Department of Clinical Nutrition

LOG BOOK 
For Clinical Nutrition Work

BSNS-206
Principles of Nutrition Assessment
BSNS 4 Semester 
th

Name Fatima Tariq Younas

Roll no. 331-BSNS-F18

Semester  4th

Course title and Principles of nutrition assessment(BSNS-

code 206)
Contact 03244440740

Email  tariqfatima450@gmail.com
SR Practical topic Activity
No.
1. Introduction to Nutritional Assessment Indoor Outdoor Forms

2.   Standards for nutrient intake, Dietary Enlist the RDAs of Macro and
Reference Intake Micronutrients

3. Direct & indirect measures: Nutritional Perform assessment of ambulatory and

Assessment of Ambulatory and Bed bedridden patients
Ridden Patient
4. Basic Nutrition Calculations, Calculations Calculate PA of 1 ambulatory and 1 non-
of PA of ambulatory and non-ambulatory ambulatory individual
individuals
5. Calculate energy requirements Protein Calculations for energy requirements and
requirements of hospitalised and outdoor protein requirements
patients Subjective Global Assessment Fill SGA form of any patient
6. Role of Biochemical markers in List of Nutritional deficiency diseases
Nutritional Assessment
7. Biochemical Assessment of Macro & List of Biochemical tests required to assess
Micronutrients the nutritional status
8. Biochemical assessment of Liver and Biochemical findings of any liver patient or
Endocrine disorder endocrine disorder patient
9. Physical Assessment of Diseased Patient Assess physical features of diseased
(Physical Examination) patients & write down the good physical
signs and malnourished signs of diseased
patients
10. 24-hour recall of indoor and outdoor Formulate Food dairy for 3 days
patient   
FFQ Development
11. Food labels assessment of different food Self-assessment and formulate meal plan
items and supplements
12. Exchange list for Meal planning Highlight food items available in Pakistan
in exchange list
13. Exchange list for Meal planning   Calculations through exchange list
  
14. Growth charts Assess
PRACTICAL 1.

INTRODUCTION TO NUTRITIONAL ASSESSMENT

Nutritional Assessment is mainly done via four steps that need to be done step by step to assess
the patient most accurately and prescribe diet to patient. Every step comprises of various methods
mainly diet history collection that is our main concern.]

Following are the main steps to follow for the best assessment possible.

ANTHROPOMETRIC

Height, weight,BMI, length for infants, head circumference, IBW and frame size etc

BIOCHEMICAL FINDINGS

Blood and urine sample are collected to be examined and tested in laboratory to find the
desired substance from the sample for further diagnosis and prognosis of diseases.

PHYSICAL EXAMINATION

Sign and symptoms observed and reported by patient. Mainly face color, physique, eye
socket, nails and hair indicate the most at first sight about patient’s health & eating habits.

DIETARY HISTORY

There are various tools used to obtain this part of our assessment as it depicts us about
eating pattern, economic wellbeing and their medical conditions such as lactose tolerance
etc.

Outdoor and indoor forms below:-

 FATIMA MEMORIAL HOSPITAL,

SHADMAN, LAHORE
NUR-FMS
School of Nutrition

INDOOR NUTRITIONAL ASSESSMENT

Date: __________________
Patient Name: __________________ Ward/block: ____________ Bed/Room No.:__________
Age: _______ Height: _______ Weight: _______ BMI: _____________ IBW: ____________
Medical Diagnosis: ___________________________________________________________
WEIGHT HISTORY
No Change _____________ Increased ________ Decreased _________

DIETARY HISTORY
No Dietary intake change: ___________ Change in Dietary Intake: ____________________________

Type of Diet before Hospitalization: ______________________________________________________

Type of Diet after Hospitalization: _______________________________________________________

Caloric Intake in 24 Hours: _____________________________________________________________

Supplement Intake: ___________________________________________________________________

Food Item Quantity Type

Milk Products

Meat

Vegetables

Fruits

Bread and Cereals

Fat / Cooking Oil

 GI - FUNCTION

Appetite: ______________ Nausea: ______________ Anorexia: ____________________

Vomiting: ______________ Diarrhea: ______________ Constipation: _________________

Others: ________________________________________ Duration: ____________________

PHYSICAL EXAMINATION

Edema: ________________ Muscle wasting: ___________ Ascites: ______________________

Skin: _________________ Mouth: __________________ Nails: _______________________

Eyes: ________________ Teeth: __________________ Hair: ________________________

METABOLIC STATUS

Low Stress ______________ Moderate Stress ______________ High Stress ______________

TOTAL INPUT AND TOTAL OUTPUT

Oral: ________________________ ml Output: _____________________ ml

IV: __________________________ ml Others: _____________________ ml

FEEDING ROUTE

Oral: ___________ NG: ___________ PEG: ___________ PEJ: ___________

FUNCTIONAL CAPACITY

Bedridden: _________________ Ambulatory: _________________ Active: _____________

BIOCHEMICAL FINDINGS

Date Test Result Date Test Result

 SGA RATING

Well-nourished: ___________ Malnourished: _______________ Severely Malnourished: ________________

Dietitian Signature: __________________

 DIETITIAN’S NOTES

Date: _________________________________

Patient Name: _________________________________

Fatima Memorial Hospital

Age/ Sex: _________________________________

NUR-FMS School of Nutrition

MR No: _________________________________

Shadman Lahore, Pakistan

Room/ Bed No:_________________________________

Date/ Time Dietary Recommendation Signature

Fluid Requirement:

Preferred Feeding Route:

Mechanism of Diet:

Type of Diet:

Supplement:
Date/ Time Dietary Recommendation Signature
 FATIMA MEMORIAL HOSPITAL, SHADMAN, LAHORE
D Deartment Of Nutritional Sciences

OUTDOOR NUTRITIONAL ASSESSMENT AND RECOMMENDATION FORM

Date: _______________Patient Name: __________________________________________

Contact No.:__________Age: _______ Height: _______ Weight: _______ BMI: _____________

IBW: _____________Medical
Diagnosis:____________________________________________________________

WEIGHT HISTORY
No Change _____________ Increased ________ Decreased _________

DIET HISTORY

Daily consumption of foods from each food group:

 Milk Products __________  Bread and Cereals __________

 Fruits __________  Vegetables __________

 Meat __________  Fat __________

How often do you consume the following in a week?

Carbonated Beverages_______ Bakery Products________ Fast Food __________

MEAL TIMINGS MEALS FREQUENTLY SKIPPED

 Breakfast Time: ______________  Breakfast: ______________

 Lunch Time:______________  Lunch:______________

 Dinner Time: ______________  Dinner: ______________

GI FUNCTION

Appetite: ______________ Nausea: ______________ Anorexia: ____________________

Vomiting: ______________ Diarrhea: ______________ Constipation: _________________

Others: ________________________________________ Duration: ____________________

 PHYSICAL EXAMINATION

Edema: ________________ Muscle wasting: ___________ Ascites: ______________________

Skin: _________________ Mouth: __________________ Nails: _______________________

Eyes: ________________ Teeth: __________________ Hair: ________________________

WATER INTAKE
Glasses/day: __________________

Temperature:  Cold  Room Temperature  Warm

SLEEP-WAKE CYCLE
Wake up Time: _______________ Sleep Time: _______________

EXERCISE & WALK

Type of Exercise: ____________________________ Duration: ______________ _
BIOC BIOCHEMICAL FINDINGs
Lipid profile _____________________ CBC (Hb) _______________________

Renal Function test (RFT) ___________Liver Function test (LFT) ___________

Iron __________________Calcium _______________Vitamin D_____________

Vitamin B12 ____________Allergy/Drug Interaction: _______________________________

METABOLIC STRESS

 No stress  Low  Moderate  High

SGA RATING

 Well-nourished  Moderately malnourished  Severely malnourished

RECOMMENDATIONS

Caloric Requirement: __________________________________________________________

Fluid Requirement: __________________________________________________________

Preferred Feeding Route: __________________________________________________________

Mechanism of Diet: __________________________________________________________

Type of Diet: __________________________________________________________

PRACTICAL 2

STANDARDS FOR NUTRIENT INTAKE, DIETARY REFERENCE INTAKE

DRI

DRI is the general term for a set of reference values used to plan and assess nutrient intakes of healthy people that includes the
Recommended Dietary Allowance (RDA)
Adequate Intake (AI)
Tolerable Upper Intake Level (UL)
Estimated Average Requirement (EAR)

DRIs related to energy

AMDR (acceptable macronutrient distribution range)
EER (estimated energy requirement)
DIETARY REFERENCE INTAKES (DRIS): RECOMMENDED INTAKES FOR
INDIVIDUALS,VITAMINS
Food and Nutrition Board, Institute of Medicine, National Academies

Life Stage Vit A Vit C Vit D Vit E Vit K Thiamin Riboflavin Niacin Vit B6 Folate Vit Bl2 Pantothenic Biotin Cholineg

Group (μg/d)a (mg/d) (μg/d)b,c (mg/d)d (μg/d) (mg/d) (mg/d) (mg/d)e (mg/d) (μg/d)f (μg/d) Acid (mg/d) (μg/d) (mg/d)

Infants

0–6 mo 400* 40* 5* 4* 2.0* 0.2* 0.3* 2* 0.1* 65* 0.4* 1.7* 5* 125*

7–12 mo 500* 50* 5* 5* 2.5* 0.3* 0.4* 4* 0.3* 80* 0.5* 1.8* 6* 150*

Children

1–3 y 300 15 6 0.5 0.5 6 0.5 150 0.9

5* 30* 2* 8* 200*

4–8 y 400 25 5* 7 55* 0.6 0.6 8 0.6 200 1.2 3* 12* 250*

Males

9–13 y 600 45 11 0.9 0.9 12 1.0 300 1.8

5* 60* 4* 20* 375*

14–18 y 900 75 5* 15 75* 1.2 1.3 16 1.3 400 2.4 5* 25* 550*

19–30y 900 90 5* 15 120* 1.2 1.3 16 1.3 400 2.4 5* 30* 550*

31–50y 900 90 5* 15 120* 1.2 1.3 16 1.3 400 2.4 5* 30* 550*

51–70y 900 90 10* 15 120* 1.2 1.3 16 1.7 400 2.4i 5* 30* 550*

>70y 900 90 15* 15 120* 1.2 1.3 16 1.7 400 2.4i 5* 30* 550*

Females

9–13 y 600 45 11 0.9 0.9 12 1.0 300 1.8

5* 60* 4* 20* 375*

14–18y 700 65 5* 15 75* 1.0 1.0 14 1.2 400i 2.4 5* 25* 400*

19–30y 700 75 5* 15 90* 1.1 1.1 14 1.3 400i 2.4 5* 30* 425*

31–50y 700 75 5* 15 90* 1.1 1.1 14 1.3 400i 2.4 5* 30* 425*

51–70y 700 75 10* 15 90* 1.1 1.1 14 1.5 400 2.4h 5* 30* 425*
 >70y 700 75 15* 15 90* 1.1 1.1 14 1.5 400 2.4h 5* 30* 425*

Pregnancy

14–18y 750 80 15 1.4 1.4 18 1.9 600 j 2.6

5* 75* 6* 30* 450*

19–30y 770 85 5* 15 90* 1.4 1.4 18 1.9 600 j 2.6 6* 30* 450*

31–50y 770 85 5* 15 90* 1.4 1.4 18 1.9 600 j 2.6 6* 30* 450*

Lactation

14–18 y 1200 115 19 1.4 1.6 17 2.0 500 2.8

5* 75* 7* 35* 550*

19–30y 1300 120 5* 19 90* 1.4 1.6 17 2.0 500 2.8 7* 35* 550*

31–50y 1300 120 5* 19 90* 1.4 1.6 17 2.0 500 2.8 7* 35* 550*

NOTE: This table (taken from the DRI reports, see www.nap.edu) presents Recommended Dietary Allowances (RDAs) in bold type and Adequate Intakes (AIs) in ordinary type followed by an asterisk (*). RDAs and AIs may both be used as goals
for individual intake. RDAs are set to meet the needs of almost all (97 to 98 percent) individuals in a group. For healthy breastfed infants, the AI is the mean intake. The AI for other life stage and gender groups is believed to cover needs of all
individuals in the group, but lack of data or uncertainty in the data prevent being able to specify with confidence the percentage of individuals covered by this intake.

a
As retinol activity equivalents (RAEs). 1 RAE = 1 μg retinol, 12 μg b-carotene, 24 μg a-carotene, or 24 μg b-cryptoxanthin. The RAE for dietary provitamin A carotenoids is twofold greater than retinol equivalents (RE), whereas the RAE for preformed vitamin A is the same as RE.

b
As cholecalciferol. 1 μg cholecalciferol = 40 IU vitamin D.

c
In the absence of adequate exposure to sunlight.

d
As a-tocopherol. a-Tocopherol includes RRR-a-tocopherol, the only form of a-tocopherol that occurs naturally in foods, and the 2R-stereoisomeric forms of a-tocopherol (RRR-, RSR-, RRS-, and RSS-a-tocopherol) that occur in fortified foods and supplements. It does not
include the 2S-stereoisomeric forms of a-tocopherol (SRR-, SSR-, SRS-, and SSS-a-tocopherol), also found in fortified foods and supplements.

e
As niacin equivalents (NE). 1 mg of niacin = 60 mg of tryptophan; 0–6 months = preformed niacin (not NE).

f
As dietary folate equivalents (DFE). 1 DFE = 1 μg food folate = 0.6 μg of folic acid from fortified food or as a supplement consumed with food = 0.5 μg of a supplement taken on an empty stomach.

g
Although AIs have been set for choline, there are few data to assess whether a dietary supply of choline is needed at all stages of the life cycle, and it may be that the choline requirement can be met by endogenous synthesis at some of these stages.

h
Because 10 to 30 percent of older people may malabsorb food-bound B12, it is advisable for those older than 50 years to meet their RDA mainly by consuming foods fortified with B 12 or a supplement containing B12.

i
In view of evidence linking folate intake with neural tube defects in the fetus, it is recommended that all women capable of becoming pregnant consume 400 μg from supplements or fortified foods in addition to intake of

food folate from a varied diet.

j
It is assumed that women will continue consuming 400 μg from supplements or fortified food until their pregnancy is confirmed and they enter prenatal care, which ordinarily occurs after the end of the periconceptional period—the critical time for formation of the neural
tube.
 DIETARY REFERENCE INTAKES (DRIS): RECOMMENDED INTAKES FOR INDIVIDUALS,
ELEMENTS
Food and Nutrition Board, Institute of Medicine, National Academies
Life Stage Calcium Chromium Copper Fluoride Iodine Iron Magnesium Manganese Molybdenum Phosphorus Selenium Zinc Potassium Sodium Chloride

Group (mg/d) (μg/d) (μg/d) (mg/d) (μg/d) (mg/d) (mg/d) (mg/d) (μg/d) (mg/d) (μg/d) (mg/d) (g/d) (g/d) (g/d)

Infants

0–6 mo 210* 0.2* 200* 0.01* 110* 0.27* 30* 0.003* 2* 100* 15* 2* 0.4* 0.12* 0.18*

7–12 mo 270* 5.5* 220* 0.5* 130* 11 75* 0.6* 3* 275* 20* 3 0.7* 0.37* 0.57*

Children

1–3 y 500* 11* 340 0.7* 90 7 80 1.2* 17 460 20 3 3.0* 1.0* 1.5*

4–8 y 800* 15* 440 1* 90 10 130 1.5* 22 500 30 5 3.8* 1.2* 1.9*

Males

9–13 y 1300* 25* 700 2* 120 8 240 1.9* 34 1250 40 8 4.5* 1.5* 2.3*

14–18 y 1300* 35* 890 3* 150 11 410 2.2* 43 1250 55 11 4.7* 1.5* 2.3*

19–30 y 1000* 35* 900 4* 150 8 400 2.3* 45 700 55 11 4.7* 1.5* 2.3*

31–50 y 1000* 35* 900 4* 150 8 420 2.3* 45 700 55 11 4.7* 1.5* 2.3*

51–70 y 1200* 30* 900 4* 150 8 420 2.3* 45 700 55 11 4.7* 1.3* 2.0*

>70 y 1200* 30* 900 4* 150 8 420 2.3* 45 700 55 11 4.7* 1.2* 1.8*

Females

9–13 y 1300* 21* 700 2* 120 8 240 1.6* 34 1250 40 8 4.5* 1.5* 2.3*

14–18 y 1300* 24* 890 3* 150 15 360 1.6* 43 1250 55 9 4.7* 1.5* 2.3*

19–30 y 1000* 25* 900 3* 150 18 310 1.8* 45 700 55 8 4.7* 1.5* 2.3*

31–50 y 1000* 25* 900 3* 150 18 320 1.8* 45 700 55 8 4.7* 1.5* 2.3*
 51–70 y 1200* 20* 900 3* 150 8 320 1.8* 45 700 55 8 4.7* 1.3* 2.0*

>70 y 1200* 20* 900 3* 150 8 320 1.8* 45 700 55 8 4.7* 1.2* 1.8*

Pregnancy

14–18 y 1300* 29* 1000 3* 220 27 400 2.0* 50 1250 60 12 4.7* 1.5* 2.3*

19–30 y 1000* 30* 1000 3* 220 27 350 2.0* 50 700 60 11 4.7* 1.5* 2.3*

31–50 y 1000* 30* 1000 3* 220 27 360 2.0* 50 700 60 11 4.7* 1.5* 2.3*

Lactation

14–18 y 1300* 44* 1300 3* 290 10 360 2.6* 50 1250 70 13 5.1* 1.5* 2.3*

19–30 y 1000* 45* 1300 3* 290 9 310 2.6* 50 700 70 12 5.1* 1.5* 2.3*

31–50 y 1000* 45* 1300 3* 290 9 320 2.6* 50 700 70 12 5.1* 1.5* 2.3*

NOTE: This table presents Recommended Dietary Allowances (RDAs) in bold type and Adequate Intakes (AIs) in ordinary type followed by an asterisk (*). RDAs and AIs may both be used as goals for individual intake.
RDAs are set to meet the needs of almost all (97 to 98 percent) individuals in a group. For healthy breastfed infants, the AI is the mean intake. The AI for other life stage and gender group is believed to cover needs of all
individuals in the group, but lack of data or uncertainty in the data prevent being able to specify with confidence the percentage of individuals covered by this intake.

SOURCES: Dietary Reference Intakes for Calcium, Phosphorous, Magnesium, Vitamin D, and Fluoride (1997); Dietary Reference Intakes for Thiamin, Riboflavin, Niacin, Vitamin B6, Folate, Vitamin B12, Pantothenic Acid,
Biotin, and Choline (1998); Dietary Reference Intakes for Vitamin C, Vitamin E, Selenium, and Carotenoids (2000); Dietary Reference Intakes for Vitamin A, Vitamin K, Arsenic, Boron, Chromium, Copper, Iodine Iron,
Manganese, Molybdenum, Nickel, Silicon, Vanadium, and Zinc (2001); and Dietary Reference Intake for Water, Potassium, Sodium, Chloride, and Sulfate (2004). These reports may be accessed via http://www.nap.edu.

Reprinted with permission from the National Academies Press, Copyright © 2000, National Academy of Sciences.
 Dietary Reference Intakes (DRIs): Recommended Intakes for Individuals,
Macronutrients
Food and Nutrition Board, Institute of Medicine, National Academies
Total Total Linoleic a-Linoleic
Watera Fiber Acid Acid
Life Stage Carbohydrate Fat Proteinb

Group (L/d) (g/d) (g/d) (g/d) (g/d) (g/d) (g/d)

Infants

0–6 mo 0.7* 60* ND 31* 4.4* 0.5* 9.1*

7–12 mo 0.8* 95* ND 30* 4.6* 0.5* 11.0c

Children

1–3 y 1.3* 130 19* ND 7* 0.7* 13

4–8 y 1.7* 130 25* ND 10* 0.9* 19

Males

9–13 y 2.4* 130 31* ND 12* 1.2* 34

14–18y 3.3* 130 38* ND 16* 1.6* 52

19–30 y 3.7* 130 38* ND 17* 1.6* 56

31–50 y 3.7* 130 38* ND 17* 1.6* 56

51–70y 3.7* 130 30* ND 14* 1.6* 56

>70y 3.7* 130 30* ND 14* 1.6* 56

Females

9–13 y 2.1* 130 26* ND 10* 1.0* 34

14–18 y 2.3* 130 26* ND 11* 1.1* 46

19–30y 2.7* 130 25* ND 12* 1.1* 46

31–50y 2.7* 130 25* ND 12* 1.1* 46

51–70 y 2.7* 130 21* ND 11* 1.1* 46

>70y 2.7* 130 21* ND 11* 1.1* 46

Pregnancy

14–18y 3.0* 175 28* ND 13* 1.4* 71

19–30y 3.0* 175 28* ND 13* 1.4* 71

31–50y 3.0* 175 28* ND 13* 1.4* 71

Lactation

14–18 y 3.8* 210 29* ND 13* 1.3* 71

19–30y 3.8* 210 29* ND 13* 1.3* 71

31–50y 3.8* 210 29* ND 13* 1.3* 71

 Dietary Reference Intakes (DRIs): Additional Macronutrient Recommendations
Food and Nutrition Board, Institute of Medicine, National Academies

Macronutrient Recommendation
Dietary cholesterol As low as possible while consuming a nutritionally adequate diet As
Trans fatty acids low as possible while consuming a nutritionally adequate diet As low
Saturated fatty acids as possible while consuming a nutritionally adequate diet Limit to no
Added sugars more than 25% of total energy
PRACTICAL 3

DIRECT & INDIRECT MEASURES: NUTRITIONAL ASSESSMENT

OF AMBULATORY AND BED RIDDEN PATIENT

DIRECT METHOD

HEIGHT
1. Height should be measured without shoes
2. The individual’s feet should be together, with the heels against the wall or
measuring board.
3. The individual should stand erect, neither slumped nor stretching, looking
straight ahead, without tipping the head up or down. The top of the ear
and outer cornea of the eye should be in a line parallel to the floor.
4. A horizontal bar, a rectangular block of wood, or the top of statiometer
should be lowered to rest flat on top of the head.
5. Height should be read to the nearest ¼ inch or 0.5cm.

WEIGHT
1. Scale accuracy must be determined. Frequent calibration is required.
2. Use a beam balance scale not a spring scale, whenever possible.
3. Weigh the subject in light clothing without shoes.
4. Record weight to the nearest ½lb or 0.2 kg for adults and ¼lb or 0.1 kg
for infants. Measurements above the 90th percentile warrant further
evaluation.

INDIRECT METHOD

HEIGHT
ADULT RECUMBENT

Steps

1. Stand in the right side of the body

2. Align the body so that lower extremities, trunk, shoulders and head are
straight.
3. Place a mark the top of the sheet in line with the crown of the head and
one at the bottom of the sheet in line with the base of the heels.
 4. Measure the length between marks with measuring tape.

KNEE HEIGHT

Knee height measurement is highly correlated with upright height. It is useful in

those who are ambulatory and cannot stand erect. It is also used in patients with
spine deformities.

Steps.

1. Use the left leg for measurements

2. Bend the left knee and left ankle to 90-degree angles. A triangle may be used
if available.

3. Using knee height calipers, open the caliper and place the fixed part under the heel.
Estimating height from knee height
4. Place the sliding blade down against the thigh
(approximately 2 inches behind the patella)
5. Measure the heel to the anterior surface of
thigh, using a cloth measuring tape.
6. Obtain the measurement and convert it to
centimeters by multiplying by 2.54.
7. Formulas to use are
Men (height in centimeters) 64.19(0.04 age) + (2.02 x knee height in cm)
Women (height in centimeters) 84.8 (0.24 age) + (1.83 x knee height in cm

Estimating height in bedridden patients

Estimates of pharmacokinetic parameters and evaluation of nutritional status rely on accurate

measurement of not only body weight but also height. However, a number of common
disabilities and disease processes make it difficult to accurately measure standing height in
many patients. Therefore, various formulae based on bones that do not change length have
been developed. These methods include knee height, forearm length and demi-span.

KNEE HEIGHT

Knee height is correlated with stature and, until recently, was the preferred method for
estimating height in bedridden patients. Knee height is measured using a sliding broad-blade
caliper. A device designed for this purpose is commercially available. The patienfs height is
then estimated using a standard formula.

While lying supine, both the knee and ankle of the patient are held at a 90-degree angles. One blade of a sliding
Medifoi m caliper is placed under the heel of the foot: and the other blade is placed on the anterior surface of the thigh.
The shaft of the caliper is held parallel to the long axis of the lower leg : and pressure is applied to compress the tissue.
Height (in cm) is then calculated from the formula below:

Females
Height in cm = 84.38 - (0.24 X age) + (1.33 X knee height)
Males
Height in cm = 64.19 - (0.04 X age) + (2.02 X knee height)

Forearm length

This method is popular in the UK. The only tool needed is a tape to measure the ulna length
between
the point of the elbow and the midpoint of the prominent bone of the wrist. This value is
thencompared with a standardized height conversion chart.12

Estimating height from ulna length

Measure between the point of the elbow and the midpoint

of the prominent bone of the wrist (left side if possible).

Height in meters is determined from the following

chait, bssed on the uln3 length 3S measured in cm.

Men (< 65 years) 1,94 L93 i.9i 1.8S i«7 LS5 1.84 1.82 1.80 1,78 1.76 1.75 1.73 L71

Women {>65 JLS4 1.S3 1,81 1.79 1,78 1.76 1.75 1.73 1.71 1,70 i.e& 1,&6 l.SS 1.63
years)
IVIen(< 65 years) 1.G9 1,67 1,66 1,64 1.62 1.60 1,68 1.57 LSS 1.53 1.51 1.49 l.m L46

Women fs-G5 1,61 1,60 ：LSS L5G 1.55 1.S3 152 1.50 L4B 1.47 1,45 1,44 1,42 3L40
years)
Estimating height from demispan

m easure the distance from the middle of the sternal notch to the
tip of the middle finger (left arm if possible). Check that
patient's arm is horizontal and in line with shouldeis. Gslculate
stature (in cm) froni the formula
Females

Height in cm = (1.35 x demispan (cm))

+60.1 Males

Height in cm = (1.40 x demispan (cm))

+57.8
 Conclusion

All three methods provide reasonably accurate estimates of stature in normally proportioned
adults. Demi-span may be easier to obtain in patients with lower limb dysfunction. For
patients with severe

contractures, forearm length may more practical.

PA= energy requirement and physical activity

AMBULATORY PATIENT

TEE=BEExPAxIF

Male 40kg 5’2’’ 18 years old

 Height= 5x12+2=62inch=157.48cm

BEE=66.5+(13.7xwt in kg) +(5xht in cm) –(6.8xage)

=66.5+ (13.7x40) +(5x 157.48)–(6.8x18)

= 66.5+(548)+ (787.4)-(122.4)
=1401.9-122.4
=1279.5kcaL
TEE= 1279.5X 1X 1=1279.5kcal

NON AMBULATORY PATIENT

Male 60kg 5’4’’ 20 years old burned= 40%

Height= 5x12+4=64inch=162.56cm

TEE=BEExPAxIF

IF=1-1.5

BEE=66.5+(13.7xwt in kg) +(5xht in cm) –(6.8xage)

=66.5+ (13.7x60) +(5x 162.56)–(6.8x20)

=66.5+ (822) +(812.8)-(136)

=1565kcal

TEE=1565 x 1 x 1.5

=2347.95kcal
PRACTICAL 5
CALCULATE ENERGY REQUIREMENTS PROTEIN
REQUIREMENTS OF HOSPITALISED AND OUTDOOR PATIENTS
SUBJECTIVE GLOBAL ASSESSMENT

TEE=BEExPAxIF

BEE= Basal Energy Expenditure

PA= Physical Activity

IF=Injury Factor

To calculate energy requirements, we first have to find out injury factor and
physical activity of the patient. Injury factor is calculated by nutriti9onist
himself where as physical activity is described by patient by his activity or
exercise if any throughout the day.

PHYSICAL ACTIVITY

Type of Activity Range

No Activity/Sedentary 1.0-1.1

Slightly activity 1.2-1.3

Moderately active 1.3-1.5

Vigorous/Athletes 15.-1.7

INJURY FACTOR
 Types of Injury Severity Values
Surgery  Minor 1.0-1.1
 Major 1.3-1.9

Trauma  Mild 1.15-1.35

 Skeletal 1.2-1.35
 Severe 1.4-1.8

Infection  Mild 1.0-1.2

 Moderate 1.2-1.5
 Severe 1.4-1.8

Burns  Up to 40% burn 1-1.5

 Up to 100% burn 1.95

PROTEIN REQUIREMENT:

Health Condition  Range (g/kg) protein requirement 

Normal health  0.8-1 ×body weight 

Fever, Fracture/Infection 1.5-2 ×body weight 

Extensive Burns  1.5-3 ×body weight 

Protein Depletion  1.8-2 ×body weight 

Formulae for energy requirements:

Mifflin equation 
=10 (weight in kg )+ (6.25 x height in cm )- (5 x age)+( S)

S= 5 for men

S= -161 for women

Harris-Benedict Equation 
Men =66.5+(13.7 x weight in kg)+5(height in cm)-(6.8 x age) 

Women =665.1+(9.6 x weight in kg)+(1.86 x height in cm)-(4.7 x age)

INDOOR PATIENT

Male 22 years 5’4’’ 70kg severe infection due to

meningitis

TEE= BEE x PA x IF

Height=5x12+4 = 64inch = 162.56cm

BEE= 66.5+(13.7 x weight in kg) + (5 x height in cm)- (6.8 x age)

=66.5+(13.7 x 70) +(5 x 162.56)-(6.8 x 70) 

=66.5+(959) + (812.8) -(476)

= 1362.36 kcal
TEE= 1362.36 x 1 x 1.4

= 1907.22kcal

Protein requirement= 2 x 70 = 140g daily

OUTDOOR PATIENT
Female 36 years 60kg 5’2’’ working woman with exercise routine

TEE=BEE x PA x IF

Height=5x12+2= 62inch = 157.48cm

BEE=665.1+(9.6 x weight in kg) + (1.86 x height in cm)-(4.7 x age)

=665.1+(9.6 x 60) + (1.86 x 157.48) - (4.7 x age)

=665.1+ (576) + (292.9) – (169.2)

=1364.8kcal

TEE= 1364.8 x 1.3 x 1

= 1774.2kcal

Protein Requirement= 0.8 x 60 =48g

SGA forms

There are many typical SGA forms used for assessment

PRACTICAL 6
ROLE OF BIOCHEMICAL MARKERS IN NUTRITIONAL ASSESSMENT
Interpretation Reference range Limitations and Implications

Albumin (ALB) Decreased levels can occur 3.5-5 g/dL A negative phase reactant,
following acute and chronic impacted by inflammatory
(35-50 g/L)
inflammatory states; often stress, (protein losing
associated with other deficiencies conditions and hemodilution.
(i.e., zinc, iron, and vitamin A) Hepatic proteins are indicators
reflecting that ALB transports of morbidity and mortality:
(many small molecules
Globulin (GLOB) Globulin proteins include enzymes 2.3-3.4 g/dL Significance confounded by
and carriers that transport proteins acute stress reaction, infection,
(23-34 g/L)
including antibodies that primarily inflammatory conditions.
assist in immune function and fight
infection.
A/G Ratio It represents the relative amounts of A/G Ratio 1 : 1 is Albumin levels fall and
ALB and GLOB normal , globulin levels rise with
inflammatory stress.
< 1 : 1 is disease state

Transferrin (Tf or Tf increased with low iron stores, Adult male: 215-365 Lead can biologically mimic
TFN) and prevents build up of highly mg/dL (2.15-3.65 g/L) and displace iron thus releasing
toxic excess unbound iron in Fe into circulation and high
Adult female: 250-380
circulation. In iron overload states amount of Tf.
mg/dL (2.50-3.80 g/L)
Tf levels decrease Tf is a negative acute phase
Pregnancy and estrogen
reactant diminished in chronic
HRT associated with
illness and hypoproteinemia.
high Tf.

Transferrin Tf-sat decreases to <15% in Fe Increased Tf-sat when low

Saturation (Tf-sat deficiency; useful in diagnosis of vitamin B6 as in aplastic
or TSAT) iron toxicity or Fe overload
anemia.
PreAlbumin Measure of inflammatory status. Malnutrition: <8 Sensitive to acute zinc
(PAB)/ Zinc deficiency reduces PAB levels. mg/dL deficiency and acute stress
Transthyretin reaction. PAB values do not
(TTR) reflect protein status, but is a
prognostic index for mortality
and morbidity
Retinol-binding Measure of inflammatory status. 2.6-7.6 mg/dL Sensitive to stress response;
protein (RBP) vitamin A and zinc
deficiencies, and hemodilution;
increased in chronic renal
disease
C-Reactive A sensitive marker of bacterial Low risk for CVD = Useful metabolic indicator for
Protein high disease and systemic inflammation; adults.9 Acute-phase reactant;
sensitivity (hs- associated with periodontitis, less than 1.0mg/L relates mostly to bacterial
CRP) trauma, cardiovascular disease, Intermediate risk for infection, central adiposity,
neoplastic proliferation and bacterial trauma and neoplastic activity.
infections. CVD = 2.9mg/L
 High risk for CVD =
greater than 3.0mg/L
Seek inflammatory
cause if > 10mg/L

Fibrinogen Decreased fibrinogen related to 200-400 mg/dL If ,100 Good test and retest reliability,
prolonged Pro Time (PT) and Partial mg/dL, increased risk and covariance is stable over
Thromboplastin Time (PTT); of bleeding. time; diets rich in Omega 3/6
produced in liver; rises sharply It should be monitored fatty acids reduce fibrinogen
during tissue inflammation or in conjunction with blood levels.
necrosis; association with CHD, blood platelet levels
stroke, myocardial infarction and involved with
peripheral arterial disease. coagulation status.

METABOLIC INDICATORS

INSULIN-LIKE GROWTH FACTOR-1 (IGF-1) OR SOMATOMEDIN C

The peptide mediator of growth hormone activity produced by the liver; half-life of a few
hours; much less sensitive to stress response than other proteins.
Principles

Low in chronic undernutrition; increases rapidly during nutrition repletion; TSAT, PAB,
and RBP are not affected.
Interpretation Elevated levels associated with elevated GH in acromegaly and neoplastic activity.

Adult: 42-110 ng/mL.

Reference Children age 0-19: can vary with age, gender.
Range

Reduced levels are seen in hypopituitarism, hypothyroidism, liver disease, and with
estrogen use.
Limitations Growing evidence of elevated IGF-1 as a prognostic biomarker of neoplastic activity.
 HEMOGLOBIN A1C (HGBA1C)
Glycated hemogoblin is a form og hemoglobin that is chemically linked to sugar.
Most monosaccharides, including glucose, galactose anf fructose, spontaneously bind with hemoglobin, which is present in
HgbA1C the blood stream.

Glycosylated hemoglobin; dependent on blood glucose level over life span of RBC (120 days)
The more glucose the Hgb is exposed to, the greater the % HgbA1C.
Principles

Assessment of the mean glycemic blood level and of chronic diabetic control detecting for the previous 2-3 months.
Interpretation

Non-diabetic adult/child: 4%-5.9%

Controlled diabetes 9(DM): 4-7%
Reference Fair DM control: 7-8%
Range Poor DM control: .8%

HbgA1 measurement is a simple, rapid, and objective procedure.

Home testing is available.
Limitations

INSULIN, FASTING

Insulin is a peptide hormone produced by beta cells of the pancreatic islets.

Insulin It is considered to be the main anabolic hormone of the body.

Pancreatic hormone signaling cell membrane insulin receptors to initiate glucose

transport into cell; test fasting 7 hours, or 1 or 2 hours post prandial; usually
Principles ordered with blood glucose test.

Elevated levels associated with hyperinsulinemia related to metabolic syndrome;

diagnosis of insulinproducing neoplasms; excess insulin associated with
Interpretation inflammatory conditions.

Adult values: Fasting 6-27 μ IU/mL 1 or 2 hours.

Reference
Range

Good to test and retest reliability, and covariance is stable over time.
Limitations Insulin antibodies may invalidate the test.

Immune Interpretation Reference range Limitations and Implications

Dysregulation Tests

Allergies/Sensitivity
Immunoglobulins Used to determine Total IgA: Adults = 85-463
immunodeficiency states; mg/dL; Children = 1-350 mg/dL
(IgA, IgG, IgE,
measurement of +IgE Total IgG: <2.0 mcg/mL;
IgM,) =allergic disorders;
Total IgE = <10 IU/mL
+IgG=delayed immunologic
sensitivity or intolerance RAST IgE: =<1 IU/mL low
response allergic risk
IgA: largest % Ig primarily Total IgM: Adults 48-271
made in GI lymphoid tissue mg/dL Children 17-200 mg/dL
and marker of immune Total IgD =<15.3 mg/dL
strength and response

Innate Immune Factors

Total Leukocyte Decreased in protein-energy
malnutrition and
Count (TLC)
immunocompromised
state.

Cytokines

Adaptive Immune Factors

Eosinophils Blood: Wide range of
clinical conditions reflect
(Eosinophil
nonspecific eosinophilia;
leukocyte) elevated related to possible
allergies, asthma,
sensitivities, or cancers;
particularly elevated
eosinophils are found with
intestinal parasites;
noninfectious conditions.
Food Intolerance/Sensitivity Panels
Antigen Leucocyte NSAIDS, glucocorticosteroids,
Cellular vitamin C, bioflavonoids can
suppress the immunologic
Antibody Test
response and promote a false
(ALCAT) negative. IgA used as a
biomarker of adequate immune
response
Mediator Release Test NSAIDS, glucocorticosteroids,
(MRT) (immunologic vitamin C, bioflavonoids can
food reaction test) suppress the immunologic
response and promote a false
negative. IgA used as a
LIST OF NUTRIENT DEFICIENCY DISEASES:

MACRONUTRIENTS:
Carbohydrate deficiency:
 Acidosis
 Ketosis
 Hypoglycemia
 Constipation
 Mood swings

Protein deficiency:
 Marasmus
 Kwashiorkor

Fat deficiency:
 Atherosclerosis
 Cognitive decline
 Coronary heart disease
 Chronic inflammation

MICRONUTRIENTS

DISEASES DUE TO VITAMINS DEFICIENCY:

FAT SOLUBLE VITAMINS:

 Vitamin A Xerophthalmia, night blindness

 Vitamin D: rickets
 Vitamin E: sterility in males and abortions in females
Vitamin K: Bleeding Diathesis
Water soluble:
Vitamin B:
 B1: beriberi 
 B3: pellagra 
 B2: Ariboflavinosis
 B5: Paresthesia
 B6: Dermatitis & Anemia
 B7: Dermatitis, enteritis
 B12: Megaloblastic anemia

Vitamin C: scurvy 
TRACE MINERALS:

 Iron: Iron-deficiency anemia

 Iodine: goiter
 Chromium: decreased muscle function
 Zinc: impaired immune system
 Fluoride: increase risk of bone fractures
 Calcium: Decreased bone mineralization, rickets, osteoporosis
 Selenium: Cardiomyopathy, increased cancer and cardiovascular risk
 Copper: anemia, neutropenia
 Potassium: kidney stones
Practical 7
Nutrient name Interpretation Reference range Limitations and Implications

Thiamin (B1) Normal: 70-200 nmol/L Amount (and activity) of enzyme

affected by drugs, iron, folate, or
vitamin B12 status, malignant or GI
diseases, and diabetes.
Riboflavin (B2) Amount or activity of enzyme may
change with age, iron status, liver
disease, and glucose6-phosphate
dehydrogenase deficiency.
Niacin (B3) Nicotinic acid: 0.0−5.0 Niacin (nicotinic acid) is a water
ng/mL Nicotinamide: soluble vitamin that is also referred
5.2−72.1 ng/mL to as vitamin B3. Nicotinamide
(nicotinic acid amide) is the
derivative of niacin
Folate 1. Deficiency leads to increase in 1. Normal: MCV 80-100 fL 1. Not sensitive or specific for
MCV (mean corpuscular volume) folate. Possible involvement with
2. Normal:< or equal 4 lobes
and macrocytic RBCs B6, B12, SAMe and other cofactors
per neutrophil
in the methionine pathway
2. Increased neutrophil lobe count 3. 2-10 mcg/L serum;
seen in folate deficiency. 2. Lobe count sensitive but not
140-960 ng/L RBC
specific
3. Both RBC and serum folate are
indicators of body stores. 3. Plasma from non-fasting subjects
may reflect recent intake; RBC
folate is not measured accurately.
Cobalamin (B12) 1. Deficiency leads to 1. Not sensitive or specific for
increase to MCV B12.
2. Increased neutrophil lobe 2. Lobe count sensitive but
count in B12 deficiency not specific
3. Levels <150 ng/L indicate 3. Marginal deficiency not
deficiency (age affects correlated with level.
level). 4. Specific for B12 but
4. MMA excretion >300 requires normal BCAA
mg/24 hr in B12 levels; available at most
deficiency. Sensitive test laboratories.
without being overly 5. Test must be repeated with
specific oral administration of
5. Abnormal B12 absorption intrinsic factor (IF) to
indicated by excretion ,3% differentiate IF deficiency
of B12 radioactivity per 24 and malabsorption. Rarely
hours. used because of necessity
6. Hcy level is an independent of radioactive B12
risk factor for CVD, 6. Cardiovascular event risk is
venous thrombotic disease, increased even at slightly
and other diseases; folic elevated levels. Hcy has a
acid and vitamins B12 and strong association with
B6 reduce plasma Hcy degenerative neurologic
levels. Total Hcy (oxidized conditions like Parkinson’s
1 reduced forms) is an disease and dementias. Hcy
intermediate amino acid in suggests poor methylating
methionine metabolism. capacity of client with need
for increased intake of folic
acid, B6, B12, and SAMe.
Ascorbic acid Leukocyte C is less affected by Blood samples must be carefully
(Vitamin C) recent intake, but plasma levels in prepared for assay to prevent
 fasting person parallel leukocyte vitamin C breakdown. Oxalate,
levels; plasma preferred for acutely glucose, and proteins interfere with
ill patients because leukocyte level some assays; recent intake can mask
is affected by infection,22 some deficiency
drugs, and hyperglycemia;
Retinols (vitamin Retinol levels<20 mcg/dL indicate Exposure of serum to bright light or
A) severe deficiency; specific levels are oxygen destroys vitamin A; low
being determined for RBP (retinol binding protein) level
placental/newborn deficiency serum is associated with low vitamin A,
levels. zinc and iron (see protein-energy
section). Vitamin A’s gene
transcription is on the nuclear
RXR;22 the vitamin D receptor
forms a heterodimer, requiring
balance between vitamins A and D
for optimum function.
Tocopherols Lower values found in infants. Plasma level depends on recent
(Vitamin E) intake and level of lipids, especially
TGs, in blood. Smoking and BMI
also negatively affect tocopherol
levels.
Cholecalciferol . 1. Adult: 25-100 U/L
(D3) and (D2) Child 1-12 yr:<350
ergocalciferol U/L
2. 2. 30 – 100 ng/mL
3. 3. 2.5-4.5 ng/dL
25- Available at all laboratories. If
hydroxyvitamin D elevated serum calcium, further
(25- OH-D) / evaluation recommended by testing
Calcifediol/ vitamin 1,25 DOH, PTH, ionized or
Calcidiol free calcium, vitamin A retinol and
osteocalcin (as a vitamin K2
marker) before supplementation.
Osteocalcin (OC) / Can be used as a marker of Vitamin K2 is not as involved with
undercarboxylated metabolic trend, suggesting low or coagulation as K1. Vitamin K2 is
osteocalcin high vitamin K2; useful in assessing important in calcium metabolism
(ucOC) need for a vitamin K2 rich diet or and therefore calcium and vitamin D
K2 supplementation to optimize status. There is a synthetic vitamin
(K2 marker)
formation of intracellular bone K3, usually administered IV that has
osteocalcin. K2 inhibits soft tissue similar actions as K2, and is being
calcification. OC and ucOC are used as adjunctive to integrative
considered more sensitive markers cancer therapy
of bone activity than alkaline
phosphatase during corticosteroid
therapy

Test Interpretation Reference Range Limitations and Implications

Prediabetes Prediabetes, blood glucose levels Non-diabetic FBG = American Diabetes Association
diagnosis are higher than normal but not <99 mg/dL recommends testing for
high enough for a diagnosis of prediabetes in adults without
Impaired fasting glucose: 100-
diabetes. symptoms who are overweight
125 mg/dL
or obese, and who have one or
more additional risk factors for
diabetes
Diabetes 1. Two or more FBG levels 1. Elevated glucose levels
diagnosis >126 mg/dL are normally appear with
diagnostic; random level physiologic stress;
>200 mg/dL followed by whole blood gives
fasting level >126 mg/dL slightly lower values.
are diagnostic. Fasting
levels of 110 to 126
mg/dL indicate impaired 2.Serum:
glucose tolerance (IGT.) Fasting: <110 mg/dL
2. Serum levels FBG >200 (<6.1 mmol/L)
mg/dL at 2-hour point is 30 min: <200 mg/dL
diagnostic; (<11.1 mmol/L)
2-hour level <140 and 1 hour: <200 mg/dL
all 0- to 2-hour levels 2. Often used for
(<11.1 mmol/L)
<200 are normal; confirmation;
2 hours: <140 mg/dL
140-199 at 2 hours ambulatory patient
(<7.8 mmol/L)
indicates IGT. only; bed rest or stress
3 hours: 70-115 mg/dL
Gestational diabetes: impairs GGT;
(<6.4 mmol/L)
fasting >105; inadequate
4 hours: 70-115 mg/dL
1-hour GGT >190; carbohydrate
(<6.4 mmol/L)
2 hour GGT >165; consumption before test
Urine: glucose negative
and 3-hour GGT >145 invalidates results.
mg/dL.
Diabetes 1. Tight diabetes control requires 1. 70-99 mg/dL (3.9-5.5 mmol/L) A combination of glucose
monitoring frequent monitoring of glucose monitoring (by patient) and
levels. laboratory measurement of
2. Normal levels: 1%-2% of total glycated proteins are needed to
protein Ranges vary according to effectively monitor glucose
2. Allows assessment of average method used. control; fructosamine must be
glucose levels for previous 2-3 interpreted in light of plasma
weeks. protein half-lives, and HgbA1C
must be interpreted in light of
RBC half-life.

3. Normal levels:
3. Allows assessment of average
glucose levels for previous 2-3 Nondiabetic: 4-5.9%
months and verification of Good diabetic control: 4-7%
patient’s serum glucose log.
Fair diabetic control: 6%-8%
Poor diabetic control: >8%;
Mean blood sugar 205 mg/dL or Department of Defense study
greater is associated with (July 2005) 47% percent
increased risk of side effects increase in diabetes among
veterans with the highest levels
of dioxin

PRACTICAL 8
BIOCHEMICAL ASSESSMENT OF LIVER AND ENDOCRINE DISORDER

Name of the Test Ranges Interpretation

1. Thyroxine T4 F: 5-12  Increases in hyperthyroidism 

mcg/dL
 Decreased in hypothyroidism or malnutrition 
M:4-12
mcg/dL
2. Triiodothyronine T3 40-180  Increased in hyperthyroidism
ng/dL
 Decreased in hypothyroidism 

3. Thyroid Stimulatiing 0.5-5  Decreased in hyperthyroidism 

Hormone (TSH) mlU/L
 Increased in hypothyroidism 

4. Antithyroglobulin <4 IU/L  Anti TG bind to thyroglobulin and effect thyroid

Antibody (anti-TG) hormone synthesis, storage and release 

5. Antithyroid peroxidae <9 IU/L  Thyroid antibodies act in thyroid cell and initiates
Antibody  inflammatory and cytotoxic effect on thyroid
follicle 
Name of the Test Ranges Interpretition
      1.  Bilirubin  0.3-1 mg/dL  Levels elevated by cancer of pancreas,
liver or bile duct obstruction 

2.  Alanine Amino 4-36 U/L (infants :  Injury to liver results in elevated level
Transferase (ALT) 2*Adults ) ALT.
 Depressed in malnutrition 

3.Gamma Glutamyl F:4-35 U/L  Used to evaluate progression of liver

Tranferase(GGT) disease 
M:12-38 U/L
 Screening of alcoholism 

4.Alkaline Phosphatase 30-120 U/L  Elevated levels in liver and bone diseases 
(ALP)
5.Aspartate Amino 0-35 U/L  Used when occlusive heart disease or
Trasferase (AST) hepatocellular disease is suspected

6.Alpha 1 Antitrypsin 85-213 mg/dL  Decreased or absent alpha 1 band 

(A1AT)
 Associated with emphysema 
 Elevated with infection, inflammation or
malignancy 
PRACTICAL 9

PHYSICAL ASSESSMENT OF DISEASED PATIENT (PHYSICAL EXAMINATION)

Body Part Normal Findings   Abnormal  ETIOLOGY

findings 

1. Skin  Healthy color, soft,  Excess fat stores  Excess energy intake,Diabetes
smooth  Dry with fine lines  Essential fat deficiency
 Yellow  Excess carotene, jaundice
pigmentation

2. Nails  Smooth, translucent,  Spoon shaped  Iron deficiency, heart disease

slightly curved and  Dull  Protein deficiency, chemical
firmly attached to nail effects
bed  Pale, mottled
 Vit. A&C deficiency, infection

3. Scalp  Pink, no lesions, tender   Softening  Vit D deficiency

4. Hair  Shiny, consistency in  Lack of shine, thin,  Protein or zinc deficiency,

color and quantity sparse hypothyroidism
 Easily pluck able  Biotin deficiency, psoriasis
 Corkscrew hair  Copper or vit C deficiency,
menkes disease

5. Face  Skin warm, smooth, dry,  Swollen  Protein deficiency, steroid and
soft medication
 Pallor
 Iron or folic acid deficiency,
 Moon face
low-perfusion
 Protein deficiency, Cushing
disease

6. Eyes  Evenly distributed brows,  Pale conjunctiva  Iron folate deficiency, low
lids, lashes, pink output states
 Night blindness
conjunctiva without  Vit A deficiency
discharge, clear cornea,  Dry, grayish, white
skin without cracks spots  Gaucher’s disease 
 Softening of cornea  Riboflavin deficiency, infection

7. Nose  Uniform shape, able to  Scaly, greasy with  Riboflavin & niacin deficiency
identify aromas, mucosa yellow material around  Irritation of skin membranes
pink and moist nares
 Inflammation,
redness of sinus tract 

8. Lips, mouth  Pink, symmetric, smooth  Angular stomatitis  Riboflavin & niacin deficiency,
intact herpes
 Chapped or peeling
 Dehydration, environmental
 inflammation
exposure
  Protein, folic acid, xerostomia

9. Tongue   Pink, moist, midline,  Magenta  Vit b12 deficiency, Crohn’s

symmetric with rough disease
 Smooth, slick, loss
texture of papillae  Folate, niacin, riboflavin
deficiency
 Distorted taste
 Zinc deficiency, medication

10. Gums  Pink, moist without  Spongy, bleeding,  Riboflavin & vit c deficiency,
sponginess receding poor hygiene
 Red, swollen  Vit B12 deficiency, lymphoma

11. Teeth  Repaired, no loose teeth,  Missing, loose  Excess sugar intake, trauma,
color maybe various teeth, caries aging, syphilis
shades of white  White or brownish  Excess fluoride, enamel
patches hypoplasia
PRACTICAL 10

24-HOUR RECALL OF INDOOR AND OUTDOOR PATIENT FFQ DEVELOPMENT

24 HOUR- RECALL

Name of patient:

Gender:

Age:

Occupation:

Physical activity

Types:

Walking 30min/day

Brisk walking: 30min/day

Stretching: 20min/day

Minutes per day: 80 minutes of moderate activity

Food Group My Plate 24- hour recall

recommended
quantity

Fruits(cups) 2

Vegetales (cups) 2 1/2

Protein foods (tsp,Oz,cups) 5 1/2

Dairy( cups) 3

Grains (Oz) 6

Fats/Oil (tsp) 6

Empty calories (kcal) <200 kcal from aded

sugar
FFQ DEVELOPMENT
Name Age Gender Height BMI

Physical Activity Diagnosis

Food Daily Twice a Once a Every 15 Once a never

week week days month
Meat and
products
Turkey
Beef
Chicken
Fish
Mutton
Organ meat
Steak

Drinks
Tea
Coffee
Cocoa
Carbonated
drinks
Fruit juices
Water
Milkshake

Fruits
Apple
Banana
Mangoes
Apricot
Peach
Melon
Pineapple
Tinned fruits
Seasonal fruits
Dates

Dry fruits
Almonds
Cashew
Walnuts
Pistachio
Hazelnut

Pulses
Split green
gram
Black eyed
beans
Yellow pigeon
peas
Kidney beans
Split black
gram
Green gram
Black gram
beans
Split red
lentils
Split bengal
gram
Chick pea
White bean
Green pea

Vegetable
s
Carrots
Potato
Cucumber
Onion
Broccoli
Cucumber
Spinach
Pumpkin
Tomato
Beetroot
Lady finger
Radish
Carrot
Celery
Egg plant
Cabbage
Corn
Beans
Pea
Turnip
Ginger
Lettuce
Sweet potato
Bitter gourd

Dairy
Milk
Cheese
Fats
Butter
Yogurt
Mayonnaise
Olive oil

Sweets
Sugar
Chocolate
Bakery
Fast food
Egg
Rice
PRACTICAL 11

FOOD LABELS ASSESSMENT OF DIFFERENT FOOD ITEMS AND SUPPLEMENTS

PRACTICAL 12

EXCHANGE LIST FOR MEAL PLANNING

STARCH
Cereals, grain, pasta, bread, crackers, snack, starchy vegetable, cooked beans, peas and lentils are starches.

1 starch is

½ cup cooked cereal, grain or starchy vegetable

½ cup of cooked rice or pasta

1 oz of a bread product, such as 1 slice of bread

¾ oz to 1 oz of most snack foods(some snacks also have extra fat)

A choice on starch list has

15grams of carbohydrates

0-3 grams of protein

1.1 grams of fat

1.2 80 calories
FRUITS
Fresh, frozen and dried fruits and fruit juices are on this list

1 fruit choice is

½ cup of canned or fresh fruit or unsweetened juice

2 small fresh juice

3 tablespoons of dried fruits

A choice of fruits on list has

15 grants of carbohydrates

0 grant of protein

0 grant of fat

60 calories

MILK
1 cup equals 8 fluid oz or ½ pint

Different milk categories give you different amount of 1 milk choice

12 g of carbohydrates

8 g of proteins

0-8 g of fat

100-160 g of calories

NON- STARCHY VEGETABLES

1 non starchy vegetable is

½ cup cooked vegetable and vegetable juice

1 cup raw vegetable

A choice on this list equals

5 g of carbs

4 g of protein
1 g of fat

25 calories