By

Dr. Yousri Mostafa Hussein

Ph.D. Immunology (U.K)

Immunotherapy Course (USA)

Professor of Immunology and Molecular Biology

Head of Medical Biochemistry Department

Faculty of Medicine, Zagazig University

Dr. Yousri Mostafa Hussein

Professors of Immunology and Molecular Biology

Faculty of Medicine, Zagazig University

Dr. Dina Mohamad El Nemr

By:

Aim for a healthy weight

Be physical active each day.

Let the food Pyramid guide your food choices.

Choose a variety of grains daily, especially whole

grains.

Choose a variety of fruits and vegetables daily

keep food safe to eat.

Choose a diet: low in saturated fats and

cholesterol and moderate in total fat.

Choose beverages and foods to moderate your

intake of sugars.

Choose and prepare foods with less salt.

Drugs are highly regulated by FDA.

Supplements are considered safe until demonstrated

to be hazardous by FDA.

Herbals and botanicals are totally unregulated.

Vegetarian’s vitamin D, B12.

Pregnant women folate.

Elderly persons Vit. B12 and folate.

People at risk of osteoporosis calcium, estrogen

and vitamin D.

People at risk of losing blood iron.

People on restricted diets vitamins and minerals.

Heart diseases:

High saturated fat and cholesterol.

Low intake of vitamins, veggies and fruits,

Cancer: Low intake of veggies, fruits and fiber.

Diabetes:

High saturated fat.

Low intake of veggies and fruits.

Osteoporosis: Low Ca and Vit. D intake

Obesity: Excessive energy intake and high fat.

It is an in-depth evaluation of both objective

and subjective data related to an

individual’s food and nutrient intake,

lifestyle and medical history.

The assessment leads to a plan of care, or

intervention, designed to help the individual

either maintain the assessment status or

attain a healthier status.

The data for a nutritional assessment falls into

five categories including:

1- Anthropometric measures:

These are the objective measurements of body muscle

and fat as height, weight, body measures…..

and others.

The Body Mass Index (BMI) is used to estimate

the body-fat mass:

)m()height(

(kg) Weight22BMI (kg/m2) =

Obese when it’s > 30 kg/m2

2- Biochemical tests:

There are some biochemical tests which might give a

clue about the nutritional state of a patient. These

tests include the assay of:

Total plasma proteins, albumin, globulins,

fibrinogen and ferritin.

Hemoglobin and hematocrite value.

Products of protein metabolism as urea, creatinine,

uric acid, in addition to 24 hours urinary nitrogen.

3- Immune system integrity:

As lymphocyte count, skin tests ….. and others.

4- Clinical assessment:

Observation of the clinical signs and symptoms of

good and poor nutrition.

5- Recording patient usual habits of eating:

Cultural and social aspect and the psychological

state of the patient should be recorded.

Religion of the patient should also be considered in

the planning of the dietary regimen.

1) Primary nutritional deficiency:

This type results from the dietary deficiency of a given

nutrient as vitamin deficiency.

2) Secondary nutritional deficiency:

This might result from certain barriers to the use of

any nutrient as:

Malabsorption syndrome.

Celiac disease.

Lactose intolerance … and others.

Diet therapies are specially designed and

prescribed for medical and/or general

nutritional reasons.

By combining foods appropriate for each

individual and drinking the proper amount of

water → can help maintain the best possible

health.

1. To increase or decrease body weight.

2. To rest a particular organ.

3. To produce a specific effect as a remedy (as

regulation of blood sugar in diabetes).

4. To overcome deficiencies by the addition of food

rich in some necessary element (as supplementing

the diet with iron for treating microcytic anemia).

1) Enteral oral feeding:

As long as possible, regular oral feedings are

preferred. Supplements are added, if needed.

2) Tube feeding:

If a patient is unable to eat, but the gastrointestinal

tract can be used tube feeding may provide the

needed support.

A number of commercial formulas are available or

blended formula might be calculated and prepared.

These formulas provide water, energy, proteins and

micro-nutrients.

A) Mechanical complications of tube feeding:

1.Mechanical injury to soft tissues.

2.Aspiration of liquids leads to aspiration pneumonia.

This is the most serious complication and is life

threatening in many cases.

3.Block of the tube or its dislodgment.

B) Gastrointestinal complications:

1. Pharngitis and esophagitis.

2. Diarrhea

3. Inadequate gastric emptying

4. Emesis

5. Bleeding

C) Metabolic complications:

1. Disorders in acid base balance.

2. Disorders affecting blood glucose level.

3) Parenteral Nutrition:

Venous infusion of

solutions containing

the recommended

nutrients.

Examples of nutritional solutions:

1. Basic parenteral solutions usually contain glucose,

amino acid and water. Electrolytes, minerals and

vitamins can also be added.

2. Solutions containing additional energy in the form of

emulsified fat. Intravenous fat solutions are isotonic

and well tolerated.

3. Solutions containing low dextrose and high fat

content. This is to provide fixed concentration of

energy to spare proteins. Utilized in:

Patients with hyperglycaemia, respiratory failure and

liver diseases.

Patients with large estimated energy requirements.

A) Complications due to catheter:

1. Catheter thrombosis

2. Sepsis

3. Ulceration of blood vessels.

B) Metabolic complications:

1. Hyperglycemia: Due to rapid infusion of

hypertonic dextrose solutions.

2. Non-calcular cholecystitis, due to biliary stasis.

3. Zinc deficiency due to diarrhea.

4. Abnormalities in liver enzymes, due to trapping of

fat in the hepatocytes.

5. Hypophosphatemia and hypokalemia, due to shift

to intracellular compartment.

Therapeutic diets can be divided into

three groups:

A) Diet of Altered Consistency.

B) Diet that Restrict Nutrients.

C) Diet that Supplement Nutrients.

1) Clear liquid diets:

This type of diet usually contain sugar and some

electrolytes.

Because of its low calories and minimal protein

content its use is limited to short period.

It consists of foods that are in liquid state at body

temperature.

It’s used in:

Acute gastroenteritis

Acute illness.

Preparation for diagnostic gastrointestinal

procedures.

Post-operative ileus.

Partial intestinal obstruction.

Patients who haven’t taken any food by mouth

for long periods.

2) Full liquid diet:

It contains enough calories, proteins, vitamins

and minerals.

Dairy products, eggs, soft cereals and fruit juice

are usually added to supplement this diet.

It’s low in residue and indicated in:

Patients with difficulty in chewing or swallowing.

Partial intestinal obstruction.

Can be fed through a tube in patients with

prolonged coma.

3) Mechanicals soft diet:

This diet includes foods permitted in the liquid diet

as well as foods containing easily digested

carbohydrates.

Eggs, cheese, ground meat, refined cereals, grain,

potatoes, starch, cooked fruits, vegetables and cakes

are often included.

It’s also low in residue and can be used for patients

who have difficulty in chewing or swallowing.

Mechanical soft diet that restrict spices and

seasonings “bland diet” is used for patients with

peptic ulcers.

1) Sodium restricted diet:

In these types of diets, a certain nutrient is

designed to be restricted or even eliminated, to aid

in the management of certain disease states. The

most common types include:

Sodium is the main extra-cellular cation. In

diet, it originates from:

Sodium naturally occurring in certain foods e.g.

baking powder, baking soda.

Sodium added during food processing.

Table salt added.

Typical diets contain about 4-6 gm sodium/day,

hence sodium restriction can be divided into:

a. Mild sodium restriction (2-3 g/day).

b. Moderate sodium restriction (1gm/day).

c. Strict sodium restriction (0.5 g/day).

d. Severe sodium restriction (0.25 g/day): rarely

used.

Hypertension.

Conditions with sodium retention and edema

i.e. congestive heat failure.

Liver disease, especially those associated with

ascites.

Chronic renal failure.

2) Protein restricted diet:

Intended for patients suffering from chronic liver

cirrhosis or hepatic encephalopathy.

Also, in chronic renal failure patients to decrease

symptoms of uremia.

The amount of protein restriction varies

according to the circumstances. The usual

amount given ranges from 15-50 gm/day

depending upon the symptoms are severe or mild.

3) Fat restricted diet:

Useful in treatment of:

Malabsorption syndromes

Liver diseases

Cholecystitis

Arterial and coronary heart diseases

Hypertension.

The following items are allowed:

Beverages: as skim milk, coffee, tea and

fruit juice.

All kinds of bread, cheese: dry or fat free

meat, liver, fish, beef and lamb. Broiling,

baking or billing of meat is necessary.. Skin

of poultry must be removed.

Vegetables and fruits.

A) High calcium diet

Include mainly milk, cheese, yogurt, egg yolk,

beans, figs and green vegetables. Also, canned fish

with bones represents a rich source of calcium. The

average daily intake is about 700 mg.

Calcium provided by milk and milk products is

easily absorbed than that provided by vegetables.

Calcium rich diet is important for:

Children during growth.

Women in menopause, to prevent osteoporosis

that occur due to estrogen deficiency.

Children with lactose intolerance who can’t

tolerate liquid dairy products may be able to

tolerate non-liquid dairy products such as

cheese and yogurt.

B) High potassium diet:

Diet rich in potassium include:

Fruits as apricots, bananas,

oranges and pineapples.

Animal sources as beef and liver.

Usual diets provide about 3 gm potassium/day.

While, high potassium diet contains 4.5-7 gm/day.

It’s indicated in cases of:

Post-operative, due to intravenous administration

of solutions that don’t contain potassium.

Cushing disease

Diarrhea

Metabolic alkalosis.

Excessive use of diuretics.

High potassium diet might also have a direct

antihypertensive effects.

C) High fiber diet:

It includes:

Fresh fruit and vegetables

Whole bread and grains

Seeds and legumes

Bran products.

Typical diet contains about 8 gm fibers/day.

It is used for:

Treatment of gastrointestinal disorders as irritable

bowel.

Reduction of blood sugar in diabetic patients.

Reduction of cholesterol level in patients with

hypercholesterolemia.

Weight reduction.

Women who eat well balanced diet, high in

nutrients and avoid known risks (as smoking) tend

to have fewer complications during pregnancy, labor

and are more likely to deliver larger and healthier

babies.

Good nutrition before pregnancy is important

as the amount of “resources” childbirth requires

increased.

Pre-pregnancy nutrition is a process of

“building up” the immune system in preparation of

pregnancy and its’ one of the major factors in

determining the success rate of conceiving healthy

children.

The period of gestation is and exceedingly

rapid growth period. The human life grows from a

single fertilized ovum to a fully developed infant

weighing about 3 kgm.

To meet nutrient needs:

calories and protein.

folate to avoid neural tube defects.

Fe synthesize blood

Should make sure to get:

Enough vit D, Ca: for bones

Enough vit A (excess harmful to fetus).

Weight gain 25-35 pounds in average weight woman

during pregnancy.

Calories must be sufficient to:

Supply the increased energy demanded by

increasing metabolic workload.

Spare protein for tissue building.

The increased requirements during pregnancy are

due to:

Rapid growth of fetus.

Development of placenta.

Enlargement of maternal tissues.

Increased maternal circulating blood volume.

Formation of amniotic fluid (contain proteins).

Food sources for pregnant women include: milk,

meat, eggs and cheese for protein supply and also

provide calcium, iron and vitamins.

Food sources for iron

include liver, meat, fruits,

green vegetables, dried

beans and cereals.

Proper nutrition is important after delivery to

help mother recover and to provide enough food

energy and nutrients for a woman to breastfeed her

child.

Women with serum ferritin < 70 µg/L need

iron supplement to prevent iron deficiency anemia

during pregnancy and post-partum.

Highest nutrient needs in life.

Extra 300 calories/day as in 2nd and 3rd

trimesters.

needs for: protein and most vitamins

including vit. A, B6 and folate.

Sufficient water and fluid intake.

Viral hepatitis are group of inflammatory diseases

caused by hepatitis viruses, including A, B, C, D …

and others.

Bed rest is essential.

A daily intake of 3000-3500 ml fluid guards against

dehydration, gives a general sense of well-being and

improves appetite.

Optimal nutrition is the major therapy and provides

foundation for recovery of injured liver cells and

over-all return of strength.

The ideal diet for hepatitis infection patients consists

of:

Protein is essential for liver cell regeneration.

It also provides lipotropic agents as choline and

methionine for conversion of fats into lipoproteins

removal from liver preventing fatty infiltration.

Diet should supply from 75-100 gm of high quality

protein daily.

Diet should supply 300-400 gm carbohydrates daily.

Sufficient glucose must be provided to restore

protective glycogen reserves and to ensure the use of

protein for vital tissue regeneration.

Adequate amount of fat make the food more

palatable and encourages the anorexic patient to eat.

Moderate amount for easily used fat such as:

Whole milk, cream, butter, margarine and vegetable

oil is beneficial.

Diet should incorporate about

100-150 gm of such fat daily.

2500-3000 Kcal are needed daily to provide energy

required for tissue regeneration process and to

renew strength and power.

At first, the food may need to be in liquid form,

using concentrated or commercial formulas for

frequent feedings.

As the patient can tolerate solid food appetizing and

attractive food is needed.

Liver diseases may advance to chronic stage of

cirrhosis.

1. Proteins: In absence of impending hepatic coma

about 80-100 gm protein/day are needed to correct

severe under nutrition, regenerate functioning liver

tissue and replenish plasma proteins.

2. Low sodium: usually restricted to 500-1000 mg/day

to help reduce fluid retention.

3. Texture: If esophageal varices develop soft foods

may be necessary.

4. Optimal general nutrition: The same principles

outlines for hepatitis are continued for cirrhosis

for the same reasons.

5. Caloric intake: Carbohydrates should be taken

freely.

6. Vitamins supplementations: Especially vit. B

complex, according to the patient’s need and

deficiency.

7. Fat intake: Moderate fat is used.

8. Alcohols: Completely prohibited, since their

detoxication represent a burden on the activity

of hepatic cells.