Types of Therapeutic Diets

A therapeutic diet is a meal plan that controls the intake of certain foods or
nutrients. It is part of the treatment of a medical condition and are normally
prescribed by a physician and planned by a dietician. A therapeutic diet is
usually a modification of a regular diet. It is modified or tailored to fit the
nutrition needs of a particular person.

Therapeutic diets are modified for (1) nutrients, (2) texture, and/or (3) food
allergies or food intolerances.

Common reasons therapeutic diets may be ordered:

 To maintain nutritional status
 To restore nutritional status
 To correct nutritional status
 To decrease calories for weight control
 To provide extra calories for weight gain
 To balance amounts of carbohydrates, fat and protein for control of
diabetes
 To provide a greater amount of a nutrient such as protein
 To decrease the amount of a nutrient such as sodium
 To exclude foods due to allergies or food intolerance
 To provide texture modifications due to problems with chewing and/or
swallowing

Common therapeutic diets include:

1. Nutrient modifications
 No concentrated sweets diet
 Diabetic diets
 No added salt diet
 Low sodium diet
 Low fat diet and/or low cholesterol diet
 High fiber diet
 Renal diet

2. Texture modification
 Mechanical soft diet
 Puree diet

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3. Food allergy or food intolerance modification
 Food allergy
 Food intolerance

4. Tube feedings
 Liquid tube feedings in place of meals
 Liquid tube feedings in addition to meals

5. Additional feedings – In addition to meal, extra nutrition may be

ordered as:
 Supplements – usually ordered as liquid nutritional shakes once,
twice or three times per day; given either with meals or between
meals
 Nourishments – ordered as a snack food or beverage items to be
given between meals mid-morning and/or mid-afternoon
 HS snack – ordered as a snack food or beverage items to be given at
the hour of sleep

The following list includes brief descriptions of common therapeutic

diets:

Clear liquid diet –

 Includes minimum residue fluids that can be seen through.
 Examples are juices without pulp, broth, and Jell-O.
 Is often used as the first step to restarting oral feeding after surgery or
an abdominal procedure.
 Can also be used for fluid and electrolyte replacement in people with
severe diarrhea.
 Should not be used for an extended period as it does not provide
enough calories and nutrients.

Full liquid diet –

 Includes fluids that are creamy.
 Some examples of food allowed are ice cream, pudding, thinned hot
cereal, custard, strained cream soups, and juices with pulp.
 Used as the second step to restarting oral feeding once clear liquids are
tolerated.
 Used for people who cannot tolerate a mechanical soft diet.
 Should not be used for extended periods.

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No Concentrated Sweets (NCS) diet –
 Is considered a liberalized diet for diabetics when their weight and blood
sugar levels are under control.
 It includes regular foods without the addition of sugar.
 Calories are not counted as in ADA calorie controlled diets.

Diabetic or calorie controlled diet (ADA) –

 These diets control calories, carbohydrates, protein, and fat intake in
balanced amounts to meet nutritional needs, control blood sugar levels,
and control weight.
 Portion control is used at mealtimes as outlined in the ADA “Exchange
List for Meal Planning.”
 Most commonly used calorie levels are: 1,200, 1,500, 1,800 and 2,000.

No Added Salt (NAS) diet –

 Is a regular diet with no salt packet on the tray.
 Food is seasoned as regular food.

Low Sodium (LS) diet –

 May also be called a 2 gram Sodium Diet.
 Limits salt and salty foods such as bacon, sausage, cured meats,
canned soups, salty seasonings, pickled foods, salted crackers, etc.
 Is used for people who may be “holding water” (edema) or who have
high blood pressure, heart disease, liver disease, or first stages of
kidney disease.

Low fat/low cholesterol diet –

 Is used to reduce fat levels and/or treat medical conditions that interfere
with how the body uses fat such as diseases of the liver, gallbladder, or
pancreas.
 Limits fat to 50 grams or no more than 30% calories derived from fat.
 Is low in total fat and saturated fats and contains approximately 250-300
mg cholesterol.

High fiber diet –

 Is prescribed in the prevention or treatment of a number of
gastrointestinal, cardiovascular, and metabolic diseases.
 Increased fiber should come from a variety of sources including fruits,
legumes, vegetables, whole breads, and cereals.

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Renal diet –
 Is for renal/kidney people.
 The diet plan is individualized depending on if the person is on dialysis.
 The diet restricts sodium, potassium, fluid, and protein specified levels.
 Lab work is followed closely.

Mechanically altered or soft diet –

 Is used when there are problems with chewing and swallowing.
 Changes the consistency of the regular diet to a softer texture.
 Includes chopped or ground meats as well as chopped or ground raw
fruits and vegetables.
 Is for people with poor dental conditions, missing teeth, no teeth, or a
condition known as dysphasia.

Pureed diet –
 Changes the regular diet by pureeing it to a smooth liquid consistency.
 Indicated for those with wired jaws extremely poor dentition in which
chewing is inadequate.
 Often thinned down so it can pass through a straw.
 Is for people with chewing or swallowing difficulties or with the condition
of dysphasia.
 Foods should be pureed separately.
 Avoid nuts, seeds, raw vegetables, and raw fruits.
 Is nutritionally adequate when offering all food groups.

Food allergy modification –

 Food allergies are due to an abnormal immune response to an
otherwise harmless food.
 Foods implicated with allergies are strictly eliminated from the diet.
 Appropriate substitutions are made to ensure the meal is adequate.
 The most common food allergens are milk, egg, soy, wheat, peanuts,
tree nuts, fish, and shellfish.
 A gluten free diet would include the elimination of wheat, rye, and barley.
Replaced with potato, corn, and rice products.

Food intolerance modification –

 The most common food intolerance is intolerance to lactose (milk sugar)
because of a decreased amount of an enzyme in the body.
 Other common types of food intolerance include adverse reactions to
certain products added to food to enhance taste, color, or protect
against bacterial growth.

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 Common symptoms involving food intolerances are vomiting, diarrhea,
abdominal pain, and headaches.

Tube feedings –
 Tube feedings are used for people who cannot take adequate food or
fluids by mouth.
 All or parts of nutritional needs are met through tube feedings.
 Some people may receive food by mouth if they can swallow safely and
are working to be weaned off the tube feeding.

https://www.cdss.ca.gov/agedblinddisabled/res/VPTC2/9%20Food%20Nutrition%20and%20Pr
eparation/Types_of_Therapeutic_Diets.pdf aa
https://www.aic.sg/sites/aicassets/AssetGallery/Community%20Care%20providers/ILTC%20N
utrition%20Movement/Therapeutic%20diets%20portion%20recipes.pdf
https://livehealthy.chron.com/agerelated-changes-affect-nutrition-2420.html
https://www.encyclopedia.com/sports-and-everyday-life/food-and-drink/food-and-
cooking/nutritional-assessment

Elements of the Assessment

The data for a nutritional assessment falls into four

categories: anthropometric , biochemical , clinical, and dietary.

Anthropometrics.

Anthropometrics are the objective measurements of body muscle

and fat . They are used to compare individuals, to compare growth in
the young, and to assess weight loss or gain in the mature individual.
Weight and height are the most frequently used anthropometric
measurements, and skinfold measurements of several areas of the
body are also taken.

As early as 1836, tables had been developed to compare weight and

height in order to provide a reference for an individual's health status.
The Metropolitan Life Insurance Company revised height and weight
tables in 1942, using data from policyholders, to relate weight to
disease and mortality. There has been much discussion about the
relevance (and appropriateness) of using the individuals who buy life
insurance as a basis for "ideal" height and weight. There are also a

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number of problems with using a table to determine whether an
individual is at the right weight—or even what the "ideal
Women

Height Feet–Inches Small frame Medium frame Large frame

4 10 102–111 109–121 118–131
4 11 103–113 111–123 120–134
5 0 104–115 113–126 122–137
5 1 106–118 115–129 125–140
5 2 108–121 118–132 128–143
5 3 111–124 121–135 131–147
5 4 114–127 124–138 134–151
5 5 117–130 127–141 137–155
5 6 120–133 130–144 140–159
5 7 123–136 133–147 143–163
5 8 126–139 136–150 146–167
5 9 129–142 139–153 149–170
5 10 132–145 142–156 152–173
5 11 135–148 145–159 155–176
6 0 138–151 148–162 158–179
Men

Height Feet–Inches Small frame Medium frame Large frame

5 2 128–134 131–141 138–150
5 3 130–136 133–143 140–153
5 4 132–138 135–145 142–156
5 5 134–140 137–148 144–160
5 6 136–142 139–151 146–164
5 7 138–145 142–154 149–168
5 8 140–148 145–157 152–172
5 9 142–151 148–160 155–176
5 10 144–154 151–163 158–180
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Men

Height Feet–Inches Small frame Medium frame Large frame

5 11 146–157 154–166 161–184
6 0 149–160 157–170 164–188
6 1 152–164 160–174 168–192
6 2 155–168 164–178 172–197
6 3 158–172 167–182 176–202
6 4 162–176 171–187 181–207

Weight" means. Tables should therefore be used only as a guide, and

other measurements should be included in the data collection and
evaluation.

In 1959, research indicated that the lowest mortality rates were

associated with below-average weight, and the phrase "desirable
weight" replaced "ideal weight" in the title of the height and weight
table.

To further characterize an individual's height and weight, tables also

include body-frame size, which can be estimated in many ways. An
easy way is to wrap the thumb and forefinger of the nondominant
hand around the wrist of the dominant hand. If the thumb and
forefinger meet, the frame is medium; if the fingers do not meet, the
frame is large; and if they overlap, the frame is small.

Determining frame size is an attempt at attributing weight to specific

body compartments. Frame size identifies an individual relative to the
bone size, but does not differentiate muscle mass from body fat.
Because it is the muscle mass that is metabolically active and the
body fat that is associated with disease states, Body Mass
Index (BMI) is used to estimate the body-fat mass. BMI is derived
from an equation using weight and height.

To estimate body fat, skinfold measurements can be made using

skin-fold calipers. Most frequently, tricep and subscapular (shoulder

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blade) skin-folds are measured. Measurements can then be
compared to reference data—and to previous measurements of the
individual, if available. Accurate measuring takes practice, and
comparison measurements are most reliable if done by the same
technician each time.

To estimate desirable body weight for amputees, and for paraplegics

and quadriplegics, equations have been developed from cadaver
studies, estimating desirable body weight, as well
as calorie and proteinneeds. Calorie needs are determined by the
height, weight, and age of an individual, which determine an estimate
of daily needs.

The Harris-Benedict equation is frequently used, but there are

quicker methods to estimate needs using just height and weight.
Opinions and methods vary on how to estimate calorie needs for
the obese. As previously mentioned, body fat is less metabolically
active and requires fewer calories for support than muscle mass. If an
individual's current body weight is more than 125 percent of the
desirable weight for the individual's height and age, then using body
weight to estimate calories needs usually leads to an over-estimation
of those needs.

Biochemical data.

Laboratory tests based on blood and urine can be important

indicators of nutritional status, but they are influenced by
nonnutritional factors as well. Lab results can be altered by
medications, hydration status, and disease states or
other metabolic processes, such as stress . As with the other areas
of nutrition assessment, biochemical data need to be viewed as a
part of the whole.

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Clinical data.

Clinical data provides information about the individual's medical

history, including acute and chronicillness and diagnostic
procedures, therapies, or treatments that may increase nutrient
needs or induce malabsorption . Current medications need to be
documented, and both prescription drugs and over-the-
counter drugs, such as laxatives or analgesics, must be included in
the analysis. Vitamins , minerals , and herbal preparations also
need to be reviewed. Physical signs of malnutrition can be
documented during the nutrition interview and are an important part
of the assessment process.

Dietary data.

There are many ways to document dietary intake. The accuracy of

the data is frequently challenged, however, since both questioning
and observing can impact the actual intake. During a nutrition
interview the practitioner may ask what the individual ate during the
previous twenty-four hours, beginning with the last item eaten prior to
the interview. Practitioners can train individuals on completing a food
diary, and they can request that the record be kept for either three
days or one week. Documentation should include portion sizes and
how the food was prepared. Brand names or the restaurant where the
food was eaten can assist in assessing the details of the intake.
Estimating portion sizes is difficult, and requesting that every food be
measured or weighed is time-consuming and can be impractical.
Food models and photographs of foods are therefore used to assist in
recalling the portion size of the food. In a metabolic study, where
accuracy in the quantity of what was eaten is imperative, the
researcher may ask the individual to prepare double portions of
everything that is eaten—one portion to be eaten, one portion to be
saved (under refrigeration, if needed) so the researcher can weigh or
measure the quantity and document the method of preparation.

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Food frequency questionnaires are used to gather information on how
often a specific food, or category of food is eaten. The Food Guide
Pyramid suggests portion sizes and the number of servings from
each food group to be consumed on a daily basis, and can also be
used as a reference to evaluate dietary intake.

During the nutrition interview, data collection will include questions

about the individual's lifestyle—including the number of meals eaten
daily, where they are eaten, and who prepared the meals. Information
about allergies , food intolerances, and food avoidances, as well as
caffeine and alcohol use, should be collected. Exercise frequency
and occupation help to identify the need for increased calories.
Asking about the economics of the individual or family, and about the
use and type of kitchen equipment, can assist in the development of
a plan of care. Dental and oral health also impact the nutritional
assessment, as well as information about gastrointestinal health,
such as problems with constipation , gas or diarrhea, vomiting, or
frequent heartburn.

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