Subject: Medical Nutrition Therapy

ASSIGNMENT: Go through scientific literatures and solve the following questions

Total marks- 20
a. Nutritional prevention measures for COVID 19 (10 marks)
COVID 19 is a severe respiratory infection caused by the coronavirus. It gradually
leads to fibrosis in lungs and blockage of the respiratory pathway, and this leads to
death. As we all know that infections are prevalent in this world since its inception.
But humans have fought them. Still fighting COVID 19 is becoming difficult. But
human bodies have a well developed immune system that helps to fight infectious
agents. So, when we talk about nutritional prevention measures, immunity-boosting is
the main target.
1. Meeting macronutrient intake, as recommended by RDA by consuming high-
quality sources of proteins, fats, and carbohydrates, is helpful for providing
enough energy to the body and improve the immune system.
2. Consume daily diet as per the recommendations by food pyramid or Healthy
eating plate. Include all the food groups in your diet.
3. Prefer local and fresh food ingredients for cooking (local ingredients are
recommended as exotic ingredients are transported from places apart, and there
are chances of viral contamination while fresh products do not pass through many
humans before coming to your house).
4. Include anti-inflammatory and immunity-boosting spices like turmeric (curcumin
has anti-inflammatory properties, and it also helps to improve immunity), clove,
and dried ginger in your diet. E.g., Turmeric milk with dried ginger.
5. Use garlic and ginger while cooking meals as they help in boosting immunity and
reduces oxidative stress on the body.
6. Foods that lead to inflammation must be avoided as during this phase, and you
need your immune system to focus on fighting the virus and not the oxidative
stress in your body. E.g., Refined foods, unhealthy fats, fried foods.
7. Avoid alcohol as it has been proven that alcohol increases susceptibility to
respiratory disorders like pneumonia. Moreover, it damages the immune system of
the body.
8. Restrict the portion sizes of the meals as per the recommendation by national
dietary-association.
9. Restrict the amount of salt and table sugar in the daily diet
10. Avoid the consumption of alcoholic beverages

b. Calculate the calorie and macronutrient requirement for a 60 years old man (ht:
172cm, wt: 75kg), hospitalized currently after being diagnosed with COVID 19.
What will be your counselling tips and dietary guidelines?(10 marks)
1. Age of the male= 60 years
Height = 172cm
Weight = 75 kg
According to Harris-Benedict equation, the BMR of the patient is,
 BMR= 66.5 + (13.75 x weight in kg) + (5.003 x height in cm) – (6.755 x age in
years)
= 66.5 + (13.75 x 75) + (5.003 x 172) – (6.755 x 60)
= 66.5 + 1031.25 + 860.516 – 405.3
= 1958.266 – 405.3
= 1552.966
The patient has sedentary life thus the PAL value is 1.53 and stress factor is 1 as
the patient is bed-ridden
Thus, total energy requirement= BMR x 1.53 = 1552.966 x 1.53 = 2,376.037
kCal/ day

2. Carbohydrate requirement = 65% of total calorie intake (as the patient needs more
energy to prevent muscle erosion)
= 0.65 x 2376.037 =1544.424 kcal from CHO per day
Now, 1 gram CHO gives 4kCal energy
Thus, amount of CHO = 1544.424/4 = 386.10gms

3. Protein requirement = 15% of total calorie intake (as the patient needs more
energy to prevent muscle erosion)
= 0.15 x 2376.037 = 356.4kcal from protein per day
Now, 1 gram protein gives 4kCal energy
Thus, amount of protein = 356.4/4 = 89.101gms

4. Fat requirement = 20% of total calorie intake (as fats digestion demands more
energy and the patient’s body already loses calories due to fever )
= 0.20 x 2376.037 =475.2074 kcal from fat per day
Now, 1 gram fat gives 9kCal energy
Thus, amount of fat = 475.2074/9 = 52.8gms
Counselling tips:
1. Do not walk out of the confined area, i.e. do not break the rules of isolation.
2. Use handkerchief and cover your mouth as well as nose while coughing and sneezing.
Do not remove the triple-layer mask if possible.
3. Complete the meals provided by the hospital pantry and do not insist on the family
members to provide home-cooked meals while you are in the isolation ward.
4. Drink ample amount of warm water to relieve the congestion and other symptoms
related to the disease.
5. Avoid smoking and alcohol (optional tip as this won’t be available in the isolation
zone or the clinical space where the patient is being treated)
6. Take enough rest
7. The food may seem to be tasteless to the patient due to severe congestion. But the
patient needs to be advised to take adequate food even if it seems to be tasteless.
Dietary guidelines:
1. Consume more amounts of simple carbohydrates, and lesser dietary fibres as the body
need more energy due to increased BMR due to fever.
2. Consume at least 15% of proteins per day to fight muscle erosion. Take oral supplements
of whey protein, i.e. Oral Nutrient Supplements (ONS) for proteins to prevent further
muscle erosion.
3. The fat intake should be moderate to relieve the digestive system.
4. Consume adequate levels of Vitamin C, Vitamin D and vitamin B 6 to boost your
immunity.
5. Consume enough amounts of minerals like iron (to prevent the drop in haemoglobin
levels and maintain an adequate supply of oxygen), calcium, and zinc.
6. Do not consume more amount of salt
7. Avoid refined and packaged foods completely
8. Eat colourful vegetables and fruits (as they are rich in antioxidants)
9. Take oral anti-inflammatory and antioxidant nutrient supplements regularly

Exercise 2: Total marks: 25

a. Elaborate on the need for nutritional assessment for a patient suffering from
COVID 19 (10 marks)
The patient suffering from COVID 19 undergoes many biochemical and physical
changes in the body. Thus, the need for continuous nutritional assessment arises in
such patients to predict the severity of the disease. The need for all the parameters of
nutritional assessment is described as follows:
1. General assessment:
The need for general assessment in COVID 19 patient arises to know about the
age, ethnicity and current habits of smoking and alcohol consumption in the
patient. Age indirectly represents the metabolic and immune strength of the person
to fight the disease. Moreover, it directs the clinicians and dieticians to the path of
intervention for that patient. The smoking and alcohol consumption status also
indicate the immune strength of that patient. The normal body temperature
2. Anthropometric assessment:
Anthropometric assessment is necessary to know the physical fitness of the
patient. The BMI, waist to hip ratio and skeletal muscle mass analysis is used to
identify if the person is obese, overweight, underweight or normal. All the
categories have different dietary interventions.
3. Biochemical assessment:
By doing the biochemical assessment of the patient, a nutritionist can know about
the presence of inflammation-inducing molecules (e.g., C-reactive protein) in the
body. Moreover, it is also carried out to know if the patient has any micronutrient
(vitamins and trace mineral) deficiencies. The severity of infection is indicated by
high total bilirubin levels (as haemoglobin degenerates bilirubin is released as a
byproduct in the blood). Further, if the patient has other medical conditions like
Hypertension and Diabetes, the parameters like total cholesterol and BSL are
regularly checked to monitor any changes in those conditions.
4. Clinical assessment:
It is essential to determine the clinical parameters of a patient like fever, fatigue,
blood pressure, etc. to know about the severity of COVID-19 symptoms. Further,
 clinical assessment is done to know about all the medical conditions that a person
is suffering. The current medications related to COVID 19 and other medical
conditions are listed along with their effects and interaction in order to get a clear
idea about the prescription of nutrient and food intake.
5. Dietary assessment:
Finally, dietary assessment of any patient is to be known to get an idea about the
regular diet of the patient. The sudden increase in calorie intake can also create
complications in the patient. Further, the dietician needs to know about any
ongoing nutrient supplementation that the patient has been prescribed by his
doctors so that he/she can take that into account and prescribe current nutritional
supplementation.

b. Design a nutritional assessment chart for a hospitalized patient with COVID 19

(15 marks)
Nutritional assessment chart for COVID-19 patients (ABCD method of
assessment)

General information of the patient

Name
Age
Gender
Ethnicity
Smoking status
Anthropometric analysis
Parameter Values Interpretation
Weight (kg)
Height (cm)
BMI (kg/m2)
Waist circumference (cm)
Waist to hip ratio
Skeletal muscle mass
Biochemical analysis
Parameter Values Interpretation
Serum Urea
Creatinine
Cystatin C
Direct Bilirubin
Serum albumin
Total cholesterol
Vitamin-D levels
Zinc
C-reactive protein (CRP)
Blood haemoglobin
WBC count
Clinical assessment
Parameter Value Interpretation
Body temperature
 Blood pressure
Respiratory rate
Other symptoms Note down if the patient experiences malaise, nausea,
vomiting, diarrhoea, headache, etc.
Next step is to identify if the person has any other medical conditions like pregnancy
or infections like HIV. Moreover, conditions like Hypertension, Diabetes,
Cardiovascular disorders, Anemia, etc. are also to be identified. The ongoing
medications of the patients and their potential interaction with the nutritional
supplements are to be kept in mind.
Medication Dosage Interaction of medicine
Medicine 1
Medicine 2
Medicine 3
Current medication for
COVID-19

Dietary assessment
Dietary recall of last 24 hours
Home dietary recall (before
the symptoms of COVID-19
started appearing)
Dietary pattern Vegetarian/ non-vegetarian/ lacto-ovo-
vegetarian/vegan etc.
Daily calorie intake (in
normal days)
Ongoing nutritional
supplementation (if any)

References:
1. Who.int. 2020. Report Of The WHO-China Joint Mission On Coronavirus Disease
2019 (COVID-19). [online] Available at: <https://www.who.int/publications-
detail/report-of-the-who-china-joint-mission-on-coronavirus-disease-2019-(covid-
19)> [Accessed 8 April 2020].
2. Sarkar, D., Jung, M. K., & Wang, H. J. (2015). Alcohol and the Immune
System. Alcohol Research: Current Reviews, 37(2), 153–155.
3. Euro.who.int. (2020). Retrieved 10 April 2020, from
http://www.euro.who.int/en/health-topics/health-emergencies/coronavirus-covid-
19/novel-coronavirus-2019-ncov-technical-guidance/food-and-nutrition-tips-during-
self-quarantine.
4. Cascella, M., Rajnik, M., Cuomo, A., Dulebohn, S., & Napoli, R. (2020). Features,
Evaluation and Treatment Coronavirus (COVID-19). Ncbi.nlm.nih.gov. Retrieved 9
April 2020, from https://www.ncbi.nlm.nih.gov/books/NBK554776/.