WELL COME
TO
Diet Therapy & Meal
Planning
• In the late 18th century, Lavoisier began
studies in nutrition. He studied the role of
respiration in metabolism of food. He is c
alled “the father of nutrition science.”
• Other important scientists who made valu
able contributions to the study of nutrition
were- Lusk, Atwater, McCollum, Benedict
, Rose and Rubner.
Dietetics
Dietetics is the subjects which deals wit
h general diet menu designed for indivi
dual (infant, children, adolescent, adult,
pregnant, lactation, old age) who requir
e normal diet and who require extensiv
e modified diet (therapeutic diet).
Dietitian
Dietitian is a person who plans and supervises th
e preparation of therapeutic or other diets for ind
ividuals or groups in hospitals, institutions, other
establishments and for workers in particular sect
ors, gives instructions in selection and proper pr
eparation of food according to dietetic principles,
performs duties related to nutrition programmes
and may be responsible for food purchasing on
behalf of an organization or establishment.
Registered dietitian
A registered dietitian (RD) is a person
who has been extensively trained and
certified as an expert in all things deal
ing with dietetics, food and nutrition. T
hey educate on proper nutrition as we
ll as oversee diet programs and food
preparation.
Types of a dietitian
General dietitian
They promote healthy eating habits and diet
ary modifications that help prevent and treat
certain illnesses. On a large scale dietitians
work for hospitals, schools and other instituti
ons, managing food services. They educate
the community on the healthy eating habits
and conduct research.
Clinical dietitian
• Clinical dietitian works in hospitals, nursing care
facilities and institutions. They work with doctors
and health workers to develop nutrition program
s the patients needs. The Clinical dietitians evalu
ate the results for effectiveness. If a patient has
high blood pressure a Clinical dietitian explains
how to cut down Na from the diet, for example.
Clinical dietitians can specialize in diabetes, weig
ht management, renal diseases or critically ill pat
ient care.
Consultant dietitian
• A consultant dietitians screen clients for their nutritional n
eeds and advice necessary changes. People go to cons
ultant dietitians with a goal, weight loss or lower blood pr
essure and get diet plans to achieve the goal. Consultant
dietitians can work with health care facilities, in their own
private practice, for wellness programs, sports team, or n
utrition related organizations.
Community dietitian
• Community dietitians work with individuals or groups, pro
moting disease preventions and healthy eating. They oft
en work public health clinics, health maintenance organiz
ations and home health agencies. They evaluate individu
als’ needs and create nutritional plans accordingly. They
instruct children, the elderly, and pupil with special needs
how to grocery shop and prepare food, as well.
Role of Dietitian
The roles of a dietitian are numerous. After proper nutritional assessmen
t is measured, a detailed report is written in the individuals or patient’s r
ecords. Specific order sheets must be collected in the patient’s records.
Follow up evaluations are done including clinical and biochemical monit
oring. Intolerance to feeding regimens and early detection of potential c
omplications are immediately brought to the attention to the physician. T
he major roles of a renowned dietitian are as follows:
 Dietitian has an important role to prepare modification diseases diet esp


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ecially planning the diet of a convalescing patient.
He/ She plans a healthy diet chart as per the doctor’s diet prescription.
Prepare the patient mentally to accept the modified diet.
Plan the diet and make it more appetizing and appealing.
Enlightens and motivates the patient as per the needs regarding the tec
hnical and scientific aspects governing the diet.
Scope of nutrition and dietetics
• Dieticians in hospitals, nursing homes and multispecialty clinics.
• Food service managers in food service institutions, airline, caterin
•
•
•
•
•
•
•
•
g, star hotels and other catering agencies.
Nutritionist in community, companies and private organizations.
Resource person to conduct nutrition programmes in villages.
Nutrition counselors in Non-Govermental Organizations (NGOs)
Research Scientist/expert in research and development centers li
ke National Institute of Nutrition (NIN), Indian Dietetic Association
(IDA), Indian Council of Agricultural Research (I.C.A.R.) and Cent
ral Food Technological Research Institutes (C.F.T.R.I.)
Recruitment as Nutritionists and Quality Assurance Executives in
multi-national companies.
Recruitment as Academicians.
Entrepreneurs in different sectors related to health, diet, and food.
Food Writer and Critics.
.
.
Diet therapy
• Diet Therapy is the use of food in the treatment
of a disease. This is accomplished by changin
g the patient’s normal diet in order to meet th
e altered requirements resulting from diseases
or injury.
• Therapeutic diets are normally prescribed by th
e doctor attending the patient in a hospital.
Objectives/ Purposes of Diet T
herapy
The objectives of diet therapy are as follows:
• To increase or decrease body weight
• To maintain a state of positive health and good nutritio
•
•
•
•
nal status
To ensure adequate nutrition for all age groups and ph
ysiological conditions
To correct nutrient deficiency that may occur
To prevent chronic degenerative processes and diseas
es
To adjust food intake to the body’s ability to metabolize
the nutrient e.g. carbohydrate modifications in diabetes
mellitus .
Classification of Therapeutic D
iet
According to function, therapeutic diet is classifie
d into four group:
• Primary Therapy: Here diet is the only way to treat th
e diseases. In case of non insulin dependent diabetes
mellitus (NIDDM), the macronutrients mainly carbohydr
ate modification is needed. Primary diet therapy is also
used in non-complicated obesity, inherent metabolic di
seases (Galactosemia, Lactose intolerance), Vitamin A
deficiency, Iron deficiency anemia, IDD and other nutrit
ional deficiencies.
• Integral Therapy: It is used in conjunction with therap
eutic agents. i.e. here both diet and medicine is require
d , e.g. atherosclerosis, insulin dependent diabetes me
llitus (IDDM).
• Adjunct Therapy: Here diet helps but no
t an integral part, e.g. in case of hyperten
sion, sodium may be restricted, but medic
ine is must. In the ulcer patients, irritating
foods should be avoids but medicine is es
sential.
• Supportive Therapy: Medical treatment i
s the only way to treat the disease, but a
good diet helps to recovery fast, e.g. bon
e fracture, surgery diet.
Signs of good nutritional status
• Shiny hair, smooth skin, clear eyes and alert exp
•
•
•
•
ression and firm flesh on well-developed structur
e.
Correct weight in relation to his height.
Physical and mental responses should be norma
l.
Good stamina and resistance to diseases.
Regular sleep and elimination habits.
Signs of poor nutritional status
 Apathetic attitude in general towards life.
 poor physique, very little stamina, dull lifel
ess hair, dull eyes, slumped posture, fatigu
e and depression.
 Overweight or underweight.
 Diet, sleep and elimination habits are irreg
ular.
 Clinical symptoms of nutritional deficiencie
s may be present but may not exhibit any
symptoms.
Guidelines for good health
•
•
•
•
•
•
•
Maintain regularity in your routine.
Eat as much natural foods as you can.
Consume seasonal foods as far as possible.
Eat well but do not ‘overeat’.
Avoid excessive salt and spices.
Avoid too much sweets, specially sugar.
Eat foods which contain carbohydrates, especially
starch and fibre.
• Avoid foods that contain large amounts of cholester
ol and saturated fats.
• Watch your weight and maintain ideal weight.
• Avoid eating the same kind of foods all the time an
d eat a variety of foods.
Reference Man
• Reference man is between 20-39 years of age
and weighs 55 kg. He is free from diseases an
d physically fit for active work. On each workin
g day he is employed for eight hours in occupa
tion that usually involves moderate activity. Wh
ile not at work he spends eight hours in bed, 46 hours sitting and moving around and two hou
rs in walking and in active recreation or in hous
e hold duties.
Reference Woman
• Reference woman is between 20-39 years of a
ge, healthy and weighs 45 kg. She may be eng
aged for eight hours in general household work
, in light industry or in other moderately active
work. Apart from eight hours in bed, she spend
s 4-6 hours sitting or moving around only throu
gh light activity and two hours in walking or in a
ctive recreation or in household duties.
Meal
planninig
Balanced Diet
• A diet, which provides all the essential nutrien
ts in sufficient quantities to meet our needs, is
called an adequate or balanced diet. We ne
ed a plan to select a balanced diet so simple
and attractive that everyone can understand
and follow it.
• This practical plan, known as a food guide, he
lps to ensure good nutrition through proper fo
od selection.
What is meal planning?
• Meal planning involves deciding what to eat pe
r day at each meal. It takes thought, effort and
use of knowledge about nutrition.
• We need to plan the meals to ensure that the n
eeds of each family member are met. The plan
can be flexible to take advantage of lower price
s of seasonal foods and to meet the needs and
choices of the family.
• Meal planning should involve- Planning, Purch
asing, Preparation and Serving.
Objectives in meal planning
• To satisfy the nutritional needs of the family me
•
•
•
•
mbers, according to their age and occupation.
Keep expenditure within the family’s food bud
get.
To decide amounts of foods to be purchased fr
om each food group.
To consider family size and composition.
To consider food storage space and conditions
of storage, to decide how often we need to purc
hase various foods.
•
•
•
•
In order to translate the meal plan into meals that meet the famil
y’s need, the following additional steps have to be takenPrepare a food purchases list, taking the food preferences of me
mbers into account.
Use methods of preparation, which retain nutrients, without sacri
ficing palatability.
Serve meals, which are appetizing and attractive and fit in the sc
hedule of the members.
Manage the time, energy and available materials efficiently, with
the help of the family members.
If we make a weekly plan for all meals, we can save time, energ
y and money. It will also help us to avoid monotonous meals.
Which factors should be consid
ered in diet prescription?
a) Dietetic history:
• Economic status: The economic status of the patient is an
important practical consideration in formulating a diet prescr
iption. During an acute illness or convalescence a few expe
nsive items may be permissible, but for more prolonged or c
hronic illnesses, foods must be within the means of the pati
ent.
• Vegetarian or non-vegetarian: Whether the patient is a ve
getarian or not must be known. If vegetarian, then the ‘degr
ee’ of vegetarian should be assessed; for example, vegans
do not eat even eggs or dairy products, ‘egg vegetarians’ ea
t eggs and fish but not animal flesh; and ‘home vegetarians’
are vegetarian at home, for family reasons, but relish meat
or chicken at a restaurant or party.
• Food intolerance: The dietetic history should elicit wh
ether a patient can tolerate all foods: especially milk, p
ulses, spices, egg, meat, fish and prawn. Milk may pro
duce diarrhea in some and constipation in others; thos
e with colonic disorders are likely to get flatulence with
pulses. Such foods should be restricted or excluded as
necessary.
• Depending on the diseases, certain foods may have to
be excluded. In peptic ulcer and gastritis, spices and c
hillies are not permitted. For a patient confined to bed,
fried foods and pulses are best avoided as they produc
e flatulence.
• Allergy: Allergy to food manifests as urticaria,
abdominal cramps, or bleeding. The common
allergens are shellfish and egg, and these hav
e to be excluded.
• Occupation and time of meals: The occupati
on of the patient and the time he takes his mea
ls have to be noted. A mill-worker who works o
n different shifts requires more detailed instruct
ions for a peptic ulcer diet than a clerk whose h
ours of work are fixed.
b) Calorie Requirement:
• A person confined to bed tends to consume less calories than a
person undergoing physical exertion. Bed-rest also decreases
appetite. For an average adult confined to bed, about 1400-160
0 kcal may be adequate. Fever increases the calorie needs.
• A diet high in calories is indicated for undernourished or conval
escent patients. They are advised to take more cereals, butter
and oils at the main meals and snacks of milk, sandwiches or bi
scuits at mid-morning, mid-evening and before retiring.
• A low calorie diet is indicated for all obese patients. A diet consi
sting of raw and cooked vegetables, fruits, eggs, meat, fish, chi
cken and skimmed milk, with a low intake of cereals provides b
ulk, satiety, adequate proteins and relatively few calories. Avoid
ing fat reduces weight.
c) Protein Requirement:
• Total intake of proteins is usually adequate in a
standard non-vegetarian diet. For vegetarians, t
he important sources of proteins are milk, cere
als and pulses. In diseases of the colon, whole
milk usually produces diarrhea while pulses pro
duce flatulence. The protein requirements of ve
getarians with colonic diseases can only be me
t by providing commercial protein foods, or by s
upplying skimmed milk powder which is usually
more easily digested than fresh milk.
Cirrhosis, nephritic syndrome, pregnancy a
nd lactation:
• A high protein diet is prescribed to patients with low ser
um albumin, as in liver cirrhosis without liver failure and
in the nephritic syndrome. It is also advisable to increas
e the protein intake during pregnancy and lactation. For
a non-vegetarian, this can be done by increasing the qu
antity of meat, chicken, fish or egg. For the vegetarian,
extra skimmed milk, cottage cheese, and pulses are ad
vised. All pulses, including gram (Bengal gram) and gro
undnut, are relatively inexpensive and palatable protein
-rich foods.
Liver and kidney failure:
• During hepatic coma or uremia, protein has to
be withheld temporarily and carbohydrate rich
foods like fruit juice, banana, sugar cane juice
and lemonade with sugar, honey or jiggery ar
e advised.
d) Fat Requirement:
• Fats are a convenient source of calories. Fats are not as i
ndispensable as proteins, though prolonged deficiency of
essential fatty acids leads to skin changes. A high-calorie
diet should contain fatty foods like cream, butter, ghee an
d oil and fats should be freely used in cooking. A low-calor
ie diet contains little fat.
e) Carbohydrate Requirement:
• Carbohydrates provide bulk and together with fats, form th
e chief sources of calories. If a high-calorie diet is to be pr
escribed, carbohydrates in the form of chapattis, bread an
d biscuits provide comparatively inexpensive nourishing fo
ods. For a low-calorie diet they are used sparingly.
f) Vitamin Requirement:
The best sources of vitamins are liver, yeast, w
hole grain cereals and fruits. Vitamin A is deriv
ed from egg, milk and butter, while carrots and
green vegetables provide the pro-vitamin A, car
otene. Vitamin B-complex is derived from unrefi
ned cereals and flesh foods. The best sources
of vitamin-C are fresh fruits, vegetables and ger
minating cereals. Vitamin-D can be easily acqui
red by exposure of skin to the sun for about hal
f an hour.
g) Mineral Requirement:
Calcium is available from milk. The usual diet is seldo
m deficient in phosphorus. Iron is available from cereal
s, liver, kidney and egg. Sodium is easily provided by c
ommon salt added to food. A low sodium diet may hav
e to be prescribed during fluid retention, cardiac failure
, or the nephritic syndrome. The potassium intake can
be increased with vegetables and fruits. A low potassiu
m intake is advisable for patients with kidney failure.
h) Fluid Requirement:
• Inadequate fluid intake can lead to constipation.
Fluid intake should be liberal enough to ensure t
he passage of 1500-2000 ml of light-colored uri
ne per day.
• Fluids need to be restricted when excretion is i
mpaired, as in acute nephritis and kidney failure
. The water requirement per day is then calculat
ed as: 1000 ml a day to replace the insensible l
oss in respiration and perspiration, plus the volu
me of urine passed during the previous 24 hour
s.
Reference Books
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Human Nutrition and Applied Dietetics----A.K. Obidul Huq
Dietetics--- Srilakhsmi
Nutrition and Diet Therapy-Lutz & Przytulski
Bio-nutrition-S. Paul
Nutrition and Dietetics ------ Shubhangini A. Joshi
Fundamentals of Foods, Nutrition and Diet Therapy - S.R.
Mudambi ; M.V.Rajagopal
 Clinical Dietetics and Nutrition--- F.P. Antia
 Food and Nutrition--- Swaminathan; Vol-I & II
 Diet Manual; Nutritionist-Dietitian’s association of the Phi
lippines; 4th edition; October 1994
Estimation of Desirable Body Weig
ht (DBW)
•
Infant:
•
6-months old infants
10-months old infants
7-months old infants
DBW (kg)= (6÷2) + 3 =3+3= 6 kg DBW (kg)= (10÷2)+3=5+3= 8 kg
DBW (kg)= (7÷2)+3 =3.5+3= 6.5 kg or 7 kg
N.B: [Infant weight will be- Doubled at 5-6 months, Tripled at 12 months, Quadrupled at 24 months] (If birth w
t is not know, use 3 kg or 3000 g)
•
Height or Length:
DBW (kg) = (Age in months ÷ 2) + 3
At birth : 50 cm
At 1 year : (--) + 24 cm
At 2 year : (--) + 12 cm
At 3 year : (--) + 8 cm
At 4-8 year : (--) + 6 cm
•
Children:
DBW (kg) = (Age in years x 2) + 8
6-years old child
DBW (kg) = (6x2) + 8
=12+8 = 20 kg
•
Example
50 cm
50 + 24 = 74 cm
74 + 12 = 86 cm
86 + 8 = 94 cm
94 + 6 = 100 cm
N.B: [ +2 for every year]
8-years old child
DBW (kg) = (8x2) + 8
=16 + 8 = 24 kg
10-years old child
DBW (kg) = (10x2) + 8
=20+8 = 28 kg
2-years old child
DBW (kg) = (2x2) + 8
=4 + 8 = 12 kg
Adult:
•
Method-1: Derived formula based on BMI (Body Mass Index)
DBW (kg)= Desirable BMI x Height (m2)
Desirable BMI for men= 22
Desirable BMI for men= 20.8 or 21
Male (5’6”): DBW (kg) = 22 x 1.68 m2
= 22 x 2.82 m2
= 62 kg
•
Female (5’3”): DBW (kg) = 21 x 1.6 m2
= 21 x 2.56 m2
= 53.76 or 54 kg
Method-2: Tannhauser’s Method
DBW (kg) = (Height in cm – 100) – (10% off) ± 1
eg. Male (5’6”): DBW (kg) = (168-100) = 68 kg – 6.8 or 7 = 61 kg
DBW for male = 61+1 = 62 kg
DBW for female = 61-1 = 60 kg
Estimation of Total Calorie Require
ment (TCR) or TER/Day
Infant (1-12 months) :
4-months old child
TCR/Day = 120 kcal x 5.4 kg (DBW)
=648 or 650 kcal
TCR/Day = 120-110 kcal/ KDBW
6-months old child
TCR/Day = 120 kcal x 6 kg
=720 or 700 kcal
9-months old child
TCR/Day = 110 kcal x 7.5 kg
=825 or 850 kcal
Children (1-12 years) : TCR/Day = 1000 + (100 x age in years)
4-years old child
TCR/Day = 1000 + (100 x4) kcal/day
=1400 kcal/day
7-years old child
TCR/Day = 1000 + (100 x7)
=1700 kcal/day
11-years old child
TCR/Day = 1000 + (100 x11)
=2100 kcal/day
Adolescents (13-18 years) : TCR/Day = 45 kcal/ KDBW
(Averages both sexes)
13-15 years
16-18 years
Boys
55 kcal
Girls
45 kcal
Boys
45 kcal
Girls
40 kal
Average 45 kal/ KDBW
Example13 years old Boys (5’4”)
16 years old girls (5’2”)
TCR /Day = 45 kcal x 56 kg (DBW) TCR /Day = 45 kcal x 50 kg (DBW)
= 2520 or 2500 kcal
= 2250 kcal
18 years old boys (5’7”)
TCR /Day = 45 kcal x 63 kg
= 2835 kcal
Adult :
TCR/Day = DBW (kg) x Activity level
Activity level
Bed rest
Example of Activity
Ref: [Krause’s method]
27.5
Sedentary
30
Secretary, Clerk, Typist, Cashier, Administrator, Bank Teller etc.
Light
35
Teacher, Student, Nurse, Housewife with maids, Lab technician
Moderate
40
Housewife without maids, Vendor, Mechanic, Driver etc.
Heavy
45
Farmer, Labour, Fisherman, Heavy equipment operator etc
Example•
•
Pregnant Women : TCR/Day = Normal requirement + 300 kcal
Lactating Women : TCR/Day = Normal requirement + 500 kcal
For light activity, (DBW = 52 kg)
TCR/Day = 52 x 35
= 1820 or 1800 kcal/day
For Sedentary activity, (DBW =62 kg)
TCR/Day = 62 x 30
= 1860 or 1900 kcal/day
For Moderate activity, (DBW = 49 kg)
TCR/Day = 49 x 40
= 1960 or 2000 kcal/day
Distribution of Total Calorie Re
quirement (TCR)
Method-1: By Percentage distribution
Carbohydrate
Protein
Fat
% of TER
50-70 % or Average of 60%
Infants , children, adolescent
10 %
Adult
10-12 %
Normal adult, Moderately active adolescent 20-25 %
s, Children
Very active individuals
30-35 %
Example: 7-years old children
•
•
•
•
TER/day = 1700 kcal
CHO/day
= 1700 x 0.60 = 1020 kcal ÷ 4 = 255 g
Protein /day = 1700 x 0.10 = 170 kcal ÷ 4 = 42.5 g or 45 g
Fat /day
= 1700 x 0.30 = 510 kcal ÷ 9 = 56.6 g or 55 g
[C, P and F are rounded off to nearest 5]
• Rx Diet: 1700 kcal, C255 g P45 g F55 g
Moderately active housewife; DBW of 52 kg
•
•
•
•
TER/day = 52 x 40 = 2080 or 2100 kcal
CHO/day
= 2100 x 0.60 = 1260 kcal ÷ 4 = 315 g
Protein /day = 2100 x 0.10 = 210 kcal ÷ 4 = 52.5 g or 50 g
Fat /day
= 2100 x 0.30 = 630 kcal ÷ 9 = 70 g
• Rx Diet: 2100 kcal, C315 g P50 g F70 g
Calorie Distribution List
Exchange list Servings/
s
amount
CHO
(g)
Protein Fat
(g)
(g)
Na Kcal
(mg)
Serving Size/
day
Skim Milk
1 glass
(240 ml)
12
8
0
120
2 to 3
Protein, Ca,
(5-10% of total cal Vit-B2
orie)
Low fat milk
“
12
8
5
120
Whole milk
“
12
8
10
170
2. Vegetables
½ cup
5
2
small 9
28
3 to 8
Vit-A,C, Fol
ic acid
3. Fruits
Different
10
small
small 2
40
2 to 6
Vit-A,C; K
2
small 5
70
6 to 16 (60% of t CHO, Thia
otal calorie)
min, Niacin
Fe
1.
4. Rice, Bread a ½ cup = 25g parb 15
nd more Star oiled rice/smash
chy foods
ed potato,
1cup=20g puffe
d rice (Muri),
80
Rich
Source
Exchange lists
5.
6.
Servings/
amount
Meat, fish (Low 30
fat/lean meat)
CHO
(g)
Protein Fat
(g)
(g)
Na
(mg)
small 7
3
Meat, fish (Med 30
ium fat)
small 7
5
75
Meat, fish (High
fat)
Egg
Pulses (Low con
c.)
Pulses (Medium
conc.)
30
small 7
8
100
50
½ cup
small 6.7
3
1
90
16
½ cup
6.4
2.7
6.8 70
smal
l
smal
l
Pulses (High con ½ cup
c.)
13
5.4
smal
l
72
Fats and Oils
0
0
5
45
1 tea spoon
12.5
Kcal
55
Serving Size/
day
Rich
Source
2 to 4
Fe, Prot
(10-15% of total ein, niaci
calorie)
n, thiami
n
36
4 to 8
(20-30% of total
calorie)
Diet Prescription
Sample-1: Rx Diet: 1000 kcal, C150 g P50 g F23 g
Food Items
Servings
CHO
(g)
Proteins
(g)
Fat
(g)
Total
kcal
Milk (skim)
1
12
8
-
80
Vegetables
5
25
10
-
140
Fruits
4
40
-
-
160
Sugar
1
5
-
-
20
Pulses (low conc.)
1
3
1
-
16
Bread/Cereal
(150-85 = 65/15 = 5)
5
75
10
-
340
Egg
½
-
3.3
3.4
45
2.5=1(med)+ 1
(low fat)
-
17.5
10
160
2 tsp
-
-
10
90
-
160
49.8
23.4
1051
Meat/ Fish
(50-32.3 = 17.7/7 = 2.5)
Fats and Oils
(23-13.4 = 9.6/5 = 2)
Total=
Sample-2: Rx Diet: 1700 kcal, C255 g P45 g F55 g
Food Items
Milk (whole)
Vegetables
Fruits
Sugar
Pulses (low conc.)
Bread/Cereal
(255-85 = 170/15 = 11.3)
Egg
Meat/ Fish
(45-45.3 = 0)
Fats and Oils
(55-13.4 = 41.6/5 = 8.3)
Total=
Servings
1
5
4
1
1
11.5
CHO
(g)
12
25
40
5
3
172.5
Proteins
(g)
8
10
1
23
Fat
(g)
10
-
Total
Kcal
170
140
160
20
16
805
½
-
-
3.3
-
3.4
-
45
-
8.5 tsp
-
-
42.5
382
-
257.5
45.3
55.9
1738
Example-1:
• Nusrat (23) is a housewife and her weight is 63 kg. Rece
ntly she went to a dietitian and complain about her hyper
tension and anemia. Calculate and prepare a diet menu f
or her. (She is 149 cm long).
History: Name: Nusrat;
Age: 23 years;
Weight: 63kg; Height:1
49cm; BMI: 28.38 ; Health condition: Over weight; Activity: li
ght; Socio-economic status: Middle class.
Health Problems: Hypertension, Anemia, Over weight
Estimation of Daily Calorie Requirement for Nusrat
•
•
DBW (kg) = (149-100) – (10% off) ± 1
= (49 – 4.9) - 1
= 43 kg
DCR = DBW (kg) x Activity level
= 43 x 35
= 1505 kcal
Since Nusrat is obese person, so•
•
Expected loss of weight = 500g/week
Prescribed calories to be= (1500 – 500)= 1000 kcal
Distribution of Energy
• Energy: 1000 kcal/day with control fat (decreased saturated fat)
• Carbohydrate (60%): 150g; Protein (20%): 50g; Fat (20%) : 23g; Cholesterol: 230
mg/day
Diet Prescription: Rx Diet: 1000 kcal, C150 g P50 g F23 g Cholesterol 230 mg
Rx Diet: 1000 kcal, C150 g P50 g F23 g
Food Items
Servings
CHO
(g)
Proteins
(g)
Fat
(g)
Total
kcal
Milk (skim)
1
12
8
-
80
Vegetables
5
25
10
-
140
Fruits
4
40
-
-
160
Sugar
1
5
-
-
20
Pulses (low conc.)
1
3
1
-
16
Bread/Cereal
(150-85 = 65/15 = 5)
5
75
10
-
340
Egg
½
-
3.3
3.4
45
2.5=1(med)+ 1
(low fat)
-
17.5
10
160
2 tsp
-
-
10
90
-
160
49.8
23.4
1051
Meat/ Fish
(50-32.3 = 17.7/7 = 2.5)
Fats and Oils
(23-13.4 = 9.6/5 = 2)
Total=
Menu Plan or Meal Distribution
Breakfast
Hotchpotch (Khichuri)/
Bread/Toast /Cereals
Egg
1Servings
½ Svg
½ cup vegetable mixed khichuri or 1 slice bread or
1 ps medium size atta ruti.
1 ps egg pouched or boiled
Milk
1 Svg
1 glass milk made with/ without sugar
Mid morning snacks
Noodles/ Butter cookies
Lunch
Fruit juice or Lasschi
1 Svg
1 Svg
Rice
Fish / meat
Leafy vegetables
Pulses
Curd/ Puddings
Noodles/ butter cookies
2 Svg
2 Svg
2 Svg
1 Svg
½ Svg
1 Svg
Fruits juice or Lasschi
1 Svg
1 cup noodles with mixed vegetables or 2 ps biscui
ts
1 glass fruit juice or fruit lasschi
1 ½ cup or full plate parboiled rice
2 ps or 60g locally available fish or chicken
2 cup dark green leafy vegetables
1 cup medium concentration lentils or mung bean
1 cup (100) or 1 slice
1 cup noodles with mixed vegetables or 2 ps biscui
ts
1 glass fruit juice or fruit lasschi
Afternoon snacks
Cornflakes/Muri/popcorn
1 Svg
Fruit juice or Lasschi or Horlic 2 Svg
s
½ cup cornflakes made with/without milk and suga
r/ 1 cup muri/ popcorn
1 glass fruit juice or fruit lasschi or Horlicks
Dinner
Rice
Fish / meat
Leafy vegetables
Pulses
2 Svg
2 Svg
1 Svg
½ Svg
1 cup or half plate parboiled rice or 2 lice bread
1 ps or 30g locally available fish or chicken
1 cup dark green leafy vegetables
½ cup medium concentration lentils or mung bean
1 Svg
1 glass milk made with/ without sugar
Bed Time
Milk
Tea: not more than 2-3 cups in a day
Cooking oil: 2-3 teaspoon vegetable oil for whole day cooking process
Water: minimum 10-12 glasses of water should be taken daily to avoid
constipation.
Special Tips
• Exercise should be continue for minimum 1 hour (running, swimmi
•
•
•
•
•
•
•
•
•
ng, dancing, yoga etc).
1 or 2 glass water should be taken before meal.
Mixed salad should be eaten so much as possible.
Eat variety of native and seasonally available fruits and vegetable
s.
Among fruits and vegetables one servings must be from citrus fruit
s and green leafy vegetables.
Vegetable oil is preferable because it contains more unsaturated f
atty acid which is beneficial for atherosclerosis patient.
Try to eat more sea food such as sea fish, sea weeds because it c
ontains more unsaturated fatty acid.
Try to avoid fatty meat or fatty fish (such as pungus fish).
Reduce alcoholic drinks intake and avoid smoking.
Don’t add extra salt during cooking and don’t take extra salt du
ring eating.
THANKS
Mosby items and derived items © 2006 by Mosby, Inc.
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