Clinical Nutrition and Dietetics Chapter Notes | Home Science for Class 12 - Humanities/Arts PDF Download

Introduction

• Nutrition is the science of food, nutrients, and other substances, focusing on their digestion, absorption, and utilization by the body.
• It encompasses social, psychological, and economic aspects of food and eating.
• Optimum nutrition is crucial for immunity, protection from infections, and promoting recovery from illnesses and management of chronic diseases.
• Inadequate nutrient intake impairs immune defenses, wound healing, medication utilization, and organ functions, increasing complication risks.
• Nutrition plays a significant role in disease management, complementing medical treatment in some cases and being central in others.
• Nutritional status and support before and after illness influence prognosis, recovery, and hospitalization duration.
• Illness can cause nutrient imbalances even in individuals with previously good nutritional status.
• Health and nutrition are closely linked; poor nutrition exacerbates health problems and worsens existing conditions.
• Clinical Nutrition, also known as Medical Nutrition Therapy, specializes in nutrition during illness.

Significance

• Nutritional care has gained global importance, particularly in recent times, due to its impact on health outcomes.
• Health problems, illnesses, or diseases and their treatments can impair eating, swallowing, digestion, absorption, metabolism, and excretion.
• A single affected function can lead to broader impacts on other body functions if the condition worsens.
• Clinical nutrition focuses on nutritional management for patients with established diseases, addressing organ, tissue, or system dysfunctions.
• Conditions range from minor and acute to major and chronic, requiring adequate nourishment delivered by trained dietitians, medical nutrition therapists, or clinical nutritionists.
• These professionals use a systematic, logical approach to the nutrition care process, addressing each patient’s unique needs holistically.
• The patient is the primary focus of the nutritional care process.
• Advances in medicine and pharmacology in the 20th and 21st centuries have controlled many communicable diseases, but new diseases like HIV/AIDS have emerged.
• Non-communicable diseases such as obesity, heart disease, hypertension, and diabetes are increasing, occurring at younger ages, with India poised to become the diabetes capital of the world.
• Older populations require specialized nutritional attention, increasing the need for nutritional care, support, and diet counseling.
• Clinical nutritionists and medical nutrition therapists play key roles in disease prevention, health promotion, and recommending therapeutic diets for disease management.
• New scientific knowledge highlights physiological and metabolic disturbances in chronic and acute diseases, leading to advanced nutritional assessment methods and new nourishing techniques and supplements.
• Advances in the food and pharmaceutical industries have driven basic nutrition research, revealing roles of nutrients, nutraceuticals, phytochemicals, and bioactive substances in gene expression, metabolic regulation, and disease prevention and treatment.
• Antioxidants like beta-carotene, selenium, vitamin E, and vitamin C from food have protective roles.
• According to the FSSAI, foods for special dietary uses, functional foods, nutraceuticals, or health supplements are specially processed or formulated to meet specific dietary needs due to physical, physiological, or disease conditions, differing significantly from ordinary foods.
• These foods may contain plants, botanicals, minerals, vitamins, proteins, metals, amino acids, enzymes, animal-origin substances, or dietary substances to supplement total dietary intake.
• Medical foods are specially manufactured for specific disease management, regulated, and used under a doctor’s prescription.
• Phytochemicals and bioactive compounds are non-nutrient food constituents with physiological or biological activity that influence health.

Basic Concepts

• Dietitians and medical nutrition therapists provide advice and translate technical information into dietary guidelines for patients and healthy individuals across the life cycle (pregnancy to old age) to maintain good nutritional status and health.
• Nutrition and diet therapy improve overall health for patients with conditions like diarrhea, vomiting, food allergies, anemia, fever, typhoid, tuberculosis, ulcers, hyperacidity, heartburn, epilepsy, gastrointestinal problems, AIDS, hypertension, cancer, osteoporosis, obesity, burns, metabolic disorders (e.g., diabetes), and kidney, liver, or pancreatic disorders.
• Patients undergoing surgery require pre- and post-operative nutritional support.
• Clinical Nutrition and Dietetics focuses on the nutritional requirements of patients with various diseases, prescribing appropriate diets.
• Objectives of Diet Therapy:
  • Promote recovery by formulating diets that meet patient needs while considering food habits.
  • Modify existing diets to ameliorate and control disease conditions.
  • Correct nutritional deficiencies.
  • Prevent short-term and long-term complications in chronic diseases.
  • Educate and counsel patients on adhering to prescribed diets.
• Dietitians consider the effects of illness on food acceptance and utilization, including nutritional stress, psychological stress, food acceptance, and acceptability of modified therapeutic diets.
• Nutritional Care During Illness:An organized group of activities including:
  • Assessing nutritional status.
  • Diagnosing nutritional problems.
  • Planning and prioritizing nutrition interventions to meet nutritional needs.
  • Monitoring and evaluating nutritional care outcomes, making changes as needed.
• The nutritional care process applies to individuals or groups in various settings, including healthy clients in fitness/wellness programs, pregnant women, elderly persons, and patients in clinics or hospitals (municipal, government, charitable, or private).
• Clinical nutrition and dietetics professionals:
  • Plan diets to meet nutritional needs at different life stages.
  • Modify diets for disease conditions, considering physical state, occupation, cultural, ethnic, and socio-economic backgrounds, treatment regimens, and individual preferences.
  • Plan diets for special groups like athletes, space travelers, submarine workers, defense personnel, and industrial workers.
  • Promote health and well-being for hospital or outpatient clinic patients and institutional settings (e.g., old age homes, schools, orphanages).
  • Manage food services in institutional settings.
  • Assist patients with chronic diseases like diabetes and heart disease to prevent complications and improve quality of life.
  • Enhance health care services through better patient care management, holistic care, and improved survival and recovery rates.
• Nutritional Assessment: Involves:
  • Collecting detailed health, diet, personal, and medication histories.
  • Conducting anthropometric measurements.
  • Relating laboratory and physical measurements to the above and the physician’s diagnosis.
  • Interpreting data to identify current and potential nutritional deficiencies.
• Physicians are ultimately responsible for meeting patients’ medical needs, but dietitians prescribe diets, ensure food provision in hospitals per dietary restrictions, and provide counseling based on the physician’s diagnosis and nutritional assessment.
• Clinical nutrition is increasingly integrated into mainstream medical treatment, with dietitians as integral members of medical teams.
• Dietitians ensure appropriate diets and optimal nutritional care by assessing nutritional status, analyzing nutrient needs (which vary by disease state), and developing nutrition care plans for hospitalized or outpatient department patients.
• Normal and therapeutic diets are planned to maintain or restore good nutrition, considering food patterns, frequency, disease diagnosis, physician prescriptions, health status, physical condition (ability to eat, chew, swallow, digest, absorb), hunger, physical activity, lifestyle, dietary supplements, and cultural, ethnic, or religious beliefs.
• Types of Diets:
  • Standard, Normal, or Regular Diet: Includes all food groups, meets healthy individuals’ needs, but in hospitals, is low in fried fatty foods, sweets, spices, and condiments.
  • Modified Diets:Adjusted to meet medical needs, involving:
    • Changes in consistency or texture (e.g., fluid, soft diets).
    • Increases or decreases in energy intake.
    • Adjustments in nutrient amounts (e.g., high protein for surgery, low protein for kidney failure, high/low fiber, low fat, low sodium, restricted fluids, restricted foods high in non-nutritive constituents like oxalates in spinach).
    • Changes in meal frequency, feeding intervals, or special plans for altered feeding routes.
• Changes in Consistency:
  • Liquid Diets: Fluid at room temperature, also called full fluid diets, free from fiber, nutritionally adequate, easily absorbed if the gastrointestinal tract functions normally, suitable for those unable to chew or swallow (e.g., coconut water, fruit juice, soup, milk, buttermilk, milkshakes).
  • Clear Liquid Diet: Thinner consistency (e.g., clear soups, juices without pulp, light tea), prescribed post-surgery, but limited in meeting full nutritional needs.
  • Soft Diets: Semi-solid, lightly seasoned, low in fibrous or gas-forming foods, easy to chew and digest (e.g., khichdi, sago kheer), minimizing risks of indigestion, abdominal distention, nausea, cramping, or gastrointestinal issues.
  • Mechanical Soft Diet: Includes soft, mashed, pureed foods for elderly with chewing difficulties, distinct from therapeutic soft diets, which are soft, simple, easily digestible, low in harsh fiber, fat, or spices, recommended for digestive rest.
• Feeding Routes:
  • Oral Feeding: The preferred method, by mouth.
  • Tube Feeding: Nutritionally complete feeds delivered through a nasal tube to the stomach for patients unable to chew or swallow (e.g., unconscious or with esophageal issues), preferred over intravenous if the gastrointestinal tract functions.
  • Intravenous Feeding: Special solutions delivered via a vein drip for patients unable to use tube feeding.
• Prevention of Chronic Diseases:
  • Good nutrition and healthy lifestyles can control and delay chronic disease onset.
  • Modern processed foods, high in additives, fat, sugar, and low in fiber and health-conferring constituents, necessitate guidance for appropriate food choices.
  • Urban Indian diets over the past decade show increased fat and refined sugar consumption, reduced fiber, vitamins, and minerals, and higher animal protein in non-vegetarian populations.
  • These changes are linked to increased chronic diseases like obesity, colon cancer, diabetes, cardiovascular disease, and hypertension.
  • Increased sugar, fat, and reduced fiber, combined with less physical activity, contribute to obesity and diabetes.
  • High sodium in processed foods, low potassium from fruits, vegetables, grains, legumes, low calcium, reduced physical activity, and stress increase hypertension risk.
  • Clinical nutritionists provide diet counseling to prevent such issues and guide groups like schools and colleges.

Preparing for a Career

• Knowledge Requirements:
  • Physiological changes in disease conditions.
  • Changes in Recommended Dietary Allowances (RDAs) and nutrient requirements during illness.
  • Types of dietary modifications needed.
  • Traditional and ethnic cuisines.
  • Basic biological and physical sciences (chemistry, biology, physiology, biochemistry).
  • Microbiology, food microbiology, and safety.
  • Food quality and assurance, food laws, and regulations.
  • Physics for effective use and maintenance of food preparation, storage, and service equipment.
  • Food service management, including quantity food production.
  • Bookkeeping, accounts, record-keeping, and personnel management.
  • Psychology, sociology, education, and counseling for effective diet counseling.
  • Epidemiology and patterns of nutritional disorders and diseases.
• Skills Requirements:
  • Assessing nutritional status using clinical and biochemical criteria.
  • Planning diets customized to individual patient needs and specific disease conditions.
  • Recommending and administering diets.
  • Communicating for diet counseling.
  • Adapting to cultural milieus, food taboos, and overcoming fads/myths.
  • Surveying patient populations.
  • Conducting laboratory research using biochemical parameters.
  • Performing experimental research with patients to evaluate diets, drugs, and nutritional supplements.
• Educational Pathway:
  • Pass 10+2, followed by a B.Sc. in Home Science or Nutrition/Food Technology.
  • For dietitians, complete a Postgraduate Diploma in Dietetics with an internship to become a registered dietitian.
  • B.Sc. graduates in Home Science, Life Sciences, Biochemistry, Microbiology, or Biotechnology can pursue a Postgraduate Diploma.
  • M.Sc. in Food Science and Nutrition or Dietetics is preferred for specialization and employment.
  • After university education, qualify as a Registered Dietitian, subject to regulatory laws in many countries.
  • For teaching and research careers, clear National or State Eligibility Tests (UGC) and pursue a Ph.D.

Scope

• Clinical Nutrition and Dietetics offers rewarding career opportunities as dietitians, diet counselors, teachers, researchers, or corporate consultants.
• Primary roles include dietitian, diet counselor, or clinical nutritionist in research and teaching.
• Career opportunities exist in the food industry, research and development, and production of medical foods, nutraceuticals, tube feeds, nutritional support formulations, and functional foods.
• The field is ideal for those interested in using food to control, prevent, and treat disease conditions.
• It has a promising future due to expanding research into physiological and psychosocial changes in diseases and increasing acceptance of nutritional considerations in prevention, treatment, and cure.
• Research contributes to developing drugs, nutritional supplements, community rehabilitation, dietary guidelines, and nutrition education.
• Clinical nutritionists contribute to public policy, designing and implementing preventive and promotive nutrition programs to address nutritional deficiencies.
• Job Roles:
  • Dietitian in hospitals, clinics, wellness centers, gyms, or slimming clinics with consultants.
  • Key member of healthcare teams providing nutrition support in hospitals, including specialty departments.
  • Freelance dietitian.
  • Dietitian in catering services for hospitals, schools, or industrial canteens.
  • Entrepreneur developing and supplying specialty foods for health purposes.
  • Teaching and academics in universities or colleges.
  • Research, including clinical research in medical and nutrition research laboratories.
  • Consultant in companies developing therapeutic foods and supplements.
  • Food service manager/provider in hospitals.
  • Nutrition marketing.
  • Technical writing.