JIGAWA STATE COLLEGE OF NURSING SCIENCE

HADEJIA CAMPUS
LECTURE NOTE N DIETETICS
PREPARED BY: - Lawan Yusif
[email protected]
INTRODUCTION: -
Diet is the sequence and balance of meals in a day. It is concerned with the
eating patterns of individuals or a group. Some people may eat twice in a day
(breakfast and dinner); others may eat four times (breakfast, lunch, snack and
dinner); still others may seem to be chewing all day long
What we eat and drink to help keep us alive and well, to help us grow, develop,
work and play is called food. Food is anything edible. It includes all foods and
drinks acceptable for that particular society, culture or religion. Food gives us a
feeling of comfort and satisfaction. Eating certain foods establishes our identity.
What we eat and how we eat makes up our food habit. Most of our food habits are
learned in the home from our parents. As we grow up, our experience and learning
help us to change some of these food habits.
Nutrition is the interaction between food and the body. It is about the nutrients
contained in food, and their action, interaction and balance in relation to health
and disease. It is the process by which people can ingest, digest, absorb, transport,
utilize and excrete food substances. In addition, nutrition is concerned with social,
cultural and physiological implications of food and eating. In general, the science
of nutrition is the science of showing how food nourishes the body.
HISTORY OD DIETETICS
Dietetics is the application of the science of nutrition to the human being and
diseases. However, the term “dietitian” used to describe a practitioner of dietetics,
was in use long before the science of nutrition had become an accepted discipline.
The first use of the tittle was recorded in 1899, in U.S.A when the dietitian was
described as ‘a person working in a hospital who provided nutritious meal to
patients’. The earliest dietitians were therefore mainly concerned with provision of
food and usually trained as home economists.’ The role of the dietitian has
changed markedly in the past 50 years, and the dietitian is now accepted as the
expert in the planning and evolution of nutritional care for patients requiring
therapeutic regimens as for the population in general.
The profession of dietetics is relatively a young one, first formalize in the united
states in 1917 with the foundation of the American Dietetics Association (ADA).
In the United Kingdom, the first dietitians were nurses and the first dietetics
department opened in the Edinburgh Royal Infirmary in 1924. The British
Dietetics Association (BDA) was established in 1936. The profession develops
rapidly in other countries, and in 2004 there were 23 dietetics Associations
registered with the European Federation of the Association of Dietitians and
36national dietetics associations registered with the International Committee of
Dietetics Association.
Dietetics is derived from word dieto which means diet and the word diet is
derived from the Latin diaeta, meaning ‘mode of life’, a word that up until the last
century was often used in a much broader sense than its current meaning. The word
dietetics was noted in the early writings of Hippocrates (460 BC), Plato (460–348
BC), and Galen (130–200 AD). Recently, dietetics as a profession has been defined
by the American Dietetic Association as the integration and application of
principles derived from the disciplines of food, nutrition, management,
communication, biological, physiological, behavioral and social sciences to
achieve and maintain human health.
A nutrient is an active chemical component in food that plays a specific
structural or functional role in the body’s activity. Sugars, starches and fibre are
often grouped together as they are all carbohydrates. Vitamins and minerals are
needed in very small amounts and they are called micronutrients.
 Dietetics is the branch of knowledge concerned with the diet and its effects on
health, especially with practical application of scientific understanding of
nutrition. Dietetics is the science of managing food and nutrition to promote
health. Registered dietitians are food nutrition experts who provide nutritional
services in hospitals, schools, nursing care facilities, and other institutions. These
essential health care professionals are responsible for developing food and
nutrition programs to prevent and treat illness or promote general dietary health.

Dietetics has been practiced as long people have been eating. According to
earliest historical evidence our ancestors were forced to concentrate on simply
findings food with little concern about the variety or composition of that food.
One of the fascinating accounts of the relationship between specific food and
illness is found in land’s treatise of scurvy written in 1953.When it was discovered
that lemons and limes or juice would prevent scurvy. It was life-saving piece of
knowledge. Vitamin C from citrus fruits was later termed anti scurvy vitamin.
Other break through come when vitamin A was found to be a factor in the
prevention of skin lesion and blindness in both animal and people, and when niacin
one of the B-vitamin group, was found to prevent pellagra in humans.
ORIGIN OF DIETETICS AND DIET THERAPY
Although not officially recognized as a profession, dietetics (and nutrition) has
constituted a branch of the medical art since the time of the ancient Greeks.
Intervention in the nutritional habits of the patient was a method of treatment
Physicians and philosophers believed that proper diet was a precondition for
corporal and intellectual well-being. Dietetics was known in the 8th century BC.
Later, Hippocrates (5th century BC), the father of medicine wrote, “Let the
food be the medicine, the medicine be the food,” emphasizing that diet was the
best way to treat disease. He presented his nutritional concepts in his work on
diet. Among his aphorisms are found statements which are in agreement with
current research, such as “persons who are naturally very fat are apt to die
earlier than those who are slender”. Another example of the influence of food
on many aspects of life in ancient Greek society comes from the famous
philosophical works of Plato (5th–4th century BC), who makes frequent
references to human diet. According to the philosopher, a moderate and thus
healthy diet consists of cereals, legumes, fruits, milk, honey and fish. In
addition, the dietary patterns presented in the Platonic dialogues were very
similar to the current Mediterranean diet. Plato suggested that the therapeutic
approach to human diseases should be made through the regulation of diet
rather than with medication, “Wherefore one ought to control all such diseases,
so far as one has time to spare, by means of dieting rather than irritate a
fractious evil by drugging”. He recognized the importance of the proper
nutrition for corporal development in many passages in his texts “for there
ought to be no other secondary task to hinder the work of supplying the body
with its proper exercise and nourishment”.
Many physicians highlighted the importance of diet in maintaining health
and in the treatment of diseases. Members of the famous medical school of
Alexandria like Erasistratus and Herophilus, Celsus and Galen, produced many
writings on diet. Galen was the Roman emperor’s physician, an anatomist,
physiologist and a fruitful writer and his word in medicine and science became
law. He was one of the believers in diet, and said “health depends chiefly on the
choice of food.” He stressed the therapeutic value of climate and a full diet for
tuberculosis, and emphasized the value of milk in the treatment of disease. In
later years, Boorde, a physician and experienced traveller of the 16th century,
wrote 2 short books related to health, Breuyary of health and A compendious
regiment or a dietary of health. He included brief chapters on bread, potage
(soup), meat, eggs and cheese, fish and fowl, roots, herbs, fruits and spices, and
diets for the following: sanguine, phlegmatic, choleric and melancholic
temperaments and pestilence, fever, gout, leprosy, consumption, palsy, madness
and dropsy.
 Hospital dietetics appeared in the 12th century as shown in the records of the
history of St. Bartholomew’s Hospital in London, the oldest British hospital,
established in 1123. In the Middle Ages, and even through the 18th century,
hospital diet was based on bread. Other components were beef, beef broth, ale
cawdel, beer, mutton, mutton broth, cheese, butter, milk pottage, rice milk,
sugar soppes and water gruel. Only little change in the type or amount of the
daily food allowance for patients at St. Bartholomew’s was noticed a century
later. Four different kinds of diet existed at that time; the common diet, the
broth diet, the thin or fever diet, and the milk diet.
The common diet was simply the normal diet. The broth diet was the same as
the common diet but without any meat. The thin or fever diet did not include
meat, beer or butter and consisted of 1 pint of milk with tapioca, arrow root,
sago or rice as prescribed, and barley water. The milk diet consisted of milk
porridge, 12 ounces of bread, 2 pints of milk with tapioca, arrow root, sago or
rice as prescribed, barley water, 1 ounce of butter and bread pudding 3 times a
week when ordered. At that time, most of the other hospitals in London used the
same terms to describe their diets, with some including such terms as full,
middle, and low diet, and spoon or fever diet. By the early part of the 20th
century, therapeutic diets had become more common and were usually named
after the physician who prescribed them, such as Meulengraght’s diet and the
Sippy diet and the various adjustments of each. Nowadays, emphasis in diet
therapy is placed on a diet adequate in all nutrients, with minimal modifications
in quantity, consistency and texture of food according to patient needs.

THE EVOLUTION OF DIETETICS AS A PROFESSION

War, which has always influenced man’s lifestyle, food and health, ought to
take some credit for the rise of the dietetic profession. Florence Nightingale
(1820–1910), founder of the nursing profession, was also designated the first
hospital dietitian. She said, “You cannot diet a patient from a book; you cannot
make up the human body as you would a prescription.” On November 5, 1854,
she arrived at the barracks hospital in Scutari with a small band of nurses during
the Crimean War. They found a hopeless confusion, lack of supplies and
patients who were almost starved. The next day she began to cook extra from
food supplies she had brought and within a week she had an extra diet kitchen
established. In addition, due to her organizing ability (characteristic of a
dietitian today), the purveyor’s department was reorganized, a corps of medical
orderlies was established and the cooking service of the soldier-patients’ food
was rearranged and improved.
Alexis Soyer (1809–1858), a famous chief born in France, also went to the
Crimea, where he was recognized as the first army dietitian and was given
credit for the rise of the dietetic profession. He taught the soldiers how to cook
and to make their diet delicious and nutritious. After his return to London, at the
request of Miss Nightingale, he organized schools of hospital cookery, planned
kitchens and general diets and wrote a booklet on the preparation of diets for
sick soldiers which were adopted by the military hospitals.
During Soyer’s, time and despite his leadership, dietetics was considered a
woman’s profession. However, the year 1936 saw the first male member of the
American Dietetic Association, and an increasing number of young men
followed.
In the Second World War they served not only as dietitians in military
services but with the Veterans Administration and in civilian positions. In the
United Kingdom, dietitians who first followed Miss Nightingale’s example
came from the nursing profession, but the progress in the science of nutrition
and the specialized knowledge required for modern therapeutic diets led to
dietetics becoming a specialized field of training with specific academic
qualifications as well as hospital training.

WHAT IS DIETETICS?
 Dietetics is an interdisciplinary and applied subject that is concerned with
the application of nutritional sciences for treatment of disease and the
promotion of health for individuals and groups.
It is an academic program that prepares students to use advanced knowledge
about food and nutrition to help prevent and treat disease maintain and promote
health. It is:
 People oriented and science – focused
 Evidence based
 The first step toward a professional credential
DIETITIAN
A dietitian (or dietician) is an expert in dietetic; that is human nutrition and
the regulation of diet alters their patient’s nutrition based upon their medical
condition and individual needs. Dietitians are regulated health care
professionals licensed to assess, diagnose, and treat nutritional problems.
A registered dietitian (RD) or registered dietitian nutritionist (RDN) is a
dietitian who meets all of a set of special academic and professional
requirements, including the complication of a bachelor’s degree with an
accredited nutrition curriculum, an internship at an approved health care facility,
food service organization, or community agency, and satisfactory performance
on a registration exam.
Recognition of the dietitian as a food and nutrition expert becomes official in
1917. This however was not the actual beginning of the practice of dietetics.
The use of diet in the treatment of disease was already an ancient practice even
though it was based more on trial and error than on scientific knowledge. Beside
physician others including home economist; nurses and cooks were practicing
and teaching about good dietary practice and researches were uncovering the
health promoting effect.
ROLES OF DIETITIAN
 Dietary modification to address medical issues involving dietary intake is a
major part of dietetics the study of nutrition as it relates to health. In a school
setting, the dietician might travel to a school and provide students with
information and training on health eating. When they work in an office setting,
they see clients who come to them for assistance in meeting their dietary needs
or for help with dieting, they also may focus their education on certain health
and dietary issues like diabetes, unhealthy weight or hypertension and work
specifically with those groups in community or healthcare settings. Dieticians
and nutritionists are an important part of our food service management and
health care teams. Other duties of a dietetics specialist might include;
 Collaborating with food manufactures to improve the nutritional quality
of prepared meals.
 Advice and counsel others on food and nutrition
 Develop meal plan for clients
 Assess the dietary and health need of the clients
 Keep abreast of the latest research on nutrition and food sciences
 Improving the understanding and accuracy of food labels
 Increasing public awareness of nutritional habits and standards.
 Creating facility wide nutritional programs for correctional, educational
and health care institutions.
QUALITIES/ SKILLS OF A DIETITIAN
 Good decision making and judgement capabilities
 Ability to instruct others
 Good reading and comprehension skills
 Good coordination skills and ability to adjust one’s action in relation to
others
 Being socially perceptive, that is aware of the reactions of others and
understanding those reactions
  Ability to identify and solve complex problems

BRANCHES OF DIETITIANS
 Clinical Dietitian
Clinical dietitians work in hospitals nursing care facilities and other health care
facilities to provide dietary consultations to patients and their families. They
confer with other health care professionals to review patient’s medical charts
and develop individual plans to meet nutritional requirements. Some clinical
dietitian will also create or deliver out-patient or public education programs in
health and nutrition.
 Pediatric Dietitians
Pediatric dietitians provide nutrition and health advice for infants, children, and
adolescents. They focus on early nutritional needs, and often work closely with
doctors, school health services, clinical, hospitals and government agencies in
developing and implementing treatment plans for children with eating disorders,
food allergies or any condition where a child’s diet factors into the equation,
such as childhood obesity.
 Neonatal Dietitians
Neonatal dietitian provides individualized medical nutrition therapy for
critically ill premature new-born; they are considered a part of the neonatal
intensive care unit medical team. The neonatal dietitian performs clinical
assessment of patients, designs nutrition protocols and quality improvement
initiation with the medical team, develops enteral and parenteral regimen, helps
establish and promote lactation/breastfeeding guidelines and often overseas the
management of infection prevention in the handling, storage, and delivery of
nutritional products.
  Community Dietitians
Community dietitians works with wellness programs, public health agencies,
home care agencies, and health maintenance organizations. These dietitians
apply and distribute knowledge about food and nutrition to individuals and
groups of specific categories, life-styles and geographic areas in order to
promote health. They often focus on the needs of the elderly, children, or other
individuals with special needs or limited access to health food. Some
community dietitians conduct home visits for patients who are too physically ill
to attend consultations in health facilities in order to provide care and
instruction in grocery shopping and food preparation

 Food Services Dietitians

Food service dietitians or managers are responsible for large scale food
planning and service. They coordinate, assess and plan food service processes in
health care facilities, school food service programs, prisons, restaurants, and
company, cafeterias. These dietitians may perform audits of their departments to
ensure quality control and food safety standards and launch new menus and
various programs within their institution to meet health and nutritional
requirements. They train and supervise other food service workers such as
kitchen staff, delivery staff, and dietary assistants or aides.
 Gerontological Dietitians
Gerootological dietitians are specialists in nutrition and aging. They work in
nursing home; community based aged care agencies, government agencies in
aging policy and in higher education in the field of gerontology (the study of
aging)
 Research Dietitian
Research dietitian may focus on social sciences or health services research for
example, investigate the impact of health policies or behavior change or
evaluate program effectiveness. They may survey food services systems
management in order to guide quality improvement some research dietitian
study the biochemical aspects of nutrients interaction within the body in
universities, they also may have teaching responsibilities. Some clinical
dietitians roles involves research in addition to their patients care workload

 Administrative Dietitians
Administrative or management dietitians oversee and direct all aspect of clinical
dietetics service operations in hospitals government agencies, company
cafeterias, prisons, and schools. They recruit, train and supervise employees of
dietetics department including dietitians and other personnel. They set
department goals, policies and procedures, procurement, equipment and
supplies, ensure safety and sanitation standards in food service, and administer
budget management.
 Business Dietitians
Business dietitians serve as resource people in food and nutrition through
business, marketing and communications dietitians expertise in nutrition is often
solicited in the media for example providing expert guest opinion on television
and radio news or cooking shows, columnist for a newspaper or magazine, or
resource for restaurants on recipe development and critique. Business dietitians
may author books or corporate newsletters on nutrition and wellness. They also
work as sales representatives for food manufacturing companies that provide
nutritional supplements and tube feeding supplies.
 Consultant Dietitians
Consultant dietitians are those in private practice or practice on a contractual
basis with health care facilities or corporations such as used in Australia,
Canada and the United State consultant dietitians contract independently to
provide nutrition or health related consultation and educational program to
individuals and health care facilities as well as sports team, fitness, clubs, and
other health related business and corporation.