Final Presentation

Members:
Yusra Asif FA19-FSN-036
Ayman Jamil FA19-FSN-040
Alvina FA19-FSN-044
Saira Nadeem FA19-FSN-046
Ayesha Khan FA19-FSN-056
 Contents of Presentation
• Peptic Ulceration
• Dengue
• IBS
• Diabetes Mellitus
• Hepatitis C

2
 Introduction
• Done Clinical internship at New Life Medicare Hospital
Sahiwal affiliated with DHQ (District Head Quarter ) Sahiwal
Nutrition Care Process
We have use a systemic way to medical nutrition therapy called the
Nutrition Care Process. It includes:
❖ Nutrition Assessment; ABCD Method:
• A=Anthropometric measures
• B=Biochemical Analysis
• C=Clinical signs
• D=Dietary Recommendations
❖ Nutrition Diagnosis
❖ Nutrition Intervention
❖ Nutrition Monitoring and Evaluation

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Peptic Ulceration

Yusra Asif
FA19-FSN-036(B)

4
 Peptic Ulceration
Peptic ulceration is a condition in which open sores or ulcers develop on the
lining of the stomach, duodenum or esophagus.
Causes:
Peptic ulcers can be caused by several factors, including:
• Infection with Helicobacter pylori (H. pylori) bacteria
• Long-term use of nonsteroidal anti-inflammatory drugs (NSAIDs) i.e.,
aspirin
• Excessive alcohol consumption
• Stress
Symptoms;
• Abdominal pain
• Bloating • Loss of appetite
• Nausea • Weight loss
• Vomiting • black or bloody
stools
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Case study:
Name Solat Gender Female Age 40 years Diagnostic tests • Endoscopy
H. Pylori is detected by:
Weight 70kg Height 5’.2" BMI 36.43
• Blood tests
• Stool tests

BP Temperatu 98°F BMR 1613.6 • Breath tests

120/70 re

Sleep 9pm to Pulse rate 74 Fluid 8-10 glass

time 6 am intak
Diet type: Low Fat Diet +
e
BRAT Diet
Total 2259.8 Physical Sedentar
Calories ~2200 Activity y (1)

Previous Ulceration
Complaint

Active Burning Sensation +Nausea + diarrheal +

Complaint ulceration

Family history Ulceration and constipation

Diet Timings Menu Kcal

1-2 glass of water 45 kcal

Plan: Pre-Breakfast (5-6 Chea seeds soaked overnight in water (1tsp in 1 glass )
am)

Oatmeal(1 bowl) with banana(1) and honey 1tsp / 2 boil eggs + 1 toast 450 kcal
with Apple Sauce
Breakfast (7-9 am)

Midmorning 1 medium apple /12 almonds / falsa juice 1 cup 90 k Cal

(10:30-11:30 am) Kehwa ( ginger + Elaichi+ cumin ) 120 kcal

Lunch chapatti(2 small )+Daal(yellow, 1/2 cup) ( in 2tsp of canola oil)+Salad 160kcal+200
(1-3 pm) 1cup raw kcal+25kcal
Or 1 Bowl Boiled Rice +Yogurt =385kcal

Snack time Yogurt (low fat) 6 oz with Strawberries ¼ cup 100 kcal+60kcal
(4-5pm) =160 kcal

Dinner Chapatti + (Gravy chicken + vegetable; pumpkin) /steamed chicken(salt 80 kcal + 150 +160 cal
(7-9 pm) and black pepper) 2 oz + mint Raita = 390 kcal
+ 80 kcal

Bedtime Milk 1 glass add 1 pinch of Haldi/ cardamom 100

(10-11pm)

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Total 2000 k cal
 Do and Don'ts of Peptic Ulceration
Do Don’t

• You Sleep timing should at least6-8 • Smoke or use tobacco products

hrs • Consume excessive amounts of
• Stay hydrated ,14-15 glass of water alcohol
• Avoid fast food / fatty food • Take NSAIDs or aspirin
• Walk should be at least 15 – 35 mins • Eat late at night or just before going to
• Medicine use according to physician bed. Lying down with a full stomach
• Recall after 15 -21 days( Change of can increase the risk of acid reflux
plan ) • Take excess amount of Milk
• Practice good hygiene consumption because it can worsen H.
• If you skip the meal, take the next not Pylori infection in stomach
that
 Discussion
➢ Probiotics:
Help ulcers by fighting an H. pylori infection. Nutraceutical:
Probiotic are foods that contain live microorganisms Turmeric ; contain
intended to maintain or improve the "good" bacteria Curcumin may help
(normal micro flora) in the body reduce inflammation,
Some probiotics are: promote ulcer
• Yogurt healing, and inhibit
• Traditional homemade pickles, such as cucumber H. pylori growth
pickles, carrot pickles, or mixed vegetable pickles,
are often prepared by fermentation
• kefir
• sauerkraut
➢ Berries:
They are rich in antioxidants; cranberry juice may be
useful in treating H. pylori infection
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i.e. ;Strawberries, falsa
 Dengue
Ayman jamil
FA19-FSN-040
INTRODUCTION

11
 Continue
Symptoms; Diagnostic tests
• High fever 1.Polymerase Chain Reaction
• Severe headache and eye pain (PCR)
• Joint and muscle pain 2.NS1 antigen test
• Rash 3.ELISA
• Mild bleeding 4.RDTs (Rapid Diagnostic Tests)

Note
The diet recommended in the
results is high protein, low carb,
and low fat.
The below-mentioned diet
contain carbs of less than 15g
and fat of less than 2g

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 Case study
Name: Rubina Age: 37yrs Gender: Female

Weight: 53kg Height: 5’1” BMI: 19.9kg/m2

BP: 95/70 Temp: 102F Pulse rate: 74

Fluid intake: 8-10 glass Sleep time: 6-7hours BEE: 1400-1500kcal

Physical activity: Sedentary A/C: Fever, weakness, P/C: Anemia,

dehydration, skin osteoporosis
rash, sore throat,
pain in eyes

F/H: DM, anemia Diagnose: Dengue Diet type: High protein diet

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 Biochemical Test

Test Name: Previous Report After 7 Days Reference Range

RBCs: 4.5× 109/L 5× 109/L 5 × 109/L

Hb: 11g/dl 14g/dl 13 to 16 g/dl

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Amylase: 146 × 109/L 300 × 109/L 150 to 400 × 10 /L

TLC: 16.0µL 9.5µL 4.0-11.0µL

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 Result
Timing Serving and diet Calories

Early morning • 1 cup of herbal tea or coconut water with 1 tsp of honey 50

6 to 7 am • Two soaked almonds 20

• 1 pinch of chia seed, flax seed and kalonji

Drink 2 glasses of detox water

• 2 omelette eggs with onion and tomatoes 578

Breakfast: • 1 small apricot + apple

7 to 8 am
• Oatmeal with skim milk and chopped kiwi + 1 tablespoon of honey

Mid-morning snacks: • 1 small container of low-fat yogurt with berries and almonds 150

10 To 11 am 150
• Fruit smoothie with banana, papaya, and chia seeds + 1 tablespoon of honey

Lunch: • Grilled chicken breast with air-fried vegetables (such as tomato, peppers, and onions) 148

1 to 2 pm
• 1 bowl of kale, asparagus, broccoli, and spinach squeezed with lemon and black pepper

114
• 1 bowl of khichri with chicken
320

Evening snacks: • 1 Raw carrot and 1 cucumber stick squeezed with lemon 42

34to 4 pm • 1 bowl of vegetable soup with 3 oz of lean chicken 160

72
• ½ bowl of pomegranate + 1 tablespoon of honey

Drink 2 glasses of detox water

Dinner: • Grilled fish with steamed vegetables 450

52
• ½ bowl of grapes + 1 tablespoon of honey

Bedtime snacks: • 1 glass of low-fat milk + 1 pinch of turmeric 100

31
• ½ bowl of mulberries + 1 tablespoon of honey

Total calories: 2523

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 Discussion
Nutraceuticals for dengue:
• Vitamin C
• Zinc
• Probiotics
• Omega-3
• Papaya Leaf Extract

MNT for Dengue:

• Hydration
• Electrolyte Balance
• Small, Frequent Meals
• Adequate Protein
• Nutrient-Dense Foods
• Avoid Excessive Fats and Sugars

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 Discussion
Do Don'ts

• Recalls • Avoid caffeine

• Use mosquito repellents • Avoid OTC drugs
• Wear protective clothing • Avoid high fat meat
• Use bed nets • Don't allow water to accumulate
• Keep doors and windows • Don't ignore mosquito bites
screened specially
• Drink 2 to 3-liter water • Don't rely solely on mosquito coils
or candles

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 Discussion
➢ Papaya: Papaya leaf extract is often used in traditional dengue treatment to help boost platelet count.
It can be consumed in the form of papaya leaf juice or as an herbal tea.

➢ Coconut Water: Coconut water is hydrating and rich in electrolytes, making it beneficial for
combating dehydration and replenishing essential nutrients.

➢ Pomegranate: Pomegranate juice or fresh pomegranate seeds are known for their antioxidant
properties and can help boost immunity and aid recovery.

➢ Green Leafy Vegetables: Include nutrient-dense leafy greens such as spinach, kale, and broccoli.
They provide vitamins, minerals, and antioxidants that support overall health and recovery.

➢ Oatmeal: Oatmeal is easy to digest and provides energy, fiber, and essential nutrients. It can be
prepared with water or milk and topped with fruits and nuts.

➢ Chicken Soup: Chicken soup is a comforting and easily digestible option that provides hydration,
protein, and nutrients. Choose a broth-based soup with lean chicken and vegetables.

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“Irritable bowel syndrome”

Name: Alvina
Registration No: FA19-FSN-044
 Introduction
Irritable bowel syndrome (IBS) is a common disorder that affect the stomach and
intestines, also called the gastrointestinal tract.
• Cramping, abdominal pain
• Bloating, gas
• Diarrhea, constipation
“Types of IBS”
There are three types of IBS:
I. Alternating bowel habits (IBS-A)
II. Constipation-predominant IBS (IBS-C)
III. Diarrhea-predominant IBS (IBS-D)

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 MNT for IBS
• low FODMAP diet
• Drink six to eight glasses of water.
• Slowly increase dietary fiber by 2 to 3 g/d
• Soluble fiber is beneficial for IBS
• Introduce the Probiotics rich diet
Nutraceuticals:
• Psyllium Husk
• Peppermint
• Turmeric

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 Case study
Name: Maryam Age: 22yrs Gender: Female

Weight: 43kg Height: 5’1” BMI: 17.9kg/m2

BP: 90/60 Temp: 98F Pulse rate: 74

Fluid intake: 8-10 glass Sleep time: 6-7hours BEE: 1400-1500kcal

CHO: 168.7g (50%) Proteins: 112.5g (25%) Fats: 41.6g (25%)

Physical activity: Sedentary A/C: Diarrhea P/C: Constipation, piles

F/H: constipation+ piles Diagnose: IBS Diet type: FODMAP+BRAT

diet + Fiber rich
diet

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 Biochemical Test
Test Name: Previous Report After 7 Days Reference Range

Hb: 9.9g/dl 13g/dl 12-16g/dl

Cholesterol: 260mg/dl 110mg/dl 125-200mg/dl

Amylase: 13U/L 80U/L 0-86U/L

TLC: 16.0µL 9.5µL 4.0-11.0µL

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 Diet plan
Timing: Food Item CHO: Protein: Fats Kcal

Pre breakfast: Take 1 tsp Psyllium Husk with 1 glass

6:00-6:30AM of lukewarm water
10-15mints walk after Pre-breakfast

Breakfast: Oatmeal with sliced banana with 1 15g 3g 0g 80+60 + 45

7:00-9:00AM tablespoon of ground flaxseed . 15g 0g 0g
0g 0g 5g

Mid Morning: 1 glass Smoothie (Kiwi+ Banana 15g 0g 0g 60+60+60+60+100

10:30-11:00AM +mango slice+1 tsp honey+ skim 15g 0g 0g
Milk) 15g 0g 0g
15g 0g 0g
15g 8g 2g

Lunch: Must drink 1-2 glass water before 15g 3g 0g 80+120

12:00-1:00PM lunch. 15g 8g 5g
1 bowel khichdi (Rice with Lentils)
with peppermint yogurt.

Evening Snack: 1 bowl chat ( Boiled chickpea+ 15g 3g 3g 80+60+60+60+60+45

4:00-5:00PM Banana+ Blueberry + Apple slices+ 15g 0g 0g
Sliced melon + lemon squeeze) 15g 0g 0g
15g 0g 0g
15g 0g 0g

Physical activity: Walk must for 10-15 mints

5:30-6:00PM

Dinner: Must drink 1-2 glass water before 0g 7g 2g 45+ 25

7:00-9:00PM dinner. 5g 2g 0g
1 bowel chicken veg soup.

Bed time: 1 glass skim milk+ 1 pinch of 15g 8g 1g 100+25

10:00-11:00PM turmeric 0g 0g 0g

Total: 230g (57.5%) 42g (10.5%) 18g (2%) 1300kcal 24

 Discussion
• FODMAP stands for fermentable oligosaccharides, disaccharides,
monosaccharide and polyols. They can help to restore a healthy balance of
gut flora.
• BRAT diet(bananas, rice, apples, toast) diet is often recommended for
patients suffering from diarrhea you may consume foods that ease the GI
tract.
• Psyllium Husk is fiber pro is high in soluble fiber and they maintain a
healthy digestive system and overcome the diarrhea.
• Turmeric helps Amylase to perform work in our body.
• Black pepper helps in improving metabolism, reduce depression, boosts
immunity.

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Diabetes Mellitus

SAIRA NADEEM
(FA19-FSN-046)

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 Diabetes Mellitus

• Metabolic disease
• Hyperglycemia(High level of glucose in blood)
• It develops when your pancreas doesn’t produce enough insulin and your
body doesn’t respond to insulin properly
Symptoms:
• Fatigue
• Weight loss
• Blurred vision
• Polyphagia
• Polyuria
• polydipsia

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 Types of Diabetes
There are three main types of diabetes:
• Type 1 diabetes (IDDM)
• Type 2 diabetes (NIDDM)
• Gestational diabetes (Pregnancy)
Diagnosis:
Test Ranges How test is performed
HbA1C ˃6.5% Average blood glucose level
of past 2-3 months
Fasting blood glucose ≥126mg/dl Fasting at least 8 hours
test before the test. Test is
performed in morning
Random glucose test ≥200mg/dl This test is for diabetic
patient taken any time of day
and no need to fast. 28
 MNT
• Low fat diet
• High fiber diet
• Low carbohydrate diet
Nutraceuticals
• Cinnamon
• Ginger
• Probiotics
• Fenugreek

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 Case study
Name Sadia Age 40yrs
Gender Female Weight 70kg
Height 5.6 BMI 24kg/m²
BEE 1600kcal IBW 59kg
Temperature 98F Pulse rate 79
Fluid intake 12 glass Sleep time 8 hours
BP 120/85 A/C Fatigue+ Frequent
urination +thirst
Family history DM+HTN Hb 9.1
HbA1C 8.1 BSR 230
Dos •7-8 hours sleep Don'ts •Avoid bakery items
•Drink plenty of water •Avoid beverages
•20 minutes walk •Avoid high fat food
•Recall after 15 days

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 Diet plan
Timing Food items C P F Kcal

Pre breakfast 20 minutes of Walk regularly 0 0 5 45

(5am-6am) 7 Almonds soaked in water
Breakfast Drink 1-2 glass of water before 15 minutes of meal 30 6 1 160
(7am-9am) 1 cup oat meal+1 sliced apple+almonds+1 pinch fenugreek 15 0 0 60
0 0 5 45
Snack (10:30am- 1 cup yogurt with added 1 pinch of cinnamon powder 15 8 5 120
11:30am)

Lunch Drink 1-2 glass of water before 15 minutes of lunch 15 3 1 160

(1pm-3pm) 1 chapatti +1/2 cup yellow lentils +salad 15 7 2 125
5 2 0 25
Evening Snack 1 Bowl fruit salad 15 0 0 60
(4pm-5pm)

Dinner Drink 1-2 glass of water before 15 minutes of Dinner 15 3 1 160

(7pm-9pm) 1 chapatti+3 oz grilled chicken+salad with olive oil 0 21 6 135
5 2 0 25
dressing+Raita
0 0 5 45
15 8 5 120
Bed time 1 glass skim milk 15 8 2 100
(10pm-11pm)

Total 155g 70g 40g 1450kcal

 Results

• The diabetic patient have hyperglycemia .Diet plan provided to each patient is
according to their energy requirement and their BMI.Two variable were selected to
analyze the effect of diet on patient health

• 1. Variable is random blood glucose level 2. Variable is hemoglobin level

Analysis of diabetes Mellitus before and after guidelines

Before After

Random blood glucose mg/dl Hb Random blood glucose mg/dl Hb

230 9.1 160 10

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 Discussion

• Cinnamon may lower blood sugar level by increasing movement of sugar

from bloodstream to cells

• Soaked almonds have high fiber regulate blood sugar level

• Probiotics may improve insulin resistance

• Skim milk is better dietary choice for managing diabetes because of its
lower fat content

• Oatmeal have high fiber content and essential minerals

• Olive oil rich source of antioxidant reduce blood sugar and cholesterol

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Hepatitis C

Ayesha Khan
FS19-FSN-056
 Hepatitis C
• Liver Inflammation
• Hepatitis C virus
• Transmitted by Body Fluids
• Incubation
– 2 weeks – 6 months
• Symptoms
– Fever
– Loss of appetite
– Dark urine
– Nausea and vomiting Hepatitis C Virus
– Jaundice
– Pains in muscles and joints

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 Medical Nutrition Therapy
• Frequent small meals
– Soft or Regular Diet
• 30-35 kcal/kg body weight
• Protein intake increased
– 1.2g/kg body weight
• Nutraceuticals
– Clove
– Cinnamon
– Milk Thistles
– Peppermint
– Oregano
– Thyme

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 Case Study
Name : Nazia Age : 27 yrs Gender : Female
Weight: 57 kg Height : 5’1” BMI: 23.7kg/m2
B.P.: 100/60 Temp.: 99 OF Pulse Rate: 82
Physical 1400-1500
Fluid Intake: 8-10 Glass Sedentary BEE: Kcal
Activity:
CHO: 166 g Proteins: 93.75 g Fats: 50 g
A/C: Fatigue, Weakness, Pale Skin, Yellowish Eyes
Family
HCV, DM, HTN
History:
Diagnosis: HCV + Anemia + Fever + HTN
Diet Type High Protein Diet + DASH Diet

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 Biochemical Tests
Test Name Initial Report After 15 Days Normal Range

Hb 9.1g/dL 10 g/dL 12/1-15.1 g/dL

Uric Acid 4.7 mg/dL 4.4 mg/dL 2.7-7.3mg/dL

Cholesterol 210mg/dL 180mg/dL 125-200mg/dL

TLC 42000 uL 40000 uL 40000uL

ALT 40 U/L 37U/L 7-35 U/L

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 Diet Plan
Timing Food item Kcal CHO (g) Pro (g) Fat (g)
15 2 1 0.6
Pre Breakfast 1 cup milk thistle tea + 2 cardamom
5:30-6:00 Walk for 15-20 minutes

1-2 glass water 10 minutes before

Breakfast
½ cup oats with 1 banana, 258 35.1 5 9
7:00-8:00
2 walnuts, 1 tbsp chia seeds
Fruit chaat 60 15 - -
Snack
(1 bowl)
10:30-11:30

1-2 glass water 10 minutes before

1 cup vegetable salad with olive oil 70 5 2 5
Lunch
2/3 cup yogurt with Cumin 120 15 8 5
1:30-2:00
1 bowl okra / any vegetable curry 95 10 4 2.5
1 multi grain Chapatti 80 15 3 1

2 shami kabab 75 - 7 6
Evening snack 50 7.5 4 1
1 cup Sugar free Tea
4:00-5:00
Walk for 15-20 minutes

1-2 glass water 10 minutes before

70 5 2 5
1 cup vegetable salad with olive oil
Dinner 120 15 8 5
2/3 cup mint raita
7:30-8:30 270 - 42 5
6 oz. pan grilled/steamed chicken
102 15 - 5
1 small slice brownie

Bedtime Snack
1 cup lukewarm milk with 1 tsp honey 120 20 8 2
10:00-11:00
Total 1505 kcal 159.6 g 94g 39
52.1g
 Discussion
• High Protein Diet for healing and repair
• Milk Thistle have silymarin that lowers inflammation
• Fruits and Vegetables are rich in anti-oxidants
• Chia Seeds rich in fibres and Alpha linolic acid; a natural detox for
liver
• Cumin increases bile production
• Olive Oil raises HDL and reduces fat deposits
• Canola Oil reduces fatty liver grade
• Cardamum reduces cholesterol and triglycerides

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 Conclusion
• File Reading
• Patient Counseling
• Diagnosis
• Designing MNTs
• Evaluating Results

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