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LIBERALIZED GERIATRIC DIET MANUAL
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TABLE OF CONTENTS
Page No.
Liberal Geriatric Diet Philosophy
List of Diets
Regular / Liberal Geriatric Diet
Mechanical Soft Diet
No Added Salt (NAS)
No Concentrated Sweets (NCS)
Calorie Restricted (1400 - 1600 calories)
Lactose Restricted
Puree I
Puree II
Thickened Liquids
Clear Liquids
Diet Order for Dialysis Treatment
Tube Feeding
Appendix
3
2
3
4
7
9
10
12
15
16
18
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LIBERAL GERIATRIC DIET PHILOSOPHY
Introduction
The goal of nutrition care in the long-term care setting is to provide for adequate intake of
calories, protein, vitamins, minerals, and fluids. Serving a variety of foods that the residents are
accustomed to eating will promote this goal. Using restrictive modified diets can often block the
above goals. Residents can find it difficult to adapt to modified diets because of life-long dietary
habits, compromised taste sensation and/or chewing abilities, the personal and ethnic
significance of certain foods, and poor or unpredictable appetites. Restrictive diets may lower
appetite and subsequently cause weight loss and/or malnutrition, both major risk factors for
mortality in older individuals.
Since passage of the Omnibus Budget Reconciliation Act of 1987 (OBRA) long term care
facilities must strive to guarantee individuals the same levels of choice, autonomy and dignity
they held prior to entering the residential setting. The dual goal of a Liberal Geriatric Diet
Philosophy is to fulfill both the nutritional needs and the freedom of choice for residents of longterm care facilities.
Principles
Within the liberal geriatric diet philosophy residents receive the least restrictive diet possible
through the promotion of the following principles:
1.
2.
3.
4.
Order Regular diets whenever possible.
Institute mild dietary restrictions when necessary.
Avoid multiple diet restrictions.
Strive to provide the least amount of mechanical alteration to the diet.
4
LIST OF DIETS
When ordering a diet for a resident, physicians are asked to select from the following diets:
1.
2.
3.
4.
5.
6.
7.
8.
9.
Regular / Liberal Geriatric
Mechanical Soft Diet
No Added Salt (NAS)
No Concentrated Sweets (NCS)
Calorie Restricted (1400 - 1600 calories)
Lactose Restricted
Puree I
Puree II
Thicken Liquids
a.
Syrup Consistency
b.
Honey Consistency
c.
Pudding Consistency
1.
2.
Clear Liquid
Diet order for dialysis treatment
Other Diets:
5
REGULAR / LIBERAL GERIATRIC DIET
I.
Description
The regular diet is designed for patients who do not require any dietary restrictions. The
“Dietary Guidelines for Americans” and the “Food Guide Pyramid” (see appendix) have
been used as the basis for this and all other diets and menus in this edition. Unless
otherwise indicated, the food groups and daily amounts of each food group in the regular
diet should be followed when planning any diet in this manual. This diet includes a high
Vitamin C food daily, and a high Vitamin A food 3 - 4 times a week.
II.
Approximate Composition
Calories
2200 - 2600
Protein 65 - 70 grams
III.
Adequacy
This diet contains all nutrients necessary to provide and maintain adequate nutrition based
on the Recommended Dietary Allowances, 1989 revision.
FOOD GROUPS
FOODS ALLOWED
Milk
All types; yogurt
2 or more servings
1 serving equals 1 cup
Meat and equivalents
Meat, fish, shellfish
Poultry, cheese, eggs,
dried beans, peas and
Lentils, peanut butter,
Seeds and nuts
At least 5 meat
equivalents
(Use the leanest cuts of
meat, skinless poultry,
and low or lower fat
cheeses; limit egg yolks
To 4 per week)
DAILY AMOUNTS
1 equivalent equals:
1 oz. Meat, fish,
shellfish or poultry,
(edible portion
weighed after
Cooking) or
1/4 cup ricotta or
Cottage cheese; or
½ cup cooked dried
Beans, peas, or lentils,
or
2 tablespoons peanut
butter; or
6
REGULAR / LIBERAL GERIATRIC DIET
FOOD GROUPS
FOODS ALLOWED
DAILY AMOUNTS
1/4 cup canned tuna
or salmon; or
1 whole egg or 2
egg whites*
Fruits
All types
2 or more servings
1 serving equals:
1 medium apple,
orange, banana or
pear; or
½ cup of chopped,
cooked or canned
fruit; or
3/4 cup fruit juice
Vegetables
All types, including potatoes
corn, lima beans, peas, dark
3 or more servings
1 serving equals:
1 cup raw; or
½ cup cooked; or
3/4 cup juice
Soups
All types
As desired
1 serving equals;
6 ounces or 3/4 cup
Breads and Cereals
All types, especially
whole grains
6 or more servings
1 serving equals:
1 slice of bread; or
*Due to the potential danger of salmonella infection, consumption of raw and soft cooked fresh shell eggs in any
form is to be avoided. Whether poached, fried, scrambled or “boiled” in the shell, they should be hard cooked, that
is, until both the white and yolk are firm. For more information, contact your local health department.
7
REGULAR / LIBERAL GERIATRIC DIET
FOOD GROUPS
FOODS ALLOWED
DAILY AMOUNTS
3/4 ounce ready to
eat cereal; or
½ cup cooked
cereal; or
½ cup cooked pasta;
or ½ cup cooked rice
Fats
All types
As needed for
adequate caloric
intake
Desserts
All types
As desired for
Adequate caloric
intake
Beverages
Miscellaneous
All types, include 6
or more cups of water
and other fluids per day
Sugar, condiments, jam
jelly, preserves, syrup,
sweets
As needed to meet
fluid requirements
As desired for
adequate caloric
intake
Herbs, spices, flavorings
As desired for flavor
and palatability
Salt
As needed for flavor
and palatability
8
MECHANICAL SOFT DIET
I.
Description
This diet modifies the consistency of the regular diet and is used when there is difficulty
in chewing regular food. All foods allowed on the regular diet may be included. Certain
foods must be chopped or ground depending on the texture of foods and individual needs.
Some patients may tolerate tender cooked whole meats while others may require it
chopped or ground. If a soft diet is ordered, it will be assumed to be a Mechanical Soft
Diet. This diet includes a high Vitamin C food daily, and 3 - 4 high Vitamin A foods a
week.
II.
Approximate Composition
Calories
2200 - 2600
Protein 65 - 70 grams
III.
Adequacy
This diet contains all nutrients necessary to provide and maintain adequate nutrition based
on The Recommended Dietary Allowances, 1989.
FOOD GROUPS
FOODS ALLOWED
Milk
All types, yogurt
None
Meat and equivalents
Tender meat and poultry,
whole chopped or ground;
fish, shellfish, cheese, eggs,
peanut butter and dried beans,
peas and lentils
Any other than tender
meats, meats with
gristle.
Fruits
All types
Raw, cooked, canned, frozen,
whole, chopped, mashed as
tolerated.
Any not tolerated
Vegetables
All types, including potatoes,
corn, lima beans, peas, raw,
cooked, canned, frozen; whole,
chopped mashed as tolerated,
Any not tolerated
Soups
All types
Any not tolerated
9
FOODS OMITTED
MECHANICAL SOFT DIET
FOOD GROUPS
FOODS ALLOWED
Breads and cereals
All types, especially
whole grains
Any not tolerated
Fats
All types
None
Desserts
All types
Any not tolerated
Beverages
All types
None
Miscellaneous
All types
FOODS OMITTED
Any not tolerated
10
NO ADDED SALT (NAS) DIET
The No Added Salt diet is appropriate for residents with moderate hypertension or cardiac
disease. This diet is a regular diet with the exception that no salt may be added to food after
preparation, and no highly salted foods will be served. This will reduce the sodium content of
the Regular Diet by approximately one gram per day. No salt packet or shaker is allowed with
the patient’s meal, however, salt substitute will be included on the resident tray with doctor’s
order.
NO CONCENTRATED SWEETS (NCS) DIET
I.
Description
This diet closely resembles the regular diet, restricting only those foods which are high in
sugar or other concentrated sweets. It can be used for overweight patients, or for any
diabetic patient whose weight and blood sugar levels are under control. It does not
require adherence to a strict meal pattern and since it does not restrict calories, it should
not be ordered for patients who need to lose weight. This diet will include an evening
snack. It includes a high Vitamin C food daily, and 3 - 4 high Vitamin A foods a week.
II.
Approximate Composition
Calories
2000 - 2200
Protein 67 - 70 grams
III.
Adequacy
This diet contains all nutrients necessary to provide and maintain adequate nutrition based
on the Recommended Dietary Allowances, 1989 revision.
FOOD GROUPS
FOODS ALLOWED
Milk
All types; yogurt, plain
or sweetened with
artificial sweetener
Chocolate milk,
sweetened
condensed milk
Meat and equivalent
All types; use the leanest
cuts of meat, skinless poultry
and low or lower fat cheeses;
Limit egg yolks to 4 per week
Glazed, honey coated
meats or prepared
with sugar or syrup
Fruits
All types; fresh, frozen
canned without sugar;
unsweetened juices, fruit
frozen or canned with
fruit juice or sugar
substitute.
11
FOODS LIMITED OR
OMITTED
Fruit canned or frozen
in heavy syrup,
sweetened juices;
candied fruit
Vegetables
All types including
Potatoes, corn, lima beans,
peas.
Candied vegetables
Soups
All made with foods allowed
Fruit soups made with
sugar.
12
NO CONCENTRATED SWEETS (NCS) DIET
FOOD GROUPS
FOODS ALLOWED
Breads and Cereals
All types, especially whole
Danish rolls, sweet
grains, including raisin bread, rolls, glazed
plain doughnuts, quick breads,
doughnuts, sugar
cooked and prepared cereals
coated cereals, cereals
(without sugar coating)
with sugar as the
first ingredient
Fats
All types
None
Desserts*
Any made with foods allowed;
dietetic pudding, gelatin,
ice cream, plain cakes and cookies
(no icing), pie, ice milk, sherbet,
sweetened flavored gelatin
Cake with frosting,
cookies with icing.
Beverages
Coffee; tea; diet soda; diet
non-carbonated fruit flavored
beverages, diet cocoa or hot
chocolate beverage
Regular carbonated
beverages, beverages
sweetened with sugar
Miscellaneous
FOODS OMITTED
Sugar substitutes; dietetic and Regular jam, jelly,
all-fruit jam, jelly, preserves,
preserves, syrup,
low calorie diet syrup small
honey, molasses
amounts of sugar (1-2 tsp)
included in a baked good.
Cocoa powder, chocolate
flavoring, herbs, spices, flavorings
Salt
Vinegar, pickles, mustard
Worcestershire sauce, soy sauce
* See the ADA Exchange List for the “Free Foods” and “Foods for Occasional Use”
13
Sweetened powdered
Sweet pickles
CALORIE RESTRICTED DIET
I.
Description
The low calorie diet is indicated when reduction in weight is desirable, or for a diabetic
that requires tighter glycemic control. The diet follows the pattern for the regular diet
with modification made in total calorie content and includes an evening snack with 12 15 grams of carbohydrates. This diet provides a range of 1400 - 1600 calories. Included
is one high Vitamin C food daily, and 3 - 4 high Vitamin A foods a week.
Based on the diabetic exchange list, this diet is approximately calculated according to the
following meal plan:
FOOD
TOTAL
EXCHANGE
BREAKFAST
LUNCH
DINNER
Milk
2
1
Bread
7
2
2
2
Fruit
3
1
1
1
Vegetable
3
1
2
Meat
5
2
3
Fat
3
1
1
EVENING
SNACK
1
1
1
This diet is a range of calories, therefore, an additional exchange of milk, bread or fruit may be
added to any of the meals. In addition, according to the revised American Diabetic Association
guidelines of 1995, bread, milk and fruit exchanges may be used interchangeably without
significantly affecting glycemic control. Consult the 1995 guidelines for the exchange lists for
meal planning.
II.
Approximate Composition
Calories
1400 - 1600
Protein 65 - 70 grams
III.
Adequacy
This diet includes the basic food groups in adequate amounts but fats and carbohydrates
are limited to reduce total calories below normal requirements. Iron and thiamine intake
may be marginal.
FOOD GROUPS
FOODS ALLOWED FOODS LIMITED OR
14
OMITTED
Milk
Skim, 1%, 2%; buttermilk
made from skim, 1%, 2%
milk; yogurt made from skim,
1% or 2% milk
Limit 2-3 servings daily
Meat and equivalents
Baked, broiled, lean beef, lamb
Meats high in fat such
liver, ham, lean pork, veal;
as bacon, fat back,
skinless poultry; water packed
duck, goose, luncheon
tuna and salmon; frankfurters;
meats, sausage,
dried beans and peas; cottage
scrapple and
cheese, cheeses, eggs; fish,
processed fish (fish
shellfish; luncheon meats at
cakes, fish sticks)
least 86% fat free. Limit to
fish canned in oils,
5 - 6 equivalents daily
cheese dip, cheese
spread, Cheddar
cheese
Fruits
All unsweetened juices,
(water packed) fruit; fresh
fruit; fruit canned in natural
juices (no sugar added) or
light syrup.
Whole, chocolate,
buttermilk made from
whole milk
Fruits canned in
and fruit
nectars; dietetic
heavy syrup,
sweetened juices
Vegetables
All types cooked without
fat. Limit to 1 - 2 servings
daily; white potato, corn,
lima beans, peas; Use other
vegetables, especially raw,
frequently to total 3 vegetable
or more daily
Fried, creamed,
buttered vegetables,
candied potatoes
Soups
Bouillon, fat free broths,
homade soups with foods
allowed
Creamy rich soups
made with foods
not allowed
Breads and Cereals
Limit to 7 - 8 servings daily;
whole grain or enriched breads,
rolls; crackers; hot or cold
cereals; macaroni, spaghetti,
Sugared doughnuts,
sweet rolls, sugar
coated cereals.
15
noodles, rice, plain doughnuts
CALORIE RESTRICTED DIET
FOOD GROUPS
FOODS ALLOWED
FOODS LIMITED OR
OMITTED
Fats
Limit to 3 servings daily:
butter, margarine, cream,
mayonnaise, regular salad
dressing, vegetable oils
Dietetic salad dressings.
All others
Desserts
Any made with foods allowed;
dietetic puddings, and gelatin;
angel food cake; ice cream,
plain cakes and cookies (no
icing), pie, sherbet, ice milk,
sweetened flavored gelatin
All others
Beverages
Coffee, tea, non-caloric
carbonated beverages, noncaloric fruit flavored beverages
Regular carbonated
beverages, prepared
drink mixes with
sugar added
Miscellaneous*
Sugar substitutes; dietetic and Regular sweetened
All-fruit jam, jelly preserves,
jam, jelly, preserves;
low calorie diet syrup (read
honey, molasses,
labels), cocoa powder, sugarsyrup, candy, regular
free hot chocolate, beverages
hot chocolate
(counted in daily calorie
beverages
total). Herbs, spices,
flavorings, salt, vinegar,
sugar-free pickles, prepared
mustard, ketchup (1 tablespoon)
Worcestershire and soy sauces
Small amounts of sugar (1-2 tsp)
in a baked good.
*See the ADA Exchange Lists for “Free Foods” and “Foods for Occasional Use” for additional suggestions.
LACTOSE- RESTRICTED DIET
I.
Description
16
The Lactose-Restricted Diet is indicated for patients exhibiting the symptoms of lactose
intolerance. The only difference between this diet and a Regular Diet is the exclusion of
regular milk and milk based desserts and creamed foods. Lact-Aid milk and non-milk
based foods will be substituted for the former foods.
Fermented dairy products such as cheese or yogurt are often tolerated by lactose intolerant
individuals, and will not be eliminated unless requested.
II.
Approximate Composition
Calories
2000 - 2500
Protein 65 - 70 grams
III.
Adequacy
This diet provides all nutrients necessary to provide and maintain adequate nutrition
based on the Recommended Dietary Allowances, 1989 revision.
PUREE I DIET
I.
Description
The pureed diet is used for patients who have difficulty in chewing foods on the Regular
and Soft diets. Foods allowed on this diet include any foods on the regular diet which can
be pureed, or baked goods that can be pureed. The consistency should be smooth and
thick enough to mound on the plate. The number of daily servings of food groups follows
the guidelines for the Regular Diet, and included a high Vitamin C food daily, and a high
Vitamin A food 3 - 4 times a week.
If a Puree Diet is ordered, it will be assumed to be a Pureed I Diet.
II.
Approximate Composition
Calories
2000 - 2500
Protein 65 - 70 grams
III.
Adequacy
This diet provides all nutrients necessary to provide and maintain adequate nutrition
based on the Recommended Dietary Allowances, 1989 revision.
FOOD GROUPS
FOODS ALLOWED
Milk
All types, yogurt (no
seeds or nuts)
Any containing nuts,
coconut or seeds
Meat or equivalent
Pureed meat, fish,
shellfish, poultry; pureed
dried beans, peas, lentils;
melted or pureed cheese;
pureed hard cooked eggs;
peanut butter (creamy
All others
17
FOODS OMITTED
style) if tolerated
Fruits
Pureed fruits, fruit juices,
mashed banana and
avocado if tolerated
Whole fruits
Vegetables
Pureed vegetables,
Vegetable juices
Whole vegetables
Soups
Broth, bouillon,
pureed soups
With whole
Ingredients not
pureed
PUREED I DIET
FOOD GROUPS
FOODS ALLOWED
FOODS OMITTED
Breads and Cereals
Cooked cereals; dry cereals
pureed or softened in milk;
pureed macaroni, spaghetti,
noodles and rice; pastina
(star pasta) may not need to
be pureed; bread, rolls and
crackers pureed or softened
in milk or soup; bread or
cracker crumbs added to
pureed foods at serving time;
plain bread, rolls, etc if
tolerated
Breads, crackers
and cereals with
seeds, nuts
Fats
All types
None
Desserts
Custard, pudding, gelatin;
ice cream, sherbet, ices;
fruit whips; pureed pastries,
pies; cakes and cookies
pureed or softened in milk
or juice
Any desserts
containing nuts,
coconut, or seeds
or whole ingredients
Beverages
All types
None
Miscellaneous
Sugar, condiments, clear
jam, jelly, syrups, honey
Herbs, spices, flavorings
18
Any with seeds,
nuts, whole fruits or
vegetables
Coarsely ground,
mixed with seeds
and nuts
Smooth sauces and gravies
Sauces and gravies
with whole fruits,
vegetables, meat
Salt
PUREED II DIET
I.
Description
All foods are pureed (including baked goods) and strained, and includes a high Vitamin C
food daily, and a high Vitamin A food 3 - 4 times a week. This diet can be fed through a
syringe.
FOOD GROUPS
FOODS ALLOWED
Milk
All types, yogurt (no
seeds or nuts)
Any containing nuts,
coconut or seeds
Meat or equivalent
Pureed meat, fish,
shellfish, poultry; pureed
dried beans, peas, lentils;
melted or pureed cheese;
pureed hard cooked eggs;
peanut butter (creamy
style) if tolerated
All others
Fruits
Pureed fruits, fruit juices,
mashed banana and
avocado if tolerated
Whole fruits
Vegetables
Pureed vegetables,
Vegetable juices
Whole vegetables
Soups
Broth, bouillon,
pureed soups
With whole
Ingredients not
pureed
Breads and Cereals
Cooked cereals; dry cereals
pureed or softened in milk;
pureed macaroni, spaghetti,
noodles and rice; pastina
(star pasta) may not need to
be pureed; bread, rolls and
crackers pureed or softened
Breads, crackers
and cereals with
seeds, nuts
19
FOODS OMITTED
in milk or soup; bread or
cracker crumbs added to
pureed foods at serving time;
plain bread, rolls, etc if
tolerated
Fats
All types
None
PUREED II DIET
FOOD GROUPS
FOODS ALLOWED
Desserts
Custard, pudding, gelatin;
ice cream, sherbet, ices;
fruit whips; pureed pastries,
pies; cakes and cookies
pureed or softened in milk
or juice
Any desserts
containing nuts,
coconut, or seeds
or whole ingredients
Beverages
All types
None
Miscellaneous
Sugar, condiments, clear
jam, jelly, syrups, honey
FOODS OMITTED
Any with seeds,
nuts, whole fruits or
vegetables
Herbs, spices, flavorings
Coarsely ground,
mixed with seeds
and nuts
Smooth sauces and gravies
Sauces and gravies
with whole fruits,
vegetables, meat
Salt
THICKEN LIQUIDS
This diet order may be included with Mechanical Soft or Pureed Diet. The Thicken Liquid Diet
is indicted for residents with swallowing difficulties associated with dysphagia or a mouth or
throat structural compromise.
Thicken Liquids must be ordered by the physician designating what consistency the liquids need
to be thickened for the patient’s tolerance. Below are listed the three consistencies which can be
ordered.
1.
2.
Syrup Consistency
Honey Consistency
20
3.
Pudding Consistency
When ordering Thicken Liquids, the physician must specify one of the above consistencies.
CLEAR LIQUIDS
I.
Description
The Clear Liquid Diet is used for acute states of illnesses until a full liquid diet or solid
foods are tolerated. It also may be used prior to diagnostic tests. The Clear Liquid Diet is
nutritionally inadequate, and should not be used longer than 72 hours without progression
unless altered nutrition support is provided.
II.
Approximate Composition
Calories
800 - 900
Protein Negligible
III.
Adequacy
This diet is inadequate in all nutrients. It should be used for limited periods of time,
usually no longer than 48 hours.
FOODS ALLOWED
FOODS OMITTED
Clear broth, bouillon
Flavored gelatin, high
protein gelatin
Water ice, popsicles,
fruit ice
Fruit juices; apple,
grape, cranberry juice
cocktail; cran-apple,
cran-grape, cran-raspberry,
strained orange or grapefruit
juice
Beverages: tea, coffee,
carbonated beverages, fruit
flavored drinks, commercially
prepared high protein clear
liquid products
Sugar, sugar substitutes
Water
21
All others
Fruit flavored drinks
DIET ORDER FOR DIALYSIS TREATMENT
I.
Description
There is no actual Dialysis Treatment Diet, per se, however, a similar nutrient content can
be accomplished by ordering the following diet order: NAS, limit dairy to ½ C milk daily,
no bananas, orange juice, prunes, or juice, or salt substitute.
This diet order is indicated for patients receiving dialysis treatment, and will be
individualized according to the resident’s needs.
II.
Composition
Calories
2000 - 2500
Protein
60 grams
III.
Nutritional Adequacy
This diet is deficient in calcium based on the Recommended Dietary Allowances, 1989
revision.
TUBE FEEDING
I.
Description
A feeding tube can be used to provide liquid nutrition to patients who are unwilling or
unable to take food or fluid by mouth and who have a functional gastrointestinal tract.
The physician must order the insertion of the tube and the feeding. The order should
include:
1.
2.
3.
4.
5.
6.
7.
Name of the product
Strength of solution and if less than full, a planned schedule to increase to full
strength.
a. Number of feedings per day with amount (in cc’s) of formula for each feeding,
if intermittent feedings or
b. Hourly rate (in cc’s) of formula and the number of hours per day if continuous
feedings are used.
Amount of water and number of times the tubing is to be flushed within 24 hours.
Amount of water to be used with medications.
Total volume of formula plus water per day.
Total number of calories provided per day.
II.
Composition
The nutritional content of the tube feeding will depend upon the amount and type of
formula used.
III.
Adequacy
22
Commercial tube feeding formulas are designed to provide 100 percent of the
Recommended Dietary Allowances of all vitamins and minerals when given in the
amounts specified by the manufacturer. The adequacy for calories and protein will
depend on the individual patient’s assessed needs.
Guidelines to safely administer tube feeding:










Elevate head of bed 30 degree - 45 degree angle to prevent aspiration.
Administer formula at room temperature.
Initial infusion of isotonic formulas may be given full strength.
Initial infusion of hypertonic formulas should be initiated at ½ the strength, at a rate of
usually 50 cc/hour
Residuals should be checked every 4 hours with reinstallation of the aspirate.
Tube feedings held if the residual is greater than twice the rate of infusion, and the
physician notified.
Tube irrigated every 4 hours with 30cc - 50cc water, using a 50cc syringe for irrigating
and aspirating tube.
Formula hang time is no longer than 8 hours, and formula unused after 24-48 hours
should be discarded.
Tubing, feeding bags, syringes, adapters, and irrigation sets are changed every 24 hours.
Medications to be administered via small bore tubes are preferred as elixirs and powders,
which lessen the potential of clogging the tube. Medication in tablet form should be
crushed.
Generally, strength should be increased before rate. Rate and concentration should not be
increased concurrently.
The rate is usually increased by 25cc/hour daily until desired volume is achieved. Rate may be
increased more rapidly dependent upon the patient’s clinical status and tolerance.
APPENDIX
TABLE OF CONTENTS
Dietary Guidelines for Americans, 1990 . . . . . . . . . . . . . . . . . . . .A
Food Guide Pyramid . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . B
High Vitamin A and Vitamin C Food Sources . . . . . . . . . . . . . . . C
Calculations for Ideal Body Weight / Adjusted
Ideal Body Weight . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .D
23
Guidelines for Calculating Calorie Needs . . . . . . . . . . . . . . . . . . . E
Guidelines for Calculating Protein Needs . . . . . . . . . . . . . . . . . . . F
Guidelines for Calculating Fluid Needs . . . . . . . . . . . . . . . . . . . . .G
Evaluating the Significance of Weight Loss . . . . . . . . . . . . . . . . . H
25
Dietary Guidelines for Americans, 1990
There are seven guidelines for a healthful diet for healthy Americans ages 2 years and over. They
are currently the best advice from nutrition experts and are the basis of Federal policy. They are
also the basis for the diets and menus in this diet manual.
1.
Eat a Variety of Foods to get the energy, protein, vitamins, minerals, and fiber
you need.
2.
Maintain Healthy Weight to reduce your chances of having high blood pressure,
heart disease, a stroke, certain cancers, the most common kind of diabetes and
other types of illness.
3.
Choose a Diet Low in Fat, Saturated Fat, and Cholesterol to reduce your risk
of heart disease, obesity and certain types of cancer.
4.
Choose a Diet with Plenty of Vegetables, Fruits, and Grain Products which
provide important needed vitamins, minerals, fiber and complex carbohydrates,
and which are lower in fat.
5.
Use Sugars Only in Moderation as they are too high in calories and limited in
nutrients for most people.
6.
Use Salt and Sodium Only in Moderation to help reduce your risk of high blood
pressure.
7.
If you Drink Alcoholic Beverages, Do So in Moderation as they supply
calories, but little or no nutrients. In addition, excessive intake of alcohol can
cause many health problems and addiction.
This information has been compiled from Nutrition and Your Health: Dietary Guidelines for Americans. U.D. Department of
Agriculture and Health and human Services, 1990.
A.
U.S.D.A’S FOOD GUIDE PYRAMID
Fats,
Oils,
Sweets,
Use sparingly
Milk,
Meat,
Yogurt,
Cheese,
2-3 Servings
Fish,
Poultry,
Dry Beans,
Eggs, Nuts
2-3 Servings
Vegetables
3-5 Servings
Breads -
Fruits
2-4 Servings
Cereals - Rice 6-11 Servings
Pasta
B.
APPENDIX
HIGH VITAMIN A AND C FOOD SOURCES
FRUITS
VEGETABLES
*
Apricots, fresh
***
Broccoli
*
Apricots, dried
**
Brussel Sprouts
*
Apricot Nectar
*
Carrots
***
Cantaloupe
***
Greens
**
Grapefruit
Beet
**
Grapefruit Juice
Chard
*
Mango
Collard
**
Orange
Dandelion
**
Orange Juice
Kale
**
Papaya
Mustard
**
Strawberries
Spinach
**
Tangerine
*
Pumpkin
**
Tangelo
**
Peppers - green or red
*
Sweet Potatoes
**
Tomatoes
**
Tomato Juice
**
Tomato Sauce
*Vitamin A Source Include 3 - 4 times a week.
** Vitamin C Source Include Daily
*** Vitamin A & C Source - Include Daily
C
APPENDIX
CALCULATION OF IDEAL BODY WEIGHT RANGE
MEN:
106 lbs. for the first five feet of height
plus 6 lbs. for each additional inch.
WOMEN:
100 lbs. for the first five feet of height
plus 5 lbs. for each additional inch.
ADJUSTMENT:
Small Frame - subtract 10%
Large Frame - add 10%
Under five feet in height - subtract 2 lbs. for every inch under five feet.
Source: Rossman, I. Clinical Geriatrics, Lippincott Co., 1979
ADJUSTMENT OF IDEAL BODY WEIGHT FOR THE OBESE
The body weight used in formulas for calculating calorie needs should be modified for obese
individuals (who are 125% or more of ideal body weight (IBW).) Because the obese person has
a greater percentage of body fat, which is less metabolically active, using actual body weight will
overestimate calorie needs. Conversely, using ideal body weight will not account for the
increased calorie expenditure required for moving the excess weight.
The following formula can be used to determine ideal body weight for the obese:
[Actual Body Weight (kg) - Ideal Body Weight (kg)] x .25 + IBW (kg) = Adjusted Body Weight
Source: Grant, A. & DeHoog, S. Nutritional Assessment and Support. 4th ed. Seattle, 1991.
D.
APPENDIX
GUIDELINES FOR CALCULATION OF CALORIC NEEDS
Harris-Benedict Equation (BEE):
NOTE:
a.
Calorie Needs = BEE x Activity Factor x Injury Factor
BEE
MALE = 66 + (13.7 x W) + (5 x H) - (6.8 x A)
FEMALE = 655 + (9.6 x W) + (1.7 x H) - (4.7 x A)
W = weight in kg. [weight (lbs) + 2.2 = weight (kg)]
H = height in cm. [height (inches) x 2.54 = height (cm)]
A = age in years
b.
Multiply by activity factor:
confined to bed or recliner - 1.1
sedentary / out of bed or recliner - 1.2
light activity / ambulatory - 1.3
c.
To promote weight gain:
add 250-500 calories per day
d.
To promote weight loss:
subtract 500 calories per day to lose 1 lb. Per week
*subtract 250 calories per day to lose ½ lb. Per week.
*(more realistic weight loss goal for most long-term care residents.)
E.
APPENDIX
GUIDELINES FOR CALCULATION OF PROTEIN NEEDS
1.
Convert the Ideal Body Weight (IBW) of the resident to kilograms.
2.
Multiply the IBW by the appropriate protein requirement from the chart below:
Protein Requirements (grams / kg. IBW)
0.8
Average adult (non-stressed)
1.2
Draining wound, fracture, or recent major surgery
1.0-1.1 *Pressure ulcer (stage I)
1.2
*Pressure ulcer (stage II, III or IV )
1.0-1.2 Mild albumin depletion (Alb: 2.8-3.5)
1.2-1.5 Moderate to severe albumin depletion (Alb: <2.7)
0.5
Acute renal failure without dialysis
1.0-1.2 Hemodialysis
1.2-1.4 Peritoneal dialysis (all types)
*Description of Pressure Ulcers
Stage I:
A persistent area of skin redness (without a break in the skin) that does not
disappear when pressure is relieved.
Stage II:
A partial thickness of skin is lost (epidermal layer has been lost, but the
dermis is at least partially intact); may present as blistering surrounded by
an area of redness and / or induration.
Stage III:
A full thickness of skin is lost, exposing the subcutaneous tissues; presents
as shallow crater (unless covered by eschar-thick brown, black or yellow
crest); may be draining.
Stage IV:
A full thickness of skin and subcutaneous tissue is lost, exposing muscle
and / or bone; at this stage, the sore may be covered with an eschar,
draining, necrotic, reddened, and / or indurated.
F.
APPENDIX
GUIDELINES FOR CALCULATION OF FLUID NEEDS
Estimated fluid needs for adults 65 years of age or older are 30 cc per kilogram of actual body
weight per day (or ideal body weight for the obese person).
Use 35 cc/Kg/day for adults 65 years of age or younger and 25 cc/Kg/day for adults with renal or
cardiac complications.
Additional Factors That Increase Fluid Needs
Factor
Fever
Moderate perspiration
Profuse perspiration
Heated mattress
Fistula, vomiting, diarrhea
Added cc/day
500-1500 cc
500 cc
1000 cc
Up to 1000 cc
Intake should equal output
G.
APPENDIX
EVALUATING THE SIGNIFICANCE OF WEIGHT LOSS
Determining the significance of weight loss as well as actual weight loss in pounds is specified in
the requirements for participation in Medicare/Medicaid Facilities (OBRA). This formula is the
one listed in the guidelines and obtained from Nutrition in Long-Term Care Facilities, The
American Dietetic Association.
Time Interval
1 Week
1 Month
3 Months
6 Months
Significant Weight Loss (%)
1.0 - 2.0
5.0
7.5
10.0
Severe /Weight Loss (%)
greater than 2.0
greater than 5.0
greater than 7.5
greater than 10.0
Percent weight change = usual weight - actual weight x 100
Usual weight
H.