Clinical Nutrition Manual

1. INTRODUCTION

Nutrition refers to the processing of nutrient materials, principally food, and assimilation of
nutrients for growth, maintenance of health and reproduction. It is a basic need that changes
throughout the life-cycle and along the continuum of wellness and illness. In the context of
human nutrition, nutrition is characterized by six process stages namely, ingestion, digestion,
absorption, transport, assimilation, and excretion. Of interest therefore, is chemical composition
of food and interactions of nutrients as well as culture, attitudes and behaviors’ that influence
dietary patterns. To this extent, the scope of nutrition practice and science is universally viewed
from the perspectives of clinical nutrition and public health nutrition.

Clinical nutrition practice has emerged as an important discipline in modern medicine. It entails
the use of diets and nutrients in prevention of diseases and as an essential component of the
medical treatment. The practice is founded on knowledge relating to diagnosis of actual or high
risk of diet-related diseases and diseases that affect intake, absorption and metabolism of
dietary constituents. Overtime, with increasing evidence on the relationship between nutrition
status and risk of several diseases and disorders, the nutrition and infection cycle, knowledge
on synergistic and antagonistic drug-nutrient reactions, role of optimal nutrition and patient
recuperation, clinical nutrition service is now globally recognized as an essential component of
health care system and its operations. In this regard, it is noteworthy that the nutraceuticals
industry has grown exponentially during the last decade and the need for clear guidelines on
their application as curative and rehabilitative care services in the local context is required.

1.1. THE PURPOSE AND SCOPE OF THE MANUAL

In line with mandate of the Ministry of Medical Service, the purpose of this manual is to
strengthen delivery of nutrition services and accelerate their integration in curative and
rehabilitative care through the following:

a). Provision of a framework for engaging health care workers, service providers and other
stakeholders in planning, standardization and delivery of quality nutrition services;

b). Defining actions that health workers and service providers need to take to improve
alignment of nutrition services with curative and rehabilitative care services;

c). Equipping health workers with knowledge on identification of nutritional risks and
nutrition interventions for common clinical and nutrition related conditions;

d). Provision of knowledge on common clinical conditions and the role of specific nutrients in
disease management and;

e). Establishment of a foundation for the development of guidelines and job aids, review of
training curriculums and patient materials, and implement quality assurance.

This manual can be used in conjunction with the following important publications:
 Integrated Management of Acute Malnutrition Guidelines, June, 2008
 Out – patient Therapeutic Program manual,
 Kenyan National Guidelines for Nutrition and HIV/AIDS
 The Kenya National Technical Guidelines for Micronutrient Deficiency Control, 2008

1.2. NUTRITION CARE DURING PREGNANCY AND LACTATION

Energy and Protein

Dietary intake during pregnancy should provide the energy that will ensure the full term delivery of a healthy newborn baby of adequate size and appropriate body composition by a woman whose weight and body composition are consistent with long-term good health and well-being. The ideal situation is for a woman to enter pregnancy at a normal weight and good nutritional status. The energy requirement of pregnant woman is determined by several factors. These include the need to ensure adequate growth of the fetus, placenta and associated maternal tissues; to provide for increased metabolic demands of pregnancy in addition to maintaining adequate maternal weight, body composition and physical activity throughout gestational period as well as sufficient stores of nutrients for lactation. Special consideration must be made for women who are under or overweight when they enter pregnancy. A proper dietary balance is necessary to ensure sufficient intake for adequate growth without drawing from the mother’s own tissues to maintain her pregnancy.

The increased energy needs during lactation is imposed by additional demands and needs for adequate milk production and secretion. The additional demands correspond to the energy cost of milk production. Fat stores accumulated during pregnancy may cover part of the additional energy needs in the first few months of lactation. The average energy requirement for normal women is 2150kilocalories per day. Table 1 below shows recommended energy and protein requirements for women during pregnancy and lactation.