Module One: Dietetics

Course Justification
1-The course will help students to adopt a lifestyle and
sound behaviors to become role model for the
individual, familial ,and community they will serve in
the future.

2- Develop a graduate who will apply the knowledge and

skills learned, and is able to take a relationship in
motivating community served.

Learning objectives

By the end of the course, Students will know the

following:
Definition and concept: therapeutic food, therapeutic
diet, food security, food safety
Diet and chronic diseases

Diet plan for selected diseases conditions (therapeutic

diets)

Describe the relation between nutrition and health

Prescribe diet plans for selected disease conditions

(therapeutic diets)
After completing the course, the student should be able
to:
Activate and mobilize the community toward improved
health
 Encourage the community to follow healthy lifestyle

Dietetics

Dietetics means diet prescription during disease. In some

diseases, the patient can be kept on the usual diet, while
in others, the diet is modified into" therapeutic diet" with
:the following objectives

Suit manifestations of the disease as in pyrexia, or -1

diarrhea

Meet the particular dietary needs of the case as -2

.restriction of protein or fat

Help saturation of the tissue reserves and restoration of -3

physiological functioning that contribute to body
.resistance and improve prognosis

.Compensate for any existing or expected deficiency -4

The rapidly increasing worldwide prevalence of chronic

diseases such as diabetes mellitus, hypertension and
hyperlipidaemia as a result of populations progress to
adopt an unhealthy eating pattern and sedentary lifestyle
has led to a significant proportion of mortality and
morbidity. Hence, dietary component remains the
cornerstone in chronic disease management for people
who suffer from chronic diseases as well as for those who
are at risk of developing diseases, apart from medication
.and physical activity

Medical nutrition therapy is considered as an integral part

in chronic disease management as part of the evidence-
.based clinical practice guidelines
 Medical nutrition therapy refers to the dietary
management of patients with diet-related medical
conditions in the form of assessment, education and
counseling and recommendation of special nutrition
supplements, in order to improve the patients overall
health status and to reduce healthcare cost involved in
.disease management

Medical nutrition therapy (MNT) for common chronic

medical conditions such as diabetes mellitus,
hypertension, lipid disorders and chronic renal failure will
.be highlighted in the following section

Medical Nutrition therapy of diabetes

Type 2 diabetes is the more common form of diabetes,

mainly occurring in elder persons and is associated with
obesity among the population. In view of this, , medical
nutrition therapy should emphasize on gradual weight loss
(0.25 to 1.0kg/week) for overweight people with type 2
diabetes via diet and lifestyle modifications; whereas for
type 1 diabetes, the main effort should be directed
towards dietary manipulation and insulin therapy to
improve glycemic control. Also, diet plan should be
tailored to individual preference, physical activity level,
cultural and ethnic practices; and dietary habits. Special
attention on dietary requirements should be paid to
patients with diabetes during their sick days, travel,
exercise; pregnancy and lactation for female patients as
well as youth and elderly persons. Priority placed on
.amount of CHO, not source of the CHO
 Carbohydrate (CHO) in the form of unrefined fiber rich
rather than simple sugars which is slowly absorbed
preventing rapid swings in circulating glucose. So eating
an apple is better than drinking the same amount of CHO
as apple juice. Dietary fiber intake should be increased,
concentrating on soluble fibers as pulses and fruits.
Dietary fibers may also promote satiety and assist weight
.loss (30 g fiber/day is recommended)

Calories should be tailored to the needs of the patient.

The overweight diabetic patient is started on a reducing
diet of approximately 1000-1600 Kcal daily. The lean
.patient is put on isocaloric diet

Fat in the diet should be reduced to less than 30% of the

total energy intake. Of these, 10% in the form of saturated
fatty acids with the remainder coming form both
polyunsaturated and monounsaturated fat sources.
.Cholesterol should not exceed 300 mg daily

Salt should be limited to <6 g daily if normotensive and 3

.g if hypertensive

Low calorie/sugar-free products sweetened with non-

nutritive sweeteners Care should be taken to avoid
excess energy intake. As for the general population,
people with diabetes are encouraged to consume a variety
of fibre-containing foods. Sugar alcohols and non-nutritive
sweeteners are safe when consumed within daily intake
levels as established by the FDA. Fat and cholesterol:
among individuals at high risk for developing type 2
diabetes, structured programs that emphasize lifestyle
changes that include moderate weight loss (7% body
weight) and regular physical activity (150minutes/week),
with dietary strategies including reduced calories and
reduced intake of dietary fat, can reduce the risk for
developing diabetes and are therefore recommended.
Individuals at high risk for type 2 diabetes should be
encouraged to achieve the recommendation for dietary
 fibre (14g fibre/ 1,000kcal) and foods containing whole
grains (one half of grain intake). Limit saturated fat to
.<7% of total calories

.Intake of trans fats should be minimised

In individuals with diabetes, lower dietary cholesterol to

.<200mg/day

Two or more servings of fish per week (with the

exception of commercially fried fish fillets) provide n-3
.polyunsaturated fatty acids and are recommended

Protein in diabetes management

For individuals with diabetes and normal renal function,

there is sufficient evidence to suggest that usual protein
intake (15-20% of energy) should be modified. In
individuals with type 2 diabetes, ingested protein can
increase insulin response without increasing plasma
glucose concentrations. Therefore, protein should not be
.used to treat acute or prevent night time hypoglycaemia

High protein diets are not recommended as a method for

weight loss at this time. The long term effects of protein
intake >20% of calories on diabetes management and its
complications are unknown. Although such diets may
produce short-term weight loss and improved glycemia, it
has not been established that these benefits are
maintained long term, and long term effects on kidney
.function for persons with diabetes are unknown

Nutrition intervention for type 1 diabetes: For

individuals with type 1 diabetes, insulin therapy should be
integrated into an individuals dietary and physical activity
pattern. Individuals using rapid-acting insulin by injection
or an insulin pump should adjust the meal and snack
insulin doses based on the carbohydrate content of the
meals and snacks. For individuals using fixed daily insulin
 doses, carbohydrate intake on a day-to-day basis should
.be kept consistent with respect to time and amount

Monitoring carbohydrate, whether by carbohydrate

counting, exchanges, or experienced-based estimation,
remains a key strategy in achieving glycemic control.
Hence, carbohydrate counting is a useful way for patients
with diabetes who are on insulin treatment to match their
carbohydrate amount intake to the rapid insulin dosage.
People with diabetes are required to learn how to read the
food products labeling and count their total amount of
carbohydrate intake from each meal based on their daily
.allowance of total carbohydrate

Carbohydrate exchange system is an alternative way of

carbohydrate counting which offers flexibility and variety
of food choices for people with diabetes to adjust their
insulin dosage especially for those who are on insulin
pump. The standard one carbohydrate exchange is
.equivalent to 15 grams of carbohydrate

The following example illustrates the calculation of total

carbohydrate daily allowance (assuming 50% of total
calories) and the distribution of carbohydrate exchanges
:based on 1800 kcal requirement

Total carbohydrate allowance per day = 50% x 1800kcal =

900kcal divided by 4kcal = 225g

Total carbohydrate exchange per day = 225g divided by

15g carbohydrate = 15

Dietary Recommendations for Wellness

Eat lots of fruits and vegetables for 1-2 weeks.

Consume fresh cherries (effective in lowering uric
acid levels and preventing gout).
 Drink plenty of water to rehydrate the body and flush
excess uric acid out of the body.
Reduce or eliminate the consumption of meats, fried
foods and foods high in purine. Purine foods include
asparagus, meat gravies and broths, mushrooms,
mussels and sardines.
If you are overweight, consider losing weight. Weight
loss lowers serum uric acid levels. Avoid crash dieting
however.
Incorporate omega 3 oil into your diet to help reduce
inflammation and tissue damage.
Medical nutrition therapy of gout

Adequate fluid intake: 8 to 12 cups daily is important

in helping to increase uric acid excretion via urine.
Sources of fluid include plain water (recommended 50%
.of total intake daily), juices, soup and milk

Avoid alcohol intake

Consume a healthy and balanced low purine
diet: The breakdown of purine produces uric acid.
One third of purine load in human body obtained
from diet and the rest of two-third is derived from
endogenous production. A lower purine intake may
be helpful in lowering uric acid among patients with
gout and large tophi despite on uric acid lowering
drug therapy.
Maintain healthy body weight, avoid drastic
weight loss: Overweight individuals with gout are
strongly encouraged to lose weight gradually 0.5 to
 1.0kg weekly by practicing a healthy eating pattern,
as being overweight can result in building up of uric
acid.
Individuals should abstained from practicing fasting
or following a

high protein diet to lose weight as these practices

may worsen gout

.symptoms

Medical nutrition therapy for renal diseases

Diet to treat underlying disease

Restrict diet if necessary to control symptoms
Protein restricted in uremia
Sodium restriction in hypertension
Potassium restriction in hyperkalemia
Restricted protein diet is used in the treatment of patients
with symptomatic uremia or in patients with
asymptomatic moderate renal failure (creatinine
clearance< 40 ml min) in the hope of slowing the rate of
.deterioration in renal function

Medical nutrition therapy for heart failure

Dietary modifications where large meals should be

avoided and if necessary weight reduced. Salt restriction is
important and foods rich in salt or added salt in cooking
.and at the table should be avoided

Medical nutrition therapy for peptic ulcer diseases

gastric and dudenal ulcers

Reduce decaffeinated and regular coffee, cocoa, and tea -1
intake

Avoid alcohol or pepper-2

Avoid low-pH juices if they cause problems -3

Avoid large meals, especially right before bedtime -4

Encourage Non residue and low fat foods to suppress -5

mobility, acidity

Eat at least 3 small meals per day, 6 better, of -6

.reasonable bulk

Give ample time for each meal, for slow eating and -7
.proper chewing

Adequate physical and mental rest and avoid anxiety -8

.and tension

Lifestyle changes are an important component of the -9

.nutrition care plan

Patients with dyspepsia should avoid high-fat foods, -10

.sugar, caffeine, spices, and alcohol

Medical nutrition therapy for liver diseases

Nutritional management during the acute phase aims at

providing adequate amounts of energy, macro- and
micronutrients for the regeneration of hepatocytes. In this
phase, energy and protein needs are increased; however,
diets with excessive energy and protein should be
avoided. Patients with viral acute hepatitis should be
administered a healthy balanced diet, with a small
increase in protein intake [1.21.5 g/kg body weight].
Severe reductions in fat intake should be avoided since
low-fat diets are unpalatable and may enhance a patients
anorexia and under-nutrition. Small and frequent meals
are generally better tolerated. If anorexia, nausea and
 vomiting persist, fluid and/or nutrient needs should be
.administered by enteral or parenteral nutrition

Patients with fulminant hepatitis may experience severe

episodes of hypoglycemia. Moreover, they may develop
severe malnutrition. In this case, stabilization of
metabolism is mandatory and more important than
nutritional therapy, and should aim to meet daily
requirements. These patients need stable glucose
administration (150200 g), often given parenterally
through dextrose solutions. Excessive protein

administration should be avoided because it may

precipitate hepatic encephalopathy where 40 g proteins
and no added salt diet is recommended, fatty foods must
be restricted and alcohol must be avoided. Sugar, fruit
juice, fruits and boiled sweets are encouraged in order to
increase energy intake. Protein intake should be gradually
.increased as the encephalopathy resolves

Medical nutrition therapy for hypertension

Hypertension is an important risk factor of coronary heart

disease and cerebrovascular disease. Management of
hypertension through lifestyle modifications and non-
pharmacological therapy should be instituted wherever
.appropriate in ALL hypertensive individuals

Well established dietary modifications and its

recommendations that lower blood pressure are
.summarized in

Lifestyle modification Recommendation

Weight loss for overweight or obese persons, lose

weight, ideally attaining a BMI <25kg/m2; for non-
overweight persons, maintain desirable BMI
<25kg/m2.
 Reduced salt intake Lower salt (sodium chloride)
intake as much as possible, ideally to ~65mmol/d
sodium (corresponding to 1.5g/day of sodium or
3.8g/day sodium chloride)
Increased physical activity.
Smoking cessation.
Dietary Approaches to Stop Hypertension
(DASH) Diet: dietary patterns Consume a diet rich
in fruits and vegetables (8 to 10 servings/ day), rich
in low fat dairy products (2 to 3 servings/day)and
reduced in saturated fats and cholesterol.
Increased potassium intake Increase potassium
intake to 120mmol/day (4.7g/day), which is also the
level provided in DASH-type diets
A DASH dietary pattern is a diet rich in fruits,
vegetables, low fat dairy products; and includes whole
grains, poultry, fish and nuts; and contains less amounts
of red meat, sweets and sugar-containing beverages.
Hence, the DASH diet emphasize on the following
:nutrients

Low in fat, especially low in saturated fats

Low in cholesterol

Moderate protein

High in fiber

.High in calcium, magnesium and potassium

Medical nutrition therapy guidelines for

hyperlipidemia
 Medical nutrition therapy for hyperlipidaemia (especially
high LDL-cholesterol) emphasizes intake of fruits,
vegetables, grains, cereals as well as skinless, poultry,
fish, lean meats and low fat dairy products. For individuals
with hypertriglyceridaemia, in addition to the above
measures, it is important to restrict the intake of simple
.carbohydrates such as glucose and alcohol

Nutrient Recommended daily intake

Total fat 20% to 30% of total calories, Saturated fat Less

than 7% of total calories, Trans fat Less than 1% of total
calories, Polyunsaturated fat 6% to 10% of total calories,
Monounsaturated fat Up to 10% of total calories

Carbohydrate 50% to 60% of total calories (mainly from

complex

(carbohydrate

.Protein About 15% of total calories

Dietary fibre 20 to 30g daily: Fruits and vegetables 2 + 2

servings daily (>400g/day)

Cholesterol Less than 200mg daily

Total calories Balance energy intake and expenditure to

maintain

.desirable weight or prevent weight gain

:Cardio-protective food approach

Vegetable: At least 3 to 4 daily cup cooked vegetables,

1 cup raw green vegetable or salad, 1 tomato or small
carrot

Fruits At least 3 to 4 daily 1 medium apple, pear, orange,

nectarine, small banana, cup stewed, frozen or canned
fruit in natural or lite juice
 to 3 small apricots or plums, 10 to 15 grapes, cherries, 2
strawberries,1 cup of other berries, 3 prunes, dates or figs,
1 tbsp raisins, sultanas, 6 to 8 halves of dried apricots,
.180ml 100% fruit juice

Breads, cereals and grains At least 6 daily 1 medium

slice of whole grain bread or bread roll and starchy
vegetables 30g of other breads such as pita, wraps,
cup bran cereal or 2/3 cup wheat cereal or 3 crispbreads

cup cooked pasta or 1/3 cup cooked rice,1 small potato,

. cup corn

Cardio-Protective Food-Based Approach

Dietary Guidelines for prevention of osteoporosis

The main nutritional goals for the prevention and

:treatment of osteoporosis are

adequate intake of calcium and vitamin D throughout life _

stages

adequate intake of protein according to dietary reference _

intake

avoidance of excessive phosphorous ingestion _

(calcium/phosphorus ratio = 1:1 ideally)

diet rich in fruits and vegetables _

avoidance of excessive sodium intake; an intake of about _

2400mg per day is not detrimental

caffeine intake should be limited in individuals who do _

not reach recommended calcium intake; otherwise, an
intake of three cups of coffee per day does not impose a
negative effect on bone metabolism

Alcohol should be completely avoided, because it affects _

.peak bone mass in a negative way
 Osteoporosis is a disease that may be prevented
throughout life, but is particularly important to begin
primary prevention during childhood and adolescence. The
peak bone mass can be increased, and long-term bone
health can be promoted by following effective dietary
practices, exercise, healthy behaviors and life style.
Childhood and adolescence represent important times in
which to initiate and strengthen patterns of healthy habits,
such as increased calcium intake, increased physical
exercise and avoidance of health compromising behaviors
.like smoking

Diet and cancer

Today, 24.6 million people are living with cancer and 6.7
million are dying of cancer every year, that's about 20,000
global cancer deaths per day. This cancer burden is
increasing as people in the developing countries adopt
western lifestyles such as higher consumption of saturated
.fat and calorie-dense foods, and reduced physical activity

As scientific research progresses, the evidence that

dietary patterns, foods, nutrients, and other dietary
constituents are closely associated with the risk for
.several types of cancer increased

The role of diet in cancer is likely to vary by cancer type,

stage of cancer development, and genetics. Over 30% of
cancer deaths can be attributed to diet. This means that
the average person can greatly lower the risk of getting
.cancer simply by changing diet

Diet has a greater influence on some types of cancer than

others. The strongest links are with some cancers of the
gastrointestinal tract e.g. of the mouth, throat, stomach
and large bowel (colon). Diet may play a greater
 protective role earlier in life. Dietary factors may protect
against or reduce the risk of cancer. For example, fruit and
vegetables, consumed regularly, are thought to help
reduce risk, whereas a low fiber intake or a high alcohol
intake increases risk. Diet is only usually one of several
.factors involved

Dietary Fats

Diets high in fat have been linked to increased risk of

various cancers, particularly breast, colon, prostate, and
possibly pancreas, ovary, and endometrium, but a low fat
diet was not found to reduce the risk of cancer. Dietary
recommendations are to decrease total fat intake to 30
.percent of calories

Dietary Fiber

Dietary fiber falls into two categories, water-soluble fiber and water-
insoluble fiber, and is generally defined as those components of food
plants resistant to the enzymes produced by the human digestive tract.
Increasing evidence suggests that diets high in fiber-containing foods are
associated with a reduced risk for cancer, especially cancer of the colon.
A reduced risk for cancers of the breast, rectum, oral cavity, pharynx,
stomach, and other sites with diets rich in fruits, vegetables and grain
products was observed.

Fruit and vegetables

Populations consuming diets high in fruits and vegetables

tend to have a lower cancer risk. Fruits, vegetables, and
grains contain a number of nutrients, including
carotenoids, vitamin A, and vitamin C. There is an
evidence of a protective effect that include lung, colon and
rectum, breast, oral cavity, esophagus, stomach,
pancreas, uterine cervix, and ovary. For most cancer sites,
 especially epithelial cancers of the respiratory and
digestive tracts, persons with low fruit and vegetable
intake had about twice the risk of cancer as those with
high intake. Vitamin C, or fruit rich in vitamin C, provides
significant protection. Vitamin E has inhibited tumors in
experimental animals and been linked to reduced risks of
oral, stomach, and other cancer in epidemiologic studies.
Selenium also may have a protective effect. On the other
hand, supplementation with large doses of beta-carotene
may increase the risk of lung cancer in high risk subjects
.(e.g. smokers)

Fruit and vegetables contain other components that might

be of benefit in cancer prevention. Five servings of fruit
.and vegetables a day was recommended

Body weight

Maintaining body weight within the normal range may

reduce the risk of some types of cancer. Being obese (very
overweight) and having high intakes of energy may
increase the risk of some cancers. For example in
postmenopausal women, breast cancer risk is associated
with being overweight. Fat provides a large amount of
energy so a high fat diet may make weight gain more
.likely

Alcohol

People who drink large amounts of alcohol have an

increased risk of certain types of cancer, particularly liver
cancer and cancers in the mouth and oesophagus. If such
people also smoke, this makes the risk of cancer even
.greater

Carcinogens

Carcinogens are substances which can start the process of

cancer. Tobacco smoke contains carcinogens which cause
.lung cancer
 Foods may also contain carcinogens. However, the risk
from carcinogens in foods is low because if they are
present at all, it is usually in very small amounts.
Carcinogens in foods may be substances that occur
naturally, they may be due to contamination, or they be
formed during cooking or processing (e.g. in smoked foods
or foods that have been blackened during cooking e.g.
barbecuing). Aflatoxins are examples of carcinogens
present in poorly stored foods. They are linked to mouldy
produce, especially peanuts that are contaminated by the
.growth of moulds

Physical activity

Being physically active is important for weight control and

may have other benefits (e.g. increase bowel movement,
enhance immune function, raise levels of various
hormones and signaling molecules in the body that can
result in a sense of well-being). Being physically active
appears to reduce the risk of breast cancer by around 30%
and colorectal cancer by 40-50%

Red meat

It has been suggested that a high consumption of red

meat might be associated with increased risk of colon
cancer. Components of cooked meat that have been
suggested to cause this include heterocyclic amines,
polycyclic aromatic hydrocarbons, nitrogenous residues
and iron. Currently, the extent of any association remains
unclear and it is unknown whether there is a link with red
meat specifically or just with processed meat. However, it
is recommended that very high consumers of red meat
(those eating more than 140g/day or 12-14 portions per
.week) should consider a reduction

Although no diet can guarantee full protection against

disease, it is believed that the following
recommendations offer the best nutrition
 information currently available to help people
:reduce their risk of cancer

Choose most of the foods you eat from plant sources .1

a-Eat five or more servings of fruits and vegetables each

day

b-Eat other foods from plant sources, such as breads,

cereals, grain, rice, or beans several times each day

Limit intake of high-fat foods, particularly from animal .2

sources

a-Choose foods low in fat

b-Limit consumption of meats, especially high-fat meats

:Be physically active .3

a-Achieve and maintain a healthy weight

b-Be moderately active for 30 minutes or more on most

days of the week

c- Stay within your healthy weight range

Limit consumption of alcoholic beverages, if you drink .4

at all

Antioxidants

In the body, certain molecules called reactive oxygen

species (ROS) are normally produced as part of the by-
products of cellular metabolic processes utilizing
oxygen. It includes free radicals which may be oxidizing
.agents

Many factors can cause the body to produce more reactive

species than are needed. These include smoking, drinking
alcohol, too much fat in the diet, too much sun exposure,
too many pollutants in the air and even too much exercise.
Antioxidants are substances that reduce oxidation and so
 counteract the reactive species. If ROS outnumber the
antioxidant stores in the body, they can inactivate
enzymes, oxidize lipids and damage genetic materials
(DNA). These processes have been linked to ageing and a
variety of age-related conditions, including heart disease
.and cancer

There are many compounds with so-called antioxidant

properties that are derived from food (Table ). Naturally-
occurring antioxidant vitamins include carotenoids (which
may also be pro-vitamin A), the vitamin E family of
compounds (tocopherols) and vitamin C. Some elements
found in the diet exert their in vivo antioxidant effects as
metallo-enzymes such as selenium (as part of glutathione
peroxidase) and copper (as part of superoxide
dismutases). Some compounds found in fruits and
vegetables that may promote health (phytochemicals)
.are powerful antioxidants

Antioxidants in clinical practice

High intakes of antioxidant nutrients from food sources
appear to offer some health advantages. In addition, a diet
high in fruit and vegetables often means a lower intake of
fat and a higher intake of fiber, which may also protect
against many diseases. Vitamin and mineral supplements
do not necessarily make up for `poor food habits' or
`unhealthy lifestyle practices'. It is advisable to eat a wide
variety of cereals, fruit and vegetables in reasonable
amounts rather than rely on supplementation with a few
.antioxidants

Antioxidant components in food

 Food sources Compounds
Components

Citrus fruit, berries Vitamin C Vitamins

cereal grains, nuts and Vitamin E
oils derived from (tocopherols )
plants

Orange pigmented, Beta carotene

and green leafy and other
vegetables carotenoids

Cocoa, wheat bran, Copper (as Elements

yeast part of
Grains, meats superoxide
dismutases)
Selenium (as
part of
glutathione
peroxidase)

Whey protein Peptides e.g. Macronutrient-

glutathione derived

Soy Isoflavones Phytochemicals

Tea, red wine, onions, Flavonols food)
apples Herbs - Polyphenols components of
oregano, thyme Green Catechins (plant origin
tea

Meats Glutathione food

Meats, especially meat (coenzyme components of
organs, fish Q10) animal origin

Omega-3 Fatty Acids: These long chain fatty acids include the essential
nutrient alpha-linolenic acid. Most fruits and vegetables contain small
quantities of the omega-3 fatty acids including Brussels sprouts,
mushrooms and walnuts. These fatty acids balance the more common
omega-6 fatty acids found in corn and soy oils as well as the fats of meat
and dairy products. Eating more omega-3's and less omega-6's favors
anti-inflammatory actions in the body and is supportive to immune
system in general and is useful for breast and prostate cancer prevention.

In conclusion, a high intake of fat, meat, salted fish, or

alcohol correlates with increased risk of various cancers
and that ample fruits, vegetables, and, possibly, legumes
offer significant protection. Protective factors include
vitamins, selenium, and phytochemicals like carotenoids
and flavonoids. Energy balance may be a more important
risk factor than simple obesity, and physical activity has
consistently been reported to help prevent colon cancer
.and, to a lesser extent, breast cancer

Self assessment
:
Which of the following types of diets may reduce .1
?the risk of developing cancer

a. Low-fiber diet

b. High-protein diet

c. High-fat diet

d. Diet rich in vitamin C and -carotene

 There are some dietary elements having .2
:protective role against cancer such as

.a.fruits and vegetables

. b.Cereals, grains

c. mushroom, nuts

d. All of the above

Dietary elements having risky role for cancer such .3

:as

.a.fried food, sugary drinks

.b. Pulses as beans, chick peas

c. Vegetable oils, nuts

d. All of the above

In order to reduce the risk of cancer the .4

:followings are true except

a. Choose most of the foods you eat from plant sources

b. Limit your intake of high-fat foods, particularly from

animal sources

c. Achieve and maintain a healthy weight

d. Choose foods from energy dense food

Chronic kidney disease patients often have to .5

:limit the intake of which nutrient

a. Fat

b. Carbohydrates

c. magnesium

d. protein
 As part of a healthy diet, which of the following .6
foods helping to cut the risk of a coronary heart
?disease
a. pasta

b. lean steak

c. oily fish

d. skinless

7. Diet in gastric ulcer (all are correct except)

a.Eat three small meals and three snacks:

b.avoid hunger and over eating

c.Avoid eating within 3 hours before bedtime.

d.Bedtime snacks

8. Dietary prescription in hepatic encephalopathy

a.low protein diet,high sodium diet

b.increase CHO

c.decrease vitamins and minerals

d.high amount of fat

chicken

9-A current recommendation for reducing cancer

risk include A. Increase Physical Activity
B. Control Weight C. Decrease Fat Intake D. Eat plenty of
fruits and vegetables E. All of the above

10-Nutrition related factors that may increase the

risk of developing cancer include:
A. Obesity B. Red Meat Intake C. Salt Preserved Foods
D. All of the above

Poor mineralizations of bones and teeth, -11

:osteoporosis are manifestations of deficiency of

a. Fluorine

b. Iron

c. Zinc

d. Calcium

12- Drew a design for diabetic patient for daily

meals
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