NUTRITION PROBLEMS

1. An 18-month-old girl child is brought to the PHC By her mother. The child has measles.
The physician notices dryness of the conjunctiva & the cornea in both the eyes of the
child. How should the eye condition be managed?

Solution:
Diagnosis: Since there is dryness of conjunctiva and cornea in both eyes following measles
infection it is Xeropthalmia, due to Vitamin A deficiency

Management:

Immediate treatment:
 Administration of Vitamin A solution 2, 00,000 I U (>1 year children) and 1, 00,000 I
U (< 1 year children) on 2 successive days orally. This should be followed by another
dose of Vitamin A solution 4 weeks later.
 In case of persistent diarrhea or vomiting, water miscible vitamin A is given by IM.

Long term Measures:

Health Promotion: Promotion of Vitamin A rich foods
 Regular and adequate intake of retinol/ vitamin A rich foods like dark green leafy
vegetables, carrot, drumstick leaves, mango, papaya, milk, egg, butter, oil, fish
etc. Children require 400 to 600 microgram of vitamin A per day.
 Promoting Breast feeding in the community
 Control of infections (that precipitates vitamin A deficiency) like respiratory
infections, measles and Diarrhea.
Specific Protection:
Vitamin A prophylaxis
o The child has to be given Vitamin A solution 2, 00,000 I U every six
monthsup to 5 yrs of age. ( Total of 17 lakh IU)
o Fortify foods like Vanaspati, margarine, milk with Vitamin A (1200 IU)
o Enquire about measles immunization and give the injection if not given
o Educate mother regarding care of child during illness. Reduction in
contributing factors like PEM, diarrhea, vomiting, measles, Acute Respiratory
Illness.
2. The female health worker of a sub-centre during a routine fortnightly community visit
notices that Mrs. Lakshmi is pregnant for the third time. She is in her second trimester
& very pale. The health worker refers & accompanies the mother to the Physician in
the PHC. How should the physician manage the condition?

Solution:
Diagnosis: This is a case of Anaemia:
WHO Definition: Any pregnant women with Hemoglobin concentration < 11 gm%

Investigations:
 Hemoglobin estimation
 Peripheral blood smear examination
 Stool for ova and cysts

Iron requirements – First half of pregnancy – 0.8 mg/ day

- Second half of pregnancy – 2.4 mg/ day

 Under RCH II programme all pregnant mothers should take Iron and Folic acid tablets
(Ferrous Sulphate – 335 mg containing 100 mg of elemental iron and 0.5 mg of folic
acid) one tablet per day for 100 days starting in second trimester.
 If the lady is anemic then 2 tablets of same strength should be given every day from
second trimester to 3 months post-delivery.
 Educate the mother to consume iron rich diet – Green leafy vegetables, Ragi, Jaggery
etc.
 Absorption is better if she consumes tablets with promoters like lime juice. She has to
avoid taking tablets with coffee/ tea which inhibit the absorption of iron.
 Educate mother regarding side effects like metallic taste, Gastric irritation and passing
dark colored stools
 She has to be given one tablet of Albendazole 400 mg to eliminate if any worms are
present
 Use of iron fortified salt with ferric ortho phosphate

Follow up:
Recheck Hb concentration
Counsel the mother if she is not compliant with treatment
3. The PHC physician conducts weekly clinics in the sub-centres. The female health worker of
the sub-centre brings to his notice a two year old male child with severe PEM. The weight of
the child is 7.5 kg and appears severely wasted. How will the physician & the health worker
manage the child’s nutritional status?

Time frame for the management of the childwith severe malnutrition

General treatment for malnutrition

4. Plan a diet for a 26 yr old pregnant mother in second trimester. She is a clerk & weighs
57 Kgs.

Solution:

Dietary content Requirement for Additional Total

Sedentary requirement in Requirement
Women Pregnancy
Cereals (g) 410 + 35 445
Pulses (g) 40 +15 55
Green leafy vegetables (g) 100 - 100
Other Vegetables(g) 60 - 60
Roots & Tubers (g) 50 - 50
Milk & Milk products (ml) 100 +100 200
Fats & oil (ml) 20 - 20
Sugar & Jaggery (g) 20 +10 30

Pregnant mother who is a clerk is considered as a sedentary worker

Dietary Coefficient (D.C.) for Sedentary female = 0.8
Energy requirement for sedentary women is 1900 kcal
Extra allowances in Pregnancy
Calories = Extra 350 Kcal
Proteins = Extra 23 grams (55 + 23 =78gms)

Other Nutritional Recommendations:

Vitamin A = β carotene - 6400 microgram / day, Retinol – 600 microgram / day
Iron =35 mg/day
Calcium = 1200 mg/ day
Folic acid = 500 micro gm/ day
Thiamine = 1.2 + 0.2 mg per day
Riboflavin = 1.4 + 0.2 mg/day
Niacin = 16 + 2 mg/day
Vitamin B6 = 2.5 mg/dl
Ascorbic acid = 60 mg/dl
5. Plan a balanced diet for a family. The parents are teachers in a school. The son is 17 yr old &
daughter is 14 yr old.

Dietary content 1 D. C Moderat

e Moderat
Adolescent Adolescent Male e Female
Boy Girl (x1.2) (x 0.9) Total
Cereals (g) 460 460 460 552 414 1886
Pulses (g) 40 40 40 48 36 164
Green leafy vegetables (g) 40 40 40 48 36 164
Other Vegetables(g) 60 60 60 72 54 246
Roots & Tubers (g) 50 50 50 60 45 205
Milk & Milk products (ml) 150 150 150 180 135 615
Fats & oil (ml) 40 40 40 48 36 164
Sugar & Jaggery (g) 30 30 30 36 27 123

6. The 50 yr old office executive is a Diabetic. His present weight is 78 Kgs & the desirable
weight is 70 Kgs. recommend a diabetic diet.

Desirable weight = 70 Kgs

If Weight is <70 Kgs – Increase the calorie by 10kcal/kg

If the weight is > 70 Kgs – Decrease the calorie by 10kcal/kg

Actual recommendation = 40kcal/kg

Hence he is weighing >70 kg – 30kcal/kg is required

Total calorie required = 70 x 30 = 2100 kcal

If age of a diabetic patient is between

40 to 49 yrs – 5% of total calorie reduction is required
50 to 59 yrs – 10% of total calorie reduction is required
>60yrs – 20% of total calorie reduction is required

Therefore 10% of 2100 = 210

Total calorie required = 1890 kcal
7. Construct a balanced diet for 40 medical students staying in a hostel. Out of 40,20 are
vegetarian

Dietary content 1 D. C
Vegetarian 20 vegetarian students Total Requirement
Cereals (g) 460 460 x 20 9200
Pulses (g) 40 40 x 20 800
Green leafy vegetables (g) 40 40 x 20 800
Other Vegetables(g) 60 60 x 20 1200
Roots & Tubers (g) 50 50 x 20 1000
Milk & Milk products (ml) 150 150 x 20 3000
Fats & oil (ml) 40 40 x 20 800
Sugar & Jaggery (g) 30 30 x 20 600

Dietary 1 D. CNon Total

content Vegetaria Requiremen
n 20 NV students t
Cereals (g) 460 460 x 20 9200
Pulses (g) + 1 egg OR 30 g meat or 20 x 20 +
fish + 5g of fat or oil 20 egg or 600 gm
of meat + 100 gm 400 gm
20 of fat or oil pulses
Two eggs or 50 gm of meat 40 eggs or 1000
or fish OR 1 egg plus 30 gm of meat or fish
gm of meat + 10 g of fat or OR
oil 20 eggs + 600 gm
of meat + 200 gm
0 of fat or oil
Green leafy
vegetables (g) 40 40 x 20 800
Other
Vegetables(g) 60 60 x 20 1200
Roots &
Tubers (g) 50 50 x 20 1000
Milk & Milk
products (ml) 150 150 x 20 3000
Fats & oil
(ml) 40 40 x 20 800
Sugar &
Jaggery (g) 30 30 x 20 600
8. Laxman 50 years old had myocardial infarction and was admitted in a hospital. He is
being discharged after recovery. Plan a diet for minimal activity and low in fat

For a person with heart disease, proper nutrition is essential to managing symptoms and
preventing further complications. Not only can proper diet help slow the artery-clogging
process, but when combined with careful lifestyle modification, it may even stop or
reverse the narrowing of arteries.
For people with heart disease, adopting a heart-healthy diet can help reduce total and
LDL cholesterol, lower blood pressure, lower blood sugar, and reduce body weight.

Diet plan for patient with heart disease:

1. Serve more vegetables, fruits, whole grains and legumes.(>400gm/day) These foods
may be one of the most powerful strategies in fighting heart disease.
2. Choose fat calories wisely.
3. Limit total fat grams.
4. Serve a bare minimum of saturated fats and trans-fatty fats (for example, fats found in
butter, salad dressing, sweets and desserts).
5. When you use added fat, use fats high in monounsaturated fat (for example, fats found in
olive and peanut oil) or polyunsaturated fat (such as fats found in soybean, corn and
sunflower oil).
6. Serve a variety -- and just the right amount -- of protein foods. Commonly eaten
protein foods (meat, dairy products) are among the main causes of heart disease. Reduce
this nutritional risk factor by balancing animal, fish and vegetable sources of protein.
7. Limit cholesterol consumption (<300mg/day). Dietarycholesterol can raise blood
cholesterol levels, especially in high-risk people. Limiting dietary cholesterol has an
added bonus: You'll also cut out saturated fat, as cholesterol and saturated fat are usually
found in the same foods. Give patient energy by serving complex carbohydrates (such as
whole wheat pasta, sweet potatoes, whole-grain breads) and limit simple carbohydrates
(such as regular soft drinks, sugar, sweets).
8. Feed regularly. Skipping meals often leads to overeating. By serving five to six mini-
meals can control blood sugars, burn fat calories more efficiently and regulate cholesterol
levels.
9. A family consists of an adult male 60 Kg, an Adult Female 50 kg and a child of 5 years
weighing 15 Kgs. On Diet survey of this family it was observed that consumption per day in
terms of proximate principles and nutrients are as follows: Protein – 150 gm, Calories – 2000
Kcal, Fats – 10 gm, Vit A – 1000 μg, Vit B – 10 mg, Vit C – 150 mg. Comment on the diet
intake

Adult male Adult female Child 5yrs Total

(15kgs) requirement
Calorie requirement 2400kcal 2400 x 0.8 = 2400 x 0.5 = 5520kcal/day
1920kcal 1200kcal

Protein requirement 60gm 50gm 20 130 gm/day

Fat requirement 40 gm 40 gm 25gm 105gm/day

Vitamin A 600 μg 600 μg 400 μg 1600 μg/day
Requirement
Vit B Requirement 1.2mg 1mg 0.7mg 2.9 mg/day
Vit C Requirement 16mg 12mg 11mg 39 mg/day

Intake Required Deficient/Excess

Calories 2000Kcal 5520 Deficient by
3520kcal
Protein 150gm 125 Excess by 25gm
Fats 10gm 105 Deficient by 95gm
Vit A 1000 μg 1600 Deficient by 600 μg
Vit B 10mg 2.9 Excess by 7.1mg/day
Vit C 150mg 39 Excess by 111mg/day
10. The following is the daily diet of a pregnant lady, Mrs. Parvathi, age 28 years, G2 P1 L1 in
her second trimester of pregnancy. Comment on the diet. Calculate the Iron intake per day
and enumerate 3 iron rich foods.

Contents Intake Dietary Dietary Total Deficient or

content requirement Requirement excess
Rice 300gms Cereals (g) 410 + 35 445 -145
Red gram 10gm Pulses (g) 35 -15
Bengal 10gm
gram 20 +15
Egg 1 Egg 20 Adequate
(20gm) 1 (20gm)
Milk 100ml Milk & Milk 200 -100
products (ml) 100 +100
Brinjal 70gm Other 60 + 10
Vegetables(g) 60
Oil 10gm Fats & oil (ml) 20 20 -10
Sugar 20gm Sugar & 30 -10
Jaggery (g) 30
Roots & 50 -50
Tubers (g) 50
GLV 100 100 -100

11. The diet of a lactating mother is as follows: Rice – 300gms, Dhal – 50gms, Green leafy
Vegetables – 40gms, Cow’s milk – 150 ml. Comment on Quality and Quantity of diet.

Intake Dietary Dietary Total Comments

content requiremen Requirement
t
Rice 300gms Cereals (g) 410 + 60 470 -170
Dhal 50gm Pulses (g) 40 + 30 70 -20
GLV 40gm GLV 100 100 -60
Milk 150ml Milk & Milk 100 + 100 200 -50
products (ml)
Other 40 -40
Vegetables(g) 40
Roots & -50
Tubers (g) 50 50
Fats & oil (ml) 20 20 -20
Sugar & -20
Jaggery (g) 20 20