Simplified Diet Manual Tenth Edition Iowa Dietetic Association
Edited by Andrea Maher, RD, LD
•Easy-to-understand, fundamental nutrition guidelines Easy-to-understand, fundamental nutrition guidelines for normal and therapeutic dietsfor normal and therapeutic diets •Helps dietitians and foodservice managers maintain Helps dietitians and foodservice managers maintain nutritional health and well-being of clients nutritional health and well-being of clients
•Revised Guidelines for Diet Planning based on Revised Guidelines for Diet Planning based on Dietary Guidelines for Americans 2005 and USDA’s Dietary Guidelines for Americans 2005 and USDA’s MyPyramid MyPyramid
•Study guide questions train foodservice employees Study guide questions train foodservice employees in health care facilitiesin health care facilities
Pulling Ideas Together
• IDA Taskforce Survey • IDA Publications Committee• Blackwell Publishing• ICD-HCF• District Association Meetings• Dietary Managers Association• Department of Inspections & Appeals• IDA Board and Council
Chapter 1Guidelines for Diet Planning
• MyPyramid 2005
• Dietary Guidelines for Americans 2005
Dietary Guidelines for Americans 2005
1. Consume a variety of foods
2. Control calorie intake to manage body weight
3. Be physically active every day
4. Increase daily intake of fruits and vegetables, whole grains, low-fat milk and milk products
Dietary Guidelines for Americans2005
5. Choose fats wisely for good health
6. Choose carbohydrates wisely for good health
7. Choose and prepare foods with little salt
8. If you drink alcoholic beverages, do so in moderation
Black beansBlack-eyed peasChickpeasKidney beansLentilsLima beansNavy beansPinto beansSoy beansSplit peasTofuWhite beans
CornGreen peasLima beansPotatoes
ArtichokesAsparagusBeans sproutsBeetsBrussels sproutsCabbageCauliflowerCeleryCucumbersEggplantGreen beansGreen or red peppersIceberg lettuceMushroomsTomatoesTurnipsZucchini
• Nutrition Guidelines for Pregnancy and Lactation, Normal Infants, Children
• Meeting Nutritional Needs for Older Adults
Meeting Needs of Older Adults
• Use General Diet as much as possible
• Least restrictive diet is encouraged, especially residents of long-term care facilities
• Minor changes to a well-planned general diet may meet the needs of people with high blood cholesterol, diabetes, or those that need weight management.
Chapter 3Consistency Altered Diets
• ADA National Dysphagia Diets
Level 1: Dysphagia Pureed
Level 2: Dysphagia Mechanically Altered
Level 3: Dysphagia Advanced Diet
• ADA National Dysphagia Diet Liquid Consistency Levels
Sample Menu Plan for National Dysphagia Diets and Modifed Renal Diet Meal General Dysphagia Advanced Dysphagia Mechanical Dysphagia Pureed Modified Renal Breakfast Orange Juice* Oatmeal Poached Egg Blueberry Muffin Milk* Lunch Roast Pork, 2 oz Baked Potato Broccoli Whole Wheat Bread Pudding Milk* Supper Vegetable Beef Soup* Crackers Turkey Sandwich, 2 oz Diced Peaches Milk* HS Snack Banana *If thin liquids restricted, thicken to appropriate consistency
Food Groups Recommended Avoid
Breads Any well-moistened breads, biscuits, muffins, pancakes, waffles, etc. Need to add adequate syrup, jelly, margarine, butter, etc., to moisten well.
Dry bread, toast, crackers, etc.Tough, crusty breads such as French bread or baguettes.
Cereals All well-moistened cereals. Coarse or dry cereals such as shredded wheat or All Bran
Fruits All canned and cooked fruits.Soft, peeled fresh fruits such as peaches, nectarines, kiwi, mangos, cantaloupe, honeydew, watermelon.Soft berries with small seeds.
Difficult-to-chew fresh fruits such as apples or pears.Stringy, high-pulp fruits such as papaya, pineapple, or mango.Fresh fruits with difficult-to-chew peels such as grapes.
Meats, Meat Substitutes, Entrees
Thin-sliced, tender, or ground meats and poultry.Well-moistened fish.Eggs prepared any way.Casseroles with small meat chunks, ground meats, or tender meats.
Tough, dry meats and poultry.Dry fish or fish with bones.Chunky peanut butter.Yogurt with nuts or coconut.
Potatoes and Starches All, including rice, wild rice, moist bread dressing, and tender, fried potatoes.
Soups with tough meats.Corn or clam chowders.Soups that have large chunks of meat or vegetables >1 inch.
Vegetables All cooked, tender vegetables.Shredded lettuce.
All raw vegetables except shredded lettuce.Cooked corn.Nontender or rubbery cooked vegetables.
Level 3: Dysphagia Advanced Diet
Sample Menu Plan for National Dysphagia Diets and Modifed Renal Diet Meal General Dysphagia Advanced Dysphagia Mechanical Dysphagia Pureed Breakfast Orange Juice* X Oatmeal X Poached Egg X Blueberry Muffin X Milk* X Lunch Roast Pork, 2 oz Ground Pork Baked Potato No skins Broccoli X Whole Wheat Bread X/ Margarine Pudding X Milk* X Supper Vegetable Beef Soup* X Crackers Crackers in soup Turkey Sandwich, 2 oz Thin-sliced sandwich Diced Peaches X Milk* X HS Snack Banana X *If thin liquids restricted, thicken to appropriate consistency
Food Groups Recommended Avoid
Breads Soft pancakes, well moistened with syrup or sauce.Pureed bread mixes, pregelled or slurried breads that are gelled through entire thickness.
All others
Cereals Cooked cereals with little texture, including oatmeal.Slightly moistened dry cereals with little texture.Unprocessed wheat bran stirred into cereals for bulk.
Very coarse cooked cereals that may contain flax seed or other seeds or nuts.Whole-grain dry or coarse cereals.Cereals with nuts, seeds, dried fruit and/or coconut.
Fruits Soft drained canned or cooked fruits without seeds or skin.Fresh soft/ripe banana.Fruit juices with small amount of pulp.
Fresh or frozen fruits.Cooked fruit with skin or seeds.Dried fruits.Fresh, canned, or cooked pineapple.
Meats, Meat Substitutes, Entrees
Moistened ground or cooked meat, poultry, or fish. Moist ground or tender meat may be served with gravy or sauce.Casseroles without rice.Moist macaroni and cheese, well-cooked pasta with meat sauce.Moist meatballs, meat loafProtein salads such as tuna or egg without large chunks.Cottage cheese, smooth quiche.Poached, scrambled, or soft-cooked eggs.
Dry meats, tough meats (such as bacon, sausage, hot dogs, bratwurst).Dry casseroles or casseroles with rice or large chunks.Cheese slices and cubes.Peanut butterHard-cooked or crisp fried eggs.Sandwiches.Pizza.
Level 2: Dysphagia Mechanically Altered Diet
Food Groups Recommended Avoid
Potatoes and Starches Well-cooked, moistened, boiled, baked, or mashed potatoes.Well-cooked shredded hash brown potatoes that are not crisp. (All potatoes need to be moist and in sauces.)Well-cooked noodles in sauce.
Potato skins and chips.Fried or French-fried potatoes.Rice.
Soups Soups with easy-to-chew or easy-to-swallow meats or vegetables: particle sizes in soups should be <1/2 inch.
Soups with large chunks of meat and vegetables.Soups with rice, corn, peas.
Vegetables All soft, well-cooked vegetables.Vegetables should be <1/2 inch. Should be easily mashed with a fork.
Cooked corn and peas.Broccoli, cabbage, brussels sprouts, asparagus, or other fibrous nontender or rubbery cooked vegetables.
(Continued)
Level 2: Dysphagia Mechanically Altered Diet
Sample Menu Plan for National Dysphagia Diets and Modifed Renal Diet Meal General Dysphagia Advanced Dysphagia Mechanical Dysphagia Pureed Breakfast Orange Juice* X X Oatmeal X X Poached Egg X X Blueberry Muffin X Slurried Muffin Milk* X X Lunch Roast Pork, 2 oz Ground Pork Ground Pork/ Sauce Baked Potato No skins No skins/ Margarine Broccoli X Pureed Broccoli Whole Wheat Bread X/ Margarine Slurried bread Pudding X X Milk* X X Supper Vegetable Beef Soup* X X Crackers Crackers in soup Crushed in soup Turkey Sandwich, 2 oz Thin-sliced sandwich Thin sliced turkey slices Shredded hashbrowns Diced Peaches X X Milk* X X HS Snack Banana X Ripe Banana *If thin liquids restricted, thicken to appropriate consistency
Food Groups Recommended Avoid
Breads Commercially or facility-prepared pureed bread mixes, pregelled slurried breads, pancakes, sweet rolls, Danish pastries, French toast, etc., that are gelled through entire thickness of product.
All other breads, rolls, crackers, biscuits, pancakes, waffles, French toast, muffins, etc.
CerealsCereals may have just enough milk to moisten.
Smooth, homogenous, cooked cereals such as farina-type cereals. Cereals should have a “pudding-like” consistency.If thin liquids allowed, also may have: Enough milk or cream with cereals to moisten; they should be blended well.
All dry cereals and any cooked cereals with lumps, seeds, chunks.Oatmeal.
Fruits Pureed fruits or well-mashed fresh bananas.Fruit juices without pulp, seeds, or chunks.
Whole fruits (fresh, frozen, canned, dried).
Meats and Meat Substitutes Pureed meats.Braunschweiger.
Whole or ground meats, fish, or poultry.Nonpureed lentils or legumes.Cheese, cottage cheese.Peanut butter, unless pureed into foods correctly.Nonpureed fried, scrambled, or hard-cooked eggs.
Soups Soups that have been pureed in a blender or strained.
Soups that have chunks, lumps, etc.
Vegetables Pureed vegetables without chunks, lumps, pulp, or seeds.
All other vegetables that have not been pureed.
Level 1: Dysphagia Pureed Diet
Sample Menu Plan for National Dysphagia Diets and Modifed Renal Diet Meal General Dysphagia Advanced Dysphagia Mechanical Dysphagia Pureed Breakfast Orange Juice* X X X Oatmeal X X Malt-O-Meal Poached Egg X X Pur Scrambled Egg Blueberry Muffin X Slurried Muffin Pur Muffin Milk* X X X Lunch Roast Pork, 2 oz Ground Pork Ground Pork/ Sauce Pur Roast Pork Baked Potato No skins No skins/ Margarine Pur Mashed Potatoes Broccoli X Pureed Broccoli Pur Broccoli Whole Wheat Bread X/ Margarine Slurried bread Pur Bread Mix Pudding X X X Milk* X X X Supper Vegetable Beef Soup* X X Pur soup Crackers Crackers in soup Crushed in soup Pur crackers into soup Turkey Sandwich, 2 oz Thin-sliced sandwich Thin sliced turkey slices Pur sandwich Shredded hashbrowns Diced Peaches X X Pur Peaches Milk* X X X HS Snack Banana X Ripe Banana Well-mashed Banana *If thin liquids restricted, thicken to appropriate consistency
SAMPLE MENU PLAN FOR NATIONAL DYSPHAGIA DIETS(Select from foods for the day in the General Diet or any other diet. Follow the portion sizes for the appropriate diet using the textural modifications.)
Meal General Dysphagia Advanced Dysphagia Mechanical Dysphagia Pureed
Breakfast Orange Juice*Oatmeal or cornflakes*Fried EggCinnamon RollMargarineMilk*
Orange Juice*Oatmeal or cornflakes*Fried EggCinnamon RollMargarineMilk*
Orange Juice*Oatmeal or cornflakes*Scrambled EggSlurried Cinnamon RollMargarineMilk*
Orange Juice, no pulp*Malt-O-MealPureed Scrambled EggSlurried Cinnamon RollMargarineMilk*
Lunch orSupper
Baked ChickenBaked PotatoPeas and CarrotsRoll/MargarineApple PieMilk*
Ground ChickenBaked Potato-no skinPeas and Carrots, tenderRoll/MargarineApple PieMilk*
Ground Chicken, moistenedBaked Potato- no skinPureed Peas and CarrotsSlurried Roll/MargarineApple Pie- no top crustMilk*
Pureed ChickenMashed Potatoes with butterPureed Peas and CarrotsSlurried Roll/MargarinePureed pieMilk*
Treatment Algorithm for Assessment of Overweight and
ObesitySource: National Heart, Lung and Blood Institute (part of the National Institutes of Health & U.S. Dept of Health and Human Services) and North American Association for the Study of Obesity. Oct 2000. The Practical Guide: Identification, Evaluation, and Treatment of Overweight and Obesity in Adults.
Chapter 5Diets for Weight Management
• Weight Management Diet
• Calorie Controlled Diets
• Bariatric/Gastric Bypass Diet
Chapter 5Diets for Weight Management
• Weight Management Diet
• Calorie Controlled Diets
• Bariatric/Gastric Bypass Diet
Bariatric/Gastric Bypass DietRoux-en-Y procedure
• Eat 1-3 “meals” per day, snack rules vary• Consume max of 2-4 Tbsp per “meal”• Consume max of 60 gm protein daily• No liquids with meals and 30 minutes
before and after eating solids• Take small bites, chew 25 times per bite• Consume at least 64 oz water daily• Do not use straws
Chapter 6Diets for Diabetes
• Deletion of Limited Concentrated Sweets (LCS) Diet
• Consistent Carbohydrate Diet– Menu Planning Guidelines– Gestational Diabetes Meal Plan– Treatment of Hypoglycemia
American Dietetics Association position statement (2001)
“Providing adequate nutrition is the primary concern for the residents of long-term care facilities if malnutrition is to be prevented or corrected. Experience has shown that residents eat better when they are given less-restrictive diets with regular foods… with consistent amounts of carbohydrate at meals and snacks….”
Chapter 6Diets for Diabetes
• Deletion of Limited Concentrated Sweets (LCS) Diet
• Consistent Carbohydrate Diet– Menu Planning Guidelines– Gestational Diabetes Meal Plan– Treatment of Hypoglycemia
Carbohydrate Choices Grams of Carbohydrate Carbohydrate Ranges
1 15 11-20
2 30 26-35
3 45 41-50
4 60 56-65
5 75 71-80
Menu Planning
Conversion Guide
Total Carbohydrate Grams
Carbohydrate Choices
0-5 0
6-10 ½
11-20 1
21-25 1 ½
26-35 2
36-40 2 ½
41-50 3
51-55 3 ½
55-65 4
66-70 4 ½
71-80 5
81-85 5 ½
85-95 6
SUGGESTED MENU PLAN FOR CONSISTENT CARBOHYDRATE DIET(Select from foods described)
½ cup orange juice (1 choice)½ cup oatmeal (1 choice)1 slice toast (1 choice)1 egg1 cup milk (1 choice)1 Tbsp regular jelly (1 choice)1 tsp margarinecoffee
½ cup orange juice½ cup oatmeal1 slice toast1 egg1 cup milk 1 Tbsp jelly1 tsp margarinecoffee
Lunch or Supper5 carbohydrate choices =
~75 grams carbohydrate
3 oz roast beef½ cup mashed potatoes (1 choice)½ cup broccoli1 dinner roll (1 choice)2 tsp margarine2x2 brownie/frosting (2 choices)1 cup milk (1 choice)coffee
3 oz roast beef½ cup mashed potatoes½ cup broccoli1 dinner roll2 tsp margarine2x2 brownie/frosting1 cup milkcoffee
Chapter 7Fat Restricted Diets
• Low Fat Diet
(40-50 g fat)
• Cholesterol/Saturated Fat Restricted Diet
(NCEP/AHA Diet: less than 200 mg cholesterol, 25-35% of calories from fat)
Chapter 8Sodium Restricted Diets
• No Added Salt Diet
(3,000-4,000 mg sodium)
• Low Sodium Diet
(2,000 mg sodium)
Chapter 9Diets for Renal and Liver Disease
• Protein and Electrolyte Controlled Diet
• Modified Renal Diet
• Fluid Restrictions
Chapter 9Diets for Renal and Liver Disease
• Protein and Electrolyte Controlled Diet
• Modified Renal Diet
• Fluid Restrictions
“The Modified Renal Diet may be prescribed for individuals with End-Stage Renal Disease (ESRD) who are on dialysis and reside in a long-term health care setting.”
Modified Renal Diet
“The use of a standardized menu in the LTC setting make it possible to individualize the person’s nutritional needs based on their biochemistry.”
Modified Renal Diet Principles
1. Energy
2. Carbohydrates
3. Protein
4. Sodium
5. Phosphorus
6. Potassium
7. Fluids
1. Energy
• Adequate caloric intake is essential
• Ensure food substitutions provide the same energy as those provided in the General diet
2. Carbohydrates
• The addition of refined carbohydrates and simple sugars, i.e. desserts, can be useful in achieving adequate protein-sparing calories.
• If the person has diabetes, refer to the Consistent Carbohydrate Diet.
3. Protein
Protein requirements are higher for persons on dialysis
• Double egg portion at breakfast
• Large portion of meat at midday and evening meal
• Meat sandwich for snack
4. Sodium
Restriction varies according to the person’s hydration status including fluid retention
• Substitute lower sodium meats to replace high sodium meats as listed in the NAS diet
• Substitute all soup with low sodium soups or low/medium potassium vegetable
• Avoid salt substitutes, seasoning mixes
5. Phosphorus
Needs to be limited to limit bone loss
• Substitute refined CHO for whole grain or bran-containing breads and cereals, including oatmeal
• Avoid beans and legumes
• Restrict milk to ½ cup per day
• Limit cheese intake to ½ oz per day
6. Potassium
Intake should be individuals as dictated by potassium lab values
• Substitute citrus, prune, tomato juices with cranberry, apple or other low K+ juice
• Substitute citrus fruit, bananas, tomatoes, and prunes with low/med K+ fruits.
• Allow mashed or boiled potatoes, only ¼ cup per day. No baked potatoes.
7. Fluid Limits
Fluid limits, when needed, must be individualized.
Sample Menu Plan for National Dysphagia Diets and Modifed Renal Diet Meal General Dysphagia Advanced Dysphagia Mechanical Dysphagia Pureed Modified Renal Breakfast Orange Juice* X X X Cranberry Juice Oatmeal X X Malt-O-Meal Malt-O-Meal Poached Egg X X Pur Scrambled Egg Double Egg Blueberry Muffin X Slurried Muffin Pureed Muffin X Milk* X X X ½ C. Milk Lunch Roast Pork, 2 oz Ground Pork Ground Pork/ Sauce Pur Roast Pork 4 oz Roast Pork Baked Potato No skins No skins/ Margarine Pur Mashed Potatoes ¼ C. Boiled Potatoes Broccoli X Pureed Broccoli Pur Broccoli X Whole Wheat Bread X/ Margarine Slurried bread Pureed Bread Mix White Bread Pudding X X X Fruited Gelatin Milk* X X X Apple Juice Supper Vegetable Beef Soup* X X Pur soup LS Vegetable Soup Crackers Crackers in soup Crushed in soup Pur crackers into soup Unsalted Crackers Turkey Sandwich, 2 oz Thin-sliced sandwich Thin sliced turkey slices Pur sandwich 4 oz Turkey/ White
bread Shredded hashbrowns Diced Peaches X X Pur Peaches X Milk* X X X Grape Juice HS Snack Banana X Ripe Banana Well-mashed Banana Applesauce
• PKU is caused by the lack of an enzyme that normally converts phenylalanine to tyrosine.
• This causes phenylalanine to build up in the blood and brain and causes mental retardation.
• A special diet will prevent this mental retardation if it is started soon after birth.
PKU (cont)
• Now, every child is screened within a couple of days of birth for PKU.
• Before newborn screening began in the 1960’s, most children had some degree of mental retardation before they were identified as having PKU.
• Some of these individuals are now in group homes or other residential settings.
PKU (cont)
• Even though the mental retardation cannot be reversed, it is still recommended these individuals be placed on a phenylalanine restricted diet as some of the behavior problems associated with untreated PKU improve when put on the diet.
DIET PRINCIPLES
• Consume a special formula that has the phenylalanine removed, but still has all the other amino acids.
• Avoid all foods high in protein.
• Avoid all foods containing Nutrasweet. Saccharin and Splenda are ok.
• May eat measured amounts of fruits, vegetables, grains, and low protein foods.
PKU (cont)
• A registered dietitian familiar with the PKU diet should assist in menu planning and teaching.
Sample PKU Meal
• Special metabolic formula
• Fruit
• Vegetable
• Low protein food and/or grain product
Chapter 12Dining Assistance/Special Needs
• Feeding Guidelines for Individuals with Dementia
• Nutrition for Individuals with Developmental Disabilities
Study Guide Questions
• Chapters Rearranged
• Inclusion of Study Guide Questions after each chapter
• Suggested Responses in Appendix
Appendixes
• Updated Dietary Reference Intakes (DRI’s)
• Body Mass Index Table (expanded to include morbid obesity)
• Addition of calcium and iron foods
• ADA Exchange Lists for Meal Planning, 2003
Ordering Information
Phone: 1.877.762.2974
Mail: Wiley-Blackwell Customer Care 10475 Crosspoint Blvd. Indianapolis, IN 46256
Fax: 1.800.605.2665
Website: www.blackwellfood.com/9780813818788
Simplified Diet Manual Tenth Edition
Publication Date: January 2007Edited by Andrea Maher and the Iowa Dietetic Association
