Transcript Slide 1

Simplified Diet Manual
Tenth Edition
Iowa Dietetic Association
Edited by Andrea Maher, RD, LD
•Easy-to-understand, fundamental nutrition
guidelines for normal and therapeutic diets
•Helps dietitians and foodservice managers maintain
nutritional health and well-being of clients
•Revised Guidelines for Diet Planning based on
Dietary Guidelines for Americans 2005 and USDA’s
MyPyramid
•Revised Exchange Lists for Meal Planning (© 2003,
American Dietetic Association)
•Includes National Dysphagia Diet tables (© 2002,
American Dietetic Association)
•Study guide questions train foodservice employees
in health care facilities
Pulling Ideas Together
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IDA Taskforce Survey
IDA Publications Committee
Blackwell Publishing
ICD-HCF
District Association Meetings
Dietary Managers Association
Department of Inspections & Appeals
IDA Board and Council
Chapter 1
Guidelines for Diet Planning
• MyPyramid 2005
• Dietary Guidelines for Americans 2005
Dietary Guidelines for Americans
2005
1. Consume a variety of foods
2. Control calorie intake to manage body
weight
3. Be physically active every day
4. Increase daily intake of fruits and
vegetables, whole grains, low-fat milk
and milk products
Dietary Guidelines for Americans
2005
5. Choose fats wisely for good health
6. Choose carbohydrates wisely for good
health
7. Choose and prepare foods with little salt
8. If you drink alcoholic beverages, do so in
moderation
9. Keep food safe to eat
USDA MyPyramid 2005
www.mypyramid.gov
Daily Amount of Food from Each Group
1,000
1,200
1,400
1,600
1,800
2,000
2,200
2,400
2,600
2,800
3,000
3,200
Fruits
(cups)
1
1
1.5
1.5
1.5
2
2
2
2
2.5
2.5
2.5
Vegetables
(cups)
1
1.5
1.5
2
2.5
2.5
3
3
3.5
3.5
4
4
Grains
(ounce equivalents)
3
4
5
5
6
6
7
8
9
10
10
10
Meat and Beans
(ounce equivalents)
2
3
4
5
5
5.5
6
6.5
6.5
7
7
7
Milk
(cups)
2
2
2
3
3
3
3
3
3
3
3
3
Oils/Fat
(tsp)
3
4
4
5
5
6
6
7
8
8
10
11
Discretionary
Calorie Allowance
165
171
171
132
195
267
290
362
410
426
512
648
Calorie Level
Vegetable Subgroups (Cups per Week)
1,000
1,200
1,400
1,600
1,800
2,000
2,200
2,400
2,600
2,800
3,000
3,200
Dark Green
1
1.5
1.5
2
3
3
3
3
3
3
3
3
Orange
.5
1
1
1.5
2
2
2
2
2.5
2.5
2.5
2.5
Dry Beans/Peas
.5
1
1
2.5
3
3
3
3
3.5
3.5
3.5
3.5
Starchy
1.5
2.5
2.5
2.5
3
3
6
6
7
7
9
9
Other
3.5
4.5
4.5
5.5
6.5
6.5
7
7
8.5
8.5
10
10
Calorie Level
Commonly Consumed Vegetables
Dark Green
Orange
Dry beans/peas
Starchy
Other
Bok choy
Broccoli
Collard greens
Dark green
leafy lettuce
Kale
Mustard greens
Spinach
Turnip greens
Watercress
Acorn squash
Butternut squash
Carrots
Hubbard squash
Pumpkin
Sweet potatoes
Black beans
Black-eyed peas
Chickpeas
Kidney beans
Lentils
Lima beans
Navy beans
Pinto beans
Soy beans
Split peas
Tofu
White beans
Corn
Green peas
Lima beans
Potatoes
Artichokes
Asparagus
Beans sprouts
Beets
Brussels sprouts
Cabbage
Cauliflower
Celery
Cucumbers
Eggplant
Green beans
Green or red
peppers
Iceberg lettuce
Mushrooms
Tomatoes
Turnips
Zucchini
Chapter 2
Routine Diets
• General Diet
Milk 2-3 cups
Meat and Beans 2-3 servings (total 2-7 ounceequivalents)
Fruits 1-2.5 cups
Vegetables 1-4 cups
Grains 3-10 servings
Oils/Fat Use sparingly
Fluids 6-8 cups
Chapter 2
Routine Diets
• General Diet
Milk 2-3 cups
Meat and Beans 2-3 servings (total 2-7 ounce-equivalents)
Fruits 1-2.5 cups
Vegetables 1-4 cups
Grains 3-10 servings
Oils/Fat Use sparingly
Fluids 6-8 cups
• Nutrition Guidelines for Pregnancy and
Lactation, Normal Infants, Children
• General Diet
Chapter 2
Routine Diets
Milk 2-3 cups
Meat and Beans 2-3 servings (total 2-7 ounce-equivalents)
Fruits 1-2.5 cups
Vegetables 1-4 cups
Grains 3-10 servings
Oils/Fat Use sparingly
Fluids 6-8 cups
• Nutrition Guidelines for Pregnancy and
Lactation, Normal Infants, Children
• Meeting Nutritional Needs for Older Adults
Meeting Needs of Older Adults
• Use General Diet as much as possible
• Least restrictive diet is encouraged,
especially residents of long-term care
facilities
• Minor changes to a well-planned general
diet may meet the needs of people with
high blood cholesterol, diabetes, or those
that need weight management.
Chapter 3
Consistency Altered Diets
• ADA National Dysphagia Diets
Level 1: Dysphagia Pureed
Level 2: Dysphagia Mechanically Altered
Level 3: Dysphagia Advanced Diet
• ADA National Dysphagia Diet Liquid
Consistency Levels
Sample Menu Plan for National Dysphagia Diets and Modifed Renal Diet
Meal
Breakfast
General
Dysphagia Advanced
Orange Juice*
Oatmeal
Poached Egg
Blueberry Muffin
Milk*
Lunch
Roast Pork, 2 oz
Baked Potato
Broccoli
Whole Wheat Bread
Pudding
Milk*
Supper
Vegetable Beef Soup*
Crackers
Turkey Sandwich, 2 oz
Diced Peaches
Milk*
HS Snack
Banana
*If thin liquids restricted, thicken to appropriate consistency
Dysphagia Mechanical
Dysphagia Pureed
Modified Renal
Level 3: Dysphagia Advanced Diet
Food Groups
Recommended
Avoid
Breads
Any well-moistened breads,
biscuits, muffins, pancakes,
waffles, etc. Need to add
adequate syrup, jelly, margarine,
butter, etc., to moisten well.
Dry bread, toast, crackers, etc.
Tough, crusty breads such as
French bread or baguettes.
Cereals
All well-moistened cereals.
Coarse or dry cereals such as
shredded wheat or All Bran
Fruits
All canned and cooked fruits.
Soft, peeled fresh fruits such as
peaches, nectarines, kiwi,
mangos, cantaloupe, honeydew,
watermelon.
Soft berries with small seeds.
Difficult-to-chew fresh fruits
such as apples or pears.
Stringy, high-pulp fruits such as
papaya, pineapple, or mango.
Fresh fruits with difficult-tochew peels such as grapes.
Meats, Meat Substitutes,
Entrees
Thin-sliced, tender, or ground
meats and poultry.
Well-moistened fish.
Eggs prepared any way.
Casseroles with small meat
chunks, ground meats, or tender
meats.
Tough, dry meats and poultry.
Dry fish or fish with bones.
Chunky peanut butter.
Yogurt with nuts or coconut.
Potatoes and Starches
All, including rice, wild rice,
moist bread dressing, and tender,
fried potatoes.
Tough, crisp-fried potatoes.
Potato skins.
Dry bread dressing.
Soups
All soups except those in the
Avoid list.
Soups with tough meats.
Corn or clam chowders.
Soups that have large chunks of
meat or vegetables >1 inch.
Vegetables
All cooked, tender vegetables.
Shredded lettuce.
All raw vegetables except
shredded lettuce.
Cooked corn.
Nontender or rubbery cooked
vegetables.
Sample Menu Plan for National Dysphagia Diets and Modifed Renal Diet
Meal
Breakfast
General
Orange Juice*
Oatmeal
Poached Egg
Blueberry Muffin
Milk*
Dysphagia Advanced
X
X
X
X
X
Lunch
Roast Pork, 2 oz
Baked Potato
Broccoli
Whole Wheat Bread
Pudding
Milk*
Ground Pork
No skins
X
X/Margarine
X
X
Supper
Vegetable Beef Soup*
Crackers
Turkey Sandwich, 2 oz
X
Crackers in soup
Thin-sliced sandwich
Diced Peaches
Milk*
X
X
Banana
X
HS Snack
*If thin liquids restricted, thicken to appropriate consistency
Dysphagia Mechanical
Dysphagia Pureed
Level 2: Dysphagia Mechanically Altered Diet
Food Groups
Recommended
Avoid
Breads
Soft pancakes, well moistened
with syrup or sauce.
Pureed bread mixes, pregelled
or slurried breads that are
gelled through entire thickness.
All others
Cereals
Cooked cereals with little
texture, including oatmeal.
Slightly moistened dry cereals
with little texture.
Unprocessed wheat bran stirred
into cereals for bulk.
Very coarse cooked cereals that
may contain flax seed or other
seeds or nuts.
Whole-grain dry or coarse cereals.
Cereals with nuts, seeds, dried
fruit and/or coconut.
Fruits
Soft drained canned or cooked
fruits without seeds or skin.
Fresh soft/ripe banana.
Fruit juices with small amount
of pulp.
Fresh or frozen fruits.
Cooked fruit with skin or seeds.
Dried fruits.
Fresh, canned, or cooked
pineapple.
Meats, Meat Substitutes,
Entrees
Moistened ground or cooked
meat, poultry, or fish. Moist
ground or tender meat may be
served with gravy or sauce.
Casseroles without rice.
Moist macaroni and cheese,
well-cooked pasta with meat
sauce.
Moist meatballs, meat loaf
Protein salads such as tuna or
egg without large chunks.
Cottage cheese, smooth quiche.
Poached, scrambled, or softcooked eggs.
Dry meats, tough meats (such as
bacon, sausage, hot dogs,
bratwurst).
Dry casseroles or casseroles with
rice or large chunks.
Cheese slices and cubes.
Peanut butter
Hard-cooked or crisp fried eggs.
Sandwiches.
Pizza.
(Continued)
Level 2: Dysphagia Mechanically Altered Diet
Food Groups
Recommended
Avoid
Potatoes and Starches
Well-cooked, moistened, boiled,
baked, or mashed potatoes.
Well-cooked shredded hash
brown potatoes that are not
crisp. (All potatoes need to be
moist and in sauces.)
Well-cooked noodles in sauce.
Potato skins and chips.
Fried or French-fried potatoes.
Rice.
Soups
Soups with easy-to-chew or
easy-to-swallow meats or
vegetables: particle sizes in
soups should be <1/2 inch.
Soups with large chunks of meat
and vegetables.
Soups with rice, corn, peas.
Vegetables
All soft, well-cooked vegetables.
Vegetables should be <1/2 inch.
Should be easily mashed with a
fork.
Cooked corn and peas.
Broccoli, cabbage, brussels
sprouts, asparagus, or other
fibrous nontender or rubbery
cooked vegetables.
Sample Menu Plan for National Dysphagia Diets and Modifed Renal Diet
Meal
Breakfast
General
Orange Juice*
Oatmeal
Poached Egg
Blueberry Muffin
Milk*
Dysphagia Advanced
Dysphagia Mechanical
X
X
X
X
X
X
X
X
Slurried Muffin
X
Ground Pork
No skins
X
X/Margarine
X
X
Ground Pork/Sauce
No skins/Margarine
Pureed Broccoli
Slurried bread
X
X
X
Crackers in soup
Thin-sliced sandwich
Lunch
Roast Pork, 2 oz
Baked Potato
Broccoli
Whole Wheat Bread
Pudding
Milk*
Supper
Vegetable Beef Soup*
Crackers
Turkey Sandwich, 2 oz
Diced Peaches
Milk*
X
X
X
Crushed in soup
Thin sliced turkey slices
Shredded hashbrowns
X
X
Banana
X
Ripe Banana
HS Snack
*If thin liquids restricted, thicken to appropriate consistency
Dysphagia Pureed
Level 1: Dysphagia Pureed Diet
Food Groups
Recommended
Avoid
Breads
Commercially or facilityprepared pureed bread mixes,
pregelled slurried breads,
pancakes, sweet rolls, Danish
pastries, French toast, etc., that
are gelled through entire
thickness of product.
All other breads, rolls, crackers,
biscuits, pancakes, waffles,
French toast, muffins, etc.
Cereals
Cereals may have just enough
milk to moisten.
Smooth, homogenous, cooked
cereals such as farina-type
cereals. Cereals should have a
“pudding-like” consistency.
If thin liquids allowed, also
may have: Enough milk or
cream with cereals to moisten;
they should be blended well.
All dry cereals and any cooked
cereals with lumps, seeds,
chunks.
Oatmeal.
Fruits
Pureed fruits or well-mashed
fresh bananas.
Fruit juices without pulp, seeds,
or chunks.
Whole fruits (fresh, frozen,
canned, dried).
Meats and Meat Substitutes
Pureed meats.
Braunschweiger.
Whole or ground meats, fish, or
poultry.
Nonpureed lentils or legumes.
Cheese, cottage cheese.
Peanut butter, unless pureed into
foods correctly.
Nonpureed fried, scrambled, or
hard-cooked eggs.
Soups
Soups that have been pureed in a
blender or strained.
Soups that have chunks, lumps,
etc.
Vegetables
Pureed vegetables without
chunks, lumps, pulp, or seeds.
All other vegetables that have
not been pureed.
Sample Menu Plan for National Dysphagia Diets and Modifed Renal Diet
Meal
Breakfast
General
Orange Juice*
Oatmeal
Poached Egg
Blueberry Muffin
Milk*
Dysphagia Advanced
Dysphagia Mechanical
Dysphagia Pureed
X
X
X
X
X
X
X
X
Slurried Muffin
X
X
Malt-O-Meal
Pur Scrambled Egg
Pur Muffin
X
Ground Pork
No skins
X
X/Margarine
X
X
Ground Pork/Sauce
No skins/Margarine
Pureed Broccoli
Slurried bread
X
X
Pur Roast Pork
Pur Mashed Potatoes
Pur Broccoli
Pur Bread Mix
X
X
X
Crackers in soup
Thin-sliced sandwich
Pur soup
Pur crackers into soup
Pur sandwich
Well-mashed Banana
Lunch
Roast Pork, 2 oz
Baked Potato
Broccoli
Whole Wheat Bread
Pudding
Milk*
Supper
Vegetable Beef Soup*
Crackers
Turkey Sandwich, 2 oz
Diced Peaches
Milk*
X
X
X
Crushed in soup
Thin sliced turkey slices
Shredded hashbrowns
X
X
Banana
X
Ripe Banana
Pur Peaches
X
HS Snack
*If thin liquids restricted, thicken to appropriate consistency
SAMPLE MENU PLAN FOR NATIONAL DYSPHAGIA DIETS
(Select from foods for the day in the General Diet or any other diet. Follow the
portion sizes for the appropriate diet using the textural modifications.)
Meal
General
Dysphagia Advanced
Dysphagia Mechanical
Dysphagia Pureed
Breakfast
Orange Juice*
Oatmeal or cornflakes*
Fried Egg
Cinnamon Roll
Margarine
Milk*
Orange Juice*
Oatmeal or cornflakes*
Fried Egg
Cinnamon Roll
Margarine
Milk*
Orange Juice*
Oatmeal or cornflakes*
Scrambled Egg
Slurried Cinnamon Roll
Margarine
Milk*
Orange Juice, no pulp*
Malt-O-Meal
Pureed Scrambled Egg
Slurried Cinnamon Roll
Margarine
Milk*
Lunch or
Supper
Baked Chicken
Baked Potato
Peas and Carrots
Roll/Margarine
Apple Pie
Milk*
Ground Chicken
Baked Potato-no skin
Peas and Carrots, tender
Roll/Margarine
Apple Pie
Milk*
Ground Chicken, moistened
Baked Potato- no skin
Pureed Peas and Carrots
Slurried Roll/Margarine
Apple Pie- no top crust
Milk*
Pureed Chicken
Mashed Potatoes with butter
Pureed Peas and Carrots
Slurried Roll/Margarine
Pureed pie
Milk*
Dinner
Chicken Noodle Soup*
Crackers
Grilled Cheese Sandwich
Cherries
Milk*
Chicken Noodle Soup*
Crackers in soup
Grilled Cheese Sandwich
Cherries, canned
Milk*
Pureed Chicken Noodle Soup*
Crackers pureed into soup
Pureed Grilled Cheese
Pureed Cherries
Milk*
Pureed Chicken Noodle Soup*
Crackers pureed into soup
Pureed Grilled Cheese
Pureed Cherries
Milk*
Snack
Cookie
Cookie, soft
Soaked Cookie
Pureed Cookie
*If thin liquids restricted, thicken to appropriate consistency
Chapter 4
Liquid Diets and Modifications
• Clear Liquid Diet
• Blenderized Liquid Diet
• Post-Surgical Diet
• Enteral Feeding
Chapter 5
Diets for Weight Management
• Weight Management Diet
• Calorie Controlled Diets
• Bariatric/Gastric Bypass Diet
Patient
Encounter
Treatment Algorithm for
Assessment of Overweight and
Obesity
Hx of
>25
BMI?
N
o
Source: National Heart, Lung and Blood
Institute (part of the National Institutes of Health
& U.S. Dept of Health and Human Services) and
North American Association for the Study of
Obesity. Oct 2000. The Practical Guide:
Identification, Evaluation, and Treatment of
Overweight and Obesity in Adults.
Yes
BMI taken
in past 2
years?
Measure weight,
height, and waist
circumference
Calculate BMI
BMI > 25 or
waist
circumference
>88 cm (F)
>102 cm (M)
Yes
Assess
risk factors
BMI>30 or BMI 2529.9 or waist
circumference > 88
cm F >102 cm AND
2 risk factors
N
o
Clinician & patient
devise goals &
treatment strategy
for weight loss a&
risk factor control
N
o
Hx BMI > 25?
N
o
Yes
Brief
reinforcement or
education on
weight
management
Yes
Does
patient want
to lose
weight?
Advise to maintain
weight & address
other risk factors
Periodic
Weight Check
N
o
Yes
Yes
Progress
being
made/goal
achieved?
N
o
Maintenance:
Diet therapy
Behavior
therapy
Physical activity
Assess
reasons for
failure to lose
weight
Chapter 5
Diets for Weight Management
• Weight Management Diet
• Calorie Controlled Diets
• Bariatric/Gastric Bypass Diet
Chapter 5
Diets for Weight Management
• Weight Management Diet
• Calorie Controlled Diets
• Bariatric/Gastric Bypass Diet
Bariatric/Gastric Bypass Diet
Roux-en-Y procedure
•
•
•
•
Eat 1-3 “meals” per day, snack rules vary
Consume max of 2-4 Tbsp per “meal”
Consume max of 60 gm protein daily
No liquids with meals and 30 minutes
before and after eating solids
• Take small bites, chew 25 times per bite
• Consume at least 64 oz water daily
• Do not use straws
Chapter 6
Diets for Diabetes
• Deletion of Limited Concentrated Sweets
(LCS) Diet
• Consistent Carbohydrate Diet
– Menu Planning Guidelines
– Gestational Diabetes Meal Plan
– Treatment of Hypoglycemia
American Dietetics Association
position statement (2001)
“Providing adequate nutrition is the primary
concern for the residents of long-term care
facilities if malnutrition is to be prevented
or corrected. Experience has shown that
residents eat better when they are given
less-restrictive diets with regular foods…
with consistent amounts of carbohydrate
at meals and snacks….”
Chapter 6
Diets for Diabetes
• Deletion of Limited Concentrated Sweets
(LCS) Diet
• Consistent Carbohydrate Diet
– Menu Planning Guidelines
– Gestational Diabetes Meal Plan
– Treatment of Hypoglycemia
Menu Planning
Carbohydrate Choices
Grams of Carbohydrate
Carbohydrate Ranges
1
15
11-20
2
30
26-35
3
45
41-50
4
60
56-65
5
75
71-80
Conversion Guide
Total Carbohydrate
Grams
Carbohydrate
Choices
0-5
0
6-10
½
11-20
1
21-25
1½
26-35
2
36-40
2½
41-50
3
51-55
3½
55-65
4
66-70
4½
71-80
5
81-85
5½
85-95
6
SUGGESTED MENU PLAN FOR CONSISTENT CARBOHYDRATE DIET
(Select from foods described)
MEAL PATTERN
CONSISTENT CARBOHYDRATE DIET
GENERAL DIET
Breakfast
5 carbohydrate choices=
~75 grams carbohydrate
½ cup orange juice (1 choice)
½ cup oatmeal (1 choice)
1 slice toast (1 choice)
1 egg
1 cup milk (1 choice)
1 Tbsp regular jelly (1 choice)
1 tsp margarine
coffee
½ cup orange juice
½ cup oatmeal
1 slice toast
1 egg
1 cup milk
1 Tbsp jelly
1 tsp margarine
coffee
Lunch or Supper
5 carbohydrate choices =
3 oz roast beef
½ cup mashed potatoes (1 choice)
½ cup broccoli
1 dinner roll (1 choice)
2 tsp margarine
2x2 brownie/frosting (2 choices)
1 cup milk (1 choice)
coffee
3 oz roast beef
½ cup mashed potatoes
½ cup broccoli
1 dinner roll
2 tsp margarine
2x2 brownie/frosting
1 cup milk
coffee
~75 grams carbohydrate
Chapter 7
Fat Restricted Diets
• Low Fat Diet
(40-50 g fat)
• Cholesterol/Saturated Fat Restricted Diet
(NCEP/AHA Diet: less than 200 mg
cholesterol, 25-35% of calories from
fat)
Chapter 8
Sodium Restricted Diets
• No Added Salt Diet
(3,000-4,000 mg sodium)
• Low Sodium Diet
(2,000 mg sodium)
Chapter 9
Diets for Renal and Liver Disease
• Protein and Electrolyte Controlled Diet
• Modified Renal Diet
• Fluid Restrictions
Chapter 9
Diets for Renal and Liver Disease
• Protein and Electrolyte Controlled Diet
• Modified Renal Diet
• Fluid Restrictions
“The Modified Renal Diet may be
prescribed for individuals with
End-Stage Renal Disease
(ESRD) who are on dialysis and
reside in a long-term health care
setting.”
Modified Renal Diet
“The use of a standardized menu in
the LTC setting make it possible
to individualize the person’s
nutritional needs based on their
biochemistry.”
Modified Renal Diet Principles
1.
2.
3.
4.
5.
6.
7.
Energy
Carbohydrates
Protein
Sodium
Phosphorus
Potassium
Fluids
1. Energy
• Adequate caloric intake is essential
• Ensure food substitutions provide the
same energy as those provided in the
General diet
2. Carbohydrates
• The addition of refined carbohydrates and
simple sugars, i.e. desserts, can be useful
in achieving adequate protein-sparing
calories.
• If the person has diabetes, refer to the
Consistent Carbohydrate Diet.
3. Protein
Protein requirements are higher for persons
on dialysis
• Double egg portion at breakfast
• Large portion of meat at midday and
evening meal
• Meat sandwich for snack
4. Sodium
Restriction varies according to the person’s
hydration status including fluid retention
• Substitute lower sodium meats to replace
high sodium meats as listed in the NAS
diet
• Substitute all soup with low sodium soups
or low/medium potassium vegetable
• Avoid salt substitutes, seasoning mixes
5. Phosphorus
Needs to be limited to limit bone loss
• Substitute refined CHO for whole grain or
bran-containing breads and cereals,
including oatmeal
• Avoid beans and legumes
• Restrict milk to ½ cup per day
• Limit cheese intake to ½ oz per day
6. Potassium
Intake should be individuals as dictated by
potassium lab values
• Substitute citrus, prune, tomato juices with
cranberry, apple or other low K+ juice
• Substitute citrus fruit, bananas, tomatoes,
and prunes with low/med K+ fruits.
• Allow mashed or boiled potatoes, only ¼
cup per day. No baked potatoes.
7. Fluid Limits
Fluid limits, when needed, must
be individualized.
Sample Menu Plan for National Dysphagia Diets and Modifed Renal Diet
Meal
Breakfast
General
Dysphagia Advanced
Dysphagia Mechanical
Dysphagia Pureed
Modified Renal
X
X
X
X
X
X
X
X
Slurried Muffin
X
X
Malt-O-Meal
Pur Scrambled Egg
Pureed Muffin
X
Cranberry Juice
Malt-O-Meal
Double Egg
X
½ C. Milk
Ground Pork
No skins
X
X/Margarine
X
X
Ground Pork/Sauce
No skins/Margarine
Pureed Broccoli
Slurried bread
X
X
Pur Roast Pork
Pur Mashed Potatoes
Pur Broccoli
Pureed Bread Mix
X
X
4 oz Roast Pork
¼ C. Boiled Potatoes
X
White Bread
Fruited Gelatin
Apple Juice
X
Crackers in soup
Thin-sliced sandwich
X
Crushed in soup
Thin sliced turkey slices
Pur soup
Pur crackers into soup
Pur sandwich
LS Vegetable Soup
Unsalted Crackers
4 oz Turkey/White
bread
Diced Peaches
Milk*
X
X
Shredded hashbrowns
X
X
Pur Peaches
X
X
Grape Juice
Banana
X
Ripe Banana
Well-mashed Banana
Applesauce
Orange Juice*
Oatmeal
Poached Egg
Blueberry Muffin
Milk*
Lunch
Roast Pork, 2 oz
Baked Potato
Broccoli
Whole Wheat Bread
Pudding
Milk*
Supper
Vegetable Beef Soup*
Crackers
Turkey Sandwich, 2 oz
HS Snack
Chapter 9
Diets for Renal and Liver Disease
• Protein and Electrolyte Controlled Diet
• Modified Renal Diet
• Fluid Restrictions
SAMPLE MENU PLAN FOR FLUID RESTRICTIONS:
Fluid Restriction
BREAKFAST
LUNCH
DINNER
NURSING and/or
SNACKS
1000 cc
(33.3 oz)
240 cc
240 cc
240 cc
280 cc
1100 cc
(36.7 oz)
360 cc
240 cc
240 cc
260 cc
1200 cc
(40 oz)
360 cc
240 cc
240 cc
360 cc
1300 cc
(43.3 oz)
360 cc
360 cc
240 cc
340cc
1400 cc
(46.7 oz)
360 cc
360 cc
240 cc
440 cc
1500 cc
(50 oz)
360 cc
360 cc
360 cc
420 cc
1600 cc
(53.3 oz)
480 cc
360 cc
360 cc
400 cc
1700 cc
(56.7 oz)
480 cc
360 cc
360 cc
500 cc
1800 cc
(60 oz)
480 cc
480 cc
360 cc
480 cc
1900 cc
(63.3 oz)
480 cc
480 cc
480 cc
460 cc
2000 cc
(66.7 oz)
480 cc
480 cc
480 cc
560 cc
Chapter 10
Fiber Modified Diets
• High Fiber Diet
• Low Fiber, Low Residue Diet
Chapter 11
Other Modified Diets
• High Nutrient Diet
• Finger Food Modification Diet
• Vegetarian Diets
Chapter 11
Other Modified Diets
• Food Allergies and Intolerances
• Lactose Restricted Diet
• Gluten Restricted Diet
• Phenylalanine Restricted Diet
Food Allergies
•
•
•
•
•
Milk Allergy
Egg Allergy
Peanut Allergy
Tree Nut Allergy
Fish and Shellfish Allergies
Peanut Allergy
•
•
•
•
•
•
•
Beer nuts
Peanut oil
Ground nuts
Mixed nuts
Peanuts
Peanut butter
Peanut flour
Chapter 11
Other Modified Diets
• Food Allergies and Intolerances
• Lactose Restricted Diet
• Gluten Restricted Diet
• Phenylalanine Restricted Diet
Chapter 11
Other Modified Diets
• Food Allergies and Intolerances
• Lactose Restricted Diet
• Gluten Restricted Diet
• Phenylalanine Restricted Diet
Phenylalanine Restricted Diet
• PKU is caused by the lack of an enzyme
that normally converts phenylalanine to
tyrosine.
• This causes phenylalanine to build up in
the blood and brain and causes mental
retardation.
• A special diet will prevent this mental
retardation if it is started soon after birth.
PKU (cont)
• Now, every child is screened within a
couple of days of birth for PKU.
• Before newborn screening began in the
1960’s, most children had some degree of
mental retardation before they were
identified as having PKU.
• Some of these individuals are now in
group homes or other residential settings.
PKU (cont)
• Even though the mental retardation cannot
be reversed, it is still recommended these
individuals be placed on a phenylalanine
restricted diet as some of the behavior
problems associated with untreated PKU
improve when put on the diet.
DIET PRINCIPLES
• Consume a special formula that has the
phenylalanine removed, but still has all the
other amino acids.
• Avoid all foods high in protein.
• Avoid all foods containing Nutrasweet.
Saccharin and Splenda are ok.
• May eat measured amounts of fruits,
vegetables, grains, and low protein foods.
PKU (cont)
• A registered dietitian familiar with the PKU
diet should assist in menu planning and
teaching.
Sample PKU Meal
•
•
•
•
Special metabolic formula
Fruit
Vegetable
Low protein food and/or grain product
Chapter 12
Dining Assistance/Special Needs
• Feeding Guidelines for Individuals with
Dementia
• Nutrition for Individuals with
Developmental Disabilities
Study Guide Questions
• Chapters Rearranged
• Inclusion of Study Guide Questions after
each chapter
• Suggested Responses in Appendix
Appendixes
• Updated Dietary Reference Intakes
(DRI’s)
• Body Mass Index Table (expanded to
include morbid obesity)
• Addition of calcium and iron foods
• ADA Exchange Lists for Meal Planning,
2003
Simplified Diet Manual Tenth Edition
Publication Date: January 2007
Edited by Andrea Maher and the Iowa Dietetic Association
Ordering Information
Phone: 1.877.762.2974
Mail: Wiley-Blackwell
Customer Care
10475 Crosspoint Blvd.
Indianapolis, IN 46256
Fax: 1.800.605.2665
Website: www.blackwellfood.com/9780813818788
Questions?