BANAGEN,PHILIP B.

18-6650-963

NCM 105: NUTRITION AND DIET

THERAPY
COURSE MODULE

PRELIMS FINALS
Unit One. FUNDAMENTALS OF NUTRITION MIDTERMS Unit Six. DIET THERAPY
Chapter 1: Introduction and Definition of Unit Five. NUTRITION THROUGHOUT THE LIFESPAN Chapter 1: General Diet
Nutrition Chapter 1: Pregnancy A. Regular/Full Diet
Chapter 2: Overview of Nutrition and Health A. Stages B. High Fiber Diet
Chapter 3: The Importance of Nutrition B. Nutritional Problems and Interventions C. Vegetarian Diet
Chapter 4: Nursing in Nutrition: Roles of Nurses C. Recommended Diet D. Therapeutic Diet
in Nutrition and Diet Therapy Chapter 2: Lactation Chapter 2: Diets Modified in Consistency
Chapter 5: Evolution of Nutrition A. Common Nutritional Problems A. Liquid Diet
Chapter 6: Purposes of Diet Therapy B. Recommended Diet B. Soft Diet
Chapter 3: Infancy C. Low Residue/ Residue Restricted
Unit Two. BASIC TOOLS IN NUTRITION A. Nutritional Problems and Intervention D. Low Fiber
Chapter 1: FNRI and USDA Food Guide Pyramid, B. Factors Affecting Nutritional Status E. High-Fiber Diet
Pinggang Pinoy & MyPl C. Guidelines in Feeding Chapter 3: Diets in Modified Composition
Chapter 2:10 NGF (Nutritional Guide for Filipinos D. Recommended Diet A. High Calorie Diet
Chapter 3: RDA or RENI Chapter 4: Toddlers B. Low Calorie Diet
Chapter 4: FEL (Food Exchange Lists) A. Nutritional Problems and Interventions C. High Protein Diet
B. Guidelines in Feeding D. Low Protein Diet
Unit Three. SIX ESSENTIAL NUTRIENTS C. Recommended Diet E. High Carbohydrate Diet
Chapter 1: Carbohydrates Chapter 5: Pre-School and Schoolers F. Low Carbohydrate Diet
Chapter 2: Protein A. Nutritional Problems and Interventions G. Low-Fat, Cholesterol-Restricted Diet
Chapter 3: Fats B. Guidelines in Feeding H. Low Salt/ Sodium Restricted Diet
Chapter 4: Vitamins C. Recommended Diet I. Low Purine Diet/ Purine Restricted Diet
Chapter 5: Minerals Chapter 6: Adolescent J. Low Potassium Diet
Chapter 6: Water A. Nutritional Problems and Interventions K. Acid and Alkaline Diet
Inclusions of each B. Recommended Diet Chapter 4: Nutritional Support
A. Functions Chapter 7: Adulthood A. Enteral Feeding
B. Toxicity A. Nutritional Problems and Interventions B. Types of Enteral Feeding
C. Food Sources B. Recommended Diet C. Feeding Administration
Chapter 8: Elderly D. Parenteral Feeding
Unit Four. DIETARY COMPUTATIONS A. Nutritional Problems and Interventions Chapter 5: Nutritional Management of Selected
Chapter 1: Body Mass Index and Classifications B. Recommended Diet Disease Conditions
Chapter 2: Desirable Body weight
Chapter 3: Total Energy Requirement and its
Distribution
Chapter 4: Application of Food Exchange lists
and Making Sample Menu
PRELIMS
UNIT ONE. FUNDAMENTALS OF NUTRITION
Based on Maslow’s hierarchy of needs, food and nutrition rank on the same
level as air in the basic necessities of life. Obviously, death eventually occurs
without food. But unlike air, food does so much more than simply sustain life.
Food is loaded with personal, social, and cultural meanings that define our food
values, beliefs, and customs. That food nourishes the mind as well as the body
broadens nutrition to an art as well as a science. Nutrition is not simply a matter
of food or no food but rather a question of what kind, how much, how often, and
why. Merging want with need and pleasure with health are keys to feeding the
body, mind, and soul.
CHAPTER 1: INTRODUCTION AND DEFINITION OF NUTRITION
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
receiving and utilizing it for the growth and renewal of the body and for the
maintenance of the different body functions.
Food is essential to life. To sustain life, the nutrients in food must perform three
functions within the body: build tissue, regulate metabolic processes, and
provide a source of energy. A proper diet is essential to good health. A well-
nourished person is more likely to be well developed, mentally and physically
alert, and better able to resist infectious diseases than one who is not well
nourished. Proper diet creates a healthier person and extends the years of
normal bodily functions. Diet therapy is the application of nutritional science to
promote human health and treat disease.
NUTRITION is the total of all of the processes involved in consuming (taking in)
and utilizing food for energy, proper growth, functioning, and maintenance of
health. Nutrition is the most over looked part of healthy living.
CHAPTER 2: OVERVIEW OF HEALTH AND NUTRITION
Definition of terms:
1) Nutrition - is the study of food in relation to health.
2) Food- is any substance when ingested or eaten nourishes the body.
3) Nutrient - is a chemical component needed by the body to provide
energy, to build and repair tissues and to regulate life process.
4) Digestion - it is a mechanical and chemical breakdown of food into
smaller components.
5) Absorption - it is a process where the nutrients from foods are
absorb by the body into the bloodstreams.
6) Metabolism - is a chemical process of transforming foods into other
substance to sustain life.
7) Enzymes - an organic catalyst that are protein in nature and are
produced by living cells. A catalyst speeds up or slows down chemical
reactions without itself
undergoing change.
8) Nutritional Status - is the condition of the body resulting from the
utilization of essential nutrients.
9) Calorie - fuel potential in a food. One calorie represents the amount
of heat required to raise one liter of water one degree Celsius.
10) Malnutrition - It is the condition of the body resulting from a lack of
one or more essential nutrients or due to excessive nutrient supply.
Physiology of Nutrition
• Mouth: The digestive process begins in the mouth. Food is partly broken
down by the process of chewing and by the chemical action of salivary
amylase (these enzymes are produced by the salivary glands and break
down starches into smaller molecules).
On the way to the stomach:
• Esophagus: After being chewed and swallowed, the food enters the
esophagus. The esophagus is a long tube that runs from the mouth to the
stomach. It uses rhythmic, wave-like muscle movements (called peristalsis)
to force food from the throat into the stomach. This muscle movement gives
us the ability to eat or drink even when we're upside-down.
• Stomach: The stomach is a large, sack-like organ that churns the food and
bathes it in a very strong acid (gastric acid). Food in the stomach that is
partly digested and mixed with stomach acids is called chyme.
• Small intestine: absorption happens in the small intestine. Bile (produced in
the liver and stored in the gall bladder), pancreatic enzymes, and other
digestive enzymes produced by the inner wall of the small intestine help in
the breakdown of food.
• Large intestine: Undigested food passes in the large intestine. In the large
intestine, some of the water and electrolytes (chemicals like sodium) are
removed from the food.
• The end of the process: Solid waste is then stored in the rectum until it is
excreted via the anus.
 PART SECRETION ENZYME SUBSTRATE PRODUCT

Ptyalin (salivary Dextrin and

Mouth Saliva Cooked Carbohydrate
amylase) Maltose
Protein and
Pepsin Branched chain A
polypeptides
Gastric juice Renin Milk Casein Calcium Caseinate
Stomach
(acidic)
Long chain fatty
Lipase Fats
acids, glycerol
Pancreatic Branched chain Polypeptide
Trypsin amino acid amino acids
Pancreatic Long chain fatty long chain fatty
Pancreatic
Juice acids, glycerol, acids, glycerides,
Lipase
(alkaline) cholesterol cholesterol
Pancreatic Dextrin, lactose,
Dextrin and Maltose
Amylase sucrose, maltose
Facilitates fat and
Bile
Vt. A, D, E, K
Small (alkaline)
Intestine absorption
Polypeptide amino Single chain amino
Aminopeptidase
acids acid
long chain fatty
Intestinal lipase acids, glycerides, Fatty acids
Intestinal
cholesterol
juice (succus
entericus) Isomaltase maltose Glucose
Lactase lactose Glucose, galactose
Sucrase sucrose Glucose, fructose
Fats -- 95%
ENZYMES - an organic catalyst that are protein in nature and are
produced by living cells. Factors that affect digestion and absorption:
1. Crude fibers- skin and seed of fruit
3 Groups of Digestive Enzymes: 2. Preparation and cooking
1. Amylase - carbohydrate splitters 3. Disease - intestinal cancer, diarrhea
2. Lipase - fat splitters 4. Surgery - gastrectomy
3. Proteases - protein splitters 5. Parasitism
6. Presence of interfering substance

Digestibility of an average person

CHO -- 90%
Protein -- 92%
Wellness Nutrition - Achieving wellness is a continuous, never-ending journey.
Wellness is a lifestyle through which we continually strive to enhance our level of
health.
Health Literacy - is the ability to acquire and comprehend basic health concepts,
such as nutrition, and apply them to one’s own health decisions.
Health literacy allows for education to be most effective, resulting in behavior
changes.
Nurses, through formal, nonformal, and informal educational interactions, can
introduce knowledge and strategies for personal lifestyle choices that consider the
health context of patients’ lives.
Health literacy actualization means being able to use acquired health knowledge
and skills.
DEFINITION OF HEALTH
▪ In the past, health was defined as the absence of disease or illness.
▪ WHO: “Health is a state of complete physical, mental, and social well-being and
not merely the absence of disease and infirmity.”
▪ Rene Dubos “Health is a quality of life involving social, emotional, mental,
spiritual, and biologic fitness on the part of the individual, which results from
adaptations to the environment.”
HEALTH
 Physical health: The efficiency of the body to function appropriately, to
maintain immunity to disease, and to meet daily energy requirements
 Intellectual health: The use of intellectual abilities to learn and to adapt to
changes in one’s environment
 Emotional health: The capacity to easily express or suppress emotions
appropriately
 Social health: The ability to interact with people in an acceptable manner and
sustain relationships with family members, friends, and colleagues
 Spiritual health: The cultural beliefs that give purpose to human existence,
found through faith in the teachings of organized religions, in an understanding
of nature or science, or in an acceptance of the humanistic view of life
─ Health is the merging and balancing of the five physical and psychological
dimensions of health: physical, mental, emotional, social, and spiritual. This
holistic view incorporates many aspects of human existence.
ROLE OF NUTRITION
Because the primary role of nutrients is to provide the building blocks for
efficient functioning and maintenance of the body, nutrition may appear to
belong only within the physical health dimension. However, the effects of
nutrients and their sources on the other health dimensions are far reaching.
Nutrition is the cornerstone of each health dimension.
Physical health is dependent on the quantity and quality of nutrients available
to the body. The human body, from skeletal bones to minute amounts of
hormones, is composed of nutrients in various combinations.
Intellectual health relies on a well-functioning brain and central nervous system.
Nutritional imbalances can affect intellectual health, as occurs with iron
deficiency anemia.
Emotional health may be affected by poor eating habits, resulting in
hypoglycemia or low blood glucose levels. Low blood glucose occurs normally in
anyone who is physically hungry. When the body’s need for food is ignored
(e.g., when we miss meals because of poor planning or are too busy to eat),
feelings of anxiety and confusion and trembling may occur.
Social health situations often center around food-related occasions, ranging
from holiday feasts to everyday meals. Nutritional status is sometimes affected
by the quality of our relationships with family and friends.
Spiritual health often has ties to food. Several religions prohibit the
consumption of specific foods. Many followers of Islam and Judaism adhere to
the dietary laws of their religions. Both forbid consumption of pork products.
CHAPTER 3: THE IMPORTANCE OF NUTRITION
Nutrition is a vital component to overall wellness and health. Diet affects
energy, well-being and many disease states. Nutrition plays an important role in
maintaining optimum health and prevents diseases. Wrong food choices
influence the onset of metabolic disorders, degenerative diseases and
nutritional deficiencies. There is a connection between lifetime nutritional habits
and the risks of many chronic diseases such as cardio vascular diseases,
diabetes, cancer. A well-balanced diet can prevent such conditions and improve
energy levels and overall health and wellness. The basis of nutrition is FOOD.
Most people know good nutrition and physical activity can help maintain a
healthy weight. But the benefits of good nutrition go beyond weight. Good
nutrition can help:
• Decreases the chance of developing various diseases including heart disease,
diabetes, stroke, some cancers, and osteoporosis
• Reduce high blood pressure
• Lower high cholesterol
• Decreased risk of heart disease and diabetes
• Improve your well-being
• Improve your ability to fight off illness
• Improve your ability to recover from illness or injury
• Increase your energy level
• Helps keep a healthy weight
• Increases energy levels
• Improves skin health
• Boosts immune system
• Improved health and wellness
• Healthy bones and teeth
• Improved energy and mental clarity
• Weight reduction
• Improved sleep
Function of Nutrition
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.
THERAPY Functions of Nutrients in Food
Nutrients are chemical substances found in food. They perform as to provide
heat and energy, to diverse roles in the body such tissues, and to regulate body
processes. Since build and repair body nutrients are found primarily in natural
foods, adequate intake of these nutrients is necessary to carry out physiological
functions.
To sustain life, the nutrients in foods must perform the following three basic
functions within the body:
1. Provide energy
2. Build tissue
3. Regulate metabolic processes
Metabolism refers to the sum of all body processes that accomplish the basic
life-sustaining tasks. Intimate metabolic relations exist among all nutrients and
their metabolic products. Although the nutrients may be separated for study
purposes, remember that they do not exist that way in the human body. They
always interact as a dynamic whole to produce and maintain the body.
CHAPTER 4: NURSING IN NUTRITION: ROLES OF NURSES IN NUTRITION
AND DIET THERAPY
Although the dietitian is the nutrition and food expert, nurses play a vital role in
nutrition care. Nurses may be responsible for screening hospitalized patients to
identify patients at nutritional risk. They often serve as the liaison between the
dietitian and physician as well as with other members of the health-care team.
Nurses have far more contact with the patient and family and are often
available as a nutrition resource when dietitians are not, such as during the
evening, on weekends, and during discharge instructions. In home care and
wellness settings, dietitians may be available only on a consultative basis.
Nurses may reinforce nutrition counseling provided by the dietitian and may be
responsible for basic nutrition education in hospitalized clients with low to mild
nutritional risk. Nurses are intimately involved in all aspects of nutritional care.
The nurse can promote good nutrition by:
• Helping the patient understand the importance of the diet and
encouraging dietary compliance.
• Serving meal trays to patients in a prompt and positive manner.
• Assisting some patients with the eating process.
• Taking and recording patient weight.
• Recording patient intake.
• Observing clinical signs of poor nutrition and reporting them.
• Serving as a communication link.
• Nurse can apply nutrition to their personal lives, what a better reason to
understand nutrition for your own health.
Nurse’s responsibilities with nutritional care
The nurse has responsibility to assist in coordinating care and services.
The nurse usually collaborates with other members of the
health care team in nutritional assessment,
nutrition education,
delivery of dietary support- modified diets, tube feedings, IV nutrition.
The Physician is usually needed to assess gag, identify GI functionality, examine
the presence of strictures, dysphagia & swallowing disorders- from these
assessments the physician usually makes dietary prescriptions for regular diet,
modified, enteral, parenteral, palliative
The nurse collaborates with the physician to implement dietary prescriptions as
well as to re-examine the patient for nutritional imbalances and serves as an
advocate
Dietician and dietary department- is responsible for:
▪ anthropometric assessment and clinical assessment.
▪ They recommend the appropriate biochemical tests that are needed to
determine deficiencies.
▪ From these assessments, they usually make dietary prescriptions for regular
diet, modified, enteral, parenteral, palliative.
▪ They usually provide more detail about the composition of the diet- total
energy requirement, protein, and supplements that may be needed.
▪ They also recommend preparation methods of foods.
▪ They are also responsible for preparing data for nutrition education.
▪ The nurse collaborates and ensures these actions are done
The nurse also works with other health team
▪ The nurse works with the phlebotomist, nutritionist, meal services
department to ensure that the nutritional needs of the patients are met.
▪ The nurse may also communicate with the family and the patient the
changes that are important and necessary for health maintenance.
▪ The nurse usually recommends follow up care and advocates for referral to
HTN, Renal, DM, HIV/AIDS clinic and dietetics department.
The nurse also serves as Communicator
▪ Explaining the treatment regime; advocating for more detailed explanation
particularly of dietary prescriptions
▪ Interpret rationale for diet
▪ Assists in food selection, may advice on preparation style and techniques
▪ Ensures that the ordering, delivery and administration of the prescribed diet
Nurse as Teacher/Counsellor
▪ Uses informal opportunities to teach- such as during medication
administration, meal service and family visits
▪ Plan instructions- useful in primary health care and health promotion and for
new diagnoses
▪ Counsels patient and family
▪ Support, supplement and reinforce the information provided by the dietary
department
NUTRITION CARE PROCESS
Like the nursing process, the nutrition care process is a problem-solving method
used to evaluate and treat nutrition-related problems.
In nursing care plans, nutrition may be part of the assessment data, diagnosis,
plan, implementation, or evaluation. It is intended to help nurses provide quality
nursing care that includes basic nutrition, not to help nurses become dietitians.
NUTRITIONAL SCREEN
a quick look at a few variables to judge a client’s relative risk for nutritional
problems. Can be custom designed for a particular population (e.g., pregnant
women) or for a specific disorder (e.g., cardiac disease).
NUTRITIONAL ASSESSMENT
an in-depth analysis of a person’s nutritional status. In the clinical setting,
nutritional assessments focus on moderate- to high-risk patients and is useful in
diagnosing and may help identify patients at high risk for morbidity, mortality,
and malnutrition.
It is well recognized that malnutrition is a major contributor to morbidity,
mortality, impaired quality of life, and prolonged hospital stays.
Physical Symptoms Suggestive of Malnutrition
▪Hair that is dull, brittle, or dry, or falls out easily
▪Swollen glands of the neck and cheeks
▪Dry, rough, or spotty skin that may have a sandpaper feel
▪Poor or delayed wound healing or sores
▪Thin appearance with lack of subcutaneous fat
▪Muscle wasting (decreased size and strength)
▪Edema of the lower extremities
▪Weakened hand grasp
▪Depressed mood
▪Abnormal heart rate, heart rhythm, or blood pressure
▪Enlarged liver or spleen
▪Loss of balance and coordination
Subjective Global Assessment (SGA):
a clinical method of assessing nutritional status based on findings in a health
history and physical examination.
Weight Change - Unintentional weight loss and the time period of loss
Dietary Intake - Change from normal, duration, type of diet consumed
Gastrointestinal Symptoms Lasting Longer than 2 Weeks - Nausea,
vomiting, diarrhea, anorexia Functional Capacity - Normal or suboptimal;
ambulatory or bedridden
Disease and Its Relation to Nutritional Requirements - Primary diagnosis;
severity of metabolic stress Physical Signs and Severity of Findings - Loss of
subcutaneous fat (triceps, chest), muscle wasting (quadriceps, deltoids), ankle
edema, sacral edema, ascites
NURSING DIAGNOSIS
A diagnosis is made after assessment data are interpreted. Nursing diagnoses
in hospitals and long-term care facilities provide written documentation of the
client’s status and serve as a framework for the plan of care that follows. The
diagnoses relate directly to nutrition when the pattern of nutrition and
metabolism is the problem. Other nursing diagnoses, while not specific for
nutrition, may involve nutrition as part of the plan, such as teaching the patient
how to increase fiber intake to relieve the nursing diagnosis of constipation.
SELECTED NURSING DIAGNOSES WITH NUTRITIONAL SIGNIFICANCE
Pattern Nutrition and Metabolic Examples of Other Diagnoses in
Which Nutrition Interventions May
Be Part of the Care Plan
▪ High risk for ▪ Altered health maintenance Client Teaching
altered nutrition: ▪ Ineffective management of Compared with “well” clients, patients in a clinical setting may be more
intake exceeds the therapeutic regimen Infection receptive to nutritional advice, especially if they feel better by doing so or are
body’s needs ▪ Constipation fearful of a relapse or complications. But hospitalized patients are also prone to
▪ Altered nutrition: intake exceeds ▪ Diarrhea confusion about nutrition messages. The patient’s ability to assimilate new
the body’s needs ▪ Bowel incontinence information may be compromised by pain, medication, anxiety, or a distracting
▪ Altered nutrition: eating less than ▪ Altered urinary excretion setting. Time spent with a dietitian or diet technician learning about a “diet”
the body needs Effective ▪ Impaired physical mobility may be brief or interrupted, and the patient may not even know what questions
breastfeeding ▪ Fatigue to ask until long after the dietitian is gone.
▪ Ineffective breastfeeding ▪ Self-care deficit: feeding
▪ Interrupted breastfeeding ▪ Household altered
▪ Ineffective infant feeding pattern ▪ Altered tissue perfusion Ways to Promote an Adequate Intake
▪ High risk of aspiration ▪ Pain ▪ Reassure clients who are apprehensive about eating.
▪ Swallowing disorder ▪ Chronic pain ▪ Encourage a big breakfast if appetite deteriorates throughout the day.
▪ Altered oral mucosa ▪ Alterations sensory/perceptual ▪ Advocate discontinuation of intravenous therapy as soon as feasible.
▪ High risk for ▪ Unilateral oblivion ▪ Replace meals withheld for diagnostic tests.
fluid volume ▪ Knowledge deficits ▪ Promote congregate dining if appropriate.
deficits Fluid ▪ Anxiety ▪ Question diet orders that appear inappropriate.
volume deficits ▪ Body image disorder ▪ Display a positive attitude when serving food or discussing nutrition.
▪ Excess fluid volume ▪ Social isolation ▪ Order snacks and nutritional supplements.
▪ High risk for impaired skin ▪ Ineffective individual coping ▪ Request assistance with feeding or meal setup.
integrity ▪ Ineffective family coping ▪ Get the patient out of bed to eat if possible.
▪ Impaired skin integrity ▪ Defensive coping ▪ Encourage good oral hygiene.
▪ Impaired tissue integrity ▪ Solicit information on food preferences.
▪ High risk for altered
body temperature Ways to Facilitate Client and Family Teaching
Ineffective ▪ Listen to the client’s concerns and ideas.
thermoregulation ▪ Encourage family involvement if appropriate.
Hyperthermia ▪ Reinforce the importance of obtaining adequate nutrition.
▪ Hypothermia ▪ Help the client to select appropriate foods.
▪ Counsel the client about drug–nutrient interactions.
▪ Avoid using the term “diet.”
▪ Emphasize things “to do” instead of things “not to do.”
PLANNING: CLIENT OUTCOMES ▪ Keep the message simple.
Outcomes, or goals, should be measurable, attainable, specific, and client ▪ Review written handouts with the client.
centered. Client-centered outcomes place the focus on the client, not the ▪ Advise the client to avoid foods that are not tolerated.
health-care provider; they specify where the client is heading. Whenever
possible, give the client the opportunity to actively participate in goal setting, MONITORING AND EVALUATION
even if the client’s perception of need differs from yours. In matters that do not Evaluation assesses whether client outcomes were achieved after the nursing
involve life or death, it is best to first address the client’s concerns. care plan was given time to work. Ideally, the client’s outcomes are achieved
on a timely basis, and evaluation statements are client outcomes rewritten
NURSING INTERVENTIONS from “the client will” to “the client is.” In reality, outcomes may be only
Nutrition Therapy partially met or not achieved at all; in those instances, it is important to
Nutrition therapy recommendations are usually general suggestions to increase/ determine why the result was less than ideal. Evaluation includes deciding.
decrease, limit/avoid, reduce/encourage, or modify/maintain aspects of the diet whether to continue, change, or abolish the plan.
because exact nutrient requirements are determined on an individual basis.
Where more precise amounts of nutrients are specified, consider them as a Monitoring Suggestions
starting point and monitor the client’s response. ▪ Observe intake whenever possible to judge the adequacy.
▪ Document appetite and take action when the client does not eat.
 ▪ Order supplements if intake is low or needs are high.
▪ Request a nutritional consult.
▪ Assess tolerance (i.e., absence of side effects).
▪ Monitor weight.
▪ Monitor progression of restrictive diets. Clients who are receiving
nothing by mouth (NPO), who are restricted to a clear liquid diet, or who
are receiving enteral or parenteral nutrition are at risk for nutritional
problems.
▪ Monitor the client’s grasp of the information and motivation to change.
CHAPTER 5: EVOLUTION OF NUTRITION
Changing Concepts of Nutrition
• The essential nutrients, proteins, fats and carbohydrates have been
recognized in the early 19nth century.
• Specific Nutritional disorders were identified such as protein energy mal
nutrition, Vitamin A deficiency, Endemic goiter, Nutritional Anemia, Nutritional
blindness etc. and measures were found to prevent and control these disorders.
• The science of Nutrition was extended to other fields like agriculture, animal
husbandry, economics and sociology. This led to “green revolution” and “white
revolution” and increased food production.
• During recent years the science of nutrition has extended to Nutritional
epidemiology.
• The old concept of “the health sector alone is responsible for all nutritional
problems” is now realized that a broad multi factorial and integrated approach of
sectors is essential to solve today’s nutritional problems.
• The main objectives of the National Health Policy are:
o Promotion of proper nutritional status of individual, families & communities
o Prevention of nutritional deficiency disorders.
o Maintenance of the health of the individuals
o Supplementation of essential nutrients to all the vulnerable groups
o IEC related to healthy Nutrition.
Historical Milestones in Nutrition
• In pre-agricultural era, entire mankind consumed meat as early man was a
hunter. Possibly he ate from plants sources which grew in the wilderness.
• With the advent of agriculture as an outcome of civilization, man acquired the
ability to cultivate what he wanted, as by now he was influenced to some extent by
the selection of the food that he wanted to eat.
• The Bible, Book of Daniel - Daniel was captured by the King of Babylon and
had to serve in the King's court. Daniel objected to being fed fine foods and wine,
saying he preferred vegetables, pulses and water. The chief steward reluctantly
agreed to a trial, comparing Daniel's dietary preference to those of the court of the
King of Babylon. For ten days Daniel and his men had their vegetarian diet, while
the King's men had theirs. The trial revealed that Daniel and his men were healthier
and fitter, so they were allowed to carry on with their diet.
• 400 B.C: Hippocrates (Greece, ca460BC - ca370BC) the “Father of
Medicine” stated that everybody is same, no matter what they have been eating,
or where they have lived. He also said
“A wise man should consider that health is the greatest of human blessings”.
Hippocrates is also famous for having said "Let thy food be thy medicine and thy
medicine be thy food."
• 400 B.C: Foods were often used as cosmetics in the treatment of wounds. One
story describes the treatment of eye diseases, now known to be due to Vitamin A
deficiency, by squeezing the juice of liver onto the eye. Vitamin A is stored in large
amounts in the liver. • 1500’s: Scientist and artist Leonardo Da Vinci compared the
process of metabolism of the body to the burning of a candle.
• Antoine Lavoisier (France, 1743-1794) - became known as the father of
chemistry and also the father of nutrition. He became famous for the
statement "Life is a chemical process". He also designed the "calorimeter", a
device which measured heat produced by the body from work and consumption
from different amounts and types of foods.
• Christiaan Eijkman (Holland, 1858-1930) - a famous physician and
pathologist (doctor who identifies diseases by studying cells and tissues under a
microscope). He noticed that some of the people in Java developed Beriberi, a
disease which leads to heart problems and paralysis.
• Dr. James Lind (Scotland, 1716-1794) - a pioneer on hygiene in the Scottish
and Royal (British) navies. He stressed the importance of good ventilation,
cleanliness of sailor's bodies, clean bedding, below deck fumigation, fresh water by
distilling sea water, and the consumption of citrus fruits to prevent and cure scurvy.
• Dr. William Beaumont (USA, 1785-1853) - a surgeon in the US Army. He
became known as the Father of gastric physiology for his research on human
digestion. He stated that
▪ The stomach is not a grinder.
▪ There is no internal "spirit" selecting good purpose foods one way and
discarding bad purpose foods to waste.
▪ Digestion occurs because of digestive juices which are secreted from the
stomach.
▪ Foods are not digested separately and sequentially, but rather all the time
and at different rates.
▪ Stomach rumblings are caused by stomach contractions, and nothing else.
▪ Fat is digested slowly.
• Early 1800’s: It was discovered that foods are composed primarily of four
elements: Carbon,
Nitrogen, Oxygen and methods were developed for determining the amounts of
these elements.
• 1840: Justus Liebig, Germany, a pioneer in early plant growth studies, was the
first to point out the chemical make up of carbohydrates, fats and proteins.
• Dr. Stephen Babcock (USA, 1843-1931) - an agricultural chemist. He is
known for his Babcock test which determines dairy butterfat in milk and cheese
processing. He is also known for the single-grain experiment that eventually led
to the development of nutrition as a science.
 • Joule (1818-89) - 1850 the English physicist Joule (1818-89) proved that
heat and energy were interchangeable entities and that one could be measured
in terms of the other.
• 1912: Dr. Casmir Funk was the first to coin the term “Vitamins” as vital
factors in the diet.
• 1925 - Edwin B. Hart discovered that trace amounts of copper are essential
for iron absorption. • 1927 - Adolf Otto Reinhold Windaus synthesized
Vitamin D, for which he won the Nobel Prize in Chemistry.
• 1928 - Albert Szent-Györgyi isolated ascorbic acid (Vitamin C). In 1932 he
proved that it was Vitamin C by preventing scurvy. In 1937 he synthesized
Vitamin C and won the Nobel Prize.
• 1930s - William Cumming Rose identified essential amino acids which the
body cannot synthesize, but which are necessary protein components.
• 1935 - Eric John Underwood and Hedley Marston discovered the
necessity of cobalt. They were not working together - the discoveries were
made independently.
• 1936 - Eugene Floyd Dubois demonstrated that school and work
performance is linked to caloric intake.
• 1938 - Erhard Ferhnholz discovered the structure of Vitamin E, which was
later synthesized by Paul Karrer.
• 1940s: The water soluable B and C Vitamins were identified.
• 1941 - The National Research Council (USA) set up the first RDAs
(Recommended Dietary Allowances).
• 1992 - The Department of Agriculture (USA) set up the Food Guide Pyramid,
which was to be subsequently criticized by nutritionists throughout the world
for different reasons.
• 1992 - Integrated Development Foundation (IDF) was formed.
• 2002 - A link between violent behavior and nutrition was revealed in a
Natural Justice study (USA).
• 2005 - Researchers found that the adenovirus is a cause of obesity, as well
as bad nutrition.
1. It emphasizes on the psychologic and social needs of those who are sick and
the well.
2. Food preparation is simplified when the modification is based on the family
pattern and the number of items to be cooked is less.
Factors to be Considered in Planning Therapeutic Diets:
The normal diet may be modified:
a. To provide change in consistency as
in fluid and soft diet b. To increase or
decrease the energy needs
c. To increase or decrease one or more amounts of nutrients, e.g. in case of
high protein diets or sodium and potassium restricted diets, restricted fat diet,
etc.
d. To increase or decrease bulk
[high or low fiber] diets e. To
include or exclude certain allergic
foods
f. To modify the intervals of feeds [like in tube feeds etc.]
The planning of therapeutic diet implied the ability to adopt the principle of
normal nutrition to give the adequacy, economy and palatability of the food.
The diet planned should be described according to the likes of patients. Care
should be taken to modified depending upon the nature of the diseases.
THERAPY PHYSIOLOGIC VALUE OF FOOD
Food is good to eat when it fulfills the ff. qualities:
1) It is nourishing or nutritious
2) It has satiety value
3) It is prepared under sanitary conditions
4) Its palatability factors (color, aroma, flavor, texture)
5) Within the budget and suitable to the occasion.

CHAPTER 6: PURPOSES OF DIET THERAPY Nutrition Classification

Main Purpose of Therapeutic Diets: 1) According to function
The main purposes of therapeutic diet is: 2) According to chemical nature
a. To maintain good nutritional status. 3) According to essentiality
b. To correct the deficiencies which has occurred. 4) According concentration
c. To provide rest to the body or to certain part of the body for the metabolism
of nutrients.
Classification of Nutrients
d. To bring about changes in weight where ever necessary.
1) According to function:
e. Education of the patient regarding the need for adherence to prescribed diet.
- Function as energy giving, body building, body regulating.
2) According to chemical properties:
Therapeutic nutrition begins with the normal diet which are planned to restore a) Organic - protein, lipids, carbohydrates and vitamins
good nutrition a sick person. b) Inorganic - water & minerals
3) According to concentration
Advantages of Therapeutic Diets: a) Macro nutrients - Carbohydrates, Protein, Fats
The advantages of normal utilization of normal diet as the basis for b) Micro nutrients -- Vitamins,Minerals & water
therapeutic diet are: