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TherapeuticDiet Specifcations

FOR ADULT INPATIENTS


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AGENCY FOR CLINICAL INNOVATION

Tower A, Level 15, Zenith Centre

821-843 Pacifc Highway

Chatswood NSW 2067

PO Box 699

Chatswood NSW 2057T +61 2 8644 2200 | F +61 2 8644 2151

E [email protected] | www.health.nsw.gov.au/gmct/

Produced by: ACI Nutrition Network

SHPN: (ACI) 110217

ISBN: 978-1-74187-653-6

Further copies o this publication can be obtained rom the

Agency or Clinical Innovation website at: www.health.nsw.gov.au/gmct

Disclaimer: Content within this publication was accurate at the time o publication.

This work is copyright. It may be reproduced in whole or part or study or training purposes

subject to the inclusion o an acknowledgment o the source. It may not be reproduced or

commercial usage or sale. Reproduction or purposes other than those indicated above,

requires written permission rom the Agency or Clinical Innovation.

Agency or Clinical Innovation 2011

Published: November 2011

Revision date: February 2012 (Halal Diet, page 11 - specifc menu planning guidelines table revised)
mailto:[email protected]://www.health.nsw.gov.au/gmct/http://www.health.nsw.gov.au/gmcthttp://www.health.nsw.gov.au/gmcthttp://www.health.nsw.gov.au/gmct/mailto:[email protected]


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Therapeutic Diet Specications for Adult Inpatients i

FOREWORD

The NSW Government established the Agency or Clinical Innovation (ACI) as a board-governed statutory health

corporation in January 2010, in response to the Special Commission o Inquiry into Acute Care Services in NSW Public

Hospitals. The ACI seeks to drive innovation across the system by using the expertise o its clinical networks to develop

and implement evidence-based standards or patient care and treatment and care o patients.

In April 2009, the ACI (then known as the Greater Metropolitan Clinical Taskorce, the GMCT) established the Nutrition in

Hospitals Group to advise NSW Health about developing an integrated approach to optimising ood and nutritional care inNSW public healthcare acilities. The group includes doctors, nurses, dietitians, speech pathologists, consumers, academics

and ood service and health support services.

The ACI, under the auspices o the Nutrition and Food Committee o NSW Health, has developed a suite o nutrition

standards and therapeutic diet specications or adult and paediatric inpatients in NSW hospitals. These standards orm

part o a ramework or improving nutrition and ood in hospitals. The suite o nutrition standards includes:

1. Nutrition standards or adult inpatients in NSW hospitals

2. Nutrition standards or paediatric inpatients in NSW hospitals

3. Therapeutic diet specifcations or adult inpatients

4. Therapeutic diet specifcations or paediatric inpatients

In April 2010, the ACI commissioned Peter Williams, Associate Proessor, Nutrition and Dietetics, University o Wollongong,

to develop the Therapeutic diet specifcations or adult inpatients on behal o the Nutrition and Food Committee,

NSW Health.

On behal o the Agency or Clinical Innovation, I would like to thank Peter Williams, the members o the Adult

Therapeutic Diet Specications Steering and Reerence Groups, and the Nutrition in Hospitals Group co-chaired by

Helen Jackson, or their dedication and expertise in developing these specications.

Dr Hunter Watt

Chie Executive and Co-Chair, Nutrition in Hospitals Group

Agency or Clinical Innovation


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ii Therapeutic Diet Specications for Adult Inpatients


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Therapeutic Diet Specications for Adult Inpatients 1

CONTENTS

Introduction ........................................................................................................................ 5

Aims ..............................................................................................................................................................................6

Methodology .................................................................................................................................................................6

Inormation For Users .......................................................................................................... 7

Content o the specications ..........................................................................................................................................7Use o the specications ................................................................................................................................................7

Review o specications .................................................................................................................................................8

General Diets .................................................................................................................... 10

Diet: Full ......................................................................................................................................................................10

Diet: Halal .................................................................................................................................................................... 11

Diet: Kosher ................................................................................................................................................................. 12

Diet: Microbial low ...................................................................................................................................................13

Diet: Maternity ............................................................................................................................................................15

Diet: Nil by mouth........................................................................................................................................................17

Diet: No hot fuids........................................................................................................................................................18

Diet: Vegan .................................................................................................................................................................. 19

Diet: Vegetarian including milk and eggs ......................................................................................................................21

Diet: Vegetarian including milk but not eggs ................................................................................................................23

Diets Supporting Patient Consumption ............................................................................... 25

Diet: Large ...................................................................................................................................................................25

Diet: Small ...................................................................................................................................................................26

Diet: Finger ood ..........................................................................................................................................................27

Diet: Small meals 6 day .............................................................................................................................................28

Texture-Modied Diets ...................................................................................................... 29

Diet: Cut up .................................................................................................................................................................29

Diet: Sot .....................................................................................................................................................................30

Diet: Minced and bread ...............................................................................................................................................32

Diet: Minced moist.......................................................................................................................................................34

Diet: Puree and bread ..................................................................................................................................................36

Diet: Smooth puree......................................................................................................................................................37

Diet: No mixed consistency ..........................................................................................................................................39


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2 Therapeutic Diet Specications for Adult Inpatients

Allergy / Intolerance Diets .................................................................................................. 40

Diet: Allergy additive low ..........................................................................................................................................40

Diet: Allergy amine low .............................................................................................................................................43

Diet: Allergy caeine ree ..........................................................................................................................................45

Diet: Allergy citrus ree ..............................................................................................................................................46

Diet: Allergy colour low .............................................................................................................................................47

Diet: Allergy egg ree ................................................................................................................................................49

Diet: Allergy elimination simplied.............................................................................................................................51

Diet: Allergy sh and shellsh ree .............................................................................................................................53

Diet: Allergy ructose low ..........................................................................................................................................54

Diet: Allergy glutamate low .......................................................................................................................................56

Diet: Allergy gluten ree ............................................................................................................................................58

Diet: Allergy lactose low ............................................................................................................................................60

Diet: Allergy latex ree ...............................................................................................................................................62

Diet: Allergy milk ree ................................................................................................................................................63

Diet: Allergy nut ree .................................................................................................................................................65

Diet: Allergy preservative low ....................................................................................................................................67

Diet: Allergy salicylate low .........................................................................................................................................69

Diet: Allergy sesame ree ...........................................................................................................................................70

Diet: Allergy soy ree .................................................................................................................................................71

Diet: Allergy sucrose low ...........................................................................................................................................73

Diet: Allergy sulphite low ..........................................................................................................................................75

Diet: Allergy wheat ree ............................................................................................................................................77

Diet: Allergy yeast ree ..............................................................................................................................................79

Diet: Allergy FODMAPs low .......................................................................................................................................80

Diabetic Diets .................................................................................................................... 83

Diet: Diabetes no set carbohydrate ............................................................................................................................83

Diet: Diabetes set carbohydrate .................................................................................................................................85

Drug Interactions Diets ...................................................................................................... 88

Diet: Tyramine low or MAOI .....................................................................................................................................88

Diet: Graperuit nil ...................................................................................................................................................90

Energy Diets ...................................................................................................................... 91

Diet: Energy high .....................................................................................................................................................91

Diet: Energy low........................................................................................................................................................93

Diet: Energy VLED replace 1 meal (VLED1) .................................................................................................................95

Diet: Energy VLED replace 2 meals (VLED2) ...............................................................................................................97

Diet: Energy VLED replace 3 meals (VLED3) ...............................................................................................................99

Fat-Modied Diets ............................................................................................................101

Diet: Fat low saturated ............................................................................................................................................ 101

Diet: Fat low


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Fibre-Modied Diets .........................................................................................................107

Diet: Fibre high >25g ..............................................................................................................................................107

Diet: Fibre / residue low


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Diet: Protein controlled 50g .................................................................................................................................. 172



Diet: Protein high ................................................................................................................................................... 178

Diet: Purine low ..................................................................................................................................................... 179

Renal Diets ...................................................................................................................... 180

Diet: Haemodialysis ...................................................................................................................................................180

Diet: Peritoneal dialysis ...............................................................................................................................................184

Test Diets ........................................................................................................................ 187

Diet: Test 5HIAA .....................................................................................................................................................187

Diet: Test catecholamine / VMA / metanephrines .....................................................................................................189

Diet: Test aecal at .................................................................................................................................................190

Diet: Test enfuramine and clonidine studies ........................................................................................................... 191

Diet: Test gelatine ree ............................................................................................................................................ 192

Diet: Test glucose tolerance .................................................................................................................................... 193

Diet: Test histamine collection .................................................................................................................................194

Diet: Test hydrogen breath test ...............................................................................................................................195

Diet: Test methionine loading test ...........................................................................................................................196

Diet: Test occult blood.............................................................................................................................................197

Enteral And Parenteral Diets............................................................................................. 198

Diet: Enteral eed NBM ...........................................................................................................................................198

Diet: Enteral eed and ood .....................................................................................................................................199

Diet: PN NBM .........................................................................................................................................................200

Diet: PN and ood ...................................................................................................................................................201

Diet: PN and enteral ................................................................................................................................................202

Diet: PN and enteral and ood ..............................................................................................................................203

Diets Suitable For Paediatrics ........................................................................................... 204

Appendix ....................................................................................................................... 206

Consultant .................................................................................................................................................................206

Members o steering group........................................................................................................................................206

Project Managers .......................................................................................................................................................206

Members o Adult Diet Specications Reerence Group and others who commented .................................................206


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The earliest Australian publication about therapeutic

diets dates rom more than 100 years ago. In 1908,

Dr Philip Muskett, Surgeon Superintendent to the NSW

Government, published The attainment o health and

the treatment o dierent diseases by means o diet,

which was more than 600 pages o diet plans, aimed

at inorming nursing sta in hospitals. As was common

at the time, Dr Muskett did not provide evidence or

reerences to support any o his recommendations, and

many o the diets (such as those or gonorrhoea and acne)

would have no place in modern treatment.

Audrey Cahn, head dietitian at St Vincents Hospital in

Victoria, compiled a manual o special diets in 1937.

Evelyn Anderson, rom the Royal Newcastle Hospital,

seems to have been the rst NSW dietitian to have written

diet specications: a 1939 manual o 23 diet types.

Five years later, a manual rom Royal Prince Alred Hospitaldened 53 therapeutic diets, and thereater various

hospitals developed their own specications.

It was not until 1957 that the nutrition section o the

Commonwealth Department o Health published the rst

national guidelines. That publication, Notes on special

diets or use in hospitals, specied 13 diet types and

was updated regularly through the 1960s. In 1980, the

Department released the Hospital diet manual or caterers

and diet supervisors, which dened 19 diet types and was

aimed at hospitals that had no ull-time dietitians.

The NSW Health Commission published a Food services

manualin 1977. This manual ocused on the provision

o ull diets, but also included some inormation on

diet modications such as those or light diets. The later

Standards or ood services, released in 1989, specied

that special diets should be integrated into the main menu

where possible, and that a range o ood items must be

available to meet individual requirements, but did not

dene dierent therapeutic diets.

The Dietitians Association o Australia began publishing aNutrition manualin 1988. The eighth edition, published in

2009, adopted an evidence-based approach and detailed

35 diet plans.

Nonetheless, while these proessional recommendations

have inormed practice, diet standards in NSW hospitals

have remained largely a local responsibility until now, and

some dierences remain between health districts in the

range and specications o therapeutic diets used in

public hospitals.

There is a need or a uniorm statewide approach to

therapeutic diet standards to acilitate communication

between health proessionals, and to underpin recipe

and menu developments.

The objectives o the Nutrition in Hospitals Group are to:

develop a nutrition care policy or endorsement

by NSW Health

develop nutrition standards (both nutrient and

ood based)

develop therapeutic diet specications

(ie specications or the range o diets provided in

NSW healthcare acilities)

advocate or the inclusion o nutrition care standards

or the Australian Council on Healthcare Standards.

Two key documents have already been developed:

1. The Therapeutic diet specifcations part one were

developed by the NSW Health Nutrition and Dietetic

Advisors Group in 2008. That document developed aconsistent set o naming conventions and denitions

or diets in NSW hospitals.

2. The Nutrition standards or adult inpatients in NSW

hospitals, published in 2011, dened the basic ood

and nutrition needs o adult inpatients but did not

consider patients with higher or special nutritional

needs. It was acknowledged that separate guidelines

would be needed or therapeutic diets.

This document details therapeutic diet specications

or adult inpatients. A separate document will denetherapeutic diets or children in hospital.

INTRODUCTION


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Aims

This document provides detailed specications or

115 therapeutic diets used in NSW public hospitals.

The specications:

describe the oods allowed / not allowed in each diet

provide nutrient targets or each main meal

component, or those diets requiring quantitative

nutrient levels.

The specications aim to be:

presented in an agreed standardised ormat

consistent in wording and denitions

easy to read and interpret by non-specialist sta

(eg ood service or nursing sta without access to

a dietitian)

suciently detailed to reliably support sae and

appropriate meal provision to patients on

therapeutic diets

based on the best available evidence.

Following principles developed by the NSW Health

Nutrition and Dietetic Advisors Group, the diets are

named according to the nutrients to be modied (eg

low sodium, high bre), rather than disease states (eg

cardiac). This clearly describes the exact nature o the diet,

and recognises the importance o planning diets to meet

patients individual needs, rather than applying standard

protocols. The exceptions to this (diabetic, renal and

Parkinson diets), acknowledge the widespread use

and understanding o these terms.

Methodology

A steering group was established to oversee the

development o these specications (see Appendix or

membership). The steering group decided the range o

diets to be included, agreed on a standard template to

present the specications, and advised on consultation

and approval processes.

Peter Williams FDAA, Associate Proessor o Nutrition and

Dietetics at the University o Wollongong, was engaged as

a consultant to develop drat o the diets using the agreed

standard template. The diets are based on:

existing diet standards used by NSW Health acilities

the Dietitians Association o Australias Nutrition

manual(eighth edition)

the American Dietetic Associations Nutrition care

manual(available online) nationally endorsed dietetic practice guidelines

standard textbooks o dietetic practice.

Where these sources provided insucient evidence-based

inormation, targeted literature searches were undertaken

to locate primary published literature to inorm the

specications.

All drat diet specications were posted on the website o

the ACI Nutrition in Hospitals Group or open comment

and advertised in the ACI Clinician Connectnewsletter(June and July 2010 editions). The ollowing groups were

specically invited to comment:

the ACI Nutrition in Hospitals Group (which includes

doctors, nurses, dietitians, speech pathologists,

consumers, academics, and sta rom ood services

and Health Support Services)

The ACI Adult Therapeutic Diet Specications

Reerence Group (see Appendix or membership)

the NSW Health Speech Pathology Advisors Group

pathology services in each Local Health District, via

NSW Health

NSW members o the Dietitians Association o

Australia, via a weekly emailed newsletter.

A list o respondents is given in the Appendix. Appropriate

suggested changes were incorporated and approved by

the steering group, and a revised version was sent to the

NSW Health Nutrition and Dietetic Advisors Group or

review. A nal version was then submitted to the Nutrition

and Food Committee o NSW Health or approval andendorsement.


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INFORMATION FOR USERS

Content of the specicationsThese specications give guidance about the type and

quantities o suitable oods or adult inpatients needing a

range o therapeutic diets. There are our broad categories

o diets:

those that restrict or eliminate particular ood items(eg allergy or fuid diets)

those that reduce or increase the level o particular

nutrients (eg low-at or high-bre diets)

those that quantiy the level o particular nutrients

(eg 50mmol sodium or 50g protein diets)

those that speciy the appropriate texture or

presentation o ood (eg sot- or cold-ood diets).

Food preerences (eg nil bee, nil mushrooms) are not

regarded as therapeutic diets and thereore not included

in these specications. Normal menu selection processes

should accommodate such preerences.

Several diets listed in the NSW Health Therapeutic diet

specifcation part one (2008) were not included in these

specications because they are no longer in use (eg low

calcium and 150mmol sodium). One new diet was added

(FODMAPs low), and the texture-modied diets were

regrouped ater consultation with the Speech Pathology

Advisors Group and the Nutrition and Dietetics Advisors

Group, NSW Health.

For each diet, nine pieces o inormation are provided:

Aim describes the broad objective o the diet with any

quantitative daily targets.

Characteristics describes the general patterns o

oods used in the diet.

Nutrition diagnosis notes the most likely diagnosis

listed in the International dietetics and nutrition

terminology reerence manual(second edition).

Indications lists some common medical or surgical

conditions or which the diet is oten prescribed.

Nutritional adequacy provides an assessment o

whether the diet is adequate alone or whether it

needs supplementation to be nutritionally adequate.

Precautions gives instructions or warnings regarding

use o the diet in hospitals.

Paediatrics indicates suitability or use o these dietsin paediatrics.

Specifc menu planningguidelines lists the oods

allowed and not allowed on the diet.

Reerences gives a selection o authoritative sources

supporting the diet specications, arranged in reverse

date order.

Use of the specications

Diet prescription

These specications do not attempt to dene appropriate

diets to be prescribed or individual patients. Diets must

not automatically be ordered or patients with the medical

or surgical indications noted in the specications, because

a very restrictive diet may prevent good nutritional

recovery or patients who are undernourished or eating

poorly.

Appropriate health proessionals may alter the diets

to meet individual patients needs. For example, somepatients on sot diets may not tolerate bread, and this

would need to be noted at the time o ordering that diet.

Diet combinations

Combinations o diets can be ordered (eg low saturated

at and sodium restricted), but there is no need to

speciy a ull diet where it is to be combined with other

therapeutic diets. One diet (no mixed consistency) should

always be used in combination with other texture-

modied diets.


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Paediatrics

When combined with an age-appropriate diet,

many o these diets are suitable or use in paediatrics.

The age-appropriate diet will ensure the types o oods

oered, textures, serve sizes and requency o meals are

suitable or the child. I a diet species a nutrient amount

(eg sodium 80-100mmol), combining it with an age-appropriate diet (eg child 48 years) will provide less

o the nutrient. For example, the child 48 years diet

uses hal serves, so when combined with the sodium

80-100mmol diet, the child will receive around

40-50mmol o sodium. These clinical judgements

will need to be made by a clinical dietitian.

Some diets are not suitable or use in paediatrics due to

the restriction o essential nutrients or child development.

These will be noted or each diet. Please reer to the

Therapeutic diet specifcations or paediatric inpatientsor additional paediatric specic diets.

Foods allowed / not allowed

In the specic menu planning guidelines, it is not possible

to list all oods or recipe items that may be suitable

or unsuitable. Specic guidelines and some common

examples are usually included, but other oods or dishes

may also be suitable or unsuitable, depending on their

nutritional prole, ingredients and texture.

Trade names o some common products have been usedto clariy the intention o the guidelines, but their inclusion

does not imply endorsement or recommendation o these

products, nor indicate that similar products are unsuitable.

These specications are designed or patients in hospital;

they are not intended as education material or patients

prescribed therapeutic diets. For this reason they do not

mention oods that are not normally available in hospitals,

such as alcoholic beverages, takeaway oods and specialty

gourmet items.

Food availability

Not all products listed as being allowed or a specic

diet will be available at all sites and some oods may

be reserved or use in therapeutic diets only.

Nutritional supplements

These specications do not attempt to indicate which

nutritional supplements comply with each diet, since it

assumed that a dietitian will order the type and volume

o supplements according to the patients individual

needs. In many cases, nourishing oods such as

favoured milk and yoghurt are suitable alternativesto commercial supplements.

Rare diets

These specications cover diets commonly used across

NSW public hospitals. They do not include special diets

designed or research purposes or particular treatment

situations. The local dietitian will need to speciy those

diets and communicate with the ood service about

easibility and implementation.

Review of specicationsThese specications are initially endorsed until December

2012. Ongoing evaluation and revisions will be managed

by the Nutrition in Hospitals Group within the Agency

or Clinical Innovation.


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References

Agency or Clinical Innovation. NSW Health Nutrition

standards or adult inpatients in NSW hospitals. Sydney:

ACI; 2011. [drat accessed 19 June 2010]; Available at:

http://www.health.nsw.gov.au/gmct/hen/nutrition_

index.asp

American Dietetic Association. International dietetics

and nutrition terminology (IDNT) reerence manual:

standardized language or the nutrition care process.

2nd ed. Chicago: ADA; 2009.

American Dietetic Association. Nutrition care manual.

Chicago: ADA; 2009. Available at: http://www.

nutritioncaremanual.org/

Anderson E. Diet manual. Newcastle: Royal Newcastle

Hospital; 1939.

Cahn A. A manual o special diets. Melbourne:Melbourne University Press; 1937.

Commonwealth Department o Health, Nutrition Section.

Notes on special diets or use in hospitals. Canberra:

Australian Institute o Anatomy; 1957.

Dietitians Association o Australia. Nutrition manual.

8th ed. Canberra: DAA; 2009.

Health Commission o New South Wales. Food services

manual. Sydney: Health Commission o NSW; 1977.

Muskett PE. The attainment o health and the treatmento dierent diseases by means o diet. Sydney:

William Brooks; 1908.

NSW Department o Health. Standards or ood services.

State Health Publication (MA) ISBN 89.066.0.7305.3361.1.

Sydney: Department o Health; 1989.

NSW Health Nutrition and Dietetic Advisors Group.

NSW Health Therapeutic diet specications part one.

Sydney: NSW Health; 2008.

Plain J, Cornish M, Corden M. Hospital diet manual orcaterers and diet supervisors. Commonwealth Department

o Health. Canberra: Australian Government Publishing

Service; 1980.

Royal Prince Alred Hospital. Royal Prince Alred Hospital

diet manual. Sydney: RPAH; 1944.
http://www.health.nsw.gov.au/gmct/hen/nutrition_http://www/http://www/http://www.health.nsw.gov.au/gmct/hen/nutrition_


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GENERAL DIETS

Diet: Full

Aim: To provide a balanced diet with a variety o oods or patients able to eat normally.

Characteristics: A diet that conorms to the Nutrition standards or adult inpatients in NSW hospitals.

Nutrition diagnosis: NI-2.1 Inadequate oral ood / beverage intake.

Indications: Suitable or all patients who are nutritionally well and nutritionally at risk, but not those with special orhigh nutritional needs. This diet may be combined with thickened fuids.

Nutritional adequacy: Nutritionally adequate.

Precautions: Not to be used or patients with any therapeutic diet order.

Paediatrics: Not suitable or use in paediatrics.

Specifc menu planning guidelines:

ALLOWED NOT ALLOWED

Hot main dishes All

Sauces, gravies AllStarchy vegetables / pasta / rice All

Vegetables All

Soups All

Sandwiches All

Salads, dressings All

Breads, cereals All

Spreads All

Hot breakast choices All

Fruit All

Yoghurt All

Desserts All

Milk and cheese All

Beverages All

Biscuits All

MiscellaneousOne high-energy mid-meal per day required by Nutrition standards

References

1. Agency or Clinical Innovation. NSW Health Nutrition standards or adult inpatients in NSW Hospitals. Sydney: ACI;2011. [drat accessed 19 July 2010]; Available at: http://www.health.nsw.gov.au/gmct/hen/nutrition_index.asp

2. Dietitians Association o Australia. Nutrition manual. 8th ed. Canberra: DAA; 2009.
http://www.health.nsw.gov.au/gmct/hen/nutrition_index.asphttp://www.health.nsw.gov.au/gmct/hen/nutrition_index.asp


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Diet: Halal

Aim: To provide a diet suitable or patients o Islamic aith.

Characteristics: Avoids all pork products and alcohol. All meat should be Halal.

Indications: Available on request to Muslim patients.



Precautions: Use only Halal-certifed meat and avoid gelatine, which is usually rom non-Halal animal sources.

Avoid all pork products: this includes oods such as biscuits, pastry and cakes that may have pork at added (pork at

may be labelled as animal at). Avoid all ood and ingredients containing alcohol. Avoid all animal at except butter.

It is not necessary to use separate cooking pots and utensils or Halal ood, provided adequate cleaning processes can

be demonstrated. A ood saety program should be able to demonstrate adequate separation o Halal and Haram oods.

Paediatrics: Suitable or use in paediatrics when combined with an age-appropriate diet.


ALLOWED NOT ALLOWED

Hot main dishes

Bee, lamb, chicken killed by Muslim

slaughter methods (Halal)

All seaood, beans, eggs, cooked withwater or with vegetable oils or margarine

Pork and pork products

(eg ham, bacon, salami, sausages)

Foods containing alcohol

Sauces, gravies All, prepared without animal at Most stock powders with animal at

Starchy vegetables / pasta / riceAll, cooked with water, vegetable ats orbutter

Any ried or roasted in animal ats

VegetablesAll, cooked with water, vegetable ats orbutter

Any ried or roasted in animal ats

SoupsAny made without pork, ham or animalats

Any made with stock based on hambones

SandwichesAny made with Halal meat, seaood, eggs

or cheese

Pork and pork products

(eg ham, bacon, salami)

Salads, dressingsAny made with Halal meat, seaood, eggsor cheese. Use vegetable oils in dressings

Pork and pork products(eg ham, bacon, salami)

Breads, cereals All

Spreads Vegetable margarine or butter Margarine made with animal ats

Hot breakast choices Eggs, baked beans, vegetables, spaghettiPork products(eg ham, bacon, sausages)

Fruit All ruit

Yoghurt Yoghurt with Halal gelatine Yoghurt with regular gelatine

Milk and cheese All Milk. Cheese with Halal rennet. Cheese with regular rennet.

BeveragesTea, coee, sot drinks, cordial,pasteurised ruit juices

Fresh ruit juices (because o perceivedermentation risk)

Biscuits Any made with vegetable oils and ats Any made with animal ats

Miscellaneous

Coconut milk, herbs and spices, pickles,chutney, vanilla bean

Halal-certifed nutritional supplements

Flavour essences with alcohol base

Cochineal colouring

References

1. Australian Halal Food Directory. [accessed 19 July 2010]; Available at: http://www.halalaustralia.com.au/deault.asp


3. Regenstein JM, Chaudry MM, Regenstein CE. The Kosher and Halal ood laws. Compr Rev Food Sci Food Sa 2003;2:111-7.
http://www.halalaustralia.com.au/default.asphttp://www.halalaustralia.com.au/default.asp


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Diet: Kosher

Aim: To provide a diet that conorms to Jewish dietary laws.

Characteristics: There is a wide spectrum o observance. Some Jewish people will not eat pork but will disregard other laws.

Others will only eat kosher meat but will eat ood cooked with non-kosher utensils. During essential medical treatment,

necessary non-kosher oods may be used and patients may be given dispensation rom observance while in hospital.

In strict observance all meat must be killed and prepared in a special way (available rom Kosher butchers). No oods

containing non-kosher meat can be eaten; this includes many commercially processed oods containing ats. There can be

no contact between meat and milk products. Kosher ood cannot be eaten unless it is prepared using utensils and acilities

exclusively reserved or kosher use. Food cooked in an ordinary hospital kitchen would be rendered non-kosher.


Indications: Available on request to patients o the Jewish aith. Kosher meals may be acceptable to people o the Islamic aith.


Precautions: Deciding whether products have been prepared in a manner that complies with Jewish law is complex and

is done by a Rabbinic organisation that publishes theAustralian Kosher Food Bulletin. A strict observer o kosher laws will

only eat products listed in the Bulletin. Most hospitals purchase specially prepared meal packs rom an external kosher

ood supplier. Meals are kept rozen, then re-thermed and sent sealed to the patient who breaks the seal beore eating.

Note that dierent meal packs are used or Passover. The only suitable mid-meals are resh ruit. The sodium content okosher meals may prevent their use on restricted sodium diets.



ALLOWED NOT ALLOWED

Hot main dishes Kosher meal packs All others

Sauces, gravies None

Starchy vegetables /pasta / rice None

Vegetables None

Soups NoneSandwiches None

Salads, dressings Kosher meal packs All others

Breads, cereals None

Spreads None

Hot breakast choices None

Fruit Fresh ruit

Desserts Kosher meal packs All others

Yoghurt None

Milk and cheese Milk portions or cereal, tea and coee

Beverages Tea, coee All others

Biscuits None

MiscellaneousKosher cutlery packsNutritional supplements certied as Kosher

* Some commercial portion-control products are acceptable (see Kashrut Authority website).

References

1. Kashrut Authority. Kosher Product Directory. [accessed 19 July 2010]; Available at: http://www.ka.org.au/

2. Kosher Australia Pty Ltd. The Kosher Food Bulletin. 2010. Available by subscription at: http://www.kosher.org.au/

subscriptions.htm3. Dietitians Association o Australia. Nutrition manual. 8th ed. Canberra: DAA; 2009.

4. Regenstein JM, Chaudry MM, Regenstein CE. The Kosher and Halal ood laws. Compr Rev Food Sci Food Sa 2003;2:111-7.
http://www.ka.org.au/http://www.kosher.org.au/http://www.kosher.org.au/http://www.ka.org.au/


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Diet: Microbial lowAim: To provide a diet limiting oods at high risk o carrying ood-borne disease.

Characteristics: Avoids ood with a high bacterial or ungal load. Sterile diets are no longer used because they are

not cost-eective.

Nutrition diagnosis: NB-3.1 Intake o unsae ood.

Indications:

patients with neutropenia (neutrophil count 1000 cells/L)

patients who are severely immunosuppressed (eg post-transplant; undergoing some cancer treatments).

However as ood saety has improved, the standard hospital diet may be considered sae or most immunocompromised

patients.


Precautions: As these patients are oten malnourished, nutritional supplements may be required and these patients

should be supervised by a dietitian. All salads and sandwiches must be prepared on the day o service and not

purchased pre-prepared.

Paediatric: Suitable or use in paediatrics when combined with an age-appropriate diet.


ALLOWED NOT ALLOWED

Hot main dishes All well-cooked meat, poultry, sh and eggs

Undercooked meat,poultry or sh

Raw tou, smoked sh, tempeh

Sauces, gravies All cooked

Starchy vegetables / pasta / rice All cooked

Vegetables All cooked

Soups All hot soupsCold soups

Miso soup

Sandwiches

All breads

Pasteurised meats (cooked in bag) and slicedacceptable with correct ood hygiene practices

Boiled eggs, canned sh

Commercially packaged mild cheese (eg cheddar)

Cottage cheese may be used i served on the daythe package is opened

Sliced processed meats(eg ham, chicken roll)

Cold chicken or turkey

Smoked meat and sh

Pats and meat spreads

Salads, dressings

Sanitised vegetables only*

Boiled eggs, canned sh



Cottage cheese may be used i served on the daythe package is opened

Portion packs o commercial mayonnaise anddressings

Unwashed raw vegetables andsprouts, including mushrooms

Leay green vegetables,eg lettuce Salad dressings madewith blue cheese or raw eggs

Sliced processed meats(eg ham, chicken roll)

Cold chicken or turkey

Smoked meat and sh

Peeled prawns

Raw sprouts

Breads, cereals

All breads, processed ready-to-eat

Cooked breakast cereals

All cooked pasta and rices

Raw oats

Raw muesli


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ALLOWED NOT ALLOWED

Spreads Jam, peanut butter, Vegemite Pats and meat spreads, honey

Hot breakast choices All cooked

FruitSanitised resh ruit*

Portion-control packs o ruit

Fresh ruit with a rough texture(eg raspberries, rockmelons)

Yoghurt All yoghurt

Desserts

Hot desserts

Heat-treated portion-control cold desserts

Rerigerated commercial and homemade cakes,pastries and puddings

Normal rozen ice-creams

Unrerigeratedcream-lled pastries

Sot-serve icecream

Milk and cheese

All pasteurised milk and milk products


Cottage and ricotta cheese may be used i servedon the day the package is opened

Sot, semi-sot and surace-ripened cheese (eg brie,camembert, etta, blue)

BeveragesPasteurised ruit juices in sealed portions

Tea, coee, sot drink

Fresh and unpasteurised juices

Herbal teas

Biscuits All portion packs

Miscellaneous Nutritional supplementsRaw nuts and nuts in shells

Raw oysters

* All raw ruit and vegetables must be sanitised as per NSW Food Authority guidelines (see reerence 4 below, section 5).

References


2. American Dietetic Association. Nutrition care manual. Chicago: ADA; 2009. Available at: http://www.

nutritioncaremanual.org/

3. Centers or Disease Control and Prevention. Guidelines or prevention and treatment o opportunistic inections in

HIV-inected adults and adolescents. MMWR 2009;58(RR-4):1-207. [accessed 27 July 2010];

Available at: http://www.cdc.gov/mmwr/pd/rr/rr5804.pd

4. NSW Food Authority. Vulnerable persons ood saety scheme manual. NSW/FA/CP005/0805. Sydney: NSW Food

Authority; 2008.

5. Gardner A, Mattiuzzi G, Faderl S, Borthakur G, Garcia-Manero G, Pierce S et al. Randomized comparison o cooked

and noncooked diets in patients undergoing remission induction therapy or acute myeloid leukemia. J Clin Oncol

2008;26:5684-8.6. US Department o Agriculture Food Saety and Inspection Service. Food saety or transplant recipients. 2006.

[accessed 27 July 2010]; Available at: http://www.sis.usda.gov/pd/ood_saety_or_transplant_recipients.pd

7. World Health Organization & Food and Agriculture Organization. Risk assessment o Listeria monocytogenes in

ready-to-eat oods: interpretative summary. Microbiological risk assessment series 4. 2004. [accessed 27 July 2010];

Available at http://www.who.int/oodsaety/publications/micro/en/mra4.pd

8. Moody K, Charlson ME, Finlay J. The neutropenic diet: whats the evidence? J Pediatr Hematol/Oncol 2002;24:717-21.

9. French MR, Levy-Milne R, Zibrik D. A survey o the use o low microbial diets in pediatric bone marrow transplant

programs. J Am Diet Assoc 2001;101:1194-8.
http://www/http://www.cdc.gov/mmwr/pdf/rr/rr5804.pdfhttp://www.fsis.usda.gov/pdf/food_safety_for_transplant_recipients.pdfhttp://www.who.int/foodsafety/publications/micro/en/mra4.pdfhttp://www.who.int/foodsafety/publications/micro/en/mra4.pdfhttp://www.fsis.usda.gov/pdf/food_safety_for_transplant_recipients.pdfhttp://www.cdc.gov/mmwr/pdf/rr/rr5804.pdfhttp://www/


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Diet: MaternityAim: To provide a nutritionally adequate diet or pregnant and breasteeding women.

Characteristics: All oods need to comply with NSW Food Authority guidelines on ood saety in pregnancy.

Fish oered must comply with Food Standards Australia New Zealand guidelines on mercury in pregnancy.


Indications: Pregnant and breasteeding women.

Nutritional adequacy: Nutritionally adequate provided sucient ood is available to meet the higher needs o pregnant

and breasteeding women, as listed in the ollowing table (the requirements given are above those o the reerence person

in the Nutrition standards or adult inpatients in NSW hospitals):

NUTRIENT WITH HIGHER DAILY REQUIREMENTS PREGNANCY LACTATION

Energy (kJ) +1900 +2100

Folate (g) +200 +100

Vitamin C (mg) +15 +40

Calcium (mg) +300 +300

Iron (mg) +16* 0

* Usually provided with supplements, not ood.

Precautions: In addition to the ull menu, two extra dairy serves should be oered per day. Thoroughly cook all meat,

poultry and sh and thoroughly reheat all chilled ood.

Paediatrics: Not suitable or use in paediatrics.


ALLOWED NOT ALLOWED

Hot main dishes

Thoroughly cooked meats and eggs

Low-mercury sh, eg mackerel, silver warehou,Atlantic salmon, canned salmon and cannedtuna in oil, sardines, snapper, trevally, whiting,bream, mullet, garsh

Dishes with added sot cheese (eg spinach andricotta / etta) OK i cooked

For pregnant women only:shark (fake), billsh (broadbill,swordsh, marlin), orangeroughy (deep sea perch), catsh

Sauces, gravies All

Starchy vegetables / pasta / rice All

Vegetables All Raw sprouts

Soups All

Sandwiches

All breads

All other llings, including pasteurised meats(cooked in bag) and sliced acceptable withcorrect ood hygiene practices

Eggs, canned sh, hard cheese

Cold processed meats(eg ham)

Cold chicken

Sot and semi-sot cheese(eg brie, camembert, ricotta)

Pat


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ALLOWED NOT ALLOWED

Salads, dressings

Sanitised vegetables only*

Boiled eggs, canned sh, hard cheese


Raw seaood

Cold processed meats (eg ham)

Cold chicken

Sot and semi-sot cheese

(eg brie, camembert, ricotta)Sprouts

Breads, cereals All

Spreads Margarine, butter, Vegemite, honey and jam Pat


Fruit All

Yoghurt All

Desserts Sot-serve ice-cream

Milk and cheese

Pasteurised milk

Hard cheese (eg cheddar, Swiss)

Cottage and ricotta cheese may be used iserved on the day the package is opened

Sot and semi-sot cheese

(eg brie, camembert)Unpasteurised dairy products

Beverages All

Biscuits All

Miscellaneous All

* All raw ruit and vegetables must be sanitised as per NSW Food Authority guidelines (see reerence 4 below, section 5).

References

1. Food Standards Australia New Zealand. Mercury in sh. Available at: http://www.oodstandards.gov.au/

consumerinormation/adviceorpregnantwomen/mercuryinsh.cm

2. HealthInsite. Diet and pregnancy. Available at: http://www.healthinsite.gov.au/topics/Diet_and_Pregnancy

3. HealthInsite. Breasteeding and diet. Available at: http://www.healthinsite.gov.au/topics/Breasteeding_and_Diet

4. NSW Food Authority. Pregnancy and ood saety.

Available at: http://www.oodauthority.nsw.gov.au/consumers/lie-events-and-ood/pregnancy/

5. National Health and Medical Research Council. Nutrient reerence values or Australia and New Zealand. Canberra:

Department o Health and Ageing; 2006.
http://www.foodstandards.gov.au/http://www.healthinsite.gov.au/topics/Diet_and_Pregnancyhttp://www.healthinsite.gov.au/topics/Breastfeeding_and_Diethttp://www.foodauthority.nsw.gov.au/consumers/life-events-and-food/pregnancy/http://www.foodauthority.nsw.gov.au/consumers/life-events-and-food/pregnancy/http://www.healthinsite.gov.au/topics/Breastfeeding_and_Diethttp://www.healthinsite.gov.au/topics/Diet_and_Pregnancyhttp://www.foodstandards.gov.au/


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Diet: Nil by mouth

Aim: To provide no oral intake rom ood or fuids.

Characteristics: No ood or fuids are oered.

Indications: When ordered, as part o preparation or all patients undergoing general anaesthesia and various tests and

procedures (eg endoscopy). May also be ordered when it is unsae or a patient to eat (eg gastrointestinal peroration,

dysphagia) or ollowing gastrointestinal surgery.

Nutrition diagnosis: NI-2.2 Excessive oral ood / beverage intake.

Nutritional adequacy: Nutritionally inadequate.

Precautions: No water jug to be let at bedside. No menu to be oered. No supplements to be ordered with this diet.

No mid-meals to be served. Not to be combined with any other diet: this order overrules other diet orders.

Contact dietitian i this diet used or more than two days.

A 2010 Cochrane review o pre-operative asting ound there was no evidence to suggest a shortened fuid ast results in

an increased risk o aspiration, regurgitation or related morbidity compared with the standard asting policy o nil by mouth

rom midnight.

A 2001 meta-analysis ound there was no clear advantage in keeping patients nil by mouth ater elective gastrointestinal

resection and that early eeding may be o benet.

Paediatrics: Suitable or use in paediatrics.


ALLOWED NOT ALLOWED

Hot main dishes None

Sauces, gravies None

Starchy vegetables / pasta / rice None

Vegetables None

Soups None

Sandwiches None

Salads, dressings None

Breads, cereals None

Spreads None

Hot breakast choices None

Fruit None

Yoghurt None

Desserts None

Milk and cheese None

Beverages None

Biscuits None

Miscellaneous None

References

1. Brady M, Kinn S, Stuart P, Ness V. Preoperative asting or adults to prevent perioperative complications. Cochrane

Database Sys Rev 2003;(4):CD004423.

2. Ljungqvist O, Sreide E. Preoperative asting. Br J Surg 2003;90(4):400-6.3. Lewis SJ, Egger M, Sylvester PA, Thomas S. Early enteral eeding versus nil by mouth ater gastrointestinal surgery:

systematic review and meta-analysis o controlled trials. BMJ 2001;323:773-6.


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Diet: No hot uidsAim: To provide a nutritionally adequate diet with a variety o oods or patients able to eat normally but unable

to be sent hot fuids because o concerns about spillage.

Characteristics: Hot beverages and soups are excluded.


Indications:

patients with hand tremor or hemiplegia at risk o spilling drinks

patients with mouth wounds, ulcers or prone to nose bleeds

patients with burning mouth syndrome

some childrens wards and aged care units.


Precautions: An alternative beverage to tea and coee is to be available at each meal and mid-meal.



ALLOWED NOT ALLOWED

Hot main dishes All

Sauces, gravies All


Vegetables All

Soups All

Sandwiches All

Salads, dressings AllBreads, cereals All

Spreads All


Fruit All

Yoghurt All

Desserts All

Milk and cheese All

Beverages Milk, cordial, juice, iced coee, iced teaHot beverages(eg tea, coee)

Biscuits AllMiscellaneous

References:

1. Cerchiari DP, de Moricz RD, Sanjar FA, Rapoport PB, Moretti G, Geurra MM. Burning mouth syndrome: etiology.

Revista Brasileira de Otorrinolaringologia 2006;72(3);419-24.


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Diet: VeganAim: To provide a nutritionally adequate diet or people who do not eat any ood o animal origin.

Characteristics: A diet strictly eliminating oods and beverages containing any meat, poultry, sh, milk, egg, or products

derived rom them.


Indications: Vegans.

Nutritional adequacy: Not nutritionally adequate unless ortied oods (eg cereals and soy beverages) and / or

supplements are used to provide adequate vitamin B12, vitamin D, calcium, iron and zinc. High-protein plant oods must be

available at each meal.

Precautions: Care should be taken to read all product ingredients to look or ingredients o animal origin, eg casein, whey,

dairy solids, gelatine, honey, albumin, globulin and egg mayonnaise.



ALLOWED NOT ALLOWED

Hot main dishes

Dishes specially prepared or vegans based onbeans, peas, tou, textured vegetable protein(TVP), lentils, nuts

(At least one Band 1 choice per day, providing atleast 15g protein per serve; others Band 2)

Any dishes containing meat,poultry, sh, milk or eggs

Any dishes cooked with winemade with egg white as a ningingredient

Sauces, graviesVegetable-based sauces without dairy ormeat ats

Stocks and gravies made withmeat, butter, milk, or stockpowders made with animalproducts

Starchy vegetables / pasta / rice

All prepared without milk, butter or milk-

containing margarine

Vegetables prepared with milk,

cheese, animal at, or butter

VegetablesVegetables prepared without milk, butter ormilk-containing margarine

Vegetables prepared with milk,cheese, animal at, or butter

SoupsVegetable soups made without animal-basedstocks, milk, butter or milk-containing margarine

Soups prepared with meat,eggs, poultry, milk, butter ormilk-containing margarine

Sandwiches

Peanut butter, soy cheese, hummus, elael,baked beans (+/- salad)

(All Band 1, providing at least 10g proteinper serve)

All others

Salads, dressings

Beans (chickpeas, soybeans kidney beans etc),pasta, potato, rice, plus other vegetables

(Band 2, providing at least 10g protein per serve)

Egg-based mayonnaise

All others

Breads, cereals

Milk-ree breads

Rice and corn cakes

Rice, oats, corn or wheat four

Pasta and noodles made without egg

Plain corn-based, rice-based or wheat-basedcereals

Bread containing milk

Croissants

Breakast cereals with milk orhoney (eg muesli)

Spreads

Milk-ree margarine, jam, peanut butter,

Vegemite

Honey, cheese, meat spreads,

butter, milk-containing margarine


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ALLOWED NOT ALLOWED

Hot breakast choicesBaked beans in tomato sauce, mushrooms,tomatoes, spaghetti in tomato sauce

Eggs, meat

Baked beans in ham or cheesesauce

Fruit All ruits, resh and canned

Yoghurt Soy yoghurt (gelatine ree) Dairy-based yoghurt

Desserts

Fresh and canned ruit

Soy custard

Jellied ruit prepared with agar or vegetable gums

Desserts containing dairy, eggs,gelatine, cochineal or rennet(eg custards, ice-cream, regularjelly, junket)

Milk and cheese

Soy or rice milk ortied with calcium and vitaminB12

Soy cheese (ree o gelatine or animal rennet)

Cows milk and cheese

Soy cheese containing casein

BeveragesFortied soy or rice milk, juices, sot drinks,cordial, tea, coee

Cows milk, Aktavite, Ovaltine,Milo, Bonox

BiscuitsBiscuits made with only vegetable ats and oils

and no milk

Regular commercial biscuits

MiscellaneousNuts and seeds

Egg replacerCream

References


2. Craig WJ, Mangels AR, American Dietetic Association. Position o the American Dietetic Association: vegetarian diets.

J Am Diet Assoc 2009;109:1266-82.

3. Marsh K, Zeuschner C, Saunders A, Reid M. Meeting nutritional needs on a vegetarian diet. Aust Fam Phys

2009;38(8):600-2.

4. Vegan Society NSW. Available at: http://www.vegansocietynsw.com/vs/html/index.html
http://www.vegansocietynsw.com/vs/html/index.htmlhttp://www.vegansocietynsw.com/vs/html/index.html


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Diet: Vegetarian including milk and eggsAim: To provide a nutritionally adequate diet or people who do not eat any animal fesh oods.

Characteristics: A diet strictly eliminating oods and beverages containing any meat, poultry, sh, and gelatine oods

and products.


Indications: Lacto-ovo vegetarians.

Nutritional adequacy: May not be nutritionally adequate unless ortied oods (eg cereals) are used to provide adequate

iron and zinc. High-protein plant oods should be available at each meal.

Precautions: Care should be taken to read all product ingredients to look or ingredients o animal origin, eg gelatine.



ALLOWED NOT ALLOWED

Hot main dishes

Dishes specially prepared or vegetarians basedon beans, peas, tou, textured vegetable protein(TVP), lentils, nuts, milk, cheese and eggs

(At least one band 1 choice per day, providingat least 15g protein per serve; others Band 2)

Any dishes containing meat,poultry or sh

Sauces, graviesSauces without meat ats or juices; butteracceptable

Stocks and gravies made withmeat or animal products

Starchy vegetables / pasta / riceAll prepared without lard, but includingvegetables in white sauce with cheese

Vegetables prepared with lard

Vegetables All Vegetables prepared with lard

SoupsVegetable soups made without animal-basedstocks

Soups prepared with meat,poultry or sh

Sandwiches

Peanut butter, cheese, egg, salad

(All band 1, providing at least 10g protein perserve)

Sandwiches with meat, poultry or

sh

Salads, dressings

Beans (chickpeas, kidney beans etc), pasta,potato, rice, plus other vegetables

All dressings (including mayonnaise)

Band 2, providing at least 10g protein per serve)

Breads, cereals All breads, cereals, pasta and noodles

SpreadsJam, peanut butter, Vegemite, margarine,butter, honey

Meat and sh spreads

Hot breakast choicesEggs, baked beans in tomato sauce,mushrooms, tomatoes, spaghetti in tomato or

cheese sauce, creamed corn

Meat (eg bacon)

Baked beans in ham sauce

Fruit All ruits, resh or canned Jellied ruit (i made with gelatine)

Yoghurt All yoghurts without gelatine Yoghurts containing gelatine

Desserts


Jellied ruit prepared with agar orvegetable gums

Custard, ice-cream

Desserts containing gelatineor rennet

Milk and cheese All, including soy milk and cheese

Beverages Milk, juices, sot drinks, cordial, tea, coee

Biscuits All

MiscellaneousNuts and seeds

Cream


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References


2. Craig WJ, Mangels AR, American Dietetic Association. Position o the American Dietetic Association: vegetarian diets. J

Am Diet Assoc 2009;109:1266-82.


2009;38(8):600-2.

4. Australian Vegetarian Society. Available at: http://www.veg-soc.org/
http://www.veg-soc.org/http://www.veg-soc.org/


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Diet: Vegetarian including milk but not eggsAim: To provide a nutritionally adequate diet or people who do not eat any animal fesh oods or eggs.

Characteristics: A diet strictly eliminating oods and beverages containing any meat, poultry, sh, eggs, and

gelatine oods and products.


Indications: Lacto-vegetarians.

Nutritional adequacy: May not be nutritionally adequate unless ortied oods (eg cereals) are used to provide

adequate iron and zinc. High-protein plant oods should be available at each meal.

Precautions: Care should be taken to read all product ingredients to look or ingredients o animal origin, eg gelatine,

albumin, globulin and egg mayonnaise.



ALLOWED NOT ALLOWED

Hot main dishes

Dishes specially prepared or vegetarians basedon beans, peas, tou, textured vegetable protein(TVP), lentils, nuts, milk and cheese

(At least one band 1 choice per day, providingat least 15g protein per serve; others Band 2)

Any dishes containing meat, poultry,sh or eggs

Sauces, graviesSauces without meat ats or juices;butter acceptable

Stocks and gravies made with meator animal products

Starchy vegetables / pasta / riceAll prepared without lard, but includingvegetables in white sauce with cheese

Vegetables prepared with lard

Vegetables All Vegetables prepared with lard

Soups Vegetable soups made without animal-basedstocks Soups made with meat, eggs,poultry or sh

Sandwiches

Peanut butter, cheese, baked beans, hummus,alael, salad

(All band 1, providing at least 10g proteinper serve)

Sandwiches with meat, poultry,sh or eggs

Salads, dressings

Beans (chickpeas, kidney beans etc), pasta,potato, rice, plus other vegetables

(Band 2, providing at least 10g proteinper serve)

Egg-based mayonnaise

Breads, cereals

All breads, cereals, oats, corn or wheat four

Pasta and noodles made without egg Breads and cereals containing egg

SpreadsJam, peanut butter, Vegemite, margarine,butter, honey

Meat or sh spreads

Hot breakast choicesBaked beans in tomato sauce, mushrooms,tomatoes, spaghetti in tomato or cheese sauce,creamed corn

Eggs, meat

Baked beans in ham sauce

Fruit All ruits, resh or canned Jellied ruit (i made with gelatine)

Yoghurt All yoghurts without gelatine Yoghurts containing gelatine

Desserts


Jellied ruit made with agar or other vegetable

gums

Custard without egg, ice-cream

Desserts containing eggs or

gelatine (eg trife with spongecake, milk jelly) or rennet


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ALLOWED NOT ALLOWED

Milk and cheese Cows milk, soy milk, cheese

Beverages Milk, juices, sot drinks, cordial, tea, coee

Biscuits Biscuits made without eggs Biscuits made with eggs

Miscellaneous

Nuts and seeds

CreamEgg replacer

References


2. Craig WJ, Mangels AR, American Dietetic Association. Position o the American Dietetic Association: vegetarian diets.

J Am Diet Assoc 2009;109:1266-82.


2009;38(8):600-2.

4. Australian Vegetarian Society. Available at: http://www.veg-soc.org/
http://www.veg-soc.org/http://www.veg-soc.org/


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DIETS SUPPORTING

PATIENT CONSUMPTION

Diet: LargeAim: To provide additional ood or patients with greater energy and nutrient needs.

Characteristics: This diet allows patients to receive additional ood items to the standard ull diet, including a hot meal,

bread and spreads, salad or sandwich at main meals, and high-energy snacks at mid-meals.


Indications:

young men

hyper-metabolism.


Precautions: Some ood service systems will require an additional tray to provide large serves.



ALLOWED NOT ALLOWED

Hot main dishes All

Sauces, gravies All


Vegetables All

Soups All

Sandwiches All


Breads, cereals All

Spreads All


Fruit All

Yoghurt All

Desserts All

Milk and cheese All

Beverages All

Biscuits All

Miscellaneous All

References

1. Agency or Clinical Innovation. NSW Health Nutrition standards or adult inpatients in NSW Hospitals. Sydney: ACI;

2011. [drat accessed 19 July 2010]; Available at: http://www.health.nsw.gov.au/gmct/hen/nutrition_index.asp


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Diet: Small

Aim: To provide smaller servings o main-meal ood items.

Characteristics: This diet oers the same ood choices as the ull diet, but a small (hal) serve o the main menu item.


Indications: Patients with poor appetite, nausea or early satiety.

Nutritional adequacy: As hot main-meal items are the main source o protein, this diet has the potential to provide less

energy and protein than the ull diet.

Precautions: Patients ordered this diet may require nutritional supplements. It may not be possible to provide this diet at all

sites, depending on the ood service system and re-therm equipment used.



ALLOWED NOT ALLOWED

Hot main dishes All, but small (hal) serves

Sauces, gravies All


Vegetables All, but single-scoop serves (approx 40g)

Soups All

Sandwiches Two or our points o sandwiches only Six points or more


Breads, cereals All

Spreads AllHot breakast choices All

Fruit All

Yoghurt All

Desserts All

Milk and cheese All

Beverages All

Biscuits All

Miscellaneous All

References




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Diet: Finger food

Aim: To provide a diet that is easy to eat without cutlery.

Characteristics: All ood items must be able to be picked up with the ngers in one hand only. Sandwiches should be cut

into halves or quarters.


Indications: Patients who are required to lie fat (eg those with spinal injuries, or those having brachytherapy or

gynaecological, prostate or lung cancer). A nger-ood diet may also be used or patients with Alzheimers disease, other

dementia or cognitive impairment, or certain neuromuscular disorders.

Nutritional adequacy: Nutritionally adequate i appropriate choices made.

Precautions: Foods oered should be energy- and nutrient-dense and good sources o bre. Adaptive equipment (such as

plate stabilisers and guards, spouted cups and mugs with handles) and the advice o an occupational therapist may be useul.



ALLOWED NOT ALLOWED

Hot main dishes Finger oods (eg chicken nuggets, meatballs,sh ngers, cutlets, peeled boiled eggs, chickenlegs, sausages)

Wet dishes

Sauces, gravies For dipping (including portion control sauces) Sauces or gravies served with main dishes

Starchy vegetables /pasta / rice

Potato or kumara chips or wedges, or baked orsteamed cubes

Cooked rice, noodles

Vegetables All in bite-size pieces (eg carrot sticks, broccoliforets, beans)

Peas, corn or vegetables in sauces

Soups None (unless able to be served in closed mug orconsumed with straw)

Sandwiches All sandwiches, cut into halves or quartersSalads, dressings All, cut up or small pieces (eg cherry tomatoes)

Mayonnaise and dressings

Breads, cereals Breads, muns, crackers, dry breakast cereal,muesli bars

Breakast cereals with milk

Spreads All

Hot breakast choices Peeled boiled eggs

Fruit All; whole pieces preerred(eg apples, bananas, grapes, plums)

Fruit requiring a spoon to eat

Yoghurt All

Desserts Cakes, pastries or slicesIce-cream sandwiches or cones

Sot desserts such as custards or jelliesrequiring a spoon to eat

Milk and cheese All

Beverages All (may need to be served in closed mug orconsumed with straw)

Biscuits All

Miscellaneous One high-energy mid-meal per day

References


2011. [drat accessed 19 July 2010]; Available at: http://www.health.nsw.gov.au/gmct/hen/nutrition_index.asp2. Maher AK, editor; Iowa Dietetic Association. Simplied diet manual. 10th ed. Ames: Blackwell; 2007.


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Diet: Small meals 6 dayAim: To provide smaller servings o main-meal ood items and nourishing mid-meals, and spread dietary intakes

evenly throughout the day.

Characteristics: This diet oers the same ood choices as the small diet but extra items are provided at mid-meals.


Indications: Patients with reduced gastric capacity or appetite.

Nutritional adequacy: As hot main-meal items are the main source o protein, this diet has the potential to provide

less energy and protein than the ull diet, but should be adequate i nourishing mid-meals are provided.

Precautions: Patients ordered this diet will require monitoring o their protein and energy intake; they may require

supplements. It may not be possible to provide this diet at all sites, depending on the ood service system used.

Examples o deault ood and drink specications to encourage nutrient-dense choices are:

Breakast: Cereal and milk and ruit +/- hot breakast

AM: Hal or whole sandwich + extras as desired + drink

Lunch: Hot main + vegetables + dessert (no ruit, sandwich or beverage)PM: Cheese and biscuits + extras as desired + drink

Dinner: Soup and sandwich (no beverage)

Supper: Flavoured milk + extras as desired

Other high-energy mid-meals may also be suitable

(see Nutrition standards or adult inpatients in NSW hospitals, section 3.3).



ALLOWED NOT ALLOWED

Hot main dishes All, but small (hal) serves

Sauces, gravies All


Vegetables All, but single-scoop serves (approx 40g)

Soups All

Sandwiches Two or our points o sandwiches only Six points or more


Breads, cereals All

Spreads AllHot breakast choices All

Fruit All

Yoghurt All

Desserts All

Milk and cheese All

Beverages All

Biscuits All

Miscellaneous All

References1. Agency or Clinical Innovation. NSW Health Nutrition standards or adult inpatients in NSW Hospitals. Sydney: ACI;



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TEXTURE-MODIFIED DIETS

Diet: Cut up

Aim: To provide a diet more easily eaten by patients unable to cut up ood.

Characteristics: All ood items must be able to be eaten with a ork or spoon in one hand only. Solid ood should be

cut into pieces (maximum 2.5cm). Sandwiches should be cut into halves or quarters.

Nutrition diagnosis: NC-1.1 Swallowing diculty; NC-1.2 Biting / chewing diculty.

Indications:

may be ordered or patients with swallowing diculties

impaired unction o the hand, arm or shoulder

general debility

cognitive impairment.


Precautions: Patients ordered this diet should be monitored regularly to ensure adequate dietary intake.Paediatrics: Suitable or use in paediatrics when combined with an age-appropriate diet.


ALLOWED NOT ALLOWED

Hot main dishes All wet dishes

Roasts, grills, sh, omelettes; cut up

Sauces, gravies All

Starchy vegetables / pasta / rice Mashed, diced and chip potatoes

All others cut upVegetables All, cut up (except peas and corn)

Soups All

Sandwiches All sandwiches, cut into halves or quarters

Salads, dressings All, cut up or shredded

Breads, cereals All

Spreads All

Hot breakast choices All, cut up (including cutup sausages,omelettes, canned spaghetti and bacon)

Fruit All

Cut-up ruit i large

Whole resh large pieces

(eg apples, bananas, oranges)Yoghurt All

Desserts All

Milk and cheese All

Beverages All

Biscuits All

Miscellaneous One high-energy mid-meal per day

References

1. Agency or Clinical Innovation. NSW Health Nutrition standards or adult inpatients in NSW Hospitals. Sydney: ACI;2011. [drat accessed 19 July 2010]; Available at: http://www.health.nsw.gov.au/gmct/hen/nutrition_index.asp


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Diet: Soft

Aim: To provide a diet o sot-textured oods that can be easily chewed, requiring minimal biting.

Characteristics: Texture A sot. Foods in this category may be naturally sot (eg ripe banana), or cooked or cut up to alter

texture. Minimal cutting should be required; ood should be easily broken up with a ork or in the mouth. Food should be

moist or served with a sauce or gravy to increase moisture content. Target maximum particle size or adults is 1.5 x 1.5cm.

Larger sot ood items may be served i they can be broken up easily with a ork or in the mouth. This diet texture can beapplied to any portion size and most therapeutic diets.

Nutrition diagnosis: NC-1.1 Swallowing diculty; NC-1.2 Biting / chewing diculty.

Indications:

poor dentition or no dentures

painul mouth, gums or tongue (eg mouth ulcers, or ollowing surgery o the mouth)

may be ordered or patients with swallowing diculties

may be used or geriatric patients who are unable to manage a ull diet but do not need minced or pureed ood.

Nutritional adequacy: Nutritionally adequate, but may be low in dietary bre. Patients ordered this diet should be

monitored regularly to ensure adequate dietary intake.

Precautions: All oods to be naturally sot, minced or mashed, slightly rm but not tough or stringy, and without at, gristle

or bone. This diet is not necessarily a light diet (ie it can be spicy). All beverages, sauces and gravies must be thickened to

the appropriate level or individuals also prescribed thickened fuids.



ALLOWED NOT ALLOWED

Hot main dishes

Sot dishes that can be mashed with a ork(eg tuna / salmon mornay, sot macaroni cheese,faked sh, cottage pie, tou)

Sot dishes cut up (eg lasagne, smooth quichewith crumbly base, sh cakes, crpes)

Roasts, diced or minced with gravy

Well-cooked legumes (eg baked beans)

Sliced roasted meats or grills

Meat with gristle

Crumbed or ried sh

Dishes with hard pastry(eg spinach pie, regular quiche, pizza)

Casseroles with large pieces(eg curried prawns)

Dishes with crisp topping

Sauces, gravies All

Starchy vegetables /pasta / rice

Mashed and scalloped potato

Chopped pasta or well-cooked rice with plenty osauce

Roasted or baked vegetables

(including cut up)

Jacket or boiled new potatoes

Rice or pasta (i dry)

Vegetables Most vegetables, i sot enough to mash with ork

Raw vegetables

Fibrous vegetables (eg corn, celery,broccoli stalks)

Soups All

Sandwiches

Sot sandwiches with crusts removed

Use moist llings (eg diced or shaved chicken orham, salmon, tuna, egg with mayonnaise)

Sandwiches with crusts or hard llings

Bread with seeds or grains

Salads, dressings None


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ALLOWED NOT ALLOWED

Documents

ACI_AdultDietSpecs (1)