Dr. Dalia El-Shafei Assoc. prof., Community Medicine Department, Zagazig University http://www.slideshare.net/daliaelshafei THERAPEUTIC DIET THE GOALS OF DIETARY ADVICE: To prevent or manage some medical conditions To maintain or improve health using appropriate & healthy food choices To achieve & maintain optimal metabolic & physiological outcome. HPN Dyslipidemia & Coronary heart diseases Renal Diseases GIT Problems DM DIETARY RECOMMENDATIONS IN HPN DASH eating plan: -Dietary approach to stop hypertension (DASH). -Flexible & balanced eating plan which recommends: ↑Servings of vegetables & fruits (3-4 servings/d). ↑Foods rich in potassium as: milk, banana, orange & legumes. Whole grain cereals & bread. Fat-free or low-fat dairy products (3 servings/d). Lower saturated fats, cholesterol & total fats. Limiting intake. Two or more vegetarianstyle or meatless meals each week. ↓Sweets & added sugars. Low sodium (salt) intake (<2.3 mg /day.). lean meat Making healthy lifestyle changes while following the DASH eating plan is the best way to control HPN through the following: Maintaining a healthy weight (in overweight or obesity; reducing daily caloric intake by 500-1000 kcal. to have a weight loss of 1-2 pounds /week. Be physically active. Making healthy eating choices that less in sodium (by using of spices, lemon, vinegar or other salt-free seasoning blends). Stop smoking: as smoking harms every organ in the body. DIET THERAPY IN DYSLIPIDEMIA & CORONARY HEART DISEASES: Total calories: Balanced energy intake & expenditure. Carbohydrate: 5060% of total calories Protein: 15-20% of total calories Total fat: 25–30% of total calories ↑ Unsaturated fats: Olive oil & Omega-3 oil in fish Saturated fats: <7% of total calories ↓Cholesterol, transfats, saturated fats & salt. Dietary cholesterol: <200 mg/day Fibers: 20-30 g/day DIETARY RECOMMENDATIONS IN DM Choose more high fiber foods: (↑fruits & vegetables) Reduce animal or saturated fat intake • Low fat milk • Maintain blood glucose • Low fat spread instead of butter levels & cholesterol levels • Maintain a healthy gut: • Oil high in unsaturated fat, Whole grain cereals, “olive oil, omega-3 oils” Whole wheat pasta, Brown • Less fat in cooking: grill, rice dry-roast, steam Cut down on sugary foods • • • • Reduce salt intake • Cut down on added salt Sweets, eat starchy foods. • Use alternative seasonings • Look out for reduced/low Sugary drinks Use diet or low calorie, sodium foods e.g: bread • Avoid salt substitutes sugar free drinks Choose low sugar • Eat regular meals products DIETARY RECOMMENDATIONS IN RENAL DISEASES Extremely complicated. • Intended to reduce the amount of excretory work demanded of the kidneys while helping them maintains fluid, acid-base, and electrolyte balance. • Patients with CRF may have restricted proteins, Na, K, Ph. • Sufficient calories necessary: 25-50 kcal/kg BW. • Limit protein to 40 grams based on glomerular filtration rate & weight. • Sodium may be limited if the client tends to retain it. • Fluids are typically restricted for renal patients. • Calcium supplements may be prescribed. • Vit. D may be added, and phosphorus limited, to prevent osteomalcia. • Potassium may be restricted in some patients because hyperkalemia tends to occur in end stage renal disease (ESRD). Excess potassium can cause cardiac arrest. • Renal patients often have an increased need for vitamins B, C, and D. • Iron is commonly prescribed. DIET IN GASTROINTESTINAL PROBLEMS Liver cirrhosis Hepatitis Peptic ulcers Diet therapy in liver cirrhosis: Provides at least 25-35 kcal or more. In advanced cirrhosis, 5060% of kcal. should be taken from carbohydrates. Protein: 0.8-1.0g/kg BW each day. Supplements of vitamins & minerals. Sometimes cirrhosis causes ascites: Sodium & fluids may be restricted. In esophageal bleeding, fibers can be restricted to prevent irritation. Smaller feedings better than larger ones. Alcohol is prohibited Diet therapy in Hepatitis: Diet should provide 35-40 kcal/kg.BW: by carbohydrates with restriction of fat If necrosis is not If necrosis is severe, up to 70- severe: limited 80 grams of proteins to protein for cell prevent ammonia regeneration. accumulation in the blood. Diet therapy in Peptic Ulcers: Well-balanced diet of 3 meals a day. Sufficient low-fat protein. No less than 0.8g of protein/kg BW Avoid caffeine, beverages, alcohol, aspirin & smoking. NUTRITION & CANCER I. DIET AS A RISK FACTOR: Nutritional excess: • Increased caloric intake → obesity, cancer breast, uterus, esophagus …etc. • Increased saturated fatty acids → tumor growth. • Excess salting → cancer stomach and esophagus. Carcinogens in foods: • Microbial toxins: aflatoxins in long stored nuts → cancer liver. • Chemical toxins: pesticides, herbicides, nitrogenous fertilizers. • Packing materials: soldered canned food, lead pipes→cancer kidney, alum in water purification & cadmium in food industry. • Chloroform in water & alcohol. • Polycyclic aromatic hydrocarbons from food grilling over direct flame. • Food additives: colors, flavors, sweeteners, preservatives. II. DIET AS A PROTECTIVE AGENT: Fibers have a protective effect against cancer colon. Fruits & vegetables: rich in antioxidants (vit. A, E, C). Linolenic fatty acid (polyunsat. FA) has protective role against cancer breast & colon. Selenium is an antioxidant & calcium has anticancer role. Coffee & tea have useful role in prevention of cancer colon. NUTRITION & INFECTION Infection can lead to malnutrition by causing anorexia, vomiting, diarrhea or bleeding. Increased supply for nutrients to compensate for the losses is needed. Malnutrition interferes with body formation of antibodies (immunoglobulins) lymphocytes & phagocytes. Vitamins A, C & B2 are responsible for normal proliferation of phagocytes & lining epithelium of respiratory & urinary tracts. These nutrients deficiency ↑ body susceptibility to infection. ANTIOXIDANTS In the body the oxidation reactions involve highly reactive molecules called free radicals. When these free radicals are released from the mitochondria in sufficient numbers, they threaten the protective biochemical systems of the body and the cell structures & functions(damage cell proteins, lipoproteins & DNA) & can lead to diseases, as cancer, coronary heart diseases, arthritis, DM & neurodegenerative diseases as Alzheimer. Oxidative stress: Impaired balance between free radical production & antioxidant capacity resulting in excess oxidative products. SOURCES OF FREE RADICALS: Extrinsic: as radiation, pollution, smoking, pesticides & toxins. Intrinsic: as stress & inflammation. ANTIOXIDANTS Chemical compounds which may be endogenous as superoxid dismutase enzyme in the human cells or exogenous as vitamins E, C, A, selenium, zinc & phytochemicals in foods. These antioxidants neutralize the free radicals preventing them from damaging healthy cells. Sources of antioxidants (Exogenous) Betacarotene • Apricots, carrots, mangoes. Copper • Seafood, milk, nuts & lean meat Selenium • Onion, garlic, wheat germ, mushrooms. Vitamin C Vitamin E • Broccoli, cabbage, strawberry. • Whole grain cereals, nuts, wheat germ, mangoes. Phytochemicals • Green tea, apple, citrus fruits, onion, tomatoes, garlic. FUNCTIONS OF ANTIOXIDANTS: Against senility, cancer & cardiovascular diseases. Prevent progress of rheumatoid arthritis, diabetes and parkinsonism. ↓ Muscle damage in athletes. Prevent rancidity in food preservatives & cosmetics industries. ↓ Menopausal symptoms & osteoporosis. VEGETARIANISM VEGETARIANISM It is a practice of diet that excludes meat, fish and poultry, egg, milk and honey i.e., excludes any food from animal source. Lactovegetarianism: consuming milk & excluding the other animal foods. Ovovegetarianism: consuming eggs &excluding the other animal foods. Semivegetarianism: excluding meat only. Causes of choosing vegetarian diet: Mortality Religion Economical Culture Political Ethical Taste Environmental Morbidity Benefits Hazards Healthy diet if well planned “↓ risk of cancer, IHD, HPN & obesity”. Only deficient nutrient is vit. B12 “only in animal protein”.
