Types of anemia and its cure with diet chart

Diet chart

1. GUIDANCE BY PRESENTED BY MS. PRATIBHA SHARMA MS. AKANSHA PAL DIETICIAN CONSULTANT ( R.D. INTERN ) (R.D. TRAINER) DEPARTMENT OF DIETETICS CH & RC INDORE ANEMIA

2. Anemia is a condition that develops when your blood produces a lower-than-normal amount of healthy red blood cells. If you have anemia , your body does not get enough oxygen-rich blood. The lack of oxygen can make you feel tired or weak. INTRODUCTION

3. CAUSES Iron deficiency. Vitamin B12 deficiency. Folate deficiency. Certain medicines. Destruction of red blood cells earlier than normal (which may be caused by immune system problems) Long-term (chronic) diseases such as chronic kidney disease, cancer, ulcerative colitis, or rheumatoid arthritis

4. SYMPTOMS

5. complication TYPES OF ANEMIA Anemia due to vitamin B12 deficiency Anemia due to folate (folic acid) deficiency Anemia due to iron deficiency Anemia of chronic disease Hemolytic anemia Idiopathic aplastic anemia Megaloblastic anemia Pernicious anemia Sickle cell anemia Thalassemia Iron deficiency anemia

6. PATHOPHYSIOLOGY

7. . Tiredness. Iron deficiency anaemia can make you feel tired and lacking in energy (lethargic) Increased risk of infections Heart and lung problems Pregnancy complications Restless legs syndrome Complete Blood Count ( CBC ) Test Endoscopy Genetics Test Urine Test DIAGNOSTIC TEST COMPLICATION

8. PATIENT PROFILE: Patient’s Name – XYZ Age/Sex – 42 Yrs./Female Community - Hindu Occupation – Teaching Education – M.A. Economic No of family members ( adult + child ) – Adult 2 Economic Status - High Income Status Food Habit – Vegetarian Food allergy - NO Marital status - Married Addiction – No Day of admission – 03/12/2022 Day of discharge – 06/12/2022 Length of hospital stay days – 4 days CASE STUDY A Patient are upperly alright but 6 month back she started feeling body weakness & SOB during mild exaction exercicing that found it difficult to climb the stairs due to SOB. There is k/o fever , weight loss , cough

9. NUTRITION CARE PROCESS MODEL NUTRITION ASSESSMENT Collect and measure significant data. Identify nutrition problem . 2. NUTRITION DIAGNOSES Data is clustered to identify diagnosis Pes – NUTRITION PROBLEM ETIOLOGY SIGNS AND SYMPTOMS 4. NUTRITION MONITORING & EVALUATION Monitor measure and evaluate outcomes and overall impact of the intervention plan on nutrition diagnosis 3. NUTRITION INTERVENTION Planning and implementation Customised nutrition intervention Patients goals

10. SCREEENING TOOL YES NO 1. IS BMI < 20.5 NO 2. Has the patient lost weight within last 3 months YES 3. Has the patient had reduce dietary intake in last week YES 4. Is patient severely ill YES Nutrition screening is used to determine the nutrition problems rapidly. Mandatory in NABH accredited hospitals .(IDA) Nutrition Risk Screening-2002(NRS-2002 To detect the presence of malnutrition and the risk of developing malnutrition in hospital.(ESPEN) TOTAL SCORE:- 03 RESULT:- SEVERE IMPAIRED NUTRITIONAL STATUS

11. WEIGHT 47.4 kg HEIGHT 154 Cm IBW 54 Kg BMI 20.60 Kg/m2 MUAC 22 cm PHYSICAL ACTIVITY ( calculate as per NIN charts) Sedentary IBW- Calculated by using Broca’s Index (Ht. in cm-154) for Female and according to this patient’s present body weight is 7 kg lower then IBW. [IBW is based on community level] BMI- Calculated by WHO (FOR ASIANS) [wt.(kg)/ht.(m2) Normal BMI range for a healthy person should be between 18.5-22.9kg/m2 and this patient’s BMI was 20.60 kg/m2 which shows that patient’s nutritional status was normal according to BMI. [BMI is based on individuality] MUAC- Normal range is 23 cm for male and this patient’s MUAC is normal ANTHROPOMETRY NUTRITION ASSESSMENT

12. Parameters 03-12 05-12 06-12 HB 3.2 8.0 11.3 WBC 9960 7640 7643 Platelet 5.421 7.91 1.31 PT 16.2 INR 1.14 T Blirubin 0.36 D. Blirubin 0.18 SGOT 16 SGPT 20 T. Protein 6.6 Globuline 2.3 Albumin 4.3 ALK Dhos 71 A:G ration 1.9 Elt Sodium 141 Potassium 4.2 Chloride 105 BUN 15 Creatinine 1.01 Callcium 9 BIOCHEMICAL DATA

13. CLINICAL DATA PRESENT COMPLAINT ( CLINICAL SIGNS & SYMPTOMES ) k/o sever anemia c/o body weakness fever weight loss PAST MEDICAL HISTORY H/O – 2 previous blood transfusion FINAL MEDICAL DIAGNOSIS SEVER ANEMIA CLINICAL FINDINGS- Afebrile BP : 120/80 mm Hg Conscious BLOOD TRANSFUSION Date : 03/12/22 2 BLOOD TRANSFUSION

14. MEDICATION AND TREATMENT S.No Name of Drug Dosage Mechanism of Action 01 (03-12-22) T. Sompraz 40 mg Reduces the amount of acid in stomach 02 Inj Lasix 20 mg Treat high blood pressure 03 T. Ecospirin 75 mg Inhibits the action an enzyme which makes platelets 04 (06-12-22) T. Anlodipin 5 mg Blocking the voltage dependt L type calcium cannels thereby inhibiting the initial control cell growth infuse of calcium

15. MEAL MENU HOUSEHOLD MEASURE-MENT AMOUNT ( Gm/ml) ENERGY (kcal) PROTEIN (Gm) CHO (Gm) FAT (Gm) Iron MORNING TEA 1 CUP 50 ml 36 1.6 2.25 1.5 0.54 BREAKFAST (9:30 AM ) MILK PARATHA POHA 1 GLASS 1 BOWL 1 BOWL 200 ml 100 gm 100 gm 144 100 100 6.3 3 3 10 20 20 9 0.5 0.5 0.4 1.45 - LUNCH (12:00-1:00PM ) ROTI SABJI DAL SALAD 4 1 BOWL 1 BOWL 1 BOWL 120 gm 100 gm 100 gm 100 gm 400 50 100 100 12 - 7 - 80 - 18 13 - - 2.8 1.45 1.35 - EVENING (4:00PM ) COFFEE APPLE 1 CUP 1 100 ml 100 gm 72 50 3.2 - 5 10 4.5 - 0.25 0.9 DINNER (8:00-09:00PM) ROTI RICE DAL SABJI SUGAR OIL(SOYA) 3 1 BOWL 1 BOWL 1 BOWL 3 TBS 5 TBS 90 gm 100 gm 100 ml 100 gm 15 gm 25 ml 300 kcal 100 kcal 100 kcal 50 60 255 9 3 7 - - - 60 10 18 7 15 - 0.5 - - - - 20 1.45 1.35 1.45 2.9 - - TOTAL 1467 43 235.25 40.70 16.29 DIETARY HISTORY (24 HOURS HOME RECALL)

16. Energy : 1467 kcal Protein – 43 gms CHO- 235.25 gms Fats- 40.70 gms Iron – 16.29 Empty calories - 537 kcal Fluid Intake- 1 liter/day to 1.5 liter/day(1000ml ) Daily oil consumption- 3-4 TBS Food items Frequency Cereals Daily Pulses Daily Milk and milk products Daily Vegetable A Weekly Vegetable B Daily Vegetable C Daily Fruits Daily Nuts & oil seeds Daily Egg Never Non- Veg Never Sugar Daily Sweets & Desserts Rarely Bakery products Weekly Pickle & papad Rarely Junk foods Rarely Oil Daily Fried Fruits Never FOOD FREQUENCY TABLE NUTRITION CALCULATION OF HOME RECALL 24 hour recall indicates that patient was taking low calories and low minerals . Vitamins rich diet INTERPITATION

17. NUTRITION DIAGNOSIS PES STATEMENT PROBLEM ETIOLOGY SIGN AND SYMPTOMS Unintentional weight loss 2. Anemia Due to disease condition Due to lack of knowledge of nutritional intake As evidence by 5 kg weight loss in 2 month As evidence by HB- 3.2Mg

18. Energy - High energy requirements ( to fulfill demand of energy ) Protein - High Protein required for wound healing and tissue repairing Fat - 30 % of NPC CHO - 70 % of NPC adequate carbohydrates to provide energy to prevent protein sparing action and to full fill energy demand Vitamins and mineral – Vitamin – C , D , B12 , Folic acid diet , Iron rich diet Dietary Iron – 29 mg/dl Sodium : 2000 mg/day ( According to RDA ) Potassium : 3500 mg /day ( According to RDA ) Fluid Requirement : 30*54= 1.620 [1- 1.5L/day] MEDICAL NUTRITION THERAPY

19. NUTRITION INTERVANTION SHORT TERM LONG TERM To provide optimum nutritional requirement To maintain the IBW through dietary modification To provide Vitamin C or Iron rich diet To prevent further unintentional weight loss Maintain quality of life SHORT TERM AND LONG TERM GOALS

20. RDA MDA Energy- 30x IBW Energy-40xIBW =30x54= 1620 kcal /day = 40x 54= 2160kcal/day Protein- 0.85gm/kg/IBW Protein- 1.5gm/kg/IBW =45.9 gm/day 1.5x54= 81 gm/day = 45.9 * 4 = 183.60 = 81*4 = 324 NPC= 1620-183.60 kcal NPC = 2160-324 = 1436.40 kcal = 1836 kcal CHO- 70% of NPC /4 CHO- 75% of NPC/4 = 251.37 = 321.3 gm/day Fat- 30% of NPC /9 Fat- 30% of NPC/9 =48.62 gm = 61.20 gm/day Dietary Iron – 29 mg /dl ( as per RDA ) Sodium : 2000 mg/day Potassium : 3500 mg /day Fluid Requirement : 30*54= 1620 ml/day Antioxidants - Vitamin C , D , B12 Micronutrients : Folic acid , Iron rich RECOMMENDED DIETARY ALLOWANCES Calculation:- Nutrients RDA MDA Energy 1620 kcal 2160 kcal/day Protein 45.90 /day 81 gm / day Carbohydrate 251.37 gm / day 321.30gm / day Fat 48.62gm / day 61.20 gm / day Sodium 2000 mg/ day 2000 mg/day Potassium 3500mg / day 3500 mg/ day Fluid requirement 1620 ml/day 1620 ml/day NPC 1436.40kcal 1836 kcal

21. DETAILED PRESCRIBED HOSPITAL MENU MEAL MENU AMOUNT (Gm) ENERGY (kcal) PROTEIN (Gm) CH-O (Gm) FAT (Gm) IRON MORNING ( 8:00 AM ) TEA BISCUITS 50 ml 100 gm 36 1.6 2.25 0.75 0.54 0.54 BREAKFAST POHA MILK 100 gm 100 ml 100 72 3 3.2 20 5 - 4.5 1.08 0.2 LUNCH ( 12:30 ) ROTI SABJI 30 gm 50 gm 100 25 3 - 20 3 0.5 - 4.35 2.95 EVENING TIME BANANA 100 gm 100 - 25 1.25 0.36 DINNER ROTI DAL RICE MATAR ALU SABJI 30 gm 100 gm 100 gm 50 gm 200 100 100 50 12 7 3 - 80 18 20 6 - - - - 2.8 1.13 0.18 - OIL SUGAR 4 2 180 20 - - - 40 20 - - 3.2 Day 1 : 03-12-22 Normal Diet

22. DETAILED PRESCRIBED HOSPITAL MENU MEAL MENU AMOUNT ( Gm/ml) ENERGY1 (kcal) PROTEIN (Gm) CHO (Gm) FAT (Gm) Iron MORNING ( 8:00 AM ) Tea BISCUIT 50 10 36 4.9 1.6 - 2.95 0.68 0.75 0.2 0.54 0.54 BREAKFAST UPMA MILK 100 100 100 72 3 3.2 20 5 - 0.5 1.6 0.2 LUNCH ROTI SABJI 60 100 100 50 3 - 20 25 0.5 - 1.45 1.50 EVENING ANAR 50 27.37 0.67 5.79 0.9 0.8 DINNER ROTI SABJI DAL SALAD OIL SUGAR 80 50 100 50 4 2 300 50 100 25 180 20 7.5 - 7 - - - 60 6 18 - - 40 1.5 - - - 20 - 2.9 1.13 - - - 3.2 Day 2 : 04-12-22 NORMAL DIET

23. DETAILED PRESCRIBED HOSPITAL MENU MEAL MENU AMOUNT ( Gm/ml) ENERGY (kcal) PROTEIN (Gm) CHO (Gm) FAT (Gm) Iron MORNING TEA 50 36 1.6 2.5 2.25 0.54 BREAKFAST NAMKIN DALIYA MILK 50 100 100 72 1.6 3.2 10 5 0.25 4.5 4.9 0.2 LUNCH ROTI SABJI 60 50 200 25 6 - 40 3.5 1 - 9.8 1.4 EVENING BMEGRANATE 100 70 1.67 18.70 1.17 0.3 DINNER ROTI SABJI MILK OIL SUGAR 60 50 100 5 2 200 100 72 225 40 6 7 3.2 - - 40 18 5 - 10 1 - 4.5 20 - 4.9 4.9 0.2 - 32 Day 3 : 05-12-22 Normal Diet

24. SUMMARY OF 3 DAYS PRESENT HOSPITAL CALL MEAL ENERGY (kcal) PROTEIN (Gm) CHO (Gm) FAT (Gm) Iron Day 1 1408 29.8 217.25 22 17.13 Day 2 1090.97 25.97 202.04 24.35 13.86 Day 3 1512 30.27 152.70 14.67 27.1 Average 1337 28.66 190.66 20.34 19.36

25. Exchange list of the prescribed medical nutritional therapy FOOD GROUP EXCHANGE ENERGY (kcal) PROTEIN (Gm) CHO (Gm) FAT (Gm) Cereals ( Rice , Wheat , Flour ) 7 700 19.2 140 3.5 Pulses ( Tur , Moong , Chana ) P 4 400 28 72 - Milk & Milk products Paneer 3 ½ 216 125 9.6 - 15 6 13.5 7.5 Veg A ( Palak ) 2 50 - 7 - Veg B 1 50 - 5.5 - Veg C ( Batroot , Sald , Lemon ) 1 100 - 14 - Fruits 1 100 - 12.5 - Nuts & Oil Seeds ( Dry Fruits , Penute Chicky ) ½ 80 2.5 1.75 6.5 Eggs - - - - - Non- Veg - - - - - Sugar 1 , Haggery - 3 4 80 - 20 - Oil 3 135 - - 12 Sattu 2 200 10 38 - Total 2196 79.30 331.8 43

26. MEAL TIMING MENU QUANTITY HOUSE HOLD MEASUREMENT MORNING TEA 50 ml 1 cup BREAKFAST POHA MILK 100 gm 200 ml 1 bowl 1 cup MID MORNING FRUIT ( ANAR ) 100 gm 1 LUNCH ROTI SABJI DAL RICE CURD SALAD 60 gm 50 gm 50 ml 100 gm 100 ml 50 gm 2 1 bowl 1 bowl 2 bowl 1 cup ½ bowl EVENING TEA PANEER BURJI PEANUT+ HAGGERY 50 ml 50 gm 10 gm 1 bowl ½ bowl 1 -2 DINNER ROTI RICE SABJI ( METHI ) DALA SALAD ( BEETROOT ) 60 gm 100 ml 100 gm 60 ml 50 gm 2 1 bowl 1 bowl 2 bowl ½ bowl BED TIME MILK 100 ml 1 cup DETAILED PRESCRIBED HOSPITAL MENU

27. DETAILED PRESCRIBED HOSPITAL MENU ON DISCHARGE MEAL TIMING MENU QUANTITY HOUSE HOLD MEASUREMENT MORNING TEA ALMOND 50 ml 10 gm 1 cup 5-6 BREAKFAST SATTU MILK 30 gm 200 ml 1 bowl 1 cup MID MORNING FRUIT ( ANAR ) 100 gm 1 LUNCH ROTI SABJI DAL RICE CURD SALAD 60 gm 50 gm 50 ml 100 gm 100 ml 50 gm 2 1 bowl 1 bowl 2 bowl 1 cup ½ bowl EVENING SATTU PANEER BURJI PEANUT+ HAGGERY 30 gm 50 gm 10 gm 1 bowl ½ bowl 1 -2 DINNER ROTI RICE SABJI ( METHI ) DALA SALAD ( BEETROOT ) 60 gm 100 ml 100 gm 60 ml 50 gm 2 1 bowl 1 bowl 2 bowl ½ bowl BED TIME MILK 100 ml 1 cup

28. NUTRITION ASSESSMENT & MONITORING SHEET S.No Days Date Mode of Feeding Wt. Ht. MUAC Calories (Kcal) Protein (gm) CHO (gm) Fat (gm) GI Problems L C V 01 3/12 Normal Diet 47.4 154 - 1408 29.8 217.2 22 02 4/12 Normal Diet - - - 1090.37 25.9 202.0 29.35 03 5/12 Normal Diet - - - 1521 30.27 152.7 14.67 04 6/12 Normal Diet - - - discharge

29. DISCHARGE SUMMARY Total hospital stay days – 4 days Patient discharge with normal ( high protein ) diet Nutrition plan high calorie , high protein , Iron riched diet plan ANTHROPOMETRY Present Weight 47 .4 kg Height 154 cm BMI 54 BIOCHEMICAL HBC 10.2 TLC 7642 Platelets - Sodium 142 Potassium 4.5 Chloride 101 Creatnine 1.02 Calcium 10 Date 06/12/22 Energy 1512 Kcal Protein 45 gm CHO 153.7 Fat 27.5 gm ON DISCHARGE DIETARY INTAKE CLINICAL DATA- Afebrile PR: 120/min BP : 120/80 mm Hg RR: 24/min

30. TAKE HOME MESSAGE Missing of meals is not allowed Caffeine , spicy foods and gas-forming food stimulate the pancreas and could exacerbate symptoms during an acute attack. These should be totally avoided Avoid junk food and fried foods

31. MONITORING AND REASSESSEMENT Days Calories (Kcal) Protein (gm) CHO (gm) Fat (gm) Follow Up 1 1525 kcal 46 gm 321 gm 48 gm Telephone 2 1621 kcal 55 gm 320 gm 50 gm Telephone 3 1950 kcal 63 gm 310 gm 58 gm Telephone After Discharge Follow up Days 15/12/22 22/12/22 Wt. 49.4 kg 51 kg Ht. 154 cm 154 cm MUAC 22 23

32. Thank You !