CHAPTER-2

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Clinical Nutrition And Dietetics.(CONTD..)

I. BASIC TERMS USED BY CLINICAL NUTRITIONISTS AND DIETICIANS:

   Types of diet:

   A. STANDARD OR REGULAR DIET:

   Is one that includes all foods and meets the needs of healthy individuals.

   B. MODIFIED DIETS:

Are those that are adjusted to meet the medical needs of a patient whichmay involve one or more of the following:

1. Change in consistency or texture: changes in texture or consistency are done in case of problem in chewing, swallowing, digestion, ulcers or post operative conditions.

a. Liquid diet – it includes foods in a liquid state which are strained and are free from any solid particles. It includes lemon water, coconut water, clear soup, fruit juices etc.

b. Semi solid foods – it includes all foods in the semi liquid state which are free from spices. Such diets are given to patients who cannot chew or swallow solid foods or have gastro intestinal problems. It includes porridge, khichri, custard etc.

c. soft diet – It is soft easy to chew, made up of simple, digestible foods that contain no fiber or spices. It is given to patients who have gastro-intestinal problems, constipation, diarrhea.It includes dalia, porridge, khichri kheer, phirni.

2. Increase or decrease in the energy: increase or decrease of the calorie intake. In case of over weight, diabetic, high blood pressure patient calorie intake has to be reduced. Where as in case of an under weight person calorie intake has to be increased.

3. Include greater or lesser amounts of one or more nutrients: high intake of protein in case of surgery, lower intake of protein in case of kidney failure, restriction in intake of salts for a kidney patient, high intake of iron in case of anaemia patient.

4. Frequency: normally 3-4 meals are served in a day. Sometimes small meals have to be given at intervals of 2-3 hours. For eample to infants, pregnant ladies, lactating mothers, diabetes patient.

5. Food stuffs: modifications are also done to exclude foods that cause allergies and intolerance. In such a case one food is replaced by another. For intolerance of gluten to a person gluten free foods are given eg, soy, corn, tapioca, flex seed nuts etc.

6. Nutrients : Modifications are done either to maintain, restore or correct the nutritional deficiencies by decreasing, increasing or balancing a specific nutrient. For this high or low calorie diet, high or low carbohydrate, high or low fibre diets are given.

7. Methods of cooking : modifications in diet can be made by adopting cooking methods like steaming, boiling, pressure cooking, grilling, baking or poaching. These yield bland diets which are light and digestible and have minimal spices and oils.

8. Feeding routines: the best possible way for feeding the patient is orally or by mouth. However, incase a person is uconsious then he will have to be fed by

(a) tube feeding- nutritionally complete food is delivered through a tube.

 (b) intravenous feeding- the patient is nourished with special solutions which are given through a drip in a vein.

9. Prevention of chronic diseases : good diet and good nutrition can control and delay the ag of onset of chronic diseases. Processed foods that are available today have a lot of additives. Are high on fats, high on sugar, low on fibre and made mostly from refined flour. This kind of food intake leads to diseases like obesity, diabetes, cardiovascular disease and hyper tension. 

Consumption of highly processed foods with high sodium content leads to low potassium levels in the body.

Clinical nutritionists help in preventing the development of various diseases by proper diet counseling and guidance of various groups as schools, corporate sector and college etc.

PREPARING FOR A CAREER:

Professional clinical nutritionist or dietician must have the following skills:

1. knowledge of

• ·         physiological changes in disease conditions.
• ·         changes in RDA/Nutrient requirements in illness.
• ·         types of dietary modifications required.
• ·         traditional and ethnic cuisines.
• ·         different languages to be able to communicate effectively with patients.

2.  Skills of

• ·         Assessing nutritional status of patients using clinical and biochemical criteria.
• ·         Diet planning customized to requirements of individual patients and specific disease conditions.
• ·         Communication for diet counseling.
• ·         Adapting to cultural milieu
• ·         Food taboos/ fads / myths.

Dieticians must also have knowledge of

• ·         Nutrition
• ·         Food science
• ·         Food composition
• ·         Clinical nutrition and dietetics
• ·         Medical nutrition management
• ·         Food microbiology
• ·         Food quality and assurance
• ·         Food service management
• ·         Epidemiology
• ·         Patterns of prevalence and incidence of nutritional disorders and diseases
• ·         Skills in surveying patient population
• ·         Laboratory research using biochemical parameters
• ·         Skill in conducting experimental designs with patients to find out various diets, drugs and nutritional supplements.

PREPARING FOR CAREER:

1. pass 10+2 level

2. B.Sc degree with specialization in nutrition

3. post graduate diploma in Dietetics with internship.

4. Those who have B.Sc in life science, microbiology, biochemistry or biotechnology can enter into M.Sc in Food Science and Nutrition.

5. after completion of post graduation you have to qualify to obtain credentials of  a Registered Dietician

6. For teaching and research you need to qualify National or State Eligibility Test conducted by the University Grants Commission.

7. For pursuing career in academic and research you must do Ph.D in nutrition.

SCOPE OF STUDYING NUTRITION:

• Clinical Nutrition and Dietician offers a rich scope and potential for a satisfying career.
• Dietician
• Diet counselor
• Teacher
• Researcher
• Corporate consultant
• Career opportunities in food industry, production of medical foods, nutraceuticals, tube feeds, various types of nutritional support formulations or functional foods.
• Formulation of public policies
• Designing and implementing preventive and promotive nutrition programmes to tackle deficiency disorders.
• Jobs in hospitals as dietician, consultant in clinics, teacher in schools, researcher in medical research establishments, consultants in companies to develop therapeutic foods and supplements, food service managers or service provider in hospitals.

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APARNA SHARMA

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