INTERNSHIP REPORT

KHADIJA NASEER
2017-GCUF-059603

A REPORT SUBMITTED IN THE PARTIAL

FULFILLMENTOFTHEREQUIREMENT FOR
THE COURSE (INTERNSHIP AND REPORT WRITING HND-632)

BS HUMAN NUTRITION AND DIETETICS

KINGS COLLEGE OF HEALTH SCIENCES, SAHIWAL

AFFILIATED WITH
GOVERNMENT COLLEGE UNIVERSITY FAISALABAD
2021
IN THE NAME OF ALLAH, THE MOST BENEFICIENT, THE MOST
MURCIFUL
To,

The External Examiner,

Government college University,
Faisalabad

We the Supervisory Committee certify that the contents and form of the report, submitted by
Khadija Naseer, Regd. No. GCUF-2017-059603 have been found satisfactory and recommend
that it be processed for the evaluation by the External Examiner.

Dr. Mishal Murtaza Bajwa ____________________

Clinical Nutritonist and Dietitian Supervisor
Combined Military Hospital Okara

Dr. Shakila Anwar ____________________

Head of Department of Human Nutrition Internal Supervisor
Kings College of Health Sciences

Dr. Sonia Aziz

____________________
Director Academics Member
Kings College of Health Sciences Sahiwal

Dr. Javed Iqbal

Chairman ____________________
Kings College of Health Sciences Sahiwal Member
 Declaration

I, Khadija Naseer, hereby declare that presented report of internship is uniquely prepared by

me, after the completion of 3 months. It is further declared that I have developed this

accompanied report entirely on the basis of my personal efforts made under the sincere guidance

of my internship supervisors “Dr Mishal Murtaza Bajwa”. No portion of the work presented in

this report has been submitted in the support of any other degree or qualification of this or any

other University or Institute of learning, if found I will stand responsible.

Signature ____________________ Signature __________________

Dr Mishal Murtaza Bajwa Khadija Naseer

 Dedication

Every challenging work needs efforts as well as

Guidance of elders especially those who

Close to my heart

My humble efforts and dedication to my beloved

“Father and Mother”

Whose affection, love, encouragement and prays of day

and night to make me enable to get such success and

Honor

My siblings, who proved to be a backbone,

Along with all hard working and respected

Teachers and My friends, who encouraged and supported

me to do well.
 Acknowledgement

I would like to pay all our praises and humblest thanks to most Gracious, Merciful and Almighty
ALLAH who bestowed us with potential and ability to make everything possible for the
completion of our research project. I offer my humblest thanks from the core of my heart to the
Holy Prophet Hazrat Muhammad (P.B.U.H) who is forever a torch of guidance and
knowledge for humanity as a whole.
I would like to convey my gratitude to Dr. JAVED IQBAL at Kings College of Health
Sciences for his encouraging attitude, inspiring perspective and enlightened supervision
throughout the course of study. The door to DR. JAVED IQBAL office was always open for my
help, guidance, and advises from his vast exposure and sense of understanding whenever I ran
into a trouble spot or had a question about my study and internship.
It is my radiant sentiment to place on record my best regards, deepest sense of gratitude to Dr.
Sonia Aziz, Director of Academics, for her careful and precious guidance which were
extremely valuable for my study.
I am very grateful to Dr. Shakila Anwar Lecturer, Department Head of Human Nutrition in
Kings College of Health Sciences Sahiwal, for her exceptional guidance, creative
suggestions and assistance in selecting and adopting right place according to my interest.
I would also like to pay thanks to Mr. Ali Raza who taught and guided about the me to develop
a understanding for Human Nutrition and Dietetics both theoretically and practically.
I would like to express my profound gratitude to respected “Dietitian” and Internship
Coordinator for continous guidance and support throughout the internship. I am thankful of Dr.
Mishal Murtaza Bajwa (Clinical Nutritionist and Dietitian CMH Okara) and her valuable time
in completing my internship in given time frame.

Thank You
Khadija Naseer
2017-GCUF-059603
[email protected]
 Organization Introduction

Okara Cantt was established during the year 1967 in the district of Okara which is the district of
Punjab situated on the South-west to the city of Lahore. It is situated in the middle of Lahore and
Multan and is connected to both cities by National Highway and Railway Tracks. It is
approximately 25km from Division Sahiwal. Group of Military Dairy Farm/Factory is also part
of Okara. The total Area of Okara Cantonment is approximately 15010 Acres which includes an
area of 191 Acres as Defence Land and a Bazar Area of 162.96 Acres. Okara Cantonment is a
Class-II having total population of 0.067 million as per latest census. Okara Cantonment now
covers an area of 15010 Acres.

The Commanding Officer of Combined Military Hospital Okara is Brigadier Aftab.

There are 2000 beds, 16 wards, 19 ventilators, 82 doctors of which 42 are Military Entitled and
40 are Civilian inducted. 74 Armed Forces Nursing Staff and 9 Departments.
 Medicine

Radiology Pathology

Psychiatric Dermatolgy
CMH
OKARA

Dental ENT

Rehablitati
Surgery
on

Departments of CMH Okara

 Table of Contents

Sr. No. Content Page No.

1. Introduction to Nutrition
1.1 Nutritionist and Dietitian
1.2 Introduction (Internship Program)
1.3 Aims and Objectives of Internship
1.4 Advantages of Internship

2. Nutritional Assessment
2.1 Purpose
2.2 Method
2.3 Anthropometric Measurements
2.4 Biochemical/laboratory methods
2.5 Clinical Assessment/Nutrient Deficiency
2.6 Dietary History
2.7 Basic conversions
3. Calories in food groups

4. Glycemic Index of Food

5. Potassium Rich Foods

6. Macronutrients and Micronutrients

7. Weight and Height Measurement of Bed

Ridden Patients
8. Dealing with Patients

9. Nutritional Management of Obesity

9.1. Definition
9.2. Causes
9.3. Risk Factors
9.4. Types of Obesity
9.5. MNT of Obesity
9.6. Nutritional Assessment Form
9.7. Diet Plan

10. Nutritional Management of Hypertension

10.1. Definition
10.2. Classification
10.3. Risk Factors
10.4. Epidemiology
10.5. MNT of Hypertension
10.6. Diet Plan

11. Nutritional Management of Diabetes

11.1. Definition
11.2. Types Of Diabetes
11.3. Risk Factors
11.4. Signs and Symptoms
11.5. MNT of Diabetes
11.6. Nutritional Assessment Form
11.7. Diet Plan

12. Nutritional Management of Asthma

12.1. Definition
12.2. Symptoms
12.3. Types
12.4. Etiology
12.5 MNT of Asthma
12.6. Nutritional Assessment Form
12.7. Diet Plan
13. Nutritional Management of Iron Deficiency
13.1 Anemia
`3.2 Definition
13.3 Symptoms
13.4 Etiology
13.5 Epidimiology
13.6 Stages of Anemia
13.7 Clinical Findings
13.8 MNT of Anemia
13.9 Nutritional Assessment Form
14. General Activity

13. References
 Wards Rotation and Duty List

Sr.No. Date Day Wards

1. 12-07-2021 Monday Male Medical

2. 14-07-2021 Wednesday Male Medical

3. 16-07-2021 Friday Family Surgical

4. 26-07-2021 Monday Family Surgical

5. 28-07-2021 Wednesday Male Surgical

6. 30-07-2021 Friday Male Surgical

7. 02-08-2021 Monday Male Medical

 Due to Covid-19 situation,the patient count was less than the normal ratio.
So, we visit the hospital on consecutive days. We started wards rotation on
12th August,2021.

1. Introduction To Nutrition
Definition:

“The science that studies the interactions between living organisms and food”.

Human Nutrition:

The study of nutrients and other substances found in foods; how the human body
uses nutrients for growth and maintenance; and the relationship between foods, food
components, dietary patterns, and health.

History of Nutrition and Dietetics:

 The first mention of nutrition in a real context: in 475 BC, the Greek philosopher
Anaxagoras claimed that the body absorbed food and provided it with homeomerics, that
is, generative components.

 In 400 BC Hippocrates stated clearly that, food was medicine and medicine was food.

 The etymology (study of origin of words) of the word diet, it comes from the Greek word
“diaita” and actually means way of life or manner of living.

Fast forward to 16th Century:

We have the master Leonardo da Vinci:

1. Studied the human anatomy

2. First to discover the effects of heavy food and cholesterol on the blood vessels.

 In 1747, a British Navy physician, Dr. James Lind, saw that sailors were developing
scurvy.

In the 1770s came Antoine Lavoisier:

 “The Father of Nutrition and Chemistry.”

 He discovered how the metabolism really worked.

Profession of dietetics was first defined in 1899 by the American Home Economics
Association as

“Individuals with knowledge of food who provide diet therapy for the medical profession.”

 After 1917, dieticians were affiliated with the American Dietetic Association (ADA).

 In early 1970s ;
 1. High levels of malnutrition in hospitalized patients.

2. Improved procedures for delivering enteral and parenteral nutrition.

3. Role of diet in the development of chronic disease.

Nutritionist:

“A nutritionist is a person who has certified degree in Nutrition from HEC recognized Institute.
They help other people to maintain and improve their health status and prevent dieases by
providing nutrition according to their requirement”

Dietitian:

“A dietitian is a person who has certified degree in Nutrition from HEC recognized
Institute.They help other people to recover from diseasesor provide dietin the treatment of
diseases according to diseased condition.”
 Examination to evaluate people’s nutritional health and needs.

 The dietician applies the science of nutrition to the feeding and education of groups of
people and individuals in health and disease.

 Most dieticians are registered and are referred to as RDs.

To become a Registered Dietitian:

 Undergraduate degree in nutrition, food science, or food management.

 Complete a 900-hour internship.
 Pass a national exam.
 Maintain up-to date knowledge and registration by participating in required continuing
education activities.

Clinical Dietitians:

“A dietitian working in the clinical set up”.

Roles of a clinical dietician:

To deliver nutrition therapy by using the nutrition care process (NCP) that is consists of four
major components:

 Nutrition assessment.
 Nutrition diagnosis.
 Nutrition intervention.
  Nutrition monitoring and evaluation.
 The provision of specialized care and modification of diets to treat various medical
conditions.
 To provide dietary consultations to patients and their families.
 Deliver outpatient or public education programs in health and nutrition.
 Provide specialized services in areas of nourishment and diets such as enteral nutrition
and parenteral nutrition (PPN).
 They work as a team with other health professionals to provide care to patients.

Community Dietitians:

 Work with wellness programs, public health agencies, home care agencies, and health

maintenance organizations.

 Apply and distribute knowledge about food and nutrition to individuals and groups of
specific categories, life-styles and geographic areas in order to promote health.

Food Service Dietitians:

 Responsible for large-scale food planning and service.

 They coordinate with food services team to provide healthy food services.

 They train and supervise other food service workers such as kitchen staff, delivery staff,
and dietary assistants.

Dietetic Technicians:

 Involved in planning, implementing and monitoring nutritional programs and services in

facilities such as hospitals, nursing homes and schools.

 Work with, and under the supervision of a registered dietitian.

Internship Program

Introduction:

Internship is a directed practical learning and experience outside of the academic studies
in which students sharp their skills to gain experience in academic way. A student came to know
how we can be a professional by working within the hospital or any other organization.

My internship program is in 8 th semester of B.S (Hons.) Human Nutrition and Dietetics. I have
started my internship on 1 June, 2021. My internship program was in Combined Military
Hospital, Okara under the supervision of “Dr. Mishal Murtaza Bajwa Clinical Dietitian at
CMH, Okara”. She guides me at every step during practice. I have gained enough knowledge
and confidence to work as a future dietician professionally.

1.3) Aims and Objectives of Internship:

 Teach the students techniques of counseling with patients and public.

 Boost up students’ personality and their personal grooming.
 Enhance the skill of students by transition from theory to practical.
 Sharpen the students for different professions such as food authority, Clinical Dietician,
administrative and academic dieticians.
 Make them confident to conduct nutritional camps at different places such as schools,
Hospitals and Hotels.
 Awareness to public regarding importance of nutrition.

1.4 Advantages of Internship:

 Acquisition of knowledge:

Internship allows participants to acquire the practical knowledge and abilities offered by the
professional world which they wish to form part of and the same time to improve their
curriculum vitae
  Possible financial assistance:

During practical, participants may receive some financial compensation from the entity
providing the internship as help towards their training.

 Professional experience:

Participants have the opportunity of applying the reality of work of the theoretical knowledge
acquired in the classroom, thus adding a new professional experience to their curriculum vitae.

 Possibility of entering the world of employment:

Participants have the opportunity to show the organization their professional potential
with a view to a future job offer.

2. Nutritional Assessment

Nutritional Status:

It is the condition of the body resulting from the utilization of essential nutrients available to the
body. It is graded as “good”, “fair” or “poor” depending upon:

 The intake of essential nutrients

 The relative need for them
 The body’s ability to utilize them
 Existences of disease status

Nutritional Assessment

Definition:
Assessment of nutritional status is the process thereby the state of nutritional health of an
individual or a group of individuals is determined. The conclusions reached through the
nutritional assessment become the basis for intervention programs in the community and for the
planning and implementation of nutritional care of individuals
It is an in-depth evaluation of both objective and subjective data related to an individual's food
and nutrient intake, lifestyle, and medical history.

Once the data on an individual is collected and organized, the practitioner can assess and
evaluate the nutritional status of that person.

2.1) Purpose of Nutritional Assessment:

 Identify individuals or population groups at risk of becoming malnourished.

 Identify individuals or population group who are malnourished.
 To develop health care programs that meet the community needs which are defined by
the assessment.
 To measure the effectiveness of the nutritional programs & intervention once initiated.

2.2) Methods of Nutritional Assessment

 Direct method
 Indirect method

A-Direct method

The direct methods deal with the individual and measure objective criteria, while indirect
methods use community health indices that reflect nutritional influences.These are summarized
as ABCD:

 Anthropometric method
 Biochemical, laboratory methods
 Clinical methods
 Dietary evaluation methods

B-Indirect Method

These include three categories:

 Ecological variables including crop production

 Economic factors e.g. per capita income, population density & social habits
 Vital health statistics particularly infant & under 5 mortality & fertility index
 Morbidity data
 Mortality data
 Assessment of dietary intake. it involve dietary surveys.
Direct Method
2.3. Anthropometric Methods
It deals with comparative study of measurements of the body. These measurements include
weight, height, body frame, skin fold thickness and measurements of Edema-free and Fat-free
body weight. It is an essential component of clinical examination of infants, children & pregnant
women. It is used to evaluate both under & over nutrition. The measured values reflects the
current nutritional status & don’t differentiate between acute & chronic changes.

a) Body weight
 Weight is reliable indicator for nutritional status of individual.
 A desirable weight is that weight which is normal for an individual for a given height and
body frame at the present age of an individual

b) Body Frame
Body frame is an important consideration for determining the weight range that is appropriate for a
given individual.

c) Height

 The height one attains is genetic characteristic which can be modified by the adequacy of
diet
 The bed ridden patients height can be measured by different method methods such as :
Demispan ,Ulna measurements and knee.

d) Demispan
 
 It is a measurement of a patient's size, being half the distance between their hands
outstretched to either side. It can be used to estimate their height in situations where it is
hard to measure someone's height directly, e.g. if they are unable to stand.
 It is measured from a point on the midline at their suprasternal notch to the base of their
middle and ring fingers along either horizontally outstretched arm and with their wrist in
neutral rotation and zero extension or flexion.
 Measurement of the demispan is an alternative to patient standing height when measuring
patient skeletal frame size for the purposes of nutritional or other growth assessment. It
can be undertaken while the patient remains seated and thus is especially useful if they
 are unable to stand. It is also a more accurate measure of skeletal frame size in the elderly
where standing height may be shortened by kyphosis or vertebral collapse.
 Demispan should be measured with a stainless steel (non-stretchable) tape.
 An estimate of patient height can be computed from their demispan measurement:

Female height in cm = (1.35 x demispan in cm) + 60.1

Male height in cm = (1.40 x demispan in cm) + 57.8
 Standing height is measured perfectly without shoes against fixed scale attaché to a wall.

Table: Standard weight for women and men in the relation to height
 e) Skin fold Measurements
 It is the measure for the fatness of the body
1) Skin fold Measurements is the best indicator of body percentage of fat.
2) For clinical use skin folds is measured with Varniar calipers applied at constant
pressure at selected body site
3) It is the only practice method for predicting body fatness
 Which part of the body to measure
1) The triceps, biceps, sub-scapular, abdominal, suprailiac, hip, pectoral, calf, areas
are those from where body
fatness is measured
2) Measurements that involve more
than one skin fold area are more
reliable then measurements from
single area
3) The triceps measurement is most
widely used. The calipers are
applied on the outer skin fold of
the back upper arm, midpoint
between the shoulder tip and elbow.
f) Body Mass Index (BMI)
 Body mass index (BMI) is a simple index of weight-for-height
 It is the indicator of health problems and obesity as it highly co-relates with weight.
(Health Classification of body mass index is given in Table 1.3)
 In adults, it can be computed by the following equation;
Standard formula for Body Mass Index (BMI) = Weight (kg)
Height (m) 2
Table: The International Classification of adult underweight, overweight and
obesity according to BMI
Classification BMI(kg/m2)
Principal cut-off Additional cut-off
points points
Underweight <18.50 <18.50
     Severe thinness <16.00 <16.00
      Moderate thinness 16.00 - 16.99 16.00 - 16.99
     Mild thinness 17.00 - 18.49 17.00 - 18.49
18.50 - 22.99
Normal range 18.50 - 24.99
23.00 - 24.99
Overweight ≥25.00 ≥25.00
25.00 - 27.49
Pre-obese 25.00 - 29.99
27.50 - 29.99
Obese ≥30.00 ≥30.00
30.00 - 32.49
Obese class I 30.00 - 34.99
32.50 - 34.99
35.00 - 37.49
Obese class II 35.00 - 39.99
37.50 - 39.99
Obese class III ≥40.00 ≥40.00
Source: Adapted from WHO, 1995, WHO, 2000 and WHO 2004.

g) Circumferences
Head and chest circumference
A baby's brain and head do 80 percent of their growing during the first two years.
Measuring head circumference helps doctors track the brain's growth as the skull bones
fuse together. It's normal for a baby's head size to seem disproportionate to her height and
weight. The usual explanation is genetics: If a baby's parents have big heads, the baby
will probably have one too. Remember that the size of your child's head relative to the
rest of her body (especially at such a young age) is less important than a consistent
pattern of growth (not too fast or too slow).

Relationship between head size with Chest Circumference

 At Birth : Head Circumference > chest Circumference by up to 3cm
 At around 9 months to 1 year of age : Head Circumference = chest Circumference
 But thereafter chest grows rapidly as compared to brain.

h) Mid Upper Arm Circumference

 If neither height nor weight can be measured or obtained, BMI can be estimated using the
mid upper arm circumference (MUAC)
 Measuring mid upper arm circumference (MUAC) The subject should be traditionally be
standing or sitting. Use left arm if possible and ask subject to remove clothing Locate the
top of the shoulder (acromion) and the Point of the elbow (olecranon process) Measure
the distance between the 2 points, identify the mid-point and mark on the arm. Ask
subject to let arm hang loose and with tape measure, measure circumference of arm at the
midpoint. Do not pull the tape measure tight, it should just fit comfortably round the arm.

 If MUAC is less than 23.5 cm, BMI is likely to be less than 20 kg/m2 I.e. subject is
likely to be underweight. If MUAC is more than 32.0 cm, BMI is likely to be more
than 30 kg/m2 i.e. subject is likely to be obese.

 Weight change over time MUAC canalso be used to estimate weight change over a
period of time and can be useful in subjects in long term care. MUAC needs to be
measured repeatedly over a period of time, preferably taking 2 measurements on each
occasion and using the average of the 2 figures.

 If MUAC changes by at least 10% then it is likely that weight and BMI have
changed by approximately 10% or more.

i) Waist circumference
Waist circumference predicts mortality better than any other anthropometric
measurement. It has been proposed that waist measurement alone can be used to assess
obesity, and two levels of risk have been identified in Table 2.2.3

MALES FEMALE
LEVEL 1 > 94cm > 80cm

LEVEL 2 > 102cm > 88cm

 Level 1 is the maximum acceptable waist circumference irrespective of the adult age and
there should be no further weight gain.
 Level 2 denotes obesity and requires weight management to reduce the risk of type 2
diabetes & CVS complications.

j) Hip Circumference

 It is measured at the point of greatest circumference around hips & buttocks to the nearest
0.5 cm. The subject should be standing and the measurer should squat beside him

 Both measurements should be taken with a flexible, non-stretchable tape in close contact
with the skin, but without indenting the soft tissue.

k) Waist/Hip Ratio

 Waist circumference is measured at the level of the umbilicus to the nearest 0.5 cm.
 The subject stands erect with relaxed abdominal muscles, arms at the side, and feet
together.
 The measurement should be taken at the end of a normal expiration.
 High risk WHR= >0.80 for females &>0.95 for males i.e. waist measurement >80%
of hip measurement for women and >95% for men indicates central (upper body)
obesity and is considered high risk for diabetes & CVS disorders.
 A WHR below these cut-off levels is considered low risk.
l) Basal Energy Expenditure (BEE)

Calorie needs are determined by the height, weight, and age of an individual, which
determine an estimate of daily needs. It is also called Harris-Benedict Formula.
Thisformula was created in 1919, and due to changing lifestyles, it tends to overstate
calorie needs by 5%. The results tend to be skewed towards both obese and young
people.
Male = {66 + [(13.75 x weight in kg) + (5 x height (cm)] – (6.8 x age (year)}

Female = {655 + [(9.6 x weight in kg) + (1.7 x height (cm)] – (4.7 x age (year)}

m) Ideal Body Weight (IBW)

A patient's ideal body weight (as described by Devine 1974) may be calculated according
to the following equation:
 Ideal Body Weight (IBW) and Adjustments for Adults
Ideal body weight (IBW) :

Men: IBW=106 pounds (lb) for first 5′ + 6 lb for each inch over 5′
Women: IBW=100 lb for first 5′ + 5 lb for each inch over 5′
For the individual under 5′, subtract 2 lb for each inch under 5′

 Frame size adjustment 

Add or subtract 10% IBW: 

Large frame: IBW+(IBW´0.10) 

Small frame: IBW-(IBW´0.10)

 Obesity adjustment 

Adjusted ideal body weight (AIBW) is calculated as follows: 

Men: IBW=[(actual weight–IBW)0.38]+IBW 

Women: IBW=[(actual weight–IBW)´0.32]+IBW
2.4) Biochemical Tests
 The Biochemical (Laboratory) Test indicates a number of laboratory
investigations. It is useful in detecting early changes in body metabolism &
nutrition before the appearance of overt clinical signs.
 It is also useful to validate data obtained from dietary methods e.g. comparing salt
intake with 24-hour urinary excretion.
 It is precise, accurate and reproducible.
 The values observed in these investigations are compared with the references
ranges to find out the condition and quality of health person. These investigations
with references values are listed in given Table:

Laboratory Test Normal Ranges

Serum Albumin (depends on 3.3 – 5.0 g/dl

method of analysis) Senior: 3.2 – 4.4
Newborn: 2.9 – 5.5
To age 3: 3.8 – 5.4
3 – adult: 3.3 – 5.5
Alkaline phosphatase 19 – 74 IU/L
Newborn: 50 – 275
Infant: 100 – 330
Child: 90 – 230
Adult: 100 – 250
Blood Urea Nitrogen (BUN) 4 – 22 mg/dl
Senior: 8 – 18
Peds: 10 – 20
Newborn/infant: 8 – 28

Serum calcium 8.5 – 10.5 mg/dl

Chloride 100 – 106 mEq/L

Cholesterol 150 – 200 mg/dl

Children <200
Total CO2 23 – 30 mEq/L
Creatinine 0.7 – 1.5 mg/dl
Senior: 0.6 – 1.2
Newborn: 0.4 – 1.2
0 – 4 yr: 0.1 – 0.7
4 – 10 yr: 0.2 – 0.9
10 – 16 yr: 0.3 – 1.1
Ferritin 12 – 300 µg/L
<6 months: 25 – 200
6 months – 15 yr: 7 – 140
Globulin 2.3 – 3.5 g/dl

Glucose fasting levels 70 – 100 mg/dl

<50 yr: 60 – 100
Senior: 55 – 125
Premature: 20 – 60
Newborn: 20 – 110
Child: 60 – 100
Hematocrit 39 – 51%
36 – 15%
Senior: 30 – 54%
Newborn: 40 – 70%
Infant: 30 – 49%
Child: 30 – 42%
Adolescent: 34 – 44%
Hemoglobin 12 – 17 g/dl
Senior: 10 – 17
Newborn: 14 – 24
Infant: 10 – 15
Child: 11 – 16
Iron 60 – 175 µg/dl
Newborn: 100 – 200
4 months – 2 yr: 40 – 100
Child: 85 – 150
Lymphocytes count (total % 15,00 – 4,000 mm3 (closely
lymphocytes x WBC ) involved with immune system)
Magnesium 1.4 – 2.3 mEq/L

Phosphorus 2.5 – 4.7 md/dl

Senior: 2.3 – 3.7
Newborn: 4 – 9
Infant: 4.6 – 6.7
Child: 4.0 – 6.0
Potassium 3.5 – 5.0 mEq/L
Protein, total 6 – 8.4 g/dl

Reticulocyte count 25,00 – 75,000 cells

RBC count (multiply automatic 4.4 – 5.7

counter values x 1 million for 4.0 – 5.3
total 1= ) Senior: 3.0 – 5.0
(x 10/mm3)
(mil/mm3)

Sodium 136 – 145 mEq/L

Transthyretin (pre-albumin or 10 – 40 mg/dl

thyroxin-binding pre-albumin)
TIBC estimated transferring= 250 – 450 µg/dl
(0.8 x TIBC) – 43
Transferring saturation 20 – 50%
 Triglycerides 40 – 150 mg/dl

Uric acid 4.0 – 8.5 mg/dl

2.7 – 7.3
Senior: 2.9 – 8.8
2.4 – 7.2

WBC count .5 – 10.6

thousand/mm3

2.5) Clinical Examination

 It is the simplest & most practical method of ascertaining the nutritional status of a group
of individuals
 It utilizes a number of physical signs, (specific & non-specific), that are known to be
associated with malnutrition and deficiency of vitamins & micronutrients.
 Detection of relevant signs helps in establishing the nutritional diagnosis.

NUTRIENT DEFICIENCY

Area of Signs and symptoms Nutrient deficiency Pictures

examination
General Loss of appetite Iron and vitamin D,
Signs and vitamin B12
Symptoms
Pica Iron and Zinc

Loss of taste Thamin , vitamin B12,

Zinc, Folic acid

Cold tolerance Vitamin B complex

especially B6, thyroid
problem
Growth Failure to increase in Zinc and protein
failure stature

Excessive curvature Zinc and protein

of spine

Behavior Listless and apathy Vitamin B complex

Inability to Vitamin B complex, Folic

concentrate acid

Insomnia Vitamin D, vitamin B12,

Iron

Poor work capable Iron

Skin Dry skin Vitamin C

Flaky skin Folic acid, vitamin B

complex and essential
fatty acid

Rough skin Vitamin C

Bedsores Protein, vitamin C, Zinc

Excessive bruising Vitamin K, Iron and

vitamin C

Keratinization Vitamin A

Hemorrhagic spot zinc

 Symmetrical Vitamin B3 (niacin)
dermatitis

Itchy skin- pruritus Vitamin A

Carotenoderma Protein-energy and zinc

Sparse hair Vitamin D and iron

Lusterless hair Biotin and vitamin B7

Change in pigment Protein and vitamin C

Dandruff, scalp hair iron

loss

Face Pale face Vitamin B12

Scaling around the Vitamin B2 –riboflavin,

nose vitamin B6 and zinc

Swollen face Vitamin A,

Eyes Pale, dry and scaly at Vitamin B6 and B12

corners

Sensitivity to light lutein, zeaxathin

and vitamin A 

Increased vascularity Vitamin B complex

Bitot’s spots Malnutrition and vitamin

A deficiency
 Exophthalmia Vitamin A and Vitamin
B2

Conjunctival dryness Itamin A and D

Lips Fissuring at corners Vitamin B2

Swollen, puffy lips Vitamin B 3

Cracking and peeling Iron, zinc and

of skin on lips B vitamins like niacin
(B3), riboflavin (B2),
and B12
Tongue Pale  iron and B-
vitamins like folic
acid, vitamin B12
or vitaminB3
Swollen Iron, vitamin B6 and B12

Raw, scarlet red Vitamin B12

Magenta red Vitamin B2 (riboflavin)

Atrophy of papillae Vitamin B1 and B2

Smooth, shiny and Iron, vitamin B12 abd

sore folic acid

Enlarged veins under Vitamin B12

the tongue

Micro-hemorrhages Vitamin B9 and B12

Mouth Cracking at the Iron, vitamin B2 –

corners of mouth riboflavin possibly
other B vitamins
 Recurrent mouth Iron, vitamin B12,
ulcer folate and possibly
other B vitamins 
Atrophic glossitis Vitamin B12

Teeth Mottled enamel Vitamin A,C and D

Caries Vitamin D and minerals

Gums Spongy, swollen, Vitamin C

bleeding

Nails Brittle Vitamin B complex

Spoon shaped iron

Ridged Iron

Pale nails bed Vitamin C, B12 and folic

acid

Gastrointesti Diarrhea Vitamin B3

nal
Constipation Dehydration, fibre,
potassium, magnesium
and folate
Muscles Wasted Vitamin D

Sore, painful Vitamin D

 Loss of limb Vitamin D
musculature

Muscles cramp Magnesium,

potassium, sodium,
vitamin B1 and vitamin
D if there is
hypocalcaemia
Calf muscle pains Vitamin B1 –
after minimal thiamine      
exercise

Excessive calf muscle Vitamin B1- thiamine

tenderness

Walking with a Vitamin D and

waddling gait resultant
myopathy                      
      

Bowed legs Vitamin D - rickets in

childhood

Chvostek’s sign Calcium and vitamin D

if hypocalcaemia or
severe magnesium
deficiency      

Skeletal Poor posture Vitamin D

Delayed closing of Vitamin D

fontanelles (infant),

Knock knees Vitamin D, Calcium and

vitamin C

Bowed legs Vitamin D - rickets in

childhood
 Bending of ribs Calcium and vitamin D

Enlarged joints Vitamin D and C

Fleeting joint pain Calcium, vitamin C and D

2.6) Dietary Assessment

Nutritional intake of humans is assessed by five different methods. These are:

 24 hours dietary recall

 Food frequency questionnaire
 Dietary history since early life
 Food dairy technique
 Observed food consumption

24 Hours Dietary Recall

 A trained interviewer asks the subject to recall all food & drink taken in the previous 24
hours. It is quick, easy, & depends on short-term memory, but may not be truly
representative of the person’s usual intake
Food Frequency Questionnaire

 In this method the subject is given a list of around 100 food items to indicate his or her
intake (frequency & quantity) per day, per week & per month
 It is an accurate method for assessing the nutritional status.
 The information should be collected by a trained interviewer.
 Details about usual intake, types, amount, frequency & timing needs to be obtained.
 Cross-checking to verify data is important.

Food dairy:
  Food intake (types & amounts) should be recorded by the subject at the time of
consumption.
 The length of the collection period range between 1-7 days.
 It is reliable but difficult to maintain.

Observed Food Consumption:

 The most unused method in clinical practice, but it is recommended for research
purposes.
 The meal eaten by the individual is weighed and contents are exactly calculated.
 The method is characterized by having a high degree of accuracy but expensive & needs
time & efforts.
2.7) Basic Calculations

Ideal Body Weight (IBW) Ranges:

From 4feet to 6Feet and 2 inches

For Male:

106lb (for first 5 feet) + 6lb (for additional inches)

Sr. No Height Weight in kg

1. 4 42
2. 4.1 43
3. 4.2 43
4. 4.3 44
5. 4.4 44
6. 4.5 45
7. 4.6 45
8. 4.7 46
9. 4.8 46
10. 4.9 46
11. 4.10 47
12. 4.11 47
13. 4.12 ~5 48
14. 5.1 50
15. 5.2 53
16. 5.3 56
17. 5.4 59
18. 5.5 61
19. 5.6 64
20. 5.7 67
 21. 5.8 70
22. 5.9 72
23. 5.10 75
24. 5.11 78
25. 5.12~6 80
26. 6.1 83
27. 6.2 86

For Female:

100lb (for first 5 feet) + 5lb (for additional inches)

Sr. No Height Weight in kg

28. 4 40
29. 4.1 40
30. 4.2 41
31. 4.3 41
32. 4.4 41
33. 4.5 42
34. 4.6 42
35. 4.7 43
36. 4.8 43
37. 4.9 44
38. 4.10 44
39. 4.11 45
40. 4.12 ~5 45
41. 5.1 47
42. 5.2 50
43. 5.3 52
44. 5.4 54
45. 5.5 56
46. 5.6 59
47. 5.7 61
48. 5.8 63
49. 5.9 65
50. 5.10 68
51. 5.11 70
52. 5.12~6 72
53. 6.1 75
 54. 6.2 77

Height Conversion
Height into inches into cm into meter and m2

Sr.No Height Inches Cm m m2

1. 4.5 53 134 1.34 1.81
2. 4.6 54 137 1.37 1.88
3. 4.7 55 139 1.39 1.91
4. 4.8 56 142 1.42 2.03
5. 4.9 57 144 1.44 2.096
6. 4.10 58 147 1.47 2.17
7. 4.11 59 149 1.49 2.24
8. 4.12~5 60 152 1.52 2.32
9. 5.1 61 154 1.54 2.40
10. 5.2 62 157 1.57 2.47
11. 5.3 63 160 1.6 2.56
12. 5.4 64 162 1.62 2.67
13. 5.5 65 165 1.65 2.72
14. 5.6 66 167 1.67 2.79
15. 5.7 67 170 1.70 2.89
16. 5.8 68 172 1.72 2.98
17. 5.9 69 175 1.75 3.07
18. 5.10 70 177 1.77 3.16
19. 5.11 71 180 1.80 3.25
20. 5.12~6 72 182 1.82 3.34
21. 6.1 73 185 1.85 3.41
22. 6.2 74 187 1.87 3.53
23. 6.3 75 190 1.90 3.62

3.Calories In Food Groups

Food guide pyramid:

The introduction of the USDA's food guide pyramid in 1992 attempted to express

the recommended servings for six food groups.
 .

There are 6 food groups in food guide pyramid with their servings:

1. Bread , Cereal and Pasta Group(6_11 servings)

2. Vegetable Group (3_5 servings)
3. FRUIT Group (2_4 servings)
4. Meat, Poultry, Fish, Dry Beans, Egg and Nuts Group(2_3 serving)
5. Milk , Yogurt and Cheese Group(2_3 servings)
6. Fat, Oil and Sweets Group(sparingly use)

BREAD, CEREALS, RICE AND PASTA GROUP:

FOOD ITEMS(100G) CALORIES

Barley whole Grain 339
Corn Whole Grain Flour 276
Corn Flakes 375
Wheat Flour 440
Wheat Bread 263
Wheat Flour Granular(suji) 370
Wheat Flour Refined 350
Wheat Whole Grain Flour 357
 Vermicelli 345
Rice Flakes 346
Rice Polished Fried 268
Rice Polished Boiled 163
Bajra 345
Oat Whole Grain Flour 345
Rice Polished 360
Corn Bread 203
Rye Whole Grain Flour 334

LEGUMES:

Sunflower Seed 236

Soybean Seed 411
Pea Garden Cooked 84
Pea Garden Raw 336
Pigeon Pea Cooked 135
Pigeon Pea Raw 345
Mash cooked 158
Mash Bean Raw 363
Mung Bean Cooked 120
Mung Bean Raw 337
Lentil Cooked 178
Lentil Raw 348
Kidney Bean Cooked 154
Kidney Bean Raw 339
Chick Pea Cooked 360

VEGETABLES:

Bath Sponge 18
Bottle Gourd 15
Bitter Groud 19
Bringal 26
Cauliflower 27
Cabbage 23
Cucumber 16
Lady Finger 35
Lettuce 18
Mountain Ebony 56
Mustard Leave 55
Moongra 25
Mint Leave 38
 Pepper Sweet 25
Spinach 27
Kulfa 23

FRUITS:

Apple 57
Appricot 53
Banana Ripe 96
Black Berry 64
Oates Dried 293
Guava 71
Dates 131
Jaman 82
Lemon 30
Lichi 62
Loqat 45
Peach 47
Pear 58
Plum 51
Fig Fresh 76
Grapes 74

DAIRY PRODUCTS:

Butter Milk 31
Curd 52
Cheese 35
Cream 361
Mlik Buffalo whole 105
Yogurt 71
Ice cream 148

MEAT, FISH AND EGG:

Beef 244
Chicken Meat 226
Duck Meat 326
Sheep Meat 175
Fish RAO 1O1
Fish KHAGA 104
Lobster 91
Prawn 96
 Egg Yolk 350
Egg White 50
Chicken Egg Whole Raw 155
Chicken Egg Boiled 163
Duck Egg Yolk 365
Duck Egg Raw 183
Duck Egg Boiled 193

FATS, OILS AND SWEETS:

Butter 721
Ghee 874
Dalda 892
Soybean Oil 887
Sunflower Oil 900
Coconut Oil 884
Sugar white 390
Sugar Brown 371
Honey 310
Burfi 384
Lemon Juice 43
Mango Juice 74
Coffee 134
Gurr 310
Groundnut Oil 882
Olive Oil 900

5.Glycemic Index of Food

 Definition:

GI concept was originally developed to help diabetics control their blood sugar levels,
it can benefit regular exercisers and athletes too. It is a ranking of foods from 0 to 100 based on
their immediate effect on blood sugar levels, a measure of the speed at which you digest food
and convert it into glucose. The faster the rise in blood glucose the higher the rating on the index.
 In 1997 the World Health Organization (WHO) and Food and Agriculture Organization (FOA)
of the United Nations endorsed the use of the GI for classifying foods, and recommended that GI
values should be used to guide people’s food choices.

The Glycemic Index Foundation classify the GI of food as follows:

 70 or greater: High GI

 56-69: Medium GI

 55 or less: Low GI

 High Glycemic Index Food:

Foods with a high glycemic index (GI) raise blood sugar quickly and may cause health issues if
someone eats too many of them. A person may also manage their weight with a low GI diet as
part of an overall healthful eating approach.

 Low Glycemic Index Food:

A low glycemic diet uses the glycemic index to determine which foods are less likely to impact

blood sugar levels significantly. Choosing low glycemic foods may help to improve blood sugar

regulation and may be beneficial for weight loss.

A 2015 international scientific consensus agreed that healthful low glycemic diets could prevent
and manage:

 Diabetes

 Coronary artery disease

 Obesity

The experts suggested low glycemic diets are also important in insulin resistance and possibly
some cancers.
  A 2019 review Trusted Source notes that low GI diets can reduce long-term markers of
blood sugar control, body weight, and fasting blood sugar levels in people
with prediabetes or diabetes.
 A low GI diet may also help with gestational diabetes. This is a condition where someone
develops high blood sugar while pregnant, which usually resolves after they give birth.

A 2014 study Trusted Source suggests that in addition to controlling glucose and insulin
metabolism, a low GI and energy-restricted diet may also help to reduce body weight.

GIycemic Index Food List

 6.Potassium Rich Foods
Potassium:
Potassium is a mineral in our cells that helps our nerves and muscles work right. The right
balance of potassium also keeps our heart beating at a steady rate.
A potassium level that is too high or too low can be dangerous.
Ranges of Potassium in Foods:
 Low-potassium foods: Less than 100 mg
 Medium-potassium foods: 101–200 mg
 High-potassium foods: 201–300 mg
 Very-high potassium foods: Over 300 mg
List of Low Potassium Foods:
FOODS SERVING SIZE Potassium (mg)
Apple sauce ½ cup 90
Green Beans ½ cup 90
Blueberries ½ cup 60
Butter 1 Tsp Less than 5
Cheese 1 oz 20-30
Cucumber, peeled ,raw ½ cup 80
Grapes 9 Grapes 90
Lemon juice 1 50
Macaroni ½ cup 60
Olives 5 large Less than 5
Popcorns 1 cup 20-25

Pineapple ½ cup 100

Radish 1 10
Rice(white,brown) ½ cup 50
Salt 1 tsp 0
Soup (noodle) 1 cup
55
Spaghetti ½ cup 30
Sugar Powder 1tsp 0
Tea 1 cup 50
List of High Potassium Foods;
Foods Serving Size Potassium(mg)
Apricot 2 raw or 5 dry 200
Banana 1 425
Beans ½ cup 280
Beet ½ cup 260
Broccoli ½ cup 230
Dates 5 270
Dried Beans and Peas ½ cup 300-475
Fish 3 oz 300
French fries 3 oz 470
Lentils ½ cup 365
Nuts 1 oz 200
Orange 1 240
Orange juice ½ cup 235
Baked Potato 1 925
Pumpkin canned ½ cup 250
Raisins seedless ¼ cup 250
Spinach ¼ cup 420
Sweet potato baked 1 450
Tomato fresh 1 290
Yogurt 6 oz 260

 Proteins
Protein Range: 2g/kg Bodyweight

List of Low Protein Food:

Foods Serving Size Milligrams Proteins

Apple 1cup 7 0.2
Grapes ½ cup 12 0.6
Raisins ¼ cup 24 1.2
Carrot,raw,chopped ½ cup 18 0.6
Chilli,green chopped 2Tsp 4 0.1
Corn cooked ¼ cup 63 1.4
Mushrooms sliced ½ cup 28 0.7
Potato raw chopped ½ cup 75 1.8
Butter 1 Tsp 6 0.1
Mayonnaise 1 Tsp 8 0.2
Egg,whole 1 300 5.6
Milk, 2% 1cup 392 8.0
Whipped cream 1 Tsp 5 0.1
Walnuts chopped 1Tsp 50 1.1
Orange Juice ½ cup 11 0.9

List of High Protein Foods:

 Food Serving size g/gm Protein(g)
Beans 1 100g 21
Corn 1 cup 250 15.6
Boroccli 1 cup 250 2.6
Cauliflower 1 cup chopped 2
Chicken 136 26
Oats 100 17
Milk 1 8 oz 8
Pistachio 6 oz 6
Chia seeds 1 pack 5
Beef steak 6 oz 48.7
Lentils 100 9
Low fat yogurt 100 5.7
Low fat milk powder 1 tsp 2.5g

Types of Protein:

There are following types of protein:

Animal Based Protein

 Beef
 Chicken
 Egg

Plant Based Protein:

 Pea
 Soy protein
 Brown Rice
 Chickpea

Milk Based Protein:

 Whey Proteins
 Casein Protein
 Lactoferrin
 Milk Glycoprotein

7.Macronutrients and Micronutrients

 Macronutrients

Definition:
Macronutrients are defined as the nutrients that is needed in large amount and has lots of
functions in our body. Three of these essential nutrients our bodies need are called
macronutrients. These macronutrients are also the energy producing nutrients. These three
macronutrients are:

 Carbohydrates
 Proteins
 Fat

Carbohydrates:
The compounds composed of carbon, oxygen and hydrogen arranged as monosaccharides or
multiples of monosaccharides. Most, but not all, carbohydrates have a ratio of one carbon
molecule to one water molecule: (CH2O)n.

• carbo = carbon (C)

• hydrate = with water (H2O)

The two carbohydrates—glucose and

its storage form glycogen—provide about half of all the energy muscles and other

body tissues use. The other half of the body’s energy comes mostly from fat. The dietary
carbohydrate family includes:

• Monosaccharides: single sugars

• Disaccharides: sugars composed of pairs of

Monosaccharides

Polysaccharides: large molecules composed of chains of monosaccharides

Monosaccharides and disaccharides (the sugars) are sometimes called simple carbohydrates,

and polysaccharides (starches and fibers) are sometimes called complex carbohydrates.

 Monosaccharides
The three monosaccharides most important in nutrition. All have the same numbers and kinds
of atoms—each contains 6 carbon atoms, 12 hydrogens, and 6 oxygens (written in shorthand as
C6H12O6

 Glucose

Commonly known as blood sugar, glucose serves as an essential energy source for all the
body’s activities. Its significance to nutrition is tremendous.

 Fructose
Fructose is the sweetest of the sugars. Curiously, fructose has exactly the same chemical
formula as glucose—C6H12O6—but its structure differs. The arrangement of the atoms in
fructose stimulates the taste buds on the tongue to produce the sweet sensation. Fructose occurs
naturally in fruits and honey.

 Galactose
The monosaccharide galactose occurs naturally in foods as a single sugar only in very small
amounts. Galactose has the same numbers and kinds of atoms as glucose and fructose in yet
another arrangement.

 Disaccharides

The disaccharides are pairs of the three monosaccharides just described. Glucose occurs in all
three; the second member of the pair is fructose, galactose, or another glucose. These
carbohydrates—and all the other energy nutrients

 Maltose
The disaccharide maltose consists of two glucose units. Maltose is produced whenever starch
breaks down—as happens in human beings during carbohydrate digestion. It also occurs during
the fermentation process that yields alcohol.

 Sucrose
To make table sugar, sucrose is refined from the juices of sugarcane and sugar beets, then
granulated.

 Lactose

The combination of galactose and glucose makes the disaccharide lactose, the principal
carbohydrate of milk. Known as milk sugar, Lactose contributes half of the energy (kcalories)
provided by fat-free milk
Dietary fibers:
 Dietary fibers: in plant foods, the non-starch polysaccharides that are not digested by
human digestive enzymes, although some are digested by GI tract bacteria.

 Soluble fibers(fermentable): non-starch polysaccharides that dissolve in water to form a

gel. An example is pectin from fruit, which is used to thicken jellies.

Commonly found in oats, barley, legumes, and citrus fruits, soluble fibers are most often
associated with protecting against heart disease and diabetes by lowering blood cholesterol and
glucose levels, respectively.

Recommended intakes of CHO

 45- 65 % calories of TEE/day

 Consume fiber rich foods and whole foods, avoid added sugars

 On average, each person in the United States consumes about 30 teaspoons (about 120
grams) of sugars a day.

Most athletes training for up to two hours daily require about 5–7 g/ kg body weight, but
during periods of heavy training requirements may increase to 7–10 g/ kg BW. For example,
for a 70 kg athlete who trains for 1–2 hours a day:
Carbohydrate need = 6–7 g /kg of body weight Daily carbohydrate need = Between (70 × 6) =
420g and (70 × 7) = 490g
i.e. Daily carbohydrate need = 420–490g

Activity level* g carbohydrate/kg body weight/day

3–5 hours/week 4–5 4–5
5–7 hours/week 5–6
1–2 hours/day 6–7
2–4 hours/day 7–8
More than 4 hours/day 8–10

Proteins:
Protein makes up part of the structure of every cell and tissue in your body, including your
muscle tissue, internal organs, tendons, skin, hair and nails. On average, it comprises about 20 %
of your total body weight. Protein is needed for the growth and formation of new tissue, for
tissue repair and for regulating many metabolic pathways, and can also be used as a fuel for
energy production. It is also needed to make almost all of the body enzymes as well as various
hormones (such as adrenaline and insulin). Protein has a role in maintaining optimal fluid
balance in tissues, transporting nutrients in and out of cells, carrying oxygen and regulating
blood clotting. The 20 amino acids are the building blocks of proteins. They can be combined in
various ways to form hundreds of different proteins in the body. When you eat protein, it is
broken down in your digestive tract into smaller molecular units – single amino acids and
dipeptides (two amino acids linked together).

RECOMMENDED DIETARY ALLOWANCE OF PROTEIN:

Adequate Macronutrient Distribution range of Protein is 10%_30%

For athletes its ranges are different.

Protein requirements of athletes

Type of athlete Daily protein requirements per kg

body
weight (g)
Endurance athlete 1.2–1.4
Strength and power athlete 1.4–1.8
Athlete on fat-loss programme 1.6–2.0
Athlete on weight-gain programme 1.8–2.0
Source: William & Devlin, 1992; Williams,
1998; Tarnopolsky et al., 1992; Lemon et al.,
1992

FATS:

Definition:
Fatty acids are aliphatic mono-carboxylic acids mostly obtained from the hydrolysis
of natural fats and oils. Fats and oils comprise one of the three major classes of foods,the others
being carbohydrates and proteins. Chemically they may be defined as Fats and oils found in food
consist mainly of triglycerides. These are made up of a unit of glycerol and three fatty acids.
Each fatty acid is a chain of carbon and hydrogen atoms with a carboxyl group (COOH) at one
end and a methyl group at the other end (–CH3) – chain lengths between 14 and 22 carbon atoms
are most common.

Saturated fats:

Saturated fatty acids are fully saturated with the maximum amount of hydrogen; in other words,
all of their carbon atoms are linked with a single bond to hydrogen atoms. Fats containing a high
proportion of saturates are hard at room temperature and mostly come from animal products such
as butter, lard, cheese and meat fat.

Monounsaturated fats:

Monounsaturated fatty acids have slightly less hydrogen because their carbon chains contain
one double or unsaturated bond (hence ‘mono’). Oils rich in monounsaturated are usually liquid
at room temperature, but may solidify at cold temperatures. The richest sources include olive,
rapeseed, groundnut, hazelnut and almond oil, avocados, olives, nuts and seeds.

ADEQUATE MACRONUTRIENT DISTRIBUTION RANGES OF FATS:

The AMDR’s of Fats are 25%_35%.

Average body fat percentages in various sports

Sport Men% Women%
Basketball 7–12 18 –27
Bodybuilding 6–7 8–10
Cycling 8–9 15–16
Football 8–18 (not available)
Gymnastics 3–6 8–18
Running 4–12 8-18
Swimming 4–10 12-23
Tennis 12–16 20-26
Weight lifting 6–16 17–20
Throwing 12–20 12–23

MICRONUTRIENTS

Definition:
The nutrients which are required by our body in less amount are called micronutrient.

MINERALS
The mineral is a naturally occurring homogenous solid with a definite but generally not fixed
chemical composition and are ordered atomic arrangement. It is usually formed by inorganic
compound.
MAJOR MINERALS
1. Sodium
Sodium is the main cation outside cells and one of the primary electrolytes responsible for
maintaining fluid balance. Dietary deficiency is unlikely, and excesses raise blood pressure in
many people. For this reason, health professionals advise a diet moderate in salt
Deficiency Symptoms
 Not from inadequate intakes
 Hyponatremia from excessive loss
Toxicity Symptoms
 Edema, acute hypertension
Significant Sources
 Table salt, soy sauce;
 moderate amounts amounts in meats, milks, breads, and vegetables;

 large amounts in processed foods

 2. Chloride
 Chloride is the major anion outside cells, and it associates closely with sodium.
 In addition to its role in fluid balance, chloride is part of the stomach’s hydrochloric acid.
 The accompanying table provides a summary of chloride.
Deficiency Symptoms
 Do not occur under normal circumstances
Toxicity Symptoms
 Vomiting
Significant Sources
 Table salt, soy sauce ; moderate amounts

 in meats, milks, eggs; large amounts in

 processed foods

3. Potassium
 Potassium, like sodium and chloride, is an electrolyte that plays an important role in
maintaining fluid balance.
 Potassium is the primary cation inside cells;
 fresh foods, notably fruits and vegetables,are its best sources.
Toxicity Symptoms
 Muscular weakness; vomiting; if given into
 a vein, can stop the heart
Significant Sources
 All whole foods: meats, milks, fruits,
 vegetables, grains, legumes

4. Calcium

 Most of the body’s calcium is in the bones, where it provides a rigid structure and a
reservoir of calcium for the blood.
 Blood calcium participates in muscle contraction, blood clotting, and nerve impulses, and
it is closely regulated by a system of hormones and vitamin D.
 Calcium is found predominantly in milk and milk products.

 Even when calcium intake is inadequate, blood calcium remains normal, but at the
expense of bone loss, which can lead to osteoporosis

Deficiency Symptoms
 Stunted growth in children; bone loss
 (osteoporosis) in adults
Toxicity Symptoms
 Constipation; increased risk of urinary
  stone formation and kidney dysfunction;
 interference with absorption of other minerals.

5. Phosphorus
 Phosphorus accompanies calcium both in the crystals of bone and in many foods such as
milk.
 Phosphorus is also important in energy metabolism as part of ATP, in lipid transport as
part of phospholipids, and in genetic materials as part of DNA and RNA.
Deficiency Symptoms
 Muscular weakness, bone pain.
Toxicity Symptoms
 Calcification of non-skeletal tissues, particularly the kidneys
Significant Sources
 Foods derived from animals (meat, fish,

 poultry, eggs, milk)

6. Magnesium
 Like calcium and phosphorus, magnesium supports bone mineralization.
 Magnesium is also involved in numerous enzyme systems and in heart function.
 It is found abundantly in legumes and dark green, leafy vegetables.
Deficiency Symptoms
 Weakness; confusion; if extreme, convulsions,
 bizarre muscle movements (especially of eye and face muscles), hallucinations, and
 difficulty in swallowing; in children, growth failure
Toxicity Symptoms
 From nonfood sources only; diarrhea, alkalosis, dehydration
Significant Sources
 Nuts, legumes, whole grains, dark green vegetables,
 seafood, chocolate, cocoa
7. Sulfur:
 As part of proteins, stabilizes their shape by forming disulfide bridges;
 Part of the vitamins biotin and thiamin and the hormone insulin
Deficiency: None known; protein deficiency would occur first

Sources: All protein-containing foods (meats, fish, poultry, eggs, milk, legumes, nuts)
RDA: not set

Trace Minerals
1. Iron
  Iron is an essential nutrient, vital to many of the cells’ activities, but it poses a
problem for millions of people.
 Some people simply don’t eat enough iron-containing foods to support their health
optimally, whereas others absorb so much iron that it threatens their health.
 Iron exemplifies the principle that both too little and too much of a nutrient in the
body can be harmful.
Iron’s two ionic states:
 Ferrous iron (reduced): Fe++
 Ferric iron (oxidized): Fe+++

Significant Sources
 Red meats, fish, poultry, shellfish, eggs,
 legumes, dried fruits

Toxicity Symptoms
 GI distress
 Iron overload: infections, fatigue, joint pain,skin pigmentation, organ demage

Deficiency Symptoms
 Anemia: weakness, fatigue, headaches;

 impaired work performance and cognitive function; impaired immunity;

 pale skin, nail beds, mucous membranes,

 concave nails; inability to regulate body temperature; pic

2. Iodine
 Iodide, the ion of the mineral iodine, is an essential component of the thyroid
hormones.
 An iodine deficiency can lead to simple goiter (enlargement of the thyroid gland)
and can impair fetal development, causing cretinism. Iodization of salt has largely
eliminated iodine deficiency in the United States and Canada

Deficiency Disease
 Simple goiter, cretinism

Deficiency Symptoms
 Underactive thyroid gland, goiter, mental
  and physical retardation in infants (cretinism)

Toxicity Symptoms
 Underactive thyroid gland, elevated TSH,

 goiter

3. Selenium
 Selenium is an antioxidant nutrient that works closely with the glutathione peroxidase
enzyme and vitamin E.
 Selenium is found in association with protein in foods.

Deficiencies are associated with a predisposition to a type of heart abnormality is known as

Keshan Disease

Deficiency Symptoms
 Predisposition to heart disease characterized by cardiac tissue becoming fibrous (Keshan
disease)

Toxicity Symptoms
 Loss and brittleness of hair and nails;

skin rash, fatigue, irritability, and nervous system disorders; garlic breath odor.

4. Copper
 Copper is a component of several enzymes, all of which are involved in some way
with oxygen or oxidation. Some act as antioxidants; others are essential to iron
metabolism.
 Legumes, whole grains, and shellfish are good sources of copper

Significant Sources
 Seafood, nuts, whole grains, seeds,legumes

Deficiency Symptoms
 Anemia, bone abnormalities
Toxicity Symptoms
In Wilson’s disease, copper accumulates in the liver and brain, creating a life-
threatening toxicity.
 5. Manganese
 Manganese-dependent enzymes are involved in bone formation and various metabolic
processes.
 Because manganese is widespread in plant foods, deficiencies are rare, although
regular use of calcium and iron supplements may limit manganese absorption

Significant Sources
 Nuts, whole grains, leafy vegetables, tea

Deficiency Symptoms
 Rare

Toxicity Symptoms
Nervous system disorder

RECOMMENDED DIETARY ALLOWENCE OF MINERALS

STAGE Calciu Chromium Copper Fluride Iodine Iron Maganesium Maganese

S OF m (mcg/d) (mcg/d) (mg/d) (mcg/d) (mg/d) (mg/d) (mg/d)
LIFE (mg/d)
Childre 1000 15 440 1 90 10 130 1.5
n
Male 1000 35 900 4 150 8 420 2.3
Female 1000 25 900 3 150 18 310 1.8
Pragna 1000 30 1000 3 220 27 350 2.0
nt
Lactatio 1000 45 13000 3 290 9 320 2.6
n

STAGES Molybdenum Phosphorous Selenium Zinc Potassium(g/d) Sodium

OF LIFE (mcg/d) (mg/d) (mcg/d) (mg/d) (g/d)
Children 22 500 30 5 3.8 1.2
Male 45 700 55 11 4.7 1.5
Female 45 700 55 8 4.7 1.5
Pragnant 50 700 60 11 4.7 1.5
Lactation 50 700 70 12 5.1 1.5

VITAMINS
Introduction:
Vitamins are organic compound essential nutrients required in tiny amounts to
perform specific functions that promote

 Growth

 Reproduction

 Maintenance of health and life

There are two different types of Vitamins:

Fat Soluble Vitamins:

1. Vitamin A
2. Vitamin D
3. Vitamin K
4. Vitamin E
Water Soluble Vitamins:
1. Vitamin B Complex

2. Vitamin C

FAT SOLUBLE VITAMINS

VITAMIN A
Vitamin A was the first fat-soluble vitamin to be recognized.

Retinoid: is a collective term for the biologically active forms of vitamin A. Retinoids exist in 3
forms: retinol (an alcohol), retinal (an aldehyde), and retinoic acid.

Sources:
Retinoid are found in liver, fish, fish oils, fortified milk, and eggs.

Deficiency:
Vitamin A deficiency can have severe effects on the eye, eventually leading to blindness.

“Exophthalmia”

VITAMIN D
Vitamin D is more correctly classified as a “conditional” vitamin, or pro-hormone (a precursor of
an active hormone
Sources:
The best food sources of vitamin D are fatty fish (e.g., sardines, mackerel, and salmon), cod liver
oil, fortified milk, and some fortified breakfast cereals. Synthesized in skin by exposure of
sunlight.

Deficiency:
Vitamin D deficiency in adults is called osteomalacia. Osteoporosis and rickets.

VITAMIN E

Vitamin E is a family of 8 naturally occurring compounds— 4 tocopherols (alpha, beta, gamma,

delta) and 4 tocotrienols (alpha, beta, gamma, delta)—with widely varying degrees of biological
activity.

Sources:

Good food sources of vitamin E include plant oils (e.g., cottonseed, canola and sunflower oils),
wheat germ, asparagus, almonds, peanuts, and sunflower seeds

Deficiency:

 Hemolytic anemia Disorder that causes red blood cells to break down faster than they can
be replaced.

 Hemorrhaging Bleeding.

VITAMIN K

Vitamin K need for normal blood clotting. It helps in carboxylation of these proteins which
allows proteins to bind calcium, leading to activation of clotting factor. Necessary for bone
formation so bone can bind the minerals

Deficiency:
Deficiency of Vitamin K, which is necessary for the synthesis of clotting factors may result in
clinically significant bleeding.

There is evidence suggesting that mild Vitamin K deficiency may have effect on long term bone
strength and vascular health

DIETARY REFRENCE INTAKE OF FAT SOLUBLE VITAMINS

LIFE Vitamin A Vitamin C Vitamin D Vitamin E Vitamin K
STAGE (mgc/d) (mg/d) (IU/d) (mg/d) (mcg/d)
 GROUP
Children 400 25 600 7 30
Male 900 90 600 16 120
Female 700 75 600 15 90
Pregnant 770 80 600 15 75
Lactation 1300 120 600 19 90

WATER SOLUBLE VITAMINS

B Complex Vitamin
The B vitamins are a group of water-soluble vitamins that play important roles in cell
metabolism

 they are chemically distinct vitamins that often coexist in the same foods
 supplements containing all eight are referred to as a vitamin B complex
 Vitamin B1 (thiamine)

 Vitamin B2 (riboflavin)

 Vitamin B3 (niacin)

 Vitamin B4 (niacinanide)

 Vitamin B5 (pantothenic acid)

 Vitamin B6 (pyridoxine)

 Vitamin B8 (inositol)

 Vitamin B9 (folic acid)

 Vitamin B12 (various cobalamins; commonly cyanocobalamin in vitamin

supplements)

 Vitamin B7 (biotin)

Vitamin B1: Thiamine

 Part of coenzyme involved in release of energy from carbohydrates

 Metabolism of certain amino acids

 Synthesis of neurotransmitters
Deficiency
 Water soluble, not stored

 deficiency symptoms can occur within in a few days

Sources:
Cereals, Oil Seeds, Nuts, Yeast, Meat ,Egg and Fish

Vitamin B2 -RIBOFLAVIN:
 Its the central component of many cofactors and is required by all flavoproteins.

 It plays a key role in energy metabolism, and for the metabolism of fats, ketone bodies,
carbohydrates, and proteins.

Deficiency:
Signs and symptoms of riboflavin deficiency (Ariboflavinosis) include cracked and red lips,
inflammation of the lining of mouth and tongue, mouth ulcers, cracks at the corners of the mouth
(angular cheilitis), and a sore throat.

Sources;
Milk, cheese, leafy green vegetables, liver, kidneys, legumes, tomatoes, yeast, mushrooms, and
almonds are good sources of vitamin B2, but exposure to light destroys riboflavin.

Vitamin B3-Niacin:
Part of co enzymes

a) Nicotinamide adenine dinucleotide (NAD)

b) Nicotinamide adenine dinucleotide phosphate (NADP). These are cofactors and act as
oxidizing & reducing agents release energy.

Deficiency:

 Pellagra—the “4 D’s” of pellagra

Dermatitis, Diarrhea, Dementia, Death

Sources:
Dairy, Poultry, Fish, Lean Meat, Egg

Vitamin B5: Panthotheic Acid:

 Essential in the body to form antibodies and coenzyme A

 Coenzyme A is important for the synthesis of

◦ Fatty acids

◦ Polypeptides

◦ Terpenoids

◦ Steroids

Sources:
Common food sources are Organ meat, dairy, legumes, eggs, vegetables, whole grain cereals.

Deficiency:
Burning feet syndrome is the Deficiency.

Vitamin B-6: Pyridoxine:

Functions
◦ Part of coenzyme needed for amino acid metabolism

Deficiency
Rarely occurs, but signs and symptoms include:

 Dermatitis, anemia, convulsions, depression, and confusion

occurs is malnourished children taking ionized if not supplemented with pyridoxine

Sources
 Yeast, polished rice, cereal grains, egg yolk

Vitamin B8: Biotin

Functions:
◦ Cellular metabolism of carbohydrate, fat and protein.
 ◦ Production of amino acids and glucose.

Deficiency:
Deficiency causes nausea, sleepiness, alopecia and dermatitis.

Sources:
Yeast extract , liver, kidney, egg yolk , nuts , cereals

Vitamin B9-FOLIC ACID:

• Biologically active form of folic acid is

tetrahydrofolate(TH4 OR FH4)

• It is synthesized form folic acid in two steps-

• a.) reduction of folate in liver by folate

b.) reduction by dihydrofolate reductase

Sources:
Rich sources are

 Green leafy vegetables

 Whole grain
 Cereals
 Liver ,kidney
 Yeast
 Egg
Deficiency:
• Nutritional macrocytic anemia

• Megaloblastic anemia of pregnancy

• Megaloblastic anemia of infancy

• Macrocytic anemia
Vitamin B-12: Cobalamin
• Part of coenzymes needed for:
• Folate metabolism
• Maintenance of myelin sheaths
Sources:
  Vegetables, fruits, and other foods of non-animal origin are free from cobalamin unless
they are contaminated by bacteria.

 Strict vegetarians are at risk of developing B12 deficiency.

Deficiency:
• Pernicious anemia

• Gastrectomy

• Pancreatic insufficiency

• Fish tapeworm (rare)

• Helicobacter pylori infection

DIETARY REFRENCE INTAKE OF WATER SOLUBLE VITAMINS

LIFE Thiami Riboflavi Niaci Vitami Folate Vitami Pantotheni Biotin

STAGE n n n n B5 (mgc/ n B12 c Acid (mg/
GROUP (mg/d) (mg/d) (mg/ (mg/d) d) (mgc/ (mgc/d) d)
d) d)
Childre 0.6 0.6 8 0.6 200 1.2 3 12
n
Male 1.2 1.3 16 1.3 400 2.4 5 25
Females 1.1 1.1 14 1.2 400 2.4 5 25
Pragnan 1.4 1.4 18 1.9 600 2.8 6 30
t
Lactatio 1.4 1.6 17 2.0 500 2.8 7 35
n

HEIGHT MEASUREMENTS OF BED RIDDEN PATIENTS

Estimates of pharmacokinetic parameters and evaluation of nutritional status rely on accurate
measurement of not only body weight but also height. However, a number of common
disabilities and disease processes make it difficult to accurately measure standing height in many
patients. Therefore, various formulae based on bones that do not change length have been
developed. These methods include:
1. Knee height,
2. Forearm length and
3. Demi-span.
4. Arm Span
 1. KNEE HEIGHT:

Knee height is correlated with stature and, until recently, was the preferred method for estimating
height in bedridden patients. Knee height is measured using a sliding broad-blade caliper. A
device designed for this purpose is commercially available. The patient's height is then estimated
using a standard formula.

2. FOREARM LENGTH:

This method is popular in the UK. The only tool needed is a tape to measure the ulna length between
the point of the elbow and the midpoint of the prominent bone of the wrist. This value is then
compared with a standardized height conversion chart.
 3. DEMI_ SPAN:

Clinically, the most useful measurement is the demi-span. This method is recommended by the Mini
Nutritional Assessment, and, like forearm length, requires no specialized equipment. Demi-span is
measured as the distance from the middle of the sternal notch to the tip of the middle finger in the
coronal plane. Height is then calculated from a standard formula.
 4. ARM SPAN:

It is measured by using measuring tape from tip of middle finger of right hand to the tip of
middle finger of left hand.

WEIGHT MEASUREMENTS OF BED RIDDEN PATIENTS

Weighing a patient in a care setting is a vital part of the care process. Not only does it allow for
medical records to be updated and maintained, but it also allows for the correct care and
treatment to be given to the patient. Recording a patient’s weight will also allow medical staff to
assess their nutritional needs.
Weighing a patient who is ambulant is not something which gives us any cause for thought but
weighing a patient who is bed-ridden or bed-bound could be a challenging task without the
appropriate weighing scale. 
Following are the methods to measure the weight of bed ridden patients:

1. Chair Scale
2. Floor Scale
3. Bed Scale
4. Hoist Scale

1. CHAIR SCALE:

Medical chair scales, or sit-on chair scales, are an excellent way to weigh patients who have
limited mobility, or who cannot stand long enough to be weighed on a traditional floor scale.
They are easy to move around and bring to the patient when needed.
Similarly, a wheelchair scale is also very useful when weighing a person with limited or no
mobility and wheelchair users generally. This is a ramped platform on the floor which a
wheelchair can be wheeled onto to weigh the patient.
With both of these chair scale options, a patient must be able to sit in a chair to be weighed. And
like floor scales, they are best placed on a hard and flat surface for accurate measurements. This
would not necessarily be the best option for a patient who is bed-ridden or completely immobile.

2. BED SCALES:
Bed scales are ideal instruments to weigh patients who are bed-ridden and positioned
permanently lying down, with their biggest benefit being that a patient does not have to be
moved from their bed. This means that when weighing the patient there is minimal disruption,
making the process easy and comfortable; a high priority.
Like the chair scale, bed scales are available in different formats. There are portable bed scales
which consist of portable floor pads – this type of scale means that the scale can be brought to
the patient. Or there’s a more permanent solution which is a bed scale fixed to the floor. In some
cases beds are available with a built-in scale.

3. HOIST SCALES:

Hoist scales are designed to provide an effective method of accurately weighing a bed-ridden or
immobile patient. Medical hoist scales are usually a more cost-effective scale than a bed scale.
While usually being highly transportable, the downside to choosing a hoist scale is that the
patient has to be put into the hoist and then lifted, which may cause a degree of discomfort and
disturbance.
 9. Dealing With Patients
 DEMOGRAPHIC DATA:

 Name

 Gender

 Age

 Adress

 Weight

 Height

 MEDICAL HISTORY:

 Problem

 Signs and Symptoms

 Laboratory Test

 Physical Tests

 Lifestyle

 Routines

 Concerns of patient

 NCBC’s(Nutritional Complete Body Checkup)

 Weight

 Height

 BMI

 Anthropometry

 Biochemical Test (If necessary)

  DIETARY HISTORY:

 24- Hour Dietary Recall

 General Diet History

 NUTRITIONAL COUNSELLING:

 GDP(General Dietary Patterns)

 Do’s and Don’ts

 Diet Planning

 Tricks to Convince Patient To Follow Doctor’s Guidelines:

 Raise your Words not Voice.

 Tell the Benefits if patient follow guidelines.

 During Counseling use non verbal communication which patient can easily understand.

 Speak ambiguously not explaining.

 Tell Symptoms that may effect the quality of life of patient.

References:

Krause, The Nutrition Care Process(14th Edition)

 Nutritional Management of Diseases

OBESITY

Definition:
Obesity can be defined as excessive body fat, with weight 20% above average. Obesity
is an excess of adipose tissue or body fat. It can be defined as a proportion of body weight
composed of adipose tissue (percent body fat) that exceeds a range that is considered healthy.
Adult males are generally considered obese when their percent body fat is 25% and adult females
are considered obese when their percent body fat is 33%.
Basal Metabolic Index is tool used for nutritionally assessment of obesity:

Underweight 18.5kg/m2
Healthy Weight 18.5_24.9kg/m2
Overweight 25.0_29.9kg/m2
Obesity(Class 1) 30.0_34.9kg/m2
Obesity (Class 2) 35.0_39.9kg/m2
Extreme Obesity(Class 3) >40.0kg/m2

Causes of Obesity:
 Poor Diet
 Physical I activity
 Genetical Factors
 Environmental Factors
 Social Factors

Risk Factors of Obesity:

 Premature Death
  Diabetes
 Cancer
 Sleep Apnea
 High Blood Pressure
 Myocardial Infarction
 Arthritis


Types of Obesity
There are two main types of Obesity:
1. Apple Shape Obesity
2. Pear Shape Obesity

Pear Shape
 It combines a slimmer “ectomorph” upper body
with an “endomorph” lower body
 People with this shape have extra fat in the hip
and thigh area
 It’s more common among women, and it may be
part of the reason they often live longer than men.

Apple Shape
 Also called a “beer belly,” it means you have more
fat stored around your stomach, while your lower
body stays thin.
 It’s more common in men, and it's worse for your
health than the pear shape
 That’s because belly fat is often a sign that you have
more fat deeper inside, around your internal organs, as
opposed to just beneath the skin
 That kind is more closely linked to heart disease, cancer, type 2 diabetes, and high
cholesterol
Medical Nutrition Therapy of Obesity

 High protein diets include protein rich foods including:

 Meat
Poultry
Fish
Eggs
Lentils
 These are low in carbohydrates
 They are suggested to be effective in weight loss

High protein energy-restricted diets

They resulted in:
 Larger reduction of body weight
 Reduction of body fat mass
 Long term weight loss maintenance

Mechanism of high protein diet

 Since they promote a sustained level of satiety

 Sustained energy expenditure
 Increased fat oxidation and sparing of fat-free mass 

Low-Carbohydrates diet

 A low-carb diet restricts foods high in carbs including: (Paoli et al., 2013)
Sugar
Gluten Grains
Trans Fats
Artificial Sweeteners
Highly Processed Foods

 Allow food in low-carb

 Fruits
Vegetables
Whole grains

Low-Carbohydrates diet

 The low-carb diet is that decreasing carbs lower insulin levels

 Causes the body to burn stored fat for energy

 Ultimately leads to weight loss.

Physical Activity
 Bodily movement produced by skeletal muscles that requires energy expenditure
 Energy expenditure can be measured in kilocalories.

Health Benefits of Physical Activity

Following are the health benefits of physical activity:

 Develop healthy musculoskeletal tissues (i.e. bones, muscles and joints)
 Develop a healthy cardiovascular system (i.e. heart and lungs)
 Develop neuromuscular awareness (i.e. coordination and movement control)
 Maintain a healthy body weight
 Coronary heart disease
 High blood pressure
 Stroke
 Type 2 diabetes
 Colon and breast cancer
 Depression
 NUTRITIONAL Assessment Form

GENERAL INFORMATION

Date: 12-07-2021 Contact No:

Patient Name: Col. Tehseen

Age: 50 Years Height: 5’6” Weight: 73kg BMI:26kg/m2

IBW: 64kg Diagnose: Overweight

GI FUNCTION

Appetite: ͏͏□Normal □Suppressed □Increased

□Anorexia □Nousea □Diarrhea □Constipation

DIET HISTORY

Daily consumption of food from each food groups:

□Milk products □Bread cereals

□Fruits □Vegetables

□Meat □Fats

How often do you take junk food?..2_3.............times/weeks.

Meal timing: _________ Do you skip meals if yes which one?

Breakfast time: 8AM □Breakfast

Lunch time: 2:30PM □Luch

Dinner time: 8:15PM □Dinner

WATER INTAKE

Glass/day: 6-7 Glass

Temperature: Cold □ Room temperature □ Warm □

SLEEP-AWAKE CYCLE

Sleep time: 11 PM Wake up time: 5AM

EXERCISE AND WALK

Duration: 10-15 Mins Day/weeks: 3 Times a week

Type of exercise: Walk

PHYSICAL EXAMINATION

Edema □Present □Absent

Muscle wasting □Present □Absent

Ascites □Present □Absent

Skin □Healthy □Dry □Scaly □Patchy

Mouth □Normal □Sores □Altered taste sensation

Tongue □Deep red □Rough □Raw □Swollen □Smooth

Nails □Pink nail beds □Smooth □Firm □Spoon shape

Eyes □Dry membranes □Redness □Red rimmed

Teeth □Cavities □Erupting abnormally □Missing

Hair □Dull □Dry □Thin □Sparse □Wire like

BIOCHEMICAL FINDINGS

Lipid profile Hb: 14mg/dL

CBC Calium

Renal function test (RFT) Vitamin D

Liver function test (LFT) Vitamin B12

Allergy/drug interaction:

METABOLIC STRESS

□Low □Moderate □High

SGA RATING

□Well nourished □Moderately nourished □Severely malnourished

 Diet Plan
Timing Food items & quantity
Early 1 cup Kehwa(1tsp honey+1 lemon+ 1 cup warm water)
morning(6_7am)
Breakfast(8_9am 1 Cup tea(1tsp honey +1 cup low fat milk), 3 slices Bread, 1 egg fried, 1 tsp
) mustard oil
Morning snack 24 pieces of Grapes OR 2 Peaches med. OR 2 Apples med.
(11_12pm)
Lunch(1_2 pm) 1 Chapatti , 1 cup salan (mixed vegetable+ 2_3 pieces of chicken), 1 cup
salad(1 tomato+1/2 cucumber+ sprinkle lemon + black pepper 1tsp olive oil
dressing)
Evening 1 cup Pasta (white sauce+ 2-3 pieces of chicken added)
snack(4_5pm)
Dinner(8_9pm) 1cup Rice , 1 potato cutlet
Late night 1 cup milk + 3_4almonds
snack(10-11pm)

Guidelines:

*Use Mustard oil In cooking.

*Avoid all fried and junk food items.
*Use raw vegetables and fruits.
* Take 13-18 glass of water daily..
*Take exercise or walk of 15_30 minutes daily.
HYPERTENSION

Definition:
Hypertension is persistently high arterial blood pressure, the force exerted per unit area
on the walls of arteries. The systolic blood pressure (SBP), the upper reading in a blood pressure
measurement, is the force exerted on the walls of blood vessels as the heart contracts and pushes
blood out of its chambers. The lower reading, known as diastolic blood pressure (DBP),
measures the force as the heart relaxes between contractions. Blood pressure is measured in
millimeters (mm) of mercury (Hg). Adult blood pressure is considered normal at 120/80 mm Hg.

 Classification of Blood Pressure for Adults Ages 18 or Older

Normal Systolic BP(mmHg) Diastolic BP(mmHg)

<60years 140 90
>60years 150 >90

Risk Factors of Hypertension:

Following are the risk factors of Hypertension:

  Obesity
 Smoking

 Hypercholestromia
 Male Gender
 Chronic Kidney Disease
 Retinopathy

Epidemiology of Hypertension:

Hypertension affects many Americans, but often goes undiagnosed in its early stages. It is
frequently referred to as the “silent killer” because there are typically no symptoms.
Approximately 67 million—one in three—American adults had hypertension in 2009 and
another one in three adults had prehypertension. Only 47% of those with hypertension were
successfully managing it. In addition, hypertension was listed as a primary or contributing cause
of more than 348,000 deaths in 2009.

Medical Nutrition Therapy for Hypertension

DASH—Dietary Approaches to Stop Hypertension

Dietary Approaches to Stop Hypertension (DASH) was one of three studies conducted in the late
1990s that examined the effect of diet on blood pressure in individuals with hypertension. These
clinical trials focused on a diet composed of a variety of foods that not only reduced sodium
intake but increased potassium, magnesium, calcium, and fiber intakes within a moderate energy
intake. At 2000 kcal a day, the DASH Sodium Diet provides approximately 4700 mg, potassium,
500 mg magnesium, 1240 mg calcium, 90 g protein, 30 g fiber, and 2400 mg sodium.
  Nutritional treatment of hypertension includes both lifestyle modifications and nutrition
therapy
 Increased physical activity, smoking cessation, and weight loss, as well as reduction of
sodium and alcohol intake, are primary strategies.

The Dietary Approaches to Stop Hypertension (DASH diet)

 It has been shown to be effective in lowering blood pressure and blood lipid levels,
which ultimately reduces the risk for cardiovascular disease

 Rich in fruits, vegetables, whole grains, and contains some lean protein sources like
chicken, fish and beans

 Limited in sugar-sweetened foods and beverages, red meat, and added fats

 DASH diet is rich in magnesium, potassium and calcium, which are protective against
high blood pressure.

 DASH diet is inversely associated with the risk for type II diabetes mellitus

 When combined with exercise, it can result in significant weight loss, which improves
insulin sensitivity, and can decrease the risk for diabetes by as much as 37 percent

 The DASH diet doesn't list specific foods to eat

 Instead, it recommends a dietary pattern that focuses on the number of servings of

different food groups.
Grains and grain products
 Grains include bread, cereal, rice and pasta
 Focus on whole grains because they have more fiber and nutrients than do refined grains.
 Grains are naturally low in fat. Keep them this way by avoiding butter, cream and cheese
sauces

Fruits

 Many fruits need little preparation to become a healthy part of a meal or snack
 Examples of one serving include one medium fruit, 1/2 cup fresh, frozen or canned fruit,
or 4 ounces of juice.
 Have a piece of fruit with meals and one as a snack, then round out your day with a
dessert of fresh fruits topped with low-fat yogurt

Vegetables
 Tomatoes, carrots, broccoli, sweet potatoes, greens and other vegetables are full of
fiber, vitamins, and such minerals as potassium and magnesium.
 Examples of one serving include 1 cup raw leafy green vegetables or 1/2 cup cut-up
raw or cooked vegetables
 Low Fat/Non-Fat Dairy Foods
 Milk, yogurt, cheese and other dairy products are major sources of calcium,
vitamin D and protein
 Go easy on regular and even fat-free cheeses because they are typically high in
sodium.

Lean Meat, Fish, Poultry

 Choose lean varieties and aim for no more than 3 ounces a day.
 Cutting back on your meat portion will allow room for more vegetables
 Trim away skin and fat. Refrain from frying
 Eat heart-healthy fish, such as salmon, herring and tuna

Nuts, seeds, legumes

 Consume 4 to 5 times per week
 Spice up salads by adding raw or unsalted dry roasted nuts or seeds, such as
walnuts or sunflower seeds
 Coat chicken or fish with a crushed nut mixture
 Try breads with nuts or seeds in them
 Grab a handful of unsalted nuts for a snack.

Fats
DASH helps keep your daily saturated fat to less than 6 percent of your total calories by limiting
use of meat, butter, cheese, whole milk, cream and eggs in your diet, along with foods made
from lard, solid shortenings, and palm and coconut oils.

NUTRITIONAL ASSESSMENT FORM

GENERAL INFORMATION

Date: 16-07-2021 Contact NO:

Patient Name: F/O NCE Zeeshan

Age: 70Years Height: 5’6’’ Weight: 72kg BMI: Normal

IBW: 70kg BP: 135/90mmHg Diagnose: Hypertension

GI FUNCTION

Appetite: ͏͏□Normal □Suppressed □Increased

□Anorexia □Nousea □Diarrhea □Constipation

DIET HISTORY

Daily consumption of food from each food groups:

□Milk products □Bread cereals

□Fruits □Vegetables

□Meat □Fats

How often do you take junk food?...............times/weeks.

Meal timing: _________ Do you skip meals if yes which one?

Breakfast time: 9 AM □Breakfast

Lunch time: 3AM □Lunch

Dinner time: 8AM □Dinner

WATER INTAKE

Glass/day: 8-10 Glasses

Temperature: Cold □ Room temperature □ Warm □

SLEEP-AWAKE CYCLE

Sleep time: 12 AM Wake up time: 7AM

EXERCISE AND WALK

Duration: 10-15 Minutes Day/weeks: 2-3 Days A Weeks

Type of exercise: Walk

PHYSICAL EXAMINATION

Edema □Present □Absent

Muscle wasting □Present □Absent

Ascites □Present □Absent

 Skin □Healthy □Dry □Scaly □Patchy

Mouth □Normal □Sores □Altered taste sensation

Tongue □Deep red □Rough □Raw □Swollen □Smooth

Nails □Pink nail beds □Smooth □Firm □Spoon shape

Eyes □Dry membranes □Redness □Red rimmed

Teeth □Cavities □Erupting abnormally □Missing

Hair □Dull □Dry □Thin □Sparse □Wire like

BIOCHEMICAL FINDINGS

Serum ALT: 34 u/L Hb: 13mg/dL

Serum Total Biliribin: 13 Um/L RBC: 4.75 x 105

Serum Sodium: 157mmol/L Platelet Count: 200 x 105

Serum Urea: 5.2mmol/L Vitamin B12: N/A

Allergy/drug interaction: N/A

METABOLIC STRESS

□Low □Moderate □High

SGA RATING

□Well nourished □Moderately nourished □Severely malnourished

Pre-Breakfast 1 glass warm water with 1 tsp of chia seeds added into it
OR
(6:00-7:00am) 4-5 seeds of kolanji + 1-2 drops of lemon + 1 tsp of honey with ½ or 1 glass of
water (room temperature)
OR
1 Garlic clove with water

Breakfast 7-8tbsp. oatmeal cooked in water + 1 tsp grinded flaxseed, sprinkle on oatmeal
with 2-3 strawberries
(8:00-9:00am)
OR
1 chapati + ½ cup vegetable salan or 1 eggwhite with vegetables
Mid-morning Soak 5 almonds in water and eat those almonds try this once a week)
(11:00-12:00pm) OR
You can take 1 apple/banana/guava/ 2-3 strawberries
1 glass of water + 1 bowl vegetable salad (cucumber + carrot+ beetroot) with 1
Lunch chapatti +1/2 cup meat salan with 2 small pieces of meat + 1 cup mint raita
OR
(1:00-2:00pm) 1 chapatti + ½ cup vegetable salan (daal + squash salan)
OR
4-5 tbsp. brown rice with 1 steamed piece of chicken + 1 cup raita

Evening Snack Take ½ cup aaalu channa chaat with vegetables salad (do not use
condiments/spices)
(3:00-4:00pm)
OR
1 cup fruit chaat

Dinner 1 cup boiled rice with daal

OR
(9:00-10:00pm) 1 cup boiled rice in milk with 1-2tsp sugar
OR
1 chapati + ½ cup vegetable salan with less oil
Bed-Time 1 cup of milk with 1tsp of ispagoal husk
(10:00-11:00pm)
 Diabetes Mellitus

Definition:
Diabetes mellitus is not a single disease but a diverse group of disorders that differ in origin and
severity. Yet all forms of diabetes mellitus share one common characteristic: hyperglycemia
resulting from defects in insulin production, insulin action, or both.

Type 1 Diabetes Mellitus

. Pancreatic beta cell destruction and eventually absolute insulin deficiency.
Symptoms
 Hyperglycemia
 Excessive Thirst
 Frequent urination
 Significant weight loss
 Electrolyte disturbances
Complications
Ketoacidosis

Macrovascular disease

 Coronary Heart Disease

 Perpeheral vascular disease
 Cerebrovascular disease

Microvascular Disease

 Retinopathy
 Nephropathy

Neuropathy

Medical Nutrition Therapy (MNT)

 Integrate insulin regime into preferred eating and physical activity schedule
 Adjust pre-meal insulin dose based on insulin-to-carbohydrate ratios.
 Energy intake to prevent weight gain in disease
 Adequate energy and nutrient intake to promote growth and development in children
 Cardioprotective Nutrition interventions
Type 2 Diabetes Mellitus
About 90-95% of all diagnosed cases of diabetes are type 2 diabetes mellitus. It occurs most
frequently in adults, but is being diagnosed with increasing frequency in children and adolescent
as well. It results due to insulin resistance and insulin resistance.
Risk Factors
 Obesity
 Older Age
 Race or Ethnicity
 Prediabetics
 History of Gestational Diabetes
Clinical Findings
 Abnormal patterns of insulin secretion and action
  Decreased cellular uptake of glucose and increased postprandial glucose
 Increased release of glucose by liver (gluconeogenesis) resulting in fasting hyperglycemia
 Central obesity
 Hypertension
 Dyslipidemia
Symptoms
 Hyperglycemia
 Fatigue
 Excessive Thirst
 Frequent urination

Medical Nutrition Therapy (MNT)

 Lifestyle strategies (food/eating and physical activity) that improve glycemia, dyslipidemia
and blood pressure.
 Nutrition education (carbohydrate counting and fat modification) and counseling
 Energy Restriction
 Blood Glucose monitoring to determine adjustments in food or medications
 Cardioprotective nutrition interventions

NUTRITIONAL ASSESSMENT FORM

GENERAL INFORMATION

Date: 26-07-2021 Contact NO:

Patient Name: S/W Parveez

Age: 42 Years Height: 5’5’’ Weight: 59Years BMI: 24.5kg/m2

IBW: 56Years Diagnose: Diabetes

GI FUNCTION

Appetite: ͏͏□Normal □Suppressed □Increased

□Anorexia □Nousea □Diarrhea □Constipation

DIET HISTORY

Daily consumption of food from each food groups:

□Milk products □Bread cereals

□Fruits □Vegetables

□Meat □Fats

How often do you take junk food? 1-2 times/weeks.

Meal timing: _________ Do you skip meals if yes which one?

Breakfast time: 8-9AM □Breakfast

Lunch time: 1-2AM □Lunch

Dinner time: 8-9AM □Dinner

WATER INTAKE

Glass/day: 8-10 Glass/Day

Temperature: Cold □ Room temperature □ Warm □

SLEEP-AWAKE CYCLE

Sleep time: 9PM Wake up time: 5AM

EXERCISE AND WALK

Duration: 15-20Mins Day/weeks: 5 days a week

Type of exercise: Walk

PHYSICAL EXAMINATION

Edema □Present □Absent

Muscle wasting □Present □Absent

Ascites □Present □Absent

Skin □Healthy □Dry □Scaly □Patchy

Mouth □Normal □Sores □Altered taste sensation

Tongue □Deep red □Rough □Raw □Swollen □Smooth

Nails □Pink nail beds □Smooth □Firm □Spoon shape

Eyes □Dry membranes □Redness □Red rimmed

Teeth □Cavities □Erupting abnormally □Missing

Hair □Dull □Dry □Thin □Sparse □Wire like

BIOCHEMICAL FINDINGS

Blood Glucose: 201 mg/dL Hb: 12/dL

RBC’s: 5.50 x 109/L BSF: 87mg/dL

Platelets: 300 x 109/L Vitamin D: N/A

TLC: 7.0 x 109/L Vitamin B12: N/A

METABOLIC STRESS

□Low □Moderate □High

SGA RATING

□Well nourished □Moderately nourished □Severely malnourished

Diet Plan

Timing Food items & quantity

Early 1 cup Kehwa(1tsp honey+1 lemon+ 1 cup warm water)
morning(6_7am)
Breakfast(8_9am 1 Cup tea(1 Cup low fat milk)Without Sugar, 2 Slices of Bran Bread, 1Boiled
) Egg without Yolk
Morning snack 1 Guava OR 12-14 pieces of Jamun
(11_12pm)
Lunch(1_2 pm) ½ Barley Chapatti , ½ Cup salan (mixed vegetable), 1 cup salad(1
tomato+1/2 cucumber+ sprinkle lemon + black pepper 1tsp olive oil dressing)
Evening 1 Cup PopCorns
snack(4_5pm)
Dinner(8_9pm) 1 Chapatti Barley + Chicken(Gravy, 2Pieces of Chicken) ½ Plate
Bed Time 3_4almonds Soaked
(10-11pm)
 Asthma

Definition:
Asthma is a chronic inflammatory disorder of the airway involving many cells and cellular
elements such as mast cells, eosinophils, T lymphocytes, macrophages, neutrophils and epithelial
cells. Inflammation is the primary problem in asthma and is thought to be primarily
Immunoglobin (IgE) mediated.
Symptoms
 Cough
 Dyspnea
 Chest tightness
 Wheezing
 Increased respiratory rate
 Labored breathing
 Tachycardia
 Hypoxia
 Etiology

Asthma is usually divided into two types:

1. Allergic asthma
2. Non-Allergic asthma
1) Allergic Asthma
It is most common and is triggered predominately by inhaled indoor allergens mite allergen,
pet dander, pollen, and mild.
2) Non-Allergic Asthma
Non Allergic Asthma is caused by anxiety, stress, exercise, cold air, dry air, hyperventilation,
smoke, viruses and other factors.

Medical Nutrition Therapy (MNT)

 Protective effect of Omega-3 fatty acids, vitamin C and Zinc
 Limit the intake of high fat foods and portion control can prevent gastric secretions, which
exacerbate GERD.
 Nutritionally adequate diet is recommended.
 For overweight individuals, weight loss may result in improvement of asthma.

NUTRITIONAL ASSESSMENT FORM

GENERAL INFORMATION

Date: 30-07-2021 Contact NO:

Patient Name: Sep.Rohil

Age: 56Years Height: 5’6” Weight: 65kg BMI: 24kg/m2

IBW: 62kg Diagnose: Asthma

GI FUNCTION

Appetite: ͏͏□Normal □Suppressed □Increased

□Anorexia □Nausea □Diarrhea □Constipation

DIET HISTORY

Daily consumption of food from each food groups:

□Milk products □Bread cereals

□Fruits □Vegetables

□Meat □Fats

How often do you take junk food?...............times/weeks.

Meal timing: Do you skip meals if yes which one?

Breakfast time: 8-9AM □Breakfast

Lunch time: 2-3PM □Lunch

Dinner time: 8-9PM □Dinner

WATER INTAKE

Glass/day: 6-7 Glass/Day

Temperature: Cold □ Room temperature □ Warm □

SLEEP-AWAKE CYCLE

Sleep time: 10PM Wake up time:5AM

EXERCISE AND WALK

Duration:10-15 Mins Day/weeks: 2-3 Times A Day

Type of exercise: Walk

PHYSICAL EXAMINATION

Edema □Present □Absent

Muscle wasting □Present □Absent

Ascites □Present □Absent

Skin □Healthy □Dry □Scaly □Patchy

Mouth □Normal □Sores □Altered taste sensation

Tongue □Deep red □Rough □Raw □Swollen □Smooth

Nails □Pink nail beds □Smooth □Firm □Spoon shape

Eyes □Dry membranes □Redness □Red rimmed

Teeth □Cavities □Erupting abnormally □Missing

Hair □Dull □Dry □Thin □Sparse □Wire like

BIOCHEMICAL FINDINGS

Hb: 14g/Dl Iron: N/A

ESR: 30 Calium: Low

Renal function test (RFT): N/A Vitamin D: N/A

Liver function test (LFT): N/A Vitamin B12: N/A

Allergy/Drug Interaction: N/A

METABOLIC STRESS

□Low □Moderate □High

SGA RATING

□Well nourished □Moderately nourished □Severely malnourished

Diet Plan
Timing Food items & quantity
Early 1 cup Kehwa(1tsp honey+ 1 cup warm water)
morning(6_7am)
Breakfast(8_9am 1 Cup tea(1 Cup low fat milk) 2 Slices of Bread, 1Boiled Egg
)
Morning snack 1 Apple( Without Peel) OR 2-3 Appricot
(11_12pm)
Lunch(1_2 pm) 1 Chapatti(Wheat OR Barley) + 1 Cup Chicken Broth(Low Spices)
Evening 1 Cup PopCorns
snack(4_5pm)
Dinner(8_9pm) 1 Chapatti Barley + Salan ( Any Vegetable)) ½ Plate
Bed Time 3_4almonds Soaked
(10-11pm)
13. Anemia

Iron Deficiency Anemia

Pathophysiology Iron deficiency anemia is characterized by the production of

(microcytic) erythrocytes and a diminished level of circulating hemoglobin. This
microcytic anemia is the last stage of iron deficiency, and it represents the end
point of a long period of iron deprivation. iron deficiency anemia in adult men is
the result of blood loss. Large losses of menstrual blood can cause iron deficiency
in women, many of whom are unaware that their menses are unusually heavy.

SYMPTOMS

 Behavioral changes such as fatigue.

 Anorexia.
 Pica.
 Pagophagia (ice eating).
 Abnormal cognitive development in children.
 Growth abnormalities, epithelial disorders.
  A reduction in gastric acidity are also common.
 Reduced immunocompetence.

Etiology

The etiology of iron-deficiency anemia varies greatlyIt can result from

 Inadequate ingestion
 Inadequate absorption
 Increased blood loss or excretion
 Increased destruction resulting in decreased release from stores
Epidemiology

Iron-deficiency anemia is the most common nutritional anemia and affects many
different groups. The most vulnerable groups in the United States are children
under the age of 2 years, menstruating females, pregnant women, and frail older
adults. Anemia in frail older adults is becoming increasingly common with the
rapid rise in the population over 85 years of age.

Stages of Deficiency

 Stage 1: Moderate depletion of iron stores No dysfunction

 Stage 2: Severe depletion of iron stores No dysfunction
 Stage 3: Iron deficiency Dysfunction
 Stage 4: Iron deficiency Dysfunction and anemia

Clinical Findings

 Early Inadequate muscle function

 Growth abnormalities
  Epithelial disorder
 Reduced immunocompetence
 Fatigue Late
 Defects in epithelial tissues
 Gastritis
 Cardiac failure Stages of Deficiency

Medical Management

 Assess for and treat underlying disease

 Oral iron salts
 Oral iron, chelated with amino acids
 Oral sustained-release iron
 Iron-dextran by parenteral administration
Nutrition Management

 Increase absorbable iron in diet

 Include vitamin C at every meal
 Include meat, fish, or poultry at every mea
 Decrease tea and coffee consumption.

GENERAL INFORMATION

Date: 02-08-2021 Contact NO:N/A

Patient Name: Sep Adil

Age:24 yrs Height:5.7 Weight:55 BMI:20.5kgm2

IBW:67 Diagnose:Anemia

GI FUNCTION
Appetite: ͏͏□ Normal □ Suppressed □ Increased

□ Anorexia □ Nausea □ Diarrhea □ Constipation

DIET HISTORY

Daily consumption of food from each food groups:

□ Milk products □ Bread cereals

□ Fruits □ Vegetables

□ Meat □ Fats

How often do you take junk food?........1.......times/weeks.

Meal timing: Do you skip meals if yes which one?

Breakfast time :08:00am □ Breakfast

Lunch time: 14:00 pm □ Luch

Dinner time: 20:00pm □ Dinner

WATER INTAKE

Glass/day: 7-8 Glass

Temperature: Cold □ Room temperature □ Warm □

SLEEP-AWAKE CYCLE

Sleep time:22:30 pm Wake up time: 06:00am

EXERCISE AND WALK

Duration: 10 mins Day/weeks:2-3 days

Type of exercise: Walk

PHYSICAL EXAMINATION

Edema □ Present □ Absent

Muscle wasting □ Present □ Absent

Ascites □ Present □ Absent

Skin □ Healthy □ Dry □ Scaly □ Patchy

Mouth □ Normal □ Sores □ Altered taste sensation

Tongue □ Deep red □ Rough □ Raw □ Swollen □ Smooth

Nails □ Pink nail beds □ Smooth □ Firm □ Spoon shape

Eyes □ Dry membranes □ Redness □ Red rimmed

Teeth □ Cavities □ Erupting abnormally □ Missing

Hair □ Dull □ Dry □ Thin □ Sparse □ Wire like

BIOCHEMICAL FINDINGS

TLC: 4.0*109 Hb: 9.5g/dl

RBC:4.33*109 MCH:2.5 fL

PCV:0.42 I/L Vitamin D:N/A

Liver function test (LFT):N/A Vitamin B12:N/A

Allergy/drug interaction:

METABOLIC STRESS

□ Low □ Moderate □ High

SGA RATING

□ Well nourished □ Moderately nourished □ Severely malnourished

1.6 DIET PLAN:

Timing Food items & Quantity

Breakfast 1Chappati (Greece 1 tsp Desi ghee ) + ½ cup Vegetable gravy
8:00- 8:30 am Or
1 Chappati (Greece 1 tsp Desi Ghee) + 1 egg omlette + 1 cup y
Mid-morning 1-2 Banana + 1 Peach
snack Or
11:00- 11:30 am 2-3 Plum
Lunch 1 chappati + ½ cup Gravy (any cooked vegetable or meat) + Salad
14:00- 14:30 pm Or
 10 tbsp rice(boiled) + 1 shami + 2-3 tbsp yogurt (raita)
Or
1 cup Grilled Chicken+ Red Bean Salad (few lemon drops added to it +
black pepper)
Evening snack 2 Med. Apple + 6 Cashew
16:00- 16:30 pm Or
1 Cup Pomegranate
Dinner 1 Chapatti+ ½ cup( 2-3 pieces) chicken and vegetable salan
20:00- 20:30 pm Or
1 cup Chicken Macaroni
Late night snack 1 cup Milk (low fat milk)
(1 hr before
sleep)

1. General Activity
jBalanced Diet Awareness among Children

Balanced Diet
It is defined as the appropriate amount of foods from all food groups. The balance of foods
selected over time can make an important difference to health. Consuming vaiety of foods from
different fruits and getting essential nutrients from it.
Motive
Spreading awareness about what is balanced diet, and how one can achieve the good health
status by intaking the adequate and sufficient amount of nutrients for their overall health and
most importantly.

Assessment Methods
 Clinical Signs and Symptoms
 Dietary Recall
 Preferences

Instruments
Weight Machine

Fruit Art Competition

After giving the students lecture about balanced diet. Fruit Art Competition was held in The
Eduactors Al-Aleem Campus Okara.

References:
 Krause’s Food the Nutrition Care Process 14th Edition By L.KATHELEEN MAHAN
 Nutrition Therapy and Path physiology 3rd Edition By Kathryn P.Sucher
 Nutrition and Diet Therapy10 Edition By Ruth A Roth
 https://www.google.com/url?
sa=t&rct=j&q=&esrc=s&source=web&cd=&cad=rja&uact=8&ved=2ahUKEwjAttHHnY
jxAhVRglwKHfl6BdYQFjABegQIBBAD&url=https%3A%2F%2F2.zoppoz.workers.dev%3A443%2Fhttp%2Fwww.rxkinetics.com
%2Fheight_estimate.html&usg=AOvVaw3g2xYVcH09rdgUqdYtVPdM
 https://www.google.com/url?
sa=t&rct=j&q=&esrc=s&source=web&cd=&cad=rja&uact=8&ved=2ahUKEwiemNOll4
jxAhXLhVwKHTA6CQUQFjAIegQIDxAE&url=https%3A%2F
%2Fwww.solentscales.co.uk%2Fblog%2Fwhats-the-best-method-to-weigh-a-bed-ridden-
patient&usg=AOvVaw1WEjrR-RNPCw85EC3pcCCZ
 Understanding normal and clinical nutrition 8th editon.
 The Complete Guide to Sports Nutriton.
 Steele MF, Chenier TC. Arm-span, height, and age in black and white women. Ann Hum
Biol. 1990 Nov-Dec;17(6):533-41. [ PubMed ] PMID: 2281945 [PubMed - indexed for
MEDLINE]
 Han TS, Lean ME. Lower leg length as an index of stature in adults. Int J Obes Relat
Metab Disord. 1996 Jan;20(1):21-7. [ PubMed ] s
 Nutrition Therapy and Pathophysiology 3rd Edition
 Understanding normal and clinical nutrition 8th edition
 Source: Adapted from WHO, 1995, WHO, 2000 and WHO 2004.

 https://us.secashop.com/knowledge/application-tips/how-can-i-accurately-measure-
bedridden-patients-1
 http://www.rxkinetics.com/height_estimate.html
 https://cnatraininghelp.com/cna-skills/measuring-height-and-weight-for-supine-patient/
 https://pubmed.ncbi.nlm.nih.gov/9506190/