How to design a diet therapy. Diet therapy of peptic ulcer

1. INTRODUCTION TO DIET
THERAPY ALONG WITH
REFERENCE TO PEPTIC
ULCER
-Gokul Arora
-M.Sc. Medical Biochemistry
4/13/2021 1

2. CONTENTS
• THERAPEUTIC DIET
• FOOD ACCEPTANCE IN ILLNESS
• HOW ILLNESS AFFECTS NUTRITION
• NUTRITIONAL ASSESSMENT IN CLINICAL SETTINGS
• THERAPEUTIC DIETS
• TYPES OF FEEDING
• PEPTIC ULCER
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3. THERAPEUTIC DIETS
• Diet Therapy is use of appropriate foods as a tool in the recovery from illness.
• 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).
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4. FOOD ACCEPTANCE IN ILLNESS
• Illness leads to poor food acceptance due to:
(i) Reduced desire or interest in food due to lack of appetite,
gastrointestinal disturbances or discomfort after eating.
(ii) Reduced appetite due to inactivity.
(iii)Reduced appetite due to some drugs.
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5. HOW ILLNESS AFFECTS NUTRITION
• The patient may face problems such as poor appetite, too much or too little
food served etc.
• Food acceptance of modified diets can be a problem as therapeutic diets may
be bland, less salty, poor in texture and choice.
• In fever, the metabolic rate is increased and so the need for all nutrients is
increased. Nutrient utilization is adversely affected in metabolic diseases.
• The patient’s lack of movement for many days increases loss of nitrogen and
calcium from the body.
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6. NUTRIONAL ASSESSMENT IN CLINICAL
SETTINGS
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7. ANTHROPOMETRIC MEASUREMENTS
• Body Mass Index (BMI), a value calculated from height-
weight data, is an indicator of the body fat content.
• Skinfold measurements help to assess the energy
reserves in the form of fat. An average of three of these
values are used to compare with a set of normal values.
• Midarm Circumference (MC) gives an indication of body
protein reserves and helps to detect protein malnutrition.
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8. OTHER MEASUREMENTS
• Clinical Assessment includes examination of eyes, teeth, gums, tongue, skin and hair
to observe symptoms of nutritional deficiency. It is quick, but subjective and not specific.
• Dietary Assessment is an essential basis for dietary counselling. There are several
methods used, which include 24 hour recall, food frequency list, a food diary, diet history
and observations at meal times. These help in evaluation of the food intake to detect
possible deficiencies.
• Laboratory Assessment involves whole blood, blood serum and blood plasma
analysis; sometimes urine analysis is done to determine the level or the excretion rate of
the nutrients or their metabolites.
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9. PLANNING OF THERAPEUTIC DIETS
• Energy Needs:
The resting energy expenditure (REE) can be measured with a portable equipment, which
measures volumes of oxygen (VO2 ) consumed and carbon dioxide expired (VCO2 ). The REE is
increased in patient suffering from burns, fevers, infection, fractures, trauma etc. and lowered in
malnutrition.
Protein Needs: Loss of nitrogen is increased by stress. If the losses in urine are measured, the
protein intake can be increased to make up for the loss. When the loss is unknown, protein intake
can be proportional to energy intake, as indicated - Calorie : Nitrogen ratio in Severe stress is —
150 : 1 to 100 : 1
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10. THERAPEUTIC DIETS
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TYPES OF
DIETS
Normal Hospital
Diet
Liquid Diets
Clear-liquid
Diet
Full Liquid
Diet
Soft Diet
Pureed Diet
Soft Fiber-
Restricted
Diet

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Clear-liquid Diet
 Drinks such as tea, coffee, clear fruit juices,
coconut water, sherbets, extracts of dal, rice, popped
cereals, fat-free broth, carbonated drinks.
 Milk (X)
 Portions of 20-25 ml every hr or 2.
 If the fluids are chosen well, the diet can provide
200-500 kcal, some sodium, potassium and ascorbic
acid.
Full Liquid Diet
 In full liquid diet, foods included are –liquids and
foods which are liquid at body temperature.
 It can provide adequate nutrition, with the
exception of iron.
 Skim milk powder is added to increase the protein
content of the diet.
This diet has high calcium and fat content and is
low in fiber.
Mechanically Soft Diet
 This is also called Dental Soft Diet, as it is
prescribed for those who cannot chew, due to
absence or removal of teeth or ill-fitting dentures.
Pureed Diets
 Pureed diets include foods, which are smooth,
soft and need hardly any chewing. These are
good for patients who have difficulty in
swallowing.
 All foods are blended or pureed in a mixer.
Liquids are added to get the consistency needed
by the patient.
Soft Fiber-Restricted Diet
 Indigestible carbohydrates are excluded from
this diet. Indigestible fibers include those which
make up cell wall of plants.

13. TYPES OF FEEDING
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Tube feeding
 If a patient whose gastrointestinal tract is working,
cannot take sufficient food orally, tube feeding is
resorted to.
 Since the feed must be formulated to meet the
nutritional needs of the patient, it is also called
formula feed.
 Different types of formulas.
 Mode of feeding = Nasogastric tube, gastrotomy
tube or jejunostomy tube.
Parenteral feeding
 In parenteral feeding, the nutrient
preparations are given directly into a vein.
A 5% dextrose solution in water (DSW) is
usually given by a peripheral vein (also known
as IV drip) to provide fluids and some energy.
Total Parenteral Nutrition (TPN)
 TPN is used only when it is not possible to
use enteral route and the patient is
hypermetabolic or debilitated.
 TPN solutions being hypertonic are
introduced into a large central vein where the
solution gets diluted quickly in the high rate of
blood flow.

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PATHOPHYSIOLOGY

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Reference: -https://www.researchgate.net/publication/271600068

17. TREATMENT CHART FOR PEPTIC ULCER
I. Milk and banana diet = 3-5 days
II. Thereafter, the following diet may be adopted:
1. Upon arising : 25 black raisins soaked overnight
2. Breakfast : Fruits such as bananas, mangoes, musk melon, custard apple and figs and a
glass of milk(Avoid sour fruits).
3. Mid morning : carrot juice/coconut water.
4. Lunch : Steamed vegetables, whole wheat chappatis/ rice.
5. Mid-afternoon : Few dates+milk.
6. Dinner : Lightly cooked vegetables, whole wheat chappatis and fruits.
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18. Explain the formulation of diet therapy.
Also, tell about diet therapy in peptic
ulcer.
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