Diet in Health and Disease (Therapeutic Nutrition)
What this domain tests
Therapeutic nutrition uses diet to prevent, treat or manage disease while maintaining nutritional status. The exam tests principles for diabetes, hypertension, obesity, renal disease and diarrhoea, and the reasoning behind each modification.
Core rules
- Diabetes: distribute carbohydrate evenly, favour complex carbohydrate and fibre, control portion size and match medication; avoid calling for a “no-carbohydrate” diet.
- Hypertension: reduce sodium, increase potassium-rich fruit and vegetables, control weight and limit alcohol; the DASH pattern is a useful model.
- Obesity: a modest energy deficit of about 500 kcal/day supports gradual loss; preserve protein, fibre and micronutrients.
- Chronic kidney disease: adjust protein, sodium, potassium and phosphorus according to stage and dialysis status; restriction is individualised.
- Diarrhoea: prevent dehydration with oral rehydration solution and continue feeding; do not starve the patient.
Worked example
A 55-year-old with type 2 diabetes, BMI 27 and HbA1c 8.5% asks for a diet. Reasoning: the priority is gradual weight loss of 5–10%, high-fibre complex carbohydrate, regular meal timing, and reduced sugary drinks and deep-fried snacks. Carbohydrate is not eliminated; it is quantified and distributed. Monitoring glucose and medication adherence are part of the plan, so the answer must not be only a food list.
Traps that cost marks
- Advising “stop all carbohydrates” in diabetes.
- Applying severe protein restriction to every kidney patient.
- Using starvation or “rest the bowel” in acute diarrhoea.
- Giving a standard diet without considering BMI, medicines or complications.