Dietary managements for anemia Presentation.pptx

Diet therapy for anemia

1. Fasting and diet therapy Submitted to Dr, G. Karthika bnys Department of fasting and dietics Submitted by M. Sowmiya , Final year bnys ,

2. Definition of anemia Anemia is defined as reduced hemoglobin concentration in blood below the lower limit of the normal range for the age and sex of the individual or it is the blood disorder characterized by reduction of rbc count, hemoglobin content, packed cell volume.
Range of haemoglobin value according to gender and age :
At birth :17g/dl
Children :11.5g/dl
Adult men: 16 g/dl
Adult women: 13g/d

3. Prevalance of anemia Anemia was prevalent in adolescent girls and associated with low SES. Socioeconomic status (SES) plays a significant role in the health outcomes of female adolescents in India, particularly in relation to anemia

4. Causes Reduction of RBC count, HC,PCV is due to:
🩸 Decreased production of rbc
🩸 Increased destruction of rbc
🩸 Excess loss of blood from the body
Whether the anemia is present and it’s severity is determined by the RBC, PCV(hematocrit), absolute values(MCV, MCHC, MCH )

5. Mean corpuscular hemoglobin concentration (MCHC) It is  a measurement of the average amount of hemoglobin in a single red blood cell (RBC) as it relates to the volume of the cell .

6. Mechanism

7. Pathophysiology Decreased red cell production : Acquired, hereditary  Increased red cell destruction : Acquired (mechanical, antibody-mediated, ( hypersplenism, RBC membrane disorders, chemical injury), hereditary  Blood loss a nd blood redistribution pregnancy, athletes, postflight astronauts

8.  Subnormal level of hemoglobin causes lowered oxygen – carrying capacity of the blood. In turns, initiates compensatory physiologic adaptation such as follow, - Increased release of oxygen from Hb - Increased blood flow to the tissues. - Maintenance of the blood volume. - Redistribution of blood flow to maintain the cerebral blood supply.

9. Pathophysiology

10. Classification of anemia  Morphological classification - Normocytic normochromic anemia - Macrocytic normochromic anemia - Macrocytic hypochromic anemia - Microcytic hypochromic anem  Etiological classification - Hemorrhagic anemia - Hemolytic anemia - Nutrition deficiency - Aplastic anemia - Anemia of chronic diseases

11. Etiological classification Hemorrhagic anemia :Excess loss of blood by internal or external bleeding.Anemia due to hemorrhage is known as hemorrhagic anemia Acute hemorrhage :sudden loss of large quality of blood. In case of accident. The replacement of RBC does not occur quickly it takes 4 to 6 weeks.Decrease of rbc count causes hypoxia. Chronic hemorrhage :loss of blood over a period of time through internal or external bleeding . It occurs in conditions like peptic ulcer, Hemophilia. Hemolytic anemia :Due to destruction of excessive RBC which is not compensated by increased RBC production.It is classified into extrinsic hemolytic and intrinsic hemolytic anemia. Extrinsic hemolytic anemia caused by destruction of rbc by external factors such as antibodies, chemicals, drugs that hemolyze the healthy rbc. It occurs in autoimmune disease,renal disorder, liver failure, infection etc Intrinsic hemolytic anemia caused by destruction of rbc due to defective RBC. It is inherited and includes the sickle cell anemia and thalassemia

12. Sickle cell anemia is due to abnormal hemoglobin [Hemoglobin S].In this alpha chain are normal and beta chain are abnormal. The molecule of hemoglobin s polymerize into long chain and precipitate inside the cells that lead to attain sickle (crescent shape rbc) and become more fragile leading to hemolysis Thalassemia is due to abnormal hemoglobin . It is known as cooley‘s anemia or mediterranean anemia Alpha thalassemia is due to less, absent or abnormal alpha chains. Beta thalassemia is due to less, absent or abnormal beta chains

13. Nutritional deficiency anemia :Anemia that occurs due to the deficiency of nutritive substance such as iron, proteins, vitamins like, c, b12, folic acid Or the condition that results from the inability of the erythropoietic tissue to maintain a normal haemoglobin concentration on account of inadequate supply of 1ormore nutrients leading to reduction in total circulating haemoglobin. Iron deficiency anemia pernicious anemia Megablastic anaemia Sideroblastic anemia Nutritional anemia Is a world wide problem Iron deficiency is the most common cause.

14. Aplastic anemia : one of the red bone marrow disorder where it is reduced and replaced by fatty tissues Anemia of chronic disease : It is characterized by short lifespan of rbc caused by disturbance in iron metabolism or resistance to erythropietin action Such as rheumatic arthritis ,Chronic infection,neoplastic disorders,Chronic renal failure

15. Iron deficiency anemia Iron deficiency is the most common cause of anemia. This may occur as a result of the factor described below DIMINISHED INTAKE
Iron intake is adequate even in vegetarians because the staple diet, consisting of cereals, has a high iron content of about 5-8 mg (89.5-143 micromol ) per 100 g
DEFICIENT ABSORPTION
Tea considerably reduces iron absorption, and could thus be a major cause of anemia.Loss Parasites associated with iron-deficiency anemia are hookworms ( Ankylostoma duodenale , Necator americanus ), whipworms and schistosomes . Each Ankylostoma duodenale worm may cause daily blood loss of 0.2 ml, which is 10 times more than that caused by Necator ameri

16. Once inside the intestine, the larvae develop into adults. They attach themselves by their mouth to the lining of the upper small intestine, where they feed on blood and produce substances that keep blood from clotting. As a result, blood is lost, and anemia may develop. Adult worms may live 2 or more years.

17. Aetiology Inadequate utilisation Blood losses Increased Demand Inadequate iron intake Inadequate absorption

18. Consequences of Anemia Anemia can result into -• Premature child birth and increased neonatal deaths. • Increased risk of infant and maternal mortality In dividuals with IDA are more prone to infections EFFECTS OF IRON DEFICIENCY: can be seen in three important areas: • Pregnancy and periods of growth • Infections • Work capacity Consequences of anemia

19. Metabolism of iron

20. Factors that affect the absorption

21. Dietary sources of iron: • ' Haem Iron' and 'Non- Haem Iron' are the two forms of dietary iron. • Haem Iron: Better absorbed (20-30%). Found in liver, meat, poultry, fish, etc. • Non-Haem iron (1-10% absorption): In vegetable foodsEg : cereals, green leaf y , legumes, nuts, jaggery and dry- fruits • Bio-availability of non- haem iron is poor. • In some areas, significant amounts of iron may be derived/ obtained from foods cooked in iron vessels

22. Recommended dietary allowance

23. Megaloblastic anemia Megalosblastic anemias are characterized by the presence of enlarged red cells ( megaloblasts ) due to the impaired cell division. Because the erythrocytes that reach the circulation are enlarged, a macrocytic and normochromic anemia There are many causes of megaloblastic anemia. The most common cause in children is LACK OF FOLIC ACID OR VITAMIN B-12. The pathophysiology of this group of anaemias has its origins in ineffective erythropoiesis

24. Pathophysiology The common feature in megaloblastosis is a defect in DNA synthesis in rapidly dividing cells. To a lesser extent, RNA and protein synthesis are impaired. Unbalanced cell growth and impaired cell division occur since nuclear maturation is arrested. More mature RBC precursors are destroyed in the bone marrow prior to entering the blood stream (intramedullary hemolysis).  [ 1 ,  3 ] The most common causes of megaloblastosis are vitamin B12 and folate deficiencies, Nuclear maturation is immature relative to cytoplasmic maturity

25. Pernicious anemia i nvolves autoimmune inflammation in the stomach and the inability to absor b vitamin B12 in the small intestine. pernicious anemia and vitamin b12 anemia Vitamin B12 deficiency anemia is a condition in which your body does not have enough healthy red blood cells, due to a lack (deficiency) of vitamin Vitamin B12 deficiency may lead to a reduction in healthy blood cells (pancytopenia). 

26. Dietary sources of vitamin B12 and Floic acid

27. Dietary management DIET In every case of anemia, the cause should be discovered and treated. In clinical practice, nutri - tional anemia is commonly associated with over- all under-nutrition and a balanced diet should be given. Usually, diet alone is not adequate and therapy with specific supplements particularly iron is also needed . In patients with a very poor diet, mainly vegetarian, or with malabsorption, Nutrient deficiency may be the cause of anemia. A nursing mother with such an anemia secretes little vitamin, in the milk, and so her breastfed infant may also become deficient A list of foods suitable for anemic patients is given below

28. Food items for a patient with anemia permitted • Bread or chapat ti of wheat, rice, maize, jowar, bajra or ragi • Breakfast cereals of wheat, rice, oatmeal or maize , Rice, cooked • Pulses, (dal) or beansVegetable salad • Vegetables, cooked • Potato, sweet potato, or yam • Meat, fish, chicken; especially liver, and bone marrow • Soup, especially liver soup • Eggs • Milk and milk productsFat for cooking, and butter • Sugar, jaggery or honeyJam or murabba • Pastries• DessertsSweets or sweetmeats • Fruits, fresh• Fruits, dried, especially raisins, dries figs, and prunes • Nuts• Condiments and spices in moderation

29. The total number of 7825 records were screened Iron-deficiency anemia is the most frequent nutritional deficiency, with women of reproductive age being particularly at risk of its development. The aim of the systematic review was to assess the effectiveness of dietary interventions to treat iron-deficiency anemia in women based on the randomized controlled trials. It included all randomized controlled trials assessing effectiveness of various dietary interventions on treatment of iron-deficiency anemia in women of childbearing age. Research studies The included studies compared the effectiveness of various dietary interventions with supplementation, placebo, control, or any other dietary intervention, while the assessed dietary interventions were based either on increasing iron supply and/or on increasing its absorption (by increasing vitamin C or vitamin D or decreasing phytate intake)

30. The duration of applied intervention was diversified from 3 months or less, through 4 or 5 months, to half of a year or more. The majority of included studies were conducted for increasing iron supply and/or increasing vitamin C supply; however, only for the interventions including increasing iron supply and simultaneously increasing its absorption by vitamin C supply were all results confirmed effective. Considering this fact, dietary interventions recommended for anemic female patients should include increased intake of iron and vitamin C. one of the Global Nutrition Targets set by the WHO which should be achieved by 2025 is a 50% reduction in anemia frequency among women of childbearing age [ 6 ].

31. The other strategy is to apply oral supplements which provide various nutrients missing in the diet at higher doses to promptly combat nutritional deficiencies and related anemia . However, applying iron supplementation may result in adverse gastrointestinal effects, such as abdominal pain, constipation, or nausea Moreover, non-physiological amounts can increase the associated health risks, such as infections . Taking this into account, such an approach may be less recommended than dietary intervention, especially for some populations, as lower quantities of iron provided within a food matrix are indicated to be in most cases a safer option, representing a more logical strategy providing the best balance of risk and benefits .Moreover , it is pointed out that iron supplementation may be considered rather as a short-term strategy for the management of iron-deficiency anemia, while dietary interventions may be treated as a long-term strategies

32. Dietary management People with iron deficiency anemia are also encouraged to increase their dietary intake of iron by prioritizing iron-rich foods. DV = Daily Value. The U.S. Food and Drug Administration (FDA) developed DVs to help consumers compare the nutrient contents of foods and dietary supplements within the context of a total diet. The DV for iron is 18 mg for adults and children age 4 years and older

33. Diet plan 🥬 Beetroot - In a blender add about one cup of chopped beetroot, blend well, strain the juice and mix a teaspoon of lemon juice. Lemon juice adds to the vitamin C content and enhances the absorption RESULTS AND DISCUSSION : Distribution of pre and post test level of hemoglobin among experimental group and control group . Result Concludes that active components in beetroot increase the hemoglobin level and red blood cell production

34. Figs - An important mineral that circulates haemoglobin in the human body, iron is found in significant amounts in the figs. Eating dried figs helps increase blood haemoglobin levels by increasing iron and reducing iron clear effect of dried figs : About 50 gms of dried Figs were consumed per day till seven weeks and hemoglobin percentage was determined after every week. It was observed that hemoglobin level increases with 0.5% per week and thus after seventh week the overall increase in hemoglobin level was observed to 3.5%. In the present s tudy dried figs are proved to be useful for improving hemoglobin level in blood

35. Curry leaf - A deficiency of iron is the most common reason for anaemia . Curry leaves being a rich source of iron and folic acid are extremely effective in increasing haemoglobin levels. Usually iron rich sources require an i ntake of folic acid for absorption in the body. The high content of folic acid in curry leaves takes care of that as well. Curry leaves also act as a potent blood purifier Animals were divided into 7 groups of six each. All animals, except normal group received 0.5 mg/ kg b.w of AlCl3 for 30 days by oral route. Rats received single oral dose of selected treatment every day 15 minutes before administration of AlCl3 and treatments were as follows: Group 1: Normal (Normal saline) Group 2: Positive control (AlCl3alone) Group3: Synthetic iron (40 mg/kg) + AlCl3 Group 4: Curry leaves (200 mg/kg) + AlCl3 Group 5: Curry leaves (400 mg/kg) + AlCl3 Group 6: Curry leaves + amla (200 mg/kg) + AlCl3 Group 7: Curry leaves + amla (400 mg/kg) + AlCl3 Aluminium chloride and extracts were dissolved in distilled water before administration. Synthetic iron was in the form of syrup and all were given p.o. using oral feeding

36. Moringa - Take about 20-25 moringa leaves finely chop and make a paste, add a teaspoon of jaggery powder and blend well. Have this churna along with the breakfast to improve your iron levels. 🥬 Take one hands moringa leaf and one hand of curryleaf + Grated coconut half the hand + 2 piece of cardamom + Jaggery ( as we need). quercetin content of Moringa leaves can increase iron uptake in the apical enterocyte   Benefits of  Moringa oleifera  leaf extract, such as improving the morphology of damaged red blood cells and antioxidants. It has become an alternative in the treatment of anemia.  Conclusions:  The nutrient content in Moringa leaf extract plays a significant part in increasing hemoglobin levels in the blood.

37. sample of 40 pregnant women were divided into two groups, namely the intervention group of 20 people and the control group of 20 people. The intervention group was given capsules of Moringa leaf extract and iron capsules every day. The control group was only given iron capsules Hb level of pregnant women in the intervention group significantly increased compared to the control group The conclusion  was that moringa leaf extract has an effect on increasing HB level,

38. 🥬 Dried fruit - Have 3-5 dates and a tablespoon of raisins as a snack or with your breakfast Dry fruits, such as raisins, apricots, dates, and figs, are rich in iron, a key component in the production of hemoglobin. Dried apricots are a fantastic choice for individuals with anemia. These golden fruits are rich in iron, a crucial mineral necessary for the production of healthy red blood cells. Iron deficiency is one of the leading causes of anemia, and incorporating dried apricots into your diet can help address this issue. Additionally, apricots are an excellent source of vitamin C, which aids in the absorption of iron.

39. Raisins , made from dried grapes, are a delicious snack that can contribute to managing anemia. They are rich in iron, vitamin C, and copper, making them a triple threat against this condition. Iron supports the production of red blood cells, while vitamin C and copper enhance iron absorption, ensuring that your body benefits from these essential nutrients. Dates are not only a natural sweetener but also a great source of iron. They are packed with this essential mineral, making them an ideal addition to your anemia -fighting diet.

40. Almonds   are a nutritional powerhouse and an excellent choice for individuals with anemia. They contain a significant amount of iron, which is essential for the production of healthy red blood cells. Almonds are also a rich source of vitamin E, which helps protect red blood cells from damage and supports their overall function. Additionally, almonds offer a good dose of copper, a mineral that aids in iron absorption. 

41. Sesame – Sesame seeds are loaded with iron, copper, zinc, selenium and vitamin B6, folate and E. Regular addition of black sesame seeds are proven to improve the haemoglobin levels and promote the absorption of iron. Take about 1 tablespoon of black sesame seeds dry roast, blend with a teaspoon of honey and roll into a ball. Have this nutritious ladoo regularly to boost your iron levels.

42. Drink dates water in empty stomach for every day. Soak dates In water previous night, in the morning peel the outer layer of the dates and remove the seed which present in it. Smash the fleshy soaked part to the water and consume it. Following up drink lemon juice for absorption of iron .

43. Diet chart For anemia With anemia Sample diet chart for anemia Breakfast : Oatmeal with sliced strawberries (rich in vitamin C) and almonds (rich in copper). Glass of orange juice (rich in vitamin C) 🥬 Oatmeal is a good source of iron and fiber, while strawberries and orange juice provide vitamin C to enhance iron absorption. Almonds contain copper, which is important for the utilization of iron

44. Lunch : Spinach salad (rich in iron and folate) and bell peppers (rich in vitamin C) Whole wheat bread (rich in iron) 🥬 Spinach good sources of iron, while bell peppers provide vitamin C to enhance iron absorption. Whole wheat bread(Rich in iron) Dinner : Baked salmon (rich in vitamin B12) with steamed broccoli (rich in iron and vitamin C) and quinoa (rich in i ron and folate) Glass of Grape juice (contains resveratrol, which may enhance iron absorption) Salmon is a good source of vitamin B12, which is important for the production of red blood cells. Broccoli and quinoa provide iron and folate, while the glass of grape juice may enhance iron absorption due to the presence of resveratrol

45. Drumstick leaves contain iron, folic acid Curry leaves contain iron and folic acid Nuts - almonds , raisins contain zinc and copper Dates- contain iron Lemon contain iron Beetroot contain iron , folic acids. Pomegranate contain iron, vitamin C, copper, riboflavin. Water melon contain iron Sapota contain copper, panthothenic acid, iron , folate, niacin , vitanminC . Amla contain vitamin Lotus stem contain copper, iron, magnesium , panthothenic acid , zinc, vitamin B6, vitamin C Fig contain iron and copper

46. FOOD TO BE AVOIDED nutrient components rich food items Fried items Beverages Transfat Packaged food Pickles Monosodium glutamate DIET CHART 6.30 AM-7.30 AM- raisin soaked water/over night soaked almond/ dates with honey/ drumstick boiled water/copper vessel water. 9.00AM -9.30 AM- keerai chappathi,coconut chutney/ ragi dosa , mint chutney/wheat dosa,curry leaves chutney .11.30AM-12.00PM- hibiscus water/ amla juice/ beet root juice/ pomegranate juice/ orange juice .2.00PM- 2.30PM- brown rice,sambar , boiled vegetables/ varagu satham , sambar, boiled vegetables. 4.30PM-5.30PM –herbal tea/ sprouted grains/fruit salad 7 .00PM-7.30PM- oats porridge/ chappathi,garlic chutney.

47. Nutritional programmes

48. Mandatory provision of Iron and Folic Acid fortified foods in Government funded health programmes The National Nutritional Anaemia Prophylaxis Programme initiated in 1970, was revised and expanded to include beneficiaries from all age groups namely children aged 6-59 months, 5-10 yr , adolescents aged 10-19 yr , pregnant and lactating women and women in reproductive age group under the National Iron Plus Initiative (NIPI) programme in 2011 Weekly Iron and Folic Acid Supplementation (WIFS) programme  Under the Weekly Iron and Folic Acid Supplementation (WIFS) programme, supervised weekly administration of IFA and biannual helminthic control are undertaken among all school going adolescent girls and boys in 6 th  to 12 th  classes enrolled in government/government-aided/municipal schools and out-of-school adolescent girls

49. Reference https://www.nhlbi.nih.gov/sites/default/files/publications/NHLBI_OSPEEC https://journals.plos.org https://www.researchgate.net/journal-home https://www.google.com/url?sa=t&source=web&rct=j&opi=89978449&url=https://www.nhlbi.nih.gov/sites/default https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6466500/ https://books-library.net/files/download-pdf-ebooks.org-02241545Ox7T8.pdf https://www.slideshare.net/slideshow/diet-in-nutritional-anemiapptx/252190601 https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9268692/