CHAPTER-2

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Clinical Nutrition And Dietetics.

NURITION-

·       It is science of food , nutrients and other substances.

·       It is the digestion , absorption and utilisation of nutrients by the body.

·       It is concerned with the social, psychological and economic aspects of food and eating.

OPTIMUM NUTRITION-

It is important for providing:

-         Immunity

-         Protection from infection

-         Promote recovery from a variety of illnesses

-         Managing chronic diseases

-         Healing wounds

-         Supporting organ functions.

CLINICAL NUTRITION

·       Deals with nutrition during illness.

·       It is also called Medical Nutrition Therapy.

·       It is a study that focuses on the nutritional management of individuals or group of individuals with established disease conditions.

·       It focuses on the nutritional management of patients with established disease.

DIETETICS AND ROLE OF DIETICIAN

DIETETICS- Branch of medicine concerned with how food and  nutrition affects human health comprising the rules to be followed for preventing relieving or curing disease by diet is called Dietetics.

Dietetics deals with feeding individuals based on the principles of nutrition.

Dietetics is science and art of human nutritional care.

CLINICAL DIETETICS.

It is the application of dietetics in a  hospital or health care Institutional setting.

It focuses on individual nutrition support and symptom management.

CLINICAL DIETETICS INCLUDES:-

-         Diet Therapy

-         Therapeutic Diets.

DIET THERAPY:

·       It is a branch of dietetics concerned with the use of food for therapeutic purpose.

·       It is a broad term that is used for the practical application of nutrition as a preventive or corrective treatment of a disease.

·       It is concerned with recovery from illness by giving good diet and prevention of disease.

·       It involves modification of existing dietary lifestyle to promote optimum health.

·       Clinical nutrition and Dietetics is concerned with nutritional requirements of patients suffering from different diseases and prescribing them the right type of diet.

·       Diseases like – obesity, osteoporosis, metabolic disorders, kidney, liver and pancreatic disorders, cancer, AIDS, anaemia etc.

PRINCIPLES OF DIET THERAPY:

-         Maintain good nutritional status.

-         Cure deficiencies or disease .

-         Provide rest to the body.

-         Help metabolize the nutrients.

-         Make changes in body weight.

OBJECTIVES OF DIET THERAPY:

1.    Formulation of the diet to meet the needs of the patient taking into consideration her/his food habits.

2.    Modification of the existing diet to ameliorate the disease condition and keep it under control.

3.    Correction of the nutritional deficiencies.

4.    Prevention of the short term and long term complications of chronic diseases.

5.    Education and counselling of the patient regarding the need to adhere to the prescribed diet.

FACTORS CONSIDERED IN DIET PLANNING:

1.    Nutritional stress

2.    Psychological stress

3.    Effect of the illness on food acceptance

4.    Acceptability of the modified therapeutic diets.

NUTRITIONAL CARE:

Nutritional care during illness is a set of organized activities and it consists of the following:

a.     Assessing the nutritional status.

b.    Diagnosis of the nutritional problems.

c.     Planning and priortising the nutritional interventions.

d.    Evaluating the nutritional care outcomes and incorporating the necessary changes in the diet.

THERAPEUTIC DIET:

Diet therapy includes prescribing specialized dietary regimes or meal plans.

Therapeutic diets refer to a meal plain that controls the intake of certain foods or nutrients.

SIGNIFICANE OF CLINICAL NUTRITION.

·       Nutritional Care has gained importance in recent times.

·       Health Problems illness, disease and their treatment can affect the nutritional status in many ways.

·       It can impair a person’s ability to eat, swallow the food.

·       Digest the food, absorb the food and even metabolism and excretion of waste.

·       Clinical nutrition focuses on the nutritional management of patients with the diseases.

·       Any body tissue/organ may be affected due to disease.

·       Disease can be minor, major, acute or chronic.

·       Whatever, be the form appropriate and correct nourishment is a  must.

This can be done only by      

a)    Trained Dietician

b)    Medical nutrition Therapist.

c)     Clinical nutritionist.

A Clinical Dietician uses a

a)    Systematic and logical approach to be nutrition care process.

b)    Focusses on the persons unique needs or patients needs.

c)     Addresses the need in holistic and individualistic manner.

Patient is the primary focus of the nutritional care process.

Several diseases have been controlled due to advancement in field of medicine and pharmacology.

At the same time several  new diseases have emerged.

Non communicable diseases like obesity, heart diseases, hypertension, and diabetes.

Number of old persons have increased due to demographic changes.

Proportion of population that requires

-         Care

-         Support

-         Diet counselling is increasing.

Clinical Nutritionists Play a vital role in.

a)    Prevention of diseases and

b)    Promotion of good health.

c)     And recommending therapeutic diets for management of various dieases.

Due to new Scientific Knowledge about physiological and metabolic disturbances in acute and chronic diseases new methods of nutritional assessment are being developed.

Study of clinical nutrition and dietetics enables the professional to

1.  plan diets appropriately to meet the nutritional requirements of various stages of the life cycle.

2. modify the diets in various disease conditions keeping in mind the physical state, occupation, cultural, ethnic and socio-economic status, treatment regime and personal likes and dislikes of the patient.

3. plan diets for the atheletes or sports persons, persons in special conditions like in space, persons working in the submarines, industrial workers or defence personnels.

4. promote the health and well being of the patients admitted in hospitals, outpatient clinics as well as in institutional settings

5.Manage food services in institutional settings like orphanages, homes, shelters, schools etc.

6. to help the patients of chronic diseases like diabetes and hyper tension in management, prevention of complication and improvement of the quality of life.

7. promote  better health in the community and better efficiency of services in terms of patient care, holistic care and contribution to better survival and recovery.

Dietician has the primary responsibility to ensure that

·       Patient receives appropriate diet

·       Optimal nutritional care

·       Administer suitable regimes to  the patients who are hospitalized and also to those who are  in outpatient department. For this they assess the nutritional status of the patient, analyse the nutrient needs and develop the nutrition care plan.

Normal and therapeutic diets are planned to maintain or restore good nutrition in the individual. This is done by the medical nutrition therapist/dietician.

This is done by taking into account the following:

o   Food pattern

o   Diagnosis of the disease

o   Prescription given by the doctor

o   Health status

o   Physical condition including ability to chew, swallow, digest absorb nutrients

o   Feeling of hunger

o   Physical activity

o   Lifestyle

o   Religious beliefs

o   Cultural and ethnic practices.

o   Frequency of intake of different foods

NUTRITIONAL ASSESSMENT:

This is required to obtain information on the patient’s nutritional status and nutrient needs.

This includes:

Detailed information on health, diet, personal and medical history.

Antropometric measurements.

Relating laboratory measurements with the physician diagnosis

Interpreting all the above data, to identify the potential nutritional deficiencies and risk of future deficiencies.

TO BE CONTD....

APARNA SHARMA BLOGGER