NUTRITIONAL

THERAPY –
NCM 105 Finals
LEGAL MANDATES related to
NUTRITION & DIET THERAPY

• FDA = FOOD and DRUG

ADMINISTRATION
• HIPPA = Health Insurance Portability and
Accountability Act
• NNCP = National Nutrition Council of the
Philippines
 FDA = FOOD and DRUG
ADMINISTRATION
The Food and Drug
Administration is responsible for
protecting the public health by
ensuring the safety, efficacy, and
security of human and
veterinary drugs, biological
products, and medical devices;
and by ensuring the safety of our
nation's food supply, cosmetics,
and products that emit radiation
FOOD and DRUG ADMINISTRATION

• According to the FDA, their responsibility

is to protect "public health by regulating
human drugs and biologics,
animal drugs, medical devices, tobacco
products, food (including animal food),
cosmetics, and electronic products that
emit radiation."
 Health Insurance Portability &
Accountability Act
• HIPAA (Health Insurance Portability and Accountability Act
of 1996) is United States legislation that provides data
privacy and security provisions for safeguarding medical
information.
What are the 5 main components of HIPPA?
5 rules to enforce Administrative Simplification: (1)
Privacy Rule, (2) Transactions and Code Sets Rule,
(3) Security Rule, (4) Unique Identifiers Rule, and
(5) Enforcement Rule. The HIPAA Privacy Rule
regulates the use and disclosure of protected health
information (PHI) by "covered entities."
• What are the four main purposes of
HIPAA?
• Privacy of health information
• security of electronic records
• administrative simplification
• insurance portability.
Provides detailed
instructions for handling a protecting a
patient's personal health information.
NNCP = National Nutrition
Council of the Philippines

National Nutrition Council,

abbreviated as NNC, is an
agency of the Philippine
government under
the Department of
Health responsible for creating a
conducive policy environment for
national and local nutrition
planning, implementation,
monitoring and evaluation, and
surveillance using state-of the
art technology and approaches.
 NNCP = National Nutrition
Council of the Philippines
• In 2005, Executive Order No. 472 named
the Department of Health as the chair of
the NNC, with the DA and DILG as vice-
chairs. It also called the NNC to re-orient
its operations to be more client-oriented
and to prioritize addressing hunger and
malnutrition, and authorized NNC to
generate and mobilize resources.
 NUTRITION GENOMICS
Nutritional genomics, also known
as nutrigenomics, is a science
studying the relationship
between
human genome, nutrition and
health. People in the field work
toward developing an
understanding of how the whole
body responds to a food via
systems biology, as well as
single gene/single food
compound relationships.
 nutritional support and end-of-
life decision making
• At the end of life, a feeding tube might
cause more discomfort than not eating.
For people with dementia, tube feeding
does not prolong life or prevent
aspiration, a feeding tube, known as a
nasogastric or NG tube, is threaded
through the nose down to the stomach to
give nutrition for a short time.
 Enteral Feeding – pertains to the delivery of food and
nutrients either orally or by the tube directly into the GIT.
It is used in patients with functioning GIT but unable to
digest required nutrients orally or for patients with
impaired digesting capacity or unable to absorb
nutrients.
o Types of Enteral Formulation
1. Ready-to-Use Formulations
a. Polymeric
b. Elemental or hydrolyzed
c. Modular
2. Tube Feedings – may be prepared from regular foods.
3. Standard Tube Feeding – fiber-free and high in
cholesterol, fat and sugar. It is milk based, sugar and
soft cooked eggs.
4. Blenderized Tube Feedings – are soft diet allowances
which can be blenderized easily.
o Complications
1. Mechanical
2. A. Nasopharyngeal irritation ( ice chips, topical
anesthetic, decongestant)
b. Luminal obstruction (flush, replace tube)
c. Mucosal erosions ( reposition tube, ice water lavage,
remove tube)
d. Tube displacement ( (replace tube)
e. Aspiration ( discontinue tube feeding)
2. GI
a. Cramping/distention (change formula, reduce infusion
rate)
b. Vomiting, diarrhea (dilute formula, reduce infusion rate,
antidiarrheal agents)
c. Constipation (promote sufficient fluids and fibers,
encourage patient activity)
3. Metabolic
a. Hypertonic dehydration ( increase free water)
b. Glucose intolerance (reduce infusion rate, give insulin)
c. Cardiac failure ( reduce sodium content, fluid restriction)
d. Renal failure ( decrease phosphate, magnesium,
potassium, protein restriction, essential amino acids
solution)
e. Hepatic encephalopathy ( decrease amount of protein)
FEEDING
 Therapeutic Diets
I. Nutrition Therapy for Obesity and Weight Control
• Degree of obesity is judged by comparing what one
weighs with the height-weight table.
a. Overweight - if one weighs 10-19% more than the
average for his height and body frame.
b. Obese – if the person weighs 20% or more than the
average for height and body frame.
Overweight and obese -condition wherein the body stores
of fat are enlarged.
Underweight or undernutrition – results when intake does
not meet the energy requirement; person weighs 10-
20% below the desirable weight.
Some Reasons for Excessive Calorie Intake
1. Family pattern of rich, high-calorie foods, mother being
a good cook
2. Good appetite, likes to eat, may dislike fruits and
vegetables
3. Ignorance of calorie value of foods
4. Skips breakfast, a frequent nibbler, takes coffee break
with high calorie snacks
5. Pattern of living
a. Sedentary occupation; idleness
b. Riding to work or school
c. Little exercise during leisure
d. Often sleeps more as person becomes older
6. Emotional outlet; easy to overcome worriness,
boredom, loneliness, grief
7. Many social events with foods; frequent eating at
restaurants
8. Lower metabolism with increasing age, but failure to
reduce intake
9. Influenced by advertising of many high-calorie foods
 Prevention of Obesity
1. There should be a change in the eating patterns so that
fewer calories are eaten
2. Children should be urged to get more exercise and
should be expected to perform some chores requiring
physical activity
3. Pre-school children should not be bribed or rewarded
with food. They should have a variety of activities.
 Planning for Weight Loss
1. Should be directed by a physician
2. Should set a reasonable goal
3. A weekly weight chart must be kept
4. Exercise must be done
 Low Calorie Diet
II. Nutrition Therapy for Diabetes Mellitus
 Diabetes
• A metabolic disease that affects the endocrine system
and the use of CHO and fat.
• There is not enough insulin available for the body’s
needs. In some patients, the Islets of Langerhans of
the pancreas are unable to produce enough insulin,
while in some, insulin that is produced for some reason
cannot be used by the tissues
• Because glucose cannot be used, the level in the blood
sugar rises– hyperglycemia until finally some of it is
excreted in the urine -- glycosuria
To excrete sugar, water is taken from the tissues, thus the
patient complains of frequent urination –polyuria and
increased thirst –polydipsia
The appetite is often increased –polyphagia because the
body is not fully using the food he normally eats. He
may also lose weight.
 2 Types of DM
1. Juvenile diabetes- occurs at any age from birth through
adolescence. It is severe, requires insulin for treatment,
and is difficult to manage.
2. Adult Type
• Occurs primarily among obese people who first became
diabetic in middle age.
• Disease is mild, stable, and well regulated by diet alone
or by diet and oral compounds.
 Characteristics of the Diet
• Diet is essentially a normal one, except that the
amounts of food and their distribution in meals are
controlled from day to day.
1. Energy –overweight diabetics are initially placed on low-
calorie diets because weight loss results in better
tolerance to carbohydrate.
In bed – 11-12 calories/lb
Sedentary - 13-14 calories/lb
Moderately active - 15-16 calories/lb
2. Protein – about 1 ½ gram per kg body weight (1/2 to 2/3
gm per lb) is usually allowed. The higher level is more
typical for patients who show a preference for protein-
rich foods.
3. CHO and fats – after subtracting the calories provided
by protein, the remainder of calories for the day are
usually divided equally between CHO and fat. The
number of grams of fat is ordinarily about the same as
the number of grams of CHON; the amount of CHO is
roughly twice the number of grams of CHON.
 Foods Preparation and Service
• All foods for the diet are measured according to the
mounts in the food exchange lists.
• Foods are prepared using only those allowed on the
meal patterns. No extra flour, bread crumbs, butter or
other foods may be used.
• Meats may be broiled, baked, roasted, or stewed. If they
are fried, some of the fat allowance may be used.
• Frozen or canned fruits packed with sugar must be
avoided
• Concentrated sweets and desserts are avoided: sugar,
candy, jelly, jam, pies, cakes, etc.
 Food Exchange Lists
• An exchange list is a grouping of foods in which the
CHO, CHON and fat values are about equal for the items
listed.
 Steps in Planning Measured Diet
1. Include basic foods to ensure adequate levels or
minerals and vitamin: 2 cups milk (3 or more for
children)
5 oz meat
2 servings vegetables
2 servings fruit
bread and cereals
2. List the CHO, CHON fat values for milk, vegetables and
fruit.
3. Subtract the CHO values of those foods from the CHO
level prescribed. Divide the difference by 15 to
determine the number of bread exchanges.
4. Subtract the total number of protein values of milk and
meat from the total fat described. Divide the difference
by 7 to determine the number of meat exchanges.
5. Subtract the total fat values for milk and meat from the
total fat prescribed. Divide the difference by 5 to
determine the number of fat exchanges.
 What is the culture Food of the
Philippines?
• Signature Dishes
Among the most popular are
marinated meats in
adobo sauce; Dininding,
a traditional dish
combining vegetables
and seafood; Laksa, a
melting pot of shrimp,
pork and vegetables;
Kari-Kari, or boiled oxtail;
and Estofado, a deep-
fried meat dish served
with potatoes.
 CORE VALUES OF
NUTRITION and DIETETICS
The general job description of a Licensed Nutritionist
includes:
• Evaluating a client's nutritional needs.
• Providing nutritional counseling and advice to clients.
• Creating a clinical nutrition treatment plan for a client.
• Educating the public on nutrition issues.
• Researching the effects of nutrition on health and fitness.