Food science and nutrition internship

Internship report
Fatima Memorial Hospital Lahore,
Punjab Pakistan.
By
Shafaq Sana
2014-GCUF-15562
BS Food Science & Nutrition
2014-2018
Department of Food Science and Nutrition
Government College University, Faisalabad
Sahiwal Campus, Pakistan.

Internship Report
Fatima Memorial Hospital Lahore
Punjab Pakistan
By
Shafaq Sana
2014-GCUF-15562
Internship report Submitted in partial fulfillment of the requirement for the
award of degree
BS Food Science & Nutrition
2014-2018
Department of Food Science & Nutrition
Government College University, Faisalabad
Sahiwal Campus, Pakistan

i
Dedication
At first dedicating this work to Allah Almighty, Without His mercy and sympathy I was
not able to accomplish this work and all those who have supported, encourage, and inspired
me throughout this journey.
Shafaq Sana
2014-GCUF-15562

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Acknowledgement
All praise to Allah almighty the most merciful and the most beneficent who gave me
confidence guidance and abilities to complete this report successfully. As it was new place
for me so was a little bit confused at the beginning but Allah almighty gave me strength at
that time. I am grateful to my parents who are always been a source of encouragement for
me throughout my life and from the start to the end of this journey.
I express my greatest gratitude to my kind hearted supervisor Madam Shazia Zahra
(consultant nutritionist and Head of Nutrition Department). Her enthusiasm shows the way
forward to me to achieve this success and who kept me in high spirit through her
appreciation she helped me a lot each time I went up to her.
I would like to thanks Madam Maham (Coordinator) and Madam Feroza for their kind
supervision, suggestion and support during internship .They provide the proper guidance
and support time to time which helps me a lot to work in such competitive environment
and timely completion of assignment.
Special thanks and appreciation goes to my university beloved teachers especially Head of
Department Dr Younas Khokhar and Madam Muneeza. However it was not possible
without the kind support of my teachers of food science & Nutrition at Government College
University Sahiwal Campus University of Faisal Abad.
Shafaq Sana
2014-GCUF-15562

iii
Executive Summary
Practical work is integral part of this degree of this. The purpose behind this task is to see,
watch and observe the actual field work where we have to serve in the coming days. For
this valuable purpose, I have learned a lot from training at Fatima Memorial Hospital
Lahore (FMHS).Fatima Memorial Hospital Lahore is attach to FMH College of medicine
and dentistry. As a teaching and training hospital. FMHCMD is a private college of
medicine located in Shadman, Lahore, and Punjab, Pakistan. It was establish in 2001 an
dis a part of Fatima Memorial System, registered with PMDC, WHO, Avicenna Directories
and IMED, affiliated with UHS and approved with ministry of health.
I started my internship on 23 January 2018 at FMH Lahore. My internship was almost of
8 weeks. Being a clinical nutrition intern, we were ask to learn assessment and cancelling
of patients, treatment and prevention of different diseases by advising them on healthy
eating.For this purpose I worked in different wards on weekly bases. Under the supervision
of the nutritional department team.
In short, I got a lot of exposure, experience and practical knowledge at FMH Lahore. I have
gained much there and I think it is the best platform for training in the nutrition department.

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Table of Content
Sr no Topic Page No
1 Fatima Memorial Hospital 1
2 Nutrition Assessment 3
3 Weight Management 9
4 Diabetes 15
5 High blood pressure 21
6 Cardiovascular Disease 28
7 Liver disease 34
8 Kidney Disease 37
9 GI disorders 41
10 Diarrhea 46
11 Peads 48
12 Fever 48
13 Anemia 52
14 Assignment Work 55
15 Extracurricular Activities 56
16 Conclusion 58

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Fatima Memorial Hospital
Fatima Memorial Hospital Pakistan’s first Muslim non-profit hospital was established in
1977 situated in Shadman , in central Lahore, it started as 200 bed community hospital for
women and children. But today by the grace of Allah almighty, Fatima Memorial Hospital
has transformed into 500 beds tertiary care general hospital. Fatima Memorial Hospital
believed in service, excellence, and quality health care to the ailing.
The philosophy of functioning of Fatima Memorial Hospital is cross subsidization where
funds generated from affording patients are utilized for the benefit of under privilege and
indigence. Today FMH stands committed to provide quality health care services. To all
categories of patients this regarding means to pay
History of FMH
FMH was born out of a tragic story of Molvi Feroz-ud-Din, a prominent scholar, lost his
young wife, Kaneez Fatima during child birth In 1917 due to swear lack of adequate
medical facilities.
In 1944 he founded the Feroz Son’s trust with an initial cash of endowment along with all
the proceeds from his books. The aim of this trust were to provide quality medical care to
the under privileged of society on a non-profit, self-sustaining basis and to promote the
education and the development of the community.
The fulfillment of this vision began in 1971, when his son and daughter in law Doctor
Abdul Waheed and Begum Sayyad Waheed donated all their assets towards the
construction of a hospital for women and children.
In 1977, it started as a 200 bed community hospital for women and children care. By the
grace of Allah almighty in the year 2000, Fatima Memorial Hospital transformed into 510
bed multi-specialty tertiary care teaching hospital. Fatima Memorial Hospital believes in
service excellence and quality health care to the ailing humanity. Core philosophy of
functioning of Fatima Memorial Hospital is cross subsidization where funds generated
from affording patients are utilized for the benefit of under privilege and indigence.
Today FMH stands committed to provide quality health care service to all categories of
patients this regarding mean to pay. Today the hospital serves not only as a hub for patients
but also as the teaching based for all human health resource which includes FMH college
of Medicine and Dentistry and for FCPS, MSPS,MD & MRCGP training of post graduate
trainees. FMH continues to be a practice base for nurses trained at the Sayeda Waheed
College of nursing.
Mission and Vision
“To provide quality health care without discrimination of patients from all walks of life.
Quality health care and research based education for all leading to integrated to social
economic community development.”
Hospital services
 Clinical services
 Surgical services

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 Maternal and child health
Clinical services
Surgical division
Surgery department was established in 1988 as a part of hospital expansion to general
hospital stock.
Today department of surgery is equipped modern, advanced surgical equipment both for
diagnostic and operative purposes. It has separate male and female surgical wards, well
equipped operation theater complex, pre and post-operative wards and state of the art
surgical intensive care unit. Department of surgery has following advanced sub specialties:
 Orthopedic surgery
 Laparoscopic surgery
 Thoracic surgery
 Plastic surgery
Medical division
Medicine department was established in 1985 and has grown into the most advanced
department both technically and functionally. It is equipped with state of art diagnostic and
clinical monitoring service. It provides tertiary clinical care in the following medical sub
specialties:
 General medicine
 Family medicine
 Pulmonology medicine
 Infectious medicine
Other departments
 Cardiology department
 Neurology department
 Nephrology department
 Ophthalmology department
Other patients department
 General OPD
 Poly clinics
 Inpatient (IPD)

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Nutrition
Nutrition is the study of nutrients in food, how the body uses nutrients, and the relationship
between diet, health and disease.
Nutrition assessment
A nutrition assessment is an in depth evaluation of both objective and subjective data
related to an individual’s food and nutrient intake, lifestyle, and medical history. Once the
data on an individual is collected and organized, the practitioner can assess and evaluate
the nutritional status of that person.
Purpose of nutritional assessment
Define a patient’s nutritional status, to define clinically relevant mal nutrition and to
monitor changes in nutritional status.
Components of nutritional assessment
 Anthropometrics: Anthropometrics are Objective measurements that help determine
amount of muscle and percentage of body fat.
Biochemical Data
Laboratory test based on blood and urine can be important indicators for nutritional status,
but their influence buy non nutritional factor as well. Lab results can be alter by medication,
hydration, disease states or other metabolic processes such as stress. As with the other areas
of nutrition assessment, biochemical data need to be viewed as a part of the whole.

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Clinical data
Clinical data provides information about the individual medical history, including acute
and chronic illness and diagnostic procedure, therapies, or treatments that may increase
nutrients needs and reduced mal absorption. Current medications need to be documented.
Dietary data
There are many ways to document dietary intake. During a nutrition interview nutritionist
may ask what the individual ate during the previous hours, begging with the last item eaten,
documentation should include portion sizes and how the food was prepared.
Total caloric requirement = BEE x Activity factor x Injury factor
 Basal Energy Expenditure (BEE)
OR
Harris-Benedict Equation
a) BEE for Male = 66.5 + (13.7 ×weight) + (5 × height) – (6.8 × age)
b) BEE for Female = 655.1 + (9.6 × weight) + (1.85 × height) – (4.7 × age)
Weight = kg, height = cm, age = years
Conversion of Height in cm
Feet x 30 cm, inches x 2.5 cm,
Activity Factor Injury Factor
No activity = 1.0-1.1 Surgery
Slightly active = 1.2- 1.3 Minor = 1.0-1.1
Moderate Active = 1.3- 1.5 Major = 1.3-1.9
Athletes heavy = 1.5- 1.7 Infection
Mild= 1.0-1.2
Moderate = 1.2-1.5
Severe = 1.4=1.8
Trauma
Skeletal = 1.2-1.35
Blunt = 1.15- 1.35
Burns
Up to 40% body surface
Area= 1.0- 1.5
Over 100% BSA= 1.95

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Quick Methods of Caloric Calculation
Estimate energy needs based on stress
 Normal: 30-35 Kcal/kg body weight
 Elective Surgery: 35-40 Kcal/kg body weight
 Severe Injury: 30-40 Kcal/kg body weight
 Extensive Burn or trauma 44-55 Kcal/kg body weight
a) Energy Needs Based on Weight & activity
Weight Sedentary Moderate Active
Over weight 20-25Kcal/kg 30Kcal/kg 35Kcal/kg
Normal 30Kcal/kg 35Kcal/kg 40Kcal/kg
Under weight 30Kcal/kg 40Kcal/kg 45-50Kcal/kg
Types of Activity
1. Sedentary Activity:
Eating, Writing, Watching television, working on computer, typing and table work in
office.
2. Light Activity:
Preparation of food, washing the utensils, dusting, ironing, light walk, fast computer
typing,
3. Moderate Activity:
Mopping and brisk walk.
4. Vigorous Exercise:
Washing clothes with hands, white washing, and very brisk walk, playing golf and
gardening.
5. Strenuous Exercise:
Swimming, jogging, bicycling, playing cricket and other games.
Estimating Protein Needs
Normal Health-------------------- 0.8-1.0gm/kg body weight
Fever, Fracture, Infection (age group) -------------------- 1.5-2gm/kg body weight
Protein depleted-------------------- 1.8-2gm/kg body weight
Extensive burns-------------------- 1.5-3.0gm/kg body weight

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Estimating Fluids Needs
1. Based on age:
 Adult ----------------- 30-50ml/kg body weight
 Infant----------------- 100-150ml/kg body weight
 Children----------------- 70-110ml/kg body weight
 Adolescent ----------------- 40-60ml/kg body weight
2. Based on weight:
First 20 kg 1500 ml & for each additional kg 25ml.
3. Based on energy intake:
1ml/ Kcal
4. Fluid calculation for renal patients:
In oliguria restricted to the daily urine output plus 500 ml. this includes the water present
in foods and drink.
(1 cup) 1 glass = 250 ml e.g. if one’s fluid requirement is 1800ml to calculate 1800 ml in
glasses then 1800÷250 = 7.2 which means 7 glasses.
Calculation of Ideal Body Weight
IBW for Men = 106 lb. for first 5 feet & 6 lb. for each additional inch
IBW for Women = 100 lb. for first 5 feet & 5 lb. for each additional inch
Subjective Global Assessment
 Is simple, reliable and dynamic.
 No anthropometric or laboratory indices are included.
Advantages
 Does not require lab testing
 Validated in liver transplant, dialysis, and HIV patients
Disadvantages
 Subjective and dependent on the experience of the observer

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Conclusion
SGA can be used regularly in routine clinical practice to assess the nutritional status and
make appropriate recommendations to prevent malnutrition.

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Weight management
Weight management is the process of adopting long term life style modification to maintain
a healthy body weight on the basis of person’s age sex a height. Methods of weight
management includes eating a healthy diet an increasing physical activity level.
Calculation of Body Mass Index
BMI= Weight (kg)/Height (m)
cm to meter/ 100
Standard BMI Women Men
Under weight <18.5 <18.5
Desirable weight 18.5-24 20-25
Over weight 25-30 25-30
Obese grade I 30-35 30-35
Obese grade II 35-40 35-40
Obese grade III 40-45 45-50
Obesity Adjustment: (Actual BW – IBW) x 0.25 + IBW
Importance
Lowering the risk of hard disease, stroke, diabetes, high blood pressure.

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Overweight and obesity
The difference between obesity and being overweight comes down to body mass index
(BMI) of 30 or higher is considered obese. Overweight is defined by a BMI of 25/29.9.
BMI is used because, for most people, it correlate with their amount of body fat.
Causes
Food and activity
People gain wait when they eat more calories than they burn through activity.
 Environment
 Genetics
 Health condition and medication
 Stress
 Emotional factor
 Poor sleep
Risk

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Patient history
Patient name: Basit Ali Age: 40 Height: 5’7 weight: 95 kg
Medical diagnosis: obese
Recommendation
Caloric requirement: 1400-1600 kcal/ day
Fluid requirement: 10-12 glass/day
Mechanism of diet: Soft diet
Type of diet: kcal, carbs, fat, protein
Diet plan for obesity
Timing Food item Serving
size/amou
nt
CHO Protein Fat Other Kcal
Pre
breakfast
6-7am
flax seed, in luke
warm water
1/1 tsp 0 0 5 45
Breakfast
7-8am
apple/banana 1/1 15 0 0 60
Oats ½ cup 15 3 0 80
Scrambled egg 1/1 0 7 4 75
Yogurt and
pumpkin seeds
1, 2/3 12 8 0+5 45+100
Snacks
10-11am
Cucumber
juice/carrot
juice/tomato
juice
2/2cup 10 4 0 50
Lunch
1-2pm
Guava 1+1 15 2 0 60
Vegetable 2/1 ½ /2 45 8 0 80

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Fish
gravy/smoked
1/1oz 0 7 4 75
Yogurt 1/2/3 12 8 0 100
Snack
4-5 pm
Almonds 6 nuts 0 0 5 45
Green tea 1/1cup 20
Cinnamon+
honey+
cardamom+
cumin
Dinner
7-8pm
Papaya/orange 1/1 15 0 0 60
Chapatti 1/1 15 0 0 60
Chicken piece 1/1oz 0 7 4 75
Salad 1/1cup 5 2 0 25
Yogurt 1/2/3 12 8 0 100
Bed time
10-11 pm
Milk 1/1 12 8 0 100
Total 188 76 27 1440
+20
=1460

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Underweight
A ratio of height to waist circumference that is below an acceptable range for healthy
people.
Symptoms
 Fragile bones
 Irregular menstrual periods or problem getting pregnant
 Hair loss
 Weak immune system

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 Dizziness
Side effects
 Prone to infection
 Hair loss
 Irregular Harmon regulation
 Anemia
 Pregnancy complication
Dietary guidelines for underweight
 Eat 5 to 6 smaller meal during the day rather than 2 or 3 large meal
 Choose nutrient rich food
History
Patient name: Nohaib Age: 25 Height: 5’3 Weight: 45 kg
Medical diagnosis: Underweight
Recommendations
Calorie requirement: 1600-1800kcal/ day
Mechanism of diet: Kcal, carbs, protein, fat
Diet plan for underweight patient
Timing Food items Serving
size/Amount
Pre
breakfast
6-7
Almonds/walnuts 1/1 - - 5 45
Breakfast
7-8
Banana 1/1 15 0 0 60
Paratha ½ 7.5 1.5 0 40
Fry egg 1 0 1 4 75
Mix veg gravy 1/1/2 5 2 0 2.5 25
Yogurt 1/2/4oz 7.5 4 4 80
Snacks
10-11
Banana ,almonds 1/1 30 8 13 60
Snack 0 0 45
160
Lunch
1-2
Banana/ apple 1/1 15 0 0 60
Rice 1 15 3 0 80
Beef 1/1oz 0 7 4 75
Veg salad 1/1 5 2 0 25

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Yogurt 4oz 7,5 4 4 80
Snacks
4-5
Veg’s
Corn & black 1/1/2 15 4 0 80
Beans salad ½ 15 7 0 125
Olive oil ½ 5 2 0+5 45+ 25
Dinner
7-8
Banana 1 15 0 0 60
Chapatti ½ 7.5 1.5 0 40
Chicken gravy 1 0 7 4 75
Vegetable salad 1 5 2 0 25
Mint raita 1/2/4oz 7.5 4 4 80
Bed time
10-11
Milk 1/2/4oz 7.5 4 4 80
185 69 51 1545
Diabetes
Diabetes refers to a group of diseases that effects how your body uses blood sugar.
Types
Chronic diabetes conditions include
 Type 1 diabetes : In most people with type 1 diabetes, the body’s immune system,
which normally fights infection, attacks and destroys the cells in the pancreas that make
insulin. As a result, pancreas stops making insulin. Without insulin, glucose can’t get
into cells and blood glucose rises above normal. People with type 1 diabetes need to
take insulin every day to stay alive.
 Type 2 diabetes: In type 2 diabetes a person's pancreas doesn't produce enough insulin,
or their body doesn't react properly to insulin, called insulin resistance. Type 2
diabetes is the most common type of diabetes. Insulin is used by the body to manage
glucose (sugar) levels in the blood and helps the body use glucose for energy.
 Potentially reversible diabetes conditions include pre-diabetes when your blood sugar
levels are higher than normal, but not high enough to be classified as diabetes

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 Gestational diabetes, which occurs during pregnancy but may resolve after the baby is
delivered.
Symptoms
Some of the signs and symptoms of type 1 and type 2 diabetes are:
 Fatigue
 Irritability
 Blurred vision
 Increased thirst
 Extreme hunger
 Frequent urination
 Slow-healing sores
 Unexplained weight loss
Causes
How insulin works
Insulin is a hormone that comes from a gland situated behind and below the stomach
(pancreas)
 The pancreas secretes insulin into the bloodstream.
 The insulin circulates, enabling sugar to enter cells.
 Insulin lowers the amount of sugar in bloodstream.
 As blood sugar level drops, so does the secretion of insulin from pancreas.
The role of glucose
Glucose a sugar is a source of energy for the cells that make up muscles and other tissues.
 Glucose comes from two major sources: food and your liver.
 Sugar is absorbed into the bloodstream, where it enters cells with the help of insulin.
 Your liver stores and makes glucose.

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Causes of type 1 diabetes
The exact cause of type 1 diabetes is unknown. Immune system which normally fights
harmful bacteria or viruses attacks and destroys your insulin producing cells in the
pancreas. This leaves you with little or no insulin. Instead of being transported into cells,
sugar builds up in bloodstream. Type 1 is thought to be caused by a combination of genetic
susceptibility and environmental factors, though exactly what many of those factors are is
still unclear.
Causes of pre-diabetes and type 2 diabetes
Family history. Risk increases if a parent or sibling has type 1 diabetes.
In pre-diabetes which can lead to type 2 diabetes and in type 2 diabetes, cells become
resistant to the action of insulin, and pancreas is unable to make enough insulin to overcome
this resistance. Instead of moving into cells where it's needed for energy, sugar builds up
in bloodstream.
Although it's believed that genetic and environmental factors play a role in the
development of type 2 diabetes. Being overweight is strongly linked to the development of
type 2 diabetes, but not everyone with type 2 is overweight.
Causes of gestational diabetes
During pregnancy, the placenta produces hormones to sustain pregnancy. These hormones
make cells more resistant to insulin.
Normally, pancreas responds by producing enough extra insulin to overcome this
resistance. But sometimes pancreas can't keep up. When this happens, too little glucose
gets into cells and too much stays in blood, resulting in gestational diabetes.
Risk factors
Risk factors for diabetes depend on the type of diabetes.
Risk factors for type 1 diabetes
Although the exact cause of type 1 diabetes is unknown, factors that may signal an
increased risk include:

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 Environmental factors. Circumstances such as exposure to a viral illness likely play
some role in type 1 diabetes.
 The presence of damaging immune system cells (autoantibodies). Sometimes
family members of people with type 1 diabetes are tested for the presence of diabetes
autoantibodies. But not everyone who has these autoantibodies develops diabetes.
 Dietary factors. These include low vitamin D consumption, early exposure to cow's
milk or cow's milk formula, and exposure to cereals before 4 months of age. None of
these factors has been shown to directly cause type 1 diabetes.
Risk factors for pre-diabetes and type 2 diabetes
 Weight. The more fatty tissue have, the more resistant cells become to insulin.
 Inactivity. The less active persons are, the greater risk. Physical activity helps control
weight, uses up glucose as energy and makes cells more sensitive to insulin.
 Family history. Risk increases if a parent or sibling has type 2 diabetes.
 Age. Risk increases as get older. This may be because tend to exercise less, lose muscle
mass and gain weight as age. But type 2 diabetes is also increasing dramatically
among children, adolescents and younger adults.
Risk factors for gestational diabetes
Any pregnant woman can develop gestational diabetes, but some women are at greater risk
than are others. Risk factors for gestational diabetes include:
 Age. Women older than age 25 are at increased risk.
 Family or personal history.
 Weight. Being overweight before pregnancy increases risk.
Complications
Long-term complications of diabetes develop gradually. Possible complications include:
 Cardiovascular disease. Diabetes dramatically increases the risk of various
cardiovascular problems, including coronary artery disease with chest pain (angina),
heart attack stroke and narrowing of arteries (atherosclerosis).

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 Nerve damage (neuropathy). Excess sugar can injure the walls of the tiny blood
vessels (capillaries) that nourish nerves, especially in legs. This can cause tingling,
numbness, burning or pain that usually begins at the tips of the toes or fingers and
gradually spreads upward. Damage to the nerves related to digestion can cause
problems with nausea, vomiting, diarrhea or constipation. For men, it may lead to
erectile dysfunction.
 Kidney damage (nephropathy). The kidneys contain millions of tiny blood vessel
clusters (glomeruli) that filter waste from blood. Diabetes can damage this delicate
filtering system. Severe damage can lead to kidney failure or irreversible end-stage
kidney disease, which may require dialysis or a kidney transplant.
Prevention
 Eat healthy foods. Choose foods lower in fat and calories and higher in fiber. Focus
on fruits, vegetables and whole grains.
 Get more physical activity. Aim for 30 minutes of moderate physical activity a day.
Take a brisk daily walk.
Dietary guidelines
 Whole wheat
 Bran bread
 Multi grain bread
Avoid
 Banana
 Raisins
 Melon
 Dates
 Mango
Vegetables
 Carrot
 Potato

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Patient history
Case study
Patient name: Aleesha Age: 34 weight: 70 Height: 5’4
Medical diagnosis: DM
Recommendation
Caloric requirement: 1400-1600 Kcal
Mechanism of diet: Soft diet
Type of diet: kcal, sugar free diet, protein, fat
Diet plan for diabetes
size/amount
Pre
Breakfast
6-7am
Fenugreek
seeds
½ tsp 0 0 5 45
Breakfast
7-8am
Apple 1/1 15 3 0 60
Whole wheat
chapatti
1/1 15 3 0 80
Fry egg 1/1 0 7 4 75
Boiled kidney
beans
1/1/2 5 2 5 70
Yogurt 1 12 8 3 100
Snacks Aloe Vera ½ tsp 20
Juice

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10-11 am Almonds 1/6 0 0 5 45
Lunch
1-2
Guava ½ 15 0 0 60
Egg veg’s
sandwich
0 7 4 75
Yogurt 1 12 8 3 100
Snacks
4-5pm
Tea 1 6 4 1.5 50
Cutlet
Meat+ veg’s 1/1/2 tsp 1.2 12 4 100
Dinner
7-8 pm
Apple ½ 15 0 0 60
Whole wheat
chapatti
1/1 15 3 0 80
Bhindi gosht 1/1/2 5 7+2 4 100
Yogurt ½ 12 8 3 100
Before
bed
10-12
Milk 1 12 8 3 100
172 77 44 1428
High Blood Pressure (Hypertension)
High blood pressure is a common condition in which the long-term force of the blood
against artery walls is high enough that it may eventually cause health problems, such as
heart disease.
Systolic
Means the pressure while the heart beats.
Diastolic
Pressure is measure as the heart reflexes.

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Category Systolic Blood
Pressure
Diastolic blood
pressure
Normal <120 <80
Pre-hypertension 120-139 80-89
Hypertension-stage1 140-159 90-99
Hypertension-Stage2 >= 160 >=100
Prevalence of Hypertension by Age
Age %Hypertensive
 18-29 > 4
 30-39 > 11
 40-49 > 21
 50-59 > 44
 60-69 > 54
 70-79 > 64
 80+ > 65
Causes
There are two types of high blood pressure.
Primary (essential) hypertension
For more adults, there’s no identifiable cause of high blood pressure. This type of high
blood pressure, called primary (essential) hypertension, tends to develop gradually over
many years.
Secondary hypertension
Some people have high blood pressure caused by an underlying condition. This type of
high blood pressure, called secondary hypertension, tends to appear suddenly and cause
higher blood pressure than does primary hypertension. Various conditions and medications
can lead to secondary hypertension, including:
 Obstructive sleep apnea
 Kidney problems
 Adrenal gland tumors
 Thyroid problems
 Certain defects in blood vessels you’re born with(congenital)

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 Certain medications, such as birth control pills, cold remedies, decongestants, over the-
counter pain relievers and some prescription drugs
 Illegal drugs, such as cocaine and amphetamines
 Alcohol abuse or alcohol use
Risk Factors
High blood pressure has many risk factors, including:
 Age
The risk of high blood pressure increases as age. Through early middle age, or about age
45, high blood pressure is more common in men. Women are more likely to develop high
blood pressure after age 65.
 Family history
High blood pressure tends to run in families.
 Being overweight or obese
The more weigh the more blood need to supply oxygen and nutrients to tissues. As the
volume of blood circulated through blood vessels increases, so does the pressure on artery
walls.
 Not being physically active
People who are inactive tend to have higher heart rates. The higher heart rate, the harder
heart must work with each contraction and the stronger the force on arteries. Lack of
physical activity also increases the risk of being overweight.
 Too much salt (sodium) in diet
Too much sodium in diet can cause body to retain fluid, which increases blood pressure.
 Too little potassium in diet
Potassium helps balance the amount of sodium in cells. If one don’t get enough potassium
in diet or retain enough potassium, one may accumulate too much sodium in blood.
Symptoms
A few people may have headache, shortness of breath, nosebleeds but these signs and
symptoms are not specific and usually don’t occur until high blood pressure has reached a
severe and life threatening stage.

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Complications
The excessive pressure on artery walls caused by high blood pressure can damage blood
vessels as well as organ in body. The higher blood pressure and the longer it goes
uncontrolled, the greater the damage.
Heart Attack: High blood pressure can cause hardening and thickening of arteries,
which can lead to heart attack, stroke and other complications.
Metabolic Syndrome: This syndrome is a cluster of disorders of body’s metabolism,
including increased waist circumference; high triglycerides; low high density lipoprotein
(HDL) cholesterol, the good cholesterol; high blood pressure; and high insulin levels.
These conditions may make likely to develop diabetes, heart disease and stroke.
Heart Failure: To pump against the higher pressure in vessels, heart muscle thickens.
Eventually, the thickened muscle may have a hard time pumping enough blood to meet
body’s needs, which can lead to heart failure.
MNT for Hypertension
DASH diet: Healthy Eating to lower blood pressure
Dash stands for Dietary Approaches to Stop Hypertension. The DASH diet is lifelong
approach to healthy eating that’s designed to help treat or prevent high blood pressure
(Hypertension). The DASH diet encourages to reduce the sodium in diet and eat a variety
of foods rich in nutrients that help lower blood pressure, such as potassium, calcium and
magnesium.
DASH diet: Sodium levels
The DASH diet emphasizes vegetables, fruits and low-fats dairy foods_ and moderate
amounts of whole grains, fish, poultry and nuts.
In addition to the standard DASH diet, there is also a lower sodium version of the diet.
 Standard DASH diet: Consume up to 2300 milligrams (mg) of sodium a day.
 Lower sodium DASH diet: Consume up to 1500 mg sodium a day.
DASH diet: What to eat
Both version of the DASH diet include lots of whole grains, fruits, vegetables, low-fat dairy
products. The DASH diet include some fish, poultry and legumes, and encourages a small
amount of nuts and seeds a few times a week.
Grains: 6 to 8 servings a day
Grains include bread, cereal, rice and pasta. Examples of one serving of grains include 1
slice whole-wheat bread, 1 ounce dry cereal, or ½ cup cooked cereal, rice or pasta.

25
 Focus on whole grains because they have more fiber and nutrients than do refined
grains. For instance, use brown rice instead of white rice, whole- wheat pasta instead
of regular pasta and whole-grain bread instead of white bread. Look for products
labeled “100 percent whole grain” or “100 percent whole wheat”.
 Grains are naturally low in fat. Keep them this way by avoiding butter, cream and
cheese sauces.
Vegetables: 4 to 5 servings a day
Tomatoes, carrots, broccoli, sweet potatoes, greens and other vegetables are full of fiber,
vitamins, and such minerals as potassium and magnesium. Examples of one serving include
1 cup raw leafy green vegetables or ½ cup cut-up raw or cooked vegetables.
 Don’t think of vegetables only as side dishes_ a hearty blend of vegetables served over
brown rice or whole-wheat noodles can serve as the main dish for a meal.
 Fresh and frozen vegetables are both good choices. When buying of frozen and canned
vegetables, choose those labeled as low sodium or without added salt.
 To increase the number of servings fit in daily, be creative. In a stir-fry, for instance,
cut the amount of meat in half and double up on the vegetables.
Fruits: 4 to 5 servings a day
Many fruits need little preparation to become a healthy part of meal and snack. Like
vegetables, they are packed with fiber, potassium and magnesium and are typically low in
fat_ coconut are an exception. Example of one serving include one medium fruit, ½ cup
fresh, frozen and canned fruit, or 4 ounces of juice.
 Have a piece of fruit with meals and one as a snack, then round out day with a dessert
of fresh fruits topped with a dollop of low-fat yogurt.
 Leave on edible peels whenever possible. The peels of apples, pears and most fruits
with pits add interesting texture to recipes and contain healthy nutrients and fibers.
 Remember that citrus fruits and juices, such as grapefruit, can interact with certain
medications, so check with doctor or pharmacist to see if they’re OK.
 If chose canned fruit or juice, make sure no sugar is added.
Dairy: 2 to 3 servings a day
 Milk, yogurt, cheese and other dairy products are major sources of calcium, vitamin D
and protein. But the key is to make sure that chose dairy products that are low fat or
fat- free because otherwise they can be a major source of fat _ and most of it is saturated.
Example of one serving include 1 cup skim or 1 percent milk, 1 cup low fat yogurt, 1
½ ounces part skim-cheese.
 Low-fat or fat- free frozen yogurt can help boost the amount of dairy products eat while
offering a sweet treat.
 Add fruit for a healthy twist.

26
 If in trouble digesting dairy products, choose lactose-free products or consider taking
an over- the-counter product that contains the enzyme lactase, which can reduce or
prevent the symptoms of lactose intolerance.
 Go easy on regular or even fat-free cheeses because they are typically high in sodium.
Lean meat, poultry and fish: 6 servings or fewer a day
Meat can be a rich source of protein, B vitamin, iron and zinc. Choose lean varieties and
aim for no more than 6 ounces a day. Cutting back on meat portion will allow room for
more vegetables.
 Trim away skin and fat from poultry and meat and then bake, broil, grill or roast instead
of frying in fat.
 Eat heart- healthy fish such as salmon, herring and tuna.
These type of fish are high in omega-3 fatty acids, which can help lower total cholesterol.
Nuts, Seeds and legumes: 4 to 5 servings a week
Almonds, sunflowers seeds, kidney beans, peas, lentils and other foods in this family are
good sources of magnesium, potassium and protein. They’re also full of fiber and
phytochemicals, which are plant compounds that may protect against some cancers and
cardiovascular disease.
Serving sizes are small and are intended to be consumed only a few times a week because
these foods are high in calories. Example of one serving include 1/3 cup nuts , 2 tablespoons
seeds, or ½ cup cooked beans or peas.
 Nuts sometimes get a bad rap because of their fat content, but they contain healthy
types of fat_ monounsaturated -fat and omega-3 fatty acids. They’re high in calories,
however, so eat them in moderation. Try adding them to stir-fries salads or cereals.
 Soybean-based products, such as tofu and tempeh, can be a good alternative to meat
because they contain all of the amino acids body needs to make a complete protein, just
like meat.
Fats and Oils: 2 to 3 servings a day
Fat helps body absorb essential vitamins and helps body immune system. But too much fat
increases heart disease, diabetes and obesity. The DASH diet strives for a healthy balance
by limiting total fat to less than 30 percent of daily calories from fat, with a focus on the
healthier monounsaturated fats.
Example of one serving include 1 teaspoon soft margarine, 1 tablespoon mayonnaise or 2
tablespoons salad dressing.
 Saturated fat and Tran’s fat are the main dietary culprits in increasing risk of coronary
artery disease. DASH helps keep daily saturated fat to less than of 6 percent of total

27
calories by limiting use of meat, butter, cheese, whole milk, cream and eggs in diet,
along with foods made from lard, solid shortening, and palm and coconut oils.
 Avoid trans-fat, commonly found in such processed foods as crackers, backed goods
and fried items.
 Read food labels on margarine and salad dressing so that one can choose those that
are lowest in saturated fat and free of Tran’s fat.
Case Study:
Patient name: Atique Ur Rehman Age: 74 Height: 5’5 Weight: 110
kg
Medical diagnosis: HTN
Recommendation
Caloric Requirement 1200-1400 kcal/day
Fluid Requirement 8-10 glass/day
Mechanism of Diet DASH diet
Type of Diet kcal-CHO Protein Fat Na diet
Diet Plan for hypertension patient
Timing Food Item Serving
size/Amount
CHO Protein Fat Kcal
Pre
Breakfast
6-7
Almonds 1/6 0 0 5 45
Apple 1 15 0 0 60
Breakfast
7-8
Multi green
Bread
2/2 30 6 0 160
Egg 1 0 7 3 45
Yogurt +
Cumin seed
1 12 8 0+5 45+100
Snack
10-11
Vegetable
Salad 1/1 cup 5 2 0 25
Radish,
Cucumber,
Tomato,
Onion

28
Lunch
1-2
Apple 2/2 30 0 0 120
Chapatti 1 15 3 0 80
Salan (kareely
ghosht)
3/2 2.5 8 3 17
Yogurt 1 12 8 0 100
Snack
4-5
Fenugreek
Seeds
½ tsp 0 0 5 45
Walnuts 1 0 0 5 45
Tea ½ 6 4 0 50
Dinner
7-8
Pomegranate 1 15 0 0 60
Chapatti 1 15 3 0 80
Fish 1 0 7 3 45
Vegetable
salad
1/1 cup 5 2 0 25
Yogurt 1 12 8 0 100
Bed time
10-11
milk 1 12 8 0 100
Cardiovascular disease
Heart is a muscular organ which pumps the blood through blood vessels of a circulatory
system. It provides blood to body with oxygen, nutrient as well as assists the removal of
metabolic wastes. In human heart is located between the lungs, in the middle compartment
of chest.

29
Functions
There are three main functions of heart transport of nutrient, oxygen and the hormones to
cells throughout the body and removal of metabolic wastes (carbon dioxide, nitrogen
waste).
Heart diseases
There are different diseases of heart like
a. Cardiovascular disease b. Heart arrhythmia
c. Atrial fibrillation d. Atheroma
e. Coronary artery f. Congenital heart defect
g. Heart valves disease h. peripheral artery disease
i. Myocardial infarction j. Angina pectoris
k. Cardiac arrest l. Myocarditis
m. Heart failure n. Cardiomyopathy
o. Shortness of breath p. Hypercholesterolemia
Risk for heart disease
There are different risks that increase the potential to develop the plague within a coronary
arty and cause to narrow them.
 Smoking
 High blood pressure
 High cholesterol
 Diabetes
 Family history of heart problems
 Obesity
Cardiovascular disease
It is a class of a disease that involves the heart or blood vessels. It includes coronary artery
disease such as angina and myocardial infarction. This disease include stroke and
peripheral arty disease involve atherosclerosis.
Types
There are different diseases like
 Coronary artery disease
 Heart attack
 Abnormal heart rhythm
 Heart failure
 Heart valve disease
 Congenital heart disease

30
 Heart muscles disease
Steps to prevent the disease
1. Control portion size
How much you eat is important as what you eat. Overloading your plate, taking seconds
and eating until you feel stuffed can lead to more calories than you should. Portion served
in restaurant are often more than anyone need.
Use a small plate or bowl to help control your portions. Eat larger portions of low calorie,
nutrient portion such as fruits and vegetables, and high sodium food. This can reshape your
diet.
2. Eat more vegetable and fruits
They are good sources of minerals and vitamins. Vegetables and fruits are low in calories
and rich in dietary fibers. It helps you to prevent the cardiovascular disease.
Fruits and vegetables to choose Fruits and vegetables to limit
 Fresh and frozen vegetable and fruits
 Low sodium canned vegetables
 Canned fruits packed in juice or water
 Coconut
 Vegetable with creamy sauce
 Fried or breaded vegetables
 Canned fruit packed
 Frozen fruit with sugar added
3. Select the whole grain
Whole grain is good source of fiber and other nutrient that play a role in regulating blood
pressure and heart health.
Grain products to choose Grain products to limit or avoid
 Whole wheat flour
 Whole-grain bread
 High fiber cereal with 5g or more fiber
in serving
 Whole grain such as brown rice barely
and buckwheat
 Whole grain pasta
 oatmeal
 White refined flour
 White bread
 Muffin
 Corn bread
 Biscuits
 Pies
 Egg noodles
 Buttered popcorn
4. Limit unhealthy fats
The American Heart Association offers these guidelines for how much fat to include in a
heart-healthy diet:

31
Types of fats Recommendation
Saturated fats No more than 5 to 6% to your daily calories,
or no more than 11 to 13g of saturated fat if
you follow 2000 calories per day
Trans fat Avoid
Fat to choose Fat to limit
 Olive oil
 Vegetable and nuts oil
 Margarine trans-fat free
 Nuts and seeds
 Avocados
 Butter
 Lard
 Bacon fat
 Gravy
 Cream sauce
 Coconut, palm
5. Choose low fat protein sources
Proteins to choose Proteins to limit or avoid
 Low fat dairy products such as skim or
low fat milk, yogurt and cheese
 Eggs
 Fish especially fatty, cold water fish,
such as salmon
 Skinless poultry
 Legumes
 Soybean and soy products
 Lean ground meat
 Full fat milk
 Organ meat such as liver
 Fatty and marbles meats
 Fried and breaded meat
6. Reduce the sodium in food
Eating a lot of sodium contribute to high blood pressure and other disease.
 Healthy adults have no more than 2,300 milligrams (mg) of sodium a day (about a
teaspoon of salt).
 Most adults ideally have no more than 1,500 mg of sodium a day.
Low salt item to choose Salt item to limit
 Herb and spices
 Salt free seasoning blend
 Reduced salt canned soup
 Table salt
 Tomato juice
 Restaurant meal

32
 Condiment such as ketch up,
mayonnaise and soya sauce
Patient history:
Patient name: Mrs. Azim Age: 50 Years Height: 5’4
Medical diagnosis: CVD Weight: 55
Recommendation
Caloric requirement: 1200-1400lcal / day
Fluid Requirement: 8-10g /day
Mechanism of Diet: Regular diet
Type of Diet: kcal /carbs /protein/ fat
Diet plan for CVD patient
Timing Food
item
Serving
size
/amount
Breakfast
7-8 am
Almonds 1/6 0 0 5 45
Apple 1 15 0 0 60
Brown
bread
1/2 15 3 1 80
Boil egg 1 0 7 0 45
Yogurt 1/600 12 8 3 100
Snack
10-11 am
Kudo
(raita)
12+15 8+3 0+1 100+80
Fenugreek
+ Black
pepper
5 45
Lunch
1-2 pm
Papaya 1 15 0 0 60

33
Corn
vegetable
1/2 15 3 1 80
Salad 2.5 1 0+15 80
Fish 1 0 7 0 45
Yogurt 1/602 12 8 3 100
Snack
4-5 pm
Walnuts 1/4 0 0 5 45
Dinner
7-8 pm
Guava 1 15 0 0 60
Chapatti 1/1 15 3 1 80
Chicken
gravy
1 0 7 0 45
Salad 1 5 2 0 25
Raita 1/602 12 8 3 100
Before
bed
10-11 pm
milk 1/602 12 8 3 100
160 68 36 1252

34
Liver disease
Liver is a largest organ inside body. It helps to digest the food, store energy and remove
poisons.
Functions
There are different functions of liver but primary are
 Bile production and exertion
 Exertion of bilirubin, cholesterol, hormones and drugs
 Metabolism of fats, protein and carbohydrates
 Enzyme activation
 Storage of glycogen, vitamin and minerals
 Synthesis of plasma proteins such as albumin and clotting factors
Kinds
There are different kinds of liver disease
 Disease caused by viruses, such as hepatitis A, hepatitis B and hepatitis C
 Disease caused by drugs, poison, or too much alcohol. Example includes fatty liver
disease and cirrhosis.
 Liver cancel
 Inherited disease, such as a hemochromatosis, and Wilson disease
Diseases
There are different diseases regarding liver like
a. Liver disease b. Viral hepatitis

35
c. Chronic disease d. Primary biliary cholangitis
e. Cirrhosis f. Nonalcoholic fatty liver
g. Liver cancer h. Gallstone
i. Liver failure j. Jaundice
k. Hepatitis C l. Ascites
m. Hepatotoxicity n. Fatty liver
Symptoms
It may vary like swelling of legs and abdomen, bruising easily, changes in color of stool
and urine, and jaundice or yellowing the skin and eyes. Sometime there are no symptoms
and can identified by tests.
Tests
Sometimes we conduct liver damage tests to identify liver disease.
Patient history
Patient name: Safia Azim Height: 5’6” Weight: 128kg
Age: 91 years Medical Diagnosis: CLD
Recommendation:
Caloric Requirement: 1400-1600kcal /day
Fluid requirement: 6-8glass /day
Types of Diet: kcal, carbs, proteins, fats, and low salt diet
Mechanism of diet: Blend / soft diet
Diet plan for Liver disease
size/amount
Pre
Breakfast
6-7am
Almonds ¼ 0 0 5 45
Breakfast
7-8 am
Banana 1 15 0 0 60
Oats +milk 1/1/2 6+15 8+3 1 50+80
Boil/scrambled
Eggs+ olive
oil
2 0 7 3+5 45+45

36
Yogurt 1/2/302 6 4 0 50
Snack
10-11am
Black pepper
Vegetable
sandwich
1/0 15 3 1 80
Bran bread
Onion,
Cauliflower
½ 2.5 1 0 12.5
Lunch
1-2 pm
Apple 1 15 0 0 60
Chapatti ½+1 7.5
+15
1.5+3 1+.5 40+80
Steamed
Chicken piece
0 7 3 45
Sprinkled
coriander
5 45
Salad(beat
cabbage, radish)
1 5 2 0 25
Snacks
4-5 pm
yogurt 1/202 4 2.6 0 33
Corn ½ 1.5 3 1 80
pumpkins ½ 7.5 1.5 0.5 40
Walnuts+
puree(cinnamon)
1 0 0 5 45
Dinner
8-9pm
Banana 2 30 0 0 120
Chapatti 1+1/2 15+7.5 3+1.5 1+0.5 40+80
Chicken piece/
gravy
15 7 3 125
Salad 0/2 5 2 0 25
Yogurt 1/3/202 4 2.6 0 33

37
Before
Bed
10-11 pm
Milk 1/3/202 4 2.6 0 33
209 65.3 40 1416
Kidney Disorder
The kidneys are two bean-shape organs in the real system. They helps the body pass waste
as urine. They also helps filter blood before sending it back to the heart.
The kidneys performs many crucial functions including:
 Maintaining overall fluid balance
 Regulating and filtering minerals from blood
 Filtering waste material from blood, medication and toxic substance
 Creating Harmons that help produce red cell, promote bones health and regulate blood
pressure
Kidney disorder
 Actual renal failure(ARF)
 Chronic renal failure(CRF)
 End stage renal failure(ERSF)

38
Actual renal failure
Actual kidney failure occurs when your kidneys suddenly become unable to filter waste
products from your blood. When your kidneys lose their filtering ability, dangerous levels
of waste may accumulate and your blood’s chemical makeup may get out of balance.
Acute kidney injury
Formerly acute renal failure (ARF), is characterized by a sudden reduction in glomerular
filtration rate (GFR), the amount of filter per unit in the nephrons and alter ability of the
kidney to excrete the daily production of metabolic waste.
Causes of AKI
 Nephrotoxity
 Severe dehydration
 Local reaction to drugs
 Glamorous infection
 Urinary tract obstruction
 Kidney stones and obstruction
Signs and symptoms of AKI
Accumulation of nitrogen and urea containing substances in blood stream leads to:
 Fatigue
 Loss of appetite
 Headache
 Nausea
 Vomiting
 Marked increased in potassium level can lead to irregularities in the kidney function
Medical nutrition therapy for AKI
 Patients with AKI caused by drug toxicity generally recover fully after they stop taking
the drug
 On the other hand, the mortality rate associated with ischemic acute tabular necrosis
caused by shocked is approximately 70%
Patient history
Name: Sajida Age: 32 Weight: 40kg Height: 5’3
Medical diagnosis: AKI
Recommendations
Caloric Requirement: 1400-1600 Kcal/day
Mechanism of diet: Soft Diet
Type of diet: Kcal, Sugar free diet, protein, fat, Na, k, mg, p, iron diet

39
Diet plan for AKI patient
size/amount
Pre
breakfast
6-7 am
Pumpkin/sunflower
seeds
1 5 45
Breakfast
7-8 am
Apple 1 15 0 0 60
Barley(almond
powder)
1.5/1.5 22.5 4.5 5.5 165
Egg boil 1 0 7 8 90
Yogurt ½ 6 4 0 50
Snacks
10-11 am
Tea ½ 6 4 0 50
Fruit smoothie
Apple/yogurt 1/ 2+1/2 36 4 0 50
Lunch
1-2 pm
Strawberry 1 15 0 0 60
Chapatti 15/1.5 22.5 4.5 1.5 120
Any vegetable
+ chicken
½+1 5 9 3 70
Raita(cucumber,
tomato, beans)
½ 11 6 0 25+50
Snack
4-5pm
Pomegranate 1+1/2 15 0 0 60
Juice
Walnuts ¼ halves 0 0 5 45
Figs ¼ 15 0 0 60
Dinner Banana 1+1 15 0 0 60

40
7-8 pm Chapatti 1.5/1.5 22.5 4.5 1.5 120
Chicken curry 102 0 7 3 45
Salad
Carrot, Radish,
Cucumber
1/1 5 2 0 25
Raita ½ 6 4 0 50
Before
bed
10-11pm
Milk 1/2/1/2 6 4 0 50
190 60.5 33 1470

41
GI Disorders (upper GI tract)

42
The gastrointestinal tract (digestive tract directional tract, GI tract, GIT, gut, or alimentary
canal) is an organ system within human and other animals which takes in food, digest it to
extract and absorb energy and nutrients, and expel the remaining waste as feces. The
mouth, esophagus, stomach and intestine are part of the gastrointestinal tract.
The human gastrointestinal tract consist of
 Esophagus
 Stomach
 Intestine
And is divided in upper and lower gastrointestinal tract. The GI tract include all structure
between the mouth and the anus forming a continuous passageway that that include the
main organs of digestion namely, the stomach, small intestine and large intestine.
Structure
The structure and function can be described both as gross anatomy and as microscopic
anatomy or histology. The tract itself divided into upper and lower tract and the intestine
small and large parts.
Upper gastrointestinal tract
The upper gastrointestinal tract consist of the buccal cavity, pharynx, esophagus, stomach,
and duodenum.
Lower gastrointestinal tract
The lower gastrointestinal tract includes most of the small intestine and all of the large
intestine.
Upper GI Disorders
 Gastroesophageal Reflux Disease (GERD)
 Gastritis
 Peptic ulcer disease
 Dumping syndrome
Examples of symptoms in upper GI disorders include
 Heartburn
 Difficulty swallowing
 Stomach pain
 Nausea
 Vomiting
 Problems in the passage of food
 Any combination of these symptoms

43
MNT for upper GI disorders
 Avoid large, high-fat meals.
 Avoid eating 2 to 3 hours before lying down.
 Elevate the head of bed by 6 to 8 inches for individual who have reflux episodes at
night.
 Avoid smoking.
 Avoid alcoholic beverages.
 Avoid caffeine-containing food and beverages.
 Remain upright for a while after eating.
 Wear loose-fitting clothing around the stomach area; tight clothing can constrict the
area and increase reflux.
 Avoid acidic and highly spiced food when inflammation exist.
 Consume a healthy, nutritionally complete diet with adequate fiber.
 Lose weight if overweight.
Lower GI Tract disorders
 Constipation
 Diarrhea
 Steatorrhea
 Inflammatory bowel disease (IBD)
 Imitable bowel syndrome (IBS)
 Diverticular disease
Examples of symptoms in lower GI disorders includes
 Abdominal pain or discomfort
 Bloating or distension
 Diarrhea
 Constipation
 Accidental stool leakage or incontinence
 Problems in the passage of food or stool
 Any combination of these symptoms
Constipation
Constipation is when you have infrequent or hard-to-pass bowel movement (meaning they
are painful or you have to strain), have hard to stools or feel like your bowel movements
are incomplete. Incomplete mean less than three bowel movements a week.
Constipation is not a disease and most of the time can be treated medically. People define
constipation on family, culture and their own experience, so it can have different meaning.

44
Causes
In most cases constipation is a symptom not a disease. Below is a list of some most common
causes of constipation.
Poor diet
 Not eating enough veggies, fruits and whole grains can make the stools hard and
difficult to pass.
 Changes in diet like when travel along with inactivity can also lead to constipation
Medication
 Many medication cause constipation.
 Let the doctor know all the medication that use on or let the doctor know if have the
constipation past before starting a new medication.
 Some example of medicine that cause constipation
 Pain medication
 Some antacid
 Antispasmodic drugs, which suppress muscles spasms
 Antidepressant drugs
 Tranquilizer
 Iron supplement
 Anticonvulsants for epilepsy
 Calcium channel blockers, for high blood pressure and heart condition
Dietary recommendation for constipation
 Add healthy saturated fat in diet
 Increase omega-3 essential fatty acid
 Add nutrient-dense and unprocessed food
 Eat small meal throughout the day rather than 3 large meal
 Avoid drinking ice cold water during meal ice cold water slow down the digestion by
lowering the amount of acid (HCI) that need to digest the food
 Stay away from over the counter laxatives chemical and herb that induce bowel
movement quickly by irritating the bowel can cause the cramps and diarrhea and lead
to laxative dependence
 Fiber- maintain an adequate source of soluble fiber. Soluble fiber helps to maintain
regularity by combining the food to form a gel that add bulk and keep the muscles of
the colon stretched and working.
Food to avoid include
 All simple and refined carbohydrates (white bread, pasta, cookies etc.)
 All food containing refined sugar

45
 Sweetened fruit juices that spied blood sugar level so rapidly
 Alcoholic beverages in excess since they hinder the functioning of the immune and
digestive system
 All tobacco product
 Bottom crawlers such as oysters, clams and lobster
 Deep-sea fish such as tuna
 Farm raised fish that contained PCB’s not enough omega-3 essential fatty acid
 Sodium nitrite found in processed food such as hot dogs, lunch meat
 Monosodium glutamate found in many food as a flavor enhancer
 Hydrogenated oil or partially hydrogenated oil found in many processed food, deep
fried food
 Product such as soy milk and ice crème that contain carrageenan a seaweed extract that
added food to retain their creamy texture. For some people carrageenan irritate the
stomach.
Patient history
Patient name : M.Samar age: 39 Height: 5’6 weight: 57 kg
Medical diagnosis: Constipation
Recommendation
Caloric requirement 1400-1600 calories per day
Fluid requirement 6-8 gal per day
Mechanism of diet soft diet
Type of diet kcal, carbs, protein, fat, fiber diet
Diet plan for Constipation
size/amount
CHO protein Fat other Kael
Breakfast
6-7
Flax seed 1tsp 5 45
Apple 1 15 0 0 60
Multigrain
bread
½ 15 3 1 80
7-8 Egg 1 0 7 4 45
Tea soup ½,1/2 7.5 4 3 60
Snack
10-11
dates ½ 15 0 0 60
Soaked in
milk
1 cup 15 8 5 100

46
Lunch
1-2
Guava 1 1.5 0 0 60
Chapatti ½ 7.5 1.5 5 40
Boiled
peas, coins,
olive oil
1/1/1 30 10 6 260
Salad
(c-family)
1/1 5 2 0 25
Yogurt
(fenugreek
seed)
½ 7.5 4 3 90
Snack
4-5
Prune 1/1 15 0 0 60
raisins 1/1 7.5 0 0 30
Dinner
7-8
oranges 1/1 15 0 0 60
chapatti 1/1 15 3 1 80
Gobhi,Moli
ghost
1,1/1 5 7 4 70
Diarrhea
Diarrhea is the frequent passage of loose watery soft stools with or without abdominal
bloating pressure and cramp commonly referred to as gas or flatulence.
Causes
Viral and bacterial infection as well as parasites intestinal disorders or disease reaction to
medication and food intolerance.
Symptoms
 watery
 liquid stools
 stomach cramps
 fever
 bloating
 bowel movement urgency
 dehydration
Helpful hint for controlling diarrhea
 Individual vary in their tolerance to food. Avoid food that cause cramping gas or
diarrhea.
 If anyone have cramp avoid food that produce gas such as carbonated drinks
 Food at room temperature that may be tolerate than hot and cold food.
 Diarrhea can lead to dehydration association with loss of minerals.
 Potassium is as important element for body. It may be lost in large quantity through
diarrhea.

47
 Drinks fluid between meals.
 Eat small amount of food frequently
 Fatty food such as fried food sauces gravies and salad dressing and highly spiced food
may not be well tolerated.
 Avoid food or juices that have a laxative effect such as prunes and prune juice.
 If anyone don’t drink regularly then avoid in diarrhea.
 Use well-cooked tender meat such as tender cuts of baked, broiled and creamed or
roasted beef.
Patient history
Patient name: M. Malik Age: 65 Height: 5’7 Weight: 85
Medical diagnosis: lose motion, diarrhea, over weight
Recommendation
Caloric requirement 1400-1600 kcal /day
Fluid requirement 8-10 Galan/day
Type of diet kcal, carbs, protein, low fiber diet, fat,
Timing Quantity
7:00 soft boiled egg 1
10:00 porridge ½ cup
1:00 Chicken soup ½ cup
5:00 khichri ½ cup
8:00 vegetable soup ½ cup
10:00 milk 1cup
Diet plan for Diarrhea
size/
amount
Breakfast
7-8
Mashed
banana
1 15 0 60
Porridge 1cup 30 6 7 100
Egg, olive
oil
1/1 7 8 90

48
Yogurt 12 8 5 150
Snack
10-11
chicken 1/2 0 7 3 75
Lunch
1-2
Boiled
mashed
potato
1 15 3 1 80
Kado ka
raita , ORS
26 11 1 180
Snack
4-5
Sagudaney
Ki kheer
1 cup 12 8 5 145
Almond 1 5 45
Dinner
7-8
Mashed
strawberries
1 15 0 0 60
Rice
pudding
¼ 15 3 1 80
Milk 1 cup 12 8 0 80
10-11 Yogurt 1 12 8 0 80
Peads
Fever:
Fever is an evaluation of body temperature that exceeds the normal daily
variation, in conjunction with an increase in hypothalamic set point. In normal
adults, the average oral temperature is 37 degree C (98.6 F).
Causes of Fever:
 Infectious
 Inflammatory
 Oncologic
 Other. CNS dysfunction, drug fever
 Life- threatening conditions
Symptoms
 Rise in temperature of body heat
 Perspiration or shivering
 Restlessness and agitated temper
 Pain and soreness all over the body but some limbs may be extra painful
and sore
 Thirst
 Loss of appetite

49
Treatment strategies
Acetaminophen is generally a first-line antipyretic due to being well tolerated
with minimal side effects. Pediatric dose: 10-15 mg/kg q4-6h (2400mg/day);
adult: 650mg q 4h (4000mg).Can be hepatotoxic in high doses; can upset
stomach. Don’t give aspirin to children under 18 years (Reye’s syndrome).
Try water sponge bath; remove blankets and heavy clothing; keep room at
comfortable temperature.
MNT for fever
 Soft texture & fluid to semi solid consistency.
 These feeding should be small and as frequent as possible.
 Generally 6-8 feedings should be sufficient.
 A high protein diet supplying 1.25-1.5g protein/kg body wt.
 Fats, judiciously increased.
 Avoid fried foods.
 Sufficient intake of Sodium, potassium.
 Plenty of water, coconut water, fruit, vegetable juice and soups.
Patient history
Patient Name: M. Danyal Age: 3 years Weight: 13 kg
Medical Diagnosis: Fever
Recommendations
Calories Required: 1000-1200 kcal
CHO: 119g
Protein: 74 g
Fats: 20g
Fluid: 6-8 glass
Mechanism of diet: soft diet
Type of diet: kcal-calcium- CHO-protein-Fat
Required calories kcal/day 200-400 kcal/day
Mechanism of diet: Clear liquid diet

50
Timing Food Quantity
6:00 am Apple juice Half cup
8:00 am Saghodany ki kheer Half cup
10:00 am Grapes fruits juice 1 cup
2:00 pm Yakhni Half cup
4:00 pm Vegetable soup Half cup
6:00 pm Apple juice 1 cup
8:00 pm Yakhni Half cup
Caloric requirement: 400-600 Kcal/day
Mechanism of diet: Full fluid diet
6:00 Porridge(walnuts/crushed
almonds)
½ cup
8:00 Prune juice 1 cup
10:00 Chicken Yakhni ½ cup
2:00 Porridge ½ cup
4:00 Orange juice ½ cup
6:00 Porridge 1/3 cup
8:00 Milk ½ cup
Caloric requirement: 600-800 Kcal/day
Mechanism of diet: soft diet

51
6:00
Soft boiled egg 1 egg
8:00
Khichri 2 cup
12:00
Rice kheer 1 cup
2:00
Doodh patti 1 cup
4:00
Double Roti (with
salan)
1/1
6:00
Kheer ½ cup
8:00
Milk 1 cup
Caloric requirement: 1000-1200 Kcal
Mechanism of diet: Regular diet
Timing
Food Quantity
6:00
Double roti+ egg 1/1+1
8:00
Fruit juice 1 cup
10:00
Shami kabab 1
12:00
Smoothie
(Apple, Banana)
1 cup
2:00 Yogurt 4 spoons

52
4:00
Strawberry ½
6:00
Rice
(with dal/chicken salan)
1 cup
8:00
Milk 1cup
Anemia
Anemia is a condition in which a deficiency in the size or number of erythrocytes or the
amount of hemoglobin (composed of heme) limits the exchange of oxygen and carbon
dioxide between the blood and the tissue cells.
Causes of anemia
 Lack of nutrients for normal
 Vitamin B12
 Folic acid
 Hemorrhage
 Genetic abnormalities
 Chronic disease states
 Drug toxicity
Nutritional Anemia
The anemia that result from an inadequate intake of iron, protein, certain vitamins (B12,
folic acid and ascorbic acid), copper and other heavy metals are frequently called
nutritional anemia. The most common nutritional anemia in the United States results from
iron and folic acid deficiency.
Dietary guideline
If IDA is related to inadequate iron in diet usually adding three portion of lean red meat
per week along with all other essential vitamin and minerals will correct the anemia. The
average mixed diet contain approximately 6 mg of iron per 1000 kcal. Iron absorption
increase as stores become depleted. Good source of iron include liver, dried beans, egg
yolk, kidney, lean beef, dark meat of chicken, dried fruits, enriched whole grain cereals,
molasses and oysters.

53
Heme-iron: is found readily in beef, pork and lamb; consume with fruits or fruit juices.
Heme-iron is absorbed well regardless of other food in the diet.
Nonheme iron: absorption is greatly affected by other food absorption of nonheme iron
is best in the presence of food rich in vitamin c or with heme containing sources. Increase
intake of vitamin c (orange, grapefruit, tomatoes, cabbage, baked potatoes, strawberries,
and green peppers), especially with an iron supplement.
Patient history
Patient name: Abida Age: 25
Height: 5’4 weight: 60
Medical diagnosis: Anemia
Recommendation
Caloric requirement 1200-1400kcal /day
Fluid requirement 6-8 Galan /day
Type of diet kcal, CHO, fat, iron diet
Diet plan
size
/amount
6-7 Grape seed 1 0 0 5 45
Break fast
7-8
Apple 1 15 60
Oat meal /
almond
1tsp 15 3 5 95
Egg/olive
powder
1/2 0 7 8 90
Milk 1/2 12 8 0 100
Snack
10-11
Dates 1/1 15 0 0 100
Shake 1/1 12 8 0 100
Lunch
1-2
Strawberries 1/1 15 100
Chapatti 1/1 15 3 0 80
Palak ghosht 1 5 9 7 75
Podinay ka
raita
1 12 8 0 100
Snack
4-5
Beats juice
/carrot juice
1/2 5 0 25

54
Dinner
7-8
Figs
/strawberries
1/1 15 60
Chapatti 1/1 15 3 0 80
Chicken
piece
1 0 7 3 45
Mix veg’s
gravy
1/1 5 2 0 25
Yogurt 1/1 12 8 0 100
Before
bed
10-11
Milk 1/1 12 8 0 100

55
Assignment work
 Remedies for Hypertension
 Remedies for Diabetes
 Remedies for CVD

58
Conclusion
The conclusion is that I had great time at Fatima memorial hospital Lahore during
internship. I had learnt a lot about different diseases, about their prevention and gained
knowledge about their medical nutrition therapies. The whole staff was very cooperative.
At the end I want to thanks Allah for giving me a chance to explore new information about
my field.

Food science and nutrition internship

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