PAF Hospital, Islamabad

Nutrition Department

CURRICULUM OF NUTRITION INTERNSHIP PROGRAM (2 Months)

Week DAY STUDY AREA ASSIGNMENT REMARKS

Monday Evaluation test and Interview
Tuesday Orientation Class
Code of conducts and ethics
1st Wednesday Basic Calculations Make a document of basic
calculations
Thursday Exchange List Make an Exchange List of common
foods
Friday Nutrition Care Process Self-Assessment on SOAP notes +
Nutritional Diagnosis Terminology
Week DAY STUDY AREA ASSIGNMENT REMARKS
Monday Abbreviations & Labs interpretation Make a table of Nutrition related
Abbreviations + Chem 7
Tuesday Therapeutic Diets Therapeutic Diets Table
2nd Wednesday File Reading 3 SOAP Notes
Thursday Rotation 1 (General wards) 3 SOAP Notes
Friday MNT (Medical Nutrition Therapy) MNT Table File
Checking
Week DAY STUDY AREA ASSIGNMENT REMARKS

Monday Rotation 2 (General wards) 3 SOAP Notes

Tuesday MUST/SGA 3 SOAP Notes
3rd Wednesday Rotation 3(General wards) 3 SOAP Notes
Thursday Rotation 4(General wards) 3 SOAP Notes
Friday Underweight 3 SOAP Notes
Overweight Normal Ranges of Blood Sugar
Obesity and Glycemic index (Table)
Diabetes Mellitus File Checking

Week DAY STUDY AREA ASSIGNMENT REMARKS

Monday Rotation 5 (General wards) 3 SOAP Notes
Tuesday Hormonal Imbalance Weight gain recommendation
Pregnancy/Lactation during pregnancy (Table) Infant
Infancy and childhood and children energy calculation
CDC growth chart
Hypertension
Coronary Heart Disease
4th Wednesday Rotation 6(General wards) 3 SOAP NOTES
 Thursday Rotation 7(General wards) 3 SOAP NOTES
Friday Renal Disorder Diet Orders and File Checking
Week DAY STUDY AREA ASSIGNMENT REMARKS
Monday Rotation 8(General wards/ICUs) 3 SOAP NOTES
Tuesday Dyslipidemia Normal Ranges of Blood Pressure
Hiatus Hernia and Lipid Profile (Table) Diet
Peptic Ulcer Orders
Diarrhea and Constipation
5th Wednesday Rotation 9(General wards/ ICUs) 3 SOAP NOTES
Thursday Rotation 10(General wards/ICUs) 3 SOAP NOTES
Diverticulosis and Diverticulitis Jaundice Diet Orders File
Friday Checking
Week DAY STUDY AREA ASSIGNMENT REMARKS
Monday Rotation 11 (General wards/ICUs) 3 SOAP NOTES
Tuesday Hepatitis and Cirrhosis Diet Orders
Cholecystectomy Cancer

6th Wednesday Rotation 12(General wards/ICUs) ICU 3 SOAP NOTES

Progress Notes
Thursday Rotation 13 (General wards/ICUs) 3 SOAP NOTES
AIDS Diet Orders File
Friday Burns Checking
Fever
Gout
Week DAY STUDY AREA ASSIGNMENT REMARKS
Monday Refeeding Syndrome + Rotation 14(ICUs) 3 Soap Notes
Tuesday Enteral Nutrition NG Form/Calculations
7th Wednesday Rotation 15 ( ICUs) 3 SOAP NOTES
Thursday Rotation 16 (ICUs) 3 SOAP NOTES
Friday Parenteral Nutrition TPN Form/Calculations
Week DAY STUDY AREA ASSIGNMENT REMARKS
Monday CPE Course (Nutrition focused physical exam 3 SOAP NOTES
part 1) + Rotation 17(ICUs)
Tuesday CPE Course (Nutrition focused physical exam 3 SOAP NOTES
part 2 +Nutrition Counseling
8th Wednesday Rotation 18( ICUs) 3 SOAP NOTES
Thursday Presentation Checking Complete File Checking

Friday FINAL CASE STUDY & Final Report submission

PRESENTATION
 Basic Calculations
1). Body mass index

BMI = weight in kg/height in meter square

WHO BMI classification

Underweight < 18.5

Normal 18.5-24.9
overweight 25-29.9
Obesity(1) 30-34.9
Obesity(2) 35-39.9

Obesity(3) >40

Example

Weight=85 kg

Height=172.72cm or 2.98m^2

BMI= 85/2.98

BMI= 28.5kg/m^2 (overweight).

2). Body Frame size

BFS = height in cm/wrist circumference in cm

Normal ranges Small Normal Large

Male >10.4 9.6-10.4 <9.6
Female >11 10.1-11 <10.1

Example

Height=172.72
Wrist circumference=18cm

Gender = female.

BFS= 172.72cm/18cm

BFS=9.5(Large)

3) Ideal body weight

Hamwi Method Rule of 5

Female= 1st 5 feet=100lbs each additional or less inch=5lbs

Male= 1st 5feet=106lbs each additional or less inch =6lbs.

If BFS is small then deduct 10%.

If BFS is large then add 10%.

If BFS is normal no need for addition or subtraction.

Example

Height=5’8”

IBW= 100+5×8

IBW= 140lbs or 64kg.

4) Adjusted body weight

Formula= (Actual weight-Ideal weight)×0.25+IBW.

Example

Given data

Actual Weight= 85kg

Height= 5’8”
IBW =64kg.

ABW= (85-64)×0.25+64

ABW= 60.4kg

5). Total energy expenditure

 Harris Benedict equation

MEN:

BMR=66.4730 + 13.7516 x weight in kg + 5.0033 x height in cm – 6.7550 x age in years.

Women:

BMR=655.0955 + 9.5634 x weight in kg + 1.8496 x height in cm – 4.6756 x age in years.

TEE= BMR × physical activity

Physical activity Ranges

Sedentary 1.2
Light active 1.375
Moderate active 1.55
Very active 1.725
Exceedingly active 1.9

Example

Weight= 85kg.

Height= 172.72cm.

Age= 32years.

Activity factor= 1.375.

Gender= Women
BMR=655.0955 + 9.5634 x 85kg + 1.8496 x 172.72cm – 4.6756 x 32

BMR= 1637.8 kcal.

TEE= 1637.8 x1.375

TEE= 2252kcal.

6). BODY FAT PERCENTAGE

DUREN BERG FORMULA

Body Fat Percentage: (1.20×BMI) + (0.23×AGE)-(10.8×GENDER)-5.4.

(Male=1, Female=0).

Body Fat Percentage For Children

Body Fat Percentage= (1.51×BMI)-(0.70×AGE)-(3.6×GENDER)+1.4.

(Male=1 Female=0).

Example

BMI= 28.5kg/m2.

Age=32.

Gender= female

Body Fat Percentage= (1.51×28.5) -(0.70×32)-(3.6×0)+1.4.

Body Fat Percentage= 22.0%.

7) Waist to Height Ratio (WHtR)

Founded by: Japanese researchers in 1995.

Formula: WHtR= waist circumference / height.

MEN WOMEN
Extremely slim <0.34 <0.34
Healthy 0.43-0.52 0.42-0.48
Overweight 0.53-0.57 0.49-0.53
Very Overweight 0.58-0.62 0.54-0.57
Morbidly obese >0.63 >0.58

Example

Height=5’8” or 172.72cm

Waist circumference= 71cm/172.72cm.

Gender= female.

WHtR= 0.41 (slim).

8). Waist to hip ratio

Founded by: Dr. Glenn Wilson in the 1970s.

Formula: WHR= waist circumference / hip circumference

Women Health risk Body shape

0.80 or below low Pear
0.81-0.85 moderate Avocado
0.85+ High Apple
Men Health risk Body shape
0.95 or below low Pear
0.96-1.0 moderate Avocado
1.0+ High Apple

Example:

Waist measurement: 71cm

Hip measurement: 110cm.

Gender= Female

WHR= 0.64 (low risk and pear body shape).

 FOOD EXCHANGE LIST

STARCHES

Each serving = 15g Carbohydrates , 0-3 g Protein, 0-1 g fat , 80 calories

FOOD Serving size

Bread
Chapatti, small, 6 inches across 1

Naan, 8 inches by 2 inches 1/4

Pancake, 4 inches across, 1⁄4 inch thick 1

Pita, 6 inches across 1/2

Biscuit, 21⁄2 inches across 1

Bread
Reduced-calorie 2 slices (1 ½ oz)
White, whole-grain, pumpernickel, rye, unfrosted 1 slice (1 oz)
raisin

Cereals and Grains;

Barley, cooked 1/3 cup
Bran, dry
Oat ¼ cup
Wheat 1⁄2 cup ½ cup
Bran 1⁄2 cup

Cooked (oats, oatmeal) ½ cup

Quinoa, cooked 1/3 cup

Rice white or brown, cooked 1/3 cup.

Starchy vegetables
cassava 1/3 cup
Corn ½ cup

Mixed vegetables with corn, peas, or pasta 1 cup

Peas, green ½ cup
Potato 1⁄4
Baked with skin large (3 oz)
½ cup or ½ medium (3 oz).
Boiled, all kind 1 cup (2 oz).
½ cup
French fried

Yam, sweet potato, plain

Whole wheat regular crackers 2-5 (3/4 oz)

Popcorn (Microwave popped) 3 cups

Beans, Peas and Lentils

(The choice on the list count as 1 stach + 1
lean meat).
½ cup
Beans, cooked (black, garbanzo, kidney, lima, navy,
pinto, white)

Lentils, cooked (brown, green, yellow) ½ cup

Peas, cooked (black-eyed, split) ½ cup

FRUITS

Each serving = 15g Carbohydrates , 0 g Protein, 0 g fat , 60 calories

Apple, unpeeled, small 1 (4 oz)

Apricot, Dried 8 halves

Apricot, fresh 4 whole (5 ½ oz)

Banana, extra small 1 (4 oz)

Cherries, sweet, fresh 12 (3 oz)

Dates 3
Figs, Dries 1½
Figs, fresh 1 ½ large or 2 medium (3 ½ oz).
Fruit cocktail ½ cup

Grapefruit, large ½ (11 oz).

Grapes, small 17 (3 oz).

Kiwi 1 (3 ½ oz).

Orange, small 1 (6 ½ oz).

Papaya ½ fruit or 1 cup cubed (8 oz).

Peaches, fresh medium 1 (6 oz)

Pear, fresh, large ½ (4 oz)

Pineapple, fresh ¾ cup.

Plums, Dried, prunes 3
Strawberries 1 ¼ cup whole berries
Watermelon 1 slice or 11⁄4 cups cubes (131⁄2 oz)
Apple juice/cider 1⁄2 cup
Fruit juice blends, 100% juice 1⁄3 cup
Grape juice 1/3 cup
Grapefruit juice ½ cup
Orange juice ½ cup

MILK
Each serving of fat free milk (Skim) low-fat (1%) = 12 g Carbohydrates , 8 g Protein, 0-3
g fat , 100 calories

Milk, buttermilk, acidophilus milk, Lactaid 1 cup

2⁄3
Yogurt, plain or flavored with an artificial cup (6 oz)
sweetener

Chocolate milk, Fat- Free 1 cup

Yogurt with fruit, Low- Fat 2/3 cup ( 6 oz)

Each serving of Reduced fat milk (2%) = 12 g Carbohydrates , 8 g Protein, 5 g fat , 120
calories

Milk, acidophilus milk, kefir, Lactaid 1 cup

Yogurt, plain 2⁄3 cup (6 oz)

Each serving of Whole milk = 12 g Carbohydrates , 8 g Protein, 8 g fat , 160 calories

Whole Milk, buttermilk, goat’s milk 1 cup

Yogurt, plain 8 oz

Chocolate milk, whole 1 cup

SWEET, DESSERTS AND OTHER CARBOHYDRATES

Each serving of Sweet , Desserts and other Carbohydrates = 15 g Carbohydrates , Protein
varies , fat varies , calories varies

Cranberry juice cocktail ½ cup

Energy drink 1 can (8.3 oz)

Fruit drink or lemonade 1 cup (8 oz)

Sports drink 1 cup (8 oz)

Pudding Regular (made with reduced-fat milk) ½ cup

Pudding, Sugar-free or sugar- and fat-free (made ½ cup

with fat-free milk)

Candy, hard 3 pieces

Honey 1 Tbsp

Jam or jelly, regular 1 Tbsp

Sugar 1 Tbsp

Ice cream, Fat- Free ½ cup

Ice cream Regular ½ cup

Sherbet, sorbet ½ cup

 NON STARCHY VEGETABLES

Each serving of non-starchy vegetables= 5 g Carbohydrates , 2 g Protein, 0 g fat , 25

calories
½ cup cooked or vegetable juice
1 cup raw vegetable

Spinach Cucumber

Eggplant Gourds (bitter, bottle, luffa, bitter melon)

Green onions Peppers (all varieties)

Radishes Greens (collard, kale, mustard, turnip)

Baby corn Beets

Tomato Mixed vegetables (without corn, peas, or pasta)

Broccoli Carrots

Okra Cauliflower

Turnips Onions

Celery Turnips

MEAT AND MEAT SUBSITUTES

 Each serving of lean meat = 0 g Carbohydrates , 7 g Protein, 0 -3g fat , 45 calories

Beef: Select or Choice grades trimmed of fat: 1 oz

ground round, roast (chuck, rib, rump), round,
sirloin, steak (cubed, flank, porterhouse, T-bone),
tenderloin

Egg substitutes, plain 1⁄4 cup

Egg whites
2

Fish, fresh or frozen, plain: catfish, cod, flounder, 1oz

haddock, halibut, orange roughy, salmon, tilapia,
trout, tuna

Lamb: chop, leg, or roast 1 oz

Organ meats: heart, kidney, liver 1 oz

Each serving of Medium fat meat and meat substitutes = 0 g Carbohydrates , 7 g Protein,
4-7g fat , 75 calories

Beef: corned beef, ground beef, meatloaf, Prime 1 oz

grades trimmed of fat (prime rib), short ribs,
tongue

Egg (Note: High in cholesterol, so limit to 3 per 1

week)

Fish, any fried product 1 oz

Lamb: ground, rib roast 1 oz

Poultry: chicken with skin; dove, pheasant, wild 1 oz

duck, or goose; fried chicken; ground turkey
 Each serving of High fat meat = 0 g carbohydrates, 7 g protein, 8+ fat, 100 calories

Cheese, regular: American, bleu, brie, ched dar, 1 oz

hard goat, Monterey jack, queso, and Swiss

Hot dog: turkey or chicken (10 per lb-sized 1

package)

Processed sandwich meats with 8 grams of fat or 1 oz

more per oz: bologna, pastrami, hard salami

Each serving of plant based protein = carbohydrates varies, protein 7g, fat varies, calories varies

Beans, cooked: black, garbanzo, kidney, lima, navy, ½ cup

pinto, white

Lentils, brown, green, or yellow ½ cup

Nut spreads: almond butter, cashew butter, 1 Tbsp

peanut butter, soy nut butter

Peas, cooked: black-eyed and split peas ½ cup

FATS

Each serving of fats contain = 0 g Carbohydrates , 0 g Protein, 5 g fat , 45 calories

Nut butters (trans fat-free): almond butter, cashew 1 ½ tsp

butter, peanut butter (smooth or crunchy)
Almonds 6 nuts

Cashews 6 nuts

Peanuts 10 nuts

Pistachios 16 nuts

Oil: canola, olive, peanut 1 tsp

Olives, black ( ripe) 8 large

Olive green, stuffed 10 large

Mayonnaise Reduced-fat 1 Tbsp

Mayonnaise, Regular 2 tsp

Walnuts 2 whole, or 4 halves

Oil: corn, cottonseed, flaxseed. grape seed, 1 tsp.

safflower, soybean, sunflower, coconut, palm,
palm kernel

Oil: made from soybean and canola oil—Enova 1 tsp

Flaxseed, whole 1 Tbsp

Pumpkin, sunflower 1 Tbsp

Sesame seeds 1 Tbsp

Butter Reduced-fat 1 Tbsp

Butter, Whipped 2 tsp

Cream, Heavy 1 tbsp

Cream, Whipped 2 Tbsp

 Nutrition related abbreviations

a.c antecibum (before meals)

a.m morning
amt amount
bis Twice (two times a day)
bd/bid bis in die (twice a day)
B.M Bowel movement
bol Bolus
BSA Body surface area
B.S Blood sugar
D5w Dextrose 5% solution
D5NS Dextrose 5% in normal saline
dil Dilute
D.W Distilled water
fl./fld fluid
gtt drops
h/hr hour
h.s/H.S hora somni (at bed time)
IM Intramuscular
inj Injection
IP Intra-Peritonial
IV Intra Venus
NS Normal saline
O.D Once a day
oz ounce
p.m Post meridiem (evening/afternoon)
p.o Per.os. (by mouth)
NPO Nill per oral ( nothing by mouth)
q.a.d Every other day
q.a.m Everyday before noon
q.d.s 4 times a day
q.p.m Everyday afternoon
q.h. Every hour
q.h.s Every night at bed time
q.1h Every 1 hour
qqh. Every 4 hour
QWK Every week
RL,R/L Ringner’s lactate (for IV)
Stat Immediately (for IV)

Sol. Solution
Syr Syrup
tab Tablet
tbsp Table spoon
tsp Tea spoon
td.s/tid Thrice a day
t.i.w Thrice a week
TPN Total Parentral Nutrition
W with
W/O Without
X Times (2x,3x)
Y.O/y.o Years old
Dx. Diagnosis
Rx. Prescription
Hx. History
FHx Family history
CHx Current history
H/O History off
K/C Known case
A/W Admitted with/Associated with
Ab Antibody
Abdo. Abdominal
Ag Antigen
Ak Above knee
AKA Above knee amputation
AKI Acute kidney injury
Alb. Albumin
b/g Background
BGL Blood glucose level
BK Below knee
BKA Below knee amputation
B/O Body of
BPM/bpm. Beats per minute
Cal. Calories
CHO Carbohydrates
Chol. Cholesterol
C/O Complains of
DOB/d.o.b Date of birth
d.o.d Date of death
E/O Examination of
F/U Follow up
HB Hemoglobin
HCT Hematocrit
Ht Height
L Liter/left
R Right
N Normal
L Liter/left
R Right
N Normal
N/D Normal delivery
NKA No known allergies
NKDA No known drug allergies
N&V/N/V Nausea, vomiting
PMS Pre/Post menstrual syndrome
SOB Shortness of breath
Sx. Surgery
SX Symptoms
Re Regarding
Pt Patient
PPN Peripheral parenteral nutrition
CPN Central parenteral nutrition
U/O Urine output
V/D./V&D Vomiting, diarrhea
wt Weight
DMo Negative
DM+ Positive
Disease
 CHEM-7

A chem 7 blood panel is a blood chemistry test that is part of a series of tests ordered before
surgery. The tests help the medical team understand the patient's general health status. Also
known as chem 7 or chem 7 basic metabolic panel, it looks at seven different substances in the
blood.

Test Ranges
Glucose test 3.9-6.1 mmol/L
BUN 2.9-8.9mmol/L
CO2 22-29mmol/L
creatinine 58-106umol/L
Serum chloride 96-106 mmol/L
Serum pottasium 3.7-5.2 mmol/L
Serum sodium 15-145 mmol/L
 Therapeutic diets and its types

Definition of therapeutic diet

A therapeutic diet is a specialized meal plan designed to regulate the intake of specific foods or
nutrients as part of the treatment for a medical condition. Typically prescribed by a physician and
carefully planned by a dietitian, it involves adjustments to a regular diet to meet the unique
nutritional needs of an individual.

Types of Therapeutic diets:

Therapeutic diets are customized based on factors such as;

 Nutrient Modification.
 Food texture modifications.
 Food allergies or intolerances.

Common reasons for prescribing therapeutic diets include:

- To maintain proper nutrition

- To improve nutritional health
- To correct poor nutrition
- To reduce calories for weight management
- To add extra calories for weight gain
- To balance carbohydrates, fat, and protein for managing diabetes
- To increase the intake of a specific nutrient, like protein
- To reduce certain nutrients, like sodium
- To avoid foods that cause allergies or intolerances
- To adjust food textures for people who have trouble chewing or swallowing.

1. Nutrient Modification diets

 No concentrated sweets diet.

 Diabetic diets.
 No added salt diet.
 Low sodium diet.
  Low fat diet and/or low cholesterol diet.
 High fiber diet.
 Renal diet.
 Low Residue Diet.
 High Calorie, High Protein Diet.
 Heart healthy diet.

2. Consistency based modification

 Regular
 Soft and Bite-Sized
 Minced and Moist
 Pureed
 Liquidized
 Mildly Thick
 Slightly Thick
 Thin Liquids

3. Food allergy or intolerances based modification

 Gluten-Free Diet
 Lactose-Free Diet

Therapeutic diet Diet description Examples(food allowed/avoid)

Nutrient modification  liberalized diet for diabetics It includes regular foods without
1) No Concentrated Sweets when their weight and blood the addition of sugar like
(NCS) diet sugar levels are under Chicken, Fish, Eggs, Broccoli
control. , Spinach, Cauliflower, Green
 Calories are not counted as beans, Berries, Apples, Pears
in ADA calorie controlled Whole wheat bread, Brown rice,
diets. Almonds, Unsweetened tea,
Black coffee, Water.
2) Diabetic or calorie  These diets regulate calorie, Fiber-rich whole grains (quinoa,
controlled diet (ADA) carbohydrate, protein, and barley), lean proteins (chicken,
 fat intake in balanced fish), non-starchy vegetables
amounts to meet nutritional (broccoli, cucumbers), low-
needs, manage blood sugar glycemic fruits (berries, apples),
levels, and control weight. legumes.
 Portion control is Foods to avoid;
implemented according to Sugary desserts, white bread,
the ADA's "Exchange List pasta made with white flour,
for Meal Planning." sugary cereals, fruit juices
 Common calorie levels used
are 1,200, 1,500, 1,800, and
2,000.
 Diabetes (Type 1 and 2),
prediabetes, insulin
resistance
3). No Added Salt (NAS) diet  Regular diet with no salt Fruits, grains, dairy etc.
packet on the tray.
 Food is seasoned as regular
foods.
4). Low Sodium (LS) diet  May also be called a 2 gram Fresh vegetables and fruits,
Sodium Diet. unsalted nuts, grains like rice and
 used for people who may be pasta, fresh meats, herbs and
“holding water” (edema) or spices for flavor.
who have high blood Limits salt and salty foods such
pressure, heart disease, liver as bacon, sausage, cured meats,
disease, or first stages of canned soups, salty seasonings,
kidney disease. pickled foods, salted crackers,
ketchup etc.
5) Low fat/low cholesterol diet  Is used to reduce fat levels skinless chicken, Turkey, fish,
and/or treat medical egg whites, legumes, tofu, low-fat
conditions that interfere with dairy, whole grains, apples,
how the body uses fat such berries, bananas, leafy greens,
 as diseases of the liver, broccoli, carrots, healthy fats (in
gallbladder, or pancreas. moderation like avocado and
 Limits fat to 50 grams or no olive oil), air-popped popcorn,
more than 30% calories rice cakes, and water or herbal
derived from fat. tea.
 Is low in total fat and Foods to avoid;
saturated fats and contains fatty cuts of meat, processed
approximately 250-300 mg meats, full-fat dairy products,
cholesterol. fried foods, high-fat snacks,
sugary foods, trans fats, fast
foods, certain oils (like coconut
and palm oil), and high-
cholesterol foods (such as organ
meats and egg yolks).
6) High fiber diet • Is prescribed in the prevention fruits, legumes, vegetables, whole
or treatment of cardiovascular, breads, and cereals.
metabolic diseases. Foods to avoid :
Constipation, irritable bowel white bread, non-whole grain
syndrome, diverticulosis cereals, canned fruits and
vegetables
7) Renal diet  Is for renal/kidney people. Cauliflower, blueberries, garlic,
 The diet plan is buckwheat, olive oil, egg whites
individualized depending on Foods to avoid;
if the person is on dialysis. High potassium foods (bananas,
 The diet restricts sodium, oranges), high phosphorus foods
potassium, fluid, and protein (dairy, whole grains), processed
specified levels. foods with added salts, certain
 Lab work is followed dark-colored sodas
closely.

8) Low Residue Diet Is used for Inflammatory bowel White bread and pasta, white rice,
disease, Crohn’s disease, well-cooked vegetables without
ulcerative colitis, diverticulitis skin or seeds, canned fruits.
Foods to avoid:
Whole grains, raw fruits and
vegetables, nuts, seeds, popcorn,
dried fruits.
9) High Calorie, High Protein Malnutrition, cancer, certain Lean meats, dairy products (milk,
Diet infections, wound healing, cheese), nuts and nut butters,
muscle wasting. seeds, legumes, whole grains,
avocado.
Foods to avoid;
Low-calorie foods, diet
beverages, foods low in protein
such as rice cakes, plain salads
without protein
10). Heart-Healthy Diet Heart disease, hypertension, high Oats, brown rice, skinless poultry,
cholesterol, post-cardiac surgery fish (especially omega-3-rich like
 salmon), nuts, seeds, olive oil,
plenty of fruits (like berries,
apples) and vegetables (like
spinach, carrots).
Foods to avoid;
Trans fats (found in some
processed foods), high-sodium
foods (like canned soups), red
meats, sugary treats, full-fat
dairy.

Consistency based No dysphagia or mild dysphagia Standard diet with no

modification modification
1) Regular

2). Soft and Bite-Sized Moderate dysphagia, difficulty Soft, moist foods easily formed
chewing into a bolus
3). Minced and Moist More pronounced chewing Small, minced, moist foods like
difficulties ground meats, soft-cooked
vegetables
4)Pureed Severe dysphagia, poor oral Smooth, homogeneous foods like
phase abilities. pureed fruits, vegetables, and
meats.
5). Liquidized Difficulty managing semi-solid Foods pureed and thinned to a
foods liquid consistency
6). Mildly Thick Need for slightly slower-moving Liquids thickened to a mildly
liquids thick consistency
7). Slightly Thick Mild difficulty with thin liquids Liquids thickened to a slightly
thick consistency
8). Thin Liquids No difficulty with swallowing Regular liquids like water, tea,
thin liquids coffee.
Food allergy or intolerances No gluten (found in wheat, For non-celiac gluten sensitivity
based modification barley, rye). (not for celiac disease), trial
1) Gluten-Free Diet inclusion of low-gluten grains
like oats, explore more gluten-
free processed foods for variety.
2) Lactose-Free Diet No lactose-containing foods For those with lactose
(found in many dairy products). intolerance, trial small amounts of
lactose-containing foods,
introduce lactose-reduced dairy
products, explore a wider range
of lactose-free alternatives
 Blood sugar ranges

Range (mg/dl) Fasting After eating 2-3 hours after

eating
Normal <99mg/dl 170-200 120-140
Impaired glucose 100-125 mg/dl 190-230 140-160
Diabetic 126 or higher >200 mg/dl 200+

Gycemic index and glycemic load of foods

Food GI GL
1) Grains and pastas
Rice
Basmati 58 22
Brown 50 16
Instant 87 36
Noodles—instant 7 19
Spaghetti (avg) 38 18

vermicelli 35 16
2) Bread 5
Pita bread 7 10
White bread 70 10
Whole wheat bread 77 9
3) Vegetables 64 5
Beets, canned
carrots 47 3
Peas (green, avg) 48 3
Potato 8
Baked (avg) 5 88 26
Boiled 75 16
French fries 85 22
Microwaved 27
Pumpkin 75 3
Sweet corn 60 11
Sweet potato 61 17
4) Legumes
Chickpeas (avg) 28 8
Kidney beans (avg) 28 7
lentils(avg) 29 5
Soy beans(avg) 18 1
5) Fruits
Apple (avg) 38 6
Apricot (dried) 31 9
Banana (avg) Cherries 22 3 51 13
Grapefruit 25 3 Grapes (avg) 46 8
Kiwi fruit (avg) 53 6 Mango 51 8
Orange (avg) 48 5 Papaya 59 10
Peach (avg
Cherries 22 3
Grapefruit 25 3
Grapes (avg) 46 8
kiwi (avg) 53 6
mango 51 8
oramge (avg) 48 5
papaya 59 10
Peach
Canned (natural juice) 38 4
Fresh (avg) 42 5
Pear (avg) 38 4
Pineapple 59 7
Plum 39 5
Raisins 64 28
Cantaloupe 65 4
Watermelon 72 4
6) Dairy foods
Milk
Full fat 27 3
Skim 32 4

Custard 43 7
Icecream
Regular( avg) 61 8
Low fat 50 3
Yogurt, low fat 33 10
7) Beverages
Apple juice 40 12
Coca cola 63 16
lemonade 66 13
Fanta 68 23
Orange juice (avg) 52 12
8) Snack foods
Tortilla chips (avg) 63 17
Peanuts 14 1
popcorn 72 8
Potato chips 57 10
9) Convenience foods
Macaroni and cheese 64 32
Pizza, cheese 60 16
10) Sweets
Chocolate 44 13
11) Sugars
Honey (avg) 55 10
Fructose (avg) 19 2
Glucose 100 10
Lactose (avg) 46 5
Sucrose (avg) 68 7
 Weight gain recommendations during Pregnancy

Range Weight lbs Weight (kg) Twins( lbs and kg )

Underweight 28-40 12-18
Normal 25-35 11-15.9 46 / 21
overweight 15-25 7-11 42/19
Obese 11-20 5-9 35/16

Infant and Children Energy Calculations

Estimated Energy Requirements

WHO and Schofiels

EER= Resting energy expenditure X Activity factor X Stress Factor

Resting Energy Expenditure

Age Gender WHO SCHOFIELD

0-3 yrs Male 60.7W (kg) - 54 0.17W(kg)
+15.17H(cm) -617.6
Female 61W (kg) - 51 16.25W (kg) + 10.232H
(cm)- 413.5
3-10 yrs Male 22.7W + 495 19.6W + 1.303H + 414.9
Female 22.5W + 499 16.97W + 1.618H +
371.2
10-18 yrs Male 17.5W + 651 16.25W + 1.372H +
515.5

Female 12.2W + 746 8.365W + 4.65H + 200.0

(Important note W = weight in kg, H =height in cm).

Activity Factors Stress Factors
Paralyzed 1.0 Surgery 1.2-1.5 Burn 1.5-2.5
Confined to bed 1.1 Infection 1.2-1.6 Starvation 0.7
Ambulatory 1.2-1.3 Trauma 1.1-1.8 Growth Failure 1.5-2.0

Dietary Reference Intake (DRI)

EER (Kcal/day) = Total energy expenditure + Energy Deposition

AGE EER AGE EER

0-3 mos (89W - 100) + 175 Boys 3-8 yrs 88.5 - (61.9A + PA[26.7W + 903H])+20
4-6 mos (89W - 100) + 56 9-18 yrs 88.5 - (61.9A + PA[26.7W + 903H])+25
7-12 mos (89W - 100) + 22 Girls 3-8 yrs 135.3 - (30.8A + PA[10W + 934H])+20
13-35 mos (89W - 100) + 20 9-18 yrs 135.3 - (30.8A + PA[10W + 934H])+25
(IMPORTANT NOTE: W= weight(kg); H= Height(m); A= Age).

Physical activity coefficients (PA), DRI (ages 3-18 years)

Gender Sedentary Low Active* Active** Very Active***

Boys 1.00 1.13 1.26 1.42
Girls 1.00 1.16 1.31 1.56
* (30-60 mins. Daily moderate activity)

** (60 mins. Daily moderate activity).

*** (120 mins. Daily moderate activity, or 60 mins. Moderate + 60 mins. Vigorous activity).
Normal Ranges of Blood pressure

Range(mm of Hg) Blood pressure category

<120/<80 Normal

120-129/<80 Elevated BP

130-139/80-89 Stage 1 HTN

140 or higher/90 or higher Stage 2 HTN

Lipid profile

lipid Desirable Borderline High Risk

Cholesterol <200 mg/dl 200-239 mg/dl 240 mg/dl
TGL <150 mg/dl 150-199 mg/dl 200-499 mg/dl
HDL 60 mg/dl. 35-45 mg/dl <35 mg/dl
LDL 60-130 mg/dl. 130-159 mg/dl 160-189mg/dl
 NG Calculations with Case study

Given Data

Name: Ali Ahmed.

Age = 45 years.

Weight = 55 kg.

Sex = Male.

Height = 5’ 7”

BMI = 19.3 ( Normal weight).

Diagnosis: Stroke with Dysphagia

Step 1: Dosing weight

Weight = 55 kg

Step 2 : Energy Requirement

Energy Requirement = 55 x 25

= 1375 kcal/ day.

Step 3: Protein Requirement. (1.2-1.5 g/ kg).

= 1.3 x 55

= 71.5 g / day.

Step 4: Fluid Requirement

= 1ml / kcal.

= 1375 ml.
Step 5: Type of feed (Intermittent).

= 1375 / 6

= 229 ml / feed ( 4 hrs. gap).

TPN FORM
 TPN Calculations with case study

Given data

Weight= 66 kg.

Height= 162cm.

Age = 45.

Step 1: Total Energy Expenditure

TEE (kcal) = weight (kg) X 25 X 1.2

TEE= 66 x 25 x 1.2

TEE= 1980 kcal/day.

IN ml form; 1ml= 1kcal so;

TEE=1980 ML/DAY.

STEP 2: Carbs Calculations (3mg/kg/min).

= 66 x 3

= 198mg x 1440 sec (seconds in 24 hours= 1440).

= 285,120 mg

= 285,120/1000 (1000 mg = 1 g).

= 285.12 g x 3.4 kcal (1g of carbs = 3.4kcal).

= 969.4 kcal.

STEP 3: Protein Calculations (0.8- 1.5)

Protein = 1.3 x 66

= 85.8 g. x 4 (1 g of protein = 4 kcal)

 = 343.3 kcal.

STEP 4: Fat calculation

= calories of carbs + protein

= 969.4 + 343.3

= 1312.7 kcal

Fat calories = Total calories - sum of carbs and protein calories.

= 667.3 kcal/10 (1 g of carbs= 10 kcal)

= 66.73 g/day.

STEP 5:

 CARBS : 50% mean 50 g per 100 ml.

Dextrose = 50g /100 x285.12
Cross multiplication;
= 570 ml.
 Fat: 20%: 2kcal /ml.
Fat = 2 kcal / 1 ml x 667.3
Cross multiplication;
Fat = 333.6 ml.
 Amino acids: 10% per 100 ml.
Amino acid = 10/100 x 85.8.
Amino acid = 858 ml.

Calories from carbs, protein, fat = 570 + 858 + 333.6.

= 1761.6 ml.

Total Kcal = 1980 -1761.6.

= 218.4 kcal. (Remaining).

 Diet Orders

Disease Diet orders

CHO PROTEIN FAT CALORIES

CKD without Moderate Moderate Low Moderate

dialysis
CKD with Moderate High Moderate Moderate

dialysis
Hiatus Hernia Moderate Moderate Moderate Moderate
Peptic ulcer Moderate Moderate Moderate Moderate
Diverticulitis Moderate Moderate Low Moderate
Fever High High Low High
Burns Moderate High Moderate High
Hepatitis Moderate High Low High

Cholelithiasis Moderate Moderate Low Moderate

Cholesectectomy Moderate Moderate Low Moderate

Cirrhosis Moderate Low Low Moderate

Hypertension Moderate Moderate Moderate Moderate
Diabetes Mellitus Low Moderate Moderate Moderate
Coronary heart Moderate Moderate Low Moderate

disease
Hepatitis Moderate High Low High