Since 1961, Azimpur, Dhaka

Clinical Therapeutic Nutrition

Submitted by: Submitted to:
Name : Saima Afrin Nitu
Roll No: 142
Reg. No: 3522
session: 2015-2016
Department: Food and Nutrition
Course No. FN 306
Contents
1. Experiment No 1 …………………………………………………….. 1
2. Experiment No 2 …………………………………………………….. 6
3. Experiment No 3 ……………………………………………………..15
4. Experiment No 5 ……………………………………………………..18
5. Experiment No 7……………………………………………………..22

0
Experiment No. 01:
Name of Experiment: BMI assessment and calculation of energy requirement of different activity
level

● BMI(Body Mass Index) : BMI means Body Mass Index. It is a value derived from the mass and
height of the individual. The BMI is defined as the body mass derided by the square of the body
height, and is universally expressed in units of kg/ m2 , resulting from mass in kilogram and height
in metres.

Formula:
2
BMI=weight(kg )÷height(m )

Example:
Height = 173 cm(1.73m), weight = 73kg
calculation = 73÷(1.73)2=24.41

● BMI range:
Underweight = < 18.5
Normal = 18.5 - 22.9
Overweight = 23 – 24.9
Pre-obese = 25 – 29.9
Obese = ≥ 30.0
Obese(I) = 30.0 - 34.9
Obese(II) = 35.0 - 39.9
Obese(III) = ≥40.0

● Classification of BMI:

BMI MEN WOMEN

LOW < 20.0 < 18.6
Desirable range 20.25 18.6 -28.6
Over Weight 25.1 - 30 23.7 - 28.6
Obese > 30 > 28.6

● Middle range of BMI: The middle range of BMI is 20.75

●IBM(Ideal Body Weigth): Ideal Body Weight that is believed to be maximally healthful for
person, based chiefly on height but modified by factors such as genders age, build and degree of
muscular development.

Formula:
IBM=BMI (middle Point)×Ht ( m 2)

1
Formula of EBW(Expected Body Weight ):
2
EBW=Lower limit (18.5)of ( BMI)∈the normal range×Ht (m )
2
EBW=Upper limit (23) of (BMI )∈thenormal range×Ht (m )
Calorie Requirement=BMI ×PAL( physical Activity Level)

● Calculation of BMI,IBW,EBW and Calorie requirement for 5 person:

Person 1:

weight = 49

2
height=4 ' 10 ' '=4×12+10 ' '=58 ' '=58×2.54 cm=147.32 cm=2.16 m

Wt (kg) 49
BMI= = =23
Ht (m2) 2.16

2
IBW=BMI( middle point)×Ht ( m )=20.75×2.16=44.82=45 kg

EBW lower=18.5×Ht (m 2 )=18.5×2.16=39.96=40 kg

EBW upper=23×Ht (m 2)=23×2.16=49.68=50 kg

EBW=( 40−50)kg

● Calorie Requirement:

She is moderate worker , so her physical activity level is 40

calorie=IBW ×PAL=45×40=1800 kcal

Person 2:
weight = 53
height=5' 5 ' '=5×12+5 ''=65 ''=65×2.54 cm=165.1 cm=1.65 m=2.72 m 2

Wt (kg) 53
BMI= = =19.5=20
Ht (m 2) 2.72

2
 IBW=BMI(middle point)×Ht (m 2)=20.75×2.72=56.44=56 kg

2
EBW lower=18.5×Ht (m )=18.5×2.72=50.32=50 kg

EBW upper=23×Ht ( m 2)=23×2.72=63.56=63 kg

EBW=(50−63)kg

● Calorie Requirement:

She is sedentary worker , so her physical activity level is 30

calorie=IBW ×PAL=56×30=1680 kcal

Person 3:
weight = 57
2
height=5 ' 1' '=5×12+1' '=61' '=61×2.54 cm=154.94 cm =1.55 m=2.40 m

Wt (kg) 57
BMI= = =23.75=24
Ht (m 2) 2.40

2
IBW=BMI( middle point)×Ht ( m )=20.75×2.40=49.8=50 kg

EBW lower=18.5×Ht (m 2 )=18.5×2.40=44.4=44 kg

EBW upper=23×Ht (m 2)=23×2.40=55.2=55 kg

EBW=(50−63)kg

● Calorie Requirement:

She is moderate worker , so her physical activity level is 40

calorie=IBW ×PAL=50×30=2000 kcal

3
 Person 4:
weight = 60
height=4 ' 11 ' '=4×12+ 11 ''=59 ''=59×2.54 cm=149.86 cm=1.498 m=2.25 m 2

Wt (kg) 60
BMI= = =26.66=27
Ht (m 2) 2.25

2
IBW=BMI(middle point)×Ht (m )=20.75×2.25=46.68=47 kg

EBW lower=18.5×Ht (m 2 )=18.5×2.25=41.63=42 kg

2
EBW upper=23×Ht (m )=23×2.25=51.75=52 kg

EBW=( 42−52)kg

● Calorie Requirement:

She is sedentary worker , so her physical activity level is 30

calorie=IBW ×PAL=47×30=1410 kcal

Person 5:
weight = 65
height=5' 4 ' '=5×12+4 ' '=64 ' '=64×2.54 cm=162.56 cm=1.63 m=2.66 m 2

Wt (kg) 65
BMI= = =24.44=25
Ht (m2) 2.66

2
IBW=BMI(middle point)×Ht (m )=20.75×2.66=55.2=55 kg

EBW lower=18.5×Ht (m 2 )=18.5×2.66=49.21=49 kg

2
EBW upper=23×Ht ( m )=23×2.66=61.1=61 kg

4
 EBW=( 49−61)kg

● Calorie Requirement:
She is high worker , so her physical activity level is 45
calorie=IBW ×PAL=55×45=2475 kcal

5
Experiment No. 02
Name of the experiment: Identification of clinical signs of nutritional deficiency diseases.

● Kwashiorkor: Kwashiorkor is a form of severe protein malnutrition characterized by edema,

and an enlarge liver with fatty infiltrates. Sufficient calorie intake but with insufficient protein
consumption, distinguished it from marasmus. Kwashiorkor case occur in areas of famine or poor
food supply . Cases in the developed world are rare.
Kwashiorkor is a form of acute malnutrition that most commonly occurs in children . This
condition is extremely serious and result from such severe protein deficiency that a child
experiences edema or swelling

● Symptoms of Kwashiorkor:
1. change in skin and hair color ( to a rest color) texture.
2. Fatigue
3. Diarrhea
4. Loss of muscle mass
5. Failure to grow or gain weight
6. Edema (swelling) of the ankles, feet and belly
7. Damaged immune system, which can lead to more frequent and sever infections.
8. Irritability
9. Flaky rash
10. Shock

● Marasmus: Marasmus is a form of severe malnutrition characterized by energy deficiency. It can

occur in anyone with severe malnufrition but usually occurs in children. Body weight is reduced to
less than 62% of the normal (expected) body weight for the age. Marasmus occurrence increases
prior to age 1, whereas kwashiorkor occurrence increases after 18 months. It can be distinguished
from kwashiorkor in that kwashiorkor is protein deficiency with adequate energy intake whereas
marasmus is inadequate energy intake in all forms, including protein . Protein wasting in

6
kwashiorkor generally leads to edema, while muscular wasting and loss of subcutaneous fat are the
main clinical sign of marasmus.

● Symptoms:
1. Weight loss
2. Dehydration
3. Chronic diarrhea
4. Stomach shrinkage

● Marasmus Kwashiorkor: Marasmus kwashiorkor is caused by acute or chronic protein

deficiency and chronic energy deficit and is characterized by edema, wasting, stunting and mild
hepatomegaly. The distinction between kwashiorkor and marasmus is frequently blurred and
mainly children present with features of both condition.

● Symptoms :
1. Loss of apetite

7
 2. Lack of energy
3. Irritability
4. change in hair color to yellow or orange

● Clinical sign symptoms of Vitamin A deficiency:

Vitamin A deficiency can result from inadequate intake ,fat malnutrition , or liver disorders.
Deficiency impair immunity and hematopoiesis and causes rashes and typical ocular effects.
● Symptoms :
1. Xerophthalmia
2. Night blindness
3. Bitot’s Spot
4. Conjunctival Xerosis

Xerophthalmia Night blindness

● Clinical sign symptoms of Vitamin D deficiency:

Vitamin D deficiency can lead to a loss of bone density , which can contribute to osteoporosis and
fractures. Severe vitamin D deficiency can also lead to other diseases. In children it can cause
rickets. Rickets is a rare disease that causes the bones to become soft and bend. In adults, severe
vitamin D deficiency leads to osteomalacia causes weak bones, bone pain and muscle weakness.

● Symptoms:
1. Getting sick or infected often
2. Fatigue and tiredness

8
 3. Bone and Back pain
4. Depression
5. Impaired Wound Healing
6. Bone Loss
7. Hair loss
8. Muscle pain

● Clinical sign symptoms of vitamin E deficiency:

Vitamin E is as important vitamin that our bodies need to function properly. Vitamin E is found in
many foods and most people who eat a healthy died get plenty of vitamin E in their bodies. When
people do not have enough vitamin E for their bodies to function properly, they are vitmin E
deficiency and many require treatment.

9
● Symptoms:
1. Muscle weakness
2. Numbness and tingling
3. Vision deterioration
4. Immune system problems.

● Clinical sign symptoms of vitamin k deficiency:

Vitamin K deficiency

● Symptoms of vitamin K deficiency:

1. Bruising from bleeding into the skin
2. Nosebleeds
3. Bleeding in stomach
4. Bleeding in gums
5. Blood in urine
6. Blood stool
7. Tarry black stool.

10
 8. Extremely heavy menstrual bleeding
9. In infants may result in intracranial hemorrhage

● Clinical sign of symptoms of vitamin B deficiency:

Pernicious anemia: Atrophic gastritis is which your stomach lining has thinned. Pernicious anemia
which make it hard for your body to absorb vitamin B 12 . Conditions that affect your small
intestine such as Crohn’s disease, celiac disease, bacterial growth, or a parasite.

● Symptoms:
1. Vomiting
2. Heartburn
3. Abdominal bloating and gas
4. Constipation or diarrhea.
5. Loss of appetite
6. Weight loss

● Microcytic anemia : Vitamin B 6 deficiency is associated with microcytic anemia, dermatitis

with cheilosis( scaling on the lips and cracks at the corners of the mouth) and swollen tongue,
depression and confusion and weakened immune function.

---

11
● Symptoms:
1. Fatigue, weakness and tiredness
2. Loss of stomina
3. shortness of breath
4. Dizziness
5. Pale skin

● Clinical sign symptoms of Vitamin c deficiency:

● Scurvy: Scurvy is as uncommon but still encountered condition that has been reported in children
with developmental or behavioral disorder ( autism) who consume restricted diets deficiency in
vitamin c or those suffering from severe neglect.

● Symptoms:
1. Swelling and bleeding of the gums
2. Often sick
3. Easily bruised and bleeding
4. Poor wound healing
5. Pain and swelling of the joint
6. Hair and tooth loss
7. Small bleeding under nails
8. Fatigue
9. Dry, pale skin
10. Difficulty breathing.
11. Difficulty swallowing
12. Dizziness when the arms are raised above the head
13. Neck vein swelling

12
● Clinical sign symptoms of Iron deficiency:
Iron deficiency in one of the most common causes of anemia. Anemia is a condition that develops
when your blood lacks enough health red blood cells or hemoglobin. Hemoglobin is a main part of
red blood cells and binds oxygen. It you have two few or abnormal red blood cells, or your
hemoglobin is abnormal or low, the cells in your body will not get enough oxygen.

● Clinical sign symptoms of Iodine deficiency:

Iodine deficiency is a lack of the trace element iodine, an essential nutrient in the diet. It may result
in a goiter. A goiter is an abnormal enlargement of the thyroid gland, which is a butterfly shaped
organ located at the base of your neck.

● Symptoms of Goiter:
1. Swelling at the base of the neck.
2. A tight feeling in the threat
3. Coughing
4. Difficulty breathing.

13
 5. Difficulty swallowing
6. Dizziness when the arms are raised above the head.
7. Neck vein swelling.

● Clinical sign symptoms of Essential Fatty Acid deficiency:

● Symptoms:
1. Dermatitis.
2. Fatty liver
3. Hair loss
4. Biochemical indications
5. Death

14
Experiment No. 03:
Name of Experiment : Eye estimation of food weight & match by weighting in balance.

The basic misconception about food is that we crave for the food which our body needs. We very
often hear ‘Let him eat it (whatever food he likes most). If he likes it so much, maybe he needs it
mores.’

Human beings are considered to be the most advanced when their intelligence is compared to that of
animals, but as far as food selection is concerned, man does not retain this position. Food is the
basic necessary of life. Food supply energy to the body, build and repair body tissue and regulate
body processes. But we can not intake food as much as we want. Rather we should intake a
balanced diet-a diet which contains all the nutrients in the right amounts as required by an
individual’s body needs.

To maintain good nutritional status, we should have good knowledge about the recommended
dietary allowances of different nutrients.

When we eat food, it is not always possible to weight the food. Hence, eye estimation is very
important to measure food intake. At first, we will estimate the weight of the food to be measured
and record it. Then we will measure the actual weight by kitchen scale and then get the difference
between estimated and actual weight. Here our task is to estimate food from every food group.

● Some factor to remember:

1. Observe the size, shape and structure of food very carefully.
2. Write a fixed number from eye estimation. Don’t overwrite the estimated number.
3. Every time measuring by the kitchen scale, adjust the pointer to zero.
4. Take the measurement when the point become still.
5. We can check the balance scale by measuring some known weight.
6. The holder used for measuring liquid or semi-solid food is measured separately. This
weight is deducted after measuring the food item.
7. Take proper household measurements of food. For example-1 table spoon should contain
15 gm,1 tea spoon = 5gm,1 glass should contain 249 ml of milk or water.

● Table no 1: Comparison between Eye estimation & Balance weight of carbohydrates such as
cereals, bead, rice etc.

Name of food Household Eye estimation Balance weight Difference(gm)

measurement (gm) (gm)
Rice 1 cup 150 180 30
Cooked Rice 1 cup 120 180 60
White Atta 1 cup 100 140 40

15
 Brown Atta 1 cup 100 130 20
Ruti (small) 1 piece 30 30 0
Ruti(medium) 1 piece 70 50 10
Ruti(big) 1 piece 70 90 20

● Table no 2: Comparison between Eye estimation & Balance weight of protein such as fish,
meat, egg etc.

Name of food Household Eye estimation Balance weight Difference

Measurement (gm) (gm) (gm)
Rui fish (belly loin) 1 piece 50 70 20
Rui fish (back loin) 1 piece 50 100 50
Chicken(drumstick) 1 piece 70 90 20
Chicken(breast) 1 piece 70 90 20
Cooked Chicken 1 piece 70 50 20
(drumstick)
Cooked Chicken 1 piece 60 40 20
(Breast)
Egg 1 piece 50 50 0
Boiled egg 1 piece 60 50 10

● Table no 3: Comparison between Eye estimation & Balance weight of spices.

Name of food Household Eye estimation Balance weight Difference

Measurement (gm) (gm) (gm)
Onion 1 piece 20 25 5
Garlic 1 piece 40 40 0
Ginger 1 piece 25 15 10

● Table no 4: Comparison between Eye estimation & Balance weight of vegetable.

Name of food Household Eye estimation Balance weight Difference

Measurement (gm) (gm) (gm)
Pumpkin 1 cup 150 130 20
Cooked pumpkin 1 cup 120 130 10
Potato 1 cup 130 130 0
Carrot 1 cup 120 135 15
Spinach 1 cup 50 60 10

16
 Cooked spinach 1 cup 120 160 40
Gourd 1 cup 120 130 10
Cooked gourd 1 cup 100 140 40

● Table no 5: Comparison between Eye estimation & Balance weight of pulses.

Name of food Household Eye estimation Balance weight Difference

Measurement (gm) (gm) (gm)
Mugi pulse 1 cup 200 200 0
Boiled Mugi pulse 1 cup 200 170 30
Lentils 1 cup 200 210 10
Boiled Lentils 1 cup 200 140 60
Channa pulse 1 cup 180 180 0

17
Experiment No. 05:
Name of Experiment: Use of the food exchange list.

● Food Exchange List: An exchange list can be defined as a list which contains a group of the
foods n specified amounts, which have approximately equal carbohydrate , protein and fat values.
This doesn’t mean that the the values of two foods within the groups are identical. There will be
some differences in their values but these tend to nullify each other because of the variety of foods
that are selected by the patient from within the group day to day. Hence any food from the given
exchange list can be substituted or exchanged for any other food in that list. In the fruits list. E.g.
one small mange can be substituted for one medium wheat lime or four tomatoes.

● The Food Lists: The following chart should the amount of nutrients in 1 serving from each list.

Food List Carbohydrate Protein Fat Calories

(gm) (gm) (gm)
Carbohydrates: 14 0-3 0-1 80
Starch: breads, cereals and
grains, starchy vegetables,
crackers, snacks, beans and
peas and lentils.

Fruits 15 60
Milk 12 8 0-3 100
fat free, low fat, 1% educed 12 8 5 120
fat, 12 8 8 160
2% whole
Sweets, Desserts and other 15 varies varies varies
carbohydrates
Meat and meat
substitutes:

Lean 7 0-3 45
Medium fat 7 4-7 75
High Fat 7 8 100
Plant based protein varies 7 varies varies

Fats 5 45
Alcohol varies 100

18
● Bread :

Food Serving Size

Bagel,large (about 40z) 1
(10z)
4
1 1
Biscuit, 2 inches across
2
Bread reduced calorie 1
2 slices ( 1 0z)
white, whole – grain, pumpernickel , rye. 2
Unfrosted raisin 1 slice (10z)
Chapatti ,small 6 inches across 1
3 1
Cornbread , 1 inch cube 1( 1 0z )
4 2
English muffin 1
2
Hot dog bun or hum burger bun 1
(1 0z)
2
Naan, 8 inches by 2 inches 1
4
1 1
Pan cake , 4 inches across, inch thick
4
Pita ,6 inches across 1
2
Roll, plain, small 1(10z)
Stuffing, bread 1
cup
3
Taco shell, 5 inches across 2
Tortilla, corn, 6 inches across 1
Tortilla, flour, 6 inches across 1

● Cereals and Grains:

Food Serving Size

Barley , Cooked 1
cup
2
1
Bran, dry cup
2

19
 1
oat cup
2
wheat

Bulgar (cooked) 1
cup
2
1
Cereals Cup
2
bran 1
cup
Cooked( oats, oat meal) 2
1
puffed cup
2
Sugar – coated 1
cup
2
unsweetened, ready, to-eat 1
cup
2

Pumpkin, Canned no sugar added 1 cup

1
pasta sauce cup
2
sweat potato 1
cup
2

● Crackers and Snacks

Food Serving Size

Animal crackers 8
Crackers-
round butter type 6
6
saltine type 3
sandwich style, cheese or peanut 3
2-5 ( 0z)
4
whole- wheat regular 3
2-5 ( 0z)
whole- wheat lower fat 4

Melba toast, about 2-inch by 4-inch piece 4 pieces

Oyster crackers 20
Rice cakes, 4 inches across
2
1
Graham cracker, 2 inch square 3
2

Popcorn 3 cups

20
 3 cups
with butter 3 cups
not fat added 3 cups
lower fat

Granola 1
cup
low-fat 4
regular 1
cup
4

1
Kasha Cup
2
1
Millet, Cooked Cup
3
1
Pasta, Cooked cup
3
Rice, white or brown, cooked 1
cup
3
wheat germ, dry 3 tbsp
1
wild rice, cooked cup
2

● Starchy vegetables :

Food Serving Size

Corn
on cob, large
Mixed vegetables with corn, peas or pasta
Peas, green
Plantain, ripe
1
Potato Large (3 0z)
4
baked with skin 1
Boiled , all kinds 1 1
cup or medium (3 0z)
2 2
mashed, with milk and fat 1
cup
french fried (over-baked) 2
1 cup ( 2 0z)

21
Experiment No. 07:
Name of Experiment: Planning of diet of different physiological condition.

Case 01:

A 52 years old government worker(man), whose weight is 71 kg and height 5’7’’. He is a diabetic
and CVD (cardiovascular disease) patient. Now determine-

1. Patient’s BMI, IBW, EBW and daily calorie requirement.

2. As a nutritionist, give dietary guideline for him.

● BMI calculation:
Height=5 '7 ' '=67 ''=(67×2.54 )cm=170.18 cm=1.7018 m( 2.896 m 2)

weight = 71kg

71
BMI= =24.52
2.896

● IBW calculation:
2
IBW=BMI middle point (20.75)timesheight(m )=(20.75×2.896)kg=60.1 kg

● IBW calculation:
2
Lower rangeof EBW=lower limit of BMI ∈normal range(18.5)×height(m )=18.5×2.896=53.58
2
Upper range of EBW=upper limit of BMI∈normal range(23)×height (m )=23×2.896=66.6

● Calorie calculation:

IBW×PAL=(60.1×30)kcal=1803 kcal

● Dietary guideline:
1. Patient should have heart healthy foods that help to reduce blood pressure, overall
cholesterol, LDL (bad) cholesterol, triglycerides, and fasting blood sugar. In general, heart
healthy means low in sodium, low in cholesterol, high in fiber, low in saturated fats, free of
Trans fat and high in antioxidants, vitamins, and minerals.
2. Incorporate leafy greens like spinach, kale, lettuce etc in your diet. Nuts are high in heart-
healthy fats, vitamins and minerals. Add walnuts, pecans, peanuts,almonds to your deit.
3. Consider replacing saturated and trans fats with healthier unsaturated fats (omega-3 and
omega-6 fatty acids), such as olive oil.

22
 4. For snacking, choose low-fat yogurt and cottage cheese over full-fat options. Try to avoid
flavored or sweetened yogurt, as these often contain a great amount of sugar. Opt for plain
yogurt instead.
5. Omit simple sugar from diet. Consider purchasing whole-grains, whole grains are higher in
fiber. They may help reduce cholesterol, lower your blood pressure, and decrease your
overall risk of heart disease. Oatmeal makes for a great breakfast.
6. Red,yellow, and orange vegetables like carrots, sweet potatoes, peppers, and squash are
packed with antioxidants and vitamins and so include in your menu list.
7. Beans, lentils , and chickpeas are high in fiber and have a low glycemic index.
8. Herbs and spices give your food flavor without adding unhealthy levels of sodium. A low-
sodium diet is important to keep your blood pressure in check. Ideally ,aim for no more than
1500 mg of sodium per day.

Another popular spice, cinnamon, has been shown to increase insulin sensitivity and reduce blood
sugar.

Case 02:

A 60 years old university teacher(man), whose weight is 70 kg and height 5’5’’. He is suffering
from diabetes, hypertension and hyperlipidemia. Under the circumstances determine-

3. Patient’s BMI, IBW, EBW and daily calorie requirement.

4. Plan a 24 hour menu for the patient with distribution of macro nutrients.

● BMI calculation:
2
Height=5 '5 ' '=65 ' '=(65×2.54)cm=165.1 cm=1.6518 m (2.7258 m )

weight = 60kg

60
BMI= =25.68(overweight )
2.7258

● IBW calculation:
2
IBW=BMI middle point (20.75) timesheight(m )=(20.75×2.7258)kg=56.56 kg

● IBW calculation:

Lower rangeof EBW=lower limit of BMI ∈normal range(18.5)×height(m 2)=18.5×2.7258=50.43

Upper range of EBW=upper limit of BMI∈normal range(23)×height (m 2)=23×2.7258=62.7

23
● Calorie calculation:
IBW×PAL=(56.56×30)kcal=1696.8 1700 kcal

As the patient is a sedentary worker and also overweight person, he should not be provided with
1700 kcal. Rather he should have a 300 kcal deducted calorie intake that means to plan a 1400 kcal
diet for him.

● Calorie distribution:

Name of nutrients % of calorie from Total calorie Amount

nutrients (kcal) (gm)
Carbohydrate 65 910 227.5
Protein 20 280 70
Fat 15 210 23.33

(65×1400) 910
Carbohydrate: kcal=910 kcal= =227.5 gm
100 4

(20×1400) 280
Protein: kcal=280 kcal= =70 gm
100 4

(15×1400) 210
Fat: kcal=210 kcal= =23.33 gm
100 9

List of the No. of CHO Protein Fat Amount of Calories

food serving (gm) (gm) (gm) food (kcal)
(gm)
Cereals 6 120 12 7.8 344 600
Meat+fish+e 2 0 24 8 135 170
gg
Pulses 1 17 7 0.7 30 100
Milk 1 8 5 5 150 ml 100
Vegetables 3 30 7.5 0 300 150
Fruits 2 20 2 0 120 100
Oil 1.33 0 0 20 20 180
Total 195 57.5 41.5 1400

24
Required calorie: 1400 kcal,
type of diet: simple CHO restricted, Na, saturated fat and animal protein moderate.

Meal Plan:

Time Food stuff Household Measurement Weight

(gm)
BreakFast Pineapple 1 90
1 slices(round)
2
Toast (brown) 2 slices 40
Butter 1 tsp 5
Egg 1 no 50
Green tea 1 cup 150 ml
Mid-morning Chira 3 30
cup
4
Lunch Rice (cooked) 2 cups 200
Chicken curry 1 pc 85
Dal 1 cup 150 ml
Mixed vegetables 1 100
cup
2
Snack Comflakes 1 30
cup
Milk 2 150ml
Dinner Roti (brown atta) 1 pcs 100
Mixed vegetables 1 100
cup
2
Salad 1 cup 100
(lettuce + cucumber
+ tomato)
Bed time dates 3 no 30
Cooking oil Soybean oil 1 tbsp 15

Case 03:

A 31 years old school teacher(woman), whose weight is 57 kg and height 5’1’’. She is pregnant and
suffering from GDM. Under the circumstances determine-

5. Patient’s BMI, IBW, EBW and daily calorie requirement.

6. Plan a 24 hour menu for the patient with calorie distribution.

25
● BMI calculation:

Height=5 '1 ' '=61 ' '=(61×2.54)cm=154.94 cm=1.5494 m(2.4 m 2)

weight = 57kg

57
BMI= =23.78(normal)
2.4

● IBW calculation:

IBW=BMI middle point (20.75)×height( m 2)=(20.75×2.4) kg=49.8 kg

● IBW calculation:
2
Lower rangeof EBW=lower limit of BMI ∈normal range(18.5)×height(m )=18.5×2.4=44.4
2
Upper range of EBW=upper limit of BMI∈normal range(23)×height (m )=23×2.4=55.2 kg

● Calorie calculation:
IBW×PAL=( 49.8×30)kcal=1494 1500 kcal
As the patient in 2nd trimester (GDM occur in 2nd trimester) and her weight is less than
normal, she should have a 300 kcal increased diet that means to plan a (1500 +300) kcal or 1800
kcal diet for her.

● Calorie distribution:

Name of nutrients % of calorie from Total calorie Amount

nutrients (kcal) (gm)
Carbohydrate 50 900 225
Protein 25 450 112.5
Fat 25 450 50

(50×1800) 900
Carbohydrate: kcal=900 kcal= =225 gm
100 4

(25×1800) 450
Protein: kcal=450 kcal= =112.5 gm
100 4

(25×1800) 450
Fat: kcal=450 kcal= =50 gm
100 9

26
 List of the No. of CHO Protein Fat Amount of Calories
food serving (gm) (gm) (gm) food (kcal)
(gm)
Cereals 7.5 150 15 9.75 450 750
Meat+fish+e 3 0 38 13 200 270
gg
Pulses 1 17 7 0.7 30 100
Milk 2 6 10 4 235 ml 200
Vegetables 4.5 45 11.25 0 550 225
Fruits 2 20 2 0 80-160 100
Oil 1 0 0 15 15 135
Total 238 83.25 42.45 1780

Required calorie: 1800 kcal,

type of diet: simple CHO restricted, Na, saturated fat and animal protein moderate.

Meal Plan:

Time Food stuff Household Measurement Weight

(gm)
BreakFast Paratha 1 pc 120
Mixed vegetables 1 cup 200
(French beans +
pumpkin + papaya)
Egg 1 no 50
Low-fat milk 1 cup 150 ml
Mid-morning Fruit(guava) 1 small 80
Lunch Rice (cooked) 2 cups 200
Fish 1 pc 85
Dal 1 cup 150 ml
Salad 1 cup 100
(cucumber + tomato
+ onions)
Fruit (pomegranate) 1 cup 80
Curd (without sugar) 1 80
cup
2
Snack Noodles 1 cup 15(raw)

27
 Dinner Tandoor Roti 1 pc 85
Grilled chicken 1 pc 85
Cucumber raita 1 cup 150
Salad 1 cup 100

Bed time Cornflakes + milk 1 30+75 ml

cup
2
Cooking oil Soybean oil 1 tbsp 135

28