Anthropometry

Anthropometry is the science of measuring the size and proportions of the human body.
It includes:

 Anthropometric measurements
 Biochemical assessment
 Clinical assessment
 Dietary management

Anthropometric measurements:
Anthropometric measurements “are a series of quantitative measurements of the muscles, bone and adipose
tissue used to assess the composition of the body”

Body mass index: measure of body fat based on height and weight.
BMI = weight (kg)/height (m2)
BMI NUTRITIONAL CALCULATIONS
Less than 16 Severe chronic energy deficiency
16-16.9 Moderate chronic energy deficiency
17-18.49 Mild chronic energy deficiency
18.5-24.9 Normal weight
25-29.9 Pre-obesity
30-34.9 Obesity grade 1
35-39.9 Obesity grade 2
Above 40 Obesity grade 3
Note: how to convert feet into meter? like 5.3 ft => 5 *12 = 60+3 = 63 * 0.0254 = 1.6002m

Basal metabolic rate: the rate at which energy needed only for body requirement like maintenance when
body is at rest

 In male = weight ×24

 In female = weight ×22

Total energy expenditure: it is any bodily movement produced by skeletal muscles that require energy
expenditure
TEE = BMR ×PAL ×IF

Physical activity level:

Inactive 1.2
Fairly active 1.3
Moderate active 1.4
Active 1.5
Very active 1.7
Injury factor:
Surgery
Minor surgery 1-1.1
Major surgery 1.3-1.9
infection
Minor 1-1.5
Major 1.4-1.8
Trauma 1.2-1.35
Ideal body weight:
 Above 5 ft
Male: 50kg + 2.3kg for each inch over 5 ft
Female: 45.5kg + 2.3 kg for each inch over 5 ft

 Less than 5 ft
Male: 50-inches less than 5 ft
Female: 45.5-inches less than 5 ft

Adjusted body weight:

ABW = ideal body weight+ 0.4(actual body weight – ideal body weight)

Demi-span:
 Male: 1.40 × Demi-span (cm) + 57.8
 Female: 1.35× Demi-span (cm) +60.1

Fluid requirement:
 Age if 50 or less ) => weight-20=A
 A ×20=b
 B +15= C (ml)
 C /2.5= glass
 Age (50+)= put 15 instead of 20

Body frame size:

Ecto  Has smaller body size as compare to age
 Face difficulty for weight gain
Meso  Normal body size
Endo  Have large body size as compare to age
 Face difficulty in weight loss

Biochemical lab testing:

 COMPLETE BLOOD COUNT: A common blood test that provides information about different types
of cells in your blood including RBCs, WBCs and platelets.

Why we perform this?

For diagnosis of every disease like

 Medical conditions
 Immune system
 Infections
 Anemia
 Cancer
 Nutritional deficiencies

Normal values
cells male female
RBCs 4.5-5.5 million cells /mcL 4.2-5.4 million cells/mcL
Hemoglobin 13.8-17.2 g/dl 12.1-15.1 g/dl
WBCs 3.4-9.6 billion cells/l 3.4-9.6 billion cells/l
platelets 135-317 billion /l 157-317 billion /l
Erythrocyte sedimentation rate:
Detects and defines minor to major infection in body. Shows immunity level of body .

 If ESR = 20(no infection)

 If ESR >20 ( infection
 If ESR<20( weak immune system)

RBCs test:
 For iron deficiency.

WBCs test:
 When recurring disease.

Vitamin D and calcium test: For bone weakness and sound from bones.

 Vitamin D normal value: 50-70ng/ml

 Calcium normal value: 8.5-10.2mg/dl

Uric acid test:

When pain in bones , pain in small bones , tension in bones .

 Male: 3.5-7.2mg/dl
 Female: 2.6-6.0mg/dl

Blood urea nitrogen:

If there are symptoms of uric acid disease but blood uric acid level is normal so we perform BUN test
 Normal value: 6-24mg/dl
Diabetes test: for determination of glucose level
It may be

 Random
 Fasting
 HB A1C

Cholesterol test: lipid profile or lipid panel test

Used to diagnose:

 Genetic diseases
 Risk of CVDs
 Pancreatitis
 Figure out risk of narrowed or blocked arteries

Electrolytes test: blood test that measures levels of body main electrolytes
Use to diagnose:

 Kidney problem, diarrhea

 Heart issues
 dehydration

Serum enzyme test: enzyme marker test

Use to diagnose:
 cancer
 diarrhea
 shortness of breath

Phosphorus test:
Use to diagnose:
 Veins standing out
 increased bone fractures
 teeth lose
 Uncontrolled diabetes

Thyroid test:
If weight suddenly decreases and unable to gain weight then may have hyperthyroidism.

Creatinine test:
Use to diagnose:
  Liver disease
 kidney disease
 if swelling .

Albumin test
Use to diagnose:
 Liver functioning
 kidney functioning
 assess nutritional status
 minor chronic illness.

Clinical Assessment:

 Physically Assessment

Eye Diseases:
Eye diseases are linked to vitamin A deficiency.

Night blindness (Nyctalopia):

 When you have trouble seeing in dim light. It happens after 6p.m.
 Due to vitamin A deficiency.

Color Blindness:

 When you are unable to see colours in a normal way.It involves red, blue and green light.
 Mostly by birth. Due to vitamin A deficiency.

Photophobia:

 Fear of light, sometimes by birth.

 It occurs in people who live in dark places.
 Due to vitamin A and vitamin B2 deficiency.

Eye Redness:
 Due to high blood pressure, body heat, stress, low water level, and sudden increase in blood pressure.

Skin Diseases: Mostly due to vitamin B12 deficiency.

 Pallor/ Yellow skin: Vitamin B complex, B12, B9 and iron deficiency
 Skin wrinkles and pigmentation: Vitamin B9, B12 and iron deficiency
 Skin patches: B.complex deficiency

Hairs:
 Spare or thin: Protein, zinc and biotin deficiency
  Easy to pull out: Protein deficiency
 Curly hairs: Vitamin C and vitamin A deficiency

Mouth: Vitamin B12 related

 Glossitis: B1, B2, B3, and B12 deficiency
 Bleeding of spongy gums: B12 and vitamin K deficiency
 Mouth side cuts: B12 deficiency
 Water from mouth: High stomach acidity

Bones:
 Bone enlargement and rickets: Vitamin D and calcium deficiency
 Poor posture: Calcium, vitamin D and phosphorus deficiency
 Knocking knees: Vitamin D and calcium deficiency

Nails:
 Spoon like nails: Protein deficiency
 Transverse lines on nails: Protein deficiency
 White dots on nails: Calcium deficiency
 White nails: Iron deficiency.

Cavities and yellow teeth: Calcium and fluoride deficiency

Portion Size:
Plate:
1 Large plate 16--18 tablespoons, 48--54 teaspoons
1 Medium plate 15--16 tablespoons, 45--48 teaspoons
1 Small plate 6--8 tablespoons, 18--24 teaspoons
Glass:
1 standard glass(disposible glasses are of250ml, 16.7 tablespoons, 50teaspoons
standard size)
Cup: Fist=1 cup
1 standard cup 150ml, 10 tablespoons, 30 teaspoons
Tablespoons and teaspoons: Thumb=2 tablespoons Fingertip=1 teaspoon
1 tablespoon 15g,15ml, 0.5 fluid ounce, 3 teaspoons, 1/16
glass
1 teaspoon 5g, 5ml, 0.167fluid ounce
Ounce (oz): Palm= 3 ounces Cupped hand=1 ounce
Type Abbreviation Measures US Conversion Uses
Ounce oz Weight 1oz= 28.35g For meat flour
sugar cheese
Fluid ounce fl oz Volume 1fl oz= 29.57ml For milk water
oil

Calories Calculation: Example of Samosa

Ingredients Serving Calories
Potatoes 2 160kcal
Non-starchy vegetables 1/2 12kcal
Flour 1 80kcal
Ghee 5 225kcal
Total= 477kcal
Adjustable Daily Macronutrient Requirement (ADMR):
Carbs 50--55%
Fat 30--35%
Protein 15--20%

Total energy(kcal)=Total calories * Required amount/100

Example: Total energy from carbs= 2000* 50/100= 1000kcal

Calculation of no. of grams:

 Calories of carbs/4= no. of grams of carbs
 Calories of fat/9= no. of grams of fat
 Calories of protein/4= no. of grams of protein

DIETORY MANAGEMENT

Gastritis

Gastritis is the inflammation of the lining of the stomach.

It can be:

 Acute gastritis – sudden onset, often from infections, certain medications (like NSAIDs), alcohol,
or food poisoning.
 Chronic gastritis – develops slowly over time, often linked to Helicobacter pylori infection, long-term
NSAID use, autoimmune conditions, or bile reflux.

Symptoms:
 Burning or gnawing pain in the upper abdomen
 Nausea or vomiting
 Bloating
 Loss of appetite
 Indigestion
 In severe cases: black/tarry stools or vomiting blood (due to bleeding in the stomach lining)
 Feeling of fullness in the upper abdomen after eating

Causes:
  Helicobacter pylori infection (most common cause of chronic gastritis) Excessive use of NSAIDs
(e.g., ibuprofen, aspirin)
 Excessive alcohol consumption
 Stress-related mucosal damage (critical illness, severe trauma)
 Autoimmune gastritis (immune system attacks stomach lining)
 Bile reflux
 Smoking
 Certain foods and beverages that irritate the stomach (spicy foods, caffeine)

Risk Factors:
 Chronic use of NSAIDs or corticosteroids
 Infection with H. pylori
 Excessive alcohol use
 Smoking
 Older age
 Stressful physical conditions (burns, surgery, trauma)
 Autoimmune disorders

Diagnosis:
 Medical history and physical examination
 Upper GI endoscopy with biopsy (to see inflammation and test for H. pylori)
 Blood tests (to check for anemia, H. pylori antibodies)
 Stool antigen test or urea breath test for H. pylori detection
 Imaging (rarely needed

Treatment:
 Eradication of H. pylori infection (if present) with antibiotics plus proton pump inhibitors (PPI)
 Avoidance of NSAIDs or use with caution, sometimes adding protective agents like misoprostol
 Acid suppression therapy (PPIs or H2 blockers) to reduce stomach acid and promote healing
 Antacids for symptomatic relief
 Lifestyle modifications (stop smoking, reduce alcohol)

Medical Nutrition Therapy (MNT):

 Eat small, frequent meals to reduce gastric irritation
 Avoid spicy, acidic, fried, or fatty foods
 Limit caffeine and alcohol intake
 Avoid smoking
 Include bland, easy-to-digest foods (e.g., bananas, rice, applesauce, toast)
 Avoid very hot or very cold foods and beverages
 Maintain adequate hydration
 Avoid eating late at night or lying down immediately after meals
 Include fiber-rich foods gradually once symptoms improve to aid digestion

Supplement:
  Probiotics
 Vitamin C
 Omega-3 Fatty Acids

Thyroid diseases

Thyroid has mainly two stages.

Hyperthyroidism: Hyperthyroidism is a condition in which the thyroid gland produces excessive amounts
of thyroid hormones (T3 and/or T4), leading to increased metabolism and over activity of body systems.

Symptoms:
(Due to overactive metabolism)

 General: Unintentional weight loss, fatigue, muscle weakness

 Skin/Hair: Warm, moist skin, fine hair, hair loss
 Temperature: Heat intolerance, excessive sweating
 Eyes: Bulging eyes (exophthalmoses in Graves’ disease), double vision, gritty sensation
 Heart: Rapid heartbeat (tachycardia), palpitations, high blood pressure
 Nervous system: Anxiety, tremors, irritability, restlessness, insomnia
 GI: Frequent bowel movements or diarrhea
 Other: Enlarged thyroid (goiter), irregular menstrual cycles, infertility

Causes:
 People live near seas
 Excess iodine intake
 Loss of muscle
 Grave’s disease(most common)
 Extra fast bleeding in period
 Anger issue
 Nerves system damage

Diagnosis:
 Blood test: Low TSH (suppressed) ,High T3 and/or T4 ,Thyroid antibodies (TSI in Graves’)
 Radioactive iodine uptake (RAIU) test: High uptake in Graves’ or toxic nodules, low in thyroiditis
 Ultrasound: To detect nodules or gland enlargement
 Physical exam: Goiter, tremors, rapid pulse, eye changes

Risk Factors
 Family history of thyroid disease
 Female gender (5–10× more common in women)
 Age 20–40 years (Graves’ disease)
 Other autoimmune disorders (type 1 diabetes, rheumatoid arthritis)
  High iodine intake
 Personal or family history of thyroid nodules

Treatment:
 Medications: Anti thyroid drugs (methimazole, propylthiouracil)
 Surgery: Thyroidectomy (partial or total)

Medical Nutrition Therapy (MNT):

Recommended:
 Adequate calorie intake to prevent excessive weight loss
 High-protein foods (lean meat, fish, eggs, legumes) to prevent muscle break down
 Calcium- and vitamin D-rich foods (milk, yogurt, fortified products) to prevent bone loss
 Anti-inflammatory foods (fruits, vegetables, whole grains, nuts),Turmeric, Soya foods
 Adequate hydration
Limit / Avoid:

 Excess iodine (seaweed, kelp, iodized salt, iodine-rich supplements)

 Stimulants like caffeine (coffee, energy drinks) to avoid worsening palpitations
 Highly processed, sugary foods (increase inflammation and heart stress)
Supplement:

 Selenium
 Vitamin D

Hypothyroidism:
A condition where the thyroid gland produces insufficient thyroid hormones (T3 and T4), causing a slowdown
in metabolism and bodily functions.

Symptoms:

 Fatigue, weakness
 Weight gain despite no increase in appetite
 Cold intolerance
 Dry, rough skin
 Hair thinning or hair loss
 Constipation
 Depression or low mood
 Slow heart rate (bradycardia)
 Hoarseness
 Puffy face, swollen eyelids
 Menstrual irregularities
 Memory problems or difficulty concentrating (“brain fog”)
 Muscle cramps and stiffness

Causes:
  Hashimoto’s thyroiditis (autoimmune destruction of thyroid) – most common
 Iodine deficiency
 Thyroid surgery or radioactive iodine treatment
 Congenital hypothyroidism (born without or defective thyroid)
 Certain medications (e.g., lithium, amiodarone)
 Radiation therapy to the neck
 Pituitary or hypothalamic disease (rare secondary causes)

Diagnosis:
 Elevated TSH (thyroid stimulating hormone)
 Low free T4 (thyroxin)
 Presence of thyroid antibodies (anti-TPO, anti-thymoglobulin) for autoimmune causes
 Ultrasound of the thyroid if nodules or goiter suspected

Risk Factors:
 Female gender (especially middle-aged women)
 Family history of thyroid disease
 Personal history of autoimmune diseases (e.g., type 1 diabetes, rheumatoid arthritis)
 Iodine deficiency or excess iodine intake
 Previous thyroid surgery or radiation exposure

Treatment:
 Lifelong thyroid hormone replacement therapy (levothyroxine)
 Regular monitoring of TSH and free T4 to adjust dosage
 Patient education on medication adherence and avoiding interference with absorption (e.g.,
taking levothyroxine on an empty stomach)

Medical Nutrition Therapy (MNT):

 Ensure adequate iodine intake (iodized salt, seafood) but avoid excess
 Balanced diet rich in fiber to manage constipation
 Avoid excessive consumption of raw cruciferous vegetables (e.g., cabbage, broccoli) and soy in
large amounts, as they can interfere with thyroid hormone production
 Ensure sufficient selenium (Brazil nuts, fish) and zinc intake to support thyroid hormone metabolism
 Maintain a well-rounded diet to support overall health and energy levels

Supplement:
 Iodine
 Selenium
 Zinc
 Vitamin D,B12

Hashimoto’s Thyroiditis:
Hashimoto's thyroiditis is a chronic autoimmune disorder in which the immune system attacks the thyroid
gland, causing inflammation and leading to hypothyroidism (underactive thyroid). It is the most common
cause of hypothyroidism.

Risk Factors:
 Female gender (more common in women)
 Age (typically middle-aged adults)
 Family history of thyroid or autoimmune diseases
 Other autoimmune diseases (e.g., type 1 diabetes, rheumatoid arthritis)
 Excessive iodine intake
 Radiation exposure to the neck area
 Pregnancy or postpartum period

Diagnosis:
 Clinical symptoms: Fatigue, weight gain, cold intolerance
 physical exam: Enlarged, firm, and sometimes nodular thyroid gland (goiter)
 Blood tests: Elevated TSH (thyroid-stimulating hormone) ,Low free T4 (thyroxin)

Medical Treatment: Levothyroxine

Medical Nutrition Therapy (MNT):

 Avoid excessive iodine
 nutrient-rich diet including fruits, vegetables, whole grains, lean proteins, and healthy fats
 Avoid goitrogens in excess: Foods like soy, cruciferous vegetables (broccoli, cabbage)
 Vitamin D and B12: Check for deficiencies as they are common in autoimmune thyroid disease
and supplement if needed

Supplement:
 Selenium

HYPERTENSION

Hypertension (high blood pressure) is a condition where the force of blood pushing against artery walls is
consistently too high, which can damage blood vessels and increase the risk of heart disease, stroke, kidney
disease and other complications.

 Normal blood pressure : around 120/80 mmHg

 Systolic (top number): pressure when the heart beats.
 Diastolic (bottom number): pressure when the heart rests between beats.

Types:
types systolic diastolic
Pre hypertension 120-140 mmHg 80-90mmHg
Hyper tension 1 140-160mmHg 90-100mmHg
Hyper tension 2 160+ mmHg 100+ mmHg
 Note: if the blood pressure is higher than 300 mmHg narrower veins like in kidney, jaw line and eyes
are burst and if the internal bleeding occur, clotting of blood take place which cause heart issues.

Causes & risk factors:

 High salt intake
 Obesity
 Physical inactivity
 Excess alcohol and caffeine
 Smoking
 Genetics/family history
 Certain medical conditions( kidney disease, thyroid problems)

Symptoms:
Often called silent killer because it usually has no symptoms until it’s severe. Possible late sign:

 Headaches
 Shortness of breath
 Nosebleeds
 Chest pain
 Dizziness

Complications:
 Heart attack
 Stroke
 Kidney damage
 Vision loss
 Aneurysm (bulge in the wall of a artery and it can burst due to hypertension)

Medical nutrition therapy:

Dash diet: high in fruits and vegetables, whole grains, low in salt and saturated fat.

Salt restriction: aim for less than 1500-2300 mg/day sodium

Exercise: at least 30 min/day, 2 days a week

Weight control: maintain healthy BMI

Avoid smoking & limit alcohol

Medication: diuretics, ACE inhibitors, ARBs , calcium channel blockers, beta-blockers

KIDNEY DISEASES
 The kidneys are two bean-shaped organs. Each kidney is about the size of a fist. Your kidney filters extra
water and wastes out of your blood and makes urine. Kidney disease means your kidneys are damaged and
can’t filter blood the way they should.

Causes:
 Reduced blood flow to kidney ( e.g. heart failure, dehydration, severe blood loss)
 Birth defect affecting kidney structure
 Severe injury or trauma to the kidneys
 Long term use of nephrotoxic medicines
 Tumor in urinary track

General symptoms:
 Fatigue
 Low Hb
 Insomnia
 ankle swelling
 muscle cramps
 pain in lower back
 eye puffiness
 dry and itchy/scaly skin
 frequent urination at night

Risk factors:
 Diabetes
 Hypertension (high blood pressure)
 Heart disease
 Obesity
 Autoimmune diseases( like lupus)
 Genetics
 Lifestyle( smoking, unhealthy diet)
 Exposure to heavy metals
 Prolonged dehydration
 Extra protein intake
 Older age
 Urinary tract infections

Complications:
 Electrolyte imbalance
 Cardiovascular problems
 Anemia
 Bone pain due to poor vitamin D activation
 Uremia( toxins buildup in blood)
 Peripheral neuropathy
 Decreased immunity
 End stage renal disease (require dialysis and kidney transplant)
 Poor wound healing
 Hormonal imbalance
  Fertility problems both in men and women.

Types of kidney diseases:

Acute kidney injury: sudden decline in kidney functions, often reversible if treated quickly. It lasts few
days to several weeks.
Symptoms:

 Oliguria(less urination)
 Dehydration
 Drowsiness/lethargy
 High BUN
 Urine scanty( high specific gravity contain RBCs, traces of glucose)

Causes:

 Pre-renal
 Post-renal

Nephrotic syndrome: condition that effect the tiny glomeruli of the kidney
Triad of Nephrotic syndrome:

 Hypoalbuminemia
 Hyperlipidemia
 Hyper proteinuria(3g in urine / day)

Symptoms:

 foamy urine, a result of excess protein in urine

 weight gain due to fluid retention
 fatigue
 loss of appetite

Cause:

 glomerular damage due to many diseases

Glomerular nephritis: inflammation of glomerular

tubes Cause:
 infection
 autoimmune disease

Symptoms:

 foamy urine
 blood in urine
 swelling in face/eyes
 high blood pressure

Kidney stones: certain combinations of ions can precipitate and get lodged in narrow section of urinary tract
which can facilitate stone formation.
Symptoms:

 back pain
 lower abdominal pain
 groin pain
 blood in the urine
 painful urination
 urge to urinate but unable to do so
 nausea or vomiting

Types:

 calcium stone
 oxalate stone

Polycystic kidney disease: It is a condition in which clusters of cysts grow in the kidney. Cysts are round
sacs with fluid in them.

Symptoms:

 high blood pressure

 belly, side or back pain
 blood in the urine
 a feeling of fulfilness
 enlarged kidney
 headache
 kidney stones
 kidney failure
 UTIs

Cause:
 Genetic mutation( it may be autosomal dominant or autosomal recessive polycystic kidney disease)

Urinary tract infection: it is an infection that affects any part of the urinary system, include kidneys,
bladder, ureters and urethra.

Symptoms:

 Frequent urination
 Pain or burning sensation during urination
 Cloudy, bloody or foul smelling urine
 Fever, chills and back pain

Cause:

 Bacterial or viral infection

 Poor hygiene.

Chronic kidney diseases: Gradual loss of kidney function, over months or years.
Symptoms:
 Fatigue
  Swelling in ankle/face
 Decreased urine
 Foamy urine
 Itching
 Nausea
 Hypertension

Cause:

 Genetic disorders
 Infections
 Diabetes
 Hypertension

Diagnosis:
Medical history: history of diabetes, hypertension, urinary infections, kidney stones, family history of kidney
diseases.
Laboratory tests:
Blood test  Serum creatinine
 Blood urea nitrogen
 Estimated glomerular filtration rate
 Electrolytes
 hemoglobin
Urine test  urinalysis
 urine albumin to creatinine ratio (ACR)
 24 hr urine collection
 Urine culture
Imaging test  Ultrasound
 CT scan
 MRI
 Doppler un
 Ultrasound
Kidney biopsy  Needle sample taken from the kidney
Specialized tests  Genetic testing
 Autoimmune screening
Medical nutrition therapy:
Protein  Moderate restriction
(0.6-0.8 g/kg without dialysis)
(1.2-1.4 g/kg with dialysis) per day
Calories  30-35 kcal/kg/day
Sodium  Limit to 2000mg/day
potassium  Restrict if BP is high( less than 2000-2500 mg)
phosphorus  Limit to 800-1000 mg/day
Fluids  Limit if ascites (often urine output
+500ml/day)

Calcium and vitamin D  Limit if calcium stones or adequate intake

Iron  Adequate iron rich foods to prevent anemia
Supplementation:
 Iron ( if anemia)
 Calcium and vitamin D ( if bone disease)

Enteral Nutrition:

Also called tube feeding or hospital nutrition.

When you can't eat physically or salty food and it is for ward patients.

Conditions:
 Trauma
 Surgery
 Injury

Why we use enteral feeding?

Sometime patient eat but can't meet the total energy requirement then goes for tube feeding. Done through GIT,
formula feeding is used, tube should be sterilized and hands must be clean. First measure tube to reach
stomach, give with injection, first check with water intake
Tube feed: prepare on spot and after tube feeding again clean tube with water

When given:

 Stroke: when not swelling the food

 Cancer patient: to meet nutritional requirements they need extra energy and more protein
 Injury
 Failure to thrive(FTT): Inability of children to eat who have failed to develop and grow normally and
don't survive
 Chronic diarrhea, nausea: because lots of electrolytes are lost
 GIT disorders: (surgery of esophagus, stomach and intestine)

Types:
 Nasogastric Tube(NGT): From nose to stomach
 Oral-Gastric Tube(OGT): From mouth to stomach
 Naso-intestinal Tube(NIT):From nose to intestine, when stomach issue/ surgery/ ulcer/ acid
consumption and in liquid form which is not required to break
 Oral-intestinal Tube(OIT): Mouth to intestine

Gastro-stomy: Through abdomen and into the stomach

Jejuno-stomy: Intestinal surgical procedure by which a tube is situated in lumen of proximal jejunum for
administration nutrition. Too much clear liquid diet like Nestle
No carbs should be added and add zero fiber diet

Complication:
 Difficulty in breathing
  Re-feeding syndrome: Electrolytes imbalance infection
 Nausea, vomiting
 Skin irritation, redness and swelling
 High osmolarity then lead to diarrhea
 If tube is dislocated then it may cause damage
 If tube is not change than causes blockage

Mostly used Formula Feeding:

 Wheat porridge squeeze with cloth and water like material remain
 Milkshake
 Blend diet + broth.
 Milk + egg
 Ensure and glucerna is given, it is most common.

Note: Feeding not more than 300 osmolarity

Parenteral Nutrition:

 Providing nutrition through veins(intravenous feeding)

 Method of getting nutrition into body through veins directly into blood

Types:
 TPN(Total Parenteral Nutrition)
 PPN(Peripheral Parenteral Nutrition)

Given To:
Cancer patients, intestinal issue patients

Nutrients Delivered:
 Sugar, carbs, protein
 Lipids, electrolytes, trace elements
 Nutrients are provided
 Hydration level is managed

Side effects:
 Mouth sore: due to electrolytes
 Fever or chill
 Long term use: poor night vision
 Increase in urination
 skin diseases
 Memory loss
 Changing heart beat rate
 Stomach pain
 Breathing difficulty
 Muscle weakness
 Fatigue.
  Tingling
 Weight gain /weight loss
 Vomiting
 Swelling: water retention in limbs and lower extremities
 Kept in fridge for 4-6 hours before use
TPN: Healthcare advisor injects catheter in large vein (superior vena cava) goes direct to heart.
PPN: in regular peripheral veins .Can be given at home.Intervals are managed to give PPN
Risks:

 Blood clots
 Liver disease
 Bones disease➡️Due to imbalance of sodium and potassium

Sports Nutrition:

 Very different diet

 Protein based diet
 Carbs-diet when event will occur for instant energy
 Moderate fat
 2700, 2800, 3500 kcal diet plans
 Heavy snacks

Supplements:

 Iron, calcium and multivitamins

 Whey protein
 Pre and post-workout carbs
 Gym must be after 18
 Before 18 Height stops growing

Polycystic ovary syndrome (PCOS):

 A syndrome that occurs due to hormone imbalance

 It is linked directly with obesity and vice versa.
 Reproductive organs of females disturb.
 There are low levels of female hormones and increased levels of male hormones.
 Estrogen and progesterone in ovaries regulates periods and their absence results in menstrual
cycle disturbance.
 There is lack of period or irregularity in it.
 In some conditions there are periods with PCOS but irregular.
 Cycle of every female is different from others (from 1 to 10 days ).
 PCOS women eggs are unable to mature having lower chances of conception.
 Almost 57% women are suffering from pcos.
 For ovulation, FSH and LH from pituitary gives signals.
 Chances of miscarriage with PCOS are very high.
Causes:
 Small sacs with water filled.
  genetics ,insulin resistance ( causes more male hormone production and obesity)
 Inflammation in lower belly.
 Sometimes PCOS lead to obesity and vice versa.
 Main cause is lifestyle
Symptoms:
 Period issues.
 Acne
 Voice coerciveness
 Headache
 Sleeplessness
 High cholesterol
 Metabolic syndrome
 Hirsutism (hair growth)
 Weight gain
 Skin darkening specially neck back
 Infertility
 Diabetes
Diagnosis:
 ultrasound
 if severe thyroid test
 hormone test as FSH and LH
Medical nutrition therapy (MNT):
 Use complex carbs
 Avoid simple carbs
 Moderate fats
 Moderate proteins
 Cinnamon ( kehwa ,powder )
 Fennel seeds (kehwa, powder, chewing)
 Haldi (detoxifies , good for uterus )
Seed cycling:
 Don’t use seed in the original form because our body can’t digest. Best way to consume make powder
or chew the seeds.
 In first 15 days flex seed and pumpkin seeds
 Next 15 days sunflowers seed and sesame seeds.
Other recommendations:
 Adapt physical activities
 Prevent Fast food
 PCOS patients are not Gymea patients.
 Periods may occur with medicine usage but are skipped when stopped taking medicine.
Medication:
 Metformin (salt name) to Prevent Insulin resistance and for periods but is not permanent solution
 Glucophage( brand name)

Supplements:
 Fenitol
 ovatol
 Uric Acid:

Uric acid is a natural waste product when the body breaks down purine (found in certain foods and naturally
produced by the body. Normally, uric acid dissolves in the blood and passes through the kidneys into urine, if
the body makes too much uric acid or the kidneys can’t remove enough, it builds up in the body. This condition
is called Hyperuricemia.

Hyperuricemia:
 High level of urea or uric acid.
 If severe known as Gout.
 Every third person now a days is effected with it
 Can be treated within a month or in a week with proper care.
Causes:
painful arthritis
Diabetes
Kidney stone.
If not treated it causes many problems.
When protein is consumed then converts into purine then nitrogen then urea and then form uric acid.
Must be extracted out of body but due to some reason can't be extracted.
Purine is rich in green leafy, organs meat
When a person has high consumption of it then it forms crystals mostly in joints or sometimes in kidney.
Crystals activate body defense system then results fight then swelling and redness and causes pain.
Symptoms:
 Pain in joints
 Swelling
 Inflammation
 Stiffness
 Mostly affects foot thumb, elbow, knee, finger joints,
 Burning sensation and pain when urinate
 Burning sensation in lower foot
 Joint dislocation
 Cyst on foot thumb
Types:
 Tophaceaous gout/ tophi uric acid ( in it crystals are formed in the form of lumps in skin or at the top
of ear joint )
 If uric acid affect kidney then it results in itching and pain in lower back ,nausea, pain during urination
,recurring fever
Risk factors
 People who consume alcohol
 People having high lead exposure
 Smokers
 Pesticides interactors
 Kidney disease
 Obese
  Diabetic
 Suffering from hypertension
Diagnosis:
 Uric acid test
 BUN test
 Creatinine test
Treatment:
 Low purine diet
 if obese reduce weight
 change lifestyle
Medical nutrition therapy:
 Vitamin C rich foods( attached to uric acid crystals break them, cause their extraction through
urine from body)
 use lemon water
 barley water
 black coffee
 complex carbs
 low protein
 useless antacids (group of pain killers, non steroid anti inflammatory drugs
Foods to avoid:
 Organ meat
 sea food
 spinach ,peas, cabbage(green vegetables)
 wheat porridge
 high proteins (beans lentils)
 white floor
Supplementation:
 Nuberry ( brand name ) includes vitamin c + cranberry extract which are very good for full body
swelling
 If pain, pain killer can be recommended but not in excess

Constipation

In constipation the motion or stool becomes hard due to excessive absorption of water in the body.
If a person passes tool 3 or less times in a week then he has constipation
Constipation is mostly due to medicine
Occurs mostly in pregnant women due to increase in size of placenta and upward and
backward constriction of digestive system
 Mostly in women after C-section
 Occurs in youngsters due to no physical activity
 more fast food intake
 In old age it occurs due to less efficient working of villi
Symptoms:
 stool passing difficulty
  pain while passing stool
 feeling of fullness
 toxicity (stool is toxic it releases gases in the body
 bleeding in the intestine because stool is hard as cement which damage the intestine
 extra production of skin leading to piles(piles occurs due to constipation)
99% persons who have constipation also have piles
 bloating
 pain in lower back
 vomiting
 fever
 mostly people gain weight some main lose weight
Causes:
 Stress
 lifestyle
 inadequate sleep
 inadequate physical activity
 high fast food intake
 less water intake
 soda drink
 extra use of painkillers
 arthritis (leading to low physical activity)
 usage of heart medicines
 constant travelling
 childhood( villi are not properly developed)
 older age
 pregnancy
Issues:
 In diabetic patients ,constipation may cause many issues
 Hypothyroidism, obesity ,increased use of laxatives may lead to Parkinson disease
Diet planning:
 Protein less
 Fiber rich diet ( normal person it may be 35 to 45 grams per day)
 Exercise for almost 50 minutes
 Frequent Meals after 2 hours
 Fiber supplement such as ispaghol husk
 Prebiotics including capsules and syrups
 Syrup such as purine juice
 Syrups, drops and tablets (laxoberon medicine)
Medical nutrition therapy (MNT):
 two to three dry plum soaked in water overnight ( eat it in the morning and drink the water too)
 two figs soaked in water overnight eat them in the morning and also drink the water)
 castor oil (in milk )
 Use basal seeds and gondkatira, these things give water to the body time to time
 Ispaghol husk (soaked in water)

Medical treatment:
 propulsive movements in intestine occur to pass stool
  enema ( if stool has not passed since 10 days, transparent liquid is poured into the anus which
increases propulsive movement of anus and helps the stool to pass)
 Tablets(bullet like tablets put in the anus, if does not work then we have to move towards operate)
 In children's insert tube
Diagnosis:
 Renal examining
 stool, blood ,electrolyte ,thyroid, ultrasound test
 x-ray
 colonoscopy
 endoscopy
Diet planning:
 Simple carbs
 High fiber
 Constipation, diarrhea diet plans are not calorie dependent, only obesity and weight gain diet
plans require exact calorie

Diarrhea

 Loose motion or watery stool

 if a person passes stool 3 to 4 times per day then he or she is suffering from diarrhea
Types:
 Acute( lasts for 2 to 3 days )
 Chronic(which takes week or even months to recover)
Causes:
 Lack of hygiene
 high dose medicine
 bacteria or viruses
 high osmolarity fruit intake ( as watermelon )
 due to villi damage
Symptoms:
 Abdominal pain
 abdominal cramps
 food poisoning
 vomiting
 fever
 sometimes bleeding
Medical nutrition therapy (MNT):

Treatment:
 give ORS, oral rehydration solution containing sugar ( potassium) and salt ( sodium)
 banana ( low fiber diet)
 BRAT diet used in diarrhea which stands for banana, rice, Apple sauce and toast
 Kehwa including mint stems ,lemon juice ,sugar, tea (these have a very good absorbing power)

Obesity
  obesity is not a disease but a condition leading to different diseases
 fats in adipose tissues
 increase in hips, thighs ,belly
 BMI increases( more than normal )
Complications:
 Type 2 diabetes
 Cardiovascular diseases
 Uric acid
 Cancer
 Hypertension
 Inflammation(edema)
 Breast and colon cancer
 Infertility
Note: 49.1% persons were obese till 2020 but 52% people were obese till 2022
Symptoms:
 BMI increases
 fats increase
 waist to hips ratio increase
 hips fat increase
Causes:
 Lifestyle
 extra calories intake
 genetics
 growing older
 no enough sleep
 pregnancy
 PCOS
 Cushing’s syndrome (in it stress hormone increases)
 hypothyroidism
 osteoarthritis (pain in joint)
Risk factors:
 obesity in family
 living at the places where fast food is common and cheap
 when your friend group is fast food loving
 depression ( depression medicine causes weight gain )
 Ortho medicine( results in weight gain)
 smokers
 people who use more cold drinks
 beta blockers (given in heart disease result in weight gain)
Diagnosis:
 Anthropometry
 ultrasound/ CT Scan/ MRI to assess fat
 cholesterol test
 glucose test
 LFT( liver function test) after thyroid test diabetes test
Medical nutrition therapy(MNT):

Counseling:
  Lifestyle change
 Proper sleep
 Physically active
 Calories adjustment
 Psychiatrist to reduced depression most common
 Most people gain weight due to depression and vise versa.
Medicine:
 Orlifit (brand name)
 Orlistat (salt name ) giving rise to oily stool excreting fat from the body
 Delit ( no oily stool )
Supplements:
 Gardenia based products (flower)
 green coffee beans
 African mangoes
 Some people use moringa for weight loss which affects the stomach
 GLP 1 (advance form of injections used for weight loss usually prescribed in diabetes )
Surgery:
If obesity is very severe then go for surgery
 Bariatric surgery (stomach is cut in it )
 gastric bypass surgery( small pouch made on stomach directly attached to the intestine,this
pouch digests the food
 laparoscopy adjustable gastric binding (LAGB) stomach is divided into two parts one is in use other
is free
 gastric sleeve (stomach is cut into sleeve like shape and only small portion of stomach is used )
Diet planning
 Use complex carbs
 reduce calories
Almost 30 to 40 plus diet plans of a obesity exist these include
 simple diet plan
 general modified diet plan
 7 days diet plan
 zone diet plan
 protein diet plan
 keto diet plan
 intermittent fasting
 Hollywood diet plan
 egg diet plan
 14 day diet plan

Pregnancy:
  Mostly relate with dietitians. First trimester has precautions. Just spotting during pregnancy is
normal but bleeding is critical.
 Hormonal changes occur. Mood swings in( first + third trimester)
 Headache during pregnancy because blood volume increases
 Constipation, nausea, vomiting, diarrhea, weight gain and morning sickness occur
 Body has many changes. Every female pregnancy is different from others
 During pregnancy if weight increase in limit then it become normal after delivery

1st trimester 2--3kg weight increase

2nd trimester 4kg weight increase
3rd trimester 4kg weight increase
Total 10--12kg/25—35 pounds weight increase
Normal baby weight 3--4kg/6—8 pounds
Immediately after delivery 8--10kg weight decreases

 Hypertension occur in pregnancy due to smoking, excessive weight gain and heartburn
 Muscle cramps, back bone and legs pain
 Anemia too much common
 Vinofer bottles recommended(injections used in drips)
 Blood bottles (have chances of side effects)
 Depression (after and during pregnancy)
 Irritation( food, smell, tea, meat)
 Insomnia, swelling in feet, dark circles, water retention
 Breast size increase(itching, suffocation)and acne.

1st trimester 2nd trimester 3rd trimester

 12 weeks  12 to 27 weeks  28 to 40 weeks

 Organ formation  ultrasound  If C-section: 36 weeks only
 Rapid growth of baby  kicking of baby start  If normal delivery: 40 weeks
 Greater chances of
miscarriage
 Folate supplements
Tests:
 CBC,
 Diabetes test,
 Hepatitis test,
 Urine test,
 BP
 Ultrasound: in second trimester

Issues:
 UTI issues (urinary tract infections)
 No proper urination
 Baby toxins excreted by mother
  Fever
 Gestational diabetes

Medical Nutrition Therapy:

 Fiber: 30 to 40 gram
 Severe constipation: 50 gram
 Every trimester: 350 calories is increased.
 Complex carbs
 Fruits and vegetables: highly recommended
 Protein rich diet
 Nuts not allowed in first trimester
 Protein: 2 gram per kg, if weight is 60 kg then protein need is 120 gram

For Pregnant Women

Calcium 1200 mg daily
Folate 600-800 mcg daily
Iron 27 mg daily

Pica: Non-food items craving

 Due to iron deficiency
 Extra caffeine: restrict in pregnancy.

Note: Papaya not allowed because it contracts the placenta so increase chances of miscarriage
 After C-section: Fat is not allowed because wound is not healed by eating fat

Supplements during Pregnancy:

 Folate, iron and multivitamins One glass of milk has how much
 If low weight: milk supplements calcium?
 If Over weight: only diet modification =276--300mg

Child nutrition:
 First 6 months baby: not require any diet, he requires only breast feeding
 Gas in baby: due to liquid intake and due to tight closure of feeder after washing which fills gas
in feeder

1 year=1000 kcal 6 months= 600 kcal

7 months=700 kcal 10 months=1000 kcal

 4 months baby: weaning should start, give mashed foods to develop taste buds such as suji ka
halwa and biscuits etc.
 6 months baby: move slowly towards solid foods
 1 year baby: bread, roti
Honey is dangerous for infants

 Because honey has bacteria "Clostridium botulinum"

 Infants digestive system is not mature enough to destroy the spores

Liver disease:

General term: include different diseases, with different reasons

Liver is vital organ, perform 100+ functions:

 Help in digestion,
 Metabolism
 Store energy

General symptoms: Vary person to person. Symptoms appear in some persons in early stages and in some
persons in late stages.

 Pale skin, pale eyes (jaundice)

 Black stool
 Enlargement of liver (last stage)
 Encephalopathy: mood swings and confusion (disorder of brain)

Diseases:
 Hepatitis
 Fatty liver disease
 Auto immune disease
 Drug induced liver disease
 Liver cancer
 Liver failure
 Cirrhosis

Hepatitis:
 Viral disease
 Inflammation of liver
 Spread from person to person

Five Types
Hepatitis A  Not serious
 Caused by contaminated water or food
 Curable

Hepatitis B  May be acute or chronic (difficult treatment)

 Spread through contaminated syringes and blood
 Also spread through intercourse and breastfeeding
Hepatitis C  Mostly chronic
 Severe form and damage liver cause cirrhosis

Hepatitis D  Not cured

 Hepatitis B converted into Hepatitis D if not treated

Hepatitis E  Caused due to pig meat and contaminated water

Fatty liver disease:

Fat stores in liver due to obesity.

Types;

 Alcoholic fatty liver: Due to alcohol consumption

 Non-alcoholic fatty liver: Due to obesity, by consuming too much fat and excessive use of medicine

Auto immune hepatitis:

 Confusion of body, cells active, attack on liver, cirrhosis start, liver damage and cancer
 This is not curable

Primary biliary cirrhosis:

 Damage of bile duct, affect liver, cirrhosis, liver
cancer Genetics: family member having liver disease

Hemochromatosis:
 Genetic disorder
 Auto immune disorder
 Body store more iron (more than capacity of liver)
 Produce toxins: these toxins cause damage to liver

Wilson disease:
 Related to copper (trace element)
 More copper is stored by liver and not removed by liver so this cause damage to liver
 Copper in blood stream damage other parts of body like brain
 No permanent treatment
 Alpha-1 (anti-trypsin) deficiency: help protein to break down enzyme

Drug induced liver disease:

 Extra use of pain killers and medicines
 Liver ability to remove toxins decrease
 At end liver stop removing toxins
 Chronic liver cancer
 Blood cancer, at end liver transplant

Cirrhosis:
 Scars in liver
  At end stage, liver fail, water in abdomen (ascites), less survival chances

Risk factors:
 Tattoo making,
 Contaminated syringes
 No precaution by lab workers,
 Pesticides company workers
 Obesity,
 High cholesterol,
 Alcohol consumption
 Intercourse
 Extra supplements

Prevention:
 Physically active
 No obesity
 No smoking
 No alcohol
 Proper fluid intake
 Proper fruits intake
 Proper vegetables intake
 Every 6 month checkup of liver

Diagnosis:
 Liver function test (LFT)
 Ultrasound
 MRI
 Liver biopsy

Medical Nutrition Therapy:

Foods Allowed Foods to Avoid

 High fiber  Salty foods

 Low fat  sugar
 Lean protein  alcohol
 Extra fruits and vegetables  red meat
 Whole grains  heavy fat

Diabetes

 >Metabolic disorder

2 Conditions

Hyperglycemia Hypoglycemia
 blood sugar level increases blood sugar level decreases
Types:

Type 1 diabetes Type 2 diabetes Secondary diabetes Gestational diabetes

 Insulin  non insulin  caused due to  in 1st time
dependent/ dependent / mature some other pregnancy after
Juvenile diabetes factors pregnancy it ends
diabetes >prediabetics
 >auto immune
disorder, travel
from gene to
genes
 body become  mature(after 35 to  due to  but if diabetes
insulin deficit 40 age) people some exist in 2nd time
 body suffers medicines pregnancy it will
become converts to type 2
insulin diabetes
dependent
 >juvenile = in 3 conditions in this type  like  factors = stressed
youngsters  >hyperglycemia hypertension , females in
 >beta-cells of (more glucose in CVDs , kidney pregnancy
pancreas are blood + pancreas medication,
destroyed by less open, less  surgeries like  NOTE :
immune system insulin production) gall bladder, C- IN 1ST TIME
(no beta-  >hypoglycemia Section etc PREGNANCY if
cells=no (vice versa) she take care of
insulin=glucose  >normal insulin herself with proper
goes into the production (insulin diet and proper
blood) produced exercise, the
according to the chances of diabetes
requirement) in 2nd time
pregnancy reduces

Symptoms:

common symptoms hunger, thirst, weight loss at early ages due to stress and no
management ,vision blurry , frequent urination, tiredness
symptoms in males infertility chances increases, immune system weakens,
muscles weak ,male testes swells
symptoms in females UIT(urinary tract infection), vaginal dryness,
itching, weakness of bones, dry skin

Complications:
 kidney issue
 neuropathy
 Dementia
 Depression/ stress, CVDs
Causes Diagnosis Treatment

 obesity,  fasting test,  change life style ,

 overweight,  blood glucose level test,  physical activity,
 age,  HbA1C(3 months  sleeping cycle,
 physical activity level, history test)  100% complex carbs,
 genetics,  No simple carbs
 hormonal disturbance,
 PCOS ,
 stress,
 lifestyle
Medical nutrition therapy:

Medical treatment Nutritional treatment

 insulin/glucophage  Multivitamin(must recommended)
 VD3 and Zn supplements (more zinc
more immunity)

Never recommend juices to diabetic patient

Weight gain

 Difficult than Weight loss

 Underweight (due to multiple reasons)

Reasons:
 Fe deficiency is due to Vitamin B12 deficiency
Note: Fe deficiency causes Hb level low (body is unable to utilize energy properly and gain weight)

 Real stress (weight don’t gain)

 Environment: not taking healthy diet/ economical problem = no weight gain
 If worms in intestine or alcohol consumption : No weight gain
 12 year older / growing age : mostly weight don’t gain
Symptoms:
 Fatigue,
 pain in all body,
 pain in feet / lower legs(due to Fe deficiency),
 muscle Fatigue,
 body irritation( move body, legs) ,
 insomnia

Test:
 Hb/CBC test
 Stomach check : ultrasound
  Not Properly teeth developed : Difficulty in eating
Medical nutrition therapy;
2000 or 2000+ calories needed

 No metabolic drink/green tea

 If Stomach issue ( cold things , like tukh melange , gund katera, yogurt etc)
 Less thing , more calories (smoothes)
 Appetizer (if not feel hungry)
 Elder one ( omaprazol + Appetizer) if not feel hungry
 Antacids : if needed (if no- digestion, irritability)
 Fe + Ca recommended (compulsory)
 Milk supplements (insure , pediasure etc)
 VD capsule : if height issue
 Exercise before eating
 Height (jumping and hanging)
 Smoothes