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Nutrition and Dietetics UNIT 2 PLANNING DIETS
Structure
2.0 Objectives
2.1 Introduction
2.2 Planning Diets
2.3 Diets for Normal Individuals
2.3.1 Concept of an Adequate or a Balanced Diet
2.3.2 Food Groups and Adequate or Balanced Diets
2.3.3 Influence of Age, Sex, Activity Level and Physiological State
2.3.4 Use of Recommended Dietary Intakes in Planning Balanced Diets
2.3.5 Guidelines for Planning Adequate/Balanced Diets
2.4 Diet Planning in Disease
2.4.1 How Disease Affects Nutritional Requirements
2.4.2 Influence of Disease on Food Intake and Dietary Patterns
2.4.3 Types of Dietary Modifications
2.4.4 Special Feeding Methods
2.4.5 Planning Diets for Patients and High Risk Individuals
2.5 Social, Economic and Psychological Factors in Diet Planning
2.6 Let Us Sum Up
2.7 Key Words
2.8 Answers to Check Your Progress
2.0 OBJECTIVES
After studying this unit, you should be able to:
● explain the rationale for diet planning;
● describe the use of food groups and recommended dietary intakes in planning balanced
diets for normal individuals;
● discuss and explain significant issues related to the influence of age, sex, activity alevel
and physiological state in planning diets;
● list the major steps involved in planning balanced diets;
● describe the influence of disease on nutritional requirements and dietary patterns;
● explain the concepts and techniques of nutritional support; and
● identify the role of physiological factors.
2.1 INTRODUCTION
As competent professionals in health care, you may interact with a number of patients in
hospital, clinic and community settings. Very often the doctor might write out a prescription
looking like the one given in Fig. 2.1.
The prescription highlights the fact that many patients would require dietary modifications
in addition to medicines. As a nurse you may be asked by patients and their relatives about
these basic elements of therapy. It would be satisfying and reassuring for the patient his/her
family to undersand from you the basis of the therapy. Hospitals/Clinics also have dietitians
who perform the role of planning diets for patients and also explaining these therapeutic
measures to them. There may be several occasions when you might interact with a dietitian.
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Remember that you are a vital link between the doctor, dietitian, and the patient. In public Planning Diets
health fieldwork you may have to do the diet planning with families.
So, you need to know more about diet planning. As you glanced at the structure of this
unit you wold have noticed the emphasis on planning diets for normal individuals. There is
a reason for this. Therapeutic diets are based on normal diets. This is why we have to
discuss diet planning for normal individuals. Once you have understood this, it becomes
easier to appreciate the rationale for therapeutic diets.
DIETARY TREATMENT
Patient details = Mrs. Raj Rani, House Wife
45 years old, female, 50 kg wt.
Diagnosis = Diabetic Mellitus
Day’s Dietary Requirement for Raj Rani (Vegetarian)
1) Total Calorie requirement 25-30 Kcal per Kg ´ 50 Kg. = 1250-1500 Kcal
2) Total carbohydrate requirement (mainly starch NOT Sugar) = 1000-1500 gm.
20-30 gm per kg ´ 50 kg.
3) Total Fat requirement = 1500-2500 gm Fat
30-50 gm per kg ´ 50 kg. = (preferably oils from
seeds)
4) Total Protein requirement = 50-75 gm of Protein
1-15 gm. Per kg ´ 50 kg.
5) Vitamins and minerals from fruits and vegetables
6) Water = 8-10 glasses
7) Fibres from fruits, vegetables
Fig. 2.1: Prescription for dietary treatment
Now coming to the section on diet planning in disease. Several diseases affect the
requirements for one or more nutrients. This means we have to change the diet accordingly.
In addition, disease can affect the appetite or the ability to chew, swallow, digest, absorb or
excrete. This also necessitates changes in dietary patterns. In this unit we will just take a
quick look at these aspects as well as the types of dietary modifications generally made.
The types of special feedings (e.g. tube feeding and intravenous feeding are discussed in
some detail. In Units 4 and 5 we will discuss dietary management in disease. You are also
aware that very often other members of a patient’s family may be at risk. It is essential to
identify individuals at risk and advise them on dietary changes in their normal diets if
required. As a nurse you could detect, nutritional problems, implement and ensure dietary
changes made or help the patient to eat or councelled.
Finally, we cannot ignore the special role of social and psychological factors. Keeping
these considerations in mind one can spell the difference between success and failure in
diet therapy. The patient is a person with his or her own likes and dislikes and attitudes.
These must be respected. This shows we care.
2.2 PLANNING DIETS
Is planning a diet essential? Yes, it is essential.
In the previous unit we discussed the importance of eating nourishing food in preventing
nutritional disorders as also in promoting a sense of well-being. In this context planning
diets has a special role; it is a way of ensuring a desirable dietary pattern.
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Nutrition and Dietetics Planning diets helps us to answer the following questions quite accurately:
● Which foods to include?
● How much of each food to include?
In other words, this useful exercise helps us to ensure that the nutrients required will be
supplied in adequate amounts. In essence it involves ‘‘selecting the right foods in the right
amounts” for each individual according to the needs.
When you seek to provide adequate health care to people, you also need a systematic
outline of what they are supposed to eat. A diet plan helps to convey this information to
patients just as it conveys facts to you, the doctor and the dietitian. It summarizes the
special food needs of a patient depending on the:
● disease and its severity
● age factor
● sex
● activity level
● physiological state (i.e. pregnancy/lactation, in the case of woman) and
● socio-economic constraints and cultural characteristics.
A diet plan is quantitative in nature and, therefore, it reduces the chances of
misunderstanding once the patient is familiar with how to measure fodstuffs using
household equipment such as cups, spoons, katories or plates.
In addition it becomes easier to explain how much food should be eaten at each of the meals.
The meal frequency (i.e. number of meals in a day) is quite an important consideration in diet
therapy and needs careful attention.
In seriously ill patients nutritional support is required. Oral feeding may not be possible so
nutrients have to be supplied either by tube feeding or intravenous feeding. Such special
feeding also requires careful planning and management.
2.3 DIETS FOR NORMAL INDIVIDUALS
We have just discussed the fact that planning diets helps us to select the right foods in the
right amounts for each individual. This is a simple description of the process of planning a
nutritionally adequate or balanced diet. You will have to wait for sub-section 2.3.1 to
appreciate the meaning of the important concept of adequate /or balanced diets.
We can select the right food for a person by using food groups. Each food group includes a
specific list of food items, which share the same function and contribute similar nutrients.
As you know, the functions of the food are dependent on the major nutrients they supply.
Once the food groups have been identified, items can be selected from each food group for
each meal. If we do this, we an be reasonably sure that all nutrients will be provided by the
day’s diet. Sub-section 2.3.2 elaborates on these aspects.
However, that does not give an answer to the question : how much of each food to
include? This would, of course, depend on the nutrient requirements of the individuals for
whom we are planning the diets. The Indian Council of Medical Research (ICMR) has laid
down recommendations for daily Recommended Dietary Allowances (RDA)/nutrient
intakes based on age, sex , activity level and physiological state (pregnancy, lactation).
See Fig. 2.2. The standards are laid down by most countries for their population. The
RDA for Indian population is presented in Table 2.5 in sub-section 2.3.4. The Dietary
reference value for all nutrients as recommended by the WHO, UK and USA is presented
in Appendix 1, Practical Manual of BNSL-102.
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Planning Diets
Deciding the amount to
Selecting right foods ® be included based on
based on food groups Recommended Dietary
Intakes (RDIs)
®
DIET PLAN
Fig. 2.2: Planning a diet
This highlights the importance of identifying the special needs of the person. An older
adult’’ nutrient requirements would be different from that of a young adult. A labourer
doing heavy physical work requires more energy than a company executive. An
adolescent’s needs are different from those of a man. We take a quick look at the
influence of age, sex, activity level and physiological state in sub-section 2.3.3. This
forms the basis for our discussion in sub-section 2.3.4 on the use of recommended
dietary intakes (RDIs) in planning adequate/or balanced diets.
So let’s begin with trying to understand the concept of an adequate or balanced diet.
2.3.1 Concept of an Adequate or Balanced Diet
A adequate/or balanced diet can be defined as one which contains different types of
food in such quantities and proportions that the need for calories, carbohydrate, fats,
proteins (macronutrients) and minerals, vitamins (micronutrients) and water are
adequately met and a small provision is made for extra nutrients to withstand short
durations of learners. The definition should also include fibre as it is important in a
diet.
If you look at the definition carefully, you would realize that a adequate/or a balanced
diet:
● consists of different types of food items.
● meets the minimum need for nutrients for the individual.
● provides for periods of leanness when the diet may possibly not supply adequate
amounts of nutrients.
Let us talk about each of these aspects.
A balanced diet consists of different types of food items: An adequate/or balanced diet
includes a variety of foods. But how do we select these foods? The major aim is to
ensure that all nutrients are supplied. This can be achieved by first classifying food into
groups, each group supplying certain specific nutrients and then selecting items from
each food group to plan a balanced meal or diet, including items from each food group
ensure that all the nutrients will be supplied, as we mentioned earlier.
An adequate/or balanced diet meets the nutrient needs: A balanced diet meets nutrient
needs because of the amounts and proportions of the foods selected.
How much should a person consume of individual foods to meet his need? This would
be based on the recommended dietary intakes (RDIs) for the individual for whom the diet
is planned. You will study more about RDIs in sub-section 2.3.4.
Adequate/or Balanced diets provide for periods of leanness: We have now examined the
first two aspects of the definition of a adequate/or balanced diet. Adequate/or Balanced
diets also provide for periods of leanness. This implies that there is a “safety margin” or
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