LEARNING OBJECTIVE: Select the appropriate diet for various medical conditions.

It is often necessary to cater to a patient's appetite, since many individuals become especially hard to please when sick. In some disease states, such as cancer, patients experience marked taste changes. Because of the importance of the nutritional elements in feeding the sick, try to carry out the patient's wishes whenever possible. A tactful and observant Hospital Corpsman can be of great benefit to the physician and dietitian in carrying out the dietary regimen. You must be aware of what comprises a well-balanced diet and should be able to recognize when dietary adjustments need to be made in special situations. This is important to meet the changing needs of the diseased body's ability to make use of foods.

The patient should be made to feel that the utmost cleanliness and care have been observed in the preparation and service of their food. The patient's face and hands should be cleaned before food is served, and the lips and teeth cleaned before and after the meal. If the mouth is dry, it should be moistened periodically.

When special or modified diets are ordered, check the contents of the tray with the written orders. An error in serving a special diet may cause discomfort, serious illness, or even death.

OBJECTIVES OF DIET THERAPY
The objectives of diet therapy are as follows:
To increase or decrease body weight

To rest a particular organ

To adjust the diet to the body's ability to use certain foods
To produce a specific effect as a remedy (e.g., regulation of blood sugar in diabetes)
To overcome deficiencies by the addition of food rich in some necessary element (e.g., supplementing the diet with iron in treating macrocytic anemia)

To provide ease of digestion by omitting irritating substances, such as fiber, spices, or high-fat foods
TYPES OF DIETS
Diets used in the treatment of disease are often spoken of by specific names that show a special composition and often indicate the purpose for which the diet is intended.

Regular Diet
The regular diet is composed of all types of foods and is well balanced and capable of maintaining a state of good nutrition. It is intended for convalescing patients who do not require a therapeutic diet.

Modified or Therapeutic Diets
Modified or therapeutic diets are modifications of the regular diet and are designed to meet specific patient needs. These include

method of preparation (e.g., baking, boiling, or broiling),

consistency (e.g., ground or chopped),
total calories (e.g., high or low calorie),
nutrients (e.g., altering carbohydrate, protein, fat, vitamins, and minerals), and

allowing only specific foods (e.g., diabetic diet).
SOFT DIET.-The soft diet is soft in texture and consists of liquids and semi-solid foods. It is indicated in certain postoperative cases, for convalescents who cannot tolerate a regular diet, in acute illnesses, and in some gastrointestinal disorders. A soft diet is an intermediate step between a liquid and regular diet and is low in connective tissue and indigestible dietary fiber. Little or no spices are used in its preparation.

The soft diet includes all liquids other than alcohol, and foods that may be incorporated into a soft poultry, and vegetables (including baked, mashed, and scalloped potatoes). Vegetables can be pured and meats ground for dental patients. Permitted desserts are custards, gelatin puddings, soft fruits, and simple cakes and cookies. Foods prohibited in a soft diet include fried foods, raw vegetables, and nuts.

LIQUID DIET.-A liquid diet consists of foods that are in a liquid state at body temperature. This type of diet is indicated in some postoperative cases, in acute illnesses, and in inflammatory conditions of the gastrointestinal (GI) tract. It is important that feedings consisting of 6 to 8 ounces or more be given every 2 to 3 hours while the patient is awake.

Liquid diets are usually ordered as clear, full, or dental liquid. Aclear liquid diet includes clear broth, black tea or coffee, plain gelatin, and clear fruit juices (apple, grape, and cranberry), popsicles, fruit drinks, and soft drinks. This diet is inadequate in all nutrients. A full liquid diet includes all the liquids served on a clear liquid diet, with the addition of strained cream soups, milk and milk drinks, ice cream, puddings, and custard. The full liquid diet is inadequate in iron, niacin, and possibly Vitamin Aand thiamin. Adental liquid diet includes regular foods blended and strained in liquid form and all foods allowed on clear and full liquid diets. Vitamin and mineral supplements may be necessary with the dental liquid diet if the recommended amounts of food are not tolerated.

HIGH-CALORIE DIET.-The high-calorie diet is of a higher caloric value than the average patient normally requires. A high-calorie diet is indicated when an increase of total calories is required by malnourished, underweight, postsurgical, or convalescing patients, especially those recovering from acute illnesses such as infections, burns, and fevers. The increase in calories is obtained by supplementing or modifying the regular diet with high-calorie foods or commercial supplements, by giving larger portions, or by adding snacks. It is given to meet a need for energy caused by the more rapid metabolism that accompanies certain diseases (especially fever, hyperthyroidism, poliomyelitis, and tuberculosis). In the liquid or soft diet, adding fats and carbohydrates increases the caloric value. The high-calorie diet is often ordered along with high protein. Proteins are added to prevent depletion of proteins in the plasma (a condition known as hypoproteinemia). As the patient progresses, a more solid diet is given.

Good sources of high-calorie foods are whole milk, cream, sweets, butter, margarine, fried foods, gravy, sauces, and ice cream. Between-meal feedings consisting of milk, milkshakes, cheese, cookies, or sandwiches are recommended, but these feedings should not interfere with the patient's appetite at mealtime.

HIGH-PROTEIN DIET.-As previously stated, protein is essential for tissue growth and regeneration. A high-protein diet is indicated in almost all illnesses (e.g., nephrosis, cirrhosis of the liver, infectious hepatitis, burns, radiation injury, fractures, some GI disorders, conditions in which the protein blood level is low, and in preoperative and postoperative cases). In some acute illnesses and disorders, such as infectious hepatitis, GI disorders, and postoperative conditions, patients may be unable to consume solid foods or the daily requirement of protein and calories because of pain or nausea. In these cases, intravenous fluids with nutrient additives are required for the patient to receive the required amount of protein. Protein-calorie deficiency is a definite factor in postoperative wound disruption. This disruption can best be prevented by preemptive nutritional measures before surgery. Antibody production will be decreased if the patient receives inadequate protein. Remember, the daily recommended intake of proteins for adults is at least 0.8 g/kg of body weight (approximately 56 g). Ahigh-protein diet should provide a minimum of 1.5 g of protein per kg of body weight (approximately 105 g). The seriously burned and radiation injury patients should receive at least 3.0 g/kg daily.

Supplement the regular diet with high-quality protein foods, such as meat, fish, cheese, milk, and eggs.