Download Click here to View, and Print this Notice

University Department of Home Science
Vinoba Bhave University, Hazaribag
Lecture Note of
Gayatri Sahu,Sr. Lecturer
Semester- I(2015-17)
Paper-III - APPLIED PHYSIOLOGY
Topic – 1.Digestive system
Introduction
The digestive system is a group of organs working together to convert food into
energy and basic nutrients to feed the entire body. In order to use the food we eat,
our body has to break the food down into smaller molecules that it can process; it
also has to excrete waste.
Alimentary canal
Food passes through a long tube
about 7 m (24 ft) long inside the body known as
the alimentary canal or the gastrointestinal tract (GI tract). The alimentary canal is
made up of the oral cavity, pharynx, esophagus, stomach, small intestines, and
large intestines. In addition to the alimentary canal, there are several important
accessory organs that help your body to digest food but do not have food pass
through them. Accessory organs of the digestive system include the teeth, tongue,
salivary glands, liver, gallbladder, and pancreas.
To achieve the goal of providing energy and nutrients to the body, six major
functions take place in the digestive system:
Phases of Digestion
1. Ingestion
2. Secretion
3. Movement
4. Mechanical and Chemical Digestion
5. Absorption
6. Elimination
Types
Mechanical (physical)
1. Chew
2. Tear
3. Grind
4. Mash
5. Mix
Chemical
Enzymatic reactions to improve digestion of
1. Carbohydrates
2. Proteins
3. Lipid
Function of digestive system-
Produces various chemicals to break down the food.
Filters out harmful substances.
Gets rid of solid wastes.
Mouth –
Structure and function
Also known as the oral cavity. The mouth is the first portion of the alimentary canal that receives
food. The mouth is the beginning of the digestive tract; and, in fact, digestion starts here when taking
the first bite of food. Chewing breaks the food into pieces that are more easily digested, while saliva
mixes with food to begin the process of breaking it down into a form your body can absorb and use.
The mouth contains many other organs- such as the teeth, toung, and the duct of salivary glandsthat work together to aid in the ingestion and digestion of food. The mouth also plays a major role in
the production of speech through the movements of the tongue, lips and cheeks.
Mouth cavity
Teeth
Teeth are the hardest structures of the human body. The type, number, and arrangement of
a set of teeth represent the dentition. Chewing is the main function of teeth. Humans have
two set of teeth :
-
Primary teeth
Permanent teeth
-
Function of teeth
Chewing
Aesthetics
Pronunciation
Structure and function of teeth
Tongue
The tongue is a muscular organ in the mouth. The tongue is covered with moist, pink tissue called
mucosa. Tiny bumps called papillae give the tongue its rough texture. Thousands of taste buds
cover the surfaces of the papillae. Taste buds are collections of nerve-like cells that connect to
nerves running into the brain. The four common tastes are sweet, sour, bitter, and salty.
Function-
Grips and moves food between teeth during chewing.
Mix food with saliva.
Moves bolus down pharynx.
Speech production
Houses test buds (= gustation)
structure of tongue
Salivary gland
The salivary glands produce saliva, which keeps the mouth and other parts of the digestive
system moist. It also helps break down carbohydrates (with salivary amylase, formerly known
as ptyalin) and lubricates the passage of food down from the oro-pharynx to the esophagus to
the stomach. There are three main pairs of salivary glands: the parotid, the submandibular and
the sublingual gland
Esophagus
After being chewed and swallowed, the food enters the esophagus. The esophagus is a long, thin,
and muscular tube about 10 inches (25 cm ) that connects the pharynx (throat) to the stomach.
It uses rhythmic, wave –like muscle movements (called peristalsis) to force food from the throat
into the stomach. This muscle movement gives us the ability to eat or drink even when we are
upside down.
Function
The esophagus seems to have only one important function in the body - to carry food, liquids,
and saliva from the mouth to the stomach.
Stomach
The stomach is a muscular organ located on the left side of the upper abdomen. The stomach
receives food from the esophagus. As food reaches the end of the esophagus, it enters the stomach
through a muscular valve called the lower esophageal sphincter.
The stomach secretes acid and enzymes that digest food. Ridges of muscle tissue called rugae line
the stomach. The stomach muscles contract periodically, churning food to enhance digestion. The
pyloric sphincter is a muscular valve that opens to allow food to pass from the stomach to the small
intestine.
Gastric glands – Cardiac glands, Funds glands and pyloric glands.
Gastric Juices – Hydrochloric acid and enzymes – Pepsin, Rennin, gastric lipase.
Structure of stomach
Function of stomach






Temporarily store food.
Chemically breaks down food.
Mechanically breaks down food.
Release acids and enzymes.
Kills bacteria that came along with the food.
Release food into the small intestine in a controlled and regulated manner.
Small intestine
The small intestine is the section of your digestive tract where the majority of food digestion and
nutrient absorption takes place. Divided into three sections-
 Duodenum,
 Jejunum,
 Ileum.
The small intestine is a 22-foot long muscular tube that breaks down food using enzymes
released by the pancreas and bile from the liver. Peristalsis also is at work in this organ, moving
food through and mixing it with digestive secretions from the pancreas and liver. The
duodenum is largely responsible for the continuous breaking-down process, with the jejunum
and ileum mainly responsible for absorption of nutrients into the bloodstream.
Contents of the small intestine start out semi-solid, and end in a liquid form after passing
through the organ. Water, bile, enzymes, and mucous contribute to the change in consistency.
Once the nutrients have been absorbed and the leftover-food residue liquid has passed through
the small intestine, it then moves on to the large intestine, or colon.
Structure of small intestine
Duodenum
The duodenum is the first and shortest segment of the small intestine. It receives partially
digested food (known as chyme) from the stomach and plays a vital role in the chemical
digestion of chyme in preparation for absorption in the small intestine. Many chemical
secretions from the pancreas, liver and gallbladder mix with the chyme in the duodenum to
facilitate chemical digestion.
Located inferior to the stomach, the duodenum is a 10-12 inch (25-30 cm) long C-shaped,
hollow tube. The duodenum is a part of the gastrointestinal (GI) tract, attached to the pyloric
sphincter of the stomach on its superior end and to the jejunum of the small intestine on its
inferior end the pancreas, liver and gallbladder all deliver their digestive secretions into the
duodenum through an orifice known as the ampulla of Vater, which is located roughly in the
middle of the duodenum on the left side. The walls of the duodenum are made of four layers of
tissue.
Structure of duodenum
Jejunum
The jejunum is the middle segment of the small intestine found between the duodenum and
the ileum. The small intestine is usually 6-7m long, about two-fifths of which (2.5 m) is the
jejunum. Most of the nutrients present in food are absorbed by the jejunum before being
passed on to the ileum for further absorption.
Ileum
Ileum, the final and longest segment of the small intestine. It is specifically responsible for the
absorption of vitamin B12 and the reabsorption of conjugated bile salts. The ileum is about 3.5
metres (11.5 feet) long (or about three-fifths the length of the small intestine) and extends
from the jejunum (the middle section of the small intestine) to the ileocecal valve, which
empties into the colon (large intestine). The ileum is suspended from the abdominal wall by the
mesentery, a fold of serous (moisture-secreting) membrane. The function of the ileum is mainly
to absorb vitamin B12 and bile salts and whatever products of digestion were not absorbed by
the jejunum. The wall itself is made up of folds, each of which has many tiny finger-like
projections known as villi on its surface.
Layer of small intestine




Serosa
Muscular layer
Submucosa
Mucosa
Structure of small intestine wall
Intestine Juice
Intestinal juice refers to the clear to pale yellow watery secretions from the glands lining
the small intestine walls. The Brunner's glands secrete large amounts of alkaline mucus in
response to (1) tactile or irritating stimuli on the duodenal mucosa; (2) vagal stimulation, which
causes increased Brunner’s glands secretion concurrently with increase in stomach secretion;
and (3) gastrointestinal hormones, especially secretin.Intestinal juice also
contains hormones, digestive enzymes, mucus, substances to neutralize hydrochloric
acid coming from the stomach and erepsin which further digests polypeptides into amino acids,
completing protein digestion.
Enzymes




Erepsin
Maltase
Lactase
Sucrase
Function of small intestine
 Absorbs nutrients from food 3 sections – duodenum, jejunum and ileum.
 Digestive enzymes secreted by various sources aide in the breakdown of protein, fats,
nucleic acids and carbohydrates.
 Structure of villi and microvilli increase surface area for greater absorption.
Large intestine
After passing through the small intestine, food passes into the large intestine, some of the
water and electrolytes ( chemicals like sodium ) are removed from the food. Many microbes
(bacteria like Bacteroides, lactobacillus acidophilus, Escherichia coli, and Klebsiella) in the large
intestine help in the digestion process.
The colon(large intestine)is a 6-foot long muscular tube that connects the small intestine to the
rectum. The large intestine is made up of the cecum, the ascending (right) colon, the transverse
(across) colon, the descending (left) colon, and the sigmoid colon, which connects to the
rectum. The appendix is a small tube attached to the cecum. The large intestine is a highly
specialized organ that is responsible for processing waste so that emptying the bowels is easy
and convenient.
Structure of large intestine
The major function of the large intestine is to absorb water from the remaining indigestible
food matter and transmit the useless waste material from the body. Finally, the rectum stores
the stool until it is expelled from the body.
Function of large intestine
Absorb Water
Absorb Vitamins
Reduce Acidity and Protect from Infections
Produce Antibodies
Role of liver and their dysfunction
Weighing in at around 3 pounds, the liver is the body’s second largest organ; only the skin is
larger and heavier. The liver performs many essential functions related to digestion,
metabolism, immunity, and the storage of nutrients within the body. The liver has multiple
functions, but its main function within the digestive system is to process the nutrients absorbed
from the small intestine. Bile from the liver secreted into the small intestine also plays an
important role in digesting fat. In addition, the liver is the body’s chemical "factory." It takes the
raw materials absorbed by the intestine and makes all the various chemicals the body needs to
function. The liver also detoxifies potentially harmful chemicals. It breaks down and secretes
many drugs.
Structure of liver
Function of liver
 Produces bile ,Secretes bile to the gall







Stores vitamins A,D,E,K
Stores sugar and glycogen
Detoxicating Action
Major role in metabolism
Plasma protein synthesis
Hormone production
Decomposition of red blood cells
Dysfunction of liver- their symptoms
 Abnormal metabolism of fats
 Digestive problems
 Nutrient malabsorption
 Blood sugar problems
 Neurological effects
 Weakened immune system
 Hormonal imbalances
Role of pancreas
The pancreas is a gland organ that is located in the abdomen. The pancreas is a 6 to 10 inch (18
to 25 cm) long organ located behind the stomach in the back of the abdomen. It is spongy and
shaped somewhat like a fish that is extended horizontally across the abdomen. It plays an
essential role in converting the food we eat into fuel for the body's cells.
It is part of the digestive system and produces important enzymes and hormones that help
break down foods. The pancreas has an endocrine function because it releases juices directly
into the bloodstream, and it has an exocrine function because it releases juices into
ducts.Enzymes, or digestive juices, produced by the pancreas are secreted into the small
intestine to further break down food after it has left the stomach. The gland also produces the
hormone insulin and secretes it into the bloodstream in order to regulate the body's glucose or
sugar level.
Structure of pancreas
The pancreas has two main functions:-An exocrine function that helps in digestion and
-An endocrine function that regulates blood sugar.
Pancreatic enzymes
 Trypsin
 Steapsin
 Amylopsin
Role of gall-bladder
The gallbladder is a pear-shaped, hollow structure located under the liver and on
the right side of the abdomen. Its primary function is to store and concentrate bile, a
yellow-brown digestive enzyme produced by the liver. Bile contains bile salts,
pigments, cholesterol and phospholipids. The gallbladder plays an important role in
our digestion of food. The gallbladder holds bile produced in the liver until it is
needed for digesting fatty foods in the duodenum of the small intestine. Bile in the
gallbladder may crystallize and form gallstones, gallstones can be painful, and cause
obstruction.
Structure of gall bladder
Topic - 2. Circulatory system
The circulatory system is a vast network of organs and vessels that is responsible for the flow of
blood, nutrients, hormones, oxygen and other gases to and from cells. Without the circulatory
system, the body would not be able to fight disease or maintain a stable internal environment —
such as proper temperature and pH — known as homeostasis.
Components of circulatory system-Blood
- Heart
- Blood vessels
There are three different types of circulation that occur regularly in the body:
1.
2.
3.
4.
Pulmonary circulation
Coronary or cardiac circulation
Systemic circulation
Renal circulation
5. Portal circulation
Function of circulatory system
 Transport nutrients, hormones
 Remove waste products
 Gaseous exchange
 Immunity
 Blood vessels transport blood
o Carries oxygen and carbon dioxide
o Also carries nutrients and wastes
 Heart pumps blood through blood vessels
A- Structure and function of Heart
The human heart is an organ that pumps blood throughout the body via the circulatory system,
supplying oxygen and nutrients to the tissues and removing carbon dioxide and other wastes. In
humans, the heart is roughly the size of a large fist and weighs between about 10 to 12 ounces
(280 to 340 grams) in men and 8 to 10 ounces (230 to 280 grams) in women,
The human heart has four chambers:
- Right Atrium
- Right Ventricle
- Left Atrium
- Left Ventricle
Layer of heart wall
- Pericardium
- Myocardium
- Endocardium
Heart valves – their structure and type
Function of Heart:
- Pumping blood around the body is the main function of the heart.
- Generating blood pressure.
- Sending deoxygenated blood to the lungs to be oxygenated.
- Sending oxygenated blood to the whole body.
- Ensuring one-way blood flow- Heart valves ensure one-way flow
- Regulating blood supply
Blood vessels
The blood vessels are the part of the circulatory system that transports blood throughout
the human body. This is an essential function as blood delivers valuable nutrients to and
removes wastes from our cells. Blood vessels are constructed of layers of connective
tissue and muscle. The inner blood vessel layer is formed of endothelium. In capillaries and
sinusoids, endothelium comprises the majority of the vessel.
Types of Blood Vessels;
•
•
•
-Arteries
- Vein
--Capillaries
Structure of blood vessels
Blood pressure
Blood pressure is defined as the lateral pressure exerted by flowing blood on the walls of the
arteries. Blood pressure is usually expressed in terms of the systolic (maximum during one
heart beat) pressure over diastolic (minimum in between two heart beats) pressure and is
measured in millimeters of mercury (mmHg). Normal resting systolic (diastolic) blood
pressure in an adult is approximately 120 mmHg (80 mmHg), abbreviated "120/80 mmHg".
Hypertension
Hypertension also known as high blood pressure. Most people with high blood pressure
have no signs or symptoms, even if blood pressure readings reach dangerously high levels.
Its causes, symptoms, risk factors and treatment.
Heart failure
Definition
Heart failure, sometimes known as congestive heart failure, occurs when your heart muscle
doesn't pump blood as well as it should. Certain conditions, such as narrowed arteries in
your heart (coronary artery disease) or high blood pressure, gradually leave your heart too
weak or stiff to fill and pump efficiently.
Causes, symptoms and prevention
B- Blood
Blood is the fluid that sustains life. It supplies essential substances and nutrients, such as
sugar, oxygen, and hormones to our cells, and carries waste away from those cells, this
waste is eventually flushed out of the body in urin, feces, sweat, and lungs. The average
human has 5 litres of blood.
Blood compostion
Blood consists of :
- Liquid plasma (volume-55-60%)
- Formed elements (cell)- (volume-40-45%)
Blood composition
Plasma (55-60%)
Corpuscles (40-45%)
Water(92%)
Nutrients
Amino acids
(R.B.C.; or Erythrocytes)
(W.B.C.; or Leucocytes)
(Platelets)
Nitrogenous waste
Gases
Electrolytes
Proteins
A granulocytes
Granulocytes
Albumins
Fibrinogen
Globulins
Lymphocytes
Basophils
Monocytes
Esinophils
Neutrophils
Structure and Function of R.B.C.,W.B.C. and Platelats.
Function of blood
 Transport
 Protective
 Regulative
 Respiration
 Trophic
 Excretive
 Homeostatic
 Maintenance of body temperature
Blood clotting
Blood clotting is an important process that prevents exessive bleeding when a blood
vessel is injured. Platelets and proteins in your plasma work together to stop the
bleeding by forming a clot over the injury.
-
Stages of blood clotting;
Stage 1. Formation of Prothombinase
Stage 2. Formation of Thrombin
Stage 3. Formation of Fibrin plug (clot)
Blood group
-
There are four major blood groups determined by the presence or absence of two
antigens- A and B- on the surface of red blood cells.
Group A
Group B
Group AB
Group O
Donor
O
A
B
AB
Recipient
O
A
B
AB
Topic – 3.Excretory System
The excretory system is the system of an organism’s body that performs the function of
excretion, the bodly process of discharging wastes.
Parts of the body that are involved in the process of excretion;
- Sweat glands
- Liver
- Lungs
- Kidney
Structure and function of kidney
The kidneys are paired organs found on each side of the back portion of the abdominal cavity.
These bean- shaped organs are proctected by the back muscles and the ribs, as well as the fat
that surrouns them like a protective padding.
Defferent parts of the kidney;
- Renal hilus
- Renal capsule
- Renal cortex
-
Renal medulla
Renal pyramids
Renal pelvis
Renal artery
Renal vein
Interlobular artery
Interlobular vein
Collecting duct
Ureter
The function unit of kidney; Nephron
Function of Kidney;
- Filter wastes from blood
- Mantains water balance
- Regulates blood pressure
- Regulates red blood cells
- Regulats acid levels
Urine formation
Urine is formed in the kidneys through a filtration of blood. Urine is about 95% water and 5%
waste products. Urine is formed in three steps;
- Filtration
- Secration
- Absorption
Factors affecting the formation of Urine;
- Intra-venous Saline Injection
- Drinking Saline Solution
- Effect of salts
- Effect of water- Deprivation
- Effect of Exercise
Factors affecting the Volume of Urine;
- Water intake
- Elimination of water by other channels
- Rate of Renal Circulation
- Colloidal osmotic pressure of plasma
-
Number of Active Glomeruli
Permeability of filter bed
Degree of Tubular Re-Absorption
Amount of solids to be Excreted by the Kidney
Suggested Books :1. Jain, A.K. testbook of Physiology. Vol - I and IIAvichol Publication Co-New Delhi.
2. ekuo'kjhj ,oa iks"k.k foKku & vk'kk dqekjh] Dykfldy ifCyf'kax ubZ fnYyhA
3.Pramila Verma and Pande,”Manaw sharir evm kriya vigyan” Hindi granth academi.Patna
Semester- III(2015-17)
Generic(Open) Elective
Paper-IX – THERAPEUTIC NUTRITION
”Therapeutic nutrition is concerned with nutritional requirements of patients suffering from different
diseases and prescribing the right type of diets for them.”- M. Swaminathan.
Diet therapy is the use of foods as an agent in effecting recovery from illness. If agent deals with
modification necessary in the diet in the treatment of different diseases.””- Proudfit and Robinson.
The main purposes of therapeutic diet is:
 To maintain good nutritional status.
 To correct the deficiencies which has occurred.
 To afford rest to the whole body or to the specific organ affected by the disease.
 To adjust the food intake to the body’s ability to metabolize the nutrients during the disease.
 To bring about changes in weight where ever necessary.
 Education of the patient regarding the need for adherence to prescribed diet.
Topic- 1. Modified therapeutic diet
A therapeutic diet is a meal plan that controls the intake of certain foods. It's a practice followed in
many hospitals as part of the treatment of a medical condition and are normally prescribed by a
physician and planned by a dietician. A modified therapeutic diet is designed to be part of an overall
treatment regimen to combat a potentially serious condition.A therapeutic diet is usually a
modification of a regular diet.
The normal diet may be modified:
 To provide change in consistency as in fluid and soft diet.
 To increase or decrease the energy needs.
 To increase or decrease one or more amounts of nutrients, like high protein diets or sodium and
potassium restricted diets, restricted fat diet, etc.
 To include or exclude certain allergic foods.
 To increase or decrease bulk diets ( high or low fibre).
 To modify the intervals of feeds (like in tube feeds ).
 To provide foods bland in flavour.
Topic-2. Soft Diet
A soft diet is made up of foods that are soft and easy to chew and swallow. These foods may be
chopped, ground, mashed, pureed, and moist. You may need to follow this diet if you have had
certain types of surgery, such as head, neck, or stomach surgery. You may also need to follow this
diet if you have problems with your teeth or mouth that make it hard for you to chew or swallow
food. The soft diet is made up simple, easily digested food and contains no hard fibre, low of fat and
no rich highly seasoned food. Example- Shredded meat, Scrambled egg, Mashed potato, Cooked
chopped vegetables, Rice, Pasta, Soft bread, Idly, Upma etc.
Liquid Diet
Liquid diets have two subtypes: the clear liquid and full liquid.
Clear liquid diet;- Clear liquid diet prevents or corrects dehydration. It also minimize gastric
simulation.
Example: Water, apple or grape juice without pulp, broth, and jell, plain gelatine, tea, coconut
water, Lemon water, glucose water, etc.
Full liquid diet;
This diet bridges the gap between the clear fluid and soft diet. A full liquid diet is made up only of
fluids and foods that are normally liquid and foods that turn to liquid when they are at room
temperature, like ice cream. It is used following operations, in acute gastritis, acute infections and
in diarrhea. You may also need to be on this diet if you are having trouble swallowing or chewing.
Example - Ice- cream, pudding, custard, juice with pulp, all vegetable soup, milk.
Bland Diet
Bland food is often a dietary recommendation for digestive issues or illnesses. Bland foods are those
that are soft, low in fiber and not spicy. When following a bland diet include foods from all major food
groups for balanced nutrition. A bland diet can be used alongside lifestyle changes to help treat ulcers,
heartburn, nausea, vomiting, diarrhea, and gas. You may also need a bland diet after stomach or
intestinal surgery.
Example:- milk, and other dairy products, low-fat or fat-free only, paneer, Cooked, canned, or frozen
vegetables, Fruit juices and vegetable juices , Breads, and pasta made with refined white flour, Eggs, Weak tea
Pudding and custard, boiled potato, soft rice, soft khichri, etc.
Topic -3.Different type of feeding pattern
There are various type of feeding methods;-
Oral feeding
Tube feeding
Nerve feeding
Oral feeding is the best for the nourishment of a patient. But in the following conditions it is
not possible to give the feeding orally and tube feeding or parenteral feeding is resorted.
 Those who cannot swallow due to paralysis of the muscles of swallowing (diphtheria,
poliomyelitis) or cancer of the oral cavity or larynx.
 Those who cannot be persuaded to eat.
 Those with persistent anorexia requiring forced feeding.
 Semiconscious or unconscious patients.
 Severe malabsorption requiring administration of unpalatable formula.
 Short bowel syndrome.
 Those who are undernourished or at risk of becoming so.
 Those who cannot digest and absorb.
 After surgery.
 Patients with neurological and renal disorders or have chronic fevers or diabetes.


Babies of very low birth weight.
Patients with spinal cord injury, burns.
Tube Feeding:
This is done by passing a tube into the stomach or duodenum through nose which is nasogastric
feeding. Into the stomach it is termed as gastrostomy, or into the intestine where is termed as
enterostomy, or into the jejunum where is termed as jejunostomy.
Type;
- Nasal or nasogastric
- Gastrostomy
- Jejunostomy
- Ractal feeding
Nasal feeding
Nasal tubes are non-surgical and temporary tubes placed through the nose and into the
stomach or intestine.
A satisfactory Tube Feeding must be:
 Nutritionally adequate
 Should be well tolerated by the patient.
 Should be easily digestible with no unfavorable reaction such as distension, diarrhea, or
constipation.
 Easily prepared .
 inexpensive
Diets for tube feeding;
-
Planned formula
Blendarized formula
-
Commercially prepared predigested foods.
Nerve feeding
Nerve feeding, also known as intravenous feeding or Parenteral nutrition , is a method of
getting nutrition into the body through the veins. While it is most commonly referred to as total
parenteral nutrition (TPN), some patients need to get only certain types of nutrients
intravenously.
Total parenteral nutrition may be required in people with the following:






A digestive tract that is not functioning
Severe pancreatitis or certain stages of ulcerative colitis
A blockage in the intestine
Certain birth defects of the digestive tract
In children, diarrhea that has lasted a long time, regardless of its cause
Short bowel syndrome due to surgical removal of a large part of the small intestine
FORMULA
COMPLICATIONS
Topic- 4.High calorie diet
This is a normal diet with an increase in the calories level to 3000 or more. If appetite is poor,
small servings of highly reinforced foods are given. The diet may be modified in consistency and
flavor, according to specific needs. Excessive amounts of foods that have a low calorific value
and fried foods which disturb the appetite should be avoided. These diets are prescribed for
weight loss, Fever, Hyperthyroidism, Burns.
Low calorie diet
These diets controls calories, carbohydrates, protein and fat intake in balanced amount to meet
the nutritional needs and control blood sugar and weight. These diet are prescribed for obesity,
diabetes, cardiovascular disease, Gout, Gall bladder disease, preceding surgery.
High protein diet
These are diets high in plant and animals, like egg, meat, fish, soya, nuts etc. These diets are
prescribed for malnourished, body builders, fever, hyper thyroidism, burns, after surgery, elderly. Per
day 100-125g.
Low protein diet
A low-protein diet is a diet in which people reduce their intake of protein. A low-protein diet is
prescribed for those with inherited metabolic disorders, like- kidney disease
High fiber diet
Dietary fiber plays a significant role in colonic function. A high fiber diet includes foods that have a high
fiber content. Soluble fiber helps to lower cholesterol and helps to regulate blood sugar levels for
individuals with diabetes. It is present in beans, legumes, oats, barley, berries, and some vegetables.
.Low fiber diet
A low fibre diet will reduce the amount of undigested material that passes through bowel. The diet is
usually used in severe diarrhea, post operations, etc.
Topic-5.Cardiovascular disease
Cardiovascular disease (CVD) is a general term describing diseases of the heart and blood vessels.
Hypertension
WHO defines hypertension as a condition in which systolic pressure exceeds 160mm hg and diastolic
pressure exceeds 95mm Hg.
Type-
Mild hypertension, Moderate hypertension, and severe hypertension.
Causes:Age, heredity , obesity, lack of physical activity, mental stress, food habits , Smoking and drinking,
excess use of salt, renal disease, etc.
Symptoms;Headache, dizziness, impaired vision, shortness of breath, pain over the heart , gastrointestinal
disturbance, failing memory, etc.
Dietary management;Low calories diet, low sodium diet, low fat diet, high fibre diet.
Atherosclerosis
Atherosclerosis is a condition where the arteries become narrowed and hardened due to an excessive
build up of plaque around the artery wall. The disease disrupts the flow of blood around the body,
posing serious cardiovascular complications.
Causes:High calorie food, high saturated fat and cholesterol food, sedentary life, mental stress and strain, Age,
endocrine hormone, smoking, wine, etc.
Symptoms;Vomiting, Chest pain, coughing, extreme anxiety, Paralysis, headache, etc.
Dietary management;Low calorie, low fat particularly low saturated fat, low carbohydrate, high fibre diet, normal protein,
minerals and vitamins, increased amount of antioxidants.
Topic -6, Acute and chronic liver disorder
Liver diseases comprise a vast range of conditions that affect the normal functioning of the liver. It
plays an important role in digestion of food, absorption of nutrients and elimination of toxic substances
from the body. There are over 100 different types of liver diseases and several lifestyle related things
that can lead to liver disease. Most common diseases include alcoholic liver disease, hepatitis, liver
cirrhosis and haemochromatosis. Some liver problems are temporary and go away on their own, while
other liver problems can last for a long time and lead to serious complications.
Acute liver failure is the appearance of severe complications rapidly after the first signs of liver disease
(such as jaundice), and indicates that the liver has sustained severe damage (loss of function of 80–90%
of liver cells).
Chronic liver failure usually occurs in the context of cirrhosis, itself potentially the result of many
possible causes, such as excessive alcohol intake, hepatitis B or C, autoimmune, hereditary and
metabolic causes (such as iron or copper overload, steatohepatitis or non-alcoholic fatty liver disease).
There are two main disease of liver;1. Viral hepatitis= jaundice.
2. Hepatic Cirrhosis
Viral Hepatitis
Hepatitis is a common liver disease. Many illnesses and conditions can cause inflammation of the liver
(hepatitis), but certain viruses cause about half of all hepatitis in people. Other types of hepatitis one
comes across are drug- infected. Viruses that primarily attack the liver are called hepatitis viruses.
There are several types of hepatitis viruses including types A, B, C, D, E, and possibly G. Types A, B, and
C are the most common. All hepatitis viruses can cause acute hepatitis. Viral hepatitis types B and C
can cause chronic hepatitis.
Hepatitis
Viral
Type A(Infectious)
Usually mild
Drug- induced
Type B(Serum)
severe
TypeC(Post-Transfusion)
Type of jaundice;
1. Hemolytic hepatitis or Jaundice
2. Obstructive Hepatitis
3. Hepatocellular hepatitis
Symptoms of hepatitis;- Anorexia, fatigue, nausea, vomiting, diarrhea, fever, weight loss, abdominal
discomfort are some of the common symptoms characterizing all types of hepatitis. Generally, jaundice
follows after these symptoms appear.
Dietary management:A high protein, high carbohydrate and moderate fat is recommended. The food must be initially of
liquid consistency.
Cirrhosis of liver
Liver Cirrhosis is a complication of liver disease which involves loss of liver cells and irreversible
scarring of the liver. Cirrhosis represents the end stage of chronic. liver disease that is accompanied by
progressive fibrosis and is characterized by development of regenerative nodules and a sustained
chronic inflammatory response.
Causes;
Cirrhosis of the liver may be due to infectious hepatitis, chronic alcoholism along with malnutrition,
metabolic-disturbance, toxic agent, etc.
Symptoms;
Cirrhosis can cause weakness, loss of appetite, easy bruising, yellowing of the skin (jaundice), itching,
and fatigue. Complications of cirrhosis include edema and ascites, anorexia, fatigue, nausea, vomiting,
diarrhea, fever, weight loss, etc.
Dietary management:The diet plays a key role if it is started at the appropriate time, that is before the disease is well
advanced. A high carbohydrate, high protein diet given in infectious hepatitis may be adequate in most
case. If hepatic coma is suspected, then dietary protein levels must be controlled. If swelling and
ascites are seen, then sodium in the diet may be restricted. Vitamins may be supplemented in the diet
to replenish liver store and repair tissue damage.The consistency of the dit should be liquid to soft with
small and frequent meals.
Topic- 6.Renal disease
Renal disease, also known as kidney disease. The kidney is a very efficient filter of the body. It has
several functions. It maintains the normal composition and volume of the blood. It does so by excreting
nitrogenous and other metabolic wastes, by regulating the excretion of electrolytes such as sodium,
potassium as well as fluids, balance of water is maintained, pH of the blood are regulated. It effectively
flushes out the soluble toxic substance.
Main disease of kidney
Here are some of the important kidney disease.
1. Glomerulonephritis.- Acute and chronic.
2. Nephrotic syndrome (Nephrosis).
3. Acute or chronic renal Failure or Uremia.
4. Proteinuria.
5. Hematuria
6. Kidney stone.
Glomerulonephritis
Glomerulonephritis is an inflammatory process affecting the gllomeruli. The consequences can be fatal.
The glomeruli are tiny filters in the kidneys. Each kidney contains millions of glomeruli. If glomeruli are
damaged, kidneys will stop working properly . The kidney can no longer remove waste and excess
fluids efficiently. Blood and protein cannot be filtered, and are excreted in the urine. you can go into
kidney failure. . It can be acute, which means it starts suddenly, or chronic, when the onset is gradual.
Acute Glomerulonephritis
In this disease, primarily the glomeruli are affected. This disease normally occurs commonly after a
streptococcal fever, tonsilitis, pneumonia or respiratory infection. It occurs more frequently inchildren
than in adults.
Symptoms;
 puffiness in the face (edema)
 urinating less often
 blood in your urine (dark, rust-colored urine)
 extra fluid in your lungs, causing coughing
 high blood pressure
Chronic Glomerulonephritis;
The chronic form of glomerulonephritis can develop over several years with no or very few symptoms.
This can cause irreversible damage to your kidneys and ultimately lead to complete kidney failure. A
genetic disease, Immune diseases can sometimes cause its.. Hereditary nephritis occurs in young men
with poor vision and poor hearing.
Symptoms;
 blood or excess protein in your urine, which may be microscopic and show up in urine tests
 high blood pressure
 swelling in ankles and face (edema)
 frequent nighttime urination
 bubbly or foamy urine (from excess protein)
 abdominal pain
 frequent nosebleeds
Dietary management:The dietary management provides optimal nutritional support. Adequate protein, salt is restricted if
there is oedema, hypertension . The fluid intake will be adjusted to output including losses in vomiting
or diarrhea.
Nephrotic syndrome (Nephrosis).
Nephrosis is a disease which affects small children. The primary degenerative effect in nephrosis is in
the capillary, basement membrane of the glomerulus. This disease is characterized by large amount of
protein (albumin) loss in urine by the body.
Causes;
Nephrotic syndrome can be caused due to progressive glomerulonephritis, diebees mellitus, systemic
lupus erythematosus, amyloidosis, malaria, drugs, toxic , etc.
Symptoms;
In the urine, large amount loss of albumin along with globulins as well as specialized binding proteins
for thyroid and iron is seen.
Dietary management:High carbohydrate, restricted salt, low proteins, moderate fat with restricted fluid are recommended,
Vitamins specially vitamin C should be given. Low fat and cholesterol in severe patients.
Acute renal Failure
Acute kidney failure happens when your kidneys suddenly lose the ability to eliminate
excess salts, fluids, and waste materials from the blood. Body fluids can rise to dangerous
levels when kidneys lose their filtering ability. A sudden loss of kidney function caused by
an illness, an injury, or a toxin that stresses the kidneys.
Causes






Loss of blood during accidents, ulcers, or at the time of delivery.
Loss of plasma as in burns and crushes.
Loss of fluid during diarrhea, vomiting, excessive urination and excessive sweating.
Serious infection.
Acute haemolytic disorders.
Nephritis or nephrosis can also result in acute renal failure.
Symptoms
Symptoms;
- Acute headache, nausea , vomiting
- Low urine volume.
- Blood in urine
- Pale skin.
- Reduced urine output
- Poor appetite,
- detectable abnormal mass, etc.
Dietary management:-
A high calorie intake is desired mainly from carbohydrates and fat. Low protein, low sodium, low
potassium diet recommended. Control of the fluid intake is necessary in order to prevent excess
retention in the body.
Chronic renal Failure or Uremia
Chronic renal failure disease is a slow progressive loss of kidney function over a period of several
years. It is also known as uremia as the level of urea in blood is very high. If chronic kidney failure ends
in end-stage kidney disease, the patient will not survive without dialysis (artificial filtering) or a kidney
transplant. It may be the end result of acute glomerulonephritis, pyelonephritis, and nephritic
syndrome.
Cause:
 A family history of kidney disease




Hypertension (high blood pressure)
Diabetes especially type I.
Progression of acute nephritis.
Bladder obstruction
 Exposure to toxic substances.
 Gout, Lupus erythematosis
 Age
 Abdominal surgical emergency.
 Some medications
Symptoms;
Blood in urine, edema - swollen feet, hands and ankles, high blood pressure, Decreased urine output,
tiredness, Itchy skin, Anemia, Muscle cramps and twitches, Nausea , Pain on the side or mid to lower
back, Loss of appetite, Unexplained headaches, Sudden change in bodyweight, Protein in urine, etc.
Dietary management:Provide adequate calories and fat, low protein diet, restricted sodium, requirements for fluid depend
on the etiology of the renal disease and the level of the GFR.
Kidney Stone
Kidney stone may be found in the kidney itself, urethra, ureter, or bladder. Kidney stone are made
up of calcium phosphate, calcium oxalate, uric acid, calcium carbonate or magnesium ammonium
phosphate
Causes:
Heredity, Infection in Urinary Tract, Climate, Occupation, Long time bed rest, food habits- consuming
foods rich in oxalates, calcium, purines and phosphate, Gout, Parathyroid Hormone, etc.
Symptoms:






A sharp pain on one side of their back or lower abdomen.
pain while urinating
urine that appears cloudy
urine that smells differently than it normally does
an urge to urinate more often than usual
pain with any symptoms – nausea, vomiting, chills , fever.
Dietary management: The diet should be low in oxalic acid and purine contents.
 Calcium and phosphates should be reduced.
 Consume large amounts of fluid.
 Intake balance diet.
 Correction of Vitamin A and B6 deficiency may be helpful.
 Brown rice, bananas, oats should be taken.
 Restricted food – tea, Coffee, ,meat, fish, dried fruits, carbonated beverages.
Topic – 7. Nutritional problems of old aged
Aging is not a disease but a biological process. Eating well is important at any age. But health issues
and physical limitations sometimes make it difficult for seniors. The elderly are at risk of poor nutrition
due to economic pressure, poor dentition, aging tissues and inadequate diet, which may be
compounded with the incidence of chronic disease. As part of aging process the functioning of the
organ may change which may influence nutrient Status..
 Reduced Basal Metabolic Rate.
 Reduced Hormone Secretion from Endocrine glands.
 Changes in Nervous System.
 Behavioral Changes.
 Changes in Skeletal System and Dentition.
 Changes in Digestive Organs.
 Changes in Heart and Blood Circulatory System.
 Changes in Skin.
 Changes in Excretory system.
 Decrease in the Number of Functioning Cells.
 Hardening of Connective Tissues.
 Decreasing Immunity Power.
Nutritional problems in the elderly can cause a number of complications, including weakened immune
systems, lowered energy levels and chronic health problems such as type 2 diabetes, high blood
pressure, heart disease, stroke and osteoporosis, anaemia, constipation. Loss of weight during old age
may be due to consumption of less calories. Blunting of taste sensation may be due to degenerative
changes in the parietal lob of brain in old age.
Nutritional requirements
Good nutrition results in speedy recovery from illness, surgery or broken bones and can generally
improve overall quality of life along with increased life span. The calorie intake should be adjusted to
maintain the body weight. It is necessary that at least 50 per cent of calories are derived from
carbohydrates. Calories and carbohydrates intake should be reduced. Protein requirements become
slightly lower in men, but increase slightly in women after 50 years of age. Protein requirements may
also be increased in some older people due to illness. Fat should be low. Vitamin D is needed for the
absorption of calcium from food and is therefore important for good bone health. Calcium, iron
minerals, Vitamins needs during old age increases. Vitamin D is needed for the absorption of calcium
from food and is therefore important for good bone health. Fibre helps in reducing cholesterol,
constipation, so it is essential for the older person.
Suggested Book:
1. Srilakshmi. B.”Dietetics”-. New age international publisher, New Delhi,
2. Mudamsi, Rajgopal “Fundamentals of food, nutritional and diet theraphy” - Mudamsi,
Rajgopal
3. Swaminathan, Dr. M.S. “Food and Nutrition” –
4. Harplani. B.D. “Dietetics, & Therapetic Nutrition” - Star publication, Agra -2 (Hindi version)
5. Verma & Pandey, Dr. Pramila, Dr. Kant Dietetics, Scientific Book Company Patna - (Hindi
version)
6. Bakshi,B.K.,“Upchararth Ahar Prabandhan tatha Samudayik Posha”( Hindi Version),
7. Dr. Paramila Verma and Dr. Kanti Pandey , Extension Education, Scientific book company
Patna. (Hindi Version)
8. Joshi, Shubhangini A, “Nutrition and Dietetics”, McGraw Hill Education (India) Private Limited
, New Delhi.