenated
shortenings
6. Chocolate, chocolate candy, cakes, cookies, pies, rich pudding
Health effects:
1. Heart disease – elevated blood cholesterol is a major risk factor for
cardiovascular diseases.
2. Risk from saturated fats - raise blood cholesterol level
3. Benefits from monounsaturated – olive oil lowers risks of heart disease.
4. Benefits from omega 3 polyunsaturated fats – lowers blood cholesterol
and prevents heart disease. Sources like fish, eaten once a week, can
lower blood cholesterol and risk of heart attack and stroke.
5. Cancer – fat does not instigate cancer development but can promote it
once it has arisen.
6. Obesity – high fat diets tend to store body fat ably.
3. Proteins:
 Came from the Greek word “protos” meaning “primary” or “holding first
place” since it is the first substance recognized as a vital part of living
tissue.
 Complex organic compounds that contain the elements carbon, oxygen,
hydrogen, nitrogen and some with sulfur.
 Every cell in the body is composed of proteins which are subject to
continuous wear and replacement
Functions:
1. Used in repairing worn out body tissue
2. Source of heat and energy
3. As components of essential body compounds
4. Maintenance of normal osmotic relations among the various body fluids.
5. As transporters – substances around the body
6. Increases body’s resistance to diseases.
7. Helping blood clot

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Food sources:
1. Complete protein foods – meat, fish, poultry, egg, milk, cheese
2. Legumes, nuts
3. Bread and cereals
Health effects of Protein:
 Protein deficiency – is usually accompanied by an inadequacy of calories
and other nutrients.
 Heart disease-foods rich in animal protein tends to be rich in saturated fats
 Cancer-studies suggest a relationship between high intake of animal
protein and some types of cancer like cancer of the prostate gland,
pancreas, kidneys, breast and colon
 Osteoporosis-calcium excretion rises as protein intake increases
 Weight control-protein rich foods are also rich in fat which can lead to
obesity with associated health risks.
 Kidney disease- excretion of end products of protein metabolism depends
on a sufficient fluid intake and health kidneys. A high protein diet increases
the work of the kidneys.
4. Minerals
Minerals Primary Primary Clinical

Function Sources Manifestation
Bone/teeth
formation, D: Retarded
Milk products, growth, rickets,
muscle
green leafy tetany
Calcium contraction,
vegetables, eggs,
regulates
cheese, legumes
phosphorus T: Hypercalemia
level in blood
Bone/teeth Dairy products,

Phosphorus formation, cell milk, poultry,
permeability fish, meat
Thyroid Seafood,
Goiter, Cretinism,
Iodine hormones Seaweeds,
Myxedema
production Iodized salt
Fluid and
D: Alkalosis, Fluid
electrolyte
Chlorine Table salt and electrolytes
balance, Acid-
imbalance
base balance
Potassium Water balance Grains, meats, Arrhythymias,

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in cells, protein vegetables, milk mental
synthesis, heart confussion,
contractility muscle weakness
D: Anemia,
Liver, oysters, lethargy
Hemoglobin
Iron leafy vegetables,
formation T: Hemosiderosis,
apricots
Hemochromatosis
Fluid balance,
acid-base Processed foods,
balance, condiments, D: Dehydration,
Sodium
passage of celery, carrots, T: Edema
materials canned foods
through cells
D:
Bone formation, Green leafy Hypomagnesemic
nerve vegetables, tetany, Renal
transmission, grains, nuts, disease, growth
Magnesium failure
smooth muscle milk, meat,
relaxation chocolate T: hypotension,
arrythmia
Organ meats, D:
Formation of nuts, cherries, Depigmentation of
Copper hemoglobin. cereals, hair and skin
Integrity of mushroom, T: Wilson’s
myelin sheet leafy veg, meat disease
of nerves
D: low growth,
alopecia, night
Wound blindness, white
healing, Grains, meats, cell defect
Zinc present in milk, eggs,
RNA, cellular liver,nuts,oyster T: nausea/
functions vomiting, diarrhea,
Abdominal
cramps, fever
5. Vitamins: Fat-soluble vitamins A, D, E and K and also water-soluble vitamins

C and B group are found in foods. These are needed for growth, normal
function of the body and normal body processes.
FAT SOLUBLE VITAMINS

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Vitamins Functions Sources Health Effects
D: Night
Beta carotene, blindness, skin
liver, egg yolk, infection, eye
cream, milk lesion, retarded
Visual cycle, margarine, growth
growth and bone yellow fruits, and ulcerations,
A
development, orange and
(Retinol) T: Headache,
reproduction, green leafy
epithelial tissue vegetables vomiting, coarse
(carrots, squash, sparse hair,
peaches), butter, swollen long
cheese. bone, cessation
of menstruation
D: Rickets, poor
Fish oils, fortifies bone growth,
Calcification of milk and dairy tetany
D bones products, egg
(Calciferol) Absorption of yolks, sunlight’s T: renal damage
Ca, Phosphorus irradiation of Hypercalcemia,
body cholesterol. weight loss,
diarrhea, nausea
Antioxidant Green leafy D: Hemolysis of

Growth vegetables, fats, RBC, increased
E
oils, liver, grains, and decrease of
(Tocopherol)
nuts, egg yolk, excretion of
butter, milk creatinine
D: hemorrhagic
disease in
newborn,
Dark green delayed blood
K Blood clotting leaves, egg yolk, clotting
(Phylloquinone,
legumes, tubers,
menadione) T: vomiting,
tomatoes
hemolysis,
albuminuria,
kennicterus
WATER SOLUBLE VITAMINS
Vitamins Functions Primary Clinical

sources manifestation
s

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Liver, orange D: Anemia,
Folic Acid RBC formation juices, green neural tube
leafy vegetables defect
D: Pernicious
Cobalamine Nerve function, anemia
Meat, milk, eggs
(B12) RBC formation T: Masks Vit B
deficiency
Ascorbic acid Collagen D: Scurvy, body

Fruits esp. citrus,
(Vitamin C) Synthesis, weakness, lack of
vegetables,
antioxidant, appetite,
tomatoes.
wound healing irritability.
Vitamin B Complex
A group of water-soluble vitamins that need to be continually replaced
because of their short life. It consists of vitamins B1, B6, B12, niacin, panthotenic
acid, folic acid and biotin.
Vitamin B Complex
Group I: Classic Disease Factors
Clinical
Primary
Vitamins Functions manifestation
sources
s
Lean pork,
D: Beriberi,
Thiamine Carbohydrate pork liver,
retarded growth,
(B1) metabolism shellfish,
poor reflexes
legumes
Animal sources
– cheese, milk,
eggs, liver
Protein, fat and D: Ariboflavinosis
Riboflavin carbohydrate Plant sources
(B2) metabolism – whole grains,
legumes, leafy
green
vegetables,
seaweeds
Niacin Energy metabolism, Animal sources D: Anorexia,

(Nicotinic acid) fatty acid synthesis/ – liver, Pellagra
oxidation, protein glandular T: Hypermotility,
synthesis/catabolism organs, lean

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meats, fish and
poultry, milk
and cheese,
eggs Paralysis in the
Plant sources respiratory
– legumes, center, stomach
nuts, whole acidity
grains,
enriched
cereals
Group II: More Recently Discovered Coenzyme Factors
Vegetable oils
D: None in adults
Pyridoxine of corn,
Coenzyme that Poor growth,
(B6) cottonseed,
functions in food anemia, and
linseed, olive,
metabolism irritability in
peanut, wheat
infants
germ
Integrity of the CNS, D: Insomnia,

Liver, meats,
Pantothenic protein, fat and muscle cramps,
eggs, milk,
acid carbohydrate tingling sensation
cheese
metabolism of extremities
Converts pyruvic
Lipoic acid acid into acetyl
CoA
Liver,
molasses,
Biotin CO2 fixation
whole grains,
nuts
Group III: Cell Growth and Blood-forming Factors
Liver, kidney
DNA and RNA D: Megaloblastic
Folic acid beans, lima
synthesis anemia, glossitis
beans
D: Pernicious
Cobalamin anemia,
Myelin formation Animal protein
(B12) Demyelination of
large fibers
Group IV: Other Related Factors (pseudo-vitamins)

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Meat
Lipotropic agent
extractives,
Inositol For transport and
brain, fruits,
metabolism of fats
legumes, nuts
Mobilizes fat, helps

Choline in nerve Egg yolk D: Fatty livers
transmission
6. Water:
 Is an inorganic molecule consisting of two atoms of hydrogen bonded to
one atom of oxygen
 Water is solid below 0 degrees centigrade at a pressure of 1 atmosphere
and vaporizes above 100 degrees centigrade
Functions:
1. Water is a universal solvent
2. Chemical reaction requires water. It serves as a catalyst in many
biological reactions especially involving digestion and aids in absorption
and circulation.
3. It is a vital component of tissues, muscles, glycogen, and is vital for
growth.
4. Acts as lubricant of the joints and the viscera in the abdominal cavity.
5. Regulator of body temperature through the ability to conduct heat.
WATER INTAKE
 The amount of water needed by the body may be met by a direct intake of
water. Water ingested as such or from water bound with foods and from
metabolic water, which is a result of oxidation of food stuff in the body.
WATER OUTPUT
 Water leaves the body through several channels such as through the skin,
an insensible perspiration; through the lungs as water vapor in the expired
air; through the gastrointestinal tract as feces; and through the kidneys as
urine. Water may also be lost together with the electrolytes through tears,
stomach, suction, breathing, vomiting, bleeding, perspiration, drainage from
burns, and discharge from ulcer, skin diseases and injured or burned
areas.
Food sources:
 Water
 Beverages
 Fruits and vegetables – contain 90% water
 Meats and cheeses – contains at least 50% water
 End product of metabolism of CHON, CHO, fats
Health effects:

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 Over hydration or water intoxication.
Sodium is lost when large amount of water is lost in the body caused by
high environmental temperature. This causes the brain to signal a need for
increased water. If water intake is increased without the increase intake of sodium,
water intoxication results. Muscle cramps, weakness or drop in blood pressure
may be manifested by the victims.
This may also arise if too much fluid is given intravenously. If the intake of
water exceeds the maximum rate of urine flow, the cells and tissues become
water-logged and diluted, resulting to anorexia, vomiting and if it occurs in the
brain it may result to convulsion, coma and even death.
 Dehydration - This condition would be serious if the loss is about 10% of

the total body water and fatal if the loss is from 20% to 22%. Critical in
babies, electrolytes are also lost with water, and the skin becomes loose
and inelastic.
PROCESS OF METABOLISM
METABOLISM is the chemical reaction involved in maintaining the living state
of cells and organisms. It is linked to nutrition and the availability of nutrients.
Bioenergetics describes the biochemical or metabolic pathways by which the cell
ultimately obtains energy. One of the vital components of metabolism is energy
formation.
CATEGORIES
CATABOLISM the breakdown of molecules to obtain energy.
ANABOLISM the synthesis of all compounds needed by the cells.
NUTRITION, METABOLISM AND ENERGY

Nutrition is the key to metabolism. The pathways of metabolism rely upon the
nutrients that they breakdown in order to produce energy. This energy in return is
required by the body to produce new proteins, nucleic acids (DNA, RNA) among
other nutrients. Nutrients in relation to metabolism include bodily requirement for
various substances, individual functions of the body, amount needed, and the level
below which poor health results among the others.
Essential nutrients supply energy (calories) and provide the necessary
chemicals which the body itself cannot produce. Food provides a variety of
substances that are essential for the building, upkeep and repair of body tissues, and
for the efficient functioning of the body. The diet needs important nutrients like
carbon, hydrogen, oxygen, nitrogen, phosphorus, sulfur and around 20 other
inorganic elements. The major elements are provided by the carbohydrates, lipids
and protein. In addition, vitamins, mineral and water are essential.

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CARBOHYDRATES IN METABOLISM
There are forms of carbohydrates in foods: starch, sugar and cellulose (fiber).
Starches and sugar are the major sources of energy for humans. Fibers provide bulk
in diet. Body tissues rely on glucose for all activities. Carbohydrates and sugars
produce glucose by digestion or metabolism.
The overall reaction for the burning of glucose is written as:
C6H12O6 + 6 O2 6 CO2 + 6 H2O+ energy
Most people consume half of their diet from carbohydrates such as dairy,
grains and starchy vegetables.
PROTEINS IN METABOLISM
Proteins are the main tissue builders of the body. Proteins aid in cell structure
functions and hemoglobin formation to carry oxygen and enzymes in the execution of
vital reactions and numerous other functions of the body. Proteins are very important
in supplying nitrogen for DNA and RNA genetic material and energy production.
Proteins are needed for nutrition because they contain amino acids. Among the 20 or
more amino acids, the human body is unable to manufacture 8 which are called
essential amino acids. These includes:
1. Lysine
2. Tryptophan
3. Methionine
4. Leucine
5. Isoleucine
6. Phenylalanine
7. Valine
8. Threonine
Foods with high biologic value are eggs, milk, soybeans, meats, vegetables
and grains.
FAT IN METABOLISM
Fats are concentrated sources of energy. They create as much energy as
either carbohydrates or protein on a weight basis.
Functions:
1. To help form cellular structure
2. To form a protective cushion and insulation around vital organs
3. To help absorb fat soluble vitamins
4. To provide a reserve storage of energy
Essential fatty acids are unsaturated fatty acids that include linoleic, linolenic,
and arachidonic acids. These are needed to be taken as part of one’s diet.
Saturated fats along cholesterol, have been implicated in arteriosclerosis and
heart disease.

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MINERALS AND VITAMINS IN METABOLISM
The minerals in foods do not contribute directly to energy needs but are
significant as body regulators and play a role in the metabolic pathways of the body.
More than 50 elements are found in the human body. About 25 elements are found
to be essential, since a deficit produces specific deficiency symptoms.
Important Mineral include:
1. Calcium
2. Phosphate
3. Iron
4. Sodium
5. Potassium
6. Chloride ions
7. Copper
8. Cobalt
9. Manganese
10. Zinc
11. Magnesium
12. Fluorine
13. Iodine
Vitamins are important organic compounds that the human body cannot
synthesize by itself and must be present in the diet.
Vitamins important in metabolism include:
1. Vitamin A
2. B2 (Riboflavin)
3. Niacin or nicotinic acid
4. Pantothenic acid
METABOLIC PATHWAYS
The chemical reactions of metabolism are structured into metabolic pathways.
These allow the basic chemicals from nutrition to be changed through a series of
steps into another chemical, by a sequence of enzymes.
Enzymes are vital to metabolism because they allow organisms to drive
desirable reactions that require energy. These reactions are also coupled with those
that release energy. As enzymes act as catalysts, they permit these reactions to
proceed efficiently. Enzymes also allow the regulation of metabolic pathways in
response to changes in the cell’s environment or signals from other cells.

18
TOPIC 2
BASIC TOOLS IN NUTRITION, STANDARDS, GUIDELINES AND NUTRIENT

RECOMMENDATION
Introduction
Every 5 years since 1980, a new edition of the Dietary Guidelines for
Americans has been published. Its goal is to make recommendations about the
components of a healthy and nutritionally adequate diet to help promote health
and prevent chronic disease for current and future generations. Although many of
its recommendations have remained relatively consistent over time, the Dietary
Guidelines has evolved as scientific knowledge has grown. These advancements
have provided a greater understanding of, and focus on, the importance of healthy
eating patterns as a whole, and how foods and beverages act synergistically to
affect health. Therefore, healthy eating pattern is a focus of the 2015-2020 Dietary
Guidelines.

19
Each day we need a number of nutrients to enable our body to carry out its
activities efficiently. To determine what nutrients, we need each day and how
much, to keep us in good health, a lot of research has been done. The results of
these studies have been used to work out the nutritional requirements.
Learning Outcome
Know the basic tools in nutrition, the Standards and Guidelines and Nutrient
recommendation.
Learning Content
1. What is Dietary Reference Intake?

2. What are the different reference value that comprises
the Dietary Reference Intake?
3. Basic Tools in Nutrition
Dietary Reference Intakes (DRIs) comprise a set of at least four nutrient-

based reference values, each of which has special uses. The reference values,
collectively called the Dietary Reference Intakes (DRIs), include the
Recommended Dietary Allowance (RDA), Adequate Intake (AI), Tolerable Upper
Intake Level (UL), and Estimated Average Requirement (EAR). A requirement is
defined as the lowest continuing intake level of a nutrient that will maintain a
defined level of nutriture in an individual. The chosen criterion of nutritional
adequacy is identified in this topic; note that the criterion may differ for individuals
at different life stages.
Dietary Reference Intakes:
1. Estimated Average Requirements (EAR) - The estimated average
requirement (EAR) is the amount of a nutrient that is estimated to meet
the requirement for a specific criterion of adequacy of half of the healthy
individuals of a specific age, sex, and life-stage.
2. Recommended Dietary Allowances (RDA) - The recommended dietary
allowance (RDA) is the average daily dietary intake level that suffices to
meet the nutrient requirements of nearly all (97–98%) healthy persons of
a specific sex, age, life stage, or physiological condition (such as
pregnancy or lactation). The RDA is a nutrient intake goal for planning the
diets of individuals.
3. Adequate Intake (AI) – Adequate Intake is the recommended average
daily intake level based on observed or experimentally determined
approximations of estimates of nutrient intake by a group or groups of
apparently healthy people that are assumed to be adequate – used when
an RDA cannot be determined.

20
4. Tolerance Upper Intake Level (UL) – the Tolerance Upper Intake Level
is defined as the highest level of daily intake that is likely to pose adverse
health effects in most human individuals.
Basic tools in nutrition are devised to aid in the planning, procuring,

preparing, serving, consuming meals for both normal and therapeutic diets of each
individual group. The proper use of these dietary guide/tools assures that
adequate diet is served according to an individual’s or group’s physical state and
eed.
Dietary Guidelines and Food Guides:
1. USDA Food Guide
The Food Guide Pyramid is an outline of what to eat each day based on the
Dietary Guidelines. It provides a general guide that lets you choose a healthy
diet that is right for you. The pyramid calls for eating a variety of foods to get
the nutrients you need and at the same time, the right amount of calories to
maintaining healthy and physically wellbeing.
MyPyramid Food Guidance System. (U.S. Department of Agriculture, Center for Nutrition Policy andPromotions .

21
MyPyramid has six color bands representing five food groups and oils. The bands
are wider at the bottom, representing foods with little or no solid fats, added
sugars, or caloric sweeteners, and become narrower at the top, indicating that the
foods that contain fats and sugars should be limited. The five food groups
represented along with oils have not changed. They are the following:
o Grains—bread, cereal, rice, and pasta group
o Vegetable group
o Fruit group
o Milk, yogurt, and cheese group
o Meat, poultry, fish, dry beans, eggs, and nuts group
o Fats, oils, and sweets group
My Plate
2. Food Exchange
List
Exchange lists provide a way of grouping foods together to help people on
special diets stay on track. A person can exchange, trade, or substitute
a food serving in one group for another food serving in the same group.
These lists put foods into six groups: starch/bread, meat, vegetables, fruit, milk,
and fats. It is a diet prescription (involves conversion of the # of gm) translated
into food exchanges.
Food exchange list is the Basic tool of nutrition in meal planning
8 Grouping in the exchange list:
1. Vegetable exchanges
2. Fruit exchanges
3. Milk exchanges
4. Rice exchanges
5. Meat and fish exchange
6. Fat exchanges
7. Alcoholic beverages

22
8. Sugar beverages
3. Food Labels
Food labelling provides information regarding food product’s common name,

name and address of manufacturer, net contents in terms of weight, measure
or count, nutrient claim, ingredients, and health claims.
4. Nutrient Guidelines for Filipino.
The Nutritional Guidelines for Filipinos (NGF) is a set of dietary

guidelines based on the eating pattern, lifestyle, and health status of Filipinos. The
NGF contains all the nutrition messages to healthy living for all age groups from
infants to adults, pregnant and lactating women, and the elderly.
a. Eat a variety of food every day to get.

b. Breast fed infants from birth to 4-6 months.
c. Maintain children’s normal growth with proper diet.
d. Consume fish, lean meat, poultry or dried beans.
e. Eat more vegetables, fruits and root crops.
f. Eat foods cooked in edible cooking oil.
g. Consume milk or milk products.
h. Use iodize salt.
i. Eat clean and safe foods.
j. Exercise regularly, do not smoke, avoid alcohol beverages.
Reference

23
Maria Lourdes Cruz-Caudal (2019), Basic Nutrition and Diet Therapy, A textbook
for Allied Health, 2nd Edition, C & E Publishing, Inc.
Ruth A. Roth (2011), Nutrition and Diet Therapy, 10th Edition, Delmar, New York
Medicine LibreTextsLibraries (2020). Understanding Dietary Reference Intake.

Retrieved from: https://med.libretexts.org/Bookshelves/Nutrition/Book
%3A_An_Introduction_to_Nutrition_(Zimmerman)/
02%3A_Achieving_a_Healthy_Diet/
2.07%3A_Understanding_Dietary_Reference_Intakes_(DRI)
Dietary Guidelines 2015-2020. Retrieved from: https://health.gov/our-work/food-

nutrition/2015-2020-dietary-guidelines/guidelines/introduction/

24
TOPIC 3
NUTRITION CARE PROCESS (ADIME Process)
Introduction
The Nutrition Care Process (NCP) is systematic approach to providing high

quality nutrition care. The NCP consist of four distinct, interrelated steps:
 Nutritional Assessment – the nurse collects documents
 Nutrition diagnosis – data collected during nutrition assessment guides the
nurse in selection of the appropriate nutrition diagnosis
 Nutrition intervention – the nurse selects the nutrition interventions that will
be directed to the root cause of the nutrition problem and aimed to
alleviating the signs and symptoms of each diagnosis
 Nutrition Monitoring and Evaluation – the final step of the process is
monitoring and evaluation, which the nurse uses to determine if the client
has achieved, or is making progress toward, the planned goal.
Learning Outcome
At the end of the lesson, the student should be able to:
Formulate a Nursing Care Process using the ADIME process.
Learning Content
1. Assessment of Nutritional Status

2. Nutrition Diagnosis and Plan of Care
3. Nutrition Intervention
4. Monitoring Nutritional Status
5. Evaluation
Assessment of Nutritional Status

Nutritional status or nutriture is the degree to which the individual’s need for
nutrients is being met by the food the persons eats. It is the state of balance in the
individual between the nutrient intake and the nutrient expenditure or need. The
evaluation of the nutritional status involves examination of the individual’s physical
condition, growth and development, behavior, blood and tissue levels of nutrients,
and the quality and quantity of the nutrient intake. In a thorough nutritional status

25
assessment, all of the following aspects are considered. Nutritional history,
physical assessment and other sources of data
Nutritional history
1. Dietary intake data. Observation of food intake is the most accurate
method of dietary intake assessment. It requires knowing the amount and
kind of food presented to the person and the record of the amount actually
eaten.
2. Food Diary. The food diary is record of what you eat and drink each day.
This method involves time, understanding, and motivation on the part of
the patient and client. The subject is asked to write down everything
he/she eats or drinks for a certain time period. Three days, particularly
two weekdays and one weekend day, have been found to be a
representative time period for more people.
3. Food Frequency. Food frequency questionnaires (FFQs) are designed
to assess habitual diet by asking about the frequency with which food
items or specific food groups are consumed over a reference period. This
method can be used to gather information on a wide range of foods or can
be designed to be shorter and focus on foods rich in a specific nutrient or
on a particular group of foods e.g. fruit and vegetables.
4. 24-hour Recall. A 24-hour dietary recall (24HR) is a structured interview
by a dietician/nutritionist or a nurse experienced in dietary interviewing to
capture detailed information about all foods and beverages (and possibly
dietary supplements) consumed by the respondent in the past 24 hours,
most commonly, from midnight to midnight the previous day.
Physical Assessment
Anthropometric Measurement. Anthropometric is the measurement of variations
of physical dimensions and gross composition of the human body at different age
levels and degrees of nutrition.
Weight (for age)
 Uses weighing scales such as beam balance scales or clinical scales
which are ideal or a bar scale in absence of the scales initially mentioned.
 Assess body mass
 A sensitive indicator of current nutritional status
 Uses reference values for age or height or both of population
 Key anthropometric measurement
Advantages
 It is a simple as it is commonly used.
 Weight can be determined fairly accurately by personnel with minimum
training
Disadvantages
 It depends on accurate age determination (which is sometimes difficult)
 Interpretation on individual basis may be complicated by edema

26
 It does not distinguish between acute and chronic malnutrition but useful
when serial measurements are taken: useful also in children less than 1
year old.
Body Mass Index (BMI)
 is the ration of weight and height
 it is used to identify lean, overweight or obese individuals
Formula: BMI = Weight in kg

(Height in meters)2
Height (for age)

 Assess linear dimensions of the following: legs, pelvis, spine, and the skull
 Less sensitive and generally an indicator of past nutritional status
(chronicity of malnutrition)
 Uses statiometer, anthropometric steel rods fixed accurately and vertically
to the wall, for infants (below 2 years), an infantometer is used
Advantages
 Inexpensive tools may be used
 It is simple to do in the field
Disadvantages
 It is less sensitive to change in growth rate
 Errors in measurement are easily made
 Other factors play a role
Weight for height/length
 Most accurate indicator of present of current state of nutrition
 An expression of leanness or wasting
Advantages
 It is nearly independent of age from 1 to 10 years
 It is probably independent of ethnic group especially in ages of 1 to 5
years
Disadvantages
 Height for age is a disadvantage
Skin fold thickness
 Assess body composition, fat distribution, and hence reserve calories
 Must be compared against standards for age and sex at all age.
 Use a reliable caliper
Mid-arm Circumference

27
 Is the circumference of the left upper arm, measured at the mid-point
between the tip of the shoulder and the tip of the elbow (olecranon process
and the acromium). MUAC is used for the assessment of nutritional status.
Other Sources of Data
Malnutrition Universal Screening Tool (MUST) - MUST' is a five-step screening

tool to identify adults, who are malnourished, at risk of malnutrition (undernutrition),
or obese. It also includes management guidelines which can be used to develop a
care plan. It is for use in hospitals, community and other care settings and can be
used by all care workers.
Subjective global assessment (SGA) evaluates whether an individual is
appropriately nourished i.e. whether nutrient intake and absorption meet the
nutrient requirements of an individual. When there is an imbalance among nutrient
intake, absorption and requirement then malnutrition occurs.
Mini Nutritional Assessment (MNA) is a validated nutrition
screening and assessment tool that can identify geriatric patients age 65 and
above who are malnourished or at risk of malnutrition. The MNA may be used in
elderly patients who are fed mashed or pureed foods. Elderly patients with
chewing or swallowing disorders (i.e. those requiring mashed or pureed foods) are
at risk of malnutrition, and evaluating their nutritional status with the MNA and
initiating nutritional therapy is very important.
Geriatric nutritional risk index (GNRI) is a widely used, simple, and well-
established tool to assess nutritional risk. The purpose of this study was to assess
the association between GNRI and all-cause mortality in diabetic foot ulcers
patients undergoing minor or major amputations
Terminology for nutrition assessment is organized in five domains

(categories):
Food/ Anthropometric Medical Nutrition- Client

Nutrition- Measurements Tests, and Focused History
Related Procedures Physical
History Findings
Food and Height, weight, Lab data Physical Personal

nutrient intake, body mass index (e.g., appearance, history,
food and (BMI), growth electrolytes, muscle and fat medical/he
nutrient pattern glucose) and wasting, alth/family
administration, indices/percentile tests (eg, swallow history,
medication, ranks, and weight gastric function, treatments
complementary/ history emptying appetite, and and
alternative time, resting affect complemen

28
medicine use,
knowledge/belie tary/alterna
fs, food and metabolic tive
supplies rate) medicine
availability, use, and
physical activity, social
nutrition quality history
of life
Examples:
“inadequate energy intake”, “overweight/obesity”, “food and nutrition related
knowledge deficit”, and “limited access to food or water”
Nutrition Diagnosis and Plan of Care
Nutrition Diagnosis is a nutrition and dietetics practitioner’s or a trained nurse’s

identification and labeling of an existing nutrition problem(s) that the practitioner is
responsible for treating. Nutrition diagnoses (eg, inconsistent carbohydrate intake)
are different from medical diagnoses (eg, diabetes).
Nutrition Problems and / or needs

Terminology for Nutrition Diagnosis is organized in three domains
(categories):
Intake Clinical Behavioral/

environmental
Too much or too little of a Knowledge, attitudes,

Nutrition problems that
food or nutrient beliefs, physical
relate to medical or
compared to actual or environment, access to
physical conditions
estimated needs food, or food safety
Note:
 Nutrition diagnosis is documented by writing a PES statement.
 The format for the PES statement is: “Nutrition problem label related to
___________ as evidenced by _____________.”
The format for each PES statement is “[Nutrition diagnosis term (problem)] related
to [etiology] as evidenced by [signs/symptoms].

29
Medical Diagnosis vs Nutritional
Medical Diagnosis Nutritional Diagnosis
Diabetes Excessive CHO intake related to evening visits to

fastfood as evidence by diet hx and high blood glucose
Liver failure Altered gastrointestinal function related to cirrhosis of

the liver as evidenced by results of indirect calorimetry
Obesity Excessive energy intake related to lack of access to

healthy food choices as evidenced by diet history and
BMI of 35
Anorexia nervosa Inappropriate food choices related to history of anorexia

nervosa and self limiting behavior as evidence by diet
history and weight loss of 5 lbs
Nutrition Intervention
A nutrition intervention is a purposely planned action(s) designed with the intent of
changing a nutrition-related behavior, risk factor, environmental condition, or
aspect of health status to resolve or improve the identified nutrition diagnosis(es)
or nutrition problem(s). Nutrition interventions are selected and tailored to the client
needs by planning and implementing appropriate interventions. Nutrition
intervention is accomplished in two distinct and interrelated steps: planning and
implementing.
Food and Nutrient administration
1. Oral nutrition – supplements (sterile liquids, semi solids or powders)
which provide macro and micro nutrients. They are widely used within the
acute and community settings for individuals who are unable to meet their
nutritional requirements through oral diet
2. Enteral nutrition - delivery of nutrients to a function GI tract in client who
have impaired ability to eat, chew, or swallow foods
3. Short-term Enteral Access - this route is intended for patients with mild
to moderate nutritional deficiency. E.g. Peripheral Vein Route
4. Long-term Enteral Access – this is a nutritional support of 2 weeks for
patients who cannot be fed through GIT. E.g.Parenteral
Hyperalimentation
5. Parenteral Nutrition - Refers to a method of feeding clients who do not
have a functioning GI tract as a result of clinical disease (malabsorption),
surgical intervention, traumas/stress, and/or malignancies;

30
Planning the nutrition intervention involves:
1. Prioritizing nutrition interventions based on urgency, impact, and available
resources
2. Collaborating with the client to identify goals of the intervention for each
diagnosis
3. Writing a nutrition prescription based on a client’s customized
recommended dietary intake of energy and/or selected food or nutrients
based on current reference standards and dietary guidelines and a client’s
health condition and nutrition diagnosis
4. Selecting specific nutrition intervention strategies that are focused on the
etiology of the problem and that are known to be effective based on best
current knowledge and evidence
5. Defining the time and frequency of care, including intensity, duration, and
follow-up Implementation is the action phase and involves:
6. Collaborating with the client to carry out the plan of care
7. Communicating the nutrition care plan
8. Modifying the plan of care as needed
9. Following up and verifying that the plan is being implemented
10. Revising strategies based on changes in condition or response to
intervention
Implementation is the action phase and involves:
1. Collaborating with the client to carry out the plan of care
2. Communicating the nutrition care plan
3. Modifying the plan of care as needed
4. Following up and verifying that the plan is being implemented
5. Revising strategies based on changes in condition or response to
intervention
Terminology for Nutrition Intervention is organized in five domains
(categories):
Food and/or Nutrition Nutrition Coordination Population

Nutrient Education Counseling of Nutrition Based
Delivery Care Nutrition
Action
Customized Formal A supportive Consultation Interventions

approach for process to process, with, referral designed to
food/nutrient instruct or characterized to, or improve the
provision. train a by a coordination nutritional

31
client in a
collaborative
skill or to
counselor-
impart
client
knowledge of nutrition
relationship,
to help care with
to establish
clients other health
food,
voluntarily care
nutrition and
manage or providers,
physical
modify institutions,
activity
food, or agencies well-being of
priorities,
nutrition, that can a population.
goals, and
and assist in
action plans
physical treating or
that
activity managing
acknowledge
choices nutrition-
and foster
and related
responsibility
behavior to problems
for self-care
maintain or
to treat an
improve
existing
health.
Monitoring and Evaluation of Nutritional Status

 To determine and measure the amount of progress made for the nutrition
intervention and whether the nutrition related goals/expected outcomes
are being met.
 To provide evidence if the intervention is/has been effectively in changing
the behavior or status of the patient.
 To evaluate nutrition care outcome.
 To create a standardized language for nutrition intervention.
The aim is to promote more uniformity within the dietetics profession in assessing
the effectiveness of nutrition intervention. Nutrition Monitoring and Evaluation
identifies outcomes/indicators relevant to the diagnosis and nutrition intervention
plans and goals.
Terminology for Nutrition Monitoring and Evaluation is organized in four

domains (categories):
Food/Nutrition-Related Anthropometric Biochemical Nutrition-

History Outcomes Measurement Data, Medical Focused
Outcomes Tests, and Physical
Procedure Finding
Outcomes Outcomes

32
Food and nutrient intake, Height, weight, Lab data (eg., Physical
food and nutrient body mass index electrolytes, appearance,
administration, (BMI), growth glucose) and muscle and fat
medication, pattern tests (eg, wasting,
complementary/alternativ indices/percentile gastric swallow
e medicine use, ranks, and weight emptying time, function,
knowledge/beliefs, food history resting appetite, and
and supplies availability, metabolic rate) affect
physical activity, nutrition
quality of life
References
eNCP 2019 edition Committee and Expert Reviewers (2020). Retrieved Aug. 3, 2020
https://www.ncpro.org/nutrition-care-process
DAPA Measurement Toolkit. Retrieved from:

https://dapa-toolkit.mrc.ac.uk/diet/subjective-methods/food-frequency-questionnaire

33
TOPIC 4
NUTRITION ACROSS THE LIFESPAN
Introduction
When it comes to staying healthy, we often are given advice on why you
shouldn’t do some things — smoke, consume excessive amounts of alcohol,
remain sedentary — and why you should do others — like eat right. But what is
generally lacking in this advice is the “how” and “what.” How should someone who
is, let’s say in their thirties or forties, be eating compared to someone who’s in their
sixties or seventies? What choices should these two age groups be making in
terms of nutrition to promote overall health? Or does “eating right” mean the same
thing, regardless of age?
These are the questions we’ve decided to tackle to help you navigate good
nutrition throughout your lifespan, including how making better choices at age 30
or 40 will help keep you healthy at 60, 70 and beyond. Remember: It’s never too
late to change dietary habits to achieve better health.
Learning Outcome
Identify the nutritional needs of each individual across the lifespan
Learning Content
1. Identify the nutritional requirements for pregnant and lactating

mothers.
2. Identify the nutritional requirements for infants.
3. Identify the nutritional needs of a child.
4. Identify the nutritional needs of an adolescent.
5. Identify the food need of the aging and the aged.
NUTRITION IN PREGNANCY
Pregnancy or gestation is the period when the fertilized ovum implants in the
uterus, undergoes differentiation, and grows until it can support extra uttering life.
Human pregnancy lasts for a period of 266 to 280 days (37-40 week). It consist of

34
3 trimesters: first, second, and third trimester which correspond to the three main
phases: implantation, organogenesis, and growth.

35
Calorie Allowances
During the course of pregnancy, the total energy cost of storage plus
maintenance (additional work for maternal heart and uterus and a steady rise in
basal metabolism) amounts to approximately 80,000 kcal. The energy cost of
pregnancy then is about 300kcal per day. The energy intake should be 36 kcal per
Weight Gain
The components of maternal weight gain is shown below.
Tissue Weight
(Pounds)
Fetus 7.5
Uterus 2.0
Placenta 1.5
Amniotic fluid 2.0
Blood volume 3.0
Extracellular fluid accretion 2.0
Breast tissue 1.0
Fat 9.0
TOTAL 28.0
The weight of the blood volume and the enlargement of the reproductive organs
are fairly constant. If the weight gain is less than the weight is less than the weight
of the maternal components in pregnancy, the growth of the fetus calls on the
reserve of the mother. Although weight gain varies, it is generally agreed that the
normal curve of weight gain is-sigmoid in shape. A small weight gain is observed
during the first trimester. A more rapid weight gain happens in the second
trimester, and slower weight gain is recorded during the third trimester. An average
weight gain during pregnancy is 24 lbs which is commensurate with a better-than-
average course and outcome of pregnancy. A gain of 1.5 to 3.0 lbs during the first
trimester and a gain of o.8 lb per week during the remainder of the pregnancy
should be the guideline. The pattern of weight gain is more important than the total
amount gained.
A sudden gain in weight after the 2oth week of pregnancy may indicate water
retention and the possible onset of pre-eclampsia.

36
Maternal Weight Gain
A. Underweight
a. High risk of having low-birth weight infants
b. Higher rates of pre-term deaths and infant deaths
B. Overweight and Obese

a. High risk of complications like hypertension, gestational diabetes, and
postpartum infections
b. Complications of labor and delivery
c. Increased likelihood of a difficult labor and delivery, birth trauma, and
cesarean section for large babies
d. Doubled risks of neural tube detects
Protein Allowances
The additional allowance of protein during pregnancy takes into account the
increased nitrogen content of the fetus and its membranes, maternal tissues, and
the added protection of the mother against complications. It has been estimated
that about 950 grams are deposited during the last 6 months of gestation. The
FAO/WHO recommends an additional 9 g of protein per day for the latter part of
pregnancy. Adjusting this for net protein utilization (NPU) of 63, an additional
allowance of a Filipino pregnant woman becomes 14 g/day or a total of 68 g/day
tor the adult pregnant woman. Pregnant adolescents should receive both the
protein allowance for their non-pregnant body weight (59 g for those aged 16-19)
and an additional 14 g/day for the pregnancy totaling 73 g.
The protein needs of a normal woman are 1.1 g/kg BW; a normal pregnant
woman requires an additional 9.5 g/day or a total of 900-950g tor the 9 months
gestation period.
Reasons for additional protein:
1. To provide for the storage of nitrogen
2. To protect the mother against many of the complications of pregnancy
3. For growth of the woman’s uterus, placenta, and associated tissues.
4. To meet the needs for the fetal growth and repair
5. For the growth of the mammary tissue
6. For the hormonal preparation for lactation
Calcium Allowances

37
Some calcium and phosphorus deposition takes place early in pregnancy,
but the amounts are small.
During the latter half of pregnancy, the intake and retention of calcium are
considerably increased. The quantity retained is more than what can be accounted
for by the fetal utilization, and it perhaps represents the establishment of a reserve
supply which may be availed of during subsequent emergencies.
An adequate supply of vitamin D is essential in the use of calcium and
phosphorus needed to calcify the fetal bones and teeth. The diet of the pregnant
woman is inadequate in calcium, she will have to sacrifice the calcium of her bones
in favor of the developing fetus. lt has been shown that the calcium and
phosphorus retained in fetus during the last two months of pregnancy are 65% and
64%, respectively, of the total body content of the full-term fetus. To satisfy these
additional needs, the daily intake of calcium must be increased from o.5 to 0.9 to
that of the non-pregnant adult's daily allowance Phosphorus is less likely to be
deficient in the average diet. If the protein requirements and other dietary
principles are observed, the need for phosphorus will be met.
Iron Allowances
At least 700 to 1,000 mg of iron must be absorbed and utilized by the
mother throughout her pregnancy. Of this total, about 24O mg is spared by the
cessation of the menstrual flow. The remainder must be made available from the
diet. The rate of absorption is increased, therefore, in the third trimester when the
needs of the fetus are highest.
lodine Allowances
Iodine is especially important during pregnancy to meet the needs for fetal
development. An inadequate intake of iodine may result in goiter in the mother or
the child. The increased need for iodine can be met by the regular use of iodized
salt in food.
Vitamin Allowances
Thiamine and niacin allowances are increased in proportion to the calorie
increase while riboflavin allowances are increased according to the higher protein
level. The need for vitamin D is increased during pregnancy to make easier the
utilization of greater amounts of calcium and phosphorus. Ascorbic acid, vital in
tissue structure, is required in considerably increased amounts.
Vitamin A is important in the epithelial cells during organogenesis and is
necessary to ensure good vision. Folic acid and vitamin B12 are important in the
synthesis of RBC. Vitamin B6 or pyridoxine requirement has been observed to be
greater during pregnancy. It has been found to have much value in preventing
severe nausea and vomiting associated with childbearing

38
During the early days of life, the infant often has low blood prothrombin
levels until intestinal synthesis of vitamin K is fully established. Vitamin K may be
given to the mother at 2 mg to 5 mg parenterally before the birth of the baby to
stabilize the prothrombin level of the infant until synthesis can take place.
Otherwise 1 mg to 2 mg can be given to the infant after birth. The use of vitamin K
supplement during the course of pregnancy is, therefore, not necessary.
Food Allowances
1. One ounce or 30got meat or its equivalent and an extra pint of milk to the
normal diet
2. Daily consumption of whole-grain cereals; enriched bread; rice; leafy
green and yellow vegetables; and fresh and dried fruits
3. Liver at least once a week
4. Egg in the daily diet
5. Fortified milk with vitamin D or fish liver oil
6. Six to 8 glasses of water daily
Complications of Pregnancy and Possible Dietary Modifications

1. Rapid weight gain and loss
2. Toxemia - increase of HBV protein, sources of iron, calcium and minerals.
Salt intake is restricted
3. Anemia – ascorbic acid-rich foods in meals
4. Diabetes – rigid control of maternal blood glucose
5. Constipation – lots of fruits, vegetables, fluid and regular exercise
6. Socio-economic and cultural factors
7. Alcohol, caffeine, nicotine
NUTRITION IN LACTATION
The preparation for assuring an adequate supply of good quality breast milk must
begin at the onset of pregnancy. Most of the dietary essentials are increased over
and above the requirements during pregnancy to meet the demands of milk
production, namely calories, proteins, calcium, vitamin A, thiamin, riboflavin, niacin,
and ascorbic acid.
Calorie Allowance

39
The actual mechanism involves in the production of milk does not demand a
great expenditure of energy. The additional food necessary for the maternal
organism to produce and secrete milk is almost negligible. The chief concern
during lactation is the loss of the food and the storage of a certain of food which
cannot be entirely accounted for by the chemical composition of the milk. Also,
extra calories may be needed for a additional activity necessitated by the care of
the infant.
The extra energy required for lactation depends on the amount of milk
produced. The food requirements are not uniform during the entire period of
lactation; nevertheless, they depend on the demands of the infant. It is generally
suggested that the extra food calories should be about twice those secreted in the
milk of approximately 700 to 1,500 calories of food tor 500 to 1,000 mL of the milk,
The FNRI recommends an increase by 1,000 calories above the normal
requirement for an average production of 850 mL of milk, with an energy value of
about 600 calories. Human milk is approximately 0.70 calories per mL or
approximately 20 calories per ounce, and it contains 1.2 g protein per 100 mL.
Protein Allowances
An adequate protein intake of HBV foods during pregnancy is essential in
preparation for lactation.
The need for protein is greatest when lactation has reached its maximum,
but it is a need which should be anticipated and planned for during pregnancy.
Lactation makes large demands on the human stores, The food intake of a
nursing mother must contain sufficient proteins to supply both the maternal needs
and the essential amino acids to be transferred through her breast for the baby's
growth. Additional protein in the diet tends to increase the yield of breast milk while
a decrease of protein lowers the amount of milk secreted. If the amount of protein
in the mother's diet does not meet the body maintenance needs and the necessary
protein content of the milk secreted, a loss of maternal body tissues will result.
The average protein allowance for the lactating mother is an additional 20.2
g protein to her normal requirement. In such a case, 20 g factor may be used.
Calcium, Phosphorus, and Vitamin D Allowances

During lactation the demand for calcium and phosphorus is increase above
the requirement of the pregnant woman. The allowance is 1.0g daily tor good milk
production. If the protein requirement and other essentials of the diet are fulfilled
the increased need for phosphorus will be met. The vitamin D requirement of 400
IU remains the same as during pregnancy.
Iron Allowances
Some lactating women tend to be anemic unless the iron allowance in the
diet is increased to the same level as that during pregnancy. During lactation the

40
loss of iron which is considered an annual basis is probably similar to that which is
lost in the menstrual flow.
The baby is born with a relatively large reserve of iron. Since milk is not a
good source of iron, a good allowance of iron in the other's diet during lactation
does not convey additional iron to the ant Nevertheless, iron-rich foods are
essential for the mother's own heath while supplements are included early in the
infanťs diet.
Vitamin Allowances
There is an increased demand tor vitamin A, niacin, riboflavin mine, and
ascorbic acid above the requirements of pregnancy during lactation.
FOOD NEEDS IN LACTATION
Nutritional Requirements
The nutritional requirements in lactation are greater than in pregnancy to ensure
enough supply of milk for the baby.
1. Calories - An addition of 1,000 calories above the normal allowance is needed.

An approximate amount of 120 calories is required to produce 100 mL of milk.
Thus, the daily production of 850 mL of milk will require an additional1,000
calories in the diet. Energy giving foods sources of calories.
2. Protein - An additional 2O g to the normal allowance is needed to compensate

for the protein lost in milk. The conversion of food into milk protein is only 50%
efficient; thus, 2 g of food protein is required to produce needed 1 g of milk
protein. Sources are milk, eggs, animal proteins legumes.
3. Calcium and phosphorus - An increase of 0.5 mg to ha ion normal allowance

is needed to prevent severe depletion of maternal calcium reserve since this is
used for milk production. Sources are milk and milk products, eggs. Etc.
4. Iron - An additional intake is recommended for blood lost parturition, for milk
iron, and basal losses.
5. Vitamin A - An additional 2,000 1U to the normal allowance is needed to

provide the amount of vitamin A secreted in milk. Sources are green leafy and
yellow vegetables, milk, eggs, etc.
6. Fluids – an intake of 8 glasses or more is recommended to increase milk

production.

41
Mother’s milk is the best food for the baby. It is easily digested, economical,
has the right temperature, and is free from harmful bacteria. For the first 3 to 4
days, the milk contains a substance called colostrum. Colostrum has high protein
content, acts as a laxative, and contains antibodies which help resist infection. It
should be given to all newborn infants. A mother who wants to breastfeed her baby
should follow the basic food groups in meal planning. Too much fried foods,
pickles, and highly-seasoned foods and stimulants such as drugs, nicotine,
caffeine, theobromine, morphine, and alcohol should be avoided. Above all, the
mother should exude a calm, happy spirit and live a quiet, contented life. She
should also exercise outdoors in fresh air and do some pleasant work. Finally, she
should have periods of rest and relaxation, both physical and mental.
Factors Affecting Milk Secretion

1. Diet
a. The volume of milk secreted is affected by the diet, but the protein and
calcium compositions are not.
b. Meat and vegetable soups (tahong, tulya, malunggay), milk, and fruit
juices have been referred to as "galactagogues (i.e., milk secretion-
stimulating).
c. Water should not be drunk beyond the level of natural thirst because it
suppresses milk secretion through its action on the pituitary hormone
that regulates milk production.
2. Nutritional State of Mothers

a. Energy-yielding constituents of human milk are maintained at the
expense of the maternal stores while the water-soluble vitamins and
vitamin A are low in poorly nourished mothers.
b. Suffiicient nutrient reserves in the mother's tissues before conception and
during pregnancy influence milk secretion.
c. Malnutrition and illnesses such as cardiac and kidney diseases, anemia,
beriberi, tuberculosis, and infections can lessen the quality and quantity of
milk flow.
3. Emotional and Physical States

a. Attitude affects milk secretion. When the mother frets about the
sufficiency of her milk, about her breast contour, and about being
tied down in her home, the flow of milk stops.
b. A relaxed temperament, pleasant surroundings, lots of rest and good
sleep enhance milk secretion.
4. Suckling

42
a. The presence of the baby and suckling, immediately after delivery,
stimulate the milk-producing glands.
b. As the baby feeds for longer periods of time, the supply of milk increases
in proportion to the body's demands.
c. Increased frequency of nursing is positively associated with infant weight
and lactation period
5. Use of Contraceptives and Drugs
a. Women who use contraceptives like pills while breastfeeding depress milk
flow and the insufficiency of milk triggers the cessation of lactation
(osteria)
b. Most drugs, including alcohol and nicotine from smoking, reach the milk
sometimes in physiologically large doses, thus affecting the quality of milk
secreted.
INFANCY
The term infant refers to a person not more than 12 months of age. A healthy
full-term infant weight 2.7 to 3.2 kg and measures 48 to 50 cm in length. His/her
head circumference average 35 cm. His/her skin is moist, elastic, and not wrinkled.
DIET
Breastfeeding
a. has physiologic and psychologic value for mother and infant
b. meets nutrient needs of early months
c. provides immunity factor and reduces chances for infection
Bottle feeding
a. formula designed to match nutritional ratio of breast milk composition,
water dilution to reduce protein and mineral concentration, added
carbohydrate to increase energy value
b. may meet needs of working mother
c. must be prepared under clean conditions and sterilized to prevent
contamination
NUTRITIONAL REQUIREMENTS
Calories
The calorie requirements of the infant are high because the proportionately
larger skin surface leads to large heat loss. A rapid rate of growth necessitates
considerable storage of energy for the activity of the infant is great. Since the activity

43
of the infant varies even more widely, more than half of the adult, the stated
allowances can serve only as an approximation. Some infants who are relatively
inactive might show excessive weight gains it they receive the recommended daily
allowances while others who are energetic might require more calories than the
levels recommended. The healthy baby, given an appropriate formula without having
it forced upon him, regulates his appetite according to his needs surprisingly well.
During infancy the baby grows faster than at any other time of life and the
calorie requirements per unit of the body weight are high. The needs of the infant
increase from month to month. At birth a baby requires about 350 to 500 calories,
and in one year, from 800 to 1200 calories: 120 calories per kilogram body weight
from the 2nd to the 7th month and 100 calories per kilogram from the 7th to the 12th
month.
The average requirement for growth in the first year is 50 calories per pound
of expected weight, 2/3 of this calorie needs being supplied by the milk and 1/3 by
the added carbohydrates.
Proteins
Allowances of 1.5 to 2.5 gm of protein per kg in the body weight from 0 to 6
months of age, and 1.5 to 2 gm per kg in the weight from6 to 12 months of age are
recommended by the FAO/WHO Expert Group.
In early infancy, milk from the mother, cow or goat comprises the only protein
food. Since the protein of milk contains all the amino acids essential tor growth, the
protein needs of the infant are not automatically met through the provision of
sufficient milk.
One and a half oz. of cow's milk per pound body weight equals 1.5 gm. of
protein per pound, which equals one-tenth of the body weight. An excess of protein
is well tolerated.
Fat
Whole cow's milk contains satisfactory levels of the essential fatty acids,
linoleic and arachidonic acids required by the infant. Low fat milk used for a short
period of time presents no problems since the infant has generous reserves of the
essential fatty acids. When low fat milk is used for a prolonged period of time or
when milk substitutes are used because of allergy, consideration must be given to
the inclusion of the essential fatty acids. Vegetable oils such as corn, soybean and
cottonseed oils are good sources. About 3 to 5 percent of fat is included when no
specific amount is stipulated. If the fats are restricted, a larger amount of protein or
sugar, or both, is required for energy sources. The suitable quantity of fat is supplied
in quantities of milk which furnish the required amounts of proteins. An excess of fat
is not desired.
Carbohydrates

44
An allowance of 1/10 ounce per lb. of body wt. Equals 1 ounce per 10 oz. of
milk is prescribed, which also equals one percent of the body weight. One-third of
the carbohydrate should be derived from the milk of the mixture, and the remainder
added in the form of starch or sugar. Later in the first year, the carbohydrate is given
in the form of a starch cereal, and the carbohydrate in the milk formula may be
reduced.
Minerals
When compared with the needs of the adults, all minerals and vitamins are
required in proportionately greater amounts by the infant. During the first four months
a liberal status of iron of the healthy infant may suffice for the rapidly expanding
blood circulation, but thereafter, special emphasis must be placed on the inclusion of
iron-rich foods lest anemia will result. An adequate mineral-salt intake is supplied to
any infant when one and one-half ounces of milk per pound of body weight are
given. Enough iron is stored in the liver of the normal infant, sufficient until the fourth
or fifth month. This deficiency is usually fulfilled by the addition of solid food
supplements (egg yolk, fortified cereals, vegetables, and fruits) which are usually
added before this time, except in the case of the completely milked infant who
refuses or is not offered these iron-containing foods in the first year.
Vitamins
If the diet of a nursing mother is nutritionally adequate the vitamins necessary
for the infant will be contained in the milk with the exception of vitamin D and
possibly ascorbic acid. The same is.true for cow's milk, except that ascorbic acid is
rarely adequate. Therefore, it is desirable to administer tomato or orange juice very
early in life, regardless of whether the baby is breastfed or formula-fed.
Vitamin B6, (pyridoxine) is essential in the diet of human infants. It has been
revealed, both experimentally and clinically, that a pyridoxine deficiency may result in
a syndrome characterized primarily by convulsions. The minimum daily requirement
of this vitamin is believed to be between 60 and 100 micrograms. Since this vitamin
is associated with essential fatty acid metabolism, requirements for each may have a
relationship to the dietary intake of the other. Pyridoxine is destroyed during
sterilization in ratio to the degree of temperature and the length of the time of the
heat. Infants whose mothers received large doses of vitamin B, during pregnancy for
treatment of nausea and vomiting may require more vitamin B6.
Unnecessary and excessive vitamin prescription and ingestion are to be
deprecated. Infants given a daily dose of 2000 IU of vitamin D achieve less growth
than infants receiving 135 IU) and far less than those given 400 IU. Any normal
infant ingest 18 ounces of cow's milk, or a comparable amount in a bottled-fed milk
food, or its equivalent of human milk (24 ounces), receives all the vitamin A and all
the vitamin B fractions (including vitamin B12) needed tor optimum growth.
Water

45
The daily fluid needs of the infant are approximately 2.5 ounces per pound of
body weight. His water balance is more easily disturbed than that of the adult
because of the large fluid losses through the Skin and respiration, and because of
the needs for elimination.
The requirement for water varies from 10 to 15 percent of the body weight, or
one and one-half to two and one-half ounces per pound of body weight. This is
supplied in the diluents of the milk mixture itself and supplemented, according to
instinctive demands, by offerings of water and fruit juices between feedings.
The needs for the various nutrients, the requirement of which increases with
age, are met chiefly by the milk diet during the first few months of life and later by the
supplementary foods included in the milk diet.
Food for Infants (3-12 months old)

Mother's milk is the best for the baby. But breast milk alone cannot meet the
baby's needs after 6 months. Earlier, at 3 months of age, start familiarizing the baby
with the taste and texture of the other foods that he/she will eventually need for
normal growth and development.
Simple Tips on how to help infants eat better

1. Beware of baby dinners or creamed products that contain nutritionally
incomplete refined starches.
2. Drain off the syrup from canned fruits before serving. It is usually rich in
sugar-something the infant does not need.
3. Watch the number of egg yolks the child consumes per week. Three or
four is plenty.
4. If the doctor says its okay, give him 2% low fat milk instead of whole milk.
It contains substantially less fat.
TIPS ON GIVING NEW FOODS

1. After his third month birthday, test the readiness of your baby to accept
new foods by placing a teaspoon between his lips.
a. If he tends to close his lips or push the teaspoon away continually,
then he is not ready. Avoid forcing him to eat.
b. But it he accepts the food from a teaspoon give liquid or semi-liquid
food first. Begin with thin lugaw, on to thicker lugaw, and then add
step-by-step mashed, chopped and thinly sliced food as your baby
grows older.
2. Start any new food with 1/2 teaspoon on the first day and add as your
baby takes to the new taste.

46
3. Never start two new foods at the same time. Let the baby get used to a
new food about two or three days before trying him out on new one.
4. Show pleasure when giving a new food. This will make him like to eat a
variety of foods.
5. Give water between feeds to provide enough liquid to remove waste from
his body and to help regulate body functions.
6. At about seven months of age, teach your baby to drink water and other
liquids from a cup. By using a teaspoon and later a cup, you can avoid the
use of feeding bottle which is often the source of a baby's infection.
7. Give finely-chopped foods when your baby starts teething. Biskotso or any
hard toast is also good at this time.
8. Offer bland foods to your baby.
a. Highly salted foods may injure his kidneys.
b. Too much sugar and sweets may develop in the baby a strong liking
for these foods which may lead to tooth decay and obesity.
9. Handle baby's food properly.
a. Wash hand with soap and clean water before handling baby's foods.
b. Dirty fingernails carry germs and eggs of worms which can cause
worm infestation.
c. Use clean utensils and keep food away from flies and insects.
d. Boil liquids and cook food thoroughly.
10. Feed baby only with freshly-cooked foods or fruits freshly-peeled. Avoid
giving left-over foods to babies.
11. If necessary, divide the recommended amount of supplementary foods
listed on next page, into several feedings during the day.
EASY-TO-PREPARE BABY FOODS

You can easily prepare baby's food from dishes cooked for the family. These
are just as nutritious and much cheaper than the commercial ones in jars or in cans.
1. Get your vegetable water for your three-month old baby from the family dishes
like sinuwam, nilaga and other vegetable dishes.
2. Prepare your lugaw and soft-cooked rice from already boiled family rice. Mix the
following proportions and boil for the given time.
Age of
Appropriate Method of
introduction Example Amounts
food(s) Preparation
(in months)

47
Thin rice gruel,
Cooked, well- oatmeal 1/2 cup thin
4 to 6 months
trained Mashed roots gruel
Cereals (1st crops
semi-solid
foods given to Thick rice gruel, 3/4 cup thick
7 to 9 months Cooked
the baby) soft-cooked rice gruel
10 to 12 1 cup
Cooked Slice bread biscuit
months 1 piece
Ripe banana, ripe

4 to 6 months Mashed papaya, ripe 2 1/2 tbsp.
mango, soft fruit
Cut into small

Fruits 7 to 9 months Soft fruit 3 tbsp.
pieces
Cut into
10 to 12
finger sized Any fruit 4 tbsp.
months
pieces
Carrots; sayote,
squash, bituelas,
potatoes, camote;
Cooked very
7 months tops kangkong; 1 tbsp.
soft
tops
pechay;malunggay
leaves
Vegetables
Cooked very
8 to 9 months finely and All vegetables 1 to 2 tbsp.
chopped
Cooked and
10 to 12
coarsely All vegetables 1 to 2 tbsp.
months
chopped
Meat & 7 months Cooked well, Chicken egg, 1/2 egg yolk
Alternatives deboned, minced meat,
11 months 1/2 egg
mashed or fresh or dried fish,
Egg Meat/ 6-11 months ground flaked or minced 1 1/3
Fish Poultry
or chopped chicken, mashed servings
or Legumes, 10 to 12
months well mongo 1 serving
Dried Beans
Whole Milk/ Meat, fresh, or cooked meat
Follow-on dried fish or = 30 g or
formula (If not chicken about 3 cm

48
cubes; fish;
2 pieces
medium
sized (55-
60g each0,
about 16 cm
on breast-
long ; 1 1/2
feeding)
cups cooked
dried beans/
nuts
preferrably
taken 3
times a week
Custards, simple
Steamed,
Other foods 8 months up puddings, plain 1 tsp.
baked
gulaman or jelly
Fats and 6 to 11 Steamed, Margarine,

4 tsp.
Oils* months baked cooking oil
6 to 11
Sugar 3 tsp.
months
*Fats and oils may be incorporated to the prepared diet by adding to the rice
gruel or mashed vegetables or served in either sautéed or fried dishes for the
baby after 6 months of age.
3. By ten months, your baby may share the family rice.
4. Get your boiled flaked fish for your 4 months old baby from the family dishes like
sinigang, pesa, tocho, sinuwam.
5. For your pureed vegetables needed by babies 5 months of age, set aside a
small amount of vegetables like squash from bulanglang, potatoes trom nilaga,
munggo from munggo guisado. Mash the unseasoned vegetables and mix with
lugaw. Season with Iittle salt. You may also try the following
6. Use the meat from the family dishes like nilaga, sinigang, for your 6-month-old
baby. Chop finely and mix with lugaw.
7. For younger babies, meat may be given "scraped as follows:
a. Before cooking the nilaga, scrape 1 side of a lean meat (i.e., beef) with
edge of spoon.
b. Turn meat and scrape other side.
c. Season scraped meat and form into patties.

49
d. Cook in hot ungreased pan until scraped meat grayish.
8. When fish like dilis is abundant and cheap, make it into fish powder using the
recipes on "More recipes for your baby."
Add the powder to the lugaw for your 6th-month-old baby or older.
9. Prepare your mashed dried beans for your 7-month-old baby when you are
serving munggo guisado to the family. Set aside a small amount of boiled,
unseasoned monggo and make it into:
FEEDING THE INFANT

Infant feeding is dyadic in nature, it has nutritional, pyschologcical and
biological interaction between mother and offspring with each one affecting the other.
An infant may be breast-fed, bottle-fed or given combined breast and bottle-
feeding.
BREAST FEEDING
Breast milk is clean. It lowers the risk of intestinal illness and general
infection. It also provides a host of protective factors both cellular and hormonal.
Breast milk is easily digested. Protein in the form of lactalbumin is superior to casein
and is readily digested by the infant's enzymes because it forms small amount of
flocculent curds. Fat remains unbound and is readily digested.
Breast milk is non-allergenic. It does not have the B-lactoglobulin or the
albumin of cow's milk to which bottle-fed babies are allergic.
Breastfeeding is beneficial to the health of the mother. It hastens the return of
her uterus to normal size. Because she does not usually menstruate, she conserves
her iron stores, an important consideration in developing countries where many
women are anemic. The child-spacing effect of breastfeeding is another advantage
to nutritional state of both the mother and the infant. However, breastfeeding may not
be advisable when mother has syphilis, diabetes, AlDS or any severe acute
infections. It is not encouraged when the mother is under emotional and mental
stress or it another pregnancy follows. Mothers who smoke heavily and who take in
contraceptive pills and drugs should refrain from breastfeeding Other
contraindications include metabolic abnormalities or severe prematurity of the
newborn which require the use of special therapeutic formulas.
BOTTLE FEEDING
Bottle or artificial feeding with cow's milk or other proprietary milk preparations
is recommended only when breastfeeding is contraindicated.
Artificial feeding is costly. Besides the milk formula, money is spent on the
bottles and nipples, cooking utensils, fuel, cold storage and even medical care
because infection seems frequent and often severe.

50
Artificial feeding is associated with infantile obesity or "protein-calorie
malnutrition plus". The reason is that double feeding often takes place. The mother
usually controls the volume and the schedule of feeding.
MIXED FEEDING
Mixed feeding is a combination of breast and bottle feeding with either one
predominating. When bottle is given to complete a single breast feeding because of
insufficiency of mother's milk, it is referred to as st feeding as complemented. When
the bottle is used to replace when one or more breast feeding as when the mother is
away from home for periods longer than feeding intervals, this method is called
supplemental.
Mix feeding is not encourage as it may lead to lactation failure.
FORMULA PREPARATION
Milk formulas are sterilized in order to reduce curd size and to prevent the
growth of harmful bacteria.
Two Methods of Formula Preparation

1. Aseptic Method
The equipment and ingredients are sterilized separately either by steam or by
boiling water for at least 25 minutes.
Next step is to funnel the sterile formula into sterile bottles, nippled and then
capped.
2. Terminal Method
The formulas are poured into clean but unsterilized bottles and are sterilized
together.
Disadvantage: Scum formation can clog the nipple holes
a. All formulas (sterilized) are slowly cooled without
shaking and stored immediately in the refrigerator
b. Left-over formulas should not be used again or re-heated.
Feeding Time
A 2.5 to 2.7 kg baby usually feeds every 3 hours.
A 3.6 to 4 kg baby usually feeds every 4 hours.
At 2 months old, the baby sleeps through the night after the 10 pm feeding.
Between 2 to 3 months old, the baby is on a 4 to 5 feeding schedule.

51
Supplementary Foods
1. Second Month - liquids like rice water, vegetable water or "calamansi"
juice may be introduced depending upon infant's acceptance and
tolerance.
2. Fourth Month - scraped banana or papaya or thin lugaw or commercial
cereal pop like "cerelac" and "ceresoy". Iron rich foods like egg yolk, liver,
meat, fish, poultry must be gradually introduced when iron stores are low.
3. Fifth to Sixth Month - full diet consisting of pureed meat, egg, fruit,
vegetables and cereals
*Weaning should take place. High calorie-high protein supplements
are called for.
*When teething begins, chewy foods such as crackers and biskotso
are given not only to soothe the sensitive gums but also to teach the baby
the art of self feeding.
4. Seventh to Eighth Month - foods are chopped finely, not strained to teach
mastication.
*Examples are soft-cooked egg with rice porridge, soft-cooked rice
with boiled fish, "munggo" and leafyvegetables, "misua" soup with beaten
egg, peanut banana mash, "kamote" cubes in meat broth and mashed
liver in green leafy vegetables.
5. Ninth to Twelfth Month - whole tender foods or foods chopped coarsely are
given.
COMMON DISORDERS
Diarrhea, allergy, vomiting, constipation and colic are disorders that affect the
nutritional status of the infant. When such condition arise
1. determine the underlying causes e.g over or underfeeding, bacterial
infections, unsuitable food, etc.
2. maintain water and electrolyte balance, and
3. modify milk formula to suit digestive capacity.
DIARRHEA
Diarrhea is most frequently caused by bacteria and viruses although both
overfeeding and underfeeding can also cause diarrhea. Cow's milk causes allergy to
some infants leading also to diarrhea. Rice water suffices for mild diarrhea but in
case of dehydration, parenteral and/or oral fluids should be given, like a locally
developed oral rehydrating therapy labeled "SI oralyte", Oresol, a pre-mixed oral
rehydration powder available in government health institutions. In acute diarrhea,
food can be given as early as 8 hours after the beginning of rehydration.

52
Breastfeeding should be maintained, with only a few hours interruption during
the early phases of therapy. As stool volume decreases, foods rich in protein are
generally added like latundan and bayabas.
VOMITING
Vomiting is commonly seen in normal infants during the first few days. As in
diarrhea, special attention must be given to fluid replacement. Other modifications
may include reducing number of feedings, acidifying milk, or making it a point to burp
the infant after every feeding.
ALLERGY
Eczema is the most common sign of allergy before 9 months of age. When
protein of milk is the offending ingredient, it is referred to as milk allergy. In lactose
intolerance, the enzyme that hydrolyzes the carbohydrate lactose in milk into glucose
and galactose is present, increasing the gut fluid volume. Bacteria in colon ferment
the lactose and a variety of gastrointestinal symptoms occur with varying severity.
CONSTIPATION
Infrequent bowel movements is not really the problem in infants but the pain
on the passage of stools, inability to complete a movement though the urge is strong,
blood in the stools and involuntary soiling of the clothes between movements. To
overcome constipation, the following measures may be taken:
1. Moderately restrict milk intake,
2. Increase fruit, vegetable, and fluid intake, change sugar in the formula to
laxative brown sugar and
3. Check reconstitution of milk formula.
COLIC
Colic is an acute paroxysm of pain, fussing, crying and irritability which lasts
for 3 months. Causes are psychologic factors, maternal and family tensions,
gastrointestinal hypermotility, functional immaturity of the central nervous system
and GI tract.
Changing the formula may bring about some improvement but not in most
cases. Physical measures such as providing a cozy warm environment, placing the
baby prone on a hot water
bottle, or a drink of warm water may at times subdue paroxysm of crying
INDICATIONS OF GOOD NUTRITION

Weight Gain

53
A steady weight gain of 150 to 240 gm/week that slows down toward the end
of the first year to about 120 gm/week is considered as the proper weight gain
(doubled birth weight at the end of 5 months and tripled at the end of 1 year).
Length
Baby length increases by about 25.4 cnm or 50% more at the end of the first
year.
Behavioral Development
0-1 month = suckles and smiles
2-3 months = vocalizes and controls head
4-5 months = controls hand and rolls over
6-7 months = sits briefly and crawls
8-9 months = grasps and pulls up
0-11 months = walks with support and stands alone
12 months = starts to walk alone
Bowel movement = normal without green or red streaks

Sleeping habits = regular
Tooth formation= average
Motor coordination = developing
Muscles = firm and well formed with moderate subcutaneous fat
NUTRITION IN CHILDHOOD
CHILDHOOD is a period of life from 1-12 years of age.
Nutritional Objectives:
1. Provide adequate nutrient intake to meet continuing growth and
development needs.
2. Provide basis of support of psychosocial development in relation to food
patterns, eating behavior, and attitudes.
3. Provide sufficient calories for increasing physical activities and energy
needs.
PRE-SCHOOLERS
Nutritional needs of the pre-school child differ from that of the adult:

54
a. There is a larger requirement for growth so there is a greater need for
protein, vitamins, and minerals.
b. The pre-schoolers activities are proportionally higher than those of the
adult so the adults calorie allowances per unit body weight must be
increased.
c. Selection of foods requires Some modifications especially for young
children.
d. Childhood presents period of rapidly changing attitudes and emotional
development-a period when food habits can be most favorably channeled.
Functions of a Diet for a Child

1. Provide fuel for muscular activity.
2. Supply necessary chemical elements and compounds that the child's body
requires for building materials and repairing worn out tissues.
3. Gives pleasure and satisfaction to the child.
Food Needs of Pre-School Children

During the pre-school period (2-6 years), the physical growth of a child is
slow while the emotional, social, and intellectual development is fast. A child is
very receptive to learning at this stage. He continues to have food preferences and
prejudices which have a great influence upon his eating habits. He becomes more
independent, selective, making him more vulnerable to nutritional deficiencies.
The pre-school child's growth is slow and irregular; there may be a
decrease in weight. His desire for food is erratic. His appetite wanes. Between the
second and third years, he may not gain an ounce for weeks, even months.
The "won't-eat era" should not alarm parents. It is expected in a normal
child's development. It could be harder on the parents than on the child. At this
time parents must be careful not to foster poor eating habits by urging, forcing, or
even bribing the child to eat. Appetite usually tends to improve as the child
approaches school age.
Pre-school children's dietary requirements vary widely even within an age
group: the small frame versus the large frame, the boy versus the girl, the short
versus the tall. The recommended dietary allowance is divided into 2 groups-1 to
3-year-olds and 4 to 6 year-olds and is based on the needs of the mean age in
each group (2 and 5) and of average weight and moderate activity.
Nutrient Allowances
1. Calories. The energy need of the pre-school child is determined by his
age, activity, and basal metabolism. About 55% of his total calorie needs

55
go to me tabolic activities, 25% to physical activity, 12% to growth needs,
and 8% to fecal loss. If the child's diet lacks calories, his body will utilize
the proteins for energy, resulting in protein calorie malnutrition (PCN). If
protein is also not adequate, tissue reserves are used for energy and body
building needs resulting to a condition called marasmus.
2. Protein. About 1.5 to 2 gm/kg of body weight is required. The child's
protein requirement are relatively higher in relation to body weight than
that of the adult. The RDA indicates that the protein need per kilogram of
body weight decreases. The protein requirements are relatively high for
periods of rapid growth and lower during periods of slow growth.
3. Vitamins and Minerals are likewise essential for normal growth and
development.
4. Fluids. The total fluid requirements of a healthy child is 4 to 6 glasses, one
to one-and-half quarts or 1000 to 1500 mL.
Feeding Problems
1. Child is eating too little.
Causes:
— The child likes few foods (food jogging)
— Appetite is lost because of too much parental urging.
— -The child is tired of the same foods eaten every day.
Remedies:
— Go slow in adding new foods. Start the meal with foods he/she likes
best.
— Serve less than what he/she will eat.
— Prepare simple dishes like "sinigang" or "tinola."
2. Child is eating too much.

Causes:
— heredity
— temperament
— appetite
— mother's insistence on a "clean plate"
Remedies:
Refrain from serving rich foods like cakes, pastries, pies, and ice cream.
3. Child is dawdling during mealtime.

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Causes:
— Child may be trying to get attention.
— Child may not be feeling well.
— Child may be given portions which are too large.
Remedies:
— Have the child regularly checked by a pediatrician.
— Avoid fussing over him/her.
— Let the child enjoy eating.
4. Child is gagging especially when fed coarse foods.

Causes:
— The child lacks proper training in eating chopped foods.
Remedies:
— Encourage self-feeding.
— Put the child in a well-ventilated bright clean eating place. Provide the
child with a colorful plate, an eye-catching cup, and utensils which he
or she can manage easily.
5. Child has aversion towards some foods.

— Give fruits as substitutes of vegetables.
— Mix vegetables with familiar foods like noodles and eggs or stuffing
them inside mashed potatoes or "kamote."
— Give milk though "halo-halo," "leche flan", "gulaman," "pinipig" "mais
con yelo or breakfast cereals.
6. Child has allergies.

Causes:
— chemicals in the air
— food preservatives
— food coloring
Remedies:
— Monitor nutrient intake.
— Make food substitutions.

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Indications of Good Nutrition
1. Weight
First Degree Malnutrition: 10% less than the standard for age and sex
Second Degree Malnutrition: 25% less than the standard for age and sex
Third Degree Malnutrition: 40% less than the standard for age and sex
2. Clinical posture: erect

arms and legs: straight
Abdomen: in
chest: out
head: normal size
skeletons: with no malformations
teeth: straight without crowding in a well-shaped jaw
(6 years of age = 24 teeth)
skin: smooth, slightly moist with a healthy glow
eyes: clear, bright, with no signs of fatigue
hair: shiny
muscles: firm
gums: light pink in color
lips: moist
tongue: without lesions
SCHOOL-AGE CHILDREN
The period between 7 and 12 years is characterized by a slow steady, growth,
increased body proportions, enhanced mental capabilities, and more mind and body
coordination. Body reserves are being laid down in preparation for the increased
needs during the adolescent stage. Growth rates vary within this period. Girls usually
cut distance boys, by the latter part of the pre-adolescent as shown on the RDA able
where the 10- 12 rererence girls weighs 3 kg more than the boys of similar age. The
gain in weight averages 1.8 -3.1 kg annually.

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Nutrient Allowances
1. Calories- Allowances decline to about 80 to 90 kcal/kg for children 7 to 9
years old and 70 to 80 kcal/kg for children aged 10 to 12 years.
2. Protein- Approximately 37 gm of protein is recommended daily for
children7 to 9 years old and 43 to 48 gm for children aged 10 to 12 years.
3. Vitamins and Minerals - As most girls start to menstruate at the age of 11
or 12, iron allowance should consider tne day of menstrual loss. Philippine
RDA sits ascorbic acid allowance at 55 mg for children 7 to 9 years old
and 65 to 70 mg for children aged 10 to 12 years. Per unit of weight,
growing children may need 2 to 4 times as much calcium as does an adult.
At levels 500 to 1000 mg of calcium daily in the diet, children show
maximum retention. The USA RDA recommended 120 mcg of iodine for
children 7 to 10 years old.
Meal Planning for Children (7 to 9-years-old)
Good nutrition helps children do better at home and in school. Growing
children need more body building foods to grow fast and strong. A good breakfast
starts a good day. Hungry, weak children are not alert and are less attentive in class.
1. Make green, leafy, and yellow vegetables and fruit a "must" in daily family
meals. Stimulate appetite with various forms, colors, sizes, and shapes of
food served.
2. Pack nutritious lunch. Remember that one packed lunch should supply at
least 1/3 of the child's daily food needs.
3. Avoid serving too spicy and highly-seasoned foods. These may destroy
the appetite for the more bland but highly-nutritious foods.
4. Make snacks count. Serve nutritious snack like root crop, beans, or fresh
fruits instead of candies and soft drinks.
How to Prepare Packed Lunch

1. Plan the meals that are cheap and easy to prepare.
a. Choose foods in season.
b. Prepare easy-to-pack dishes like fried fish or pork adobo with slices of
tomatoes, fish/meat omelet, beef tapa, or boiled kangkong tops with
alamang.
c. Use fruits in season for dessert.
2. If child prefers, prepare sandwich fillings the day or night before to save
time in the usual busy mornings. Wrap sandwiches separately.
3. If possible, include foods like milk and fruit juice for beverage.

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Feeding the School Child
1. Psychological Factors
a. more confident, expresses own food choices
b. strong urge to eat what his friends eat
2. School Environment - goals of school feeding programs in the Philippines:
a. to improve the nutrition of school children by furnishing them
wholesome food at the lowest reasonable cost
b. to aid in strengthening the nutrition and health education program of
the Public schools
c. to foster proper eating habits
3. Food Preferences
a. Child eats a wider variety of foods and has more i food likes and
dislikes.
b. Child wants simple and plain dishes.
c. Child eats what most adults do.
d. Child develops fondness food products seen in TV commercials and
appetite for food favorites of his movie idol.
Feeding problems
1. Inadequate Meals
Breakfast which provides 1/4 to 1/5 of the daily nutrient allowances is
often missed or hurriealy eaten by school children.
Causes:
a. notlhing to eat
b. late bed riser
c. arrival of school bus
d. fear of being late for school
e. rush in preparing oneself for school
A good breakfast should consist of the following:
1. Vitamin C rich fruits like papaya
2. Cereal like oatmeal or fried rice or pan de sal
3. Protein-rich foods like egg "tuyo," cheese, or milk
Lunch is also a dietary problem because so many children take their

lunch away from home. Sandwiches and hearty items such as "adobo,"
"longganisa," "tinapa" with rice, red eggs, and tomatoes are favorite
among Filipino school children. Providing a child with milk, fruit juice, or
soup prevents him/her from buying soft drinks.

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2. Poor Appetite
Causes:
a. demanding school work
b. tiring extracurricular activities
c. new outdoor experiences
d. confections and soft drinks in school
Remedies:
a. School cafeterias should offer snacks or "merienda" which are
nutritious and inexpensive.
b. Carbohydrate-rich snack products which provide little or no vitamins
and minerals must be replaced with milk and fruit beverages, "turon,"
"munggo," peanuts, fresh fruits, and bread.
3. Sweet tooth
a. Hungry growing bodies recognize the need for extra calories.
b. Parents give sweets as rewards or "pasalubong" to kids.
ADULTHOOD
Adulthood is the period of life when one has attained full growth and maturity
(between 21-50 years of age).
Nutritional Management
It includes maintenance of the desirable body weight. By the age of 60, the
average adult has accumulated about 7 extra kilograms. To prevent overweight
and obesity, it is recommended that a daily caloric allowance be reduce with
increasing age.
Physical activities may also be curtailed. Men in occupations requiring light
activity are found to have fairly constant activity patterns, between ages 20 and 45.
About 12% of the energy intake must be in the form of protein for adults with 1.2
g/kg body weight. Since vitamin C enhances the absorption of iron, its adequate
intake (70 mg for women and 75 mg for men) helps alleviate the 27% prevalence
of anemia among adult non-pregnant, non-lactating women in contrast with only
15% prevalence among men. Nutrition experts recommend adequate vitamin D
from the diet and exposure of the skin to sunlight, ,200 to 1,500 mg calcium, and
exercise as muscle pull influences the calcium content of the bone
Feeding the Adult

To stay healthy, the following guidelines must be observed by adult men
and women:

61
1. Eat a variety of foods.
2. Maintain the ideal weight.
3. Avoid too much fat, saturated fat, and cholesterol.
4. Eat foods with adequate starch and fiber.
5. Avoid too much sugar.
6. Avoid too much sodium.
7. Drink alcohol moderately.
NUTRITION FOR THE ELDERLY

Elderhood refers to the period of being past middle age.
Food Needs of the Aging and the Aged
Aging is a continuous process that starts in the womb and ends in the tomb.
It is the development sequence of all living processes as they change with the
passage of time. Old age is said to be related to psychological aging.
During physiologic aging, cellular changes occur. The changes in function in
relation to aging are believed to be caused by a loss in the number of cells. The
collagen connective tissues undergoes chemical changes with aging. The sense
of taste and the sense of smell are less acute, affecting the appetite. Less saliva is
secreted and swallowing of food is difficult. Old persons, therefore, tend to take in
more carbohydrate-rich foods which require minimum chewing and less intake of
other foods like proteins, vitamins, and minerals. Digestion is also affected due to
reduction of volume, acidity, and pepsin content. Reduced acidity has an adverse
effect on the absorption of calcium and iron and the lowering of vitamin B12 levels
in the blood Fats are poorly tolerated because they retard gastric evacuation. The
pancreatic production of an enzyme (lipase) is inadequate for satisfactory
hydrolysis or breaking down of fats.
Elderly persons are advised to cut down gradually on their food intake
especially if their lifestyle becomes more sedentary. However, they should retain
the more nutritious foods (vegetables, fruits, cereals, low-calorie foods, and milk)
and eliminate the less nutritious or higher calorie foods such as sugar in
beverages, candies, cakes and confectionaries. The habits of a lifetime are
established and are very resistant to change.
Nutrient Allowances
The nutrient allowances for the elderly, based on the Philippine 50 to
Philippine RENI are divided into 2 groups: allowances for the elderly aged co 69
years and the elderly aged 70 years and older.
1. Calories - A reduction of calories is recommended becaue of reduced basal
metabolism and physical activity. Statistios have shown that by age 60, the
average adult accumulates about 7 extra kilograms. The recommended
decrease in calorie intake is as follows:
45-55 years = 7.5% decrease

55-65 years = 7.5%

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After 65 years = 10% decrease
Around 50% to 60% of the total calories should come from

carbohydrates and about 25% to 30% from fats in the form of polyunsaturated
fatty acids. Refined sugar and saturated tatty acids have been known to
increase triglyceride and cholesterol levels in the blood. Both the quality and
the quantity of fat should be guarded as they are poorly tolerated by the
elderly.
2. Proteins - An allowance of 1.1 g/kg body weight is require his is necessary for
the prevention of progressive tissue wasting and susceptibility to disease and
infection. Older persons who have poor dietary habits or illnesses may benefit
from an increased intake.
3. Vitamins and Minerals - Calcium, iron, vitamin A, and vitamin C are important
minerals and vitamins commonly found lacking in the diet for the aged because
of low intake of meat, milk, green leafy vegetables, and fruits. The B-complex
vitamins may be in adequate amounts if enriched cereals and bread are
consumed. Vitamin and mineral supplements may be taken to further augment
the intake of these nutrients.
4. Water and Fiber - About 6 to 8 glasses should be consumed 4 daily. The

kidneys can function efficiently in eliminating waste solids if there are sufficient
fluids. Also, water stimulates peristalsis, combating constipation.
Common Problems Among the Elderly

1. Difficulty in chewing due to loss of teeth and not getting used to
dentures
Solutions :
 Chop meat or flake fish.
 Slice or chop vegetables into small bite sized pieces for easy
chewing.
2. Lack of appetite
Solutions:
 Do light exercises like walking and gardening to improve appetite
and keep the body fit.
 Eat in pleasant surroundings to make the meal enjoyable.
 Make the food attractive by varying the color, shape, and size.
3. Unwanted weight and due to lack of physical activity and/or overeating

Solutions:
 Exercise regularly.
 Eat only the lean part of the meat or fish. Avoid the fatty portion.
 Take in only moderate amounts of energy food. Steam, boil, or broil
foods. Avoid rich sauces, salad dressings, and pastries or cakes with
heavy icings.

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4. Anxiety, contusion, insecurity, or loneliness
Solutions:
 Start the day right with a good breakfast.
 Have a hobby.
 Keep up with a group. Join a club and participate in community
activities.
5. Poor digestion leading to constipation, gas pains, or diarrhea

Solutions:
 Include fruits and vegetables in your daily meals to prevent
constipation. Have four light meals. Eat the heaviest meal at
Solutions: noon.
 Drink 6 to 8 glasses of water and fruit juices everyday.
 Help digestion and keep normal flow of body fluids. If suffering from
diarrhea, take in simple foods like tea, crackers, broth of boiled
banana and kamote, lugaw, or toast. Avoid fibrous fruits and
vegetables
6. Poor absorption leading to anemia and other vitamin deficiencies

Solutions:
 Iron-rich foods like liver, lean meat, egg yolk saluyot, kulitis,
himbabao, and seaweeds are Solutions: recommended to avoid
anemia.
 Vitamin C-rich foods like papaya, mango, and dalanghita help absorb
iron and speed up healing.
 Take in foods like milk, milk products, dilis, alamang, and other leafy
vegetables. These food contain calcium needed for strong bones.
Exposure to sunlight helps maintain the bone structure.
7. Difficulty in sleeping
Solutions:
 Drink warm milk just before going to bed to assure a restful night.
 Avoid tea or coffee late in the day, if any of these cold/hot drinks
affect one's sleep.
References
Richard, B. (2019, February 27). Nutrition Needs Across Your Lifespan. Retrieved
from https://health.ucsd.edu/news/features/Pages/2019-03-11-nutrition-needs-
across-your-lifespan.aspx
Ruth A. Ross (2011). Nutrition and Diet Therapy 10th Edition. Delmar, New York.
Library of Congress Control Number: 2009930339

64
Maria Lourdes Cruz-Caudal (2019). Basic Nutrition and Diet Therapy, A Textbook
for Allied Health 2nd Edition. C & E Publishing Inc.
TOPIC 5
THERAPEUTIC DIET
Introduction
The best doctors in the world are:
“Doctor Diet, Doctor Quiet and Doctor Merryman” – Jonathan Swift.
Diet Therapy is use of appropriate foods as a tool in the recovery from illness.
In most illnesses, the patient’s diet complements the medical or surgical treatment.
The rate of recovery thus is determined by the patient’s acceptance and intake of the
diet prescribed. In certain ailments such as obesity and diabetes mellitus modified
diet is the most important input to help the patient’s recovery.
All therapeutic diets are modifications of the normal diet made in order to
meet the altered needs resulting from disease.
Therapeutic diet is planned to meet or exceed the dietary allowances of a

normal person as the aim of diet therapy is to maintain health and help the patient to
regain nutritional wellbeing.
In certain ailments it may be necessary to restrict intake of calories (as in

weight reduction diets) or sodium (as in heart ailment).
NUTRITION FOR HEALTH AND FITNESS
A. Nutrition in Weight Management

Obesity, a condition in which the natural energy reserve is increased, is a
hazard to health. It is not surprising that obese people are prone to heart disease,
gallbladder disease, diabetes, or other chronic diseases. An obese pregnant woman
is more likely to have complications than a woman of normal weight.
Reasons for Excessive Calorie Intake
1. Family patterns of rich, high-calorie foods
2. Good appetite, likes to eat

65
3. Ignorance of calorie value of foods
4. Skips breakfast
5. Pattern of living - sedentary occupation, riding to work
6. Emotional outlet - eats to overcome worries and problems
7. Many social events serving foods
8. Lower metabolism with increasing age
9. Influence by advertising of many high-calorie foods
Prevention of Obesity
1. Change in the eating pattern of families
2. Children should be encouraged to get more exercise and assigned some
chores requiring daily physical activity.
3. Pre-schoolers should not be bribed or rewarded with food.
Low-Calorie Diet
Women usually lose weight satisfactorily on diets restricted to 1,000-1,50o
calories whereas men lose weight satisfactorily on diets furnishing 1,200-1,8oo
calories. Bed patients, such as those with heart disease, are often placed on diets
restricted to 800-1,000 calories and sometimes less.
The daily food allowances for the 1,000- 1,2o0- and 1,500-calorie diets are
somewhat higher in protein than normal. This is desirable because it provides most
people with a feeling of satisfaction. Also, it helps correct the greater losses of
muscle tissues that occur during reducing. The extra protein is provided from the
meat group, with some restriction on the bread-cereal group.
Usually, the food allowances are divided into 3 approximately equal meals.
Skipping breakfast is not a good idea.
Meals with a low-calorie diet should be attractive and palatable. Herbs and
spices may be used to give variety to vegetable and/ or meat preparation. Meat, fish,
and poultry should be lean and prepared by boiling, broiling, roasting, and stewing.
Fresh fruits or canned unsweetened fruits are used.
Low-calorie diets should not include alcoholic beverages, Sweetened
carbonated beverages, cakes, candies, cookies, cream, trled foods, sweetened
fruits, pastries, pies, potato chips, pretzels, puddings, and others
B. Nutrition in Eating Disorder

Addictive behaviors are compulsive ways of living (eating, drinking, etc.).
Anorexia nervosa and Bulimia are addictive behaviors related to food intake, while

66
alcoholism is the result of addiction to alcohol and alcoholic drinks. There are no
simple causes or solutions to eating and drinking disorders.
Though eating disorders have been known since the Middle Ages, the incidence of
eating disorders is on the rise in the developed countries. One of the contributing
factors is the breakdown of social structure resulting in isolation of individuals.
All these disorders result in the deterioration of the nutritional status of the
person; therefore nutritional rehabilitation of the patient is a very important part of
therapy.
Eating Disorders
Anorexia nervosa implies loss of appetite. It can aptly be described as

denying one’s appetite.
Bulimia means “ox-hunger” or being as hungry as an ox. The persons

suffering from bulimia go on a eating binge often and feel guilty. So they try to get
rid of the food by forced vomiting, fasting, taking diuretics or using laxatives. They
keep their binge –purge behavior a secret and hence it is difficult to identify the
disorder until the stress of these episodes results in some visible impact on the
system. Even male athletes (runners, wrestlers, swimmers, etc.) and pilots also
resort to binge-purge practices.
Causes: Addictive behaviors have multiple causes – emotional, psychological,

social and biological, which result in disordered eating. Stress may have a strong
role and lack of appropriate coping mechanism is another common factor.
Symptoms of Anorexia Nervosa: The anorectic patient is often 20 to 40 per

cent below desirable weight for the age and stature and appears to be skin and
bones. Other symptoms are lowered body temperature, slower basal metabolism,
decreased heart rate (hence easy fatigue, fainting, sleepiness), iron-deficiency
anemia, rough dry scaly and cold skin from a poor nutrient intake, low white blood
cell count (increasing risk of infection and death), loss of hair, constipation (and
laxative abuse), loss of menstrual periods and deterioration of teeth due to frequent
vomiting, An anorectic person is psychologically and physically ill and needs help.
Treatment of Anorexia Nervosa: The patient is often a victim of isolation and

fear. Hence the health team must include a psychologist in addition to a physician,
dietitian and other health personnel. They should all work together to restore a
sense of balance, purpose and future with the cooperation of the patient. The first
step is to help the patient to gain weight, as a psychiatrist cannot counsel astarving
person.

67
Nutrition Therapy: The first step is to increase the person’s food intake. This
will help to stop weight loss and may help weight gain. The next is to restore regular
food habits. The third is to ensure that the patient keeps in weekly contact with the
dietitian. In all this it is critical to allow the person to feel in control of her life in the
early stage of treatment. There should be no surprises, as these may be detrimental
to progress. Anorectics are very clever and resistant. They try to disguise weight loss
or fake weight gain by wearing many layers of clothes, putting coins in the pocket
and drinking a lot of water before weighing. One needs to gain their trust to be able
to help them. The nutritional rehabilitation is slow. The nutritional care consists of
going through the stages of liquid to soft to full diet. The mode of feeding will depend
on the condition of the patient. It is important to educate the patient and help her/his
family.
Some points to note in the treatment of anorectics are:
1. Patients need to be given intravenous feedings to restore fluid and

electrolyte balance, when the patient is in a critical state and is likely to get
dehydrated.
2. When patient’s nutritional state is precarious, give peripheral parenteral
nutrition to support oral intake.
3. Get patients to be partners in the efforts to restore satisfactory nutritional
status; attain normal weight and develop normal eating patterns.
5. Anorectics are intelligent patients. Educate them about their normal growth
pattern and the intake to meet the needs for their growth. This will enable
them to set goals to attain their normal growth gradually.
6. Lastly avoid food being the center point of their day. They need to take
interest in recreational activities – music, games, reading, enjoying family
company, making friends etc. to get back to enjoying normal life of which
food is an important part.
Bulimia Nervosa
An increasing number of youngsters, especially females (models, actresses,
dancers, athletes and others) go through stages of eating large amounts of foods
(high fat sweets) and then get rid of it by vomiting. This disorder is called bulimia
nervosa. Bulemics may eat 3,000 to 5,000 calories in one extended binge and then
vomit to get rid of it. With repeated episodes, they may have chloride and potassium
deficiencies, which may lead to heart damage and other complications. Bulemics
suffer from low self-esteem and depression. It is necessary to help a bulemic
develop self-esteem through understanding self worth, develop a positive attitude,
learn to take pleasure in simple activities (listening to music, reading, writing,
drawing, sewing, knitting, gardening, playing games, etc.) and avoid depressing
inactivity. Most bulemics have irregular food habits and they may be underweight
and undernourished.
Diet for Bulemics

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Bulemics need to understand about effects of starvation on the body, their nutrient
needs and how to meet these through planned diet modification. Bulemics need to
recognise that their primary aim is the stabilization of their body weight without
having to go through binging and purging, which disturbs and hurts the body’s well
being.
Some points to note in their treatment are:
1. Help patients to understand and plan a diet which meets their normal
nutritional needs. The actual calorie expenditure needs are determined by
measuring oxygen consumption.
2. Plan the diet using basic food guide The foods thus selected meet the
mineral and vitamins needs. Hence supplements are not necessary.
3. The patient can be helped to select a varied diet, after taking her likes and
dislikes into account.
4. Teach how to measure or weigh foods to give confidence that there will be
no overeating.
5. Personalized meal plans (3 meals + snacks) with wide variety of foods
helps acceptance.
6. Avoid excessive bulk in the initial stages to have a third of stomach empty.
7. Gradually increase intake by 200 calories until the norm is reached.
8. Avoid fasting, skipping meals and eating inadequate amounts at a meal as
it leads to binges. Keep food record. These measures help to develop
confidence in themselves and make them self-reliant in managing their
diet.
C. Nutrition Exercise and Sports

The interest in physical fitness is very high in all the age groups of populations
around the world. It may be to keep fit, healthy and thus improve the quality of life or
it can be to participate in athletics and possible competition.
Our body composition, muscular ability, respiratory and cardiovascular

capabilities are very close related to nutrition and exercise. Diet and nutrition does
influence performance.
Just as eating three meals regularly is a consistent part of daily life, so should
exercise be a consistent, regular part of daily life. In physical education in schools,
activities that are appropriate for life-long participation need to be emphasized. This
will ensure physical well-being and optimal function of the majority of students. Some
of them may become athletes.
Carbohydrates
The main role of carbohydrates in physical activity is to provide energy. For athletes,
if their diet does not contain enough carbohydrate, it is likely that their performance

69
and recovery will be impaired, as carbohydrate is the key fuel for the brain and for
muscles during exercise.
Protein
Protein is important in sports performance as it can boost glycogen storage, reduce
muscle soreness and promote muscle repair. For those who are active regularly,
there may be benefit from consuming a portion of protein at each mealtime and
spreading protein intake out throughout the day.
Fat
Fat is essential for the body in small amounts, but it is also high in calories.
Consuming too much fat can lead to excess calorie intake which can lead to weight
gain over time, so this is a particular concern if you’re trying to control your weight.
The type of fat consumed is also important. Studies have shown that replacing
saturated fat with unsaturated fat in the diet can reduce blood cholesterol, which can
lower the risk of heart disease and stroke. Fat-rich foods usually contain a mixture of
saturated and unsaturated fatty acids, but choosing foods that contain higher
amounts of unsaturated fat and less saturated fat, is preferable as most of us eat too
much saturated fat.
Water
Water is essential for life and hydration is important for health, especially in athletes
and those who are physically active, who will likely have higher requirements.
Drinking enough fluid is essential for maximizing exercise performance and ensuring
optimum recovery. Exercising raises body temperature and so the body tries to cool
down by sweating. This causes the loss of water and salts through the skin.
The amount an individual sweats varies from person to person and depends on:
 Intensity and duration of exercise – longer and higher intensity exercise can
cause greater sweat loss.
 Environmental temperature – in hot, humid conditions sweat loss can
increase.
 Clothing – the more clothing that is worn, the quicker you are likely to heat up
which may cause greater sweat loss.
 Genetics – some people sweat more than others.
Generally, the more a person sweats, the more they will need to drink. Average
sweat rates are estimated to be between 0.5–2.0 L/hour during exercise.
Supplements
Supplements are one of the most discussed aspects of nutrition for those who are
physically active. However, whilst many athletes do supplement their diet,
supplements are only a small part of a nutrition programme for training. Athletes are
advised to follow a ‘food first’ approach to avoid using supplements that aren’t
needed or could result in nutrient intakes that are too high. For most people who are
active, a balanced diet can provide all the energy and nutrients the body needs
without the need for supplements.

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D. Nutrition and Bone Health
Many nutrients play a role in bone health. Some nutrients have scientifically
proven benefits, others may have benefits, but there is no research to back that up.
Some nutrients are needed in such small amounts that people are rarely deficient in
them and need not worry about getting enough. Focus on nutrients with solid
scientific evidence of need and benefit. Read food and drink labels to ensure you are
meeting your daily requirements.
With some exceptions, a balanced diet provides adequate nutrients for most
people, eliminating the need to take most supplements.
Calcium, vitamin D and magnesium are key bone health nutrients that
require special attention to ensure that you meet your daily requirement.
Although many foods contain calcium, dairy products provide the most calcium per
serving size. Calcium that has been added (fortified) to drinks may settle to the
bottom, so shake the container well before drinking. Daily requirements for calcium
change with age — people who do not eat dairy foods will need to work hard to meet
them or may need a calcium supplement.
There are food sources of vitamin D, but it is difficult to get adequate amounts from
food alone; therefore, many people benefit from a supplement.
People who consume even moderate amounts of alcohol or use proton pump
inhibitors may have increased loss of magnesium in the urine and may benefit from a
supplement (approximately 200–250 mg/day). Magnesium is found in many foods.
E. Nutrition for Oral and Dental Health

After birth, nutritional quality affects tissue synthesis as nutrients work to
maintain and repair periodontal tissues when essential. since the turnover rate of
mucosal cells is from three to seven days, some parts of the oral cavity, especially
the sulcular epithelium, can be some of the first to develop signs of poor nutritional
status. This fast cell turnover demands steady nourishment; epithelial cells have fast
rates of metabolism, differentiation, and maturation. The deficiency or abundance of
some vitamins or minerals may cause salivary gland dysfunction, sulcular epithelium
corrosion, pocket formation, hyperkeratinization of mucosa, and osteoporosis of the
alveolar bones and other bones in the body.
When the host is weak, bacteria attack periodontal tissues. The body then
sends defenders to control destructive activity and repair any damage. A thriving
host possesses nutrients to aid with bacterial attack. Healthy oral tissue is the best
protection against microbe invasion. Some nutrients influence the process of
maintaining and repairing periodontal structures more than others. Some have a

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singular benefit; others offer multiple advantages. Their joint effort affects soft and
hard periodontal tissues, host susceptibility, immune response, and wound healing.
During our lifetimes, optimal oral health depends on adequate quantities of

vitamins A, B-complex, C, D, and E; proteins; calcium, phosphorus and magnesium;
iron zine copper and some lipids, such as omega3 fatty acid.
1. Lipids perform a key role in the general health (energy, obesity, diabetes, and
hypertension) and have slight implications for the control of oral health status.
Lipids include triglycerides, phospholipids, sterols, and lipoproteins, Fat
provides a protective layer on teeth and prevents biofilm adherence. Some
fatty acids have antibacterial properties and that low levels of omega 3 fatty
acids correlate with risk for periodontitis. Clinicians should observe caution
with recommending fat intake, as excess is implicated in several chronic
diseases.
2. Protein is responsible for repair and maintenance. Amino acids repair tissues
and form antibodies to help resist infection. Protein deficiencies can influence
the synthesis ot new tissue, as key amino acids are important tor
maintenance and healing. Unacceptable amounts of protein in the diet
increases vulnerability to infection, slows wound healing, and causes
deterioration of periodontal connective tissues. Excess protein can decrease
calcium retention and influence bone health. People with plant-based diets
need to pay special consideration to acquiring sufficient amounts of protein in
their diets. Vitamin C is present in large amounts in neutrophils so, when
protein intake in insuffiçient, this also can reduce the availability of vitamin C.
3. Vitamin A in adequate amounts helps sustain immune function and the

integrity of sulcular epithelium, assists with bone remodeling, and keeps the
salivary glands working efficiently. An early sign of this vitamin deficiency is a
decrease in the rate of epithelial cell differentiation. Deficiencies throughout
life may cause salivary glandatrophy, hyperkeratinization of some oral
structures, compromised periodontal tissue healing, or carotene coloration.
Excess vitamin A can result in increased catabolism of collagen and bone.
4. Vitamin D in constant amounts is important throughout life since calcified

tissues remodel. Vitamin D is vital to general health because it controls the
presence of calcium, magnesium, and phosphorus in blood plasma. The
danger of vitamin D deficiency increases with age, lack of exposure to
sunlight, and poor eating habits. Osteomalacia, osteopenia, osteoporosis,
lamina dura and cementum loss, and an even bigger risk of developing some
cancers can be the result of such deficiency. Excessive vitamin D can cause
irreversible kidney and cardiovascular tissue damage. Vitamin D and calcium
levels have been linked to periodontal problems due to their role in bone

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homeostasis, including attachment and bone and tooth loss. However, it is
possible for depleted bone structures to reconstruct with vitamin D
supplementation.
5. Vitamin E is a group of 10 lipid-soluble compounds that 5 include tocopherols

and tocotrienols. Vitamin E functions as an antioxidant and protects red blood
cells. Insufficient vitamin E is rare but can manifest as hemolytic anemia,
Excess amounts of vitamin E in the body can create a vitamin K deficiency,
obstruction with anticoagulant drugs, and bleeding problems.
6. Vitamin K functions as a cofactor (enzyme partner) tor the synthesis of

prothrombin. Prothrombin is essential for blood clotting and is produced by
some intestinal bacteria. Deficiencies are caused by conditions that decrease
1at absorption or by antimicrobial medications that alter intestinal flora.
Symptoms include delayed bleeding and clotting time. High doses of vitamin
K interfere with anticoagulants, which could result in hemorrhage.
7. Vitamin B-complex is a group of coenzymes. These coenzymes work together

to sustain healthy oral tissues by forming new cells and preserving the
immune system. The risk of a vitamin B-complex deficiency increases with
age, ingestion of certain medications (phenytoin and methotrexate), eating
disorders, addictions, and in vegans, such deficiency can result in increased
oral tissue sensitivity, burning mouth syndrome, loss of taste, angular
cheilosis, pernicious anemia, gingivitis, and frequent oral lesions.
8. Vitamin C assists with collagen and connective tissue formation. It aids with
blood vessel integrity, phagocytosis, and wound healing. It is also a strong
antioxidant that facilitates calcium and iron absorption and protects vitamins A
and E. Low levels of vitamin C produce an facilitates calcium an increased
intracellular permeability of blood vessels and the sulcular epithelium, allowing
microbial penetration into deeper structures. The first symptom of vitamin c
deficiency is often exhibited as gingivitis. Enlarged magenta, hemorrhagic
gingiva along with a widened periodontal ligament is the result. Low levels of
vitamin C increase the risk of developing periodontal disease insufficient
vitamin C intake combined with smoking can result in grave consequence on
periodontal tissues. Smokers have greater metabolic turnover rate for vitamin
C. Excessive vitamin C in the diet can obstruct anticoagulants
9. Calcium, magnesium, and phosphorus deficiency in the diet can affect

absorption and create aggressive bone resorption It also increases the risk of
tooth mobility, premature tooth loss, and hemorrhage. Reduced dietary intake
of calcium results in more severe periodontal disease and low dietary Intake is
a risk factor for periodontal disease. Hypercalcemia, excess magnesium, and
excess phosphorus are almost unknown.

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10. Iron deficiency can lead to angular cheilosis, pallor, burning mouth syndrome,
glossitis, and atrophy or denudation of the filiform papillae, and candidiasis as
a result of lowered immune function. Excessive iron is rare, as most
individuals regulate the absorption of iron well.
11. Zinc is an essential mineral needed for wound healing and new tissue healing.
Zinc works along with iron and copper for wound healing. Malnourished
individuals run the risk of having low zinc levels. Zinc levels are naturally
suppressed during infection. Zinc deficiencies quickly weaken immunity and
reduce antibody activity. Even a modest insufficiency of Zinc can lead to
increased opportunistic infections. Immune status is closely linked to zinc
status-an important mineral to control periodontal disease. Zinc toxicity is
uncommon.
12. Copper is an important mineral, involved in both collagen and elastin

formation and regeneration. A copper deficiency causes considerable
decrease in the tensile strength of collagen. This produces bone lesions,
malformed joints, bone fragility, and vascular lesions.
Food Sources
1. Zinc: meat, fish, poultry, eggs, nuts
2. Vitamin K: dairy, green leafy vegetables 3.
3. Vitamin E: vegetable oils, whole grains, fortified food, nuts
4. Vitamin D: sunlight, fish, fortified food and drink
5. Vitamin C: citrus fruits and juices, broccoli, strawberries, peppers 6.
6. Vitamin A: dairy, eggs, fortified food and drink 7.
7. Protein: dairy, meat, fish, poultry, legumes, seeds, nuts
8. Probiotics: yogurt, cheese, buttermilk, sauerkraut 9.
9. Phosphorus: dairy, meat, soft drinks 10.
10. Omega-3 fatty acids: fish, flaxseed, canola, soybean oils
11. Magnesium: whole grains, green leafy vegetables, nuts 12. Iron: meat,
poultry, fish, eggs, dark green vegetables
12. Folic acid: green leafy vegetables, fortified food, legumes 14. Copper: soy,
shellfish, oysters, crabs, liver, nuts

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13. Calcium: dairy, fortified food, seafood 16. Boron: fruits, vegetables, legumes,
some wines, nuts
DIETARY MODIFICATION AND DIETARY THERAPY
GENERAL DIETS
1. Regular or Full diet

 Most frequently used of all hospital diets
 Designed to maintain optimal nutritional status
 Follows the principle of good meal planning and permits the use of all
foods
 Indicated for ambulatory or bed patients whose conditions do not
necessitate a modified diet
 Food selection: all foods are allowed
2. High fiber diet

 Regular diet which include liberal amounts of foods rich in dietary fiber
 Fluids are also increased
 Indications: atonic constipation (constipation caused by failure of the
colon to respond to normal stimuli for evacuation), diverticular disease,
irritable bowel syndrome, gastric ulcers, colon cancer, cardiovascular
disease, diabetic mellitus
 Food selection: vegetables, fruits, rice or substitutes(cereals, whole
grain)
3. Vegetarian diet
 Type of diet which may be preferred due to religious reasons, ecologic,
basic health principles.
 Reduce the risk of developing medical conditions such as obesity,
heart disease, hypertension, diabetic mellitus
Different types of vegetarian diet:

a. Lacto-ovo vegetarian – includes dairy and egg products
b. Ovo vegetarian – includes egg
c. Lacto vegetarian – includes dairy products
d. Vegan or pure vegetarian – eats food from plant source
e. Pesco vegetarian – includes fish but not meat
f. Pollo vegetarian – includes poultry, no meat
DIETS MODIFIED IN CONSISTENCY
1. Clear liquid diet

 A clear liquid diet is made of clear liquid foods which leave no residue
in the gastro-intestinal trace

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 Provides adequate fluid/water, 500-100 kcal of simple sugars,
electrolytes, and is fiber free and fat free
 It requires minimal digestion, as there is no residue, fiber, or fat
 It is also called as “non-residue diet”
 It is recommended for short-term use (3-5 days), can be used both
before and after surgery or diagnostic procedures and during acute
stages of illness
 It consist of “see-through” foods that are liquid at body temperature-
gelatin, tea, coffee, broth, or frozen ice pops
Purposes:
a. Relieve thirst
b. Maintain water balance
c. Minimize stimulation of gastrointestinal tract
d. Serve as initial feeding after surgery of intravenous feeding
Indication of use:
a. Pre or postoperative
b. Acute diarrhea or vomiting
c. Intestinal obstruction
d. Acute phase of fever of infection
e. Inflammatory condition of the gastrointestinal tract
f. To reduce fecal material
2. Full liquid diet

 Diet consisting of liquid foods that liquefy at body temperature
 A full liquid diet provides water, calories, protein, vitamins and
minerals, and dairy products (contain lactose); because milk is
allowed , it contains residue
 It may be indicated for some clients who have difficulty chewing or
swallowing by may not be indicated for a client following CVA
 It may be considered to be a transition diet as the client progresses
postoperatively or post-procedure from liquid to solids
 It consist of all foods on a clear liquid diets, plus milk, pudding, ice
cream, soups, yogurts, and all prepared liquid formulas; is
contraindicated with sever lactose intolerance; may have increased
cholesterol content
Indication for use:

a. Post-operative with minimal GI function
b. Fever and infection
c. Patients too ill to chew, fractured jaw, post oral surgery
d. Lesions in mouth
e. Transition from clear, to soft, to regular diet
3. Cold liquid diet

 Use after tonsillectomy, dental extraction, minor operation of the
mouth/throat

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 All liquids are served cold or iced
 Avoid sharp, sour fruit juices which can cause pain and bleeding on
postoperative area
4. Soft diet
 Also called bland diet
 This diet includes food items that contain small amounts of seasoning
and moderate fiber content but are easy to chew, digest, and absorb
 Foods that are highly seasoned, fried, high in fiber, nuts, coconuts, and
foods that contain seeds are not included in the diet as they could
cause GI symptom upset
 It can be used as a progressive or transition diet and is a modification
of a regular diet
Food sources:
a. Well cooked vegetables
b. Ripe fruits
c. Boiled, baked or canned meat/fish
d. Desserts-cakes, puddings
5. Mechanical soft diet or mechanically altered diet

 Also called “dental soft” or “geriatric soft diet”
 This diet is used for clients who have problems with chewing; focuses
on including all foods and seasonings in a form that is easily handled
by the client
 Food with soft textures, those that are tender and chopped food items
are included in the diet
 This diet is a modification of the regular diet with attention to texture
 Foods that are touch in nature-containing seeds, nuts, raw egg- are
excluded in this diet
6. Soft bland diet

 This diet is similar to soft diet but with additional restrictions
 “NO “ hot spices like black pepper, chilis, caffeine containing
beverages like coffee, team cola drinks and alcohol
Indications for use:

a. For patients with hyperacidity
b. Peptic ulcers (when bland diet cannot be tolerated)
7. Bland diet
 Foods that do not increase gastric acid production and are non-
irritating to the gastrointestinal tract
 Indicated for patients with peptic ulcer
8. Residue restricted diet

 A low-residue diet consist of food items that minimize elimination
patterns by reducing fecal volume

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 High fiber food sources are restricted in this diet along with milk and
milk products
 Erroneously called “constipating diet”
9. Low fiber diet

 This diet is one in which the choice of fruits and vegetables is limited to
those low in cellulose
 Fibrous vegetables and fruits with skin and seeds are omitted, milk is
allowed, meat with minimum tough tissue
DIETS MODIFIED IN COMPOSITION
1. Low calorie diet

 Allowance of food and drink with an energy value that is required for
maintenance in order to bring about weight reduction
 Calories are reduced by limiting carbohydrates and fats while keeping
protein at the normal level (protein should come from the low fat meat
group)
 Diet should specify calorie desired
Indications:
a. Weight reduction – in obese, hypertensive, arthritic, diabetic
b. Energy requirements – hypothyroidism, prolonged bed rest, elderly person
2. High calorie diet

 Diet which includes food and drinks with an energy value of 50 to 100%
above required for maintenance
 Food needed to supply energy/calorie are served in snacks or extra
portions at meal
 Snacks should be given in 3 exchanges + full diet + additional 50-100%
 Rice equivalents = bibingka, biko, cakes, espasol, maja

a. Underweight
b. Hyperthyroidism, injury, burns, fever and infection
c. Convalescence – the period of recovery from illness or injury or surgery
3. High protein diet

 Diet with an allowance of food and drink which provides 1.5 gm of
protein or more
 The use of high-protein diet has been indicated for athletes, and so
with patients recovering from surgery or who have large wounds or
pressure sores
 Increase in protein above normal allowance to maximize the utilization
of protein, to maximize catabolism of protein as energy source
 2 exchanges of snacks + full diet + additional extra portion of protein

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a. Protein deficiency
b. Before and after surgery
c. Hepatitis
d. Convalescence
Food sources:
a. Soybean or lactose milk
b. Cooked sweet beans
c. Tahu with syrup
d. Nuts, peanut butter
e. Meat/fish substitutes
4. Low protein diet

 Clients who have renal disease or liver disease require some form of
protein control in dietary pattern to prevent complications from inability
to handle protein solute load
 Sufficient calories are provided for the maximum utilization of the
limited dietary protein and to prevent or minimize tissue breakdown
5. Low fat
 Foods are taken from the low-fat meat groups
 More fruits and rice exchanges
 Diets where fate is restricted are used in the management of clients
who have clinical conditions related to malabsorption, chronic
pancreatitis, and gallbladder disease
 Foods that are high in fat content are omitted, and no additional fat is
used in the cooking process
 Foods that are high in oxalates (nuts, chocolates, green leafy
vegetables, beer, tea) and avoid vitamin C supplements
 Clients who are being treated for dyslipidemia, cardiovascular disease,
congestive heart failure should be placed on low fat diet
6. Low cholesterol diet

 Diet to reduce blood levels of cholesterol particularly low density
lipoprotein cholesterol
Indications:
a. Hypercholesterolemia
b. Coronary artery disease
c. Adults with family history of heart disease (primary prevention
measure)
Foods:
a. Vegetables – avoid butter, creamed, and fried
b. Milk – only skim and non fat milk
c. Meat/fish – lean meat, chicken without skin, lean beef, avoid internal
organs and sauces

79
7. Low carbohydrate diet
 Allowance of food and drink in which carbohydrate should provide no
more than 50% of required for maintenance
 Complex carbohydrates are preferred (starch, cellulose, fruits and
vegetables)
Avoid foods:
a. Starchy foods
b. Condensed milk, chocolates
c. Salad dressing
d. All sweets
8. Low sodium/ sodium restricted diet

 Sodium levels are lower than the usual sodium content of a regular diet
 Various levels of restriction are available and are based on supportive
evidence that high sodium diets correlate with hypertension and
cardiovascular disease
 It is important to evaluate food labels, medications, and restaurant
dietary intake pattern for hidden sodium sources in the diet
 Sodium is often used as a preservative in many foods; it is important
that clients be taught how to read food labels to detect sodium in food
products
9. Low potassium diet

 Potassium content in diets is reduced
 Indicated for clients with hyperkalemia
Avoid food:
a. Vegetables – cauliflower, celery, mushroom, green leafy vegetables
b. Fruits – fresh fruits
c. Rice – raisin bread, oatmeal
d. Meat
10. Low purine diet

 A purine-controlled died is indicated for clients who have gout, tumor
lysis, or multiple myeloma, and all who have elevated uric acid levels
 Excessive purine accumulation in the body leads to an increase in uric
acid, which is a normal end product of purine catabolism
 The diet includes the use of dairy food products and restricts foods
such as organ meats, anchovies, alcohol and seafood
Teaching and Learning
Reference

80
Ruth A. Ross (2011). Nutrition and Diet Therapy 10th Edition. Delmar, New York.
Library of Congress Control Number: 2009930339
Maria Lourdes Cruz-Caudal (2019). Basic Nutrition and Diet Therapy, A Textbook for
Allied Health 2nd Edition. C & E Publishing Inc.
S. R. Mudambi, M.J Rajagopal. (2006). Fundamentals food, Nutrition an Diet

Therapy. New Age International Publisher
nBritish Nutrition Foundation (2020). Nutrition for Sports and Exercise. Retrieved
from: https://www.nutrition.org.uk/healthyliving/an-active-lifestyle/eating-for-sport-
and-exercise.html
American Bone Health (May 2017). Nutrients For Bone Health. Retrieved from:
https://americanbonehealth.org/nutrition/nutrientsforbonehealth/
TOPIC 6
LEGAL MANDATES RELATED TO NUTRITION AND DIET THERAPY
Introduction
The word ‘mandate’ comes from the Latin word mandatum which means an
order or an instruction. In politics, mandate is defined as the authority, granted by the
electorate to a person or to a party that wins an election, to carry out a policy and act
as its representative. A mandate has a political, but also a legal, nature. In
constitutional law, a mandate is a set of principles that govern the relationship
between the sovereign (voters) and the person who exercises the function for which
he or she has been elected.
Mandate means a statutory requirement or appropriation which requires a political

subdivision of the state to establish, expand, or modify its activities in a manner
which necessitates additional combined annual expenditures of local revenue by all
affected political subdivisions of at least one hundred thousand dollars, or
additional combined expenditures of local revenue by all affected political
subdivisions within five years of enactment of five hundred thousand dollars or more,
excluding an order issued by a court of this state.
Learning Outcomes

81
Understand legal mandates which are related to nutrition and diet therapy.
Learning Content
1. Food and Drug Administration (FDA)

2. Health Issuance Portability and Accountability Act
(HIPAA)
3. National Nutrition Council of the Philippines (NCCP)
Food and Drug Administration (FDA)
The Food and Drug Administration (FDA) is a government agency established

in 1906 with the passage of the Federal Food and Drugs Act. The agency is
separated into divisions that oversee a majority of the organization's obligations
involving food, drugs, cosmetics, animal food, dietary supplements, medical devices,
biological goods, and blood products.
The FDA is known for its work in regulating the development of new drugs.
The FDA has developed rules regarding the clinical trials that must be done on all
new medications. Pharmaceutical companies must test drugs through four phases of
clinical trials before they can be marketed to individuals.
 The FDA inspects and reviews production facilities that make products like
food, medicine, tobacco, and other items regulated by the agency.
 The FDA gives approval to regulated products before they can be sold in the
U.S.
 FDA has the power to recall products on the market, if necessary, for safety
and other reasons.
According to the FDA, the agency holds responsibility for monitoring the safe
consumption of medical products, food, and tobacco. The FDA is relevant for
investors specifically in regards to biotech and pharmaceutical companies. FDA
approval can be crucial to companies that are heavily involved in developing new
drugs. Without the agency’s approval, regulated products under the FDA's purview
cannot be released for sale in the United States.
Health Insurance Portability and Accountability Act (HIPAA)

82
The Health Insurance Portability and Accountability Act (HIPAA) is only
regulated in the United States which makes it challenging for the healthcare industry
to outsource work. Because of reduced oversight it is difficult to have overseas
companies understand and communicate the need for identifying and reporting data
breaches.
In the Philippines, the legislature has adopted the HIPAA model and passed
the Data Privacy Act (DPA), RA 10173 , in 2012. While patterned loosely after
HIPAA, there are some prominent features in the Philippines’ DPA. The DPA
“protects individuals from unauthorized processing of personal information that is (1)
private, not publicly available; and (2) identifiable, where the identity of the individual
is apparent either through direct attribution or when put together with other available
information.” From these two important qualifiers, the DPA attempts to cover the
entirety of data privacy – not just healthcare information. It limits its scope to what is
considered private information that is identifiable with the person of the individual
and protects agencies handling information from frivolous suits.
“Personal information must be collected for reasons that are specified, legitimate,
and reasonable…. [individuals] must opt in for their data to be used for specific
reasons that are transparent and legal.” This approach to information protection
actively involves the individual who owns the information and agencies cannot act
without their express approval. Any agencies that break this rule are liable for
damages and jail time.
Compounding on the type of protected information, the law specifies the level
of diligence required for managing it: “These agencies must be active in ensuring
that other, unauthorized parties do not have access to their customers’ information.”
National Nutrition Council
The NNC, as mandated by law, is the country's highest policy-making and

coordinating body on nutrition.
NNC Core Functions
1. Formulate national food and nutrition policies and strategies and serve as
the policy, coordinating and advisory body of food, nutrition and health
concerns;
2. Coordinate planning, monitoring, and evaluation of the national nutrition
program;
3. Coordinate the hunger mitigation and malnutrition prevention program to
achieve relevant Millennium Development Goals;
4. Strengthen competencies and capabilities of stakeholders through public
education, capacity building and skills development;
5. Coordinate the release of funds, loans, and grants from government
organizations (GOs) and nongovernment organizations (NGOs); and

83
6. Call on any department, bureau, office, agency and other instrumentalities
of the government for assistance in the form of personnel, facilities and
resources as the need arises.
NNC Vision Statement
 NNC is the authority in ensuring the nutritional well-being of all Filipinos,

recognized locally and globally, and led by a team of competent and
committed public servants.
NNC Mission Statement
To orchestrate efforts of government, private sector, international organizations and

other stakeholders at all levels, in addressing hunger and malnutrition of Filipinos
through:
 Policy and program formulation and coordination;

 Capacity development;
 Promotion of good nutrition;
 Nutrition surveillance;
 Resource generation and mobilization
 Advocacy; and
 Partnership and alliance building
Reference
Jackiewicz, A., Olechno, A (2017). Mandate. Retrieved from:

https://oxcon.ouplaw.com/view/10.1093/law-mpeccol/law-mpeccol-e367
Law Insider: https://www.lawinsider.com/dictionary/state-mandate
Palmares, Rey (Apr 30, 2019). Legal Mandates. Retrieved from:

https://xiliumvirtual.com/blog/healthcare-information-security-hipaa-and-the-
philippines-data-privacy-act/
https://www.nnc.gov.ph/about-us
Department of Health http://www.doh.gov.ph/?

fbclid=IwAR1i5hpsUTUCGtEIHRbni9U_A6tZVBMJlRJPz3keyXqdPzVSGgCApdEcb
U4

84
TOPIC 7
ETHICO-MORAL PRINCIPLES RELATED TO CULTURAL AND SPIRITUAL

PREFERENCES
Learning Outcome

Understand the ethico-moral principles related to cultural and spiritual
preferences.
Learning Content
1. Nutritional Genomics
2. Nutritional Support and End-of-Life Decision
Making
3. Social, Political and Economic Issues and
Concerns affecting Nutrition Care
Nutritional Genomics
Nutritional genomics, also known as nutrigenomics, is a science studying the

relationship between human genome, nutrition and health. People in the field work
toward developing an understanding of how the whole body responds to a food via
systems biology, as well as single gene/single food compound relationships.
Since the completion of the human genome project in April 2003, research
projects into the effects of diet on the genome have grown exponentially. Nutrition
intake is both affected by, and affects, a person’s genes. The ability of the body to
take in nutrition, use nutrition effectively, and burn energy in an optimal way can vary
greatly between individuals. Conversely, the nutrition given to a body can affect the
way the genes are expressed, leading to phenotype changes. Studying the DNA of
an individual can therefore be used to generate a personalized dietary plan.
Genes, nutrition and risk factors
Reducing disease risk

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In certain individuals, diet can be a major risk factor for a number of diseases,
such as type-2 diabetes or cardiovascular diseases. For example, methionine is an
important amino acid in various metabolic processes in the body created by the
activity of an enzyme on folate (vitamin B9). A mutation in the gene that creates this
enzyme leads to less production of methionine, causing an increased risk of vascular
disease. A diet high in folate can help to alleviate this risk.
Genes and food preferences

The foods that we enjoy, and don't enjoy, has also been linked to our genes.
A preference for bitter or sweet foods is partially influenced by taste receptors T2Rs
and T1R which can lead to overeating sweet, sugar-rich foods, while variation in
ankyrin-B gene induces fat cells to store glucose at a much higher rate than normal.
The desire to consume food is governed by a variety of signals, such as blood sugar
levels, the presence of certain nutrients, signals from the gastrointestinal tract, and
many other sources of information. Genetic factors affecting these signals can lead
to under or overeating.
Nutrition can alter genetics

Chemicals that are commonly present in the diet can alter the expression of
some genes. Genes can be switched on or off by epigenetic processes, such as
methylation or addition of a methyl group to DNA that can suppress DNA
transcription. Methylation of DNA particularly takes place during the pre-natal period,
but also continues throughout childhood and into adult life.
Low-calorie intake or overeating of high fat and low protein foods during
pregnancy can lead to epigenetic events that make obesity more likely in infants.
This may be an evolved response to times of hardship, where a child is programmed
to store nutrition more effectively, although the exact mechanism is not yet fully
understood.
Overfeeding of neonatal mice can provoke permanent changes in DNA

methylation in the liver, while adults having a restricted diet (without malnutrition)
experience fewer methylation events and exhibit age-related changes more slowly.

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Nutritional Support and End-of-Life Decision Making
Nutrition support alone does not reverse or cure a disease or injury. It is adjunctive
therapy that enables a patient to meet nutrient needs during curative or palliative
therapy. Nutrition support via a feeding tube or intravenous catheter is a lifesaving
therapy for patients who are unable to meet nutrient needs orally. Guidelines are
available that provide timelines for how long clinicians should allow inadequate
intake before initiating nutrition support.1 However, the timeline for starting and
stopping nutrition support in terminally ill patients is often less clear to the clinician,
resulting in angst over what is “the right thing to do.”
Burdens of Nutrition Support

There are considerable data indicating that it is not beneficial to provide nutrition
support for patients with an irreversible (permanent vegetative state or advanced
dementia) or terminal (death anticipated within six months) illness. Seventy
prospective randomized controlled trials of nutrition support in cancer patients were
reviewed and showed no clinical benefit to this patient population. Evidence
suggests that providing nutrition support can contribute to increased suffering in
terminally ill patients due to increased nausea, vomiting, bleeding, edema,
pulmonary edema, incontinence (bladder and bowel), or infections, as well as a
potential requirement for patient restraint.
The notion that withholding nutrition support contributes to pain and suffering has
also been debated. Positron emission tomography scans have demonstrated that
when a patient is in a persistent vegetative state, the brain areas responsible for pain
perception do not function. Therefore, providing nutrition support to this patient
population to provide comfort and reduce suffering is not science based. Some
studies of patients who are dying have indicated that thirst and hunger are not a
significant problem when patients decide to forgo nutrition support and hydration. A
study of nurses caring for terminally ill patients who voluntarily chose to stop food
and fluid intake reported the nurses’ median score of the quality of the patients’
deaths as 8 (range: 0 equaled very bad death and 9 equaled very good death). For
patients with irreversible or terminal illness, it appears that nutrition support may not
benefit the patient but may increase suffering and hasten death.
Benefits of Nutrition Support

Nutrition support has been shown to benefit competent patients by reducing physical
deterioration, improving quality of life, and preventing the emotional effect of
“starving the patient to death.” Practice guidelines for palliative care in adults with
progressive head and neck cancer reported that tube feeding improved nutrient
intake, quality of life, and fluid status.10

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Home nutrition support can be a lifetime commitment for patients with intestinal
failure due to either surgical removal or disease/treatment-related impairment of a
portion of the gastrointestinal tract. Nutrition support is life sustaining, but does it
have a positive impact on a patient’s quality of life? Bozetti and colleagues examined
the quality of life for patients with advanced cancer on home parenteral nutrition
(HPN).11 The patients were severely malnourished, had limited swallowing ability,
and were no longer receiving curative therapy. The researchers reported that quality
of life was better for patients who received HPN for a minimum of three months.
Therefore, the anticipated life expectancy for patients with advanced cancer may be
a factor to consider when examining potential benefit vs. burden.
Palliative vs. Hospice Care

Palliative care provides physical symptom management, emotional support, and
spiritual comfort when no curative therapy is available or after making the decision to
no longer continue curative or life-prolonging therapies. The transition from curative
to palliative therapy should be a continuum of care to diminish any feeling of
abandonment by the patient and family.
Hospice care integrates palliative care into “focus on relieving the substantial
symptom burden patients face at the end of life, as well as advanced care planning
needs, existential concerns, and family and social stressors.”20 A study by Lorenz et
al revealed that 63% of 149 hospices surveyed in California reported denying
admission to patients receiving complex therapy, including PN (38%), EN (3%),
chemotherapy (48%), and radiation (36%). Freestanding hospice programs were
more likely to deny admission based on these criteria than hospice programs that
were part of a statewide or national chain. These restrictive admission criteria could
inhibit patients from entering a hospice program. Hospice care should ideally begin
approximately six months prior to death. The imprecise ability to predict death and
the fear that accepting hospice care is “giving up” results in many patients entering it
weeks, days, or hours before their death.
Debate Over Hydration

Hydration’s role in the dying process has been debated. Fear of making patients
uncomfortable due to thirst encourages clinicians and families to provide fluids to
patients when oral intake is declining or artificial nutrition has been discontinued.
Small studies have suggested that fluids play a minimal role in patient comfort as
long as meticulous mouth care is provided.6,7 Based on his 20 years of experience
working with terminally ill patients, Fine observed that providing “comfort foods” and
oral hydration was therapeutic for the patients. The oral intake of fluids decreases
during the dying process. Water deprivation increases the body’s production of
endogenous opiates that create a euphoric state and has been associated with a
reduction in pain. The provision of intravenous hydration can have a negative impact
on quality of life by increasing pulmonary secretions, urinary output, nausea,

88
vomiting, and edema. As stated previously, the symptoms of dry mouth should be
managed with ice chips, lip balm, and moistened swabs.
Political and socio economic issues and concerns that affect nutrition care
Food security is of supreme importance in improving the nutritional status of many

millions of people who suffer from persistent hunger and under nutrition and many
others who are at risk of facing the same situation. There is a need to clarify the
issues involved in achieving food security and to help formulate appropriate policies
and measures to strengthen it.
Ensuring household food security is a necessary condition for improving nutritional

status, but, by itself, it is not sufficient. The nutritional status of each member of the
household depends on several conditions being met: the food available to the
household must be shared according to individual needs; the food must be of
sufficient variety, quality and safety; and each family member must have good health
status in order to benefit nutritionally from the food consumed. Food insecurity leads
to much human suffering. In addition, it results in substantial productivity losses due
to reduced work performance, lower cognitive ability and school performance and
reduced income earnings. Food security and adequate nutrition are beneficial
outcomes in themselves, as well as important inputs to economic development. Food
security has three dimensions. First, it is necessary to ensure sufficient food supply
both at the national and local level. Secondly, it is necessary to have a reasonable
degree of stability in the supply of food both from one year to the other and within the
year. Thirdly, and perhaps the most critical, is to ensure that each household has the
physical and economic access to the food it needs.
An adequate food supply at the national level is necessary to achieve household

food security. Adequacy of national food supply depends on domestic food
production in relation to demand, trade policies, world food prices, foreign exchange
availability to import food from the international market and availability of food aid.
However, having an adequate food supply at the national level does not
automatically lead to food security for all households; there may still be poor
households that do not have the means to produce or the purchasing power to
procure the food they need. Inadequate access to food by the household can be
either chronic or transitory. Chronic food insecurity is a situation in which households
constantly lack adequate access to food. Transitory food insecurity is a condition in
which households do not have access to food at certain times; it arises from failure
of livestock and crop production, loss of employment, import difficulties, manmade
and natural disasters and other adverse circumstances. Household food security

89
issues differ in rural and urban settings. In urban areas, household food security
depends primarily on the level of income, often in the form of paid wages, in relation
to prices of food and other consumer goods. In rural areas, household food security
is most often determined by food availability and prices, which are commonly related
to agricultural productions, and by incomes which are determined by both on-farm
and off-farm employment opportunities. The number of the food-insecure people is at
present higher in rural areas, but the number of the urban food insecure is growing.
With urbanization growing rapidly in most developing countries, chronic food
insecurity among the urban poor is likely to become an increasingly important
problem in the future. National, regional and local availability of food depends
primarily on production, stockholding and trade. Shortfalls in food production and/or
in food availability through trade lead to food insecurity due to price rises or
breakdown in distribution channels. At the household level, inadequate access to
food is primarily due to poverty; poor households do not have sufficient means to
secure the food they need. These are the households which suffer first and most
when food supplies fall or food prices rise. An array of policy measures, suited to the
problems and conditions prevail.
Poverty is a major determinant of chronic household food insecurity. The poor do not
have adequate means or "entitlements" (6) to secure their access to food, even
when food is available in local or regional markets. Furthermore, the poor are
vulnerable to shocks that are liable to slip them into temporary (transitory) food
insecurity. The ability of households to acquire adequate food may be affected by
events beyond their immediate control, for example, price shocks, war, deteriorating
terms of trade, domestic policy changes, pests, and climatic conditions such as
droughts, storms and floods.
Who Are the Food Insecure? Depending on factors such as agro-ecological

characteristics, access to land, diversity of income sources, and state of
development of the economy, food-insecure households can be members of different
socio-economic and demographic groups in different areas. Nevertheless, some
common characteristics of the food insecure emerge, of which poverty is a central
one. The poor face the most severe constraints in their own food production and in
their access to food from markets, which renders them vulnerable to food security
crises. A number of common sociodemo graphic characteristics emerged from a
recent comparative study that looked at income source patterns of malnourished
rural poor in 13 survey areas in Africa, Asia, and Latin Americe2'2. Food-insecure
households tended to be larger and to have a higher number of dependents, and
they tended to have a younger age composition. Ownership of land or access to
even small pieces of land for farming had a substantial impact on the food security
status of rural households, even when income level is controlled for; the prevalence

90
of food insecurity tended to be higher among landless or quasi-landless households
who were much more dependent on other sources of income than farm income and
on the diversification of the rural economy; Women's income had an important
influence on the food security status of the household, and women-controlled income
was more likely to be spent on food and nutrition than male-controlled income; The
relationship between income diversification and malnutrition is difficult to generalize--
the relationship is context- and location-specific and a result of household coping
strategies. A typology of food-insecure households needs always to be aware of this
location and context specificity. Typically, the food insecure, spend a high share of
their income on staple food consumption and/or allocate a high share of their
production resources to subsistence food production in normal years; yet, they may
barely meet their needed levels of dietary intake. Different types of risks affect
various groups of food-insecure households and their members differently
Food security and nutritional well-being arising from food consumed by households
is determined by at least five interrelated factors:
 Availability of food through market and other channels, which is a function of

factors discussed above;
 Ability of households to acquire whatever food the market and other sources
have to offer, which is a function of household income levels and flows and
the resource base for subsistence farming;
 Desire to buy specific foods available in the market or to grow them for home
consumption, which is related to food habits, intra-household income control,
and nutritional knowledge;
 Mode of food preparation and to whom the food is fed, which is influenced by
income control, time constraints, food habits.
 Nutritional knowledge; and gum Health status of individuals, which is
governed by the nutritional status of the individual, nutritional knowledge,
health and sanitary conditions at the household and community levels, and
care, among others.
Again, each of these determinants has specific risk attributes that determine food
security and nutritional risk.
Food security and nutritional well-being are connected through the actual utilization
of food by individuals, as determined by some of the five above-mentioned factors
(for example, health, the composition and energy density of diet, mode of processing
and preparing food, and, for infants, the extent of breast-feeding and general child
care). While concentrating on the issue of improving household food security, an
essential step toward securing good nutritional status, this paper does not cover
these other important factors identified here, which, together with food security,
determine the ability to achieve good nutritional status.

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Reference
www.sciencedirect.com
www.ncbi.nlm.nih.gov
Greenwood, M. What is Nutritional Genomics? Retrieved from: https://www.news-

medical.net/life-sciences/What-is-Nutritional-Genomics.aspx
TOPIC 8
FILIPINO CULTURE, VALUES, PRACTICES, AND BELIEFS APPLICABLE TO

NUTRITION
Introduction
As you get to know a new patient, especially where there is a language or

culture barrier, make sure you are asking questions that give you as complete
an understanding as possible. For example, in Chinese culture, understanding
the concept and importance of hot and cold foods and how they are utilized to
regulate health at an individual level will help you better connect with your
patient to drive behavior change. Likewise understanding the dietary
restrictions of religious beliefs such as those observed by both Islamic and
Jewish faiths in their prohibition of pork or Hinduism in its prohibition of beef will
help build insightful and trusting relationships. Having this information will allow
you to give more personalized advice on when to take medications, how to
regulate blood sugars, or how to modify eating behaviors.
Learning Outcome
After the discussion the students should be able to:
1. Customized nutrition plan based on Philippine Culture, values, practices, and

beliefs.
2. Demonstrate nursing core values in implementing nutrition plan
Learning Content
1. Cultural Aspects of Dietary Planning
2. Filipino Dietary Practice

3. Core Values of Nursing as applied to Nutrition and
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Dietetics
Culture and nutrition
Recognizing that many cultures tie their eating habits to the customs of their families
can also be an important concern. Try asking, through your interpreter, if the family
all eats the same food together most often, or if there are modifications for different
individuals. Does the family follow any religious traditions or holidays that create
modifications to their traditional diet? This can help you determine whether
eliminating or changing food in one’s diet would create undue strain on the family’s
mealtime rituals. Changing portion size, for instance, might be a more appropriate
and less disruptive suggestion.
Most importantly, do everything you can to enlist the patient in developing his or her
own plan once they understand the health challenges they face. Different cultures
may encourage or frown upon consumption of different foods by individuals who
belong to their groups. Also the consumption of different foods at different stages of
life may be actively encouraged or discouraged.
This is due to the benefits and dangers of consuming these foods at certain times of
life and in certain conditions. For example most cultures will not approve of the
consumption of alcohol during pregnancy or lactation. This is due to the adverse
affects produced by this drink. Foods and nutrition may also be affected by culture,
with respect to different beliefs within the culture.
For example:
 In the Hindu and Buddhist religions the consumption of both pork and beef is
frowned upon. This is because it is considered to not be clean meat. Also
ancient Hindu scriptures prohibit the eating of these meats. As a result of this
the large majority of Hindus and Buddhists (roughly 90%) have taken this rule
to the extreme. They refuse to eat any meat at all and are strict vegetarians,
despite being allowed to eat chicken and lamb.
 Conversely only the consumption of pork and not beef is prohibited for the
same reasons in the Islamic religion and Judaism. However all other meats
consumed in these religions must be halal and kosher respectively. This
means that special prayers are performed in order to make the eating of these
animals acceptable.

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 In stark contrast Christianity and the Catholic religion allow the consumption
of any types of meat without the need for any kind of repentance to God in the
form of prayer.
 Also at the other extreme to these religions the Jain religion does not allow
the eating of any meat and any vegetables grown beneath the soil.
Within certain religious groups there are different levels of acculturation. This means
there is a large diversity with respect to the extent certain individuals follow the
teachings of their religion. In some cases this diversity may result from the patient’s
own interpretation of their particular religion. For example some individuals may be
devoutly religious and follow their religion strictly according to the teachings. Also
some individuals may not be as religious to such a degree and will tend to follow
their religion more loosely. In the case of the patients I interviewed, only the first
patient was very religious. This resulted in her food choices being greatly influenced
by religion.
Negative and Positive Impact of culture in nutrition and diet
Different cultures can produce people with varying health risks, though the role of
diet is not always clear. For example, African-Americans and many Southerners are
at greater risk for ailments such as heart disease and diabetes, but Southern-style
fried foods, biscuits and ham hocks might not be the only culprits. Income levels,
limited access to healthier foods and exercise habits might play a role as well.
Menus stressing lower-fat foods and lots of vegetables, such as those of many Asian
cultures, can result in more healthful diets, even reducing the risks for diseases such
as diabetes and cancer.
Cultural Shifts
As people from one culture become assimilated into another, their diets might
change, and not always for the better. A good example is the shift away from
traditional eating patterns among Latinos in the United States. Besides the well-
known emphasis on ingredients such as hot chiles and cilantro, traditional, nutritious
Latino meals include corn, grains, tubers such as potatoes and yucca, vegetables,
legumes and fruits. But a shift to a higher-fat, Americanized diet has raised the
obesity rate among Latinos and the health risks that go with it.
Mediterranean Example
How would you like a Mediterranean cruise? Not possible for everyone, but certain
Mediterranean cultures feature diets so healthful that lots of people try to emulate
them. According to the Cleveland Clinic, nutrition experts years ago took note of
typical diets in regions such as Crete, other parts of Greece and southern Italy,
where life expectancy was high and heart disease rates were low. The

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Mediterranean diet includes seasonal foods with minimal processing, plenty of
vegetables and whole grains, fresh fruit for dessert instead of sugary sweets, olive oil
as the main fat, and moderate amounts of dairy products, fish and poultry.
Healthier Diets
Enjoy your culture and the foods that make it special, but look for ways to tweak diet
traditions to make them more healthful. The American Academy of Family
Physicians and American Cancer Society suggest you reduce your risks for chronic
disease by eating more fruits and vegetables, limiting alcohol consumption, avoiding
high-fat and sugary foods, and cutting back on processed foods and red meat. Try
substituting less-fattening ingredients — for example, reduced-fat cheese in tacos,
veggies instead of meat in lasagna or fat-free yogurt in raita sauce. And include
exercise in your personal and family routines, aiming for 30 to 60 minutes of exercise
on most days.
Filipino Dietary Practice
Filipino food is colorful and distinctive due to the blended influences of Malaysian,
Polynesian, Spanish, and Chinese cuisines. There are three principles of Filipino
cooking: never cook any food by itself, fry with garlic in olive oil or lard, and foods
should have a sour-cool-salty taste. In place of the traditional clay pot, a large wok
called a kalawi is used for frying foods. Fried foods are allowed to absorb more fat
than is typical of other Asian cooking. Rice, steamed or fried, forms the foundation of
the diet. Rice flour is used to make noodles and bread. Noodles made of mung
beans or wheat are also common, prepared with a cooked protein (chicken, ham,
shrimp, pork) in a soy and garlic-flavored sauce. Vegetables are mixed into stews,
stir fries, and soups or braised and served as an entrée or a side. The amount of
meat, poultry, or fish a family eats depends on economic status and are added as
available to soups, stews, mixed dishes, and egg rolls (lumpia). All parts of the
animal are used in cooking including the skin, blood, and organs. Rural Filipinos
make one of the few native cheeses in Asia from water buffalo (carabao) milk. The
water buffalo milk is also often used in desserts. Fermented fish paste or sauce is a
popular seasoning used instead of salt. To add a sour-cool taste to foods, palm
vinegar or a paste made from tamarind or kamis (cucumber-like vegetable) is used.
A Filipino specialty, called kinilaw, uses sour ingredients to marinate and pickle raw
foods including fruit, vegetables, meats, organs, and seafood. Lime wedges and
chili-flavored vinegar are frequently offered on the table so that diners may add
desired levels of saltiness or sourness to their food. The coconut is widely used in
Filipino cooking as a vegetable or to make beverages, desserts, and sauces.
Common desserts include custard (leche flan) and a parfait-like dessert made of
shaved ice, coconut milk, mung beans, purple yam pudding, palm seeds, corn
kernels, pineapple jelly, and other ingredients (halo-halo).

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Regional cooking styles in the Philippines are divided into four regions: Luzon,
Bicolandia, the Viscayan Islands, and Mindanao. Luzon is ethnically diverse and the
cuisine is strongly influenced by the Spanish. In the northern areas, ocean fish and
ample amounts of anchovy sauce and shrimp paste are commonly eaten. Boiling
and steaming are the typical cooking methods, and spinach like greens (saluyot) and
drumstick plant leaves (sili) are particularly popular.
The central region is known for growing rice and for its freshwater fish. Dishes are
richly sauced and flavored with onions and garlic. The most common cooking
technique is stir-frying. Coconut products and tropical fruits are highly popular, and
sweetened rice dishes are a specialty. Bicolandia is ethnically homogenous with
culinary influences from Malaysian and Polynesian styles of cooking.
Foods tend to be very spicy due to use of chile peppers, but the spice is balanced
with coconut milk and cream. The fare in the Viscayan Islands includes abundant
use of seafood, shrimp paste, and seaweed. Specialty candies and pastries are
common due to the sugarcane plantations in the area. The cuisine of the Mindanao
region is influenced by Indonesia and Malaysia. Little pork is consumed, as much of
the region is Muslim. Sauces made from peanuts and chiles, curries, and other spicy
fare are very popular.
At the center of the Filipino family is the extended family including all paternal and
maternal relatives. Familial kinship may also include friends, neighbors, and fellow
workers. Community obligations are initiated through shared Roman Catholic rituals
and include shared food, labor, and financial resources. Elders are respected, and
children are spoiled and adored by the family until the age of six. Children are
expected to be obedient, to contain their emotions, to be very polite, to be quiet and
shy, and to avoid all conflict.
Many Filipinos believe that health requires personal harmony with the supernatural
world, nature, society, and family. Three practices promote balance and good health:
heating (balance of hot and cold), protection (safeguards body from natural and
supernatural forces, a layer of body fat for example), and flushing (cleansing the
body of impurities).
Nutrition Facts:
The traditional Filipino diet is higher in total fat, saturated fat, and cholesterol than
most Asian diets. Overweight can be associated with health and caretakers may try
to overfeed babies. Southeast Asians may calculate age on a lunar calendar, starting

96
with being one year at birth. This difference can distort use of standardized growth
curves.
Lactose intolerance is common in Filipinos. Health conditions that may compromise

nutritional status include tuberculosis, intestinal parasites, malaria, and Hepatitis B.
Possible Deficiencies
 Calcium – Calcium is needed to build strong bones and teeth. It also plays a
role in blood clotting, muscle contraction, and nerve-cell communication. In
the long term, dietary intakes well below the recommended levels may impact
bone development. Bones increase in size and mass during childhood and
adolescence, therefore adequate calcium and vitamin D should be consumed
throughout childhood into early adulthood.
 Iodine – Iodine is needed for production of thyroid hormone. Deficiency of

iodine can lead to development of an enlarged thyroid called a goiter,
hypothyroidism, and mental retardation in children whose mothers were iodine
deficient during pregnancy.
 Iron – Iron is necessary for oxygen delivery to cells and regulation of cell
growth. Iron deficiency develops gradually and is commonly seen in women of
childbearing age and children. A lack of iron results in an insufficient supply of
oxygen to cells eventually causing anemia, fatigue, poor work performance,
slow cognitive and social development in children, and decreased immunity.
 Selenium – Selenium is an essential mineral that acts as a protective

antioxidant in the body and regulates thyroid hormone. Keshan disease is a
cardiac problem that can occur in selenium-deficient children and mothers.
Selenium deficiency often accompanies iodine deficiency.
 Vitamin A – Vitamin A plays a critical role in healthy vision, growth and

development, and immune function. Vitamin A deficiency is common in
developing countries and is often accompanied by zinc deficiency. Symptoms
of deficiency include blindness, diminished ability to fight infections,
decreased growth rate, and slow bone development. Vitamin A helps mobilize
iron from its storage sites, so a deficiency of vitamin A limits the body’s ability
to use stored iron. This results in an “apparent” iron deficiency because iron
levels in the blood are low even though body stores are normal.
 Zinc – Zinc is involved in many important processes in the body. Symptoms

of zinc deficiency include delayed growth, loss of appetite, impaired immune
function, hair loss, diarrhea, delayed sexual maturation, eye and skin lesions,
delayed wound healing, taste abnormalities, and mental fatigue.

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Common Foods:
Milk/Milk Products – evaporated milk (cow, goat), white cheese (carabao, made from
water buffalo milk)
Meat/Poultry/Fish – beef, carabao, goat, pork, monkey, variety meats (liver, kidney,
stomach tripe), rabbit, chicken, duck, pigeon, sparrow, anchovies, bonita, carp,
catfish, crab, crawfish, cuttlefish, dilis, mackerel, milkfish, mussels, prawns, rock
oyster, salt cod, salmon, sardines, sea bass, sea urchins, shrimp, sole, squid,
swordfish, tilapia, tuna
Eggs/Legumes – chicken and fish eggs; black beans, black-eyed peas, chickpeas,
lentils, lima beans, mung beans, red beans, soybeans, white kidney beans, winged
beans
Cereals/Grains – corn, oatmeal, rice (long- and short- grain, flour, noodles), wheat
flour (bread and noodles)
Fruits – apples, avocados, banana blossoms, bananas (100 varieties), bread fruit,
calamansi (lime), citrus, coconut, durian, grapes, guava, jackfruit, Java plum, litchi,
mangoes, melons, papaya, pears, persimmons, pineapples, plums, pomegranates,
pomelo, rambutan, rhubarb, star fruit, strawberries, sugar cane, tamarind,
watermelon
Vegetables – amaranth, bamboo shoots, bean sprouts, beets, bitter melon, burdock
root, cabbage, carrots, cashew nut leaves, cassava, cauliflower, celery, Chinese
celery, drumstick plant, eggplant, endive, green beans, green papaya, green
peppers, hearts of palm, hyacinth bean, kamis, leaf fern, leeks, lettuce, long green
beans, mushrooms, nettles, okra, onions, parsley, pigeon peas, potatoes, pumpkins,
purslane, radish, safflower, snow peas, spinach, sponge gourd, squash blossoms,
winter and summer squashes, sugar palm shoot, swamp cabbage, sweet potatoes,
taro, tomatoes, turnips, water chestnuts, watercress, yams
Seasonings – atchuete (annatto), bagoong, baggong-alamang, chile peppers, garlic,

lemon grass, patis, seaweed, soy sauce, turmeric, vinegar
Nuts/Seeds – betel nuts, cashews, palm seeds, peanuts, pili nuts
Beverages – soymilk, cocoa, coconut juice, coffee with milk, tea
Fats/Oils – coconut oil, lard, vegetable oil
Sweeteners – brown and white sugar, coconut, honey
Meal Patterns:

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Three meals a day with a mid-morning and late afternoon snack (called meriendas)
is the traditional pattern of eating. Garlic-fried rice or bread with eggs or broiled fish,
sausage, or meat, plus hot chocolate or coffee is an example of a typical breakfast.
Sweet, cheesy rolls called ensaymada are also especially popular for breakfast.
Lunch and dinner are both large meals of similar composition that include soup, rice,
a crispy or chewy dish, a salty dish, a sour dish, a noodle dish, and often, an adobo
dish. Fresh fruit or dessert concludes the meal. Courses are served consecutively if
the meal features mostly Spanish-style dishes. Conversely, all courses are served
together, including dessert, if the meal features Filipino-style dishes. Snacks may be
small or large. Almost all foods may be eaten as snack, except rice, which is served
only at meals. Common snacks include fritters, pastries, fruits, ensaymadas, or
lumpia.
Dining tables are frequently equipped with lazy Susan turntables so that all food is
accessible to everyone. Tradition is that no one starts eating until the eldest male
starts the meal. The western style of dining with forks, knives, and spoons is
common, however, the use of just forks and spoons is also typical. The spoon is
used to hold down the food while the fork is used to pull bits away, then the spoon is
used to push food onto the fork for eating. In rural areas, fingers (of the right hand
only) are more commonly used for dining. Small mounds of rice are rolled to form a
ball that is dipped into sauce then pressed into meat or poultry and popped whole
into the mouth. Taking the last bits of food from the central platter is considered poor
etiquette.
Predominantly of Catholic faith, Filipinos celebrate many religious festivals and

saints’ days. Abundant food served buffet-style with roasted pig as the centerpiece is
customarily served on all special occasions.
Filipino food and Culture
Traditional food and dishes
The food and culture of the Philippines are largely influenced by Spanish, Chinese
and American traditions. White rice is the main food in the diet and it is usually
served three times per day. Fish is the primary protein source in the diet. Vinegar,
soy sauce, salt, fish sauce and fermented fish are traditional flavorings used in
Filipino cuisine. Philippine adobo is often dubbed the national dish, but varies from
the adobo served in other cultures. In the Philippines, adobo refers to foods stewed
in a broth of garlic, vinegar, bay leaf and peppercorns and is made with chicken, pork
or both.

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Holidays and Special Occasions
More than 80 percent of Filipinos identify as Catholic, with almost percent

identifying as another Christian denomination. Food is often the center point of
celebrations and the Philippines are known for a long Christmas season. Food
choices for the holidays vary by island and family economics, however, cocido
(meat, sausage, salt pork and ham with cabbage and beans) is considered a more
elaborate and expensive meal suitable for Christmas. Tinubong (rice cake cooked in
a bamboo tube) is a common Christmas treat or dessert.
Traditional Eating Patterns
Fresh fish is often caught daily and many families have gardens. Traditionally, a clay
pot is used for steaming rice and stewing other foods. A kalawi (similar to a wok) is
commonly used for sautéing. Courses of a meal may be served consecutively, if
Spanish in origin, or simultaneously, including dessert, if the dish is of Philippine
origin. Generally, the eldest male starts the meal, and others follow. Because soups,
stews and mixed dishes are common, forks are spoons are frequently used, but
knives may not be present on the table. Typically, three meals and two snacks, one
mid-morning and one mid-afternoon, are eaten daily.
Traditional Health Beliefs
 Flushing, heating and protection are the key elements to traditional health
beliefs. Flushing rids the body of debris, heating regulates the internal
temperature and protection involves safeguarding the body from natural and
supernatural forces. Being overweight is thought of as such protection and a
layer of fat on the body denotes resistance. Filipinos will use home remedies
and herbal medicine first. These may include drinking boiled ginger for a sore
throat and boiling corn hair in water and drinking it to promote urination. A
hilot, is a traditional practitioner sought for pain relief, and offers treatment
along the lines of chiropractic and massage. Filipinos will seek the advice or a
traditional healer or family elder prior to that of a physician and usually only
seek a doctor when the illness has advanced and home remedies have failed.
Current Food Practices
Rice and fish are still the staple foods in the Philippines,despite the availability of
fortified rice and iodized salt, micronutrient deficiencies persist. Anemia,
hypothyroidism and osteoporosis are prevalent. In urban areas, more foods are
available, including some American-style fast food and convenience foods, like
cereals, and obesity is on the rise. First generation Filipino-Americans see
themselves as more Filipino than American. However, most report enjoying

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American food just as well as traditional Filipino food and consume them equally.
While the use of butter as a spread is still uncommon, bakery foods, cereals and
waffles are commonly consumed, in addition to traditional white rice. Dairy products
are more affordable in the U.S. and have been embraced, as have processed meats.
Due to increased availability, Filipino-Americans eat a better variety of vegetables,
but rarely eat them raw. Additionally, fast food consumption and increased portions
of calorie dense foods are associated with Filipino dietary acculturation. Proper
nutrition plays a big role in disease prevention, recovery from illness and ongoing
good health. A healthy diet will help you look and feel good as well. Since nurses are
the main point of contact with patients, they must understand the importance of
nutrition basics and be able to explain the facts about healthy food choices to their
patients. Nutrition classes provide the information necessary to sort the fact from
fiction about healthy eating and pass that knowledge on to their patients. Not only
must nurses be able to explain the ins and outs of a healthy diet, they must also lead
by example.
HOW DOES NUTRITION RELATE TO HEALTH?
Healthy food choices are vital to preventing illness, particularly chronic illnesses such
as diabetes and heart disease. Nurses work in a variety of healthcare settings, not
just hospitals. While nurses in hospitals may focus more on the dietary concerns of
patients recovering from illnesses, community nurses focus more on prevention.
Nurses who work at schools or community centers can often provide nutritional
education to the public to prevent chronic conditions.
It is important that nurses understand proper nutrition as it relates to recovery as

well.
Proper nutrition is not only important for preventing disease, it is also crucial to the
recovery process. According to an article by Michael Henning titled "The healing of
the body can take place only when the nutrients that provide the building blocks for
repair are present." Due to the lack of trained nutritionists, the responsibility of
educating patients on healthy eating habits often falls to attending nurses. They can
put together diet plans for patients to take home and use long after they leave the
hospital. Protein is essential to the healing process: "Fats and carbohydrates are
also important in helping wounds to heal. They stop your body from using protein as
an energy source, allowing it to be used to heal tissue."
Not only should people recovering from illness make sure they eat right, they also
need to make sure they are eating enough. Many illnesses and treatments can
cause a loss of appetite -- including anything from a common cold to chemotherapy.
Weight loss can increase your chances of infection, notes Victoria Taylor, a dietician

101
with the British Heart Foundation. Taylor suggests "having more frequent meals, or
little snacks throughout the day."
HOW CAN NURSES TEACH PATIENTS ABOUT A HEALTHY DIET?
There are many ways nurses can teach their patients about proper nutrition as it
relates to their health. Presentations at community health centers are crucial to
community health. A nurse with the right knowledge can prepare a PowerPoint
presentation to show for a group of seniors during a health fair. They can also give
the attendees literature to take home for further study and guidance. Similarly, a
school nurse can present students with the facts about healthy nutrition during a
school assembly as well as giving them brochures to take home.
Nurses who work in hospitals and clinics are likely more concerned with nutrition as
it relates to recovery from illness, surgery or other treatments. Nurses can talk to
patients at the bedside and explain the special meals they have at the hospital that
aid recovery, as many patients will be on special diets during their stay. These
nurses can also gather informative and accurate literature to give patients when they
are discharged. Healthy eating goes far beyond the hospital, especially if the patient
plans to stay out of the hospital.
LEAD BY EXAMPLE (PRACTICE WHAT YOU PREACH)
According to an article titled "Healthy Eating for Healthy Nurses: Nutrition Basics to
Promote Health for Nurses and Patient" published in The Online Journal of Issues in
Nursing, "When healthcare professionals, such as nurses, care for their own health,
it is reasonable to think that this will help them to better care for patients." Nurses
often find themselves working a mixed schedule -- nightshifts for a few days and
then a dayshift a day or two later. Add to that the stress of the job itself, and poor
food choices may become the norm. Patients, who are likely getting information
about nutrition from their nurses, are likely to be aware of the "health habits" of those
nurses. As noted in The Online Journal of Issues in Nursing article, "[patients] were
more confident to receive diet and exercise education from a normal weight nurse."
As you can see, the importance of nutrition is clear from both sides on the healthcare
equation.
References
1. https://adoptionnutrition.org/nutrition-by-country/philippines/
2. https://www.livestrong.com/article/476301-how-culture-affects-diet/
3. McNamara K, Batalova J. Filipino immigrants in the United States.
Migration Information Source.2016.

102

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TOPIC 1

BASIC CONCEPTS IN NUTRITION AND DIET THERAPY

NUR 212 Nutrition and Diet Therapy

NUR 212 Nutrition and Diet Therapy

Prokaryotic and Eukaryotic Cells

Digestion is defined as the process of breaking down food into substances

NUR 212 Nutrition and Diet Therapy

PARTS OF THE DIGESTIVE SYSTEM

NUR 212 Nutrition and Diet Therapy

NUR 212 Nutrition and Diet Therapy

b. Micro Nutrients – are chemical element or substance required in trace

NUR 212 Nutrition and Diet Therapy

Six Essential Nutrients

NUR 212 Nutrition and Diet Therapy

NUR 212 Nutrition and Diet Therapy

NUR 212 Nutrition and Diet Therapy

Minerals Primary Primary Clinical

Bone/teeth Dairy products,

Potassium Water balance Grains, meats, Arrhythymias,

NUR 212 Nutrition and Diet Therapy

5. Vitamins: Fat-soluble vitamins A, D, E and K and also water-soluble vitamins

FAT SOLUBLE VITAMINS

NUR 212 Nutrition and Diet Therapy

Antioxidant Green leafy D: Hemolysis of

WATER SOLUBLE VITAMINS

Vitamins Functions Primary Clinical

NUR 212 Nutrition and Diet Therapy

Ascorbic acid Collagen D: Scurvy, body

Group I: Classic Disease Factors

Niacin Energy metabolism, Animal sources D: Anorexia,

NUR 212 Nutrition and Diet Therapy

Group II: More Recently Discovered Coenzyme Factors

Integrity of the CNS, D: Insomnia,

Group III: Cell Growth and Blood-forming Factors

Group IV: Other Related Factors (pseudo-vitamins)

NUR 212 Nutrition and Diet Therapy

Mobilizes fat, helps

NUR 212 Nutrition and Diet Therapy

 Dehydration - This condition would be serious if the loss is about 10% of

NUTRITION, METABOLISM AND ENERGY

NUR 212 Nutrition and Diet Therapy

NUR 212 Nutrition and Diet Therapy

NUR 212 Nutrition and Diet Therapy

BASIC TOOLS IN NUTRITION, STANDARDS, GUIDELINES AND NUTRIENT

NUR 212 Nutrition and Diet Therapy

1. What is Dietary Reference Intake?

Dietary Reference Intakes (DRIs) comprise a set of at least four nutrient-

NUR 212 Nutrition and Diet Therapy

Basic tools in nutrition are devised to aid in the planning, procuring,

Dietary Guidelines and Food Guides:

1. USDA Food Guide

NUR 212 Nutrition and Diet Therapy

o Milk, yogurt, and cheese group

o Meat, poultry, fish, dry beans, eggs, and nuts group

o Fats, oils, and sweets group

NUR 212 Nutrition and Diet Therapy

Food labelling provides information regarding food product’s common name,

4. Nutrient Guidelines for Filipino.

The Nutritional Guidelines for Filipinos (NGF) is a set of dietary