Chapter 2: Prepare client diet plan

Nutrition and Dietetics professionals in Kenya face the critical task of preparing client diet plans that not only address individual health needs but also respect cultural preferences and available resources. This chapter focuses on the systematic development of dietary goals tailored to each client, ensuring nutritional adequacy and practical feasibility. It covers essential considerations in meal planning, mechanisms to control quality and quantity, and the use of nutritional tools such as the food guide pyramid and reference standards mask to guide dietary recommendations.

2.1 Development of client's dietary goal

A dietary goal is a clear statement of what the client's diet is meant to achieve and by when. It is set after the client has been assessed and it directs every later step: the diet plan, the menu and the follow-up. A useful goal is specific, measurable, realistic for the client's situation, relevant to the client's health problem and fixed to a time. Example: "Within eight weeks Mrs Achieng will give her underweight young son one extra meal a day made from beans or eggs and a starch food, on at least five days a week." This goal names the behaviour, the measure and the period, so progress can be checked at the next visit. A goal such as "eat well" cannot be checked and is not used.

2.1.1 Factors to consider when planning meals

A diet that is correct on paper fails if the client cannot eat it, cannot afford it or does not accept it. The dietitian therefore weighs three groups of factors together before the goal is written: those in the client's body, those in the client's means and surroundings, and those in the client's family and community.

2.1.1.1 Biological determinants

Biological determinants are the features of the client's body and health that decide what the client needs and can eat.

• Age and life stage: needs for energy and nutrients change from infancy to old age, and pregnancy and breastfeeding add further needs, so a goal that suits an adult working on a farm does not suit a growing child or an elderly client.
• Sex, body size and body composition: a larger, more muscular person has a higher energy need than a smaller person of the same age, and the dietitian uses the client's measured weight and height.
• Health condition and treatment: diabetes, high blood pressure, kidney disease, HIV infection, tuberculosis and cancer each change what the diet must supply or limit, and some medicines change appetite, taste or the absorption of nutrients.
• Allergies and intolerances: a client who is allergic to groundnuts or who cannot digest lactose must have those foods removed and replaced with safe sources of the same nutrients, for example eggs, fish or legumes for protein.
• Appetite, chewing and swallowing: poor teeth, mouth sores or difficulty swallowing change the texture of foods the client can manage, and a poor appetite calls for small, frequent, nutrient-rich meals.
• Physical activity: a casual labourer or a market porter uses more energy in a day than an office clerk, and the goal for energy intake reflects the difference.

2.1.1.2 Economic and physical determinants

Economic determinants decide what food the client can obtain, and physical determinants decide what the client can store, prepare and reach.

• Household income and food prices: a client whose income is low and irregular cannot buy meat or fruit every day, so the plan uses affordable foods that carry the needed nutrients, such as beans, eggs, small fish, sukuma wiki and seasonal fruit alongside ugali.
• Availability and season: foods that are plentiful in one season are scarce and costly in another, and a plan that names seasonal alternatives stays workable through the year.
• Access to markets: a client far from a market may buy once a week, so the plan favours foods that keep without refrigeration.
• Storage, fuel and equipment: a household with one charcoal or kerosene stove and no refrigerator cannot follow a plan that needs many dishes cooked fresh and stored cold.
• Time and ability to prepare food: a client who works long hours, or an elderly client who lives alone and cannot lift heavy pots, needs meals that take little time and effort.
• Water and sanitation: a household without safe water cannot safely prepare uncooked foods or infant feeds, and this limits the foods that can be recommended.

Example: a client recovering from tuberculosis sells vegetables at a roadside stall and returns home late. A plan that asks for a fresh fish stew cooked every evening fails, but a plan that uses a pot of lentils or beans cooked on the weekend and reheated, served with vegetables and a piece of fruit, can be followed.

2.1.1.3 Social determinants

Social determinants are the beliefs, customs and relationships that shape how and what a client eats.

• Culture and tradition: each community has staple foods, special dishes and ways of preparing them, and a plan built on the foods the client already knows is accepted more readily than one that replaces them.
• Religion: observant Muslim clients avoid pork and alcohol, and many Christian and Muslim clients fast on set days or seasons, so the plan sets meal times and portions for the fasting period and does not ignore it.
• Food beliefs and taboos: a client may avoid a food because of a belief about its effect on health or on a pregnancy, and the dietitian listens, corrects wrong beliefs gently and respects those that do no harm.
• Family and household eating patterns: where the household shares one pot and the head of the household is served first, the plan must be something the family can share, and a client who eats last may need help to receive an adequate portion.
• Education and food knowledge: a client who has little education in nutrition may need simple spoken or pictorial advice, while a client who reads food labels can be given more detail.
• Work, school and social life: meals taken away from home, at work or at social events, shape what the client can control, so the goal includes advice for those occasions.
• Social support: a client who has a supportive family or a community health promoter follows a plan better than one who feels isolated.

2.1.2 Quality and quantity control in meal planning

Quality control makes sure the foods and methods in a plan give the nutrients the goal requires in a safe and acceptable form. Quantity control makes sure the amounts served match the client's targets. Both are checked on paper before the meals are produced and again when the client's progress is reviewed.

Quality control

Quality in meal planning has three parts.

• Nutrient density: choose foods that carry a lot of nutrients for their energy, for example beans, eggs, fish, vegetables and whole grains in place of sweet and fried snacks with little else.
• Freshness, safety and preparation: use fresh, undamaged, properly stored ingredients, and choose cooking methods that keep nutrients, such as steaming or lightly boiling vegetables in a small amount of water and using the cooking water in a soup or stew.
• Sensory appeal: taste, texture, colour and appearance decide whether the client eats the meal, and a nutritious meal that is left on the plate gives no benefit.

Example: for a client with a pressure sore that is slow to heal and who needs more protein, a lunch of beans and egg with vegetables is of higher quality than a plate of plain ugali and tea, even if both cost about the same.

Quantity control

Quantity control means stating how much of each food the client is to eat and then checking that the amount served is the amount planned.

1. Calculate the client's daily energy and protein targets from the assessment results.
2. Divide the targets between meals and snacks.
3. Convert each food into a portion the client can see: a level serving spoon, a ladle, a cup, a palm-sized piece or a number of items, so the plan can be followed at home without scales.
4. In a kitchen that serves many clients, weigh or measure the portion with a scale or a standard scoop, and give every client of the same diet the same size.
5. Compare the energy and protein supplied by the planned portions with the targets, adding up from the nutrient content of each food.
6. Adjust the portions until the plan meets the targets, and record the final amounts.

Worked example: a planned snack supplies 20 g of carbohydrate, 5 g of protein and 8 g of fat. Using the energy values for macronutrients (4 kcal per gram of carbohydrate and protein, 9 kcal per gram of fat):

Carbohydrate: 20 × 4 = 80 kcal

Protein: 5 × 4 = 20 kcal

Fat: 8 × 9 = 72 kcal

Total energy = 80 + 20 + 72 = 172 kcal

If the snack is meant to supply 200 kcal, the dietitian increases the portion slightly or adds a small food item, then checks the total again.

Evaluation through client feedback and follow-up

Quality and quantity are confirmed by the client's response, not by the plan alone. At each follow-up visit the dietitian asks whether the client felt hungry or full, whether the foods were available and acceptable, and whether weight, appetite and symptoms changed in the expected direction. A client who reports persistent hunger or unplanned weight loss needs the portions and the nutrient content re-checked, and a client who cannot finish a portion needs a smaller, more nutrient-dense one. Findings are recorded and the plan is adjusted.

Chapter Summary

This chapter examined the process of preparing a client’s diet plan by first focusing on the development of dietary goals tailored to individual needs. It highlighted the importance of considering various factors in meal planning, including biological determinants such as age and health status, economic and physical determinants like income and food availability, and social determinants encompassing cultural preferences and lifestyle. The chapter emphasized the need for quality and quantity control during meal planning assessments to ensure nutritional adequacy. It then detailed the fundamental principles of diet planning, including adequacy, balance, calorie control, density, moderation, and variety, which collectively guide the creation of effective dietary regimens. Tools such as the food guide pyramid and reference standards mask were introduced as practical aids to support accurate and balanced diet formulation. Finally, the chapter concluded with the steps involved in developing a comprehensive client diet plan that aligns with the established goals and principles to promote optimal health outcomes.