University of Michigan Health System Patient Food and Services Nutrition Care Manual and Pediatric Manual Administrators Email: [email protected]

Available Diet Orders at the University of Michigan Health Systems

Diet Order Purpose & Indications General Description & Principles Further Details When no dietary modification is needed and solid foods can be General Diet tolerated. No dietary restrictions. When no dietary modification is General Pediatric needed but restrictions indicated Dietary restrictions based on age Diet based on age limitations. limitations. Used post-gastric surgery for This diet does not allow foods high patients exhibiting symptoms of in sugar and liquids will be provided dumping syndrome (nausea, separate from . Smaller, vomiting, diarrhea, etc) following more frequent meals are Anti-Dumping Diet PO intake. encouraged. Nutrition Care Manual

There are four diets that fall under the bariatric diet, each is a stepwise progression to a discharge diet. These restrictions are placed to All the diets have the following facilitate weight loss and restrictions: no concentrated maintenance, to avoid dehydration, sweets, low-, no caffeine, no and to avoid distention of the gastric carbonated beverages and no Bariatric Diet pouch. straws. Nutrition Care Manual The bland diet is designed to avoid The bland diet consists of foods that irritation of the . are easily digestible and mildly It is appropriate for people with seasoned. Fried foods, highly , chronic seasoned foods and most raw or gastritis, reflux esophagitis or gas-forming fruits and vegetables Bland Diet dyspepsia. are eliminated.

Revised 3/07 1 University of Michigan Health System Patient Food and Nutrition Services Nutrition Care Manual and Pediatric Diet Manual Administrators Email: [email protected]

A bland diet consisting of ripe This diet is typically used for Bananas, Rice, Applesauce, and controlling diarrhea and provides . This diet is intended for a low fiber, low residue foods that are very short duration (3 days or less) BRAT Diet easier for the intestines to digest. due to nutritional inadequacies. This diet allows all foods but limits Calorie Controlled total calorie intake to the designated Diet Used to promote weight loss. amount.

This diet order is typical for patients with cardiovascular illnesses. Its purpose is to reduce serum cholesterol and lipid levels, to avoid Limits red meat, , whole and prevent excessive sodium , , and egg yolks, as well intake and to reduce heart disease as high sodium foods and risk. This diet controls for total condiments. It promotes whole dietary fat, saturated fat, cholesterol grains, beans, vegetables and Cardiac Diet and salt (3-4 gm sodium/day). fruits.

To reduce serum cholesterol and lipid levels, usually combined with a This diet limits cholesterol intake to low fat diet restriction. Used 200-300 mg/day by limiting red Low Cholesterol commonly with hyperlipidemia, CAD meat, cheese, whole milk, butter Diet and other cardiovascular illnesses. and egg yolks. This diet is used for pre-op and Allows visually clear and minimum immediately post-op situations, or residue liquids. Intended for a very for acute episodes of nausea and short durations (3 days or less) due Clear Liquid Diet vomiting to promote bowel rest. to nutritional inadequacies.

Revised 3/07 2 University of Michigan Health System Patient Food and Nutrition Services Nutrition Care Manual and Pediatric Diet Manual Administrators Email: [email protected]

A specified number of carbohydrates, based on age, will To provide consistent be provided at each to ensure Consistent carbohydrates, based on patient consistent carbohydrate intake, Carbohydrate, age, at meals and an HS snack to simulating a carbohydrate counting Pediatric aid in glucose management. diet. Nutrition Care Manual A specified number of To provide consistent carbohydrates, based on calorie carbohydrates, based on calorie range, will be provided at each meal level range, at meals and an HS to ensure consistent carbohydrate snack to aid in glucose intake, simulating a carbohydrate Diabetic Diet management. counting diet. Nutrition Care Manual

There are four levels of this diet. Each requires both a diet level and liquid consistency to be designated to be a valid diet order. Level 1 – To decrease the risk of aspiration Provides pureed food/meats. Level related to neurological, 2 – Provides ground meats. Level 3 neuromuscular or other etiology of – Equivalent to Mechanical Soft swallowing impairment. Prescribed diet. Level 4 – This is a general diet by Speech Pathologist after a but still requires a liquid consistency swallow evaluation has been per Speech Pathology Dysphagia Diets conducted. recommendations. Nutrition Care Manual

Revised 3/07 3 University of Michigan Health System Patient Food and Nutrition Services Nutrition Care Manual and Pediatric Diet Manual Administrators Email: [email protected]

The eating disorder diet is indicated for individuals diagnosed according to the Diagnostic Statistical Criteria (DSM-IV) with anorexia nervosa, bulimia nervosa or an eating This diet is calorie controlled, with disorder not otherwise specified and periodic increases in calories to treated in the University of Michigan goal. Typically 4 meals/day are Eating Disorder Diet Eating Disorder Program. served.

The fat-restricted diet is indicated for individuals with maldigestion, malabsorption and disorders in transport of dietary lipids. To provide no more than 60 gm fat/day for malabsorption issues related to Low Fat Diet (60 GI disease, pancreatitis, and some Lower fat menu items are provided gm/day) types of liver disease. in place of full fat items. Nutrition Care Manual Focuses on whole grains, beans, High Fiber Diet - Used for certain GI conditions to vegetables and fruits to increase High Residue promote gut health. fiber content of diet. Nutrition Care Manual Used for certain GI conditions when Limits use of whole grains, beans, Low Fiber Diet - high fiber diets can aggravate vegetables and fruits to lower fiber Low Residue symptoms. content of diet. Nutrition Care Manual

Revised 3/07 4 University of Michigan Health System Patient Food and Nutrition Services Nutrition Care Manual and Pediatric Diet Manual Administrators Email: [email protected]

Total amount of fluid (including IVF, fluid taken with medication pushes, mealtime/snack time PO intake, etc) is recorded to not exceed designated level. If no kitchen fluid restrictions indicated, ½ of total daily allotment will be allowed by This diet is used for patients with the kitchen. Note: the fluid content edema and fluid control issues such of solid foods is not included in the Fluid Restricted Diet as kidney disease, CHF, etc. estimation of total fluid intake.

To limit solid foods when digestion may be compromised. For post-op Allows any liquids or liquidifed transition from clear liquids to solid foods. Also permits smooth, foods, for severe GI strictures, or for strained foods of pudding Full Liquid Diet wired jaw conditions. consistency. This diet is for gluten sensitive individuals or those individuals diagnosed as having Celiac A diet free of products containing Gluten Free Diet Disease. gluten (wheat, barley, and rye).

This is the initial diet for patients who have developed Graft versus Host Disease of the gastrointestinal tract. The foods allowed on this diet are low in acid, fat, lactose, Foods are included one at a time to caffeine, and fiber to minimize GI check for tolerance and start with irritation and promote wound foods such as broth, Pedialyte, Jell- GVHD#1 healing. O, and popsicles.

Revised 3/07 5 University of Michigan Health System Patient Food and Nutrition Services Nutrition Care Manual and Pediatric Diet Manual Administrators Email: [email protected]

This diet is for patients with Graft This selective diet provides foods versus Host Disease of the moderately low in indigestible gastrointestinal tract who have carbohydrates, and restricted fat tolerated the limited GVHD #1 diet and lactose. New foods are added GVHD#2 without worsening GI symptoms. one at a time to check for tolerance. Nutrition Care Manual Foods that are high in protein and calories are provided, such as For use with patient who have whole milk, ice cream, butter, failure to thrive, significant weight peanut butter, etc. This diet should High Calorie, High loss or poor appetite/PO for be accompanied by a "nutrition Protein extended period of time. supplement of choice" order. Nutrition Care Manual Used with some patients for the treatment of epilepsy. The dietary restriction of this diet makes the body burn fat for energy instead of It is a diet very high in and low glucose. in carbohydrates. Nutrition Care Manual

The University of Michigan Medical Center does not have a kosher food A kosher diet is indicated for service. The following options are individuals of Jewish faith who offered to individuals who wish to adhere to the Jewish dietary laws, keep kosher while in the hospital: known as Kashruth. This diet order commercially prepared kosher will provide the patient with dinners, disposable dishes and specially prepared meals that fit flatware, and assistance with menu Kosher Diet standard Kosher guidelines. selections.

Revised 3/07 6 University of Michigan Health System Patient Food and Nutrition Services Nutrition Care Manual and Pediatric Diet Manual Administrators Email: [email protected]

This diet is for individuals who are Lactose free milk products, such as lactose intolerant or whom lactose Lactaid milk, and milk alternatives, Lactose Restricted is temporarily restricted for GI such as soy milk, are provided in Diet related issues. place of lactose containing foods.

Currently Room Service is only available in MCHC. If a patient is unable to use the Room Service phone in menu ordering, this diet MCHC Room order will ensure a member of the Service Patient Room Service staff will come assist Requires Menu the patient in ordering food Assistance preferences. N/A The mechanical is indicated for individuals who have difficulty with mastication due to conditions such as absence of teeth, loose dentures, and sore gums. It may be useful for individuals with varices, inflammation or strictures of the esophagus, and following radiation It consists of foods which are Mechanical Soft therapy to the oral, pharyngeal, or minced, chopped, or ground Diet laryngeal areas. according to individual need.

Revised 3/07 7 University of Michigan Health System Patient Food and Nutrition Services Nutrition Care Manual and Pediatric Diet Manual Administrators Email: [email protected]

This diet is indicated for patients with suppressed immune function or neutropenia (an absolute neutrophil It excludes fresh fruits and count below 1000/mm3). Its goal vegetables, with the exception of is to decrease the amount of bananas, oranges and apples bacteria in the diet since a food (assuming each will be peeled). product with a high microbial count Hot and cold foods should be eaten may lead to colonization of the within 1-2 hours of tray delivery, gastrointestinal tract, thereby otherwise these foods should be Modified Microbial increasing the risk of developing an discarded. Other foods with high Diet infection. microbial content are also excluded. This diet is intended for patients The diet is designed to eliminate who are post-esophogectomy. The foods that might be too coarse to diet consistency is modified for pass through a partially obstructed comfort and to reduce blockage esophagus or healing esophageal post surgery, as well as more anastomosis. Carbonated Mushy Soft, 6 Small providing smaller, more frequent beverages are avoided to minimize Meals meals. intrathoracic gastric distention. Fat-free options of standard foods will be provided as available. MCT oil may be needed to provide This diet is used for chyle essential fatty acids and meet No Fat Diet leaks/chylous effusions. caloric needs.

Revised 3/07 8 University of Michigan Health System Patient Food and Nutrition Services Nutrition Care Manual and Pediatric Diet Manual Administrators Email: [email protected]

This diet is typically part of a order but is also used with any individual with elevated phosphorus levels resulting from dietary intake of phosphorus. It restricts intake of It restricts intake of high high phosphorus foods such as milk phosphorus foods such as milk Low Phosphorus products, poultry, fish, meat, eggs, products, poultry, fish, meat, eggs, Diet grains and legumes. grains and legumes.

This diet is typically used with the renal population, but is also used with any individual with elevated High potassium foods are restricted, potassium levels resulting from degree of restriction is dictated by dietary intake of potassium. There designated mEq/day level. Foods are three levels of restriction that are restricted include bran available with 80 mEq/day being the flakes, dried beans and peas, nuts, Potassium most liberal and 60 mEq/d being the milk, and several fruits and Restricted Diet most restrictive. vegetables. Nutrition Care Manual

Protein restriction should be based on a ’s recommendations to Dietary protein modifications may ensure nutrition needs. Fifty be indicated for individuals who percent of the protein intake should have renal failure or hepatic be of high-biological value protein encephalopathy. Nutritional (i.e. eggs, meat, milk), to ensure Protein Restricted management will depend on the sufficient intake of essential amino Diet type and stage of the disease. acids.

Revised 3/07 9 University of Michigan Health System Patient Food and Nutrition Services Nutrition Care Manual and Pediatric Diet Manual Administrators Email: [email protected]

A pureed diet is indicated for The pureed diet consists of liquid individuals who are unable to chew and semi-liquid foods. Individual solid foods related to poorly fitting food tolerances must be considered dentures, mouth or throat pain, etc. in food selection. The individual’s The foods included in the pureed condition should determine the Pureed Diet diet require no mastication. restrictions of the diet. Nutrition Care Manual A renal diet is intended for individuals with impaired renal This diet limits foods and function and entails the following condiments high in sodium, as well restrictions: 70 mEq potassium, no as bran, dried bean and peas, nuts Renal Diet added salt, low phosphorus diet. and several fruits and vegetables. Nutrition Care Manual To decrease peristalsis and limit stimulation of the GI tract, typically Includes easily digestible foods used with PUD and GERD. Often there are low fiber, mildly seasoned, used as a transitional diet after and tender. Omits caffeine and Soft Diet surgery, as well. alcohol. Nutrition Care Manual Restricts foods high in sodium Indicated for individuals with (cured, processed) and eliminated hypertension or fluid retention often high sodium condiments (salt, soy Sodium Restricted resulting from cardiovascular, renal sauce, MSG). Note: No added salt Diet or liver disease. diet provides ~3-4 gm Na/day. Nutrition Care Manual Usually a diet advancement from For use with patient who have had clear liquid diet to general as Tonsil and recent tonsillectomy and/or tolerated, with no red dyes or red Adenoids Diet adenoidectomy. foods allowed.

Revised 3/07 10 University of Michigan Health System Patient Food and Nutrition Services Nutrition Care Manual and Pediatric Diet Manual Administrators Email: [email protected]

Dietary restrictions based on patients own restrictive practices. Vegetarian diets are used by Meat alternatives and soy products individuals who abstain from eating are provided in place of meat and Vegetarian Diet all or specific foods of animal origin. dairy. Nutrition Care Manual

Indicated for individuals who have had jaw reconstruction, traumatic injury with fixation, This diet is a liquid or liquefied diet. temporomandibular joint (TMJ) Six to eight small liquid meals per repair, or surgical resection of the day are encouraged to provide jaw for treatment of head and neck sufficient intake of energy, nutrients, cancer, and are unable to chew and fluids. An energy-dense, high- while the jaws are immobilized or protein liquid supplement should be Wired Jaw Diet until the surgical site heals. included daily

Revised 3/07 11