NUTRITION & DIET IN VARIOUS DISEASE

STATES

D M O (H)PATHANAMTHITTA

“You are what you eat”

- Krause & Mahan

• Decision making based on

– Scientific principles

– Not by food faddism

What is nutrition?

The combination of processes by the living organism receives and utilizes the materials necessary

for the maintenance of its functions and for the growth and

renewal of its components.

What is applied nutrition?

To adapt the principles of

science of nutrition to meet

the needs of an individual.

What is dietetics?

Science and art of utilizing food

and fundamentals of knowledge

of nutrition and metabolism in

various conditions of health

and disease.

NORMAL PARAMETERS

• Expected Wt. newborn: 2.5 – 4 kg

• 1 year: (Age (month) + 9 kg

2

• 1 – 6 years: 2A + 8 Kg

• 7 – 12 years: 7A - 5 Kg

2

•Acute malnutrition – only

weight is affected

•Chronic malnutrition – the

height is also affected

•Acute on chronic malnutrition

– Weight for actual height is also

affected

KWASHIORKAR & MARASMUS

Kwashiorkar

• Clinical diagnosis

– 60-80% of the expected Wt.

– Oedema

– Skin and Hair changes

– Mental apathy

MARASMUS

• < 60% of the expected

weight

• No oedema

MANAGEMENT

1. Hypothermia - Adress it

2. Hypoglycaemia - RBS < 40 mg%

10% glucose 2-4ml/Kg

3. Dehydration– Skin pinch not useful

– Examine oral mucosa

– Use Resomal (Glucose – 125, Na-45, K-40, Cl-70, Citrate-7, Mg-3, Zn-0.3, Cu-0.04)

MANAGEMENT (Contd…)

4. Vit. A – 2L on day 1, Day 2 and Day 14

5. Seizures - 4ml/Kg 10% dextrose

- 0.5 – 1 ml/kg Ca Gluconate

- 0.2 ml/Kg of Mg SO4

Restoration phase (/Kg of actual Wt.)

Cal – 150 – 120

Proteins – 3- 4 gms

Fluid – 100-150

INFANT FEEDING

• BFHI (1992)

• WABA – World alliance for breast feeding action

• World breast feeding week – 1 to 7 Aug. of every year

• Exclusive breast feeding for 6 months

• Breast feeding + home made semi solids

ENERGY REQUIREMENTS

• 1st Year – 1000 cals then 100 cal / year• Proteins

– 1-3 years: 20gms– 4-6 years: 27gms– 7-9 years: 34gms– 10-12 years: 41gms

• Previous recommendations– 50% from carbohydrates– 35% form fat– 15% from proteins

•Recommendations (contd…)

– Carbohydrates : 40-60%

– Fat : 20-30%

– Proteins : 10-15%

– Direct sugar : 5 gm

– Iodized salt : 2.5gms/day

– PUFA : 10%

CARBOHYDRATES

• Main source – Cereals

• Pectins & Gums decrease blood

sugar

• Uluva – 40% gum

• Fibres – Hypocholestrolemic effect

• Fibre requirements – 40 gm/day

PROTEINS

Egg & Milk – first class protein

FATS• Saturated fatty acids (SFA)

– Lauric, Myristic & Palmitic– Myristic is more dangerous – Increase LDL cholesterol – SFA content – Coconut oil- 92%, Sun

flower and saw flower – 10%• PUFA

– EFA are PUFA– Linoleic, Linolenic, Arachidonic– N6 to N3 ratio should be 5:1 to 10:1– PUFA both LDL & HDL

• PUFA (Contd…)

– Sun flower & Saw flower oil n6-n3 ratio is 69-70:0

– Coconut oil n6-n3 ratio is 4:1– PUFA of coconut oil is only 2%– High n6-n3 ratio

•Freeradicles diseases – Angiotoxicity, . platelet aggregation, and . immune function

– Answer for . N3 - use fish, Legumes and greens

MONO UNSATURATED FATTY ACIDS (MUA)

• Increases HDL (Good cholesterol)

• Decreases LDL (Bad cholesterol)

• Olive oil – 77% (n6-n3 ratio 8:1)

• Coconut – 6% (n6-n3 ratio 4:1)

• Palmolein – 48% (n6-n3 ratio 11:1)

FISH OIL

• Omega 3 fatty acids

• EPEA (Eicosa Penta Enoic Acid)

• DHEA (Docosa Hexa Enoic Acid)

• Decreases thromboxane A2

• Thromboxane A2, potent vasoconstrictor and platelet aggregator

RECOMMENDATIONS

• 10% SFA (Coconut oil)

• 10% PUFA (Saw flower oil)

• 10% MUFA (Olive oil or

Palmolein)

NUTRITIVE VALUE / 100 GMProtein (gm) Cal

• Breast milk 1 67• Cows milk 3 67• Rice (1 tumbler-cooked) 4 175• Egg 6 80• 1 tsp. cooked dhal 0.5 8• 1 oz fish 6 50• Mutton 1 oz 6 70• Bread 1 slice 2 70• Dosa 2 70• Iddili 2 50• Chappati 2 70

NUTRITIVE VALUE / 100 GM (Contd…)

Protein (gm) Cal• Uppuma 1 cup 6 250• 50 ground nut 5 110• Plantain 0.5 50• Pappadam 0.5 20• Biscut 0.5 20• Cereals 7-11 350• Legumes 17-20

350• Soya 43 500• Nuts 20 600• Meat 20 200• Beef 80 400

DIET IN DISEASE

• Acute nephritis – Fluid 400 ml/m2 surface area +

previous day output– SA = Ht (cm) X Wt. (Kg)

3600– Calories - Sweetened carbohydrates – Proteins – 0.75 gm/kg– Na – No added salt – Protein – No fruits

DIET IN DISEASE (Contd…)

• CRF diet

– Restrict proteins, sodium and potassium

– CRF induced rickets

– Aluminium hydroxide – 1ml/kg/day

– Calcium – 1 gm/day

– Alpha D3 – 0.25 gm / day

– Restrict milk as it contains phosphates

DIET IN DISEASE (Contd…)

• Nephrotic syndrome

– Protein RDA

– Carbohydrate – Non easily assimilable

– Lipid – PUFA

– Potassium – Liberal

– Sodium – Adequate

– Calcium – Supplement

DIET IN HEART DISEASE

•CCF

– Calories – 30% extra

– Protein – RDA

– Sodium – 0.5 to 1 gm

DIET IN RESPIRATORY DISEASE

• 10-20% extra calories

• Exclusion diet in asthma

• Citrous fruit, nuts, chocolates

cows milk, egg, fish, meat

DIET IN LIVER DISEASE

•Hepatitis

– No restriction

– Encourage salt

– Fat may cause delayed gastric

emptying

DIET IN CHRONIC LIVER DISORDERS

• Calories – 120-150%• Protein – Gr. 1 & Gr.2

encephalopathy – No restriction

• Gr. 3 & Gr. 4 – 80% of the RDA – Use milk and veg. Proteins as they

increase BCAA/Tyrosene ratio– As they increase arginine and ornithine – Helpful to remove ammonia

• FAT – Use MCT

DIET IN CHRONIC LIVER DISORDERS (Contd….)

• Vit. A – 10,000 unit daily• Vit. D2 – 5000 – 8000 units or • Vit. D3 – 3 to 5 micro gm/Kg/day• Vit. E – 50-400 IU/day• Vit. K – 2-5 mg alternate day• Micronutrient – Ca, Phosphorus & Zn• Avoid – Al, Manganese & Cu• Water soluble vitamins – double dose

DIET IN MALABSORPTION

• Lactose intolerance – Restrict lactose for 2 days

• Protein indigestion – Protease enzymes

• Fat indigestion– MCT and lipase enzymes

• Pancreatic insufficiency– MCT and enzymes

DIET IN CELIAC DISEASE

•Gluten free diet

–Avoid wheat & wheat

products, Rye, Barley & Oats

DIET IN DIABETES MELLITUS

• Aim – FBS < 115– PPBS < 140– S. Chol. < 200– S. LDL < 130

• Carbohydrate – Non easily assimilable – Wheat preferable

• Low fat – PUFA, SFA – 1.2:1• Fibres – 20-30 gm /day

DIET IN DIABETES MELLITUS (contd…)

• Carbohydrate < 5%

– Cabbage, Bringal, Tomato, Water melon, Snake gourd

• Carbohydrate – 5 to 20 %

– Beetroot, Papaya, grapes

• Carbohydrate > 20%

– Potato, Cereals, Jam

DIET IN HYPER LIPIDEMIA

• Cholesterol: < 170 - No intervention

• Cholesterol: 170 to 199 – Repeat

• Do lipid profile if in the same range

• LDL: < 110 – Acceptable

• LDL: 110 to 130 – Borderline

• LDL: > 130 – Elevated

DIET IN HYPER LIPIDEMIA (Contd…)

• Treatment – Total fat – 30%,

– SFA, PUFA, MUFA – 10%

– Cholesterol – 100mg/1000 cal.

– Aim – to keep LDL < 130

– If not, reduce SFA to < 6%, cholesterol – 66mg/1000, total 200 mg/day

DIET IN HYPER LIPIDEMIA (Contd…)

•Cholesterol content

–1 egg : 250 mg

–100 gm liver : 400 mg

–100 ml milk : 23mg

–100 gm meat : 135 mg

LONGEVITY DIET

Calorie distribution

•Fat – 10%

•Protein – 10%

•Carbohydrates – 80%

DIET IN OBESITY

• BMI - Wt. in kg / Ht. in m2

• Normal – 15-25

• Grade 1 – 25 – 30

• Grade 2 – 30 – 40

• Grade 3 - > 40

• Avoid – Oils, direct sugar and bakery items

DIET IN PKU

•Avoid – meat, fish, eggs, nuts,

pulses, cereals & bread

DIET IN GALACTOSEMIA

•Avoid – all milk and milk

products

•Favourable – Cheese, fruits,

eggs, vegetables, breads, soups

DIET IN GSD

• Use uncooked cornstarch

DIET IN GOUT

•Avoid – beef, chicken,

spinach, chocolates, coco,

alcoholic beverages

DIET IN EPILEPSY

•Ketogenic diet

– 80% calories from fat

– 60% as MCT

– Rest proteins and

carbohydrates

DIET IN DIARRHOEA

•Normal diet