Clinical Nutrition and Dietetics Notes in English Class 12 Home Science Chapter-2 Book-Human Ecology and Family Sciences Part-I

 

 Clinical Nutrition and Dietetics

Food   

All the liquid or solid substances that a human being eats and absorbs through his digestive system and uses for various bodily functions are called food.

NUTRITION 

• Nutrition is the process of consuming and using nutrients necessary for the body to stay healthy, develop, and grow.

• Nutrition is the science of understanding food, edible items and their use inside the body.

• Nutrition is not just food, it is related to your physical, mental and economic development.

Why is good nutrition important?

• Good nutrition keeps us from falling ill.

• Nutrition gives strength to the body, so that it can fight germs.

• When we are sick, good nutrition helps us recover faster.

• Nutrition gives the body strength to fight major diseases.

Effects of Inadequate/Poor Nutrition 

• The ability to fight diseases decreases, which can increase health problems.

• The body recovers slowly.

• The body is unable to utilize the medicines completely.

• Different parts of the body cannot function properly, leading to new problems.

Importance of diet, nutrition and healthy lifestyle

Good Diet + Good Nutrition + Healthy Lifestyle

Long and disease-free life

Clinical nutrition  

• When a person becomes ill, the nutrient balance in the body may be disturbed even if the person's nutritional status was previously good.

• The special care taken regarding nutrition during illness is called "Clinical Nutrition".

Who manages this?

• Trained nutritionists who create nutrition plans based on the patient's illness.

• They work in a systematic manner so that the patient gets complete nutritional care.

Dietetics

• It is a science that explains how food and nutrition affect our body and health.

• Dietitians evaluate, diagnose and treat nutritional problems. They create individual diet plans and advise patients on proper nutrition.

Importance of clinical nutrition and dietetics

1. Role in disease prevention: Dietitians and clinical nutritionists help prevent diseases and maintain good health.

2. New and serious diseases are increasing: Diseases like AIDS, heart disease, obesity, stress and diabetes are increasing; nutrition has a big role in their management.

3. Population and age changes: With the increase in the number of elderly and children, the need for proper nutritional advice and care has also increased.

4. Disease-specific diet management: Appropriate diet and nutrition plan is prepared by the clinical nutritionist according to the condition of each patient.

5. New technology and research: The discovery of new methods, foods and medicinal diets have led to new developments in nutritional treatment.

6. Individualized plan: Every person has different needs, so nutrition care should be individualized.

Advances in the field of clinical nutrition  

In India, the Food Safety and Standards Authority of India (FSSAI) has laid down guidelines for preparing food according to specific requirements.

1. Many such food items are being made now:

• Which are specifically meant to cure any disease or physical deficiency.

• Such as – protein deficiency, iron deficiency or bone strengthening foods.

2. Characteristics of such foods:

• One or more nutrients are added in them in large quantities. Such as iron, vitamins, proteins etc.

• In these, some special nutrients are included in biological form so that the body can easily digest and use them.

• Their cost may be slightly higher than regular food.

• Some food products are made for specific patients – those who cannot digest food on their own or who require a special diet.

3.Examples of products:

• Powders, capsules, tablets etc. taken on the advice of a doctor. Such as – Naan powder, which is given to children.

• Supplements rich in calcium, iron, zinc.

4. Pharmaco-nutrition:

• Nutrients that have a medicine-like effect on the body, and help fight disease.

• Such as – beta-carotene, choline, chromium etc.

Basic Concepts - Clinical Nutrition and Dietetics 

These concepts help us understand how important healthy diet, proper nutrition, and nutritional management are to fight disease.

• The role of the physician in clinical nutrition

• Diet therapy

• Nutritional care and assessment

• Types of diets 

• Methods of feeding 

• Prevention of dental diseases

Role of Dietitian / Clinical Nutrition Therapist     

• Checking the nutritional requirement of the patient and deciding the right diet after looking at the report.

• Making a diet chart according to the disease.

• Diet plan according to diabetes, heart, kidney etc.

• Creating special diets for athletes, soldiers, laborers.

• Taking care of nutrition of hospitalized and outpatients.

• Provision of food and drink for children, elderly and special institutions.

• Improving patients' recovery and quality of life through nutrition.

What things do dietitians keep in mind while preparing diet for a patient?

How many times a day and what kind of food should be given to the patient – ​​this depends on his disease and the doctor's advice.

• Can the patient chew or swallow food? How is his appetite? What does he like?

• Is the patient active or not? Does he lie down all day or moves around? What are his energy needs?

• What religion, caste or culture does the patient belong to? Are there any social or religious influences on his or her eating habits?

• Is the patient facing problems due to deficiency or excess of any nutrient in the body?

• What is the patient's mental state? Is he suffering from anxiety or depression, which may affect his eating habits?

• Are the things mentioned easily available to the patient? Can he afford them?

Diet Therapy

This is a part of treatment in which food is used as medicine. The aim is to give the patient the right food according to his illness so that he can recover quickly.

Goals of diet therapy 

• Preparing a diet keeping in mind the eating habits of the patient.

• Making dietary changes to control and improve the disease.

•  Elimination of nutrient deficiencies.

• Reducing discomfort through diet during short or long-term illness. 

• Controlling diseases like diabetes, blood pressure through food.

• Teaching the patient what and how to eat.

Nutrition Care Process

Nutrition care during illness is an organized process that involves 4 main steps:-

The process of nutritional care:

• Nutritional assessment: To determine the nutritional status of the patient.

• Nutrition Diagnosis: Identification of the problem – like weakness, malnutrition, overweight etc.

• Nutritional intervention: creating and implementing a dietary plan to correct the problem.

• Evaluating results: seeing if the plan is working – making changes if needed.

(b) Nutrition Assessment (ABCD Model)

The ABCD model is used to assess the nutritional status of a patient:

A – Anthropometric:

• Weight, Height, BMI, Body Measurement etc.

B – Biochemical (chemical test):

• Blood, urine tests to know the level of nutrients in the body.

C – Clinical:

• Physical and health examination of the patient – ​​like skin, hair, eyes, fatigue, weakness etc.

D – Dietary:

• What is the patient eating? Quality of diet, nutrient deficiencies or excesses.

Types of diets

Diets are divided into two main categories:

• Regular/Normal Diet

• For healthy people

• Balanced and according to your daily needs

• Nutrition for all ages and functions

Modified/Therapeutic Diet : 

For sick individuals, it is given as per the advice of doctor and dietician to meet the special nutritional needs.

There are 4 variations that can happen:

• Change in texture – liquid, soft, semi-liquid

• Changes in energy levels – more or less calories

• nutritional changes – such as less salt, more fibre

• Frequency of feeding – how many times a day to feed

Objective:

• quick recovery from illness

• giving strength to the body

• Helping with treatment

Types and examples of modified diets   

1. Change in texture

(i) Liquid Diet:

• These are in liquid state at room temperature.

• These are also called complete liquid diets.

• They are fiber-free, easily digestible and nutritious.

Example:

Coconut water Fruit juice Soup Milk Buttermilk Milk shake 

Benefit:

• Helpful in digestive system disorders (surgery, fever, vomiting-diarrhea)

• Useful for patients with chewing/swallowing difficulties (such as the elderly or after jaw surgery)

(ii) Clear Liquid Diet

features:

• It is thinner than normal liquid and without any residue (absolutely clear)

Example:

• Soup/juice, light tea

Benefit:

• given immediately after surgery

Limit:

• This diet does not meet all the nutritional requirements

(iii) Soft Diet

features:

• Lightly cooked, soft but solid foods

• Low fibrous, easily chewable and digestible

Example:

• Porridge, porridge, tapioca pudding

Benefit:

• Relief from vomiting, gas, indigestion, flatulence

• Without fiber, seeds, spices – to relieve the stomach

• It is given to give relief to the digestive system

(iv) Prepared Soft Diet

• When normal food becomes difficult to chew, slight modifications are made to make it softer.

• There is no special medicine or medical modification in this, only the method of cooking is changed.

Example:

• soft, mashed, or crushed foods

• Fruits and vegetables that are easy to chew

• brothy food

2. Increase or decrease in energy (calorie) intake 

In a modified diet, the energy intake is increased or decreased according to the patient's condition

1. Increase in energy (calorie) intake

• When the body needs more strength – such as during illness or weakness

Example:

• Energy diet given during fever

• More calories to maintain the body's immunity

2. Decrease in energy (calorie) intake

• When there is excess fat/weight in the body and it needs to be reduced.

Example:

• Diet given in obesity

• Weight is controlled by reducing calories.

3. Excess or deficiency of nutrients 

• According to any disease or physical condition, dieticians increase or decrease the amount of some nutrients.

• After surgery, the amount of protein is increased for quick recovery of the body.

• If the kidney is damaged then the amount of protein is reduced so that there is no pressure on the kidney.

• Fiber: Some people may need more fiber (in constipation) and some may need less (in diarrhea)

• Fat deficiency in jaundice: Less amount of fat is given to the patient.

• In high blood pressure, salt or sodium intake is limited.

• Some patients (such as those with kidney failure) need to limit fluid intake.

• Non-nutrient avoidance: Spinach is high in oxalates — which can cause stone formation, so spinach intake is limited.

Methods of feeding 

1. Oral Feeding

• The most common and safest way

• used when the patient can chew and swallow on their own

2. Tube Feeding

• When the patient cannot eat by mouth

• The food is passed through a tube to the stomach or intestine

• can be either temporary or permanent

3. Intravenous nutrition (IV Feeding / Intravenous)

• When the patient cannot eat or digest food

• nutrients are given directly through a vein

• Use in critical conditions such as post surgery, coma, ICU

Prevention of Chronic Diseases 

• Chronic diseases can be prevented and controlled with proper diet, nutrition and lifestyle.

• Eating more fat, sugar and refined foods increases the risk of diseases.

• Poor diet and less physical activities in the urban lifestyle cause diseases.

• Diseases like obesity, diabetes, heart disease, stress and high blood pressure are increasing rapidly.

• Clinical nutritionists help prevent diseases through proper diet planning and nutrition education.

• A balanced diet, exercise, reduced stress and nutritional advice are essential to prevent chronic diseases.

Preparation for Career in Clinical Nutrition and Dietetics

Required knowledge and understanding:

• Complete knowledge of nutrition, food science, chemistry, biology, physiology etc.

• Information about the changes in the body according to the disease

• Daily nutrient requirements vary from patient to patient

• Understanding of the food habits of different communities

• Ability to communicate effectively with patients in a variety of languages

• Keeping a record of food intake, understanding the mental condition of the patient

Required Skills 

• Assess the nutritional status of the patient using clinical and biochemical parameters.

• In case of specific diseases or serious conditions, preparing diet plan as per the requirement of the patient.

• Communicates effectively with patients to make dietary recommendations.

• Understanding the patient's socio-cultural background and beliefs regarding food and nutrition.

• Conducting laboratory research to understand the use of foods, drugs and nutrients and formulating diets that are useful to the patient.

skills required 

1.Basic Qualification:

• 10+2 level pass (from any recognized board)

• B.Sc. (Home Science) or B.Sc. Degree in Nutritional Science

2. To become a dietitian:

• Post Graduate Diploma in Dietetics or M.Sc. (Food Science, Nutrition or Dietetics)

3. To become a Registered Dietitian:

• Registration with internship is mandatory

4.For education and research:

• After M.Sc. one has to clear UGC NET exam

• Then one can pursue PhD or research in higher education.

Career Opportunities in Clinical Nutrition and Dietetics

• Dietitian in hospitals, gyms, schools

• Dietitians with dietary consultants or physicians

• Clinical Research / Academic Researcher

• Professor in Colleges / Teacher in Schools

• Manufacture and development of medical foods

• Technical Writer

• Food Service Proposal/Manager in Hospitals

• Nutrition Marketing / Consultant in Industries / Companies

• Clinical Nutritionist for Athletes (Sports Nutritionist)