formulation of diet therapy along with diet therapy of peptic ulcer

formulation of diet therapy along with diet therapy of peptic ulcer

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  INTRODUCTION TO DIET THERAPYALONG WITH REFERENCE TO PEPTIC ULCER -Gokul Arora -M.Sc. Medical Biochemistry 4/13/2021 1
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  CONTENTS • THERAPEUTIC DIET •FOOD ACCEPTANCE IN ILLNESS • HOW ILLNESS AFFECTS NUTRITION • NUTRITIONAL ASSESSMENT IN CLINICAL SETTINGS • THERAPEUTIC DIETS • TYPES OF FEEDING • PEPTIC ULCER 2
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  THERAPEUTIC DIETS • DietTherapy 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). 3
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  FOOD ACCEPTANCE INILLNESS • 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. 4
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  HOW ILLNESS AFFECTSNUTRITION • 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. 5
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  NUTRIONAL ASSESSMENT INCLINICAL SETTINGS 6
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  ANTHROPOMETRIC MEASUREMENTS • BodyMass 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. 7
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  OTHER MEASUREMENTS • ClinicalAssessment 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. 8
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  PLANNING OF THERAPEUTICDIETS • 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 9
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  THERAPEUTIC DIETS 10
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  11 TYPES OF DIETS Normal Hospital Diet LiquidDiets Clear-liquid Diet Full Liquid Diet Soft Diet Pureed Diet Soft Fiber- Restricted Diet
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  12 Clear-liquid Diet  Drinkssuch 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.
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  TYPES OF FEEDING 13 Tubefeeding  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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  15 PATHOPHYSIOLOGY
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  16 Reference: -https://www.researchgate.net/publication/271600068
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  TREATMENT CHART FORPEPTIC 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. 17
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  Explain the formulationof diet therapy. Also, tell about diet therapy in peptic ulcer. 18
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