sample chapter diet management 4e

DIET MANAGEMENT

Prelims.indd iPrelims.indd i 12/22/2010 3:17:55 PM12/22/2010 3:17:55 PM

Prelims.indd iiPrelims.indd ii 12/22/2010 3:17:59 PM12/22/2010 3:17:59 PM

DIET MANAGEMENT

Fourth Edition

Rekha Sharma, M.Sc. (Food and Nutrition), R.D.

Director, Clinical Nutrition and DieteticsDiabetes Foundation (India)

Former Chief Dietician, All India Institute of Medical SciencesNew Delhi

ELSEVIERA division of Reed Elsevier India Private Limited

Prelims.indd iiiPrelims.indd iii 12/22/2010 3:17:59 PM12/22/2010 3:17:59 PM

Diet Management, 4/eSharma

ELSEVIERA division of Reed Elsevier India Private Limited

Mosby, Saunders, Churchill Livingstone, Butterworth Heinemann andHanley & Belfus are the Health Science imprints of Elsevier.

First Edition 1991Second Edition 1999Third Edition 2004 Fourth Edition 2011

© Elsevier

All rights reserved. No part of this publication may be reproduced or transmitted in any form or by any means—electronic or mechanical, including photocopy, recording, or any information storage and retrieval system—without permission in writing from the publisher.

ISBN: 978-81-312-2713-8

Medical knowledge is constantly changing. As new information becomes available, changes in treatment, procedures, equipment and the use of drugs become necessary. The authors, editors, contributors and the publisher have, as far as it is possible, taken care to ensure that the information given in this text is accurate and up-to-date. However, readers are strongly advised to confi rm that the information, especially with regard to drug dose/usage, complies with current legislation and standards of practice. Please consult full prescribing information before issuing prescriptions for any product mentioned in this publication.

Published by Elsevier, a division of Reed Elsevier India Private Limited.Registered Offi ce: 622, Indraprakash Building, 21 Barakhamba Road, New Delhi - 110 001.Corporate Offi ce: 14th Floor, Building No. 10B, DLF Cyber City, Phase II, Gurgaon - 122 002, Haryana, India.

Publishing Manager: Ritu Sharma Commissioning Editor: Nilabh RanjanDevelopment Editor: Subodh K. ChauhanCopy Editor: Anu VigManager Publishing Operations: Sunil KumarManager Production: N.C. PantCover Designer: Raman Kumar

Laser typeset by Chitra Computers, New Delhi.

Printed and bound at Rajkamal Electric Press, Kundli, Haryana, India.

Prelims.indd ivPrelims.indd iv 12/22/2010 3:17:59 PM12/22/2010 3:17:59 PM

Nutrition plays an important role in the normal growth and development of human beings and is the mainstay of prevention and management of various diseases, especially when considering the increasingly sedentary lifestyles and fast food habits of the present generation. With continuing advancement and new research in the fi eld of medicine and nutrition, it is necessary to update and revise the book to bring in the latest knowledge and scientifi c developments, in terms of both normal nutrition and its variance in different diseases and surgical procedures. The fourth edition thus tries to incorporate most of the recent advances of normal nutrition, which includes macro and micronutrients and their role and functions in the body. Detailed classifi cation of carbohydrates, proteins, fats, vitamins and minerals is given along with the food sources and recommendations. Clinical nutrition segment provides the relationship of food with the well-being of the human with nutrient utilization in terms of digestion and absorption. Medical nutrition therapy is of prime importance and refers to the nutritional assessments and requirements of the patients with various diseases, nutritional defi ciency disorder or injury. It gives complete guidance for the prevention and cure at reduced costs.

Nutritional needs of infants, adults, and pregnant and lactating women have been worked out in details. It shows how an effective diet can be planned for the prevention and management of various diseases, taking into consideration the tastes, eating patterns, cultural patterns and nutritional needs of the patients suffering from them. This edition further elaborates the chapters on obesity, cardiovascular diseases, diabetes and gastrointestinal diseases. Nutrition protocols during surgeries, cancer, critical care, organ transplantation of liver and kidneys, bariatric surgery; nutrition for elderly; and other lifestyle modifi cations including exercise,

Preface to the Fourth Edition

Prelims.indd vPrelims.indd v 12/22/2010 3:17:59 PM12/22/2010 3:17:59 PM

vi Preface to Fourth Edition

etc., have also been updated with the emerging new trends and advancements.

The book is a ready reckoner for physicians, nutritionists, dieticians, medical students, interns, dietetic trainees and all students of nutrition and dietetic courses studying therapeutic nutrition. It is also a handy tool for healthy eating and disease prevention.

The recommended dietary allowances of nutrients and nutritive value of Indian foods have been taken from an Indian Council of Medical Research publication, published by National Institute of Nutrition, Hyderabad, India, 2010 and 2004, respectively.

I am thankful to the publisher for their wholehearted support and cooperation.

Rekha Sharma

Prelims.indd viPrelims.indd vi 12/22/2010 3:17:59 PM12/22/2010 3:17:59 PM

Nutrition plays an important role in normal growth and development and more so in the prevention and treatment of various diseases. With the advancement of medicine and research, a revision and updation of this book had become necessary. The third edition therefore takes note of the recent advances and incorporates all the basic needs of normal nutrition including children, pregnancy and lactation. It shows how an effective diet can be planned taking into considerations the tastes, eating patterns, cultural patterns and nutritional needs of the patients suffering from various diseases for their prevention and management. All diets are modifi cations of the normal diet. This edition especially elaborates the chapters on obesity, liver diseases, surgical disorders, cardiovascular disorders and diabetes. The book is a daily ready reckoner for physicians, dieticians, medical students, interns, dietetic trainees and all students of dietetic and nutrition courses studying therapeutic nutrition. It is also a health tool for healthy eating and disease prevention options.

The recommended daily allowances of nutrients and nutritive value of Indian foods is taken from an Indian Council of Medical Research study, published by National Institute of Nutrition, Hyderabad, India, 2004.

I am thankful to the publishers for their wholehearted support and cooperation.

Rekha Sharma

Preface to the Third Edition

Prelims.indd viiPrelims.indd vii 12/22/2010 3:17:59 PM12/22/2010 3:17:59 PM

Prelims.indd viiiPrelims.indd viii 12/22/2010 3:17:59 PM12/22/2010 3:17:59 PM

I thank my family—my husband Prof. M.P. Sharma; my children Monisha, Sandeep and Manu; and my grandson Vir—for their love and support while I was writing this book.

Rekha Sharma

Acknowledgement

Prelims.indd ixPrelims.indd ix 12/22/2010 3:17:59 PM12/22/2010 3:17:59 PM

Prelims.indd xPrelims.indd x 12/22/2010 3:17:59 PM12/22/2010 3:17:59 PM

Preface to the Fourth Edition v

Preface to the Third Edition vii

Acknowledgement ix

Chapter 1 Normal Nutrition 1Nutrients � 1Roles and Functions of Nutrients in the Body � 2

Carbohydrates � 2Fats � 3Proteins � 6Vitamins and Minerals � 8

Balanced Diet 1 � 3Energy-Yielding Foods 1 � 3Body-Building Foods 1 � 4Protective Foods 1 � 4

Dietary Goals 1 � 4Dietary Guidelines 1 � 4Basic Food Groups: A Guide to Diet Plan 1 � 5

Cereals and Cereal Products 1 � 6Milk and Milk Products 1 � 6Meat and Meat Products 1 � 6Pulses and Legumes 1 � 6Green Leafy and Other Vegetables 1 � 7Fruits 1 � 7Fats and Oils 1 � 8

Normal Diet (Menu) 2 � 1Pregnancy and Lactation 2 � 2

Breastfeeding 2 � 3Diet in Pregnancy 2 � 3Diet in Lactation 2 � 5Diet for Infants (Up to 1 Year of Age) 2 � 5

Chapter 2 Clinical Nutrition 27Clinical Nutrition 2 � 7

Contents

Prelims.indd xiPrelims.indd xi 12/22/2010 3:18:00 PM12/22/2010 3:18:00 PM

xii Contents

Digestion of Foods 2 � 7Digestive Juices 2 � 8Absorption of Nutrients 2 � 9Factors Infl uencing Digestion and �

Absorption of Nutrients 31Environmental Factors Affecting Food �

Safety and Quality; their Infl uence on Health and Disease 32

Chapter 3 Therapeutic Nutrition or Medical Nutrition Therapy 33

Nutritional Assessment 3 � 3Anthropometric Parameters 3 � 3Biochemical Parameters 3 � 7Clinical Parameters 4 � 0Dietary Assessment 4 � 0

Therapeutic Modifi cations of a Diet 4 � 3Objectives of Diet Therapy 4 � 3

Chapter 4 Diets Modifi ed in Consistency 45Postoperative Diets 4 � 5

Clear Liquid Diet 4 � 5Full Liquid Diet 4 � 5Soft, Semisolid Diet 4 � 6

Water and Beverages 4 � 6Soft and Cold Drinks 4 � 7Tea and Coffee 4 � 7Milk 4 � 7

Chapter 5 Diets in Gastrointestinal Diseases 49Acute Gastrointestinal Conditions 5 � 0Chronic and Nonacute Disorders of the �

Upper Gastrointestinal Tract 50Disorders of the Lower Gastrointestinal Tract 5 � 1

Constipation 5 � 1Irritable Bowel Syndrome (IBS) 5 � 2Ulcerative Colitis 5 � 2Malabsorption 5 � 3Coeliac Disease 5 � 3Diverticulosis 5 � 3Pancreatitis 5 � 4

Liver 5 � 4

Prelims.indd xiiPrelims.indd xii 12/22/2010 3:18:00 PM12/22/2010 3:18:00 PM

xiiiContents

Liver Diseases 5 � 4Low-Residue Diet 5 � 9High-Residue Diet 6 � 0

Chapter 6 Surgical Diets 61Preoperative Diet 6 � 1Postoperative Diets 6 � 2

Diets in Gastrointestinal Surgery 6 � 2Diets in Other Surgeries 6 � 3Diets Following Fractures 6 � 4Nutrition in Bariatric Surgery 6 � 4Nutrition in Liver Transplantation 6 � 8Nutrition in Kidney Transplantation 7 � 0Other Nutritional Disorders 7 � 5

Chapter 7 Nutrition for Critically Ill 77Burns 7 � 7

Harris–Benedict Formulas for Basal Energy �

Expenditure (BEE)/Basal Metabolic Rate (BMR) 78Equations and Factors to Estimate Actual �

Energy Expenditure (AEE) 78Equations for Predicting BMR on Adults �

(kcal/24 hours) 78Thermic Effect of Food (TEF) 7 � 9Enteral Nutrition 7 � 9Parenteral Nutrition 8 � 6

Chapter 8 Diets Modifi ed in Carbohydrates 87Diet for Diabetes Mellitus 8 � 7Nutrition Recommendations for Patients �

with Diabetes 88Calories 8 � 8Proteins 8 � 8Fats 8 � 8Cholesterol 8 � 9Carbohydrates 8 � 9Fibre 8 � 9Sodium 89 �

Alcohol 8 � 9Vitamins/Minerals 9 � 0Goals of Medical Nutrition Therapy for �

Type I Diabetes 90

Prelims.indd xiiiPrelims.indd xiii 12/22/2010 3:18:00 PM12/22/2010 3:18:00 PM

xiv Contents

Goals of Medical Nutrition Therapy for �

Type II Diabetes 91Other Nutritional Factors Associated with �

Reduced Cardiac Risk for Diabetics 103Traditional Indian Foods in Diabetes Mellitus 10 � 4Management of Diabetes Mellitus 10 � 4Health Education 11 � 8Other Associates 11 � 9

Diabetic Diets Based on the Exchange List 12 � 0Diabetic Diets—Menuwise 12 � 2Diets for Special Groups 12 � 6

Chapter 9 Diets Modifi ed in Proteins 135High-Protein Diet 13 � 6Diets in Renal Disease 13 � 7

Acute Renal Failure 13 � 7Proteinuria 13 � 7

Indoor Diet Charts for Renal Patients 13 � 9Diet for Outdoor Patients 14 � 1

Chapter 10 Diets Modifi ed in Fats 143Low-Fat Diet (Digestive Intolerance) 14 � 3Cardiovascular Diseases (CVDs) 14 � 3

Risk Factors 14 � 4Hypertension 14 � 7Atherosclerosis 14 � 8Stroke and Other Peripheral Diseases 14 � 8Cardiomyopathy and Cardiac Failure 14 � 9Rheumatic Heart Disease (RHD) 14 � 9Dietary Management 14 � 9Yoga and Exercise 15 � 7Yoga and Meditation 15 � 7

General Guidelines for Coronary Heart Disease 15 � 8Dietary Recommendations for the Prevention �

of Coronary Heart Disease (NIN) 158American Heart Association’s Guidelines for the �

Prevention of Coronary Artery disease (CAD) 159American Heart Association’s Lifestyle �

Recommendations for Risk Reduction of Cardiovascular Disease 159

Acute Cardiac Diseases (Congestive Cardiac �

Failure and Myocardial Infarction) 160

Prelims.indd xivPrelims.indd xiv 12/22/2010 3:18:00 PM12/22/2010 3:18:00 PM

xvContents

Diet for Acute Cardiac Diseases Like Congestive �

Cardiac Failure and Myocardial Infarction 160Subacute Cardiac Disease (CAD) or Ischaemic �

Heart Disease 161Low-Cholesterol, Low-Triglyceride, �

High-HDL Diet 162A Day’s Menu for Low-Cholesterol, �

High-HDL Diet 163

Chapter 11 Diets Modifi ed in Minerals 165Low-Sodium Diets 16 � 5Low- and High-Potassium Diets 16 � 7

Approximate Potassium Content of Commonly �

Used Foods 167Low- and High-Calcium Diets 17 � 0

High-Calcium Diet (Osteoporosis and �

Osteomalacia) 172High-Protein, High-Iron Diet �

(Nutritional Anaemia) 173

Chapter 12 Diets Modifi ed in Calories 175Obesity 17 � 5

Body Fat Distribution 17 � 5Percentage of Body Fat 17 � 7Health Risks of Obesity 17 � 8Weight Reduction 17 � 9Factors Contributing to Obesity 18 � 0Energy Imbalance 18 � 0Food Groups 18 � 1Energy Needs 18 � 1Proteins 18 � 2Carbohydrates 18 � 3Fats 18 � 3Vitamins and Minerals 18 � 4Approximate Daily Allowances of Each Food �

Group for an Adult on Reducing Diet/Day 185A Day’s Menu 18 � 5Obesity in Children 18 � 7Exercise 18 � 8Tips for Healthy Lifestyle 19 � 1Diet for Underweight 19 � 1

Prelims.indd xvPrelims.indd xv 12/22/2010 3:18:00 PM12/22/2010 3:18:00 PM

xvi Contents

Chapter 13 Cancer and Diet Therapy 193Infl uence of Diet on Carcinogenesis 19 � 3Dietary Risk Factors and Cancers at Various Sites �

in the Human Body 194Diet Therapy 19 � 5

Assessing the Patient’s Nutritional Status 19 � 5Formulating Appropriate Nutritional Support 19 � 6Feeding Modalities 19 � 6Eating Well During Cancer Treatment 19 � 7Can Good Nutrition Treat Cancer? 19 � 8Managing Eating Problems During Treatment 19 � 9Coping with Side Effects 20 � 0

Chapter 14 Diets for Inborn Errors of Metabolism 211Phenylketonuria 21 � 1

Sources of Phenylalanine 21 � 1Galactosaemia 21 � 2

Chicken-Based Feed 21 � 2Moong Cereal Feed 21 � 3

Coeliac Disease 21 � 3Foods to Be Taken 21 � 4Foods to Be Avoided 21 � 4

Chapter 15 Diet and Nutritional Needs of Elderly 215Factors Leading to Inadequate Nutrition 21 � 5Foods to Be Included 21 � 6Dietary Tips for Elderly 21 � 6A Day’s Menu for an Elderly Person 21 � 6

Chapter 16 Miscellaneous Diets 219Low-Purine Diet (Gout) 21 � 9Low-Oxalate Diet (Renal Stones) 21 � 9Low–Vitamin K Diet for Patients on Acitrom and �

Warfarin 219

Chapter 17 Test Meal 221300 g Carbohydrate Diet 22 � 1350 Calorie Breakfast for Diabetics 22 � 1

Appendix 223

Index 231

Prelims.indd xviPrelims.indd xvi 12/22/2010 3:18:00 PM12/22/2010 3:18:00 PM

Cancer is a term greatly feared by the general population. It more correctly refers to a disease process where development is thought to be multistep, both reversible and irreversible; some of the reversible steps may be infl uenced by dietary factors, which can also limit the multistep process from progressing and thereby protect against the development of clinical cancer.

Various studies have shown that the environment contributes to 80–90% of human cancer. The environment is broadly defi ned to include a wide range of lifestyle factors including diet, social and cultural practices, and it has also been shown that one-third of the human cancer is directly related to some dietary component.

INFLUENCE OF DIET ON CARCINOGENESIS Diet may infl uence human carcinogenesis in six general ways:

1. Diet provides the carcinogens or their immediate precursors.

2. Diet facilitates or inhibits the endogenous production of carcinogens.

3. The modifi cation of carcinogens by metabolic activation or inactivation could be affected by other dietary components.

4. Increasing or impeding the delivery of carcinogens to their site of action may be infl uenced by dietary changes.

5. Diet may alter the susceptibility of tissues to cancer induction or growth by dietary effects on tissue metabolism.

6. Diet may alter the body’s capacity to eliminate transformed cells.

Identifying the risk factors for cancer prevention is the fi rst step.

Cancer and Diet Therapy 13

Chapter-13.indd 193Chapter-13.indd 193 12/22/2010 12:19:03 PM12/22/2010 12:19:03 PM

194 Diet Management

DIETARY RISK FACTORS AND CANCERS AT VARIOUS SITES IN THE HUMAN BODY Lung cancer. Eighty percent of lung cancer deaths are attributable to smoking. There is some evidence that a diet rich in fresh fruits and vegetables that contain β-carotene could be protective in smokers.

Colorectal cancer. A high-fat diet that includes a large amount of red meat increases risk, as does a diet low in dietary fi bre. Eating lots of fresh fruits and vegetables with other sources of dietary fi bre—cereals and pulses—might be protective. There is limited evidence that some fi bre supplements are useful preventive agents.

Breast cancer. Some studies suggest that a high-fat diet is a risk factor but others show that the amount of fat in the diet is irrelevant. There could be a link with high alcohol consumption but results of such studies are again variable. Obesity is probably more important because rapid growth rate in young girls results in early menarche—an accepted risk factor. Eating lots of fresh fruits and vegetables has been shown to be protective in several studies.

Prostate cancer. A high-fat diet high in red meat seems to increase the risk of cancer developing more quickly.

Pancreatic cancer. Diets high in fat and high intake of alcohol increase the risk; eating lots of fruits and vegetables decreases the risk. Smoking is a major risk factor.

Lymphomas and leukaemias. There is no known link between diet and risk.

Liver cancer. High intake of alcohol is a risk factor.

Cancers of the female reproductive system. High-fat diet is a risk factor. Fruits and vegetables decrease the risk.

Cancers of the nasopharynx, oesophagus and stomach. There is a positive association between salted and smoked foods and cancer here. Afl atoxins and alcohol also increase the risk. Fruits and vegetables are protective.


195Cancer and Diet Therapy

Brain cancers. There is no known link between diet and risk.

Urinary tract, including kidney. Obesity seems to be a risk factor, while fruits and vegetables might be protective.

DIET THERAPY

Assessing the Patient’s Nutritional Status Factors infl uencing the nutritional status

1. Dietary patterns and habits 2. Food changes, aversions 3. Taste changes 4. Weight changes 5. Metabolic abnormalities 6. Surgical intervention, chemotherapy, radiotherapy

Patient interview, history, questionnaire Selection of nutritional parameters

1. Weight change

a. Recent (4–6 weeks) b. Long-term (More than 6 weeks)

2. Laboratory values 3. Body composition

a. Fat/lean mass b. Height/weight, body mass index

4. Cause of poor intake

a. Anorexia b. Early satiety c. Pain d. Diffi culty in swallowing e. Aversion to food taste f. Lack of strength g. Inability of position h. Diffi culty in purchasing/preparing i. Fear/depression


196 Diet Management

Formulating Appropriate Nutritional Support Calories : Nonambulatory = 20–25 kcal/kg/IBW (ideal body

weight) Hypermetabolic = 30–35 kcal/kg/IBW or Desirable weight in lb × 20 (M) Desirable weight in lb × 18 (F) Proteins : 1.5–2.5/kg/IBW or Desirable weight in lb × 0.77 Fibre : Increase fi bre.Fats : Less than 30% of total calories, avoid saturated

fats.Vit A : Increase β-carotene for cancer of lung, skin and

breast.Vit C : Vitamin C for protective action.Vit E : Folic acid, calcium to be increased.

Feeding Modalities 1. Oral—regular

a. Frequent b. Mechanically soft textured c. Blenderized d. Bland e. Lactose free f. High calorie density

2. Tube feeding (enteral nutrition) 3. Parenteral nutrition

Enteral nutrition Tube feeding has to be individualized depending upon the status of the patient.

1. Continuous tube feeding of 20–25 mL/hour of isotonic or hypertonic formula to be increased slowly.

2. Intermittent tube feeding of 120 mL every 4 hours of isotonic or hypertonic formula to be increased slowly.



There are three kinds of formulae:

1. Polymeric formulae 2. Partially hydrolysed formulae 3. Disease specifi c formulae

Parenteral nutrition 1. It is an indication when tube feeding has failed or where

gastrointestinal (GI) tract is not usable (obstruction, high-output fi stula).

2. The patient is malnourished. 3. The GI tract is unable to support nutritional needs due to

its nonavailability.

Eating Well During Cancer Treatment A nutritious diet is always vital for the body to work at its best. Good nutrition is even more important for people with cancer. Why? 1. Patients who eat well during their treatment are able to

cope better with the side effects of treatment. Patients who eat well may be able to handle a higher dose of certain treatments.

2. A healthy diet can help keep up strength, prevent body tissues from breaking down and rebuild tissues that cancer treatment may harm.

3. When one is unable to eat enough food or the right kind of food, the body uses stored nutrients as a source of energy. As a result, natural defences become weaker and the body cannot fi ght infection as well. Yet, this defence system is especially important to cancer patients who are often at risk of getting an infection.

Kinds of foods needed A good rule to follow is to eat a variety of different foods everyday. No one food or group of foods contains all the nutrients one needs.


198 Diet Management

A diet to keep the body strong will include daily servings from the following food groups:

Fruits and vegetables. Raw or cooked vegetables, fruits and fruit juices provide certain vitamins (such as A and C) and minerals the body needs. (Raw vegetables should be well scrubbed and washed.)

Protein foods. Protein helps the body to heal itself and fi ght infection. Meat, fi sh, poultry, eggs, milk, yogurt and cheese give protein as well as many vitamins and minerals.

Grains. Grains, such as bread, rice and cereals, provide a variety of carbohydrates and B vitamins. Carbohydrates provide a good source of energy, which the body needs to function well.

Dairy foods. Milk and other dairy products provide proteins and vitamins and are the best source of calcium.

Can Good Nutrition Treat Cancer? Doctors know that patients who eat well during cancer treatment are better able to cope with side effects caused by treatment. However, there is no evidence that any kind of diet or food can either cure cancer or stop it from coming back. In fact, some diets may be harmful, especially those that do not include a variety of foods. There is also no evidence that dietary supplements, such as vitamin or mineral pills, can cure cancer or stop it from coming back.

The nutritionists strongly urge patients to eat nutritious food and follow the treatment programme prescribed by a doctor who uses accepted and proven methods of treatment. People who depend upon unconventional treatments may lose valuable treatment time and reduce their chances of controlling cancer and getting well.

They also recommend that a doctor, nurse or a dietitian be consulted before taking any vitamin or mineral supplements. Too much of some vitamins or minerals can be just as dangerous as too little. Large doses of some vitamins may even stop cancer treatment from working the way it should. To avoid problems, patients should not take these products on their own and must follow the doctor’s directions for safe results.



Managing Eating Problems During Treatment All the methods of treating cancer—surgery, radiation therapy, chemotherapy and biological therapy (immunotherapy)—are very powerful. Although treatments target the cancer cells in the body, they can sometimes damage normal, healthy cells at the same time. This may produce unpleasant side effects that cause eating problems (Table 13.1).

Table 13.1. Medical/surgical factors predisposing a cancer patient to malnutrition

Cancer treatment How it can affect eating Side effects

Surgery Increases the need for good nutrition because it puts stress on the body. May slow digestion. May lessen the ability of the mouth, throat and stomach to work properly. Also, may make the mouth, throat and stomach sore.

Before surgery, a high-protein, high-calorie diet may be prescribed if a patient is under-weight or weak. After surgery, some patients may not resume normal eating at fi rst. They may receive nutrients:a. Through a needle in their vein (IV or

intravenous feeding)b. Through a tube in their nose or stomachc. By drinking clear liquidsd. By following a full-liquid diet

Radiation therapy As it damages cancer cells, it may also damage healthy cells and healthy parts of the body.

Treatment of head, neck or chest may causea. Dry mouthb. Sore mouthc. Sore throatd. Diffi culty in swallowing (dysphagia)e. Change in taste of foodf. Dental problemsTreatment of stomach may causea. Nauseab. Vomitingc. Diarrhoea

Chemotherapy As it destroys cancer cells, it may also harm parts of the body needed for eating.

Nausea and vomitingLoss of appetiteDiarrhoeaConstipation Sore mouth or throat Weight gain Change in taste of food


200 Diet Management

Cancer treatment How it can affect eating Side effects

Biological therapy (Immunotherapy)

Not known Nausea and vomitingDiarrhoeaSore mouthSevere weight loss

Side effects of cancer treatment vary from patient to patient. The part of the body being treated, length of treatment and the dose of treatment also determine whether side effects will occur. The doctor should talk to the patient about how the treatment may affect him.

The good news is that only about one-third of cancer patients have side effects during treatment, and most effects go away when treatment ends. The doctors try to plan a treatment that keeps side effects down.

Cancer treatment may also affect eating in another way. When some people are upset, worried or afraid, they may have eating problems. Losing appetite and nausea are two normal responses to feeling nervous or fearful. Such problems should last only for a short time.

One should not be afraid to give food a chance. Not everyone has problems with eating during cancer treatment. Even those who have eating problems have days when eating is a pleasure.

Coping with Side Effects This section offers practical hints for coping with treatment side effects that may affect the patient’s eating habit.

These suggestions have helped many patients manage eating problems that can be frustrating to handle. Try all the ideas to fi nd what works best for the patient. Share the needs and concerns with family and friends of the patient, particularly those who prepare meals for the patient. Patient should let them know that he appreciates their support as he works to take control of eating problems.

Loss of appetiteLoss of appetite or poor appetite is one of the most common problems that occurs with cancer and its treatment. Many things



affect appetite, including feeling sick (having nausea, vomiting) and being upset or depressed about having cancer. A person who has these feelings, whether physical or emotional, may not be interested in eating.

The patients may fi nd the following suggestions helpful in making mealtime more relaxed so that they can eat more. The patient should ensure the following:

1. Stay calm, especially at mealtime. Not hurry over meals. 2. Be involved in as many normal activities as possible. But,

if uneasy and does not want to take part, should not do it per force.

3. Try changing the time, place and surroundings of meals. A candlelight dinner can make mealtime more appealing. The patient could set a colourful table and listen to soft music while eating, eat with others or watch favourite TV programme while eating.

4. Eat whenever hungry. He need not eat just three main meals a day. Several small meals throughout the day may be even better.

5. Add variety to the menu. 6. Eat food often during the day, even at bedtime. Have healthy

snacks handy. Taking just a few bites of the right foods or sips of the right liquids every hour or so can help get more proteins and calories.

Sore mouth or throatMouth sores, tender gums, and a sore throat or oesophagus often result from radiation therapy, anti-cancer drugs and infection. If patients have a sore mouth or gums, they must see their doctor to be sure that the soreness is a treatment side effect and not an unrelated dental problem. The doctor may be able to give medicine that will control mouth and throat pain. The dentist also can give tips for care of mouth.

Certain foods will irritate an already tender mouth and make chewing and swallowing diffi cult. By carefully choosing the foods the patient eats and by taking good care of mouth, one


202 Diet Management

can usually make eating easier. Some suggestions that may help the patient are given here. Patients should:

1. Try soft foods that are easy to chew and swallow, such as

a. Milk shakes b. Bananas and other soft fruits c. Stewed peach, pear and apricot d. Watermelon e. Cottage cheese f. Mashed potatoes, macaroni and cheese g. Custards, puddings and gelatin h. Scrambled eggs i. Oatmeal or other cooked cereals j. Pureed or mashed vegetables such as peas and

carrots k. Pureed meats l. Liquids

2. Avoid foods that can irritate the mouth, such as

a. Citrus fruit or juice such as oranges, tangerine, sweet lime

b. Spicy or salty foods c. Rough, coarse or dry foods such as raw vegetables,

toast, crackers

3. Cook food until it is soft and tender. 4. Cut food into small pieces. 5. Mix food with butter, thin gravies and sauces to make it

easier to swallow. 6. Use a blender or food processor to puree food. 7. Use a straw to drink liquids. 8. Try food cold or at room temperature. Hot and warm foods

can irritate a tender mouth and throat. 9. Tilt the head back or move it forward if swallowing is hard. 10. Try sitting up or standing for about an hour after eating if

heartburn is a problem. 11. The dentist may be able to recommend a special product

for cleaning the teeth if the teeth and gums are sore.



12. Rinse mouth with water often to remove food and bacteria and to promote healing.

13. Ask the doctor about anaesthetic lozenges and sprays that can numb the mouth and throat long enough to eat meals.

Changed sense of taste or smellPatient’s sense of taste or smell may change during the illness or treatment. A condition called mouth blindness or taste blindness may give foods a bitter or metallic taste, especially meat or other high-protein foods. Many foods will have less taste. Chemotherapy, radiation therapy or the cancer itself may cause these problems. Dental problems can also change the way foods taste. For most people, changes in taste and smell go away when their treatment is fi nished.

There is no ‘foolproof’ way to improve the fl avour or smell of food because each person is affected differently by illness and treatments. However, the tips given below should help make food taste better. The patient should ensure the following:

1. Choose and prepare foods that look and smell good. 2. If red meat (such as mutton) tastes or smells strange, use

chicken, eggs, dairy products or fi sh that does not have a strong smell instead.

3. Help the fl avour of meat, chicken or fi sh by marinating it in sweet fruit juices, sweet wine or sweet-and-sour sauce.

4. Try using small amounts of fl avourful seasonings. 5. Try sweet and sour foods such as oranges or lemonade that

may have more taste. A tart lemon custard might taste good and will also provide needed protein and calories. (This should not be tried if patient has a sore mouth or throat.)

6. Serve food at room temperature. 7. Try using tomatoes or onions to add fl avour to vegetables. 8. Stop eating food that cause an unpleasant taste. 9. Visit the dentist to rule out dental problems that may affect

the taste or smell of food. 10. Ask the dentist about special mouthwashes and good mouth

care.


204 Diet Management

Dry mouthChemotherapy and radiation therapy in the head or neck area can reduce the fl ow of saliva and often cause dry mouth. When this happens, foods are harder to chew and swallow. Dry mouth can also change the way foods taste. The suggestions below may be helpful in dealing with dry mouth. Also some of the ideas for dealing with a sore mouth or throat, which can make foods easier to swallow, could be tried. The patient should ensure the following: 1. Try very sweet or sour foods and beverages such as lemonade;

these foods may help the mouth produce more saliva. (Should not try this if having tender mouth or sore throat.)

2. Suck on hard candy. This can help produce more saliva. 3. Use soft and pureed foods, which may be easier to

swallow. 4. Keep lips moist with lip moisturisers. 5. Eat food with sauces, gravies and salad dressings to make

them moist and easier to swallow. 6. Have a sip of water every few minutes to help swallow food

and talk more easily. 7. If the dry mouth problem is severe, try products that coat

and protect the mouth and throat.

NauseaNausea, with or without vomiting, is a common side effect of surgery, chemotherapy, radiation therapy and biological therapy. The disease itself, or other conditions unrelated to your cancer or treatment, may also cause nausea.

Whatever the cause, nausea can keep the patient from getting enough food and needed nutrients. Some ideas that may be helpful are given here. The patient should ensure the following:

1. Ask the doctor about medicine to help control nausea and vomiting. These drugs are called antiemetics.

2. Try these foods:

a. Toast and crackers b. Curd



c. Sherbet d. Sponge cake e. Oatmeal f. Skinned chicken (baked or boiled, not fried) g. Fruits and vegetables that are soft or bland, such as

stewed apples, bananas h. Clear liquids, sipped slowly i. Ice chips

3. Avoid the following foods:

a. Fatty, greasy or fried b. Very sweet, such as candy, cookies or cake c. Spicy or hot d. With strong odours

4. Eat small amounts often and slowly. 5. Avoid eating in a room that is stuffy, too warm or has

cooking odours that might disagree with the patient. 6. Drink fewer liquids with meals. Drinking liquids can cause

a full, bloated feeling. 7. Drink or sip liquids throughout the day, except at mealtimes.

Use of a straw may help. 8. Drink beverages cool or chilled; try freezing. 9. Eat food cold or at room temperature; hot food may add to

nausea. 10. Do not forcibly eat favourite foods when feeling nauseated.

This may cause a permanent dislike of those foods. 11. Rest after meals, because activity may slow digestion. It is

best to rest sitting up for about an hour after meals. 12. Try eating dry toast or crackers before getting up if nausea

is a problem in the morning. 13. Wear loose-fi tting clothes. 14. Avoid eating for 1 to 2 hours before treatment if nausea

occurs during radiation therapy or chemotherapy. 15. Try to keep track of when nausea occurs and what causes

it (specifi c foods, events, surroundings). If possible, make appropriate changes in diet or schedule. Share the information with doctor or nurse.


206 Diet Management

VomitingVomiting may follow nausea and may be brought on by treatment, food odours, gas in the stomach or bowel, or motion. In some people, certain surroundings, such as the hospital, may cause vomiting.

If vomiting is severe or lasts for more than a few days, the doctor can help.

Very often, if nausea can be controlled, vomiting can be prevented. At times, though, one may not be able to prevent either nausea or vomiting. Some relief may be found by using relaxation exercises or meditation. These usually involve deep rhythmic breathing and quiet concentration and can be done almost anywhere. If vomiting occurs, the patient should try the following hints to prevent further episodes:

1. Ask the doctor about medicine to control nausea and vomiting.

2. Do not drink or eat until the vomiting is under control. 3. Once vomiting is controlled, small amounts of clear liquids

may be tried. Begin with 1 teaspoonful every 10 minutes, gradually increase the amount to 1 tablespoonful every 20 minutes, and fi nally, 2 tablespoonful every 30 minutes.

4. When patient is able to tolerate clear liquids, a full-liquid diet should be tried. Continue taking small amounts frequently. If feeling comfortable on a full-liquid diet, gradually progress to regular diet.

DiarrhoeaDiarrhoea may have several causes, including chemotherapy, radiation therapy to the abdomen, infection, food sensitivity and emotional upset.

Long-term or severe diarrhoea may cause other problems. During diarrhoea, food passes quickly through the bowel before the body absorbs enough vitamins, minerals and water. This may cause dehydration and increase the risk of infection. Contact the doctor if the diarrhoea is severe or lasts for more than a couple of days. Some ideas for coping with diarrhoea are given here. The patient should ensure the following:



1. Drink plenty of liquids during the day. Drinking fl uids is important because the body may not get enough water when having diarrhoea.

2. Eat small amounts of food throughout the day instead of three large meals.

3. Eat plenty of foods and liquids that contain sodium (salt) and potassium. These minerals are often lost during diarrhoea. Good liquid choices include fat-free soup. Foods high in potassium that do not cause diarrhoea include bananas, stewed peach and apricot, and boiled or mashed potatoes.

4. Try these nutritious low-fi bre foods:

a. Curd b. Rice or noodles c. Grape juice d. Upma, semolina, porridge e. Eggs (cooked until the whites are solid, not fried) f. Ripe bananas g. Coconut water h. White bread i. Skinned chicken or fi sh (boiled or baked, not fried) j. Cottage cheese, cream cheese

5. Eliminate foods such as the following:

a. Greasy, fatty or fried b. Raw vegetables and fruits c. High-fi bre vegetables such as ladyfi nger, corn, brinjals,

beans, cabbage, peas and caulifl ower d Strong spices, such as hot pepper, curry and chillies

6. Drink liquids that are at room temperature. 7. Avoid very hot or very cold foods and beverages. 8. Limit foods and beverages that contain caffeine, such as

coffee, strong tea, some sodas and chocolate. 9. Be careful when using milk and milk products because

diarrhoea may be caused by lactose intolerance. 10. After sudden, short-term attacks of diarrhoea (acute

diarrhoea), try a clear-liquid diet during the fi rst 12 to 14


208 Diet Management

hours. This lets the bowel rest while replacing the important body fl uids lost during diarrhoea.

ConstipationSome anticancer drugs and other drugs, such as pain medicines, may cause constipation. This problem may also occur if the diet lacks enough fl uid or bulk or if bedridden.

To prevent and treat constipation, the patient should ensure the following:

1. Drink plenty of liquids—at least 8–9 glasses everyday. This will help to keep stools soft.

2. Take a hot drink about half an hour before usual time for a bowel movement.

3. Eat high-fi bre foods, such as whole-grain breads, cereals, fresh fruits and vegetables; dried beans and peas; and whole-grain products such as barley or brown rice. Eat the skin on fruits and potatoes.

4. Get some exercise, such as walking, everyday. Talk to the doctor or a physical therapist about the amount and type of exercise that is right for you.

5. Add unprocessed wheat bran to foods such as chappatis and cereals.

If these suggestions do not work, doctor should recommend medicine to ease constipation. The patient should check with the doctor before taking any laxatives or stool softeners.

Weight gainSometimes patients gain excess weight during treatment without eating extra calories. For example, certain anticancer drugs, such as steroids, can cause the body to hold on to fl uid causing weight gain; this condition is known as oedema. The extra weight is in the form of water and does not mean one is eating too much.

It is important not to go on a diet if weight gain is noticed. Instead, doctor should fi nd out what may be causing this change. If anticancer drugs are causing the body to retain water, the doctor may ask the patient to speak with a dietitian. The dietitian can



teach how to limit the amount of salt eaten, which is important because salt causes the body to hold extra water. Drugs called diuretics may also be prescribed to get rid of extra fl uid.

Tooth decayCancer and cancer treatment can cause tooth decay and other problems for teeth and gums. Changes in eating habits also may add to the problem. If eating often or eating a lot of sweets, teeth may need to be brushed more often. Brushing after each meal or snack is a good idea.

Here are some ideas for preventing dental problems for the patient. Patients should ensure the following:

1. Be sure to see the dentist regularly. Patients who are receiving treatment that affects the mouth (e.g. radiation to the head and neck) may need to see the dentist more often than usual.

2. Use a soft toothbrush. Ask the doctor, nurse or dentist to suggest a special kind of toothbrush and/or toothpaste if gums are very sensitive.

3. Rinse the mouth with warm water when the gums and mouth are sore.

4. If not having trouble with poor appetite or weight loss, limit the amount of sugar in the diet.

Lactose intoleranceLactose intolerance means that the body cannot digest or absorb the milk sugar called lactose. Milk, other dairy products and foods to which milk has been added contain lactose.

Lactose intolerance may occur after treatment with some antibiotics or with radiation to the stomach or any treatment that affects the digestive tract. The part of intestine that breaks down lactose may not work properly during treatment. For some people the symptoms of lactose intolerance (gas, cramping, diarrhoea) disappear a few weeks or months after the treatments end or when the intestine heals. For others a permanent change in eating habits may be needed.


210 Diet Management

If having this problem, the doctor may advise to follow a diet that is low in foods that contain lactose. If milk had been a main source of protein in the patient’s diet, it will be important to get enough protein from other foods. Products such as soyabean formulae and cheese are good sources of protein and other nutrients. The patient can also try soya milk.


CALORIE EXCHANGE (Food stuffs equivalent to 1 chappati—80 calories)

Name of the snack Amount (g) Generic measure

Dal vada 15 One small

Dhokla 65 Three medium-size pieces

Mathri 20 One small

Namakpara 15 3–4 pieces

Pakora 40 Two medium

Potato chips 15 Approx. 7 pieces

Potato kachori 20 Half medium

Samosa 30 One small

Biscuits (salted) 15 Approx. 5 pieces

Biscuits (sweet) 15 Approx. 5 pieces

Cream cracker 15 Approx. 2 pieces

Arrowroot biscuits 15 Approx. 3 pieces

Cheese titbits 14 Approx. 40 pieces

Fruit cake 20 One slice

Plain cake 20 One slice

Badam halwa 15 One tablespoon

Balushahi 17 Half medium

Burfi 20 One small

Fruit jelly 110 One small bowl

Gujia 15 Half small

Gulab jamun 20 One small

Imarti 15 Half medium

Jalebi 20 One small

Nan khatai 15 One small

Petha 50 One small

Pinni 15 Half small

Appendix

Appendix.indd 223Appendix.indd 223 12/21/2010 12:54:31 PM12/21/2010 12:54:31 PM

224 Diet Management

Name of the snack Amount (g) Generic measure

Rasgulla 25 One regular

Shakarpara 15 Two small

Sohan halwa 20 One-fourth regular size

Suji halwa 50 Half katori

Ice cream 40 Half cup

Puri 20 One small

Popcorn 20 One bowl

Parantha 15 Half medium

Condensed milk 35 Five teaspoons

Cheese (Amul) 20 Half cube

Baked custard 70 Half cup

Kheer 45 Half small katori

Milk cake 25 One small piece

Chakali 15 One small

Chewra (fried) 20 One tablespoon

FOOD VALUE OF PORTIONS COMMONLY USED

Food stuffs Unit (raw weight)

Carbo-hydrates

(g)

Pro-teins (g)

Fats (g)

Calo-ries (g)

Na (mg)

K (mg)

Milk and milk products

Milk (cow) 240 mL 11 8 10 166 40 350

Milk (buffalo) 240 mL 12 10 16 232 45 255

Curd (cow) 125 g 6 4 3 67 40 160

Paneer or channa 25 g – 4 3 39 58 18

Milk (skimmed dry) 25 g 13 9 – 88 40 350

Milk (skimmed fresh) 240 mL 11 6 – 70 40 350

Buttermilk (lassi) 240 mL 1 2 3 37 40 160

Khoa (whole milk) 25 g 5 4 8 108 – –

Cheese (processed) 25 g 1 6 6 82 175 21

Cereals and pulses

Atta, wheat (chappati) 25 g 17 3 – 80 5 79

Porridge (oatmeal) 25 g 16 4 3 107 – 885

Suji 25 g 18 3 – 84 5 21


225Appendix


Carbo-hydrates

(g)

Pro-teins (g)

Fats (g)

Calo-ries (g)

Na (mg)

K (mg)

Maida 25 g 18 3 – 84 9 130

Rice (raw milled) 25 g 19 2 – 84 2 19

Bread 1 slice 25 g 13 2 – 60 120 30

Pulses 25 g 15 5 – 80 40 157

Soyabeans 25 g 5 11 5 – – –

Vegetables ‘A’

Green leafy (palak, methi, sarsso, bathua, etc.)

125 g 5 3 – 32 101 220

Vegetables ‘B’

Seasonal (caulifl ower, brinjal, bhindi, etc.)

125 g 6 3 – 36 16 200

Vegetables ‘C’

Potatoes, arvi, zimikand, kachalu, sweet potatoes

50 g 10 2 – 48 11 111

Fruits ‘A’

Citrus (orange, mossami) apple, pear, papaya, melon, grapes

100 g 12 – – 48 15 90

Fruits ‘B’

Banana, chiku, mango 100 g 18 1 – 76 19 365

Eggs, meat, fi sh and chicken

Bacon 25 g – – 25 225 800 97

Mutton (goat) 100 g – 21 4 120 33 270

Liver (goat) 100 g – 20 3 107 73 160

Fish 100 g – 18 1 81 101 288

Egg (1) 40–50 g – 6 6 78 65 100

Chicken 100 g – 26 1 113 7 50

Ham 25 g – 5 1 29 275 85

Fat and oils

Butter (unsalted) 25 g – – 20 180 – –

Ghee 25 g – – 25 225 – –

Vegetable oil (saffl ower, sunfl ower, soya, corn)

25 g – – 25 225 – –


226 Diet Management


Carbo-hydrates

(g)

Pro-teins (g)

Fats (g)

Calo-ries (g)

Na (mg)

K (mg)

Sugar and jaggery

Sugar 25 g 25 – – 100 – –

Jaggery 25 g 24 – – 96 – –

Miscellaneous

Cornstarch 25 g 25 – – 100 – 4

Sago 25 g 22 – – 88 – –

Ovaltine/Bournvita 1 tsp 3 1 1 25 – –

Protinex 1 tsp 1 3 – 16 – –

Soyabean 100 g 20 45 20 436 4 1820

Honey 25 g 20 – – 80 167 –

Cornfl akes 25 g 14 2 – 64 160 40

Dry nuts

Almonds, cashewnuts, walnuts, peanuts

25 g 4 5 14 162 1 135

Apricots, dates, raisins 25 g 19 – – 76 6 245

Sweets

Cake 1 small 21 3 2 114 145 22

Pastry 1 small 35 2 13 265 – –

Burfi 1 small 10 4 2 74 – –

Rasgulla 1 small 35 3 2 160 – –

Ice cream 1 small – – – – – –

plain cup 21 4 13 217 – –

Biscuits 25 g 15 3 3 99 – –

Samosa 1 8 2 6 94 150 –

Kachori 1 15 3 10 152 150 –

Puri 1 8 1 5 81 3 49

Dalmoth 25 g 12 4 14 190 150 157

Sev 25 g 12 3 5 105 150 157

Fried moong dal 25 g 15 5 10 170 400 157


227Appendix

CALORIFIC VALUE OF HARD AND SOFT DRINKS

Quantity CHO* (g) Alcohol (g) Calories

Beer 250 mL (1 glass) 13 10 122

Brandy 30 mL (1 peg) – 14 98

Rum 30 mL (1 peg) – 14 98

Whisky 30 mL (1 peg) – 13 91

Gin 30 mL (1 peg) – 12 84

Champagne (dry) 100 mL 2 10 78

Red wine 100 mL 3 10 82

White wine 100 mL 3 9 75

Sherry 30 mL 2 5 43

Port 30 mL 4 5 51

Cola 1 bottle 21 – 84

Orange drink 1 bottle 21 – 84

Lemon drink 1 bottle 21 – 84

Plain soda 1 bottle 0 0 0

* CHO—carbohydrate.

HOUSEHOLD MEASURES

1 glass (240 mL) Height 4.11/2”

Diameter on top 3”

Diameter at bottom 2”

1 glass (200 mL) Height 4.11/2”

Diameter on top 2.1/2”

Diameter at bottom 2”

1 bowl – 125 g Height 2”

(cooked weight) Diameter 3”

1 tablespoon 15 g

1 teaspoon 5 g

1 karchi (cooked weight) 100 g

1 cup (120 mL) Tea cup height 2”

Diameter 2”


228 Diet Management

STANDARD HEIGHTS AND WEIGHTS CHART

Height Standard weight

Men Women

cm ft kg lb kg lb

152.3 5’–0” – – 50.8–54.4 112–120

154.8 5’–1” – – 51.7–55.3 114–122

157.3 5’–2” 56.3–60.3 124–133 53.1–56.7 117–125

159.9 5’–3” 57.6–61.7 127–136 54.4–58.1 120–128

162.4 5’–4” 58.9–63.5 130–140 56.3–59.9 124–132

165.0 5’–5” 60.8–65.3 134–144 57.6–61.2 127–135

167.5 5’–6” 62.2–66.7 137–147 58.9–63.5 130–140

170.0 5’–7” 64.0–68.5 141–151 60.8–65.3 135–144

172.6 5’–8” 65.8–70.8 145–156 62.2–66.7 137–147

175.1 5’–9” 67.6–72.6 149–160 64.0–68.5 141–151

177.7 5’–10” 69.4–74.4 153–164 65.8–70.3 145–155

180.2 5’–11” 71.2–76.2 157–168 67.1–71.7 148–158

182.7 6’–0” 73.0–78.5 161–173 68.5–73.9 161–163

185.3 6’–1” 75.3–80.7 166–178 – –

187.8 6’–2” 77.6–83.5 171–184 – –

190.4 6’–3” 79.8–85.7 176–189 – –

Source: Life Insurance Corporation of India


229Appendix

RECO

MM

ENDE

D DI

ETAR

Y AL

LOW

ANCE

S FO

R IN

DIAN

S—20

10G

roup

Parti

cula

rsBo

dy

wt

kg

Net

ener

gy

kcal

/d

Prot

ein

g/d

Visi

ble

fat

g/d

Cal-

cium

mg/

d

Iron

mg/

d

Vit.

A μg

/dTh

ia-

min

e

mg/

d

Ribo

-

fl avi

n

mg/

d

Niac

in

eqiv

alen

t

mg/

d

Pyrid

ox-

ine

mg/

d

Asco

rbic

acid

mg/

d

Die

tary

fola

te

μg/d

Vit.

B 12

μg/d

Mag

ne-

sium

mg/

d

Zinc

mg/

dRe

ti-

nol

β-ca

ro-

tene

Man

Sede

ntar

y w

ork

60

2320

60.0

25

600

1760

048

00

1.2

1.4

16

2.0

4020

01.

034

012

Mod

erat

e w

ork

2730

301.

41.

618

Hea

vy w

ork

3490

401.

72.

121

Wom

an

Sede

ntar

y w

ork

55

1900

55.0

20

600

2160

048

00

1.0

1.1

12

2.0

4020

01.

0

310

10M

oder

ate

wor

k22

3025

1.1

1.3

14

Hea

vy w

ork

2850

301.

41.

716

Preg

nant

wom

an+3

5082

.230

1200

3580

064

00+0

.2+0

.3+2

2.5

6050

01.

2

12La

ctat

ion

0–6

m+6

0077

.930

1200

2595

076

00+0

.3+0

.4+4

2.5

8030

01.

5

6–12

m+5

2070

.230

+0.2

+0.3

+32.

5

Infa

nts

0–6

mon

ths

5.4

92 k

cal/

kg/d

1.16

g/

kg/d

–

500

46 μ

g/

kg/d

350

2800

0.2

0.3

710

μg/k

g0.

1

2525

0.2

30–

6–12

mon

ths

8.6

80 k

cal/

kg/d

1.69

g/

kg/d

1905

0.3

0.4

650

μg/k

g0.

445

–

Chi

ldre

n

1–3

year

s12

.910

6016

.727

600

0940

032

000.

50.

68

0.9

40

80

0.2–

1.0

505

4–6

year

s18

.013

5020

.125

130.

70.

811

0.9

100

707

7–9

year

s25

.116

9029

.530

1660

048

000.

81.

013

1.6

120

100

8

Boys

10–1

2 ye

ars

34.3

2190

39.9

35

800

21

600

4800

1.1

1.3

151.

640

140

0.2–

1.0

120

9

Girl

s10

–12

year

s35

.020

1040

.435

271.

01.

213

1.6

160

9

Boys

13–1

5 ye

ars

47.6

2750

54.3

4532

1.4

1.6

162.

040

150

0.2–

1.0

165

11

Girl

s13

–15

year

s46

.623

3051

.940

271.

21.

414

2.0

210

11

Boys

16–1

7 ye

ars

55.4

3020

61.5

5028

1.5

1.8

172.

040

200

0.2–

1.0

195

12

Girl

s16

–17

year

s52

.124

4055

.535

261.

01.

214

2.0

235

12

Sour

ce: N

utrie

nt R

equi

rem

ents

and

Rec

omm

ende

d Di

etar

y Al

lowa

nces

for I

ndia

ns. I

CMR/

Natio

nal I

nstit

ute

of N

utrit

ion,

Hyd

erab

ad, I

ndia

, 200

9.


Index

AA day’s menu for an elderly person,

216A day’s menu for low-cholesterol,

high-HDL diet, 163A day’s menu, 185Absorption of nutrients, 29

carbohydrates, 29fats, 30proteins, 30vitamins, 30water, 30

Acute cardiac diseases (congestive cardiac failure and myocardial infarction), 160

Acute gastrointestinal conditions, 50Acute renal failure, 137Alpha-linoleic acid (Omega 3), 5American Heart Association’s

guidelines for the prevention of coronary artery disease (CAD), 159

American Heart Association’s lifestyle recommendations for risk reduction of cardiovascular disease, 159

Anthropometric parameters, 33body fat distribution, 34body mass index (BMI), 34

Approximate daily allowances of each food group for an adult on reducing diet/day, 185

Approximate potassium content of commonly used foods, 167

Assessing the patient’s nutritional status, 195

Atherosclerosis, 148angina pectoris, 148myocardial infarction, 148

BBalanced diet, 13Basic food groups: a guide to diet

plan, 15Biochemical parameters, 37

blood glucose, 38complete blood cell count, 38kidney disease, 40lipid profi le, 39liver enzymes, 39

Body fat distribution, 175basal metabolic rate (BMR), 36daily energy expenditure, 36percentage body fat, 35resting energy expenditure (REE),

36waist circumference, 176waist–hip ratio, 175

Body-building foods, 14Breastfeeding, 23Burns, 77

CCalories, 88Calories breakfast for diabetics, 221Can good nutrition treat cancer?, 198Cancer and diet therapy, 193Carbohydrates, 2, 89, 183

classifi cation of, 2Carbohydrate diet, 221Cardiomyopathy and cardiac failure,

149Cardiovascular diseases (CVDs), 143Cereals and cereal products, 16Chicken-based feed, 212Cholesterol, 89Chronic and nonacute disorders of

the upper gastrointestinal tract, 50Clear liquid diet, 45

Index.indd 231Index.indd 231 12/22/2010 2:19:04 PM12/22/2010 2:19:04 PM

232 Diet Management

Clinical nutrition, 27Clinical parameters, 40Coeliac disease, 53, 213Constipation, 51Coping with side effects, 200

changed sense of taste or smell, 203

constipation, 208diarrhoea, 206dry mouth, 204lactose intolerance, 209loss of appetite, 200nausea, 204sore mouth or throat, 201tooth decay, 209vomiting, 206weight gain, 208

DDiabetic diets based on the exchange

list, 120Diabetic diets—menuwise, 122

approximate food value, 122–125Diet and nutritional needs of elderly,

215Diet for acute cardiac diseases, 160Diet for diabetes mellitus, 87Diet for infants, 25Diet for outdoor patients, 141Diet for underweight, 191

approximate food value, 192Diet in lactation, 25Diet in pregnancy, 23

calcium-rich foods, 24foods rich in folic acid, 24foods rich in iron, 24

Diet therapy, 195Dietary assessment, 40Dietary goals, 14Dietary guidelines, 14Dietary management, 149

alcohol, 156antioxidants and fl avanoids, 154carbohydrates, 153fat, 150fi bre, 154salt, 155traditional foods, 156

Dietary recommendations for the prevention of coronary heart disease (NIN), 158

Dietary risk factors and cancers at various sites in the human body, 194

Dietary tips for elderly, 216Diets following fractures, 64Diets for inborn errors of

metabolism, 211Diets for special groups, 126

day’s diet for a pregnant diabetic, 131

diabetes and pregnancy, 128diabetes in children (juvenile

diabetes), 126gestational diabetes mellitus, 129pregnancy with prior-onset type

1 or type II diabetes, 129some important tips, 132

Diets in gastrointestinal diseases, 49Diets in gastrointestinal surgery, 62

diet following gastric resection, 62

diverticulitis, 62dumping syndrome, 62

Diets in other surgeries, 63caesarean section/hysterectomy/

abdominal hernia/ cholecystectomy, 63

diet following intestinal surgery, 64

mouth, throat and oesophagus, 63

Diets in renal disease, 137Diets modifi ed in calories, 175Diets modifi ed in carbohydrates, 87Diets modifi ed in consistency, 45Diets modifi ed in fats, 143Diets modifi ed in minerals, 165Diets modifi ed in proteins, 135Digestion of foods, 27Digestive juices, 28

bile, 28mouth, 28pancreas and intestinal

lining, 28stomach lining, 28


233Index

Disorders of the lower gastrointestinal tract, 51

Diverticulosis, 53

EEating well during cancer

treatment, 197kinds of foods needed, 197

Energy imbalance, 180Energy needs, 181Energy-yielding foods, 13Enteral nutrition, 79

complications of enteral feeding, 85

enteral feeding vs. parenteral feeding, 79

indications for enteral nutrition, 79

types of enteral feed formula (blenderized), 81

Environmental factors affecting food safety and quality and their infl uence on health and disease, 32

Equations and factors to estimate actual energy expenditure (AEE), 78

Equations for predicting BMR on adults (kcal/24 hours), 78

Exercise, 116, 188achieving suffi cient intensity, 190benefi cial effects of exercise, 188blood glucose: self-monitoring,

117caution, 117how much should one exercise?,

189monitoring control, 117to summarize the exercise norms,

190

FFactors contributing to obesity, 180Factors infl uencing digestion and

absorption of nutrients, 31Factors leading to inadequate

nutrition, 215

Fats, 3, 88, 183classifi cation and food sources, 4

Fats and oils, 18Feeding modalities, 196

enteral nutrition, 196parenteral nutrition, 197

Fibre, 89Food groups, 181Foods to be avoided, 214Foods to be included, 216Foods to be taken, 214Formulating appropriate nutritional

support, 196Fruits, 17Full liquid diet, 45

GGalactosaemia, 212General guidelines for coronary heart

disease, 158Goals of medical nutrition therapy for

type I diabetes, 90Goals of medical nutrition therapy for

type II diabetes, 91alcohol, 102carbohydrates, 92fats, 95fi bre, 96micronutrients, 99nonnutritive sweeteners or

artifi cial sweeteners, 100nutritive sweeteners, 100proteins, 94sodium, 99sweet choices, 101

Green leafy and other vegetables, 17

HHarris–Benedict formulas for basal

energy expenditure (BEE)/basal metabolic rate (BMR), 78

Health education, 118Health risks of obesity, 178

diabetes type II, 178hypertension, 178gastroesophageal refl ux

disease, 178


234 Diet Management

musculoskeletal problems, 178respiratory problems, 178

High-calcium diet, 172High-protein diet, 136High-protein, high-iron diet, 173High-residue diet, 60Hypertension, 147

normal blood pressure, 147

IIndoor diet charts for renal

patients, 139Infl uence of diet on

carcinogenesis, 193Irritable bowel syndrome (IBS), 52

LLiver, 54Liver diseases, 54

appendicitis, 57cholelithiasis (infl ammation of

gall bladder), 57cirrhosis, 55fatty liver, 56gall stones, 57hepatitis, 58hiatus hernia, 57liver transplantation, 57nonalcoholic steatohepatitis, 56

Low- and high-calcium diets, 170Low- and high-potassium diets, 167Low-cholesterol, low-triglyceride,

high-HDL diet, 162Low-fat diet (digestive

intolerance), 143Low-oxalate diet (renal stones), 219Low-purine diet (gout), 219Low-residue diet, 59Low-sodium diets, 165Low–vitamin K diet for patients on

acitrom and warfarin, 219

MMalabsorption, 53Management of diabetes mellitus, 104

a day’s menu for a 1700-calorie diet, 114

1700-calorie diabetic diet, 114detailed exchange list of different

food groups, 111diet therapy, 104exchange system, 110planning a diet, 106rules for food substitution, 110

Managing eating problems during treatment, 199

Meat and meat products, 16Milk, 47Milk and milk products, 16Minerals—classifi cation and food

sources, 10Miscellaneous diets, 219Monounsaturated fatty acids (MUFAs),

4Moong cereal feed, 213

method, 213

NNormal diet (menu), 21Normal nutrition, 1Nutrients, 1Nutrition for critically ill, 77Nutrition in bariatric surgery, 64

nutritional goals in bariatric surgery, 64

Nutrition in kidney transplant, 70calcium and vitamin D, 74long-term nutritional

management, 75magnesium food sources, 74management of anaemia, 73management of diabetes

mellitus, 72management of hypertension, 72management of

hypophosphataemia, 73nutrition protocol, 71phosphate food sources, 74posttransplant nutrition, 73potassium food sources, 75protocol of diet progression in

kidney transplant patients, 73recommended posttransplant

nutritional goals, 72


235Index

recommended pretransplant nutritional goals, 71

vitamin D replacement, 73Nutrition in liver transplant, 68

nutrition therapy protocols, 68pretransplant nutrition therapy

goals, 69pretransplant phase, 69posttransplant phase—acute, 69posttransplant phase—chronic,

70Nutrition recommendations for

patients with diabetes, 88Nutritional assessment, 33

OObesity, 175Obesity in children, 187

healthy eating for children, 187tips for weight reduction, 187

Objectives of diet therapy, 43Other nutritional disorders, 75Other nutritional factors associated

with reduced cardiac risk for diabetics, 103

fi sh and omega 3 fatty acids, 103soya protein, fl avonoids and

phytoestrogens, 103stanols and sterols, 103

PPancreatitis, 54Parenteral nutrition, 86

complication of parenteral feeding, 86

techniques of infusion, 86Percentage of body fat, 177Phenylketonuria, 211Pregnancy and lactation, 22Protective foods, 14Proteins, 6, 88, 182

classifi cation and food sources, 7complementary proteins, 7complete proteins, 7incomplete proteins, 7quality of proteins, 182sources of proteins, 182

Proteinuria, 137nutrient recommendations for

renal disease, 137Polyunsaturated fatty acids (PUFAs), 4Pulses and legumes, 16

RRheumatic heart disease (RHD), 149Risk factors, 144Roles and functions of nutrients in

the body, 2

SSaturated fatty acids (SFAs), 4Sodium, 89Soft and cold drinks, 47Soft, semisolid diet, 46Sources of phenylalanine, 211

foods allowed freely, 212food containing high amounts of

phenylalanine, 212foods containing 50 mg

phenylalanine/serving, 211low-protein, low-phenylalanine

food (approximately 20 mg/serving), 211

Stroke and other peripheral diseases, 148

Subacute cardiac disease (CAD) or ischaemic heart disease, 161

approximate food value, 162Surgical diets, 61

TTea and coffee, 47Test meal, 221Therapeutic modifi cations of a diet,

43Therapeutic nutrition or medical

nutrition therapy, 33Thermic effect of food (TEF), 79Thermogenesis of food, 37Tips for healthy lifestyle, 191Traditional Indian foods in diabetes

mellitus, 104Trans fatty acids (TFAs), 5


236 Diet Management

UUlcerative colitis, 52

diet for ulcerative colitis (subacute stage: bland, soft), 52

VVitamins and minerals, 8, 90, 184

vitamins—classifi cation and food sources, 8

WWater and beverages, 46Weight reduction, 179

YYoga and exercise, 157Yoga and meditation, 157
