INTERNSHIP REPORT

Shifa International Hospital,Islamabad

Sidra Ashraf

17-ARID-6165

Department of Nutrition

Institute of Food and Nutrition Sciences

Pir Mehr Ali Shah

Arid Agriculture University Rawalpindi

Pakistan

2021
 ACKNOWLEDGEMENTS

First and foremost praise is to ALLAH, the Almighty, the greatest of all, the most Beneficent
and the Most Merciful. I would like to thanks Almighty Allah for giving me opportunity,
determination and strength to do my research. His continuous grace and mercy was with me
throughout my life and ever more during the tenure of my research. He blessed me with the
determination to thrive my ambition and enabled me to cherish the fruits of my efforts.

May the peace and blessings be on the most noble of prophets and messengers, our Prophet
Mohammad (PBUH) and on his family and all of his companions. I offer to him all the
praise and gratitude and seek his assistance and forgiveness. His teachings have always been
the best source of guidance in the way of our success.

I am extremely indebted to Prof. Dr. anwar Ahmad (Director Institute Of Food And
Nutritional Sciences) for arranging this internship program. I am thankful to him for
providing necessary infrastructure and resources to accomplish my research work.

I acknowledge with deep reverence and feel much pleasure in expressing my heartiest
gratitude to my advisors Mam Asia Latif, Prof. Dr. Rai Muhammad Amir and Mam
Asma Sohail for this affectionate advisory and whose inspiring attitude made it very easy to
understand the process of internship.

I would like to thank and express my deep and sincere gratitude to Prof. Dr. Kashif Sarfraz
Abbasi for his continuous support, guidance and encouragement. In addition to being an
excellent supervisor, he is a man of principles and has immense knowledge of research in
general and his subject in particular. I appreciate all his contributions of time, support and
ideas.
I express my deepest gratitude and special thanks to Mam Anam Anwar, Mam maida and
Mam Maham, Dietitian at Shifa International hospital Islamabad, who kept hearing and
guiding me whenever I needed her, despite of her extraordinary busy schedule. All projects
during the program would be nothing without the enthusiasm and imagination from her.
Besides, this internship program makes me realize the value of working together as a team.
ALHUMDULILLAH by the help and support of above mentioned people, I completed this
report successfully.

Sidra Ashraf

17_Arid_6165
 DEDICATED

To My Beloved Father

&

To My Affectionate Mother

For Inspiring Towards

The Task of Learning

Whose Hands Are Always Raised For Our Well-Being &Success,

To My Honorable Teachers

Who Guided Me at Each And Every Step

&

To My Friends

Who Supported Me
 TABLE OF CONTENTS:

1. Introduction and importance of internship

2. Introduction to name hospital
i) History of name Hospital
ii) Departments of name Hospital

3. Introduction to Nutrition
i) Basic Definitions
ii) Principles of Nutrition
iii) The food guide pyramid
iv) Concept of Nutritional Status

4. Weekly performance
Week No 1.
i)
ii)
iii)

5. Week No 2.
i)
ii)
iii)
iv)

6. Week No 3.
i)
ii)
iii)
iv)

7. Week No 4.
i)
ii)
iii)
iv)

8. Week No 5.
i)
ii)
iii)

9. Week No 6.
i)
 ii)
iii)
iv)

10. Week No 7.
i)
ii)
iii)

11. Week No 8. Brochure Making

i)
ii)
iii)

12. Week No 9.
i)
ii)
iii)

13. Week No 10.

i)
ii)
iii)
iv)

14. Conclusion

Internship & Its objectives

Internship:

An internship is a directed, practical learning experience, outside of the academic studies, in

which students sharpen skills, gain experience through work on advanced productions, apply
classroom learning (undergraduate education) to professional settings or projects, and learn
firsthand how professional companies, hospitals or organizations operate.

Objectives:

 Focus more directly on what it means to be a professional in a specific discipline.

 Determine whether or not a particular career path appeals to you.

  Add weight of professional experience to your resume.
 Make valuable professional contacts for your future networking.

 Closed follow up of patients after giving diet plans.

 Discussion with the doctors, nurses and attendants about the condition of patients.
 Completion of folder with all types of diet charts for different diseases.
 Exam in last week of internship.
 Final report submission regarding internship training.

Characteristics:

 Provides the intern with an environment to soak up information on many subjects

relating their profession.
 Teaches the intern skills they will find valuable for use in future.
 Challenges the intern to think and grasp the new concepts quickly.
 It includes the advanced individual seeking job experience.
 Provides the opportunity to transfer knowledge into practical skills.
 It contributes to the student’s personal and development (develop self-confidence
develop corporate knowledge, develop skills).

Internship Advantages to Students:

 Begin shaping your own direction in the ‘real world’ of your profession.
 Transfer learning from classroom to workplace.
 Sharpen abilities and skills.
 Translate the theories you have learned about your chosen profession into actual day-
to-day practice

Internship Objectives for Nutrition Students:

 Result, retain and graduate individuals who are prepared to become competent entry-
level participants in dietetics.
 Promote a commitment to the profession of dietetics, professional standards, and
lifelong learning.
  Develop skills in the scientific approach to dietetics profession through successful
completion of various supervised practice rotation and distance education program.
 Offer a variety of supervised practice experiences to prepare interns for the diverse
nature of the dietetics.
 To have an understanding of the importance and effect of nutritional therapy, ranging
from meal preparation and diet modification to administration of specialized
nutritional therapies such as intravenous or tube feeding.

CHAPTER 01

Introduction

Shifa international Hospital is located in Islamabad, Pakistan. The hospital was

conceived and incorporated in 1985-1987 by a small group of Pakistani doctors and other
health care professionals working in the United States. Since then Shifa has from over 450
contributing members to being a public limited company. It is located on 11.2 acres in sector
H-8/4 Islamabad, Pakistan.

The Hospital was incorporated on September 20, 1987 as a Private Limited Company
and converted into Public Limited Company on October 12, 1989. The first Shifa office was
establishment at the residence of Dr. Zaheer Ahmad in sector F-8/3 of Islamabad. Later it was
moved to a rental blue place in Blue Area (commercial buildings area in (Islamabad), and
finally the site office building was established in January 1988 (Shifa, 2021).

The construction activity to prepare the site for laying the foundation of the Hospital
was started in the beginning of 1988. The foundation ceremony took place on October 06,
1989 by the parents and well-wishers of the sponsors and their dedicated team of colleagues
and well- wishers. After extensive discussions and many meetings, the present site in the
capital city of Islamabad was selected for this project. The name SHIFA was approved
because of its comprehensiveness, originating from our culture, belief and values in totality.

Now after more than one and a half decade Shifa International Hospital proudly
stands as a symbol of quality healthcare with its own brand name “SHIFA”. The short history
of Shifa witnesses rare dedication and devotion of its consultants, management and staff who
worked round the clock to make Shifa a reality of its own. It was the vision of the founding
sponsors which took 2 its shape in reality. The task was made possible only with the help of
their dedicated team of experts and managers under the quality oriented and inspiring
leadership.

Today, the hospital’s Block-A, B, C, D, E and F, ICU beds, new ORs etc., sprawled
on its site are efficiently functioning. Allah’s grace made it feasible and viable to carry out
such a gigantic and enormous venture. Unique in its concept and efforts set up by the
expatriate Pakistanis to repay their homeland with a beautiful gift in the form of a functional
institution in the healthcare industry of Pakistan (Shifa, 2021).

1.1 VISION:

Shifa International Hospital Ltd has been established to provide the highest quality of
medical care to the people of Pakistan. Achieving a high level of quality is the result of many
factors:

 Medical Expertise

 Clinical Excellence

 State of the Art Technology

 Caring People

 Preventive Medicine

 Health Care Management

1.2. MISSION:

The mission of the Shifa International Hospital is to provide the highest quality

medical care to all patients in a caring and compassionate manner by an outstanding team of

healthcare professionals in an atmosphere conducive to the practice of good medicine. Their

commitment to quality healthcare goes beyond bricks and mortar. All of them at Shifa

International Hospital are 3 united in pursuit of a single goal; to provide the highest quality

healthcare possible. Quality people, Quality care. That will never change.
1.3. GOALS:

Goals are specific outcomes that they expected of their organization as a whole. They

believe that success of an organization can be achieved by building a culture of continual

improvement.

 Continuously improve customer satisfaction.

 Continuously improve the quality of services and system.

 Continuously improve the Hospital’s financial performance and sustain long-term

viability.

 Continuously improve the Hospitals competitive position.

 Continuously improve the Hospitals organization and work environment.

1.4. QUALITY POLICY:

The quality policy of Shifa International Hospital is to provide cost effective quality

medical care to all patients, ensuring ethical practice of medicine. Their quality objective is to

continuously improve patient satisfaction (Shifa, 2021).

 CHAPTER 02

Organizational Structure

Shifa Management Team

Founder

Dr. Zaheer Ahmed(Late)

Board Of Directors

 Dr.Habib ur Rehman (chairman)

Audit Committee
 Dr. Manzoor H Qazi (CEO)
 Mr. M Zahid (director)
 Mr.Shafquat Ali Chaudary ( director )
 Shah Naveed Syed (director)
Human Resources &
 Mr. Qasim Farooq
Remuneration Committee

Chief Operating Officer

Chief Finance Officer

Company Secretary

Head Of Internal Audit

Branches of Organization

Clinical Services
 Medicine

Cardiology Allergy/Clinical Immunology

Dental Clinic Dermatology

Emergency Endocrinology

Gastroenterology Infectious diseases

Internal Medicine Neurology

Obstetrics & Gynecology Nephrology

Ophtha lmology Palliative Care

Podiatry Pediatrics

Psychiatry Pulmonology

Urology Rheumatology
Food and nutrition services Department:

Introduction to Food and Nutrition services department:

 Food and nutrition service definition. “Food service” means providing safe,

satisfying, and nutritionally adequate food for patients through the provision of

appropriate staff, space, equipment, and supplies. “Nutrition service” means providing

assessment and education to ensure that the nutritional needs of the patients are met.

 The department of Food and Nutrition Services (FNSD) at hospital name

International Hospital is at floor, and is managed by a Manager Support Services.

 FNSD department include:

1. Kitchen
2. Bakery
3. Chillers
4. Store
5. Dishwashing Area
6. Cafeteria
7. Consultant Lounge
 8. Dietician Office
9. Kneading Room
10. Tandoor Area
11. Manager’s Room.

 FNSD provides:

1. In-patient service
2. healthy, hygienic & appealing food tray service
3. Diet prescribed by the dietician
4. Food Court Service
5. Retail Food Service for staff
6. faculty
7. students
8. visitor
9. guests
10. patients
11. Wide range of items from full meals as well as beverages, snacks and desserts
on smorgasbord.

 Objectives:

1. To adopt previously learned theory during the work experience.

2. To develop knowledge and the perspectives of managerial skills for the management
of a foodservice operation.
3. To demonstrate the ability to provide nutrition education services and counseling to
patients
4. Effective communication within department and patients in the hospital.
5. To be able to conduct food quality and safety audits, evaluation of existing
procedures, problem identification and recommendation of changes.
6. To be able to modify menu cards according to therapeutic diets and supervise food
ordering and meal service.
7. To become familiar with rules and regulations, food service management systems,
and other areas associated with food service.
8. To seek the practical ways of diet planning.
9. To develop knowledge and the perspectives of managerial skills.
10. To adopt previously learned theory during the work experience.
11. To assist in delivery of health, nutrition and hygienic awareness.
12. To develop professional attitude in the personality.

 Number of Employees:

Office Staff :

 Kitchen Staff:

 Store Staff:

 Cashier Staff:

 Waiters

 LEARNING OUTCOME:

 Preparation of Diet Sheets according to diseases.

 Visiting kitchen and supervising the preparation of NG feeds(FNSD

feed)
  Help and supervise inpatient tray service

 Making diet plans for different calorie requirement

 Presentation on Different Diets.

 Presentation on Different Vegetables.

 Gained experience in delivery of nutritional services

 Increased knowledge regarding the field of food and nutrition

 Clear liquid Diet:

 Consist of food that are liquid at room temperature that are clear enough to see

through. Used only for short time because it does not provide enough nutrients for

good nutrition.

 COMMON PURPOSE:

 Ordered for the patients who have had surgery, acutely ill patients, and patients with
fluid loss causes by vomiting or diarrhea.

 EXAMPLES OF FOODS ALLOWED:

 Water, Broth, Coffee, Clear juices, Tea, Popsicles.

 Full Liquid Diet:

 Include all liquids included in clear liquid diet, plus all other liquids (food that
are liquid at room temperature).

 COMMON PURPOSE:

 Ordered for patients who have had surgery, patients with stomach ailments,
persons unable to chew, swallow or digest solid foods or as a transition
between a clear liquid and soft diet.

 EXAMPLES OF FOODS ALLOWED:

 Strained soups, Ice creams, Custards, All juices, cooked serials if it is soupy
thin.
 Soft Diet:

Food soft in consistency. Mildly flavored.

 COMMON PURPOSE:

Used for patients who are unable to chew or swallow, hard or coarse foods

 EXAMPLES OF FOODS ALLOWED:

Soups, fish, chicken, toast, cooked fruits and vegetables, Eggs and Ice cream.

 Diabetic Diet:

 The doctor decides how many calories are allowed. The dietician develops a
balanced plan providing the calories in to meal and snacks. Meals must be
saved on time. Person must eat everything on tray.
 This eating pattern promotes eating more vegetables, fruits, whole grains, nuts,
seeds, and lower fat or fat-free dairy products, poultry and fish. This eating
pattern also limits foods high in sodium (salt) saturated fat, red meat, sweets,
added sugars and sugar sweetened drinks.

 Regular diet:

A regular diet is a meal plan that includes a variety of foods from all of the
food groups listed below. A healthy meal plan is low in unhealthy fats, salt,
and added sugar. Follow this meal plan if you do not have any health problems
that require a special diet. A healthy meal plan may reduce your risk of heart
disease, osteoporosis (brittle bones), and some types of cancer. Ask your
dietitian how much you should eat from each food group. Includes the greatest
variety of foods.

 COMMON PURPOSE:

To maintain or attain optimal nutrition status in patients who do not require a

special diet.

 Examples:

Eat a variety of vegetables such as dark green, red, and orange vegetables. You can
also include canned vegetables low in sodium (salt) and frozen vegetables without
added butter or sauces.
 Eat a variety of fresh fruits, canned fruit in 100% juice, frozen fruit, and dried fruit.
 Include whole grains. At least half of the grains you eat should be whole grains.
Examples include whole wheat bread, wheat pasta, brown rice, and whole grain
cereals such as oatmeal.
 Eat a variety of protein foods such as seafood (fish and shellfish), lean meat, and
poultry without skin (turkey and chicken). Examples of lean meats include pork leg,
shoulder, or tenderloin, and beef round, sirloin, tenderloin, and extra lean ground beef.
Other protein foods include eggs and egg substitutes, beans, peas, soy products, nuts,
and seeds.
 Choose low-fat dairy products such as skim or 1% milk or low-fat yogurt, cheese,
and cottage cheese.

 Pureed Diet:

All found is strained or blenderized.

 COMMON PURPOSE

For patients who cannot chew or have difficulty swallowing.

 Examples:

 All liquids and beverages (nothing lumpy)

 Yogurt (without fruit)
 Pureed cooked fruits
 Pureed ripe banana
 Pureed cooked vegetables
 Cottage cheese
 Cooked cereals such as cream of rice or cream of wheat
 Smooth oatmeal
 Bread without crust pureed with milk or water
 Pureed meats
 Hummus pureed legumes
 Pudding or custard
 Ice cream, sherbet, and yogurt (without fruit, nuts or chips)
 Butter or margarine

 Renal Diet:

 A diet prescribed in chronic renal failure and designed to control intake of

protein, potassium, sodium, phosphorus, and fluids, depending on individual
conditions. ... Protein is limited; the amount is determined by the patient's
condition and is usually supplied from milk, eggs, and meat.

 Evaluation:
 • ENVIRONMENT:

 The overall environment of the hospital was very welcoming and comforting that

allow an individual to learn and grow inside out. Work environment at the hospital

was very professional.

• WORK EXPERIENCE:

 The work experience of this internship at hospital name enabled me put my all

previous theoretical knowledge into practice which was totally a different

experience. The internship in this hospital enabled me to practically apply my

previous knowledge and helped me become more confident.

 All supervisors were always ready to help and guide their juniors and internees.

 Helped me become confident in my abilities to work with members to achieve

their goals i.e. teamwork 

 Time management is a necessary skill that develops through internships, which I

have acquired to a great extent.

 Provided chance to apply the knowledge and skills that I had acquired while

studying.

 EMPLOYEES:

 The employees at hospital nameare truly helpful, have full learning about their

jobs, have critical thinking and cooperation abilities and know truly well about

how to deal with their time.

 HOW INTERNSHIP EFFECTS BEFORE & AFTER:

 Presentation aptitudes increases a ton.

 Working in different areas and departments offered me some assistance with gaining
information in fields that I didn’t study previously.
 Furnished me with profitable hands-on work experience, and addition the chance to
apply the information and abilities that I had procure while studying.
 Time management is an important ability that creates through entry level positions,
which I have obtained to extraordinary degree
 I gained clarity on my strengths, weaknesses, and interests. 
 Internship experience also fixed the concern of enhancing my resume.
 confronted and overcome the “fear of the unknown” that I had about what it’s like to
work in a professional environment
 By interacting with others in a professional environment during an internship, my
communication skills are greatly enhanced and now I really know to work and deal
with people of different caliber.
  Internships really expanded my professional network.

 RECOMMENDATIONS:

 Employ however as many internees as could reasonably be expected with the goal

that they can get additional help and the work burden can be separated

 Should listen to every one’s queries especially regarding patients and attempt to settle

them or if the patient is not fulfilled he would not incline toward this doctor's facility

next time

 Enhance their server administration as a large portion of the grievance result in late

conveyance of sustenance which is because of less number of servers.

 As the flooring of the Food and Nutrition Services Department is not the right sort, so

it ought to be revamp which will spare time and exertion of the servers while working

prompting better administration.

 The hospital needs to update their website and include more brief and accurate data so

all required information regarding their hospital is obtained.

  The menu cycle for the patients must be changed 2-3 times a year.

 Complaints of the patients must be attended carefully and suggestions must be

implemented.

 Skilled and trained personnel should be hired to reduce work load.

 Different incentives should be provided to staff members to motivate them and

improve their performance.

2. INTRODUCTION TO NUTRITION:

BASIC DEFINITIONS:
1.NUTRITION:

Nutrition is the study of foods, the nutrients present in food and other chemical constituents
and the effect of all these nutrients and constituents on health.

2.NUTRIENTS:

Nutrients are the chemical components in food that are necessary for growth and maintenance
of health. These may either be micronutrients or macronutrients.

4.MICRONUTRIENTS:

These are the nutrients required in small amount/ quantities by humans and have
a regulatory role in body. These include vitamins and minerals.

3.MACRONUTRIENTS:

These are the nutrients required in large amounts by humans and have a major role in health
maintenance. They include carbohydrates, proteins and lipids.
5.CALORIE:

Also known as Kilocalorie, or Large Calorie, it is a measure of the amount of energy supplied
by the food/ nutrients in food.

TYPES OF NUTRIENTS:
There are 6 main types of nutrients:

1. Carbohydrates class of naturally occurring compounds and derivatives formed from

them. These are the chemical constituents in foods, present either as single sugar
molecules or as multiple sugar molecules, and are the major fuel for providing energy
to the body. One gram of carbohydrate that is consumed by us produces 4 kcal
energy. Major sources include whole grain products, starchy vegetables, fruits and
sugar.
2. Proteins are the dietary components and are polymer chains made of amino acids.
These are essential for the growth and repair of the body and maintenance of good
health. 1 gram of protein provides 17kJ (4 kcal). Major sources include meat, dairy
products, lentils, legumes etc.
3. Lipids/fats are the chemical constituents in food that are hydrophobic and fat-soluble,
composed of 1 glycerol molecule attached to 3 fatty acid molecules. Most of the fats
we consume in our diet is in the form of triacylglycerols (90-95%) with cholesterol
and phospholipids making up the bulk of the remainder. These energy dense
molecules produce 9 kcal when consumed 1gram of them. Sources include oils,
butter, organ meats, avocado etc.
4. Vitamins are an essential component of diet. Total 14 in number, these chemical
substances have regulatory functions in the body. Sources include fruits and
vegetables.
5. Minerals are the chemical substances in food that perform specific functions in the
body. Fruits, vegetables, dairy products, legumes are important sources.
6. Water is also an essential component of diet, it has a very important regulatory
function in the body, necessary to maintain hydration levels of the body, and is
provided by foods and fluids.

PRINCIPLES OF NUTRITION:
There are some important principles of human nutrition that are important in accordance
with having an understanding of the science of nutrition. These principles are:
1. Principle #1:Food is a basic need of human being.

1.1 Food Security: food security is the access of the consumer to sufficient supply of safe
and nutritious food.

1.2 Food Insecurity: food insecurity is the limited or uncertain availability of safe and
nutritious food.

1.3 Food Safety: this is basically the access of the consumer to safe food.

2. Principle #2: Foods provide energy (calories), nutrients, and other substances needed
for growth and health.
2.1. Related to the basic 6 components of food i.e carbohydrates, proteins, fats,
vitamins, minerals and water
2.2. Essential and non-essential nutrients
2.3. Related Terminologies:
2.3.1. DRIs = Dietary Reference Intake: general term for new nutrient intake
standard.
2.3.2. RDAs = Recommended Daily Allowance: adequate intake of known nutrients.
2.3.3. IAs = Adequate Intake: Tentative RDAs, less scientific.
2.3.4. EARs = Estimated Average Requirements: Adequate Intake in population
groups.
2.3.5. UIs = Tolerable Upper Level Intakes: upper limit of nutrients intake.
3. Principle #3: Health problems related to nutrition originate within cells.
State of optimal cellular nutrient conditions support the phenomenon of Homeostasis.
Homeostasis is the constancy of internal environment. The balance of fluids,
nutrients, gases and temperature to ensure ongoing and proper functioning at cellular
level.
4. Principle #4: Poor nutrition can result from both inadequate and excessive levels of
nutrient intake.
Deficiency: inadequate intake> depletion of tissue reserves> decreased blood nutrient
level> insufficient availability to cells> impaired cellular functions> symptoms of
deficiency> long term health impairment.
Toxicity: Excessive intake> saturation of tissue reserve> Increased blood nutrient
level> excessive ability to the cells> impaired cellular functions> symptoms of
toxicity> Long term health impairment.
5. Principle #5: Humans have adaptive mechanisms for managing fluctuations in food
intake.
Related with the concept of storage and excretion of nutrients. Storage of
carbohydrates as glycogen and fats as an adipose tissues. Excretion through stool and
urine.
6. Principle #6: Malnutrition can result from poor diets and from disease states, genetic
factors, or combinations of these causes.
Malnutrition: means poor nutrition due to inadequate and toxicity. It might be
primary malnutrition (due to dietary intake) or secondary malnutrition (due to
surgical, diseases, medications).
Nutrient-gene interaction: gene encodes for protein synthesis and thus enzyme
synthesis which in turns effect body functioning. Diabetes lactose intolerance etc.
7. Principle #7: Some groups of people are at higher risk of becoming inadequately
nourished than others.
Pregnant and lactating women, frail elderly persons, food storage due to war,
epidemics etc.
8. Principle #8: Poor nutrition can influence the development of certain chronic
diseases.
Heart disease, diabetes, osteoporoses, obesity, strokes, cancer etc.
9. Principle #9: Adequacy, variety, and balance are key characteristics of a healthy diet.
Nutrient dense food: food that contain relatively high amount of nutrients compared
to their caloric value. E.g. fruits, cereals, nuts, meats etc.
Empty calorie food: food that provide excess of calories relative to their nutrient
contents. E.g beer, chips, bakery products.
10. Principle #10: There are no “good” or “bad” foods.

ASSOCIATED TERMINOLOGY:

1. Enrichment: Replacement of valuable nutrients like vitamins and minerals lost

during food processing operations. E.g iron in cereal products.
2. Fortification: Addition of vitamins and minerals into food product on voluntary basis
to enhance the quality of the product. E.g vitamin A and D in vegetable oil.
 3. Functional food: food that carries specific health benefits in addition to their present
essential nutrients. E.g phytochemicals.
4. Probiotics: Also called as “friendly bacteria” present in the colon of the human body.
E.g strains of lactobacillus and bifidiobacterium species.
5. Prebiotics: Also called as “intestinal fertilizers”. They promote the growth of
beneficial bacteria in the colon of human body. E.g Oligosaccharides from onion,
garlic, barley.

THE FOOD GUIDE PYRAMID:

The food guide pyramid shows the types and serving sizes for the foods we should eat
every day to stay healthy. It is an illustration of the basic nutrients that must be eaten in
certain amounts to maintain health by choosing a wholesome diet. It is built on the basis
of the 6 basic food groups i.e cereals, vegetables, fruits, dairy including milk, cheese,
yogurt etc., meat group including poultry, fish, beans, nuts and eggs and fats.

Foods are placed in the pyramid in a way that shows how important they are to our health. W
should eat more of the foods at the base than foods at the top. There are basically 6 main
groups of the foods in pyramid, each of these six groups provide some, but not all, of the
basic nutrients needed by us and foods in none of the groups can replace the foods in another
group i.e each food group is necessary to be consumed and is important than all other food
groups. All of the food groups are important for health. The food guide pyramid also shows
the number of servings of the foods in each food group that must comprise the diet daily.
Portions of pyramid

Base of the pyramid comprises of the cereal group, having 6 to 11 servings per day which
provide the adequate amounts of carbohydrates, such as 1/2 chapatti, 1 slice of bread, 1/2 cup
pasta, 1/3 cup cooked rice and 4-6 crackers are some examples of 1 serving of this group.
At the top of cereal group there is food group that comes from plants i.e vegetables and fruits
that provide vitamins, minerals and fiber. 3 to 5 servings of vegetables and 2 to 4 servings of
fruits must be consumed each day. Such as 1 cup raw vegetable or 1/2 cup cooked vegetable
makes 1 serving of vegetables (carrots, cabbage) and 1 medium sized raw fruit (apple, peach,
orange) or 1/2 cup cooked or canned fruit or 3/4 cup fruit juice (grapes, mango, range) are
examples of 1 serving of fruit.
Above fruits and vegetables are the food groups that are the sources of protein and most
minerals (iron, calcium, zinc) and can be obtained from animal sources. One serving of meat
and meat substitute is 3 oz of chicken, beef, fish, egg etc and 2 to 3 servings of dairy (milk,
cheese and yogurt) are necessary to be consumed each day.
The top and the smallest portion of the pyramid shows fats, oils and sweets that should be
consumed sparingly because these contain fat and calories, as butter, margarine, cream, salad
dressings, sweet desserts etc. Plant oils must be preferred over vegetable fats.

NUTRITIONAL STATUS OF INDIVIDUAL:

Nutritional status is a requirement of health of a person convinced by the diet, the level of
nutrients containing in the body and normal metabolic integrity. Normal nutritional status is
managed by balanced food consumption and normal utilization of all the nutrients. It is the
condition of the body which is capable of doing normal activities throughout the day.

ASSESSMENT OF NUTRITIONAL STATUS:

An individual’s nutritional status can be assessed by 4 methods:

1. Anthropometric measurements
2. Biochemical tests
3. Clinical assessment
4. Dietary assessment

1. ANTHROPOMETRIC MEASUREMENTS:

Anthropometric measurements are a series of quantitative measurements of the muscle,

bone and adipose tissues used to assess the composition of the body. The core elements of
anthropometry are height, weight, Body Mass Index (BMI), body circumferences (waiste,
hip and limbs), and skin-fold thickness. These measurements are important because they
represent the diagnostic criteria for obesity, which significantly increases the risk for
conditions such as cardiovascular disease, hypertension, diabetes mellitus and many
more. There is further utility as a measure of nutritional status in children and pregnant
women. In children, indicates stunting, wasting and being underweight. Additionally,
anthropometric measurements can be used as a baseline for physical fitness and to
measure the progress of fitness. These measurements are frequently used to assess the
 nutritional status of an individual and require standardized procedures, calibrated
instruments and trained personnel.

2. BIOCHEMICAL ASSESSMENT:

Biochemical assessment includes the conduction of laboratory tests within a nutritional

assessment and these are interpreted in addition to the clinical signs and symptoms of
respective disorder. Biochemical tests measure the levels of chemical substances present in
the blood such as serum protein, micronutrients and certain metabolic parameters.. Functional
tests measure the level of functions of vital organs like kidney and liver. Some important
biochemical tests and their normal ranges with rationales are as follows:

TEST RATIONALE NORMAL RANGES

(different laboratories may
use different reference
ranges)
Hemoglobin (Hb) Assess for iron status or Women= 12.0-15.5g/dL
indicator of anemia. Men= 13.5-17.5g/dL
Albumin (Alb) A low level may indicate 35-50g/L (3.5-5.0g/dL)
inflammation or infection.
C-Reactive protein (CRP) This is an inflammatory Ideally <10mg/L
marker which is raised when
infection or inflammation is
present.
White cell count (WCC) Immune system marker 4-11*10^9/L (4000-11000
which is raised when per cubic millimeter of
infection is present. blood)
Glycated hemoglobin Indicates an average blood Ideally <48mmol/mol or
sugar level over a period of <6.5% (diabetes)
months.
Sodium (Na) This is an indication of 135-145mmol/L
hydration status and kidney
function. A raised sodium
level may indicates
dehydration.
Creatinin It indicates the functioning of 0.2-1.1 mg/dL
kidneys. An elevated value of
 creatinine suggests impaired
working of kidneys.
Urea (Ur) Used to assess kidney 2.5-7.1mmol/L
function. High urea and other
markers levels in
combination may indicate
dehydration.
Calcium and phosphate Used as a baseline when Adjusted Ca 2.0-2.6mmol/L
assessing risk of re-feeding Phosphate 0.7-1.4mmol/L
syndrome.
Calcium is adjusted for
albumin level.
Magnesium Likely to be low if there are 0.7-1.0mmol/L
large GI losses.
Alkaline Phosphatase is another enzyme 60-300 U/L
(ALP) produced by liver cells
and an increase or
decrease in its levels
indicate serious health
conditions.

Alanine Transaminase It is an enzyme produced 40 U/L

(ALT) by liver cells, and is used
assess liver health. An
increased level in blood
indicates hepatocellular
injury.

Total Bilirubin Assess total levels of 0.2-1.1 mg/dL

bilirubin in blood, i.e a
waste product of
breakdown of heme of
hemoglobin. A higher
level of bilirubin may
indicate hemolytic
 anemia, jaundice or any
liver disease.

Cholesterol & triglycerides An increased level of 200mg/dL

cholesterol and
triglycerides in blood
may indicate any heart
problem or metabolic
syndrome.

HDL Levels of High density 45-65mg/dL

lipoproteins
LDL Levels of Low density 0-130mg/dL
lipoproteins
Micronutrients Includes vitamins and trace
elements. These are affected
by the acute phase response
if inflammation or infection
is present and so best
measured when CRP is low.

3. CLINICAL ASSESSMENT:

Clinical assessment is used to assess an individual’s nutritional status by observing or

visually inspecting the physical condition of the patient and the clinical signs and symptoms
of any nutritional disorder, such as observing skin and nails colour for iron deficiency
anemia, hair texture and volume for zinc deficiency, tongue and lips for vitamin C deficiency
etc. Clinical Assessment indicates chronic condition of the patients because clinical signs and
symptoms develop at a later stage of nutritional deficiency.

Symptoms that may impact on person’s nutritional status either through reducing nutritional
intake or increasing nutritional losses include:

 Altered bowel movements e.g dirrhoea, vomiting

 Upper gastrointestinal upset e.g reflux, bloating, nausea
  Early satiety
 Lethargy
 Dysphagia

4. DIETARY ASSESSMENT:
An estimation of the total daily calorie intake, as well as overall quality of the diet is assessed
in dietary assessment. There are different methods used in this assessment for the analysis of
food consumption and utilization, asking the patient (or their family member/ caretaker)
about his daily dietary intake will help understand patterns of eating, portion sizes, cooking
methods and types of food and drink taken. Methods being used are:
a) 24-hour Recall Record
b) Food-Frequency Questionnaire
c) 3-day Food diary or Typical Day Diet History

24-hour Recall Record: In this method the patient is allowed to record what he/she has
eaten in the last 24 hours, to assess the overall diet quality and the intake of specific
nutrients that may be involved in diseased state. The procedure must be carried out for 3
consecutive days ( 2 week days and a weekend day preferably) by the client himself for
an adequate assessment of the eating pattern, portion sizes and the specific foods being
eaten or not eaten.

Food-Frequency Questionnaire: (FFQ) is a questionnaire used to obtain data about

frequency and in some cases portion size information about food and beverage consumption
over a specified period of time, typically the past month or year. This is common dietary
assessment tool used.
 3-day Food diary or Typical Day Diet History: In this method of assessment, the patient
is asked to write down all the food commodities he/she eats during the day. This is somewhat
difficult method for sometimes because of the abnormal health condition of the patient he/she
not remembers what and how exactly they ate during that specific time period.
Dietary history: is the most accurate method of assessing an individual’s dietary intake
and usually involves an interview that is 1 to 2 hours long asking detailed history of 24 hours
dietary intake, the types of foods eaten, their portion sizes, timings of eating etc.

Write weekly work

CONCLUSION:

The whole training at KIH was a very much knowledgeable experience for me that
will help me in my future career. I would like to pay my sincere thanks to all my
supervisors for being very much cooperative and supportive during this training
period.
THANKS!