I can provide comprehensive dietary assessment together with advice and literature on all aspects of diet and nutrition including:

 

Overweight/Obesity

Children

Aims of the diet:

  • maintain or reduce body weight, depending on risk level
  • gradually build healthy dietary habits
  • improve eating behavior within the family, having the parents/guardians set an example
  • increase physical activity in relation to food intake
  • raise self-esteem

Characteristics of the diet:

  • ‘Low calorie’ diet, leading to improving eating behavior
  • regular eating pattern

Adults

Aims of the diet:

  • Reduce body weight by ½-1 kg per week. To reach the greatest health benefit, the goal is to lose 5-15% of the weight in a year. The target weight loss depends on the patient’s health status at the start of treatment, medication use, and other factors.
  • Aim for keeping the weight off over the long term.
  • Educate about healthy eating habits.
  • Provide insight into eating behavior and how to change eating behavior by means of self control techniques based on behavioral therapy

Characteristics of the diet:

  • ‘Low-calorie’ diet that leads to improvement of eating behaviors
  • increase physical activity in relation to food intake
Hypertension and heart diseases

Heart Failure

Aims of the diet:

  • reduce fluid retention
  • support blood pressure control
  • maintain/improve nutritional status.

Characteristics of the diet:

  • Low sodium: 2000-2400 mg.: distribute salt intake carefully over the course of the day; avoid sodium peaks.
  • Fluid restriction: for New York Heart Association (NYHA) class III and IV, not to exceed 1.5-2 L of total fluids (including infusion fluids)
  • If diuretics are used which result in potassium excretion: ensure a sufficient intake of potassium.
  • If potassium-retaining diuretics are used in combination with ACE inhibitors: no potassium-rich salt-replacing mineral mixtures when serum potassium is > 5.5 mmol/L
  • Ensure sufficient energy
  • Alcohol intake according to national Nutritional Guidelines. Alcohol abstinence in the case of alcohol-induced cardiomyopathy.
  • Lifestyle recommendations: smoking cessation, regular physical exercise
  • If BMI > 30 kg/m2: maintain/achieve a healthy body weight

Hypertension

Aims of the diet:

  • reduce blood pressure
  • support anti-hypertensive medication

Characteristics of the diet:

……based on national nutritional guidelines, with extra attention to:

  • low sodium diet, up to max. 2400 mg sodium
  • saturated fats: should account for 10% or less of total caloric intake
  • trans-fatty acids: < 1% of total caloric intake
  • at least 150-200 g vegetables and 2 servings of fruit per day
  • fish eaten twice weekly, one of which is a fatty fish (with low sodium)
  • alcohol according to recommendations (women a maximum of 1 standard glass and men a maximum of 2 standard glasses per day, spread out over the course of the week)
  • when potassium-retaining diuretics are being taken in combination with ACE inhibitors: no potassium-rich mineral mixtures when serum potassium is > 5.5 mmol/L
  • If diuretics are used which result in potassium excretion: ensure a sufficient intake of potassium in the diet.
  • lifestyle recommendations: weight loss, adequate physical exercise, smoking cessation
Respiratory diseases

Chronic Obstructive Pulmonary Disease (COPD)

Aims of the diet:

  • maintain/improve nutritional status and muscle mass.

Characteristics of the diet:

  • Energy: caloric intake based on basal metabolism (Harris & Benedict) + extra allowances
  • Protein-enriched: 1.5-1.7 g protein per kg of actual body weight
  • Calcium: 1000-1200 mg
  • Vitamin D: 10-20 μg
  • If overweight (BMI > 30 kg/m2): weight loss with extra attention to increasing physical exercise and adequate consumption of protein and calories, in order to retain muscle mass
Diseases/disorders of the stomach, intestines and liver

Acute/Chronic Pancreatitis

Aims of the diet:

  • reduce the symptoms
  • maintain/improve nutritional status

Characteristics of the diet:

Mild acute pancreatitis

  • oral nutrition is often resumed within 5-7 days: if oral food is not tolerated (increase in upper abdominal pain), start enteral nutrition within 5 days, through a gastric tube, with a feeding tube past the pylorus if necessary due to gastroparesis
  • Nutritional support is not necessary unless the patient has poor nutritional status.

Severe acute pancreatitis

  • nothing orally; if enteral feeding is tolerated, administer as soon as possible (the first choice is polymeric feeds, and if these are not tolerated then oligomeric feeds). Administer enteral tube feeds into the jejunum (past the ligament of Treitz). If the gastrointestinal tract is inaccessible and/or intake is inadequate, then (supplement with) parenteral nutrition.
  • Energy (enriched): basal metabolism (Harris & Benedict) + extra allowances (depending on the severity of the pancreatitis)
  • Protein-enriched: 1.2-1.5 g/kg of actual body weight
  • If possible (when hematology results have normalized and pain has decreased) change to oral feeding. Begin with a carbohydrate-rich liquid diet. Then progress to solid foods, if necessary low-fat diet.
  • After recovery there are no dietary restrictions.
  • Abstaining from alcohol is necessary only if alcohol was the cause of the pancreatitis.

Chronic pancreatitis

  • Energy-enriched: basal metabolsim (Harris & Benedict) + extra allowances
  • Protein-enriched: 1.2-1.5 g/kg of actual body weight
  • Frequent small meals
  • No alcohol (regardless of the cause)
  • For diabetes mellitus: see “Diabetes Mellitus”

An acute exacerbation of chronic pancreatitis can be treated as acute pancreatitis

Chronic Constipation

Aims of the diet:

  • improve the pattern of bowel movements and gastrointestinal symptoms

Characteristics of the diet:

Children

……..based on national Nutritional Guidelines (quality and quantity adjusted for age), with extra attention to adequate:

  • fats
  • dietary fibers: age + 5 g
  • fluids: infants approx. 150 ml per kg of body weight, children of up to 10 kg 1000-1500 ml per day.

Adults

  • fluids: 2-2.5 L of fluid, elderly at least 1.7 L
  • dietary fibers: at least 15 g fiber/1000 kcal and/or aim to increase dietary fiber 10-15 g more than in the current diet.

For all ages, pay special attention to the following: 

  • regular meal pattern with 3 main meals per day, including a big breakfast to stimulate the gastrocolic reflex
  • variation in the type of dietary fibers consumed, both fermentable and nonfermentable
  • eat slowly and chew food thoroughly
  • use caution with products that cause gas, as well as hot spices, coffee, alcohol, tobacco, carbonated drinks, sorbitol and fructose.

Celiac Disease and Dermatitis Herpetiformis (DH)

Aims of the diet:

  • improve/restore the damaged villi of the small intestine
  • maintain/restore normal growth / nutritional status
  • improve/prevent symptoms
  • improve/prevent complications

Characteristics of the diet:

  • Gluten-free diet
  • If symptoms persist 6-12 months after starting the diet, possibly restrict the use of (food products made with) gluten-free wheat starch
  • For DH: combination of dapsone and a gluten-free diet
  • Ensure adequate intake of dietary fiber, iodine, iron, vitamin B1, folic acid
  • lactose-free in the case of lactose intolerance; see Lactose intolerance

Food Sensitivities and Food Allergies (infants, nursing mothers, children, adults)

Aims of the diet:

  • contribute to the diagnosis of food sensitivities
  • reduce symptoms
  • maintain and/or achieve a complete and age-appropriate diet
  • plan for structured (re)introduction or provocation of suspect foods/allergens/triggers
  • to not limit food consumption unnecessarily
  • instruct in the practical application of avoiding the relevant allergen

Characteristics of the diet:

Infant

  • elimination of (suspected) allergens
  • for infant formula, an intensively hydrolyzed infant formula
  • introduction of solid food beginning at 6 months of age, which is important for the development of taste and oral motor function. If necessary, weaning foods can be introduced in stages. The following applies to highly allergenic foods: beginning at 6 months: wheat; beginning at 9 months: soy, fish, seeds, pits and where relevant, milk; beginning at 12 months: eggs, nuts, peanuts, seafood and shellfish

Nursing mothers

  • The first choice is breastfeeding, elimination of suspect allergens as needed unless this gets in the way of breastfeeding progress.

Children and adults

Diagnostic stage

  • diagnostic elimination or restriction of suspected foods (allergens/triggers) from the diet, and if necessary introduce replacement foods and/or dietetic products
  • provocation (open or double blind) and/or reintroduction (at once or in progressively greater amounts).

Treatment

  • therapeutic elimination or restriction of allergens/triggers for which there is evidence of food sensitivity
  • ensure a complete and age-appropriate diet (supplement vitamins, minerals and trace elements, as needed)
  • information about food products that contain the relevant allergens/triggers and, if necessary, introduction of replacement dietetic products

Ulcerative Colitis

Aims of the diet:

  • reduce the symptoms
  • support the medicinal treatments
  • maintain/achieve good growth curve / nutritional status
  • maintain/improve the fluid, mineral and electrolyte balance.

Characteristics of the diet:

Ulcerative colitis in remission

  • normalization of nutrient deficiencies
  • in the case of malnutrition: see “Weight Loss / Malnutrition”, if necessary with additional dietary products

Inflammation of the entire colon (pancolitis)

  • energy-enriched: resting/basal metabolism (Schofield/Harris & Benedict) + extra allowances
  • protein-enriched: the requirement depends on the disease activity
  • high sodium and fluids: depending on diuresis and elimination in diarrhea

Toxic megacolon

  • nothing orally
  • parenteral nutrition

Inflammation of the last section of the colon and the rectum (proctitis)

  • recommended allowances based on national Nutritional Guidelines
  • extra fluids: amounts depending on the urine volume
  • for IRA, IPAA, INRA (ileoneorectal anastomosis), (sub)total colectomy with ileoanal anastomosis (with reservoir/pouch): extra fluids: depending on urine volume; extra sodium: depending on urine volume, sodium in the urine and how much diarrhea. Salt capsules may need to be taken; solid foods should be taken with liquids; be aware of food products that can cause gas
  • probiotics in the form of VSL#3® are effective in preventing recurrence of pouchitis and preventing pouchitis directly after placement of an ileoanal pouch
  • individual customization of product and meal choice, taking into account food interolerances and completeness of the nutrition
  • for ileoostomy: see “Ileostomy”
  • for colostomy: based on national Nutritional Guidelines

Crohn Disease

Aims of the diet:

  • reduce symptoms
  • promote remission
  • support the medicinal treatment
  • maintain/achieve good growth curve / nutritional status
  • maintain/improve fluid, mineral and electrolyte balance
  • normalize nutritional deficiencies, paying specific attention to absorption problems.

Characteristics of the diet:

Crohn disease in remission:

  • Recommended allowances based on national Nutritional Guidelines
  • Normalization of nutrient deficiencies
  • If malnutrition exists, see “Weight loss / Malnutrition,” if necessary with additional dietary supplements

Exacerbation of Crohn disease:

  • Energy-enriched: resting/basal metabolism (Schofield/Harris & Benedict) + extra allowances
  • Protein-enriched: requirement depends on disease activity
  • Tube feeding: for children, total tube feeding (for 6 weeks) is the primary therapy; for adults, tube feeding should be considered to support the medicamentous treatment.
  • High fistulae: tube feeding past the fistula, and/or parenteral nutrition
  • Hyperoxaluria:
  • Extra fluids: at least 1.5 L + losses (diuresis/stool)
  • Fats: based on national Nutritional Guidelines, if necessary with calcium supplementation
  • Oxalate restriction is only useful when there are recurring kidney stones.
  • Stricture in the small intestine: depending on the nature and site of the stricture: avoid coarse dietary fibers, consistency: ground or puréed / liquid, enteral and/or parenteral nutrition.
  • Resection of terminal ileum and adequate intake: supplement the fat-soluble vitamins if tests show a deficiency and vitamin B12 (by injection), tube feeding and/or parenteral nutrition.
  • Additional dietary supplements in the event of reduced food intake
  • For short bowel symdrome: see “Short Bowel Syndrome”
  • For ileostomy: see “ileostomy”
  • For lactose intolerance: see “lactose intolerance”
  • For colostomy: see national Nutritional Guidelines.

Cystic Fibrosis

Aims of the diet:

  • maintain/achieve good nutritional status

Characteristics of the diet:

  • Energy-enriched: 100-150% of the recommended dietary allowance, depending on the individual energy requirements. The total individual energy requirements can be assessed on the basis of clinical observation, (growth) and nutritional status. Determining energy requirements based on resting/basal metabolism (the Schofield/Harris & Benedict equation) + extra allowances (up to 50%) often turns out to underestimate the need, in practice, in the case of CF patients.
  • Protein-enriched: for catch up growth / weight gain, and for respiratory infections

children

  • 9-15% of total caloric intake in the case of chronic malnutrition

adults

  • 1.6-2.0 g/kg of body weight for adults
  • Fats: recommended daily allowance, with at least 2% of total caloric load in the form of polyunsaturated fatty acids
  • Supplementing vitamins A, D, and E is standard, vitamin K according to indication
  • extra sodium in the event of hot weather, fever, diarrhea or strenuous physical exercise
  • for CFRD: treatment with insulin and, as needed, continuation of energy-enriched diet; for more information see “Diabetes Mellitus”
  • for DIOS: adequate fluid intake, optimal enzyme supplementation and oral laxatives.

Colonic Diverticulosis and Diverticulitis

Aims of the diet:

  • for colonic diverticulosis: relieve symptoms and prevent complications
  • for colonic diverticulitis: heal infection and inflammation and rest the bowels.

Characteristics of the diet:

Colonic diverticulosis

  • follow national Nutritional Guidelines with adequate dietary fiber: 3.4 g/MJ per day, balance between fermented and unfermented fibers, if necessary fiber-enriched diet (at least 15 g/1000 kcal and/or aim for at least 10-15 g more than the ordinary diet)
  • in the case of healthy and complete nutrition with adequate fiber: 2 L drinking fluids
  • in the case of fiber-enriched diet: 2-2.5 L drinking fluid
  • regular meals with a big breakfast in order to promote the gastrocolic reflex
  • eat slowly and chew food well

Colonic diverticulitis

  • nothing by mouth in the acute phase: for mild forms of uncomplicated diverticulitis (clear) liquid meals without pits, seeds or pulp, low-residue liquid meals or tube feeding; enteral or parenteral feeding for severe forms.

Dumping Syndrome

Aims of the diet:

  • reduce symptoms
  • maintain/improve nutritional status

Characteristics of the diet:

  • Frequent small meals
  • Chew well and eat slowly.
  • Mainly high osmolar liquid food and meals rich in carbohydrates are poorly tolerated:
  • limit consumption of drinks with meals
  • restrict mono- and disaccharides, as they increase relative intake of fats and protein.
  • Try milk (dairy products) in small amounts. These are not always well tolerated. Cultured dairy products are sometimes better tolerated.
  • For malnutrition: see “Weight Loss / Malnutrition”

Gastroesofageal reflux

Aims of the diet:

Infants

  • maintain/optimize growth curve.

Adults

  • reduce symptoms by achieving healthy body weight (BMI 20-25 kg/m²)
  • aim for normoglycemia
  • optimize/improve elimination pattern

Characteristics of the diet:

Infants

  • symptoms of uncomplicated reflux in children can be limited by thickening food.

Adults

  • ample dietary fiber and fluid intake
  • limited consumption of alcohol
  • limited consumption of fats
  • reduced portion sizes and increased frequency of meals
  • spread food throughout the day
  • if necessary, eliminate foods that influence LES pressure, acid secretion and/or pH
  • if overweight, see “Overweight”

Lactose Intolerance

Aims of the diet:

  • reduce symptoms
  • maintain/achieve complete nutrition.

Characteristics of the diet:

  • Lactose-restricted, depending on the degree of intolerance:
  • 5-10 g lactose per day is generally well tolerated. Some people may tolerate more than this.
  • Cultured dairy products are better tolerated than non-cultured.
  • Milk is better tolerated if it is taken spread over the course of the day in combination with meals.
  • If lactose restriction still gives problems: restrict lactose further or go lactose-free.
  • Use of lactase enzyme, as needed
  • Follow national Nutritional Guidelines, with extra attention to calcium and vitamin B2.

Cirrhosis of the Liver

Aims of the diet:

  • reduce symptoms/complications
  • maintain/improve nutritional status
  • support the medication

Characteristics of the diet:

  • Energy enriched: basal metabolism (Harris & Benedict) + extra allowances
  • Protein enriched: 1.2-1.5 g protein/kg ideal weight (the requirement depends on the severity of the liver cirrhosis)
  • Frequente meals (4-7 x per day)
  • Small meal before bedtime with carbohydrates and protein (related to nitrogen balance at night) and a good breakfast as soon as possible after rising
  • No alcohol

Ascites

  • Restricted sodium: not to exceed 2000 mg per day
  • Restricted fluids: for hyponatremia (< 125 mmol/L)

Encephalopathy

  • Protein-enriched: 1.2-1.5 g protein/kg ideal weight

Cirrhosis of the liver with complications

  • osteoporosis: see “Osteoporosis”
  • malnutrition: see “Weight Loss / Malnutrition”

Liver Disease

Aims of the diet:

  • maintain/achieve good growth curve / nutritional status
  • prevent vitamin and mineral deficiencies
  • prevent hypoglycemia
  • limit a delay in motor development
  • teach good dietary habits based on normal eating habits for age.

Characteristics of the diet:

  • Energy-enriched: depends upon the extent of impaired digestion and of underweight / failure to thrive
  • Protein (enriched):
  • aim for 2 – 3.5 g/kg ideal body weight
  • foods of high biological value, distributed throughout the day
  • for encephalopathy: protein: 1-1.5 g/kg ideal body weight
  • Fats:
  • preference for emulsified fats
  • ensure adequate amounts  of essential fatty acids
  • severe cholestasis: fats should be partially in the form of medium chain triglycerides (MCT) as an energy source
  • carbohydrates: for hypoglycemia, have frequent meals and meals during the night (if necessary, via continuous enteral tube feeding during the night) or continous enteral tube feeding during the day and during the night
  • if diuretics have an unsatisfactory effect and/or if there is fluid retention: restrict fluid and sodium

Diarrhea in Toddlers

Aims of the diet:

  • normalize elimination pattern
  • maintain/achieve a good growth curve.

Characteristics of the diet:

  • based on national Nutritional Guidelines, with attention to adequate amounts of fat, fiber, fluid and fructose (the 4 Fs: fat, fiber, fluid and fruit sugar)
  • normalize intake of mono- and disaccharides and sweets.

Irritable Bowel Syndrome (IBS) / Spastic Colon

Aims of the diet:

  • reduce symptoms

Characteristics of the diet:

  • Increased fluids: 1.5-2.5 L in drinking fluids
  • A regular dietary pattern, with extra attention to having 3 main meals per day, including a large breakfast to stimulate the gastrocolic reflex
  • No standard fiber enrichment, but adjust the quantity of fiber to the symptom pattern.
  • For constipation, increase dietary fiber:
  • at least 15 g per 1000 kcal and/or aim for 10-15 g more than in the normal diet
  • varied use of different types, both fermentable and non-fermentable fibers
  • ensure complete nutrition, due to the possible omission of foods due to symptoms
  • identify and restrict specific products that can cause symptoms
  • identify products that cause gas, hot spices, coffee, alcohol, tobacco, carbonated drinks, sorbitol, fructose
  • if lactose-intolerant: see “Lactose-intolerance”

Short Bowel Syndrome

Aims of the diet:

  • improve/maintain nutritional status
  • achieve/maintain good fluid and electrolyte balance
  • treat/prevent vitamin and/or mineral deficiencies
  • reduce the frequency and/or quantity of defecation, stoma output or fistula output to a manageable level

For jejunocolic anastomosis patients, also:

  • prevent D-lactate acidosis
  • prevent (calcium oxalate) kidney stones.

Characteristics of the diet:

  • postoperative treatment: following bowel resection/ostomy, parenteral nutrition may be necessary during a shorter or longer period (> 1 year to lifelong), whereby oral and/or tube feeding is gradually increased, based on tolerance. The duration of parenteral support depends partly on the remaining functional intestine and the presence or absence of a colon.
  • Energy-enriched: basal metabolism (Harris & Benedict) + extra allowances, and 30-50% above that
  • Protein: can be given in polymeric form
  • Carbohydrates, fats:
  • normal amounts of mono- and disacharides, preference for polysacharides
  • soluble fibers are preferable
  • frequent meals
  • supplement vitamins and minerals as needed
  • if tube feeding is given, polymeric feeds are preferable.

Intact colon and > 1 meter of ileal resection

  • low-fat: MCT fat (medium chain triglycerides) can be an alternative source of energy
  • for hyperoxaluria and calcium oxalate calculi: a diet low in oxalate
  • if the resection is >60 cm of terminal ileum: supplement vitamin B12
  • high-sodium
  • supplement fluid intake with ORS, as needed.

Jejunostomy

  • no more than 500 ml hypotonic drinks per day, Other ORS
Surgery

Bariatric Surgery – Preoperative/Postoperative

Preop

Aims of the diet:

  • to assess whether the patient is a suitable candidate for bariatric surgery
  • to assess which surgical procedure could be most successful
  • to maintain/improve nutritional status, specifically aimed at preventing/treating nutrient deficiencies
  • to prepare the patient well for life after the surgery through an educational program around diet and lifestyle.

Characteristics of the diet:

  • If necessary, for 2-6 weeks preoperatively, stay on a Very Low Calorie Diet (VLCD) to shrink the liver, which will facilitate the operation.
  • multivitamin and mineral supplements for any nutrient deficiencies that may already be present

Postop

Aims of the diet:

  • to reduce weight and maintain the target weight:

gastric band

  • > 45% Excess Weight Loss (EWL) is attainable

Roux-en-Y gastric bypass/sleeve gastrectomy

  • > 60% EWL is attainable

duodenal switch

  • >70% EWL is attainable
  • maintain/improve nutritional status, specifically aimed at preventing/treating nutrient deficiencies
  • reduce/prevent comorbidity
  • reduce/prevent physical and/or psychological symptoms.

Characteristics of the diet:

  • Initial postoperative nutrition varies from one institution to another. Usually the patient is started on (clear) liquid meals, and the diet is then built up gradually.
  • based on national Nutritional Guidelines, with an emphasis on adequate fluids and fibers
  • Energy-restricted
  • Protein: at least 60 g, but aim for a daily intake of 90 g (Roux-en-Y gastric bypass / duodenal switch)
  • regular eating pattern, frequent (small) meals
  • chew well and take time eating a meal
  • separate fluids and solid foods during the meals (Roux-en-Y gastric bypass, sleeve gastrectomy, duodenal switch)
  • stop eating when satiated and/or nauseous
  • multivitamin supplements:

gastric band/sleeve gastrectomy

  • Advise taking 1 x multivitamin with 100% RDA, with at least 2/3 of the nutrients represented in the supplement; be sure the supplement does contain B vitamins, zinc and selenium, and 100% RDA of iron and folic acid.

Roux-en-Y gastric bypass/duodenal switch

  • advise taking 2 x multivitamin with 100% RDA with at least 2/3 of the nutrients represented in the supplement; be sure the supplement does contain B vitamins, zinc and selenium, and 100% RDA of iron and folic acid. If necessary supplement calcium and vitamin D.

Ileostomy

Aims of the diet:

  • stabilize/improve the fluid and electrolyte balance
  • prevent passage disorders of the digestive tract / obstruction due to food wast
  • prevent unwanted weight gain and weight loss
  • maintain/improve nutritional status
  • ensure appropriate consumption of foods or products that can cause constipation, gas, stains and odors.

Characteristics of the diet:

  • Follow national Nutritional Guidelines, with the exception of fluids and sodium:
  • 2-2.5 L fluid per day: fluid intake should be increased if there are symptoms of dehydration, the urine has a dark color and urine output is low (less than one liter). (Does not apply to high output ileostomy.)
  • High sodium: if symptoms caused by sodium deficiency occur
  • Draw attention to:
  • avoiding unwanted weight gain and weight loss
  • eating slowly and chewing foods well, especially high-fiber foods
  • products that can cause gas, stains and odor formation
  • fecal consistency
  • increased loss of fluid and salt.

Intermaxillary Fixation

Aims of the diet:

  • maintain/improve nutritional status
  • restore elimination to a normal pattern

Characteristics of the diet:

  • liquid consistency
  • in accordance with national Nutritional Guidelines, with attention to adequate caloric, protein, dietary fiber, and fluid intake
  • equal distribution of food and drinking fluids over the course of the day
  • use caution with hot spices and acid products when there is mouth pain.

Preoperative and Postoperative Care

Aims of the diet:

  • maintain/improve nutritional status
  • reduce symptoms

Characteristics of the diet:

  • Energy-enriched: basal metabolism (Harris & Benedict) + extra allowances (30% for preoperative and 50% for preoperative if weight gain is desired)
  • Protein-enriched: preoperatively: 1.5-1.7 g/kg body weight; postoperatively: 1.2-1.7 g/kg body weight. In intensive care, a diet of 1.2-1.5 g/kg body weight is adequate. Calculate the protein requirement based on the actual weight. Ensure adequate amounts of vitamins/minerals, depending on the pathology.
  • Ensure adequate fluids, a minimum of 1.5 to 2 L per day, correcting for significant losses and fever (350 ml per degree).
  • For malnutrition: see “Malnutrition”
Eating disorder

Anorexia Nervosa

Aims of the diet (determined individually in consultation with caregivers and other health care providers):

  • in the stage at which weight gain is the goal: aim for 0.3-1 kg per week
  • then maintain healthy weight
  • achieve a (healthy) complete food intake and establish adequate eating behavior
  • change irrational thought patterns about food and weight through psychoeducation
  • prevent relapse

Characteristics of the treatment:

  • Be attentive to the possibility of refeeding syndrome.
  • If there has been laxative abuse, prescribe a diet rich in dietary fiber, if necessary.
  • Motivate patient to undergo treatment and behavioral modification.
  • psychoeducation with regard to: providing insight into nutrition and food-related topics, effects of fasting and/or purging behavior, effects of malnutrition, hunger and satisfaction, digestion
  • Behavior modification through: normalizing dietary pattern, providing insight into and changing irrational thoughts

Binge Eating Disorder

Aims of the diet:

  • normalize eating habits, aiming for a complete nutritional diet, a regular meal schedule and structure.
  • reduce the eating binges
  • stabilize weight: in the longer term (moderate) weight loss
  • modify irrational thought patterns about food and weight, through psychoeducation
  • prevent relapse

Characteristics of the treatment:

  • psychoeducation with regard to:
  • providing insight into nutrition, food related topics and weight
  • effects of eating patterns (physical, psychological and social)
  • behavioral modification through: learning how to manage food cravings through self-control techniques and development of alternative behavior, learning how to manage food cravings through insight into and changing irrational thoughts, for weight loss: energy-restricted diet

Bulimia Nervosa

Aims of the diet:

  • achieve a (healthy) complete diet and adequate eating habits
  • modify irrational thought patterns about food and weight, through psychoeducation
  • prevent relapse
  • maintain a healthy weight

Treatment characteristics:

  • motivating the patient to be in treatment is an important part of the treatment
  • in the case of laxative abuse: a diet high in dietary fiber, if necessary
  • psychoeducation with regard to: providing insight into nutrition and food-related topics, effects of fasting and/or purging behavior, effects of malnutrition, hunger and satiation, digestion
  • behavior modification through: restoring normal eating habits, providing awareness of and changing irrational thought patterns
Diseases of the kidney

Chronic Kidney Disease (CKD)

Aims of the diet:

  • Treat the factors affecting the rate of progression:
  • slow the rate of renal deterioration
  • support blood pressure regulation: aim for a blood pressure of < 130 Hg, age-dependent for children
  • reduce the fluid retention
  • reduce the proteinuria to < 1 g/14 hours.
  • Treat the complications:
  • contribute to good calcium and phosphate metabolism: aim for a serum phosphate of < 2.0 mmol/L (children < 1 year old), < 1.8 mmol/L (children > 1 year old) and serum calcium 2.1-2.6 mmol/L, < 1.5 mmol/L (adults)
  • contribute to the treatment of metabolic acidosis: aim for a serum total HCO3 CO2 of 20-22 mmol/L; treat with medication in children
  • regulate the electrolyte balance: aim for serum potassium of < 5.0 mmol/L (children), < 5.5 mmol/L (adults)
  • prevent nutrition-related complications: aim for serum urea of < 20 mmol/L (children), < 30 mmol/L (adults)
  • reduce the risk of cardiovascular complications
  • reduce weight, if overweight
  • promote healthy habits (exercise, smoking cessation)

Characteristics of the diet:

Children:

  • Energy: resting metabolism (Schofield) + extra allowances. Maintain ratio of weight to height (growth curve)
  • Protein: 0.8-1.8 g/kg of body weight, depending on age and serum urea levels
  • Low sodium: not to exceed 2000 mg
  • Potassium restrictions based on the lab results: at > 5 mmol/L; restrict based on age, dietary assessment and whether potassium-lowering medications are being taken.
  • Phosphate restriction based on the lab results: < 400 mg/day (infants), 400-600 mg/day (children < 20 kg), < 800 mg/day (children > 20 kg), in combination with phosphate binding medication, where relevant
  • Restricted fluids: 300 ml/m² of body surface area + urine production
  • Restricted calcium: in food, restrict to 100% of the recommended allowance

Adults

  • Energy: basal metabolism (Harris & Benedict) + extra allowances (unless it is obvious that there is significant fluid retention)
  • Low protein diet 0.8 g/actual weight (if BMI is > 27 kg/m2, the protein calculation is based on the weight for a BMI of 27 kg/m2)
  • Low sodium: not to exceed 2400 mg
  • Potassium restriction based on lab results:
  • When serum potassium is > 5 mmol/L: 2000-3000 mg per day, depending on dietary assessment and/or use of potassium-lowering medications
  • Phosphate restriction based on lab results: when serum phosphate is > 1.5 mmol/L: phosphate should be 800-1000 mg, which must not get in the way of adequate protein intake. If phosphate binding medication is indicated, the phosphate binding medication will need to be balanced with phosphate intake in the diet.
  • Calcium: < 2000 mg elemental calcium, which includes the calcium obtained from calcium-based phosphate binders
  • Fluids:
  • at least 1.5-2 L per day
  • For patients with heart failure, a fluid restriction of 1.5-2 L per day is recommended; if a high dose of diuretics is needed in order to prevent fluid retention, restrict fluid to 1.5 L per day.
  • Fluids from solid food are not included in the fluid restriction calculation.
  • for kidney stones and gout: at least 2.5-3 L per day

Chronic Kidney Disease – Hemodialysis (HD)

Aims of the diet:

  • Treat the complications:
  • contribute to good calcium and phosphate metabolism: aim for a serum phosphate of < 2.0 mmol/L (children < 1 year old), < 1.8 mmol/L (children > 1 year old), < 1.5 mmol/L (adults) and serum calcium of 2.1-2.6 mmol/L
  • contribute to the treatment of metabolic acidosis: aim for a serum total CO2 of 20-22 mmol/L; treat with medication in children
  • regulate the electrolyte balance: aim for serum potassium of < 5.0 mmol/L (children), < 5.5 mmol/L (adults)
  • aim for serum urea of < 20 mmol/L (children), 20-30 mmol/L (adults)
  • reduce the fluid retention
  • maintain/achieve a good growth curve/nutritional status
  • reduce the risk of cardiovascular complications
  • support blood pressure regulation: aim for a blood pressure of < 130 Hg (adults), age-dependent for children
  • reduce weight if overweight
  • promote healthy habits (exercise, smoking cessation).

Characteristics of the diet:

Children:

  • Energy: resting metabolism (Schofield) + extra allowances. Maintain ratio of weight-to-height (growth curve).
  • Protein: 1.2- 2.6 g/kg of body weight, depending on age and serum urea levels
  • Low sodium: not to exceed 2000 mg (to prevent fluid overload, hypertension and to support the fluid restrictions)
  • Potassium restriction based on the lab results: if > 5 mmol/L, restrict potassium depending on age, dietary assessment and whether potassium-lowering medications are being taken
  • Phosphate restriction based on the lab results: if serum phosphate is more than the indicated limit, restrict as follows: < 400 mg/day (infants), 400-600 mg/day (children < 20 kg), < 800 mg/day (children > 20 kg), possibly in combination with phosphate binding medication
  • Restricted fluids: 300 ml/m² of body surface + urine output, depending on maximum weight gain of about 1-2 kg between 2 dialysis periods
  • Calcium restriction: in food, restrict to 100% of the recommended allowance

Adults

  • Energy: basal metabolism (Harris & Benedict) + extra allowances (unless it is obvious that there is a significant fluid retention)
  • Protein: 1.0-1.2 g/kg of body weight, based on the actual body weight, unless the patient is overweight and/or has fluid overload, in which case: When BMI is > 27 kg/m2, base the protein allowance on the weight for a BMI of 27 kg/m2. When there is fluid overload, base the protein allowance on the weight before there was fluid overload. In the case of severe malnourishment, the protein requirement will be higher.
  • Low sodium: not to exceed 2400 mg
  • Potassium restriction based on lab results: when serum potassium is > 5.5 mmol/L: 2000-3000 mg per day, depending on dietary assessment and/or use of potassium-lowering medications.
  • Phosphate restriction based on lab results: when serum phosphate is > 1.5 mmol/L: 800-1000 mg, which must not get in the way of adequate protein intake. If phosphate binding medication is indicated, the phosphate binding medication will need to be balanced with the phosphate intake in the diet.
  • Calcium: < 2000 mg elemental calcium, which includes the calcium obtained from calcium-based phosphate binders
  • drinking fluids: 0.8 L + urine output per day (depending on BMI, urine output and cardiac function). The interdialytic weight gain must not exceed 4.0-4.5% of the dialysis target weight for stable patients without heart failure.
  • if there is constipation: see “Chronic Constipation”

Chronic Kidney Disease – Peritoneal Dialysis (PD)

Aims of the diet:

  • Treat the complications:
  • contribute to good calcium and phosphate balance: aim for a serum phosphate of < 2 mmol/L (children < 1 year old), < 1.8 mmol/L (children > 1 year old), < 1.5 mmol/L (adults) and serum calcium of 2.1-2.6 mmol/L
  • contribute to the treatment of metabolic acidosis: aim for a serum total CO2 of 20-22 mmol/L; treat with medication in children
  • regulate the electrolyte balance: aim for serum potassium of < 5.0 mmol/L (children), < 5.5 mmol/L (adults)
  • aim for serum urea: < 20 mmol/L (children), 20-25 mmol/L (adults)
  • reduce fluid retention
  • prevent unwanted weight gain.
  • maintain/achieve a good growth curve/nutritional status
  • reduce the risk of cardiovascular complications
  • support blood pressure regulation; work towards a blood pressure of < 130 Hg; this is age-dependent in children
  • reduce weight if overweight
  • promote healthy habits (exercise, smoking cessation)

Characteristics of the diet:

Children

  • Energy: resting metabolism (Schofield) + extra allowances. Maintain the ratio of weight-to-height (growth curve).
  • Protein: 1.4-3.0 g/kg body weight, depending on age and serum urea levels.
  • Sodium: not to exceed 2000 mg (to prevent fluid overload and hypertension, and to support fluid restrictions)
  • Restricted potassium based on the lab results; if over 5 mmol/L: restrict according to age, dietary assessment and whether potassium-lowering medications are being taken
  • Phosphate restriction based on lab results; restrict when serum phosphate is above the designated limit: < 400 mg/day (infants), 400-600 mg/day (children < 20 kg) and < 800 mg/day (children > 20 kg), if applicable in combination with phosphate-binding medication
  • restricted fluids, only restricted in the event of reduced ultrafiltration: 300 ml/m² body surface area + urine production
  • restricted calcium: in food, restrict to 100% of the recommended allowance

Adults

  • Energy: basal metabolism (Harris & Benedict) + extra allowances (unless it is obvious that there is significant fluid retention)
  • Protein: 1-1.2 g/kg body weight, based on the actual body weight, unless the patient is overweight and/or there is overfilling, in which case: When BMI is > 27 kg/m2, base the protein guidelines on the weight for a BMI of 27 kg/m2. When there is overfilling, base the protein allowance on the weight prior to overfilling. The protein requirements are higher in the presence of peritonitis or malnutrition.
  • Low sodium: not to exceed 2400 mg
  • Restricted potassium based on lab results; if serum potassium is over 5.5 mmol/L: 2000-3000 mg per day or depending on dietary assessment and/or use of medications that lower potassium
  • Phosphate restriction based on lab results; restrict when serum phosphate is above 1.5 mmol/L: 800-1000 mg; this must not get in the way of adequate protein intake. If phosphate binding medication is indicated, the phosphate-binding medication will need to be balanced with phosphate intake in the diet.
  • Calcium: < 2000 mg elemental calcium, which includes the calcium obtained from calcium-based phosphate binders
  • fluids: normal fluid intake: 1.5 L/day, unless there is poor ultrafiltration
  • for constipation: see “Chronic constipation”

Chronic Kidney Disease – Kidney Transplants

Aims of the diet:

In the short term

  • Treat the complications:
  • regulate the electrolyte balance, aim for a serum potassium of <5.5 mmol/L
  • support blood pressure regulation
  • reduce fluid retention
  • contribute to good calcium and phosphate balance. Aim for a serum phosphate of < 1.5 mmol/L (adults).
  • maintain/achieve good growth curve/nutritional status
  • prevent food infection

In the long term (after about 2 months)

  • prevent or treat complications, which arise partly as a result of taking immunosuppressants and corticosteroids (there is an elevated risk of diabetes)
  • prevent overweight

Adults

  • BMI < 25 kg/m2 or waist circumference of < 80 cm for women and < 94 cm for men. If BMI and/or waist circumference is higher, weight should be reduced by at least 5-10%.

Children:

  • maintain/achieve good growth curve/nutritional status
  • prevent osteoporosis
  • reduce the risk of cardiovascular complications: aim for a serum LDL cholesterol of < 2.5 mmol/L
  • promote healthy habits (exercise, smoking cessation).

 

Characteristics of the diet:

Children:

  • Energy: resting metabolism (Schofield) + extra allowances (if there is a tendency to be overweight, then low-calorie diet)
  • Protein: 0.9-2.5 g/kg body weight/day depening on age and serum urea levels
  • Phosfate: hypophosphatemia is often seen in the short term, and is treated with medication
  • Fluids: when there is good renal function, ensure ample fluid intake: depending on age, this can be 1000-2000 ml/day
  • Base nutrient composition as far as possible on the recommended allowances
  • If the kidney has begun functioning well, no restrictions are necessary. Depending on the clinical course of the transplant, temporary dietary restrictions may be necessary. See “Chronic Kidney Disease”

Adults

  • Energy:
  • in the short term: basal metabolism (Harris & Benedict) + extra allowances
  • in the long term: adequate amounts, balancing consumption with the elevated risk of excess weight gain.
  • Protein:
  • in the short term: 1.2-1.5 g/kg of actual body weight (when BMI is > 27 kg/m2; the protein allowance calculation is based on on the weight for a BMI of 27 kg/m2)
  • in the long term: 0.8 g/kg of actual body weight (when BMI is > 27 kg/m2; the protein allowance calculation is based on the weight for a BMI of 27 kg/m2)
  • when corticosteroids are taken at doses of > 0.2 mg/kg/day: 1.0 g/kg of actual body weight (when BMI is > 27 kg/m2; the protein calculation is based on the weight for a BMI of 27 kg/m2)
  • Sodium: not to exceed 2400 mg
  • Potassium: restrict based on lab results: when serum potassium is > 5 mmol/L: 2000-3000 mg per day depending on dietary assessment and/or use of potassium-lowering medications
  • Calcium and vitamin D: When corticosteroids are being taken at high doses, supplement calcium carbonate and vitamin D
  • Phosphate: restrict based on lab results: when serum phosphate is > 1.5 mmol/L: 800-1000 mg, which must not get in the way of adequate protein intake. If phosphate binding medication is indicated, the phosphate binding medication will need to be balanced with phosphate intake in the diet.
  • Fluids:
  • If urine output is insufficient, restrict fluids: 1000 ml (500 ml drinking fluids + 500 ml from solid food) + diuresis
  • If urine output is sufficient, drink at least 2 L per day.

Chronic Kidney Disease – Nephrotic Syndrome

Aims of the diet:

  • Treat the complications:
  • reduce fluid retention
  • reduce protein loss
  • support blood pressure regulation
  • maintain/achieve good growth curve/nutritional status
  • prevent or treat complications that arise partly from the use of immunosuppressants and corticosteroids: there is an elevated risk of diabetes with long-term use
  • prevent overweight
  • prevent osteoporosis
  • reduce the risk of cardiovascular complications: aim for a serum LDL cholesterol of < 2.5 mmol/L
  • promote healthy habits (exercise, smoking cessation)
  • prevent food infections (when taking high doses of immunosuppressants and/or corticosteroids)

Characteristics of the diet:

Children:

  • Energy: resting metabolism (Schofield) + extra allowances (over the long term may need to be slightly restricted, due to the elevated risk of excess weight gain from prolonged use of corticosteroids)
  • Protein: follow recommended dietary allowances for age per kg of ideal body weight (no protein restriction)
  • Sodium restriction: amount of sodium depending on weight/age and use of ACE inhibitors (usually mildly low-sodium food; when there is severe fluid overload, a stricter sodium restriction may be necessary)
  • Calcium and vitamin D: based on recommended amounts. Supplement as needed, when there is prolonged use of corticosteroids.
  • Fluids: restrict when there is fluid overload, depending on weight/age.

Adults

  • Energy: basal metabolism (Harris & Benedict) + extra allowances (adequate caloric intake over the long term based on consumption in association with elevated risk of excessive weight gain due to prolonged use of corticosteroids)
  • Protein: 0.8 g/kg actual body weight, corrected for fluid retention.(If BMI is > 27 kg/m2, the protein calculation is based on the body weight for a BMI of 27 kg/m2)
  • Sodium restriction: not to exceed 2400 mg (if there is severe fluid overload, a stricter sodium restriction of up to 1200 mg may be necessary)
  • Potassium restriction based on lab results: if serum potassium is > 5.5 mmol/L: 2000-3000 mg per day, it is dependent on dietary assessment and/or use of potassium lowering medications
  • Calcium and vitamin D: based on recommended amounts. Supplement as needed during prolonged use of corticosteroids.
  • Fluids: 1.5-2 L per day, or if there is severe fluid overload, 1.5 L per day
  • for hyperlipidemia: see “Hypercholesterolemia”
  • for chronic renal dysfunction: see “Chronic Kidney Disease”
  • for diabetes mellitus: see Diabetes mellitus”

Urinary Calculus (Urolith)

Aims of the diet:

  • prevent further growth of the stone
  • contribute to preventing recurrent stones

Characteristics of the diet:

  • Extra fluids: a quantity of drinking fluids that results in at least 2 L of urine output. In particular, drink copiously at and around mealtimes and before bedtime. For cystine calculi, aim for urine output of at least 3½ L. In selecting beverages, half should consist of water or mineral water, and the rest of (low-calorie) drinks.
  • Calcium: follow recommended allowances
  • Low sodium: not to exceed 2400 mg
  • Protein: normalize to 0.8-1.0 g protein/kg. Avoid consumption of large quantities of animal protein.
  • Restrict the use of dietary oxalate
  • Follow national Nutritional Guidelines, with extra attention to:
  • consumption of adequate amounts of vegetables and fruit
  • consumption of adequate dietary fiber
  • moderate use of alcohol.
  • If there is excessive uric acid being excreted (hyperuricosuria), restrict purine
  • If overweight, see “Overweight”
Metabolic disorders

Inborn Error of Metabolism

Diabetes Mellitus

Aims of the diet:

  • Normalize blood sugar levels: aim for fasting blood glucose levels between 4.0-6.1 mmol/L (capillary blood) or 4.5-6.9 mmol/L (venous blood), postprandial 4.0-9.0 mmol/L, HbA1c <53 mmol/mol
  • Normalize blood pressure and lipid profile
  • Prevent postponement of complications related to diabetes, i.e. micro- and macroangiopathies
  • Normalize body weight and waist circumference.

Characteristics of the diet:

  • Carbohydrates:

Children

  • achieve a balance between medication, carbohydrate intake, physical activity and stress (if possible, self-regulation through regular self-monitoring)
  • functional distribution of carbohydrates throughout the day
  • 50-55% of energy in the form of carbohydrates
  • > 1 year: dietary fibers: 2.8-3.4 g/MJ per day.

Adults

  • achieve a balance between medication, carbohydrate intake, physical activity and stress (if possible, self-regulation through regular self-monitoring)
  • functional distribution of carbohydrates throughout the day
  • at least 40% of daily caloric intake in the form of carbohydrates
  • dietary fibers: 3.4 g/MJ per day.
  • Fats:

Children

  • 30-35% energy
  • saturated fats: not to exceed 10% of caloric intake
  • trans-fatty acids: not to exceed 1% of caloric intake
  • polyunsaturated fats (PUFA): not to exceed 10% of caloric intake
  • monounsaturated fats (MUFA): 10-20% of caloric intake
  • omega-3 fatty acids (fish oils): 0.45 g/day.

Adults

  • 20-40% of energy
  • saturated fats: not to exceed 10% of caloric intake
  • trans-fatty acids: not to exceed 1% of caloric intake
  • polyunsaturated fats: not to exceed 12% of caloric intake
  • omega-3 fatty acids (fish oil, EPA and DHA): 450 mg
  • cholesterol: not to exceed 300 mg.
  • in the event of dyslipidemia, 2-3 g of phytosterol/phytostanol daily is advised to supplement the recommendations above aimed at restoring normal lipid levels (decrease in LDL and total cholesterol levels to up to a maximum of 15%). This also applies to children 5 years and older.
  • If overweight, see “Overweight,” with extra attention to preventing hypoglycemia and personal advice being the responsibility of the whole team.

Hypercholesterolemia

Aims of the diet:

  • reduce the risk of coronary heart disease by:
  • improving the TC/HDL ratio (< 5 mmol/L)
  • increasing intake of vegetables, fruit, whole grain products and omega-3 fatty acids

Characteristics of the diet:

  • Fats:
  • total fat: 20-40% of caloric intake at a healthy weight, 20-35% of caloric intake for overweight individuals (BMI > 25 kg/m2)
  • <10% of total caloric intake in saturated fats
  • < 1% of caloric intake in trans-fatty acids
  • maximum 300 mg cholesterol
  • minimum 200 g vegetables and 2 portions of fruit
  • 450 mg omega-3 fatty acids (EPA and DHA)
  • If there is not enough fish in the diet, an acceptable alternative is nutritional fish oil-enriched products or fish oil capsules
  • linoleic acid: 2% of total caloric intake
  • alpha linoleic acid: 1% of caloric intake.
  • alcohol: women – no more than 1 glass per day, men – no more than 2 glasses per day
  • maximum 6 g salt per day
  • dietary fibers: 3.4 g/MJ per day
  • for hypertriglyceridemia: follow hypercholesterolemia guidelines, plus no alcohol
  • for diabetes mellitus: see “Diabetes Mellitus”
  • if overweight, see “Overweight”

Idiopathic Reactive Hypoglycemia

Aims of the diet:

  • to attain normal glycemic levels
  • to reduce symptoms

Characteristics of the diet:

  • Carbohydrates:
  • 4 or more meals containing carbohydrates daily
  • preference for the use of polysaccharides; normal use of mono- and disaccharides (no more than 15-25% of caloric intake) within equally balanced meals, and occasionally greater restriction
  • Dietary fibers: at least 15 g dietary fibers /1000 kcal and/or aim for 10-15 g dietary fibers more than in the usual diet
  • Moderate consumption of alcohol and caffeine

Osteoporosis

Aims of the diet:

  • to delay (further) bone loss and limit fractures.

Characteristics of the diet:

  • Calcium: 1000-1200 mg depending on age and sex. For celiac disease, cirrhosis of the liver and poor fat absorption with inflammatory bowel disease: 1500 mg.
  • Follow national Nutritional Guidelines, with extra attention to vitamin D and calcium
  • Protein: based on recommended allowances
  • Ensure moderate consumption of salt, alcohol, caffeine and oxalate
Neurological Disorders

Neurological Disorders

Neuromuscular Disorders (NMD)

Oncology

Aims of the diet:

  • maintain/improve the nutritional status, or prevent it from deteriorating unnecessarily
  • reduce the symptoms or prevent them from worsening unnecessarily
  • inform patients and/or their caregivers as thoroughly as possible about the relationship between diet and cancer (treatment)

Characteristics of the diet:

No general standard advice exists for cancer. The advice is partly based on the symptoms, the treatment, and the stage of disease. Dietary recommendations are first based on a diet composed of foods the patient is accustomed to. If necessary, other foods with similar nutritional values may be recommended or the consistency of the food may be altered. Supplementary nutrition such as liquid meals, preparations and supplements are advised for weight loss or for certain symptoms.

 

Enteral or parenteral nutrition is indicated when oral intake is inadequate or not possible. The choice to use enteral or parenteral nutrition should be well considered, and the benefits must outweigh the drawbacks. Depending on the symptoms and medical information with respect to the treatment and prognosis, a choice is made from the following diets:

Adequate diet

  • A diet which provides a satisfactory amount of energy, protein, vitamins and minerals in order to maintain the nutritional status and which makes daily functioning possible. This diet is aimed at the actual situation and the effects over the mid-to-long term. Prevention counseling for the long term regarding diseases such as cardiovascular disease, diabetes and cancer are not a priority. The principles of adequate diet are:
  •  Energy: basal metabolism (Harris & Benedict) + extra allowances
  • Protein: 1 g protein/kg ideal body weight
  • fats and carbohydrates: enough to cover the energy requirements (the ratio of fats to carbohydrates and their food sources are less important)
  • vitamins, minerals, trace elements: follow recommended allowances
  • Fluids: 1.5 L drinking fluids (> age 65: 1.7 L).

High-calorie and high-protein diet

  • Energy-enriched: basal metabolism (Harris & Benedict) + extra allowances (if there is severe physical stress, no more than 150% of the basal metabolism is given)
  • Protein(-enriched): 1.2-1.7 g protein/kg of actual body weight
  • High calorie and high-protein diet is relevant only if one goal is to improve nutritional status
  • vitamins, minerals, trace, elements: follow recommended allowances.

Palliative diet

  • a diet primarily aimed at maximum well-being and at resolving or coping with symptoms. A palliative diet is called for if the disease is developing rapidly, in a very progressed stage, and no cancer treatment is possible anymore. Death is expected to come more likely within a few weeks than within a few months. The principles of palliative nutrition are:
  • Intake of energy and nutrients to the extent that the patient can. Maintaining nutritional status is not a priority.
  • Intake of fluids is more important than energy-producing foods and nutrients.
  • In the palliative-terminal phase, deliberately refraining from force-feeding fluids and/or food contributes to reducing the symptoms
Psychofarmaca and food

Use of Lithium for Biploar Disorders and Depression

Aims of the diet:

  • prevent lithium intoxication and obesity

Characteristics of the diet:

  • Preserve the amount of sodium in the diet from the moment of going on medication
  • Ensure extra sodium and fluids in the event of warm weather, fever, diarrhea, overexertion and calorie restrictions
  • if weight is too high, see “Overweight”

Use of Nonselective MAO Inhibitors for Depression

Aims of the diet:

  • prevent hypertensive crisis.

Characteristics of the diet:

  • tyramine restricted diet
Rheumatic diseases state

Gout (Arthritis Urica)

Aims of the diet:

  • reduce symptoms by lowering the amount of uric acid production and/or by promoting its excretion

Characteristics of the diet:

  • For excessive weight (BMI > 25 kg/m2): see “Overweight”
  • Purine restriction: avoid products with > 150 mg purine per 100 g (based on the higher risk of acquiring gout when intake is high)
  • Extra fluids: 2-3 L drinking fluids distributed throughout the day
  • Alcohol: no more than 1 unit per day, preferably at least 3 alcohol-free days per week

Rheumatoid Arthritis

Aims of the diet:

  • reduce symptoms
  • maintain/achieve a healthy body weight
  • maintain/improve nutritional status

Characteristics of the diet:

  • Micronutrients: vitamin B1, B6 and B12, iron and folic acid based on recommended allowance. If corticosteroids are being used: supplementation of vitamin D and calcium (a minimum of 1500 mg including preparations).
  • For other conditions, such as pressure ulcers, dysphagia, weight loss / malnutrition, diabetes mellitus, overweight condition, chronic constipation or diarrhea: see the relevant disease description
Dietary Issues in the Care of the Mentally Disabled

Aims of the diet:

  • to prevent, eliminate, reduce and/or compensate for symptoms and conditions related to nutrition, in order to contribute to the recovery, preservation or improvement of the client’s state of health and/or well-being
  • advise, supervise and treat the client and his living environment (total client system)
Artificial Nutrition

Aims of the diet:

  • To optimize the nutritional status when not enough food can be taken in by mouth, partly depending on the underlying disease and treatment.

Characteristics of the diet:

  • Energy: basal metabolism (Harris & Benedict) + extra allowances, evaluation of weight fluctuations and intake to customize the individual requirements
  • High-protein: 1.2-1.5 g/kg actual body weight, depending on liver and kidney function
  • Fluids: at least 1.5 L, not including fluid loss
Sports

Aims of the diet:

  • contribute to improving the athletic performance
  • prevent/reduce symptoms
  • for injuries: promote recovery and rehabilitation
  • maintain/achieve a healthy competition weight
  • prevent eating disorders

Characteristics of the diet:

  • complete sports nutrition (50-60% of caloric intake in the form of carbohydrates, 1.2-2 g protein/kg of actual body weight, and at least 20% of caloric intake in the form of fat) customized to the individual athlete
  • Extra fluids: 2-5 L, depending on exertion and climate

 

Reference: The Dutch Dietetic Association (NVD)