Diet does not substitute drugs but it is considered a complementary therapy. The goals of dietary advice are:  To prevent or manage some medical conditions  To maintain or improve health through the use of appropriate and healthy food choices  To achieve and maintain optimal metabolic and physiological outcome

1. Dr. Dalia El-Shafei
Assoc. prof., Community Medicine Department, Zagazig University
http://www.slideshare.net/daliaelshafei

2. THERAPEUTIC DIET

4. THE GOALS OF DIETARY ADVICE:
To prevent or manage some medical
conditions
To maintain or improve health using
appropriate & healthy food choices
To achieve & maintain optimal
metabolic & physiological
outcome.

5. HPN
Dyslipidemia &
Coronary heart diseases
DM
Renal Diseases GIT Problems

6. DIETARY RECOMMENDATIONS IN HPN
DASH eating plan:
-Dietary approach to stop hypertension (DASH).
-Flexible & balanced eating plan which recommends:
↑Servings of vegetables
& fruits (3-4 servings/d).
↑Foods rich in potassium
as: milk, banana, orange
& legumes.
Whole grain cereals &
bread.
Fat-free or low-fat dairy
products (3 servings/d).
Lower saturated fats,
cholesterol & total fats.
Limiting lean meat
intake.
Two or more vegetarian-
style or meatless meals
each week.
↓Sweets & added sugars.
Low sodium (salt) intake
(<2.3 mg /day.).

8. Making healthy lifestyle changes while following the DASH eating plan
is the best way to control HPN through the following:
Maintaining a healthy weight (in overweight or obesity;
reducing daily caloric intake by 500-1000 kcal. to have a
weight loss of 1-2 pounds /week.
Be physically active.
Making healthy eating choices that less in sodium (by using
of spices, lemon, vinegar or other salt-free seasoning
blends).
Stop smoking: as smoking harms every organ in the body.

9. DIET THERAPY IN DYSLIPIDEMIA & CORONARY
HEART DISEASES:
Total calories:
Balanced energy
intake & expenditure.
Carbohydrate: 50-
60% of total calories
Protein: 15-20% of
total calories
Total fat: 25–30% of
total calories
↑ Unsaturated fats:
Olive oil & Omega-3
oil in fish
Saturated fats: <7% of
total calories
↓Cholesterol, trans-
fats, saturated fats &
salt.
Dietary cholesterol:
<200 mg/day
Fibers: 20-30 g/day

10. DIETARY RECOMMENDATIONS IN DM
Choose more high
fiber foods: (↑fruits
& vegetables)
• Maintain blood glucose
levels & cholesterol levels
• Maintain a healthy gut:
Whole grain cereals,
Whole wheat pasta, Brown
rice
Reduce animal or
saturated fat intake
• Low fat milk
• Low fat spread instead of
butter
• Oil high in unsaturated fat,
“olive oil, omega-3 oils”
• Less fat in cooking: grill,
dry-roast, steam
Cut down on sugary
foods
• Sweets, eat starchy foods.
• Sugary drinks
• Use diet or low calorie,
sugar free drinks
• Choose low sugar
products
Reduce salt intake
• Cut down on added salt
• Use alternative seasonings
• Look out for reduced/low
sodium foods e.g: bread
• Avoid salt substitutes
• Eat regular meals

11. DIETARY RECOMMENDATIONS IN RENAL DISEASES
Extremely complicated.
• Intended to reduce the amount of excretory work demanded of the kidneys while helping them
maintains fluid, acid-base, and electrolyte balance.
• Patients with CRF may have restricted proteins, Na, K, Ph.
• Sufficient calories necessary: 25-50 kcal/kg BW.
• Limit protein to 40 grams based on glomerular filtration rate & weight.
• Sodium may be limited if the client tends to retain it.
• Fluids are typically restricted for renal patients.
• Calcium supplements may be prescribed.
• Vit. D may be added, and phosphorus limited, to prevent osteomalcia.
• Potassium may be restricted in some patients because hyperkalemia tends to occur in end stage renal
disease (ESRD). Excess potassium can cause cardiac arrest.
• Renal patients often have an increased need for vitamins B, C, and D.
• Iron is commonly prescribed.

12. DIET IN GASTROINTESTINAL PROBLEMS
Liver cirrhosis Hepatitis Peptic ulcers

13. Diet therapy in liver cirrhosis:
Provides at least 25-35 kcal
or more.
In advanced cirrhosis, 50-
60% of kcal. should be
taken from carbohydrates.
Protein: 0.8-1.0g/kg BW
each day.
Supplements of vitamins &
minerals.
Sometimes cirrhosis causes
ascites: Sodium & fluids
may be restricted.
In esophageal bleeding,
fibers can be restricted to
prevent irritation.
Smaller feedings better
than larger ones.
Alcohol is prohibited

14. Diet therapy in Hepatitis:
Diet should
provide 35-40
kcal/kg.BW: by
carbohydrates
with restriction
of fat
If necrosis is not
severe, up to 70-
80 grams of
protein for cell
regeneration.
If necrosis is
severe: limited
proteins to
prevent ammonia
accumulation in
the blood.

15. Diet therapy in Peptic Ulcers:
Well-balanced diet of
3 meals a day.
Sufficient low-fat
protein.
No less than 0.8g of
protein/kg BW
Avoid caffeine,
beverages, alcohol,
aspirin & smoking.

16. NUTRITION & CANCER

17. I. DIET AS A RISK FACTOR:
Nutritional excess:
• Increased caloric intake → obesity, cancer breast, uterus, esophagus …etc.
• Increased saturated fatty acids → tumor growth.
• Excess salting → cancer stomach and esophagus.
Carcinogens in foods:
• Microbial toxins: aflatoxins in long stored nuts → cancer liver.
• Chemical toxins: pesticides, herbicides, nitrogenous fertilizers.
• Packing materials: soldered canned food, lead pipes→cancer kidney, alum in
water purification & cadmium in food industry.
• Chloroform in water & alcohol.
• Polycyclic aromatic hydrocarbons from food grilling over direct flame.
• Food additives: colors, flavors, sweeteners, preservatives.

18. II. DIET AS A PROTECTIVE AGENT:
Fibers have a
protective effect
against cancer
colon.
Fruits &
vegetables: rich
in antioxidants
(vit. A, E, C).
Linolenic fatty
acid (polyunsat.
FA) has
protective role
against cancer
breast & colon.
Selenium is an
antioxidant &
calcium has
anticancer role.
Coffee & tea
have useful role
in prevention of
cancer colon.

19. NUTRITION & INFECTION

20. Infection can lead to malnutrition by causing anorexia,
vomiting, diarrhea or bleeding. Increased supply for nutrients
to compensate for the losses is needed.
Malnutrition interferes with body formation of antibodies
(immunoglobulins) lymphocytes & phagocytes.
Vitamins A, C & B2 are responsible for normal proliferation of
phagocytes & lining epithelium of respiratory & urinary tracts.
These nutrients deficiency ↑ body susceptibility to infection.

24. ANTIOXIDANTS

25. In the body the oxidation reactions
involve highly reactive molecules
called free radicals. When these
free radicals are released from the
mitochondria in sufficient numbers,
they threaten the protective
biochemical systems of the body
and the cell structures &
functions(damage cell proteins,
lipoproteins & DNA) & can lead to
diseases, as cancer, coronary heart
diseases, arthritis, DM &
neurodegenerative diseases as
Alzheimer.

26. Oxidative stress: Impaired balance between free radical production
& antioxidant capacity resulting in excess oxidative products.

27. SOURCES OF FREE RADICALS:
Extrinsic: as
radiation, pollution,
smoking, pesticides &
toxins.
Intrinsic: as stress &
inflammation.

28. ANTIOXIDANTS
Chemical compounds which may be endogenous as superoxid
dismutase enzyme in the human cells or exogenous as vitamins E, C,
A, selenium, zinc & phytochemicals in foods. These antioxidants
neutralize the free radicals preventing them from damaging healthy
cells.

30. Sources of antioxidants (Exogenous)
Beta-
carotene
• Apricots,
carrots,
mangoes.
Copper
• Seafood,
milk, nuts &
lean meat
Selenium
• Onion,
garlic,
wheat germ,
mushrooms.
Vitamin C
• Broccoli,
cabbage,
strawberry.
Vitamin E
• Whole grain
cereals,
nuts, wheat
germ,
mangoes.
Phyto-
chemicals
• Green tea,
apple, citrus
fruits, onion,
tomatoes,
garlic.

31. FUNCTIONS OF ANTIOXIDANTS:
Against senility, cancer & cardiovascular diseases.
Prevent progress of rheumatoid arthritis, diabetes and parkinsonism.
↓ Muscle damage in athletes.
Prevent rancidity in food preservatives & cosmetics industries.
↓ Menopausal symptoms & osteoporosis.

32. VEGETARIANISM

33. VEGETARIANISM
It is a practice of diet that excludes meat, fish and poultry, egg, milk
and honey i.e., excludes any food from animal source.
Lacto-
vegetarianism:
consuming milk &
excluding the
other animal foods.
Ovo-
vegetarianism:
consuming eggs
&excluding the
other animal foods.
Semi-
vegetarianism:
excluding meat
only.

35. Causes of choosing vegetarian diet:
Mortality Religion Culture Ethical Environmental
Economical Political Taste Morbidity

36. Healthy diet if well
planned “↓ risk of
cancer, IHD, HPN &
obesity”.
Benefits
Only deficient nutrient
is vit. B12 “only in
animal protein”.
Hazards