Final Report

Table of contents:
Subject page
1 Introduction 3
2 Day-1- 4
3 Day -2- 5
4 Day -3- 14
5 Day-4- 14
6 Day-5- 23
7 Day-6- 32
8 Day-7- 32
9 Day-8- 37
10 Day -9- 37
11 Day-10- 42
12 Day-11- 45
13 Day-12- 52
14 Day-13- 53
15 Last week. 54
16 Conclusion 59
17 Limitations 59
18 Recommendations 59
19 Summary table of activities 60
20 Nutritional guidelines 61
21 References 75
22 Appendices 76
1
Day -1- 1Aug2023 Tuesday
From the start, we made our way to the nutrition department on the ground floor, which is
located in the kitchen. We began to become familiar with the hospital orally and determine the
laws and plans we will be working on during the training. At exactly nine o'clock, the initial
round was conducted to get to know the patients, their number, and see their system for lunch
preparation. Our first stop was the private department, which occupies the fourth floor of the
hospital, and we got acquainted with the cases in the department through the attached board in
the nursing department(appendix-1-). Then we went to the CCU department and got acquainted with
the cases that were there, then we went to the intensive care department and passed all the cases
and looked at their file and what they suffer from diseases and the results of the examinations
and the interpretation of all these results and diagnoses and from this department to the internal
department and it was as the special department we looked at The cases were passed through the
board in the nursing department, and at the end of the tour we went to the maternity department
After the end of the tour, we applied the HACCP system to the kitchen, where the system was
divided into the whole group After that, we got acquainted with the type of papers on which the
diet is written and given to the kitchen staff to start preparing lunches, as the color was orange
for diabetics, pink for the regular diet, yellow for liquids, light and mixture, and green for kidney
patients. The types of forms used in nutritional evaluation were discussed (MNA, NRS, NCP
FORMAT), We were asked for a homework, which is to search for lab data results, so that it was
divided into the entire group (Appendix 2) After that, we conducted the second round again around
the departments in the order as in the first round, then we returned to the office again and
discussed the cases that we want to identify, and we trained about the communication skill and
the situations that may occur during our conversation with patients and what we may be exposed
to.
2
Day -2- 2Aug2023 Wednesday
On the second day of the training, we conducted the first round as usual, which was at nine
o'clock in the morning, and we went to all departments in a row, starting from the special
department until the maternity department. We discussed the task that was asked of us, which is
the results of medical analyzes related to nutrition, such as ALP, AST, ALT, ESR, and others
(Appendix 2). Then we went to the second round at exactly 11 o'clock as usual, after which the data
of the patient, Muhammad Zaghloul, was taken to make an NCP form with writing a diet for 7
days, as this patient was admitted to the hospital suffering from H.CVA . (Attached below) Then the
case was discussed, how to write pes statement.
3
4
Patient Name: X Weight: 70Kg. BMR: 1496 Calories (according to Mifflin equation
formula)
Gender: Male Height: 173cm EER: 1795.2Calories.

Age: 58 BMI: 23.4 kg/m2 (normal) Ward: ICU
Case description "Mr. Zaglol was diagnosed with a cerebrovascular accident (CVA). It was found that he has
hypertension, diabetic foot, and weakness in the general and right thigh areas."
Medical History Hypertension.
Surgical History None
Food Allergies None
Use of Medications Risperdal, Decort, Nexium, mannitol, B-complex.
24 hr. recall ‫وبين‬jj‫ ك‬،‫دة حبش‬jj‫رام كب‬jj‫ ج‬90 ،‫اح‬jj‫تين تف‬jj‫ حب‬،‫رام‬jj‫ج‬60 ‫ قطعتين لحمة‬،‫ مغرفتين بازيالء‬،‫ معالق رز‬9 ،‫ جرام خبز أسود‬50 ،‫ بيض‬،‫لبنة‬
‫ كوب لبن مع خيار‬،‫ جرام‬50 ‫ خبز اسود‬،‫خضار‬.
PA & stress factor PA = (1.2) || Stress Factors: No stress factor
Physical examination diabetic foot, and weakness in the general and right thigh areas.
Lab results - Blood pressure:135/105(hypertension)
- Pulse: 74pbm(normal)
- Creatinine:1.07 mg/dl(normal)
- Potassium:4.1mg/dl(normal)
- Soduim:143mg/dl (normal)
- Urea (blood urea nitrogen):20mg/dl (normal)
Diagnosis: - low consumption of water related to lack of knowledge evidence by Lab result data and MNA.
- General weakness related to poor appetite and Low consumption of water evidence by MNA
Nutrition intervention - Type of diet: Dash and Consistent carbohydrate diet.

(Daily energy, protein, - The Mifflin-St Jeor formula Males: (10*weight [kg]) + (6.25*height [cm]) – (5*age [years]) + 5
fat and type of diet So, the BMR (10*70) +(6.25*173) -(5*58) +5
= 1496 calories.
- Daily Energy Requirements: 1795.2Calories
- Patient’s EER: 1795.2 Calories.
(1795.2*55%)/4=246g of CHO.
246/15=16 choice (4 choice for each meal and 2 choice for each snack)
As we consider that the g of CHO in 1 choice=15 so the total CHO of 1 meal 60g for snack:30 g
- Daily Protein Requirements: )1795*18%) \4= 80g of protein (18% according to Dash diet)
- Daily fat requirements: (1795*27%) \9 = (53g of fat) (27% according to Dash diet)
Monitoring and - “Strive to achieve optimal HIN levels within the normal range and maintain healthy ranges for
evaluation other lab results by adhering to a balanced diet that ensures nutritional adequacy”
- Ensure that his blood sugar and blood pressure are regularly monitored and checked as
directed by a doctor.
- Follow up his diet daily.
5
Diet planning for 7 days:
6
Day -1-
Carbs Protein Fats calories
Breakfast
(g) (g) (g) (Cal)
1 Egg Omlette with Spinach
3g 13g 10g 100cal
Whole grain toast.
15g 4g 1g 100cal
1 cup of fresh sliced cucumber and
5g 2g 0g 25cal
green bell pepper.
5g 3g 5g 78cal
2 tablespoons of hummus
8 1 4 80
15g of dark chocolate
19 8 6 160
100g of kidney beans
5 0 0 25
½ cup of berries
Total 60g 31g 26g 570cal
Snack-1- Carbs Protein Fats calories
1 cup of fruits cocktail (Orange, plum
30 1 0 100
and milk)
Lunch Carbs Protein Fat calories
½ cup of cooked freekeh
22 5 0 70
1 cup of Spinach soup
6 7 2 75
3 oz of grilled chicken breast
0 25 5 150
2 cups of Arabic salad with1 medium
17 4 0 70
beet
0 0 5 45
1tsp of olive oil
15 1 0 45
1 small orange
Total 60 42 12 455
Snack-2- carbs Protein Fats calories
3cups of pop corn
20 3 0 90
1 tsp of olive oil
0 0 5 45
1 cup of green tea
0 0 0 0
2 cups of fresh slice of carrots and
10 2 0 55
cabbage
0 6 3 70
1 medium egg
Total 30 11 8 260
Dinner carbs protein Fats Calories
1 cup of lentil soup 30 7 1 200
1slices of crispy bread 15 1 0 63
1 ½ cup of carrots and green onion 15 3 0 30
1tsp of olive oil 0 0 5 45
Total 60 33 18 340
TOTAL FOR DAY 240g 96g 52g 1725
7
Day -2-
Breakfast Carbs Protein Fats calories
(g) (g) (g) (Cal)
(Spanish pastry with egg) 30 10 0 80
1 whole wheat pita bread 0 6 4 60
1 medium egg 2 1 0 10
Spinach leaves cut into small pieces 5 2 0 25
1 cup of steamed broccoli 15 0 0 60
1 small palm 5 2 0 30
1 cup of Arabic salad
Total 57 21 4 265
½ cup of strawberries 15 5 0 60
1 small apple 15 0 0 60
Total 30 5 0 120

1 cup of cooked bulgur 33 6 0 151
1 cup of beans soup 24 13 2 160
1 medium grilled chicken breast 0 25 5 250
1 cups of Arabic salad with1 medium 5 2 0 50
beet 0 0 5 45
1 tsp of olive oil
Total 62 44 12 656
15g of dark chocolate 8 1 4 80
½ cup of orange juice 15 0 0 60
1date 5 0 0 30
Total 32 1 10 140
2oz Grilled salmon 0 13 8 100
2 slices of crispy bread 30 2 0 125
1cup of carrots and green onion 5 2 0 25
1-cup of shredded iceberg lettuce 1 0 0 5
1 cup of slice cucumber 5 2 0 20
5- Dried Apricots 20 1 0 100
Total 61 20 8 460
TOTAL FOR DAY 242g 82g 35g 1640gcal
DAY-3-
Breakfast Carbs protein Fats Calories
8
- ½ cup of oats 30g 4g 2g 150cal
- ½ cup fresh blueberries 15g 1g 0g 40cal
- ¼ cup chopped pecans 4g 2g 14g 140cal
- 1 cup low fat milk (1%) 12g 4g 3g 100cal
Total 61 11 19 430
Snack Carbs protein Fats Calories
- ¾ cup of slice apple 20g 0g 0g 40cal
- 1 tablespoon almond butter 5g 3g 9g 90cal
- 1cup Air Popped Popcorn 5g 1g 0g 30cal
Total 30 4 9 160
Lunch Carbs protein Fats Calories
- 3 oz grilled chicken breast 0g 25g 3g 250cal
- 2 small whole wheat bread 30g 4g 0g 80cal
- ½ cup hummus 5g 3g 5g 87cal
- 1 cup mixed greens 5g 2g 0g 25cal
- ½ cup cherry tomatoes 3g 2g 0g 25cal
- ½ yogurt 7g 2g 3g 100cal
1 cup of Arabic salad 10 0 0 30
Total 60 40 11 600
- 1 small orange 15g 0g 0g 60cal
- ¼ cup pumpkin seeds 5g 3g 5g 50cal
- 2 dates 10g 0g 0g 45cal
Total 30 3 5 155
Dinner Carbs protein Fats Calories
- 3 oz grilled salmon 0g 18g 9g 150cal
- 1cup cooked brown rice 30g 2g 0g 120cal
- 1 cup steamed asparagus 0g 2g 0g 13cal
- 1 small dinner roll 15g 0g 0g 60cal
- 1 small peach 15g 0g 0g 60cal
Total 60 22 9 430
Total 241 80 34 1780
9
10
DAY-4-

- 1 cup cooked steel-cut oats 30g 5g 2g 150cal
- ½ cup fresh raspberries 15g 0g 0g 40cal
- ½ cup chopped walnuts 4g 8g 30g 150cal
- 1 cup low fat milk 12g 8g 2g 105cal
Total 61 21 34 445

2 tablespoons of dried fruit 15g 0g 0g 60cal
1tablespoon of chia seed 5g 2g 3g 50cal
4oz of plain Greek yogurt 5g 8g 5g 100cal
1cuo of Air popped popcorn 5g 1g 0g 30g
Total 30 11 8 240

- 1 small sweet potato 15g 2g 6g 160cal
- 1 cup of cooked freekeh 30g 0g 0g 250cal
Total 60 26 19 600

- ½ cup almonds 14g 6g 14g 150cal
Total 30 6 14 210

3 ounces grilled steak 0g 20g 3g 110cal
1 cup cooked brown rice 30g 0g 0g 200cal
1 cup of roasted Brussels sprouts 2g 2g 0g 25cal
1 small dinner roll 15g 0g 0g 60cal
1 small pear 15g 0g 0g 40cal
Total 62 22 3 440
Total 242 86 78 1900
11
DAY-5-

1 poached egg 0g 5g 4g 60cal
1 tbsp olive oil 0g 0g 5g 45cal
1 whole wheat bread 15g 0g 0g 60cal
6 oz Fat free plain yogurt 12g 20g 3g 100cal
1 cup orange juice 30g 0g 0g 120cal
Total 60 25 11 390
1cup salad 5g 2g 0g 25cal
½ tbsp olive oil. 0g 0g 5g 45cal
3 cups popcorn 15g 1g 0g 30cal
0.5 oz whole wheat cracker 10g 0g 0g 60cal
Total 30 3 5 160

2 oz Salmon 0g 15g 3g 200cal
1 tablespoon of olive oil 0g 0g 5g 45cal
2 cup salad 10g 2g 0g 50cal
¾ cup mashed potatoes 20g 0 0g 100cal
Total 60 17 8 550
2 rice cakes 15g 1g 1g 60cal

1 tbsp of peanut butter. 0g 3g 8g 90cal
1 apple 15g 0g 0g 60cal
Total 30 4 9 210
½ cup oatmeal 15g 5g 2g 150cal
½ tablespoon of almond butter. 3g 2g 4g 45cal
½ pear 15g 2g 0g 60cal
½ cup fat free milk 12g 20g 3g 100cal
Total 60 29 9 420
Total 240 78 42 1730
12
Day -6-
Breakfast
(g) (g) (g) (Cal)
1 Egg Omlette with Spinach 3g 13g 10g 100cal
Whole grain toast. 15g 4g 1g 100cal
1 cup of fresh sliced cucumber and green bell pepper. 5g 2g 0g 25cal
2 tablespoons of hummus 5g 3g 5g 78cal
100g of kidney beans 19 8 6 160
½ cup of berries 5 0 0 25
1 cup of fruits cocktail (Orange, plum and milk) 30 1 0 100
½ cup of cooked freekeh 22 5 0 70

1 cup of Spinach soup 6 7 2 75
3 oz of grilled chicken breast 0 25 5 150
2 cups of Arabic salad with1 medium beet 17 4 0 70
1 small orange 15 1 0 45
Total 60 42 12 455
3cups of pop corn 20 3 0 90
1 tsp of olive oil 0 0 5 45
1 cup of green tea 0 0 0 0
2 cups of fresh slice of carrots and cabbage 10 2 0 55
Total 30 11 8 260
1 cup of lentil soup

30 7 1 200
1slices of crispy bread
15 1 0 63
1 ½ cup of carrots and green onion
15 3 0 30
1tsp of olive oil
0 0 5 45
Total 60 33 18 340
13
Day-7-
Breakfast
(g) (g) (g) (Cal)
(Spanish pastry with egg)
30 10 0 80
1 whole wheat pita bread
0 6 4 60
1 medium egg
2 1 0 10
Spinach leaves cut into small pieces
5 2 0 25
1 cup of steamed broccoli
15 0 0 60
1 small palm
5 2 0 30
Total 57 21 4 265
Total 30 5 0 120
1 medium grilled chicken breast 0 25 5 250
1 cups of Arabic salad with1 medium beet 5 2 0 50
Total 62 44 12 656
1date 5 0 0 30
Total 32 1 10 140
0 13 8 100
2oz Grilled salmon
30 2 0 125
2 slices of crispy bread
5 2 0 25
1cup of carrots and green onion
1 0 0 5
1-cup of shredded iceberg lettuce
5 2 0 20
1 cup of slice cucumber
20 1 0 100
5- Dried Apricots
Total 61 20 8 460
TOTAL FOR DAY 242g 82g 35g 1640gcal
14
Day -3- 3Aug2023 Thursday
On the third day, we made the tour on time. We went through all the departments, then back to
the office, and discussed the condition of Mohammed and how we started writing the "pes"
statement. Then we wrote and researched which foods are rich in potassium and sodium (Appendix 3),
then we discussed the carbohydrate regimen of the consistent diet and then received a diet for the
whole day and divided the amount of protein, carbohydrates, fats and calories for that day. And
then we did the second round around the divisions.
Days-4- 8Aug2023 Tuesday
On this day, we made the rounds as usual, each at its own time, the first at nine and the second at
exactly eleven, then the usual discussion session began, which was about nutrition during the
stages of life, about the pregnant woman, the results of the examinations and her need for
nutrients during the pregnancy stage, and then We discussed vitamins and minerals (Appendix 4), our
need for them, and what foods are present, and how do they increase or decrease them. We also
discussed foods that contain iron and what affects its absorption (Appendix 5), whether it enhances
its absorption or prevents it. A new case was received about gestational diabetes and anemia for a
pregnant woman of age 38 years old for work NCP form and a seven-day diet that takes into
account her nutritional needs (attached below).
15
Patient Name: Jomana Weight: 92K BMR: 1,798 calories (According to Mifflin equation formula)
gender: Female Height: 170cm EER: 2300 calories (according to gestational diabetes guide)
Age: 38 years old BMI: 318 k/m2 (obese) Ward: ‫الوالدة‬
Mrs. Jomana is a pregnant woman admitted to the hospital for cesarean birth, was diagnosed with
Case description
gestational diabetes
Medical History Anemia
Food Allergies/Intolerances None
Use of Medications None
24 hrs. recall ‫ قطعة جبنة بيضاء‬+‫½ رغيف خبز أبيض‬+‫ سنيكرز حجم كبير‬+‫قطعة معجنات جبنة وزعتر‬
PA & stress factor PA = (1.2) || Stress Factors: Surguy (1.3)
- Uric acid: 5 mg/dl (normal)

- Sodium: 134mg/dl (low)
Lab results
- Hemoglobin: 9g\dl (low)
- Blood pressure:120/80 (normal)
- Random blood suer:300mg/dl (high)
Physical examination None

- Imbalanced dietary intake of carbohydrate related to high intake of refined sugar and
chocolate as evidence by elevated blood glucose levels and 24 hrs. recall.
Diagnosis:
- Elevated food-rich in iron requirement related to anemia as evidence by medical history.
- (Consistence carbohydrate diet and iron-rich food)

- Daily Energy Requirements: (Women with gestational diabetes and a BMI between 25 and
34% should eat 25 calories per kilogram of body weight, which means 25 * body weight = 25
* 92 = 2300 calories per day
- Daily Protein Requirements: needs for protein during third trimesters of pregnancy is
“1.1/k body weight” +25
Nutrition intervention
= “1.1*92” +25= 126.2g/day
(Daily energy, protein, fat
- The needs of carbohydrate are”50-60%”
and type of diet)
(2300*50%)/4=285g of CHO
285/15=19 choice
- (2 choice breakfast, 2 choice snack, 5 ½ choice lunch, 2 choice snack, 5 ½ choice dinner, 2
choice snack)
- The RDA of iron for pregnant women is 27mg
- The daily requirement of fat 20-35% (70g)
- Control blood glucose levels and carb metabolism, reduce risk of mother developing diabetes,
heart disease and obesity after pregnancy that's by Establish healthy eating pattern and food
choices
- Monitor her blood sugar regularly by checking blood sugar frequently as directed by doctor.
- Follow-up her diet, make sure to eat limited amounts of sugars and starches commensurate
Monitoring and evaluation
with the number of calories specified for the day, and increase food rich in vitamins and
minerals such as iron, especially because she suffers from anemia.
- Follow up on her movement and direct her to start moving and increase her activity in order to
maintain her weight and not increase it beyond the permissible limit
16
Diet planning for seven days:
17
Day-1-
Breakfast Carbs Protein Fats calories Iron

(g) (g) (g) (Cal) (mg)
1½ slice of whole wheat bread 22.5 0 0 70 1
1tsp of olive oil 0 0 0 45 0
1tsp of Oregano as a flavor 0 0 0 0 0
70g of simmered liver chicken 0 17 4 150 9
1 ½ cup of Arabic salad 7 3 0 25 0.7
1 egg 0 3 3 70 0
Total 30 25 7 370 10.7
Snack-1- Carbs Protein Fats calories Iron
1 cup of fruits cocktail (Orange, plum and 30 1 0 100 0.3m
milk)
Lunch Carbs Protein Fat calories Iron
1 cup of cooked freekeh 45 9 0 150 2.5
1 cup of Spinach soup 6 7 2 75 2
1 medium grilled chicken breast 0 33 11 250 0.5
2 cups of Arabic salad with1 medium beet 17 4 0 70 3
1 small orange 15 1 0 45 0.1
Total 82 56 18 630 9
Snack-2- carbs Protein Fats calories Iron
15g of dark chocolate 8 1 4 80 2
100g of kidney beans 19 8 6 160 3
½ cup of berries 5 0 0 25 0
Total 32 9 10 140 5
Dinner carbs protein Fats Calories Iron
3-ounce (85-gram) serving of cooked beef 0 22 12 200 2
1 cup of lentil soup 30 7 1 200 2.5
2 slices of crispy bread 30 2 0 125 0
1cup of carrots and green onion 5 2 0 25 0
1 cup of slice cucumber 5 2 0 20 0
2 dates 10 0 0 55 0.6
Total 80 35 18 665 5
3cups of pop corn 20 3 0 93 0
1 tsp of olive oil 0 0 5 45 0
1 cup of green tea 0 0 0 0 0
2 cups of fresh slice of carrots and 10 2 0 55 0
cabbage 0 6 3 70 0
1 medium egg
Total 30 11 8 265 0
TOTAL FOR DAY 283g 134g 60g 2200g 30
18
Day-2-
(g) (g) (g) (Cal) (mg)
(Spanish pastry with egg) 15 5 0 40 0
½ whole wheat pita bread 0 0 5 45 0
1tsp of olive oil 0 6 4 60 0.5
1 medium egg 2 1 0 10 1
Spinach leaves cut into small pieces 5 2 0 25 1
1 cup of steamed broccoli 5 9 14 180 7
1 oz of pumpkin seeds 4 1 0 15 0.2
1 cup of slice cucumber
Total 31 24 23 375 9.7
½ cup of strawberries 15 5 0 60 0.3m
½ cup of plain reek yogurt 15 15 9 160
Total 30 20 9 220 0.3
1 cup of cooked bulgur 33 6 0 151 2
1 cup of beans soup 24 13 2 160 3
1 medium grilled chicken breast 0 33 11 250 0.5
1 cups of Arabic salad with1 medium 10 2 0 50 1
beet 15 1 0 45 0.2
1 small orange 0 0 5 45 0
1 tsp of olive oil
Total 82 55 13 720 6.7
1date 5 0 0 30 0.3
Total 32 9 10 140 5.3
100g Grilled salmon 0 23 8 180 1
½ cup of cooked quinoa 20 4 2 110 2
1cup of carrots and green onion 5 2 0 25 0
1-cup of shredded iceberg lettuce 1 0 0 5 0
1 cup of slice cucumber 5 2 0 20 0
5- Dried Apricots 20 1 0 100 1
Total 81 35 15 510 4
½ cup (cooked) serving of soybeans 15 14 7 150 4.5
1 cup of ginger tea 0 0 0 0 0
1 small apple 12 0 0 45 0.2
1 egg 0 4 4 70 0.3
Total 30 18 15 270 4.7

TOTAL FOR DAY 286g 140g 75g 2235g 30
19
Day-3-

(g) (g) (g) (Cal) (mg)
½ cup fresh blueberries 11 1 0 55 0
½ cup of plain yogurt 7 5 3 70 0.2
¼ cup of chia seeds 13 7 9 180 3
Total 30 13 11 305 3.2
1 oz of pumpkin seeds 5 9 14 180 7
1 cup of Arabic salad 10 2 0 45 1
1 small apple 15 0 0 45 0
Total 30 11 14 270 8

1 serving of whole wheat spaghetti 30 8 1 175 0
½ cup of Mashed colored capsicum 7 2 0 25 0.5
½ cup chopped onion 7 2 0 25 0
1 tablespoon of olive oil 0 0 5 45 0
3oz grilled chicken breast 0 20 3 110 2
1 small Appel 15 0 0 60 0
2date 10 0 0 60 0.6
Total 82 55 13 720 3.1
1date 5 0 0 30 0.3
Total 32 9 10 140 5.3
1 cup of cooked brown rice 30 2 1 60 1
3 oz of grilled chicken breast 0 20 3 110 1
05 cup of mixed sautéed vegetables 10 4 0 50 0
1 cup of grilled eggplant 10 2 0 20 0
1 cup of yogurt 15 10 6 70 0
Total 80 35 15 510 2
1 small apple 12 0 0 45 0.2
1 egg 0 4 4 70 0.3
Total 30 18 15 270 4.7
TOTAL FOR DAY 286g 140g 73g 2170g 26.2
20
Day-4-

(g) (g) (g) (Cal) (mg)
½ cup fresh plum 10 1 0 40 0.5
¼ cup of oats 15 4 2 90 1
Total 32 10 5 200 2
Total 30 11 14 270 8

¾ cup of cooked bulgur 30 5 0 145 2
1 cup of Molokhiya soup 12 2 16 220 2
½ cup chopped onion 7 2 0 25 0
3oz grilled chicken breast 0 20 3 110 1.5
½ cup of plain yogurt 7 4 2 70 0
Total 81 35 21 700 5.5
1date 5 0 0 30 0.3
Total 32 9 10 140 5.3
1 cups of cooked brown rice 60 6 2 280 1
½ cup of Arabic salad vegetables 5 1 0 25 0
1 cup of yogurt 15 10 6 140 0
Total 80 57 14 690 3
1 small apple 15 0 0 45 0.2
1 egg 0 4 4 70 0.3
Total 30 18 15 270 5
21
Day-5-

(g) (g) (g) (Cal) (mg)
8 tablespoons of mashed potato 22 3 5 140 0
2 tablespoons of hummus 6 3 5 80 2
2 mini cucumbers 3 1 0 20 0
Total 31 7 10 240 2
½ cup of Garbanzo Beans 20 6 2 110 3
Total 30 8 2 155 4

¾ cup of cooked bulgur 30 5 0 145 2
1 oz of lentils soup 15 7 0 91 3
½ cup chopped cucumber 7 2 0 25 0
3oz grilled salmon fish 0 25 14 200 0
1 medium avocado 12 3 22 240 0.6
½ cup of plain yogurt 7 4 2 70 0
Total 81 48 38 816 5.6
1date 5 0 0 30 0.3
Total 32 9 10 140 5.3
1 cups of cooked brown rice 60 6 2 280 1
1 cup of yogurt 15 10 6 140 0
Total 80 57 14 690 3
3 medium Dried Figs 30 0 140 2
2
Total 30 2 140 2
TOTAL FOR DAY 286g 128g 74g 2190 22
22
Day-6-

(g) (g) (g) (Cal) (mg)
½ cup fresh plum 10 1 0 40 0.5
¼ cup of oats 15 4 2 90 1
Total 30 10 5 200 1.7
1date 5 0 0 30 0.3
Day-7-
Total 32 9 10 140 5.3
Breakfast
1 cup of cooked bulgur Carbs
33 Protein
6 Fats
0 calories
151 Iron
2
1 cup of beans soup (g)
24 (g)
13 (g)
2 (Cal)
160 (mg)
3
½ cup freshgrilled
1 medium plum chicken breast 10
0 133 011 40250 0.50.5
½ cup ofofplain
1 cups yogurt
Arabic salad with1 medium 710 52 30 7050 0.21
¼ cup of oats
beet 15
15 41 20 9045 1 0.2
Total
1 small orange 32
0 10
0 55 200
45 20
1Snack-1-
tsp of olive oil Carbs Protein Fats calories Iron
Total
1 oz of pumpkin seeds 582 955 1418 700
180 77
1Snack-2-
cup of Arabic salad 10
carbs 2Protein 0Fats 45calories 1 Iron
½
Total cup (cooked) serving of soybeans 15
30 14
11 147 150
270 8 4.5
Lunch
1 small apple Carbs
12 Protein
0 Fat
0 calories
45 Iron
0.2
1¾egg cup of cooked bulgur 0
30 54 04 70
145 2 0.3
Total
1 cup of Molokhiya soup 32
12 218 1611 265
220 25
Dinner
½ cup chopped onion 7carbs 2protein 0Fats 25Calories 0 Iron
3oz grilled chicken breast 0 20 3 110 1.5
3-ounce
1 small Appel(85-gram) serving of cooked 0
15 022 012 60200 02
beef
1 cup of Arabic salad 30
10 27 01 45200 0 2.5
1½cupcupof
oflentil
plain soup
yogurt 730 42 20 70125 00
Total
1cup of carrots and green onion 81
0 35
0 215 700
45 5.50
1 cup of slice cucumber 10 0 0 55 0.6
2 dates
Total of kidney beans
100g 80
19 835 618 665
160 35
1date
Snack-3- 5carbs 0Protein 0Fats 30calories 0.3Iron
Total 32 9 10 140 5.3
5 of Dried Apricots 24 1 0 100 2
cup ofofgreen
1 cups teabrown rice
cooked 0
60 60 20 0
280 10
16 oz
cups of fresh
of grilled slicebreast
chicken of carrots and 05 2
40 60 30
240 20
cabbage
1 medium egg
cup of yogurt 15 10 6 140 0
Total 29 9 8 250 2
TOTAL
Total FOR DAY 282g
80 136g
57 1470g 2220g
690 3 26
1 small apple 15 0 0 45 0.2
1 egg 0 4 4 70 0.3
23 Total 30 18 15 270 5
Days-5- 9Aug2023 Wednesday
As usual, we did the usual rounds, then we discussed the case of a patient with gestational
diabetes, after that we touched on a new case of irritable bowel disease, what is this disease, what
is the diet that is used with these people, and how do we deal with this diet. After that, we took a
new case, and it was about a patient suffering from Lung cancer and diabetes as well, to make an
NCP form for her, and the condition and diet of this patient were discussed, and what is the
nature of the diet for cancer patients, which is normally high in protein and high in calories, but
since she suffers from diabetes, the number of carbohydrates per day must be taken into account
according to the number of calories allocated to her.
24
Patient Name: Samira Weight: 60kg BMR: 1,207 Calories/day
Gender: Female Height: 158cm EER: 1800cal
Age: 60 BMI:27.2 kg/m2 (Overweight) Ward: ICU
Samira, a 60-year-old widow who is at risk of malnutrition, was diagnosed with a mouth ulcer and
Case description
abdominal pain.
Medical History Lung cancer, Diabetes mellitus.
Food Allergies/Intolerances None
Use of Medications Metformin, Lasix.
24 hr. recall ½ ‫ كوب ملوخية‬،‫ معالق رز‬9 ،‫ حبة تفاح‬،‫ كأسة شاي‬،‫ قطعة جبنة صغيرة‬،‫غريف خبز‬.
PA & stress factor PA: 1.2 (hospitalize patient) || Stress factor: (no)
- Glucose fasting: 355mg/dl (high)
- Hemoglobin: 13.6mg/dl (normal)
Lab results
- Creatinine: 0.6mg/dl (normal)
- Potassium: 3.8mg/dl (normal)
- Sodium: 130mg/dl (normal)
- Inadequate oral intake related to loss of appetite and lack of knowledge as evidenced by
Diagnosis:
24hrs recall and MNA score.
Physical examination At risk of Malnourished, mouth ulcer and abdominal pain.
- (Consistence carbohydrate diet and high protein high calorie diet)

RMR according to The Mifflin-St Jeor formula:
Women: (10 × weight in kg) + (6.25 × height in cm) - (5 × age in years) – 161
= 1,207 Calories/day
- Daily Energy Requirements: 25 to 35 k-calories per kilogram of body weight
Nutrition intervention
= 30* 60 = 1800 Cal/day
(Daily energy, protein, fat and
- Daily Protein Requirements “body weight* 2 = 120g
type of diet)
- The needs of carbohydrate are”50-60%”
(1800*50%)/4=225g of CHO
225/15=15 choice
- (3 choice breakfast, 2 choice snack, 4 choice lunch, 2 choice snack, 4 choice dinner)
- The daily requirement of fat 20-35% (60g)
Monitoring and evaluation - The dietary goal is to improve nutritional intake and significantly reduce the risk of
malnutrition and weight loss during active treatment.
25
- Follow-up her diet, make sure to eat limited amounts of sugars and starches commensurate
with the number of calories specified for the day, and increase the food high in protein
26
Day -1-
Breakfast
(g) (g) (g) (Cal)
3g 13g 10g 100cal
Whole grain toast.
15g 4g 1g 100cal
5g 2g 0g 25cal
green bell pepper.
5g 3g 5g 78cal
19 8 6 160
30 1 0 100
and milk)
22 5 0 150
6 7 2 75
6oz of grilled chicken breast
0 40 10 250
17 4 0 70
beet
0 0 5 45
1tsp of olive oil
15 1 0 45
1 small orange
Total 60 57 12 390
3cups of pop corn
20 3 0 90
1 tsp of olive oil
0 0 5 45
1 cup of green tea
0 0 0 0
10 2 0 55
cabbage
0 6 3 70
1 medium egg
Total 30 11 8 260
Total 60 11 6 340
27
Day -2-
DAY-3- (g) (g) (g) (Cal)
½ whole wheat pita bread 15 10 0 80
- Spinach
½ cup ofleaves
oats cut into small pieces 2 30g 1 4g
0 2g
10 150cal
- 1¼cupcupofchopped
steamedpecans
broccoli 5 4g 2 2g
0 14g
25 140cal
- 11 small
cup low fat milk (1%)
palm 15 12g 0 4g
0 3g
60 100cal
Total
Total 42 46 21 94 265
19 400
Snack-1-
Snack Carbs Protein
Carbs Fats
protein calories
Fats Calories
- 1¾small
cup of slice apple
apple 15 20g 0 0g
0 0g
60 40cal
- Total
1 tablespoon almond butter 30 5g 5 3g
0 9g
120 90cal
- 1cup Air Popped Popcorn 5g 1g 0g 30cal
Lunch
Total Carbs 30 Protein 4Fat 9calories 160
Lunch
1 cup of beans soup 24 Carbs
13 protein
2 Fats
160 Calories
- 6oz
6 ozgrilled
grilledchicken
chickenbreast
breast 0 0g 40 40g
5 5g
250 250cal
- 12 small
cups whole wheatsalad
of Arabic breadwith1 medium 5 30g 2 4g
0 0g
50 80cal
- beet
½ cup hummus 0 5g 0 3g
5 5g
45 87cal
- 11 tsp
cupofmixed
olive greens
oil 5g 2g 0g 25cal
- Total
½ cup cherry tomatoes 62 3g 61 2g
12 0g
656 25cal
- ½ yogurt 7g 2g 3g 100cal
Total 8 60 1 4
53 80
11 600
Snack
1date 5 Carbs
0 protein
0 Fats
30 Calories
- Total
1 small orange 32 15g 1 10
0g 140
0g 60cal
Dinner
- ¼ cup pumpkin seeds carbs 5g protein Fats
3g Calories
5g 50cal
- 3oz
2 dates
Grilled salmon 0 10g 20 0g
8 0g
150 45cal
Total
2 slices of crispy bread 30 30 2 30 5125 155
1cup of carrots and green onion
Dinner 5 2
Carbs 0
protein 25
Fats Calories
- 16 cup
oz grilled
of slicesalmon
cucumber 5 0g 2 40g
0 9g
20 300cal
- 5-
1cup cooked brown rice
Dried Apricots 20 30g 1 2g
0 0g
100 120cal
- Total
1 cup steamed asparagus 61 0g 27 2g
8 0g
510 13cal
- TOTAL
1 small dinner
FOR DAY roll 227g 15g 115g 0g
35g 0g
1700gcal 60cal
- 1 small peach 15g 0g 0g 60cal
Total 60 45 9 553
Total 227 114 34 1860
28
DAY-4-

- 1 cup cooked steel-cut oats 30g 5g 2g 150cal
- ½ cup chopped walnuts 4g 8g 30g 150cal
- 1 cup low fat milk 12g 8g 2g 105cal
Total 46 21 34 400

2 tablespoons of dried fruit 15g 0g 0g 60cal
1tablespoon of chia seed 5g 2g 3g 50cal
4oz of plain Greek yogurt 5g 8g 5g 100cal
1cuo of Air popped popcorn 5g 1g 0g 30g
Total 30 11 8 240

- 1 small sweet potato 15g 2g 6g 160cal
- 1 cup of cooked freekeh 30g 0g 0g 250cal
Total 60 46 11 600

- ½ cup almonds 14g 6g 14g 150cal
Total 30 6 14 210

6 ounces grilled steak 0g 20g 5g 110cal
1 cup cooked brown rice 30g 0g 0g 200cal
1 cup of roasted Brussels sprouts 2g 2g 0g 25cal
1 small dinner roll 15g 0g 0g 60cal
1 small pear 15g 0g 0g 40cal
Total 62 22 5 440
Total 228 106 72 1900
29
DAY-5-

1 poached egg 0g 5g 4g 60cal
1 tbsp olive oil 0g 0g 5g 45cal
1 whole wheat bread 15g 0g 0g 60cal
6 oz Fat free plain yogurt 12g 20g 3g 100cal
½ cup orange juice 15g 0g 0g 60cal
Total 45 25 12 330
1cup salad 5g 2g 0g 25cal
½ tbsp olive oil. 0g 0g 5g 45cal
3 cups popcorn 15g 1g 0g 30cal
0.5 oz whole wheat cracker 10g 0g 0g 60cal
Total 30 3 5 160

6 oz Salmon 0g 40g 10g 300cal
1 tablespoon of olive oil 0g 0g 5g 45cal
2 cup salad 10g 2g 0g 50cal
¾ cup mashed potatoes 20g 0 0g 100cal
Total 60 22 15 650
2 rice cakes 15g 1g 1g 60cal

1 tbsp of peanut butter. 0g 3g 8g 90cal
1 apple 15g 0g 0g 60cal
Total 30 4 9 210
½ cup oatmeal 15g 5g 2g 150cal

½ tablespoon of almond butter. 3g 2g 4g 45cal
½ pear 15g 2g 0g 60cal
½ cup fat free milk 12g 20g 3g 100cal
Total 60 29 9 420
Total 225 103 50 1770
30
Day -6-
Breakfast
(g) (g) (g) (Cal)
3g 13g 10g 100cal
Whole grain toast.
15g 4g 1g 100cal
5g 2g 0g 25cal
green bell pepper.
5g 3g 5g 78cal
19 8 6 160
30 1 0 100
and milk)
22 5 0 150
6 7 2 75
6oz of grilled chicken breast
0 40 10 250
17 4 0 70
beet
0 0 5 45
1tsp of olive oil
15 1 0 45
1 small orange
Total 60 57 12 390
3cups of pop corn
20 3 0 90
1 tsp of olive oil
0 0 5 45
1 cup of green tea
0 0 0 0
10 2 0 55
cabbage
0 6 3 70
1 medium egg
Total 30 11 8 260
Total 60 11 6 340
31
Day -7-
(g) (g) (g) (Cal)
½ whole wheat pita bread 15 10 0 80
Spinach leaves cut into small pieces 2 1 0 10
1 cup of steamed broccoli 5 2 0 25
Total 42 21 4 265
Total 30 5 0 120

6oz grilled chicken breast 0 40 5 250
1 cups of Arabic salad with1 medium 5 2 0 50
beet 0 0 5 45
1 tsp of olive oil
Total 62 61 12 656
1date 5 0 0 30
Total 32 1 10 140
3oz Grilled salmon 0 20 8 150
5- Dried Apricots 20 1 0 100
Total 61 27 8 510
TOTAL FOR DAY 227g 115g 35g 1700Cal
32
Day-6- 10Aug2023 Thursday.
As usual, we made the rounds by going to all the departments, and then after that we went back
to the office and reviewed what was previously taken, we discussed about individuals with IBD
and the diet that should be followed by those patients which was of a low-fiber diet. Vitamins
and minerals were also reviewed again, and a high-calorie, high-protein diet was written for a
cancer patient, in addition to this, the diet for gastric bypass operations was discussed, which was
initially the patient consume liquids only, then starting with heavier things such as gel and
pudding, and then small and few pieces of food. It was also discussed what are the things that
should be abstained from, such as eating and drinking together, drinks that It contains caffeine,
fries, chocolate, spices, etc., and all of these were within the nutritional guidelines.
Day-7- 15Aug2023 Tuesday
At exactly nine o'clock on this day, we started the first round as usual. We went through all the
departments, from the private to the maternity department, then we returned to the office and
there we discussed several topics, including food high in potassium, and stress factor, and NCP
was given to a heart patient (attached below), and we discussed her condition and diagnosis, After the
second round at exactly eleven o'clock, we returned to the department to discuss general nutrition
issues.
Patient Name: X Weight: 60Kg. BMR: 1,355 Calories/day According to Mifflin-St Jeor formula
Gender: Male Height: 168cm EER:.1130 calories/day

Age: 58 BMI: 21.3 kg/m2 (Normal) Ward: ICU
Case description "Mr. Mohammad was admitted to the hospital for catheterization.
Medical History HTN.

Food Allergies None
Use of Medications Coumadin.
33
24 hr. recall ،‫اب‬j‫رام كب‬j‫ غ‬140 ،‫ة‬jj‫ع لحم‬j‫ قط‬3 ،‫ة‬j‫وب بامي‬jj‫ ك‬،‫الق رز‬jj‫ مع‬9 ،‫اح‬j‫ة تف‬j‫ وحب‬،‫ بندورة‬،‫ خيارة‬،‫ معلقة كبيرة زيت زيتون‬،‫ معلقة لبنة‬2 ‫خبز أبيض‬
‫ وخيار وبندورة وخبز‬،‫ومعلقتين حمص‬
PA & stress factor PA = (1.2) || Stress Factors: surgery (1.3)

Lab results - Triglyceride:152mg\dl(elevated)
- LDL: 150 mg\dl (elevated)
- Cholesterol: 198 mg\dl(normal)
- (Hemoglobin A1C): 5 (normal range)
Diagnosis: - Restirected sodium requirement related to hypertension as evidence by medical history.

- Restricted fat requirement related to elevated triglyceride and LDL level as evidence by lab result
data.
Nutrition intervention - Type of diet: Dash diet.
(Daily energy, protein, fat and - The Mifflin-St Jeor formula Males: (10*weight [kg]) + (6.25*height [cm]) – (5*age [years]) + 5
type of diet) So, the BMR (10*60) +(6.25*168) -(5*58) +5
=: 1,355 Calories/day
- Daily Energy Requirements: 1355*1.2*1.3= 2130 calories/day.
The micronutrient requirement.
- Carbohydrate: (2130*55%)/4=292g of CHO.
292/15=19 choice (5choice for each meal and 2 choice for each snack)
As we consider that the g of CHO in 1 choice=15 so the total CHO of 1 meal 75g for snack:30
- Daily Protein Requirements:)2130*18%) \4= 95g of protein (18% according to Dash diet)
- Daily fat requirements: (2130*27%) \9 = (64g of fat) (27% according to Dash diet)
- Sodium requirement: 2300mg/dl related to dash diet guide.
Monitoring and evaluation - “Strive to achieve optimal HIN levels within the normal range and maintain healthy ranges for other
lab results by adhering to a balanced diet that ensures nutritional adequacy”
- Ensure that his blood pressure is regularly monitored and checked as directed by a doctor.
- Follow-up his diet, make sure to eat limited amounts of processed, canned food, with the number of
calories specified for the day, and increases food rich in vitamins and minerals, Avoid canned and
ready-made food.
- Ensure that the sodium level stays within the normal range by limiting the sodium intake to 2300mg
per day.
34
Day -1-
Breakfast Carbs Protein Fats calories Sodium
Day -2- (g) (g) (g) (Cal) (mg)
½ loaf of or brown Arabic bread 30 6 1 160 150
Breakfast
3 medium-sized falafels. Carbs
15 3Protein 1 Fats 80 calories200 Sodium
4Tbsp of low fat labneh (g)
0 (g)
14 6 (g) 110 (Cal) 100 (mg)
1 cup of corn flex
1 small baked potato (90g) 30
15 36 1 1 80 160 10 200
1 cup of lowof
1 cup milk
natural orange juice 12
15 08 0 3 80 80 5 130
1 tbsp 1ofboiled
peanutegg
butter 00 77 3 3 55 55 2 70
1 cup of mashed banana and strawberry
2 tbsp of avocado 30
0 00 5 1 45 160 2 10
2 boiled eggs white 0 7 3 55 10
Total Total 75g

72g 33g
28g 17g
11g 610cal
510cal 470mg 420mg
Snack-1- Carbs Protein Fats calories Sodium
½ cup of oats 15 1 0 80 1
1 medium
½ cupsize
of of boiledmilk
low-fat potato 15
6 41 3 1 45 80 60 20
1cup of carrots sizes of apricots
2 medium 58 02 0 0 30 25 0 40
¼ loaf6ofmedium
Arabic sizes
breadof almonds 15
0 03 5 1 45 80 0 200
1 boiled egg
Total 029 57 8 3 200 55 61 65
Total Lunch Carbs

35 Protein
13 Fat5 calories
240 Sodium
330
1 cup of cooked freekeh 30 6 1 160 7
Lunch1 cup of Spinach soup Carbs
10 4Protein 0 Fat 50 calories250 Sodium
2/3 cup3 of
oz cooked
of grilled chicken breast
rice 0
30 21
6 9 1 165 160 80 7
1 cup of beans soup salad with
2 cups of Arabic 10
10 44 0 0 50 50 25 700
3 oz of1grilled
cup of chicken
fresh carrots.
breast 010 421 0 9 50 165 25 80
1tsp of olive
2 cups of Arabic salad oil with 0
10 04 5 0 45 50 0 25
1 small
1 cup of fresh orange
carrots. 15
10 14 0 0 45 50 3 25
Total 75 40 15 565 390
Total Snack-2- 75
carbs 40
Protein 10
Fats 520
calories 840
Sodium
3cups of popcorn (without salting)
Snack-2- 15
carbs 3Protein 1 Fats 80 calories3 Sodium
3cups 1ofcup
popcorn (without
of green tea salting) 15
0 03 0 1 0 80 0 3
1 tsp of1 olive oil
small apple 015 30 1 5 80 45 1 0
1 smallTotal
orange 15
30 63 7 1 205 80 4 3
Dinner carbs protein Fats Calories Sodium
Total 30 6 7 205 4
1 cup of lentil soup 30 6 1 160 460
Dinner1 slice of crispy bread carbs
15 1protein 0 Fats 80 Calories
100 Sodium
2/3 cup1 of
cupcooked
of cucumber
pasta and green onion 10
30 46 0 1 50 160 10 5
1 cup of chopped onionyogurt.
¾ cup of low-fat and tomato(cooked) 12
10 84 3 0 90 50 80 7
1cup of6 medium
chopped six of cherry
Pepper Sweet (cooked) 8
10 04 0 0 40 50 5 7
¼ cup Total
of cooking cream 075 19
1 4 20 420 170 650 35
TOTAL
1 cup of orangeFORjuiceDAY 285g
15 103g
0 51g
0 200080 1575 5
Total 75 17 21 540 165
TOTAL FOR DAY 287g 104g 55g 2010 1760
35
Day -3-
Breakfast Carbs Protein Fats calories Sodium
(g) (g) (g) (Cal) (mg)
½ loaf of or brown Arabic bread 30 6 1 160 150
3 medium-sized falafels. 15 3 1 80 200
4Tbsp of low fat labneh 0 14 6 110 100
1 small baked potato (90g) 15 3 1 80 10
1 cup of natural orange juice 15 0 0 80 5
1 boiled egg 0 7 3 55 2
2 tbsp of avocado 0 0 5 45 2
Total 75g 33g 17g 610cal 470mg
Total 30 11 14 200 80
Lunch Carbs Protein Fat calories Sodium
1 serving of whole wheat spaghetti 30 8 1 175 5
½ cup of Mashed colored capsicum 5 2 0 25 3
3oz grilled chicken breast 0 20 3 110 80
2date 10 0 0 60 2
Total 75 32 9 520 390
Snack-2- carbs Protein Fats calories Sodium
3cups of popcorn (without salting) 15 3 1 80 3
Total 30 6 7 205 4
Dinner carbs protein Fats Calories Sodium
1 cup of cooked brown rice 30 3 1 80 10
1 cup of mixed grilled vegetables 10 4 0 50 25
1 cup of yogurt 12 8 3 90 120
Total 72 17 9 350 300
TOTAL FOR DAY 282g 99g 56g 1885 1245
36
Day-8 16Aug2023 Wednesday
On this day we started the rounds as usual, the first at nine o'clock and the second at eleven
o'clock. Between the two rounds, we did several things, the first of which was dealing with a
patient from outside the hospital who was suffering from migraines and hypertension. Her weight
was measured and a nutritional schedule was designed that suits her condition by the supervising
specialist. After that, we talked about several terms such as aspiration pneumonia Emphysema,
Barrett’s esophagus, belching, cancer cachexia, chronic PEM, COPD, cholecystectomy, cystic
fibrosis, emphysema, gastroparesis, gastrostomy, goiter, hemochromatosis. (Appendix-6-) A case of a
72-year-old man who is suffering from emphysema that severely affects both lungs were discussed
We also talked about herbs likes black pepper, ginger, Cinnamon, sagebrush, cumin, anise,
Marjoram, caraway, hibiscus, their benefits, the permissible dose, and people who should not take
them. (Appendix-7-). We also talked about foods that help sleep, like bananas, almonds, and kiwi, and
also foods that help to wakeup such chia seeds, watermelon, dates etc. (appendix-8-)
Day-9- 17Aug2023 Thursday.

As usual, we began the rounds, the first one at nine o'clock and the second one at eleven o'clock.
We discussed kidney patients today, and an 88-year-old man was taken to the NCP for various
diseases, such as high blood pressure, CHF, and kidney failure (attached below). Additionally, a diet
was developed for a patient who is sensitive to gluten. She was instructed to consume 2000
calories for a seven-day period.
Patient Name: W Weight: 70Kg. BMR: 1275.5 Calories/day According to Harris-Benedict equation.
Gender: Male Height: 168cm EER:.2240cal/day according to predialysis guide.

Age: 88 yrs. BMI: 24.8 kg/m2. (Normal) Ward: ICU
Case description "Male, 88 years old was diagnosed with renal failure.
Medical History Hypertension, Congestive heart failure, renal failure.
Food Allergies None
Use of Medications Lasix, dopamine.
24 hr. recall None
PA & stress factor PA = (1.2) || Stress Factors: No stress factor
37
Lab results - Blood pressure: 89/52 (hypotension)
- Creatinine:1.73mg\dl(elevated)
- Potassium:4.02 mg\dl (normal)
- sodium: 142mg\dl(normal)
- magnesium: 2.17 (normal range)
Diagnosis: - restricted protein intake related to elevated creatinine serum as evidence by lab data result.
- restricted sodium requirement related to heart failure and hypertension as evidence by medical history.
Nutrition intervention Type of diet: Therapeutic Lifestyle Change Diet (TLC), renal diet(predialysis), dash diet.
(Daily energy, protein, fat BMR (according to Harris benedict equation) =66.4730 + 13.7516 x weight in kg + 5.0033 x height in cm –
and type of diet) 6.7550 x age in years.
= 1275.2caloreis\day
Daily Energy Requirements: (according to predialysis guide)
= kcal/kg body weight= 30-35 for people who aged 60 or above.
= 32*70= 2240cal/day.
Patient’s EER: 2240 Calories.

(2240*55%)/4=308g of CHO
Daily Protein Requirements:50g (0.70) (0.60-0.75g/kg bodyweight) (according to predialysis guide)
Daily fat requirements: (2240*30%) \9 = (74g of fat) (30% according to TLC diet)
Sodium: 2000 mg/dl – potassium: 2300mg/dl – phosphorus: 900mg/dl (according to predialysis guide)
Monitoring and evaluation - “Strive to achieve optimal HIN levels within the normal range and maintain healthy ranges for other lab
results by adhering to a balanced diet that ensures nutritional adequacy”
- Ensure that the sodium level stays within the normal range by limiting the sodium intake to 2000mg per
day, potassium and phosphorus.
Diet for 3 days:
38
Meal Carbs Protein Fats Calories
Breakfast:
1 medium plum(66g) 15 0 0 60
1 cup of water melon 12 1 0 50
1 boiled egg(50g) 0 5 6 80
2 slice of white bread 30 6 2 160
Snack
3 cups of popcorn 18 3 1 95
1 medium apple (200g) 29 0 0 125
Lunch
1 cup of shredded lettuce (36g) 1 0 0 6
(9tbsp) of cooked rice 30 3 0 160
Chicken breast, rotisserie, skin not eaten (1oz) 0 6 1 40
100 g of peas soup 20 6 2 130
1 cup of natural orange juice 30 0Protein 0Fats Calories
120
Meal Carb
Snack s
1Breakfast:
baby boiled potato (60g) 12 1 3 80
21 tbsp
mediumof hummus
apple 515 20 60 82
60
11tbsp
smallofcarrot
labneh 50 03 01 20
30
Lunch
½ cup of foul 15 3 1 80
12 slice
cup of
of shells
wholepasta
wheat(210g)
bread 50
15 63 11 240
80
11 cup of slice sweet
cup of Arabic salad pepper (92g) 45 02 0.16
0 18
25
1 small baked potato 80
1 cup of slices cucumber 40 20 010 15
1 tsp of olive oil 90
1 slice pf toasted whole bread 15 3 0 80
Snack
2 tbsp of olive oil with some of spices for- 018 03 20 180
3 cups of popcorn 1 95
flavoring
½ medium size of mango 15 0 0 60
Snack 3
Lunch
2 cup of fruit salad 30 0 0 120
1 cup of cucumber and carrots salad. 5 0 0 25
12 medium size of cachous nuts and almond 0 0 10 90
Total
Chicken breast, rotisserie, skin not eaten (1oz)
310g 49g 55g 2250kcal
0 6 1 40
¾ cup of skimmed yogurt 12 8 3 90
1 cup of natural orange juice 30 0 0 120
2 tsp of olive oil and spices 0 0 10 90
Snack
5 medium fresh dates 15 0 0 60
2 medium size dried fig 15 0 0 60
4 halves walnuts 0 0 5 45
Lunch
1 cup steamed broccoli and eggplant 10 4 0 50
1 cup of cooked burghul 30 6 0 160
flavoring
1 plum 15 0 0 60
Snack 3
2 cup of fruit salad 30 0 0 120
39
12 medium size of cachous nuts and almond 0 0 10 90
Total 295g 52g 70g 2015kcal

Meal Carb Protein Fats Calories
s
Breakfast:
1 medium orange 15 0 0 60
1tbsp of labneh 0 3 1 30
½ cup of cooked lentils 15 3 1 80
2 slice of whole wheat bread 30 6 2 160
Snack
3 cups of popcorn 18 3 1 95
1 medium plum 15 0 0 60
Lunch
1 cup of cucumber and sweet pepper salad. 5 0 0 25
¾ cup of skimmed yogurt 12 8 3 90
1 cup of pineapple juice 30 0 0 120
2 tsp of olive oil and spices 0 0 10 90
Snack
20 mediums of grape 30 0 0 120
1 tbsp of avocado 0 0 3 30
½ cup of slices sweet pepper and carrots 3 1 0 10
Lunch
1 cup steamed carrots and marrow 10 4 0 50
1 cup of cooked freekeh 30 6 0 160
flavoring
1 apple 15 0 0 60
Snack 3
1 cup of orange juice 30 0 0 120
40 15 medium size peanuts 0 0 5 45
4 small pieces of unsweetened biscuits 15 2 0 80
Total 295g 52g 70g 2100kcal
Day 10 21 Aug. 2023 Monday
On this day of the third week, we did the first and second round as usual. We learned about new cases,
including a patient suffering from an epilepsy for RTA, lung fibrosis, the relation between medication
coumadin and vitamin K, and we learned a little about valve replacement patients through the nature of
the diet, so that the diet is in the first day is light, and after that, it is back to the normal diet. After the first
and second rounds, which were divided between the students of the groups, we got to know a new type of
patient, who are patients with hyperthyroidism and hypothyroidism. We talked about the foods that should
be avoided, such as cauliflower, broccoli, and cabbage, so that they are allowed to be eaten. In the case of
complete cooking, calories are also reduced by up to 700 calories for these patients. We also discussed the
41
condition of patients who suffer from this disease, which is accompanied by anemia. In addition to this,
we learned about thyroid hormones, which are TSH, T3, T4 and a case of NCP was taken for a patient
with hypothyroidism (attached below). In addition to anemia, we were asked to make a diet for her for one
day only. After that, an article was discussed that was about the disease itself and about their nutrition.
Patient Name: X Weight:85 Kg. BMR: 1,579 Calories/day According to Mifflin equation.
Gender: female Height: 164cm EER:.20cal/day
Age: 27 yrs. BMI: 31.6 kg/m2 (Obese Class I) Ward: none
Case description "Female, 27 years old was diagnosed with hypothyroidism.
Medical History Hypothyroidism, anemia.
Food Allergies None
Use of Medications Iron supplement
24 hr. recall None
PA = (1.27)
PA & stress factor
Stress Factors: No stress factor
Lab results - None
Diagnosis: - Increase iron requirement related to anemia as evidence by medical history.
Type of diet: high iron diet
BMR (according to Mifflin equation) = BMR = 10W + 6.25H - 5A - 161
= 1579 kcal/day
Nutrition Daily Energy Requirements: (according to hypothyroidism guide)

intervention 1579*1.27=2005cal/day
(Daily energy, 2005-30%= 1400cal/day
protein, fat and
type of diet)
Daily carbohydrate requirements: (1400*55%) \4=193/15=13 choice. (
Daily Protein Requirements: (1400*25%)/4= 88g
Daily fat requirements: (2240*30%) \9 = 47g
Iron from food:18 mg/day
- Encourage weight loss to avoid complication

Monitoring and
- Optimize nutritional adequacy to improve nutritional status.
evaluation
- Monitor iron level constantly.
42
Meal Carbohydrate Protein Fats Calories Iron
Breakfast:
15 3 1 80 1
1 slice of whole wheat bread
0 0 5 45 0
1tsp of olive oil
0 0 0 0 0
1tsp of Oregano as a flavor
10 4 0 50 1
2 cups of Arabic salad
5 3 5 80 1
2 tbsp of hummus
15 3 1 80 1
1 small boiled potato
Snack:
8 1 4 80 2
19 8 6 160 3
5 0 0 25 0
½ cup of berries
Lunch:
20
3-ounce (85-gram) serving of cooked beef 0 8 160 2
2
2
4
Snack-2-
3cups of pop corn 20 3 0 93 0
2 cups of fresh slice of carrots and 10 2 0 55 0
cabbage 0 6 3 70 0
1 medium egg
Lunch:
½ cup of cooked freekeh 15 3 1 80 2
2 cups of Arabic salad with1 medium beet 10 4 0 50 3
Total 195g 87g 43g 1380cal 20mg
43
Day 11 22 Aug. 2023 Tuesday
On this day of the third week, we did the first and second round as usual. It was not as full as
before, but the nutritional conditions of liver patients were discussed, including people who
suffer from fat on the liver and: High in protein and calories, low in fat and moderate in
carbohydrates. We also touched on the disease of fluid accumulation in the abdominal area,
which is known as ascites. In turn, we discussed how to measure the ideal body weight and dry
weight of these patients through a multi-step equation, and we studied the effect of alcohol on
these patients, as it is considered one of the causes of the disease, as it affects Absorption of B
vitamins. A case of the disease was taken from a 32-year-old young man suffering from liver
cirrhosis (attached below), we calculated his dry weight and wrote the PES statement. Another case
that was taken was an intensive care patient suffering from diabetes. She was admitted to the
hospital for a catheterization procedure, and a diet was prescribed for her for only one day, also
we talk about nutrition for Athletes and gym players.
Gender: male Height: 170cm EER:.2000 Cal/day according to liver cirrhosis guide
Age: 32 yrs. BMI: 28 kg/m2 (Overweight) Ward: ICU
Case description "Male, 32 years old was diagnosed with liver cirrhosis and mild ascites.
Medical History Liver cirrhosis.

Food Allergies None
Use of Medications None
24 hr. recall Water only
44
PA & stress factor PA = (1.2) || Stress Factors: 1.2
Physical examination Food ulcer.
Lab results - ALP: 150IU/L (elevated)
- ALT: 80IU/L (elevated)
- Sodium: 145mg/dl (normal)
- Bilirubin: 1.5mg/dl (normal)
Diagnosis: - High protein, high calories intake related to liver cirrhosis as evidence by medical history
- Restricted sodium intake related to ascites as evidence by medical history.
Nutrition Type of diet: diet rich in iron
intervention Dry-weight:
(Daily energy, 1. NTBW (Normal total body water) = ABW * % of body water= 81*60%=48.6l
protein, fat and 2. Actual Total Body Water (L) = 142x NTBW /Actual Serum Sodium = 142*48.6/ 145=47.5l
type of diet) 3. Excess BW = Actual Total Body Water – NTBW= 47.5-48.6=1

4. Dry Weight: ABW – Excess BW= 81-1= 80kg
BMR (according to Mifflin equation) = BMR = 10W + 6.25H - 5A - 161
= 1,718 Calories/day
Daily Energy Requirements: BMR*PAL*Stress factor

= 1718*1.2*1.2= 2470.
2470-500= 1970. Approximately 2000cal/day.
Ideal body weight: G. J. Hamwi Formula= 48.0 kg + 2.7 kg per inch over 5 feet
(170cm = 67inch) || (5 feet= 60 inch) = (67-60) = 7 inch
= 48+2.7*7 = 67kg = IBW.
Daily carbohydrate requirement: (2000*55%)/4= 275/15=18 choice (4 for each meal and 2 for each snack)
Daily Protein Requirements:1.2*80= 96g
Daily fat requirements: 2000*30%/9=65g
Monitoring and - Regularly monitor for complications such as hepatic encephalopathy, ascites, variceal bleeding, and
evaluation infections. Adjust the diet as needed to manage these conditions.
- Schedule regular follow-up appointments with a healthcare provider and registered dietitian to track
progress, make necessary dietary adjustments, and address any concerns
- Educate the patient and their caregivers about the importance of adhering to dietary recommendations,
managing symptoms, and seeking prompt medical attention when needed.
Diet for 3 days:
meal Carbs Protein Fats Calories
45
Breakfast
3 medium-sized falafels. 15 3 1 80
4Tbsp of low fat labneh 0 14 6 100
1 small baked potato (90g) 15 3 1 80
2 tbsp of avocado 0 0 5 45
1 boiled egg 0 7 3 55
Snack-1-
½ cup of oats 15 3 0 80
½ cup of low-fat milk 6 4 3 45
2 medium sizes of apricots 8 0 0 30
6 medium sizes of almonds 0 0 5 45
Lunch
1 cup of cooked freekeh 30 6 3 160
1 cups of Arabic salad with 5 2 0 25
Snack-2-
3cups of popcorn 15 3 1 80
½ tsp of salt 0 0 0 0

1 slice of crispy bread 15 1 0 80
1 cup of cucumber and green 5 2 0 25
onion 10 5 2 70
Snack-3-
1 boiled egg 0 7 3 55
12 medium sizes of grapes 15 0 0 60
Total 270 90 58 1900

Breakfast
46
½ cup of foul 15 3 1 80
60g of white cheese 0 14 6 100
1 small baked potato (90g) 15 3 1 80
8 medium sizes of olive 0 0 5 45
Snack-1-
8 small unsweetened biscuits 30 6 2 160
Lunch
1 cup of cooked burghul 30 6 3 160
1 cup of okra soup 10 4 0 50
Snack-2-
1 cup of peas soup 30 6 3 160

1 cup of cucumber and green 5 2 0 25
onion 10 5 2 70
Snack-3-
½ cup of corn flix 15 3 1 80
½ cup of skimmed milk 10 7 2 70
6 medium sizes of almond 0 0 5 45
4 cheery 5 0 0 20
Total 270 96 58 2060

Breakfast
47
4 tbsp of hummus 10 4 1 160
60g of white cheese 0 14 6 100
8 medium sizes of olive 0 0 5 45
Snack-1-
8 small unsweetened biscuits 30 6 2 160
Lunch
1 cup of cooked burgle 30 6 3 160
Snack-2-

1 cup of cucumber and tomato 5 2 0 25
10 5 2 70
Snack-3-
½ cup of corn flix 15 3 1 80
½ cup of skimmed milk 10 7 2 70
6 medium sizes of almond 0 0 5 45
4 cheery 5 0 0 20
Total 270 96 58 2060
Patient Name: X Weight:68 Kg. BMR:1,298 Calories/day

According to Mifflin equation.
Gender: female Height: 162cm EER:.1500cal/day
Age: 81 yrs. BMI: 25.9 kg/m2 (Overweight) Ward: ICU
Case description "Female, 27 years old was admitted to the hospital with normal cath. And short of breath.
Medical History Diabetes
48
Food Allergies None
Use of Medications Vilanterol
24 hr. recall NPO
PA & stress factor PA = (1.2)

Stress Factors: 1.3
Lab results - Creatinine: 0.8 normal

- Urea: 19mg/dl normal
- Sodium: 148mg/dl elevated
Diagnosis: - Restricted sodium intake related to elevated sodium serum as evidence by lab data result.
Nutrition intervention Type of diet: consistent carbs diet& DASH

(Daily energy, BMR (according to Mifflin equation) = BMR = 10W + 6.25H - 5A - 161
protein, fat and type = 1298Cal/day
of diet)
Daily Energy Requirements:
1579*1.2*1.3= 2024
2024-500(to lose weight) = 1500 Cal/day
Patient’s EER: 1500 Calories.

(1500*55%)/4=210g of CHO
210/15=13choice (3 choice for each meal and 2 choice for snacks)
Daily Protein Requirements: (1500*18%)/4= 68 g (18% according to DASH diet)
Daily fat requirements: (1500*27%) \9 = (45g of fat) (27% according to DASH diet)
Sodium: 2300mg
Monitoring and - “Strive to achieve optimal HIN levels within the normal range and maintain healthy ranges for other lab results
evaluation by adhering to a balanced diet that ensures nutritional adequacy”
- Control blood glucose levels and carb metabolism, reduce risk of Diabetic complications
- Follow-up his diet, make sure to eat limited amounts of processed, canned food, with the number of calories
specified for the day, and increases food rich in vitamins and minerals, Avoid canned and ready-made food.
- Ensure that the sodium level stays within the normal range by limiting the sodium intake to 2300mg per day.
meal Carbs Protein Fats Calories Sodium

Breakfast
49
1 slice of whole wheat bread 15 3 1 80 70
3 medium-sized falafels. 15 3 1 80 200
2Tbsp of low fat labneh 0 7 3 55 50
1 small baked potato (90g) 15 3 1 80 10
2 tbsp of avocado 0 0 5 45 2
1 boiled egg 0 7 3 55 2
Snack-1-
½ cup of oats 15 1 0 80 1
½ cup of low-fat milk 6 4 3 45 60
2 medium sizes of apricots 8 0 0 30 0
6 medium sizes of almonds 0 0 5 45 0
Lunch
½ cup of cooked freekeh 15 3 1 80 3
1 cups of Arabic salad with 5 2 0 25 15
Snack-2-
3cups of popcorn 15 3 1 80 3
½ tsp of salt 0 0 0 0 1000
½ cup of lentil soup 15 3 1 80 250

1 slice of crispy bread 15 1 0 80 100
1 cup of cucumber and green onion 5 2 0 25 10
½ cup of skimmed yogurt 10 5 2 70 80
Total 195 65 42 1400 2190
Day 12 23 Aug. 2023 Wednesday
50
The situation of the rounds did not differ much from the previous week. We did two rounds, each
group in the morning round at approximately nine o’clock and the second round at eleven
o’clock. Between the two rounds we were asked to write nutritional instructions for a patient
suffering from gout and she needed guidance. Then a case was taken. We discussed its status,
about her lab data result, the 24hr. recall and the screening (attached below).
Case description: Patient Y is an 81 years old Asian female, she derived to the hospital to operate
catheratization for 3rd time, she has diagnosis with hypertension, gout, her anthropometric
data, weight = 96 kg, height = 157 cm
Screening: According to mini nutritional assessment, she is at risk of malnourishment (score=9)
Personal information: Patient Y, female, Asian
Food intake, 24h recall: - ‫ نص قطعة خبز ابيض‬، ‫ نص كأسة لبن‬، ‫ كأسة عصير مشمش‬،‫ حبة عجوت شوكوالتة‬، ‫قطعة معجنات زعتر وجبنة‬
she is suffering from fluid retention, high risk of malnutrition, acute kidney failure, anemia, hypertension
Lab data results Serum K: 5.8
Serum Creatinine: 1.9
Blood urea nitrogen: 43.2
Cholesterol: 234
Triglyceride: 242
LDL: 172
Hemoglobin: 10.1
Random sugar: 80
Serum Na: 140
Blood pressure: 139/60 mmHg
51
Day 13 24 Aug. 2023 Thursday
On this day, we made the rounds as usual. After that, certain types of medications were
discussed, and whether there is a conflict between them and certain types of foods. There were
approximately 25 types of medications like megaxin, Heparin, zinaxim, sulfa drugs,
clindamycin, zinaxim, rifampicin, azithromycin, Plavix, amoxiclav, Asp, pantover, mycophen,
Risperdal, tranxene, betaren, vancomycin, aspirin, insulin, Rocephin, concur, Nexium, clexan,
Lasix, coumadin, (appendix-9-) which were divided equally among the groups. After that, two
articles were discussed, the first article, which was entitled nutrition during pregnancy, lactation
and early childhood and its complication for maternal and long-term child health. the second is
titled ketogenic diet for obesity. Also, between the two rounds, we went to talk to some
patients. One of them was a patient who had undergone a gastric bypass operation. We then
discussed information presented by the patient, which was about the Lamb Tail Fat and whether
it is actually healthy or harmful. After research, it turned out that a small spoonful contains
large amounts of cholesterol and fats. The activities here ended for the day.
52
Last week. 26,27,28,29,30 Aug 2023. Saturday to Wednesday
The last week of the practical training course, which started from the 26th of the eighth month
until the thirtieth, the routine was very similar this week at the level of activities and events. The
main goal of the activities was to do communication skill with the patients. Every one or two
students was required to Admission to different patients as much as the hospital situation allows.
The cases ranged from accident cases, diabetes cases, hypertension, childbirth, miscarriage,
stomach ulcer patients, and a thyrodisim patient. These cases were distributed throughout the
week for me. In addition to all of this, several topics were discussed, including an article. About
liver patients, it was titled nutrition in chronic liver disease we discuss the macronutrient for this
patient and how we calculate the percentage of it, also we discussed of the type of food for
patients with acrodermatitis enteropathica, android obesity, anaphylactic shock, ascites, beriberi
cretinism and another article entitled Energy, Protein, Carbohydrate, and Lipid Intakes and Their
Effects on Morbidity and Mortality in Critically Ill Adult Patients, This is in addition to a
discussion of medical history for a patient as written by the doctor. Two cases were discussed
(attached below), and an explanation was made about food label and how to analyze it. And
understanding it, ghee and its relationship with obesity and heart health and comparing it to other
oils. At the end of the training on the last day, the activity of making a report for a patient was
given in order to complete the requirements of the report. (An external file is attached next to this file)
We also went to the pharmacy attached to the hospital and learned about some types of formula,
including jevity. The instructions were written for infants, and instructions for gout patients and
lupus erythematosus patients. A case was taken about a patient suffering from gout, esophageal
reflux, and heart failure (attached below). The goal of this case was Recognizing the
prioritization of diseases in order to write a diet for them. In the beginning, the food containing
Vitamin K conflicts with Coumadin, then diabetes, then heart failure, and finally weight loss. In
addition to this, during this week we also discussed tube feeding for patients, and we discussed
how to make a mixture in the hospital of 2000 calories per day, so that each cup contains only
500 ml. Other cases are discussed (also attached below with answers)
53
54
The two cases
Case Answer
Case-1- 1. Inadequate Nutrition
Sarah, a 16-year-old high school student, has just 2. Low Body Weight
discovered that she is pregnant. At 5’3’’ and 105 lb., 3. Skipping Breakfast
she is underweight and her typical diet lacks many 4. Unhealthy Snacking
essential nutrients. For breakfast, she has coffee and a 5. Meal Skipping]
doughnut, if anything at all. She often skips lunch or 6. Caffeine Intake
eats chips from the vending machine. She then eats a 7. Lack of Prenatal Care
well-rounded dinner with her family. What risks do 8. Potential Anemia
you see in this situation for Hannah and her baby? 9. during pregnancy, which can result in fatigue,
weakness, and other complications for both
Sarah and her baby.
Case-2- BMR = 10 * weight (kg) + 6.25 * height (cm) - 5 * age

A 20-year-old African American woman was (years) + 5
exclusively breastfeeding her 4-month-old infant since Weight in kilograms: 140 lbs. / 2.205 = 63.49 kg
birth. At one of her postpartum visits, a breastfeeding Height in centimeters: 168 cm
assessment was performed. During the assessment, she BMR = 1590.9 calories per day
mentioned that she was interested in losing weight. A EER = BMR * Activity Factor
24-hour diet recall was used to obtain a dietary EER = 2463.695 calories per day
assessment. For breakfast, she consumed a 1/2 cup of Add Calories for Lactation:
oatmeal with 1/4 cup of skim milk, 1/2 teaspoon of Since she is exclusively breastfeeding, it's
butter, and 1 teaspoon of sugar, and an 8-ounce glass recommended to add an extra 300-500 calories per day
of orange juice (approximate amounts). Between to support lactation. Average 400
meals, she snacked on a half a box of Wheat Thin EER with Lactation = 2863.695 calories per day
crackers and an 8-ounce glass of fruit-flavored water. Monitor Progress:
She recalled having a turkey and cheese sandwich on It's essential to track her progress and make adjustments
wheat bread for lunch and a sloppy joe sandwich, as needed. Consultation with a healthcare provider or
made with ground beef, for dinner. To determine her registered dietitian can help her create a balanced meal
individual energy need, the mother was asked her ideal plan and ensure her weight loss is safe and sustainable
weight and activity level. For these subjective data, she while supporting her lactation needs.
was given descriptions for each of the physical activity
levels and instructed to identify her ideal weight.
Based on her perception, she selected the moderate
activity level and 140 lbs. as her ideal weight.
55
Gender: male Height: 185cm EER:.1960cal/day

Age: 44yrs. BMI: 32.4 kg/m2 (Obese Class I) Ward: ICU
Case description "Male, 44 years old was admitted to the hospital with heart failure
Medical History Heart failure, gout, GERD.

Food Allergies None
Use of Medications Lasix, aspirin, coumadin, pepticum, Aldactone
24 hr. recall NPO
PA & stress factor PA = (1.2) || no stress factor
Lab results - INR: 1.1 normal.
Diagnosis: - Low vitamin k diet related to complication between vit. K and coumadin as evidence by medication history.
- Low purine diet related to gout as evidence by medical history
- Restricted sodium requirement related to heart failure as evidence by medical history.
- Restricted calories requirement related to obese as evidence by BMI classification.
Nutrition intervention Type of diet: low purine DASH DIET.
(Daily energy, BMR (according to Mifflin equation) = BMR = 10W + 6.25H - 5A - 161
protein, fat and type = 2051Cal/day
of diet)
Daily Energy Requirements:
1579*1.2= 2460
2460-500(to lose weight) = 1960 Cal/day
Patient’s EER: 1960Calories.

(1960*55%)/4=270g of CHO
270/15=18choice (4 choice for each 3 meal and 2 choice for 3 snacks)
Daily Protein Requirements: (1960*18%)/4= 88 g (18% according to DASH diet)
Daily fat requirements: (1960*27%) \9 = (59g of fat) (27% according to DASH diet)
Sodium: 2300mg
56
Monitoring and - Schedule regular appointments with a primary care physician or a specialist,
evaluation - Review the patient's medical history, including past hospitalizations, surgeries, and medications
- Make sure he eats enough food and gets all his needs, while staying away from salts and foods rich in purines,
fats, etc.
Mix 2500 high protein /high kcal
Breakfast,
2 whole wheat bread
1tsp of olive oil
1 medium whole egg and 1 white egg
60 g of cheese
1/2 cup of boiled foul
1 cup of yogurt
Carbs Protein Fats Calories
40 30~ 10 600~
lunch,
6 oz grilled chicken breast
- 2 small whole wheat bread
- ½ cup hummus
- 1 cup mixed greens
- ½ cup cherry tomatoes
- ½ yogurt
1 cup o yogurt
60 53 11 700~
dinner
1 cups of cooked brown rice
57
6 oz of grilled chicken breast
½ cup of Arabic salad vegetables
1 cup of yogurt
1 oz of lentil soup
1 apple
80 57 14 700
Major Case Study: Enteral and Parenteral Nutrition
Mr. R, a 35-year drug user, is hospitalized after a motor vehicle accident (MVA). He is currently suffering
from a severe concussion and lapses of consciousness, a broken jaw, multiple broken bones, and possible
internal injuries. He had not eaten anything for several days PTA because he was overdosing on drugs.
Enteral feeding has been recommended in order to improve his nutritional status and given his decreased
level of alertness. The patient will be bedridden until his mental status improves. A nasogastric feeding tube
has been inserted and the physician has asked for your recommendation regarding the type of formula and
amounts of kcal/protein needed for this patient. Ht.: 5’11” Current wt.: 156 # UBW: 167 # Serum albumin:
3.0 mg/dL
1. Write 1 PES statement for this patient.

Inadequate protein-energy intake related to multiple broken bones, broken jaw, possible internal injuries
and a current weight lower than usual and ideal body weight.
2. Is the nasogastric feeding route appropriate for this patient? Why or why not?
The nasogastric feeding route is not appropriate for this patient because he is currently experiencing
lapses of consciousness. During one of these moments of unconsciousness, the patient is at risk for
aspiration
3. What daily intake of kcals, protein, and fluids would you recommend for this patient and
why? Show calculations for estimated needs, give recommendations as kcal/d, g protein/d,
ml fluid/d.
58
Ht.: 5’11 x 2.55 cm/in=180.34cm REE= 1666.125 x 1.2-1.4 (skeletal trauma) x 1.2
Current wt.: 156# x (1kg/2.2#) = 70.9 kg (bed rest) = 2400-2800 kcal/day
IBW: 106 + (11 x 6) = 172 +/- 10% Protein= 1.2-1.5 g/kg/day= 70.9(1.2) to
Serum albumin= lower than normal range (3.5- 70.9(1.5) = 85 – 106 g protein/d
5.0) Fluid= 1 mL/kcal = 2400-2800 ml fluid/d
REE= 10(70.9) + 6.25(180.34) – 5(35) + 5
REE= 1666.125 x IF x AF
4. Based on the needs of this patient, describe three desirable characteristics for the type of
formula you would recommend. Give one example of an appropriate enteral formula
meeting
A good example is Jevity 1.0. This formula contains fiber, vitamins A, B-6, B-12, C, D, E and K, and
minerals such as calcium, magnesium, iron and zinc.
Conclusion:
In conclusion, nutrition is an essential component of overall health and well-being. Nutritional coaching
provides individuals with the knowledge and skills to make informed food choices that can have a
profound impact on their physical and mental health. This training has given us a deeper understanding of
the importance of nutrition in maintaining a healthy body and mind. Let's take this knowledge and
continue to make informed choices that nourish and support our bodies."
- Understanding the basics of nutrition: This is done through quick and summary reviews of the
basics of nutrition that were studied in the first years of the bachelor’s degree.
- Tailoring nutrition to individual needs: Nutrition is not one-size-fits-all. Training helps
individuals understand that nutritional needs can vary depending on age, gender, activity level,
and specific health conditions whether diabetes, stress, kidneys, cancer, or others.
- Prevention and Management of Health Conditions: Training has enabled us to take proactive
measures to prevent diet-related health problems such as obesity, heart disease and diabetes. It
also provides tools for managing conditions such as food allergies, celiac disease, and irritable
bowel syndrome through dietary modifications.
Limitations:
59
There is a lot more to this topic however the limitations I faced in training were not having
enough patients to communicate with, handle and mentor. Patients were either too tired and
exhausted or did not want to talk to a nutritionist.
Recommendations:
There are not many recommendations regarding training, but in my personal opinion, the skill of
communicating with patients should be from the beginning to the end of the training in order to
build strong knowledge of the details of how to communicate with patients and the issues that we
may encounter during this and others. It is also necessary to deal with patients from outside the
hospital more than what happened, and with different cases such as weight loss, athletes, etc.,
and this may be through the presence of an outpatient nutrition clinic in the hospital for nutrition.
There are some cases that need to be addressed more than what happened, such as kidney
patients, cancer patients, athletes, polycystic ovary syndrome patients, and other cases, but from
this point of view, they come from the hospital itself, which basically lacks these departments.
Summary table of activities:
Day -1- Communication skill, doing Haccp, discussion nutrition forms and essential in
nutrition and lab data result
Day -2- Muhammad Zaghloul, was taken to make an NCP form with writing a diet for 7
days, as this patient was admitted to the hospital suffering from H.CVA.
Day-3- How to write pes statement and discussion potassium and sodium in food
Day-4- Lab data result for pregnancy and discussion the mineral and vitamins with NCP for
gestational diabetes.
Day-5- NCP for lung cancer patients.
Day-6- Diet for IBD individuals the diet for gastric bypass operations was discussed and
recommendation for them.
Day-7- NCP was given to a heart patient and discuss general issue in nutrition
Day-8- Discuss some terms related to nutrition, NCP for emphysema patient, herbs and its
effects, also food help in sleep and wakeup.
Day-9- NCP for various diseases, such as high blood pressure, CHF, and kidney failure, diet
60
‫‪for patient with gluten sensitivity.‬‬
‫‪Day -10-‬‬ ‫‪Hypo and hyper thyrodisim patient, thyroid hormone, and nutrition for these patients‬‬
‫‪Day-11-‬‬ ‫‪Liver cirrhosis, dry weight, ideal body weight and ascites‬‬
‫‪Day-12-‬‬ ‫‪nutritional instructions for a patient suffering from gout with NCP case‬‬
‫‪Day-13-‬‬ ‫‪Two articles in different topic,‬‬
‫‪Last week.‬‬ ‫‪Communication skill and some of different cases.‬‬
‫‪Nutritional guidelines:‬‬
‫االرشادات التغذوية ملرضى السكري والضغط‪:‬‬
‫املتابعة الطبية‪ :‬يجب على مرضى السكري وارتفاع ضغط الدم مراقبة حالتهم بانتظام مع فريقهم الطبي واتباع‬
‫التوجيهات الطبية املحددة لضمان تحسن الحالة‪.‬‬
‫تن اول األطعم ة ذات مؤشر الجاليس يمي ال دموي منخفض‪ :‬يفض ل تن اول األطعم ة ذات مؤشر الجاليس يمي‬
‫الدموي منخفض‪ ،‬مثل الحبوب الكاملة‪ ،‬والخضروات‪ ،‬والفواكه‪ .‬هذا يساعد في تجنب ارتفاع مستويات السكر‬
‫في الدم‪.‬‬
‫الحص ول على األلي اف الغذائي ة‪ :‬تن اول األلي اف الغذائي ة من مص ادر مث ل الحب وب الكامل ة‪ ،‬والخض روات‪،‬‬
‫والفواكه‪ ،‬والبقوليات يمكن أن يساعد في تحسين إدارة مستويات السكر والضغط‪.‬‬
‫الح د من األطعم ة الغني ة ب امللح‪ :‬تقلي ل تن اول امللح يمكن أن يس اعد في خفض ض غط ال دم‪ .‬تجنب األطعم ة‬
‫اململحة ومكمالت الصوديوم‪ ،‬واستخدام التوابل واألعشاب لتحسين النكهة‪.‬‬
‫تناول مصادر صحية للبروتين‪ :‬اختر مصادر صحية للبروتين مثل اللحوم املشوية‪ ،‬والدجاج املطهو بدون جلد‪،‬‬
‫واألسماك‪ ،‬والبيض‪ ،‬واملكسرات‪ ،‬والبقوليات‪.‬‬
‫‪61‬‬
‫الحد من الدهون املشبعة‪ :‬تجنب الدهون املشبعة والدهون املتحولة قد يساهم في الحفاظ على صحة القلب‬
‫واألوعية الدموية‪.‬‬
‫الحجم والتوزيع الصحيح للوجب ات‪ :‬تن اول وجب ات ص غيرة ومتك ررة ق د يس اعد في إدارة مس تويات الس كر في‬
‫الدم بشكل أفضل‪.‬‬
‫السيطرة على الوزن‪ :‬الحفاظ على وزن صحي يمكن أن يساعد في تحسين إدارة السكر والضغط‪.‬‬
‫شرب السوائل بشكل مناسب‪ :‬تناول كميات كافية من املاء يمكن أن يساعد في تحسين الصحة العامة‪.‬‬
‫التواص ل م ع فريق الرعاي ة الصحية‪ :‬دائًم ا م ا يكون التواص ل م ع األطب اء وأخص ائيين التغذي ة ض رورًي ا لتلقي‬
‫الدعم والتوجيه املالئمين لحالتك‪.‬‬
‫االرشادات التغذوية لسكري الحمل واالنيميا‪:‬‬

‫متابع ة الفحوصات الدورية‪ :‬يجب متابعة مستويات السكر في الدم بانتظام بمساعدة الفريق الطبي‪ .‬تحكم في‬
‫مستويات السكر في الدم يساعد في منع مشاكل صحية محتملة لألم والجنين‪.‬‬
‫تحسين نمط الحياة والتغذية‪ :‬اتباع نمط حياة صحي يشمل تناول وجبات متوازنة ومناسبة وممارسة النشاط‬
‫البدني املعتدل يمكن أن يساعد في التحكم في مستويات السكر‪.‬‬
‫تناول ثالث وجبات طعام صغيرة ووجبتين أو ثالث وجبات خفيفة في أوقاٍت منتظمة يومًي ا بشرط عدم تفويت‬
‫أٍي من الوجبات الصغيرة أو الخفيفة‪.‬‬
‫تناول كمية أق ّل من الكربوهيدرات في وجبة الفطور باملقارنة مع الوجبات األخرى‪ ،‬ففي الصباح‪ ،‬تكون مقاومة‬
‫األنسولين أقوى‪.‬‬
‫تناول كمية ُم حّد دة وثابتة من الكربوهيدرات في كل وجبة ووجبة خفيفة‪.‬‬
‫توزيع الوجبات‪ :‬تناول وجبات صغيرة ومتكررة طوال اليوم يمكن أن يساعد في الحفاظ على استقرار مستويات‬
‫السكر في الدم‪.‬‬
‫ُخ‬
‫اختي ار األطعم ة الغني ة باأللي اف مث ل ال بز املص نوع من الحب وب الكاِم ل ة والحب وب واملعكرون ة واألرز والفواك ه‬
‫والخضروات‬
‫تناول األطعمة التي تحتوي على كمية أقّل من السكر والدهون‪.‬‬
‫‪62‬‬
‫شرب ثمانية أكواب أو (‪ 1.89‬لتر) على األقل من السوائل يومًي ا‪.‬‬
‫ُت‬
‫لتجّن ب هبوط ُم ستوى السكر في الدم على املرأة املصابة بسكري الحمل أن بقي معها دائًم ا بعض أنواع السكر‬
‫مثل أقراص الغلوكوز أو الحلوى الصلبة‪.‬‬
‫أن تتناول حصة واحدة من الفواكه أو ما يعادل ‪ 15‬غراًم ا من الكربوهيدرات قبل ُم مارسة أغلب النشاطات التي‬
‫تدوم لنصف ساعة‪ .‬أّم ا إذا كانت املرأة الحاِم ل ُت مارس الرياضة ُم باشرًة بعد تناول الوجبة الغذائية‪ :‬عليها تناِو ل‬
‫ه ذه الوجب ة الخفيف ة بع د انته اء التم رين‪ .‬أم ا إذا كانتُ تم ارس الرياض ة بع د تن اول وجب ة الطع ام بس اعة أو‬
‫ساعتين‪ ،‬فعليها تناول‬
‫الوجبة الخفيفة قبل ُم مارسة التمرين‪.‬‬
‫االنيميا‪:‬‬
‫تن اول مص ادر غذائي ة غني ة بالحدي د‪ :‬تش مل ه ذه األطعم ة اللح وم الحم راء املش وية‪ ،‬وال دواجن‪ ،‬واألس ماك‪،‬‬
‫والبيض‪ ،‬والحبوب الكاملة‪ ،‬والبقوليات‪.‬‬
‫تعزيز امتصاص الحديد‪ :‬تناول األطعمة الغنية بفيتامين ‪ C‬مثل البرتقال والفراولة يمكن أن يساعد في تحسين‬
‫امتصاص الحديد من األطعمة‪.‬‬
‫تجنب تناول القهوة والشاي أثناء الوجبات‪ :‬الكافيين في القهوة والشاي يمكن أن يقلل من امتصاص الحديد‪.‬‬
‫استش ارة الط بيب‪ :‬إذا كانت مس تويات االنيمي ا مرتفع ة‪ ،‬ق د يكون من الض روري تن اول مكمالت الحدي د تحت‬
‫إشراف الطبيب‪.‬‬
‫متابعة الفحوص الدورية‪ :‬يجب متابعة مستويات الهيموغلوبين والحديد في الدم بانتظام وفًق ا لتوجيهات الفريق‬
‫الطبي‪.‬‬
‫ت ذكر دائًم ا أن االستشارة الطبي ة الدوري ة ضرورية لض مان تلقي العناي ة الصحية املالئم ة واملخصص ة لحالت ك‬
‫الفردية‪.‬‬
‫‪63‬‬
‫االرشادات التغذوية ملرضى السكري وسرطان الرئة‪:‬‬
‫تن اول وجب ات صحية ومتوازنة‪ :‬يجب أن تتض من وجبات ك مص ادر متع ددة من البروتين ات‪ ،‬والكربوهي درات‪،‬‬
‫والدهون الصحية‪ ،‬واأللياف‪ .‬تناول وجبات متنوعة يساعد في تلبية احتياجات الجسم املختلفة‪.‬‬
‫السيطرة على تناول الكربوهيدرات‪ :‬ملريض السكري‪ ،‬من املهم مراقبة كمية الكربوهيدرات التي تؤخذ‪ ،‬وخاصة‬
‫الكربوهيدرات البسيطة مثل السكريات املكررة‪ .‬تناول الكربوهيدرات ذات الفائدة الصحية مثل الحبوب الكاملة‬
‫يمكن أن يساعد في تحسين إدارة مستويات السكر في الدم‪.‬‬
‫التحكم في حجم الوجب ات‪ :‬ق د تس اعد وجب ات ص غيرة ومتك ررة في الحف اظ على مس تويات الس كر في ال دم‬
‫مستقرة‪ ،‬وتجنب االرتفاعات الحادة في السكر بعد تناول وجبات كبيرة‪.‬‬
‫زيادة تناول الخضروات والفواكه‪ :‬الخضروات والفواكه تحتوي على العديد من الفيتامينات واملعادن واأللياف‪،‬‬
‫وهي مفيدة لدعم جهاز املناعة والصحة العامة‪.‬‬
‫‪64‬‬
‫ُمل‬ ‫ُمل‬
‫تقلي ل تن اول ال دهون املش بعة وا هدرجة‪ :‬ال دهون املش بعة وا هدرجة يمكن أن تزيد من مخ اطر أم راض القلب‬
‫واألوعي ة الدموية‪ُ .‬ي فض ل استبدالها بال دهون الصحية مث ل ال دهون غ ير املش بعة‪ ،‬مث ل زيت الزيت ون وزيت‬
‫الكانوال‪.‬‬
‫ش رب الس وائل بكمي ات كافي ة‪ :‬الحف اظ على جس مك مرطب ا مهم للحف اظ على وظائف ه الطبيعي ة‪ .‬ش رب املاء‬
‫والسوائل الصحية يمكن أن يكون مفيًد ا‪.‬‬
‫تجنب األطعم ة املص نعة واملعالج ة بكثاف ة‪ :‬تل ك األطعم ة غالًب ا م ا تحت وي على كمي ات عالي ة من الس كريات‬
‫املضافة والدهون الصناعية‪ .‬الفاكهة والخضراوات‬
‫تن اول على األق ل كوبين ونص ًف ا من الخض راوات والفاكه ة يومًي ا‪ ،‬أدِخ ل الخض راوات والفاكه ة في كل وجب ة وفي‬
‫الوجبات الخفيفة‪.‬‬
‫قلل من تناول الصلصات ومرق التوابل وصوص الغمس لتجنب زيادة السعرات الحرارية‪.‬‬
‫الحب وب الكامل ة‪ .‬تش مل الخ بز واملعكرون ة املص نوعين من الحب وب الكامل ة والرقائق املص نوعة من الش عير‬
‫والشوفان واألرز البني‪.‬‬
‫البروتين ات‪ .‬تناول مجموعة متنوعة من األغذي ة الغنية ب البروتين بم ا في ذل ك اللح وم قليل ة ال دهون وال دواجن‬
‫واملأكوالت البحرية والبيض والبقوليات واملكسرات‪.‬‬
‫تناول مصادر جيدة للبروتين‪ :‬البروتين يساعد في بناء وصيانة األنسجة‪ .‬يمكن تناول اللحوم املشوية‪ ،‬والدجاج‬
‫املطهو بدون جلد‪ ،‬واألسماك‪ ،‬والبيض‪ ،‬واملكسرات‪ ،‬والبقوليات كمصادر جيدة للبروتين‪.‬‬
‫اللحوم املص َّن عة واللحوم الحم راء‪ .‬قِّل ل من األطعمة مثل اللحم املقدد والسجق واللحوم الباردة والنقانق‪ .‬عند‬
‫َخ‬
‫تناول اللحوم الحم راء‪ ،‬اختر قطع اللحم قليلة الدهون‪ .‬يمكنك طهي الطعام عن طريق ال بز أو الشي أو السلق‬
‫ًال‬
‫بد من القلي أو الشي على الفحم‪ .‬اهتم بالبدائل األكثر صحة مثل األسماك أو الدواجن أو البقوليات‪.‬‬
‫تقليل تناول امللح‪ :‬تناول كميات كبيرة من امللح يمكن أن يزيد من ضغط الدم ويسبب مشاكل صحية أخرى‪.‬‬
‫االرشادات الغذائية ملرضى الكلى‪:‬‬
‫ًا‬
‫تقييد تناول السوائل وفق لرأي الطبيب‪ .‬والبد من املحافظة على الوزن ضمن الحدود الطبيعي‬
‫ًا‬
‫ملعرفة أن الجس م يحص ل على الس عرات الحرارية الكافي ة جنب إلى جنب م ع الحب وب والبقولي ات‪ ،‬يس تطيع املريض تن اول‬
‫ًا‬
‫األطعمة املحتوية على السكر أو الجلوكوز شريطة أال يكون املريض مصاب بالسكري‪.‬‬
‫يعتبر اللبن والحبوب والبقوليات والبيض والدجاج من املصادر األساسية للبروتين‪ .‬ينصح هؤالء املرضى املصابين بمرض الكلى‬
‫املزمن ال ذين لم يخض عوا إلى اآلن للغس يل الكل وي بتقليص ال بروتين في النظ ام الغ ذائي‪ .‬وينصح ه ؤالء املرضى بتن اول ‪0.8‬‬
‫‪65‬‬
‫ًا‬
‫ج رام لكل كيل وجرام من وزن الجسم يومي ‪ .‬ومتى تم الب دء في الغسيل الكل وي‪ ،‬يحت اج املريض إلى نظ ام غ ذائي محت وي على‬
‫ًا‬
‫نسبة عالية من البروتين (خصوص املرضى الخاضعين للغسيل الكلوي)‪.‬‬
‫تجنب تناول البروتينات الحيوانية مثل اللحوم والدجاج واألسماك املحتوية على بروتين عالي وبوتاسيوم وفسفور‪ .‬حيث يمكن‬
‫أن تصبح جميع هذه املحتويات من البروتين الحيواني مؤذية للمرضى املصابين بمرض الكلى املزمن‪.‬‬
‫ًا‬
‫البد من تقليل كمية الدهون‪ ،‬ويعتبر زيت فول الصويا وزيت الفول السوداني مفيد للجسم لكن من املستحسن تناول هذه‬
‫الزيوت بكميات محدودة‪.‬‬
‫ينصح معظم املرضى بتن اول كمي ات منخفض ة من امللح‪ .‬فال تض يف امللح إلى مائ دة الطع ام‪ .‬وال تتن اول األطعم ة املطبوخة‬
‫بمسحوق الخ بز وفي حال ة تناولك له ا‪ ،‬فيجب تناوله ا بكمي ات كافي ة‪ .‬وتجنب اس تخدام ب دائل امللح ألنه ا تحت وي على كمي ات‬
‫كبيرة من البوتاسيوم‪.‬‬
‫يمكن تناول الخضروات املحتوية على كميات منخفضة من البوتاسيوم بعقالنية‪ .‬لكن البد من معالجة الخضروات املحتوية‬
‫على كمي ات كب يرة من البوتاس يوم للتخلص من البوتاس يوم ومن ثم يمكن تناوله ا قب ل االس تهالك‪ .‬ولتحس ين الطعم‪ ،‬يمكن‬
‫إضافة عصير الليمون‪.‬‬
‫يمكن تناول الفاكهة املحتوية على نسبة منخفضة من البوتاسيوم مثل التفاح والبابايا والتوت ولكن ملرة واحدة في اليوم‪ .‬وفي‬
‫يوم الغسيل الكلوي‪ ،‬يستطيع املريض تناول أي ثمرة فاكهة واحدة‪ .‬والبد من تجنب عصير الفواكه وماء جوز الهند‪ .‬وتجنب‬
‫تناول الفواكه الجافة والفول السوداني وبذور السمسم وجوز الهند الطازج أو الجاف‪.‬‬
‫اللبن ومنتجات اآلليان يمكن تناول ‪ 300‬إلى ‪350‬م ل من اللبن أو منتجات األلبان املشروبات الباردة البد من تجنب البيبسي‬
‫وفانتا وفروتي‪ .‬وال يجب تناول عصير الفواكه أو ماء جوز الهند‬
‫تختلف توصيات النظام الغذائي بعد إجراء عملية تحويل مسار املعدة حسب كل حالة على حدة‪ .‬يتبع النظام الغذائي‬
‫ًة‬
‫بعد إج راء عملية تحويل مسار املعدة عاد نهًج ا تدريجًّي ا ملساعدتك على العودة إلى تناول األطعمة الُّص لبة‪ .‬ويعتمد مدى سرعة انتقالك من‬
‫خطوة إلى أخرى على سرعة تعافي جسمك وتكُّي فه مع التغير الحادث في أنماط تناول الطعام‪ .‬يمكنك في العادة بدء تناول األطعمة العادية بعد‬
‫ثالثة أشهر من الخضوع للجراحة‪ .‬في كل مرحلة من مراحل النظام الغذائي الخاص بعملية تحويل مسار املعدة‪ ،‬يجب أن تكون حريًص ا على‬
‫ما يلي‪:‬‬
‫‪66‬‬
‫شرب ‪ 64‬أونصة (‪ 1.89‬لتًر ا) من السوائل يومًّي ا‪ ،‬لتجنب الجفاف‪ ،‬ارتشاف السوائل بين الوجبات‪ ،‬وليس مع وجبات الطعام‪ .‬انتظر‬
‫نحو ‪ 30‬دقيقة بعد األكل لشرب أي شيء وتجنب شرب أي شيء قبل األكل بنصف ساعة‪.‬‬
‫تن اول الطع ام والش راب ببطء لتجنب ح دوث متالزمة اإلغ راق ال تي تح دث عن د دخ ول األطعم ة والس وائل إلى أمعائ ك الدقيق ة‬
‫بسرعة وبكميات أكبر من املعتاد؛ ما يتسبب في الغثيان والقيء والدوخة والعرق واإلسهال‪.‬‬
‫تناول األطعمة الغنية بالبروتين يومًي ا‪ ،‬اختر األطعمة واملشروبات منخفضة الدهون والسكر‪ ،‬تجنب تناول الكحوليات‪ ،‬قلل تناول‬
‫الكافيين الذي يمكن أن يسبب الجفاف‪ ،‬تناول املكمالت الغذائية املحتوية على الفيتامينات واملعادن يومًي ا وفًق ا لتوجيهات مقدم‬
‫الرعاية الصحية‪.‬‬
‫امضغ األطعمة جيًد ا حتى تصبح مهروسة تماًم ا قبل البلع‪ ،‬وال يكون هذا إال بعد تجاوزك مرحلة االقتصار على السوائل‪.‬‬
‫السوائل في اليوم األول بعد الجراحة‪ ،‬لن ُي سمح لك إال بشرب السوائل الصافية‪ .‬بمجرد بدء تناول السوائل الصافية‪ ،‬يمكنك‬
‫ُمل‬ ‫َمل‬
‫البدء في تناول سوائل أخرى‪ ،‬مثل‪ :‬السوائل التي يمكنك تناولها خالل املرحلة األولى‪ :‬ا َر ق‪ ،‬العصير غير ا حلى‪ ،‬الشاي أو القهوة‬
‫منزوعي الكافيين‪ ،‬الحليب (الخالي من الدسم أو بنسبة ‪ 1‬باملائة)‪ ،‬الجيالتين أو املصاصة املثلجة الخالية من السكر‬
‫األطعمة املهروسة‪ ،‬بعد نحو أسبوع من تقبل الجسم للسوائل‪ ،‬يمكنك البدء في تناول األطعمة املطحونة واملهروسة‪ .‬يجب أن تكون‬
‫األطعمة لها ذات قوام املكرونة اللينة أو السائل السميك‪ ،‬ودون وجود أي قطع طعام صلبة في الخليط‪.‬‬
‫ُك‬
‫يمكنك تناول من ثالث إلى ست وجبات صغيرة يومًي ا‪ .‬يجب أن تتكون كل وجبة من ‪ 4‬إلى ‪ 6‬مالع ق كبيرة من الطعام‪ .‬ل ببطء ‪-‬‬
‫نح و ‪ 30‬دقيق ة لكل وجبة‪ .‬باإلض افة الى اختي ار األطعمة ال تي سوف ُت ه َر س جي ًد ا‪ ،‬مث ل‪ :‬اللح وم أو ال دواجن أو األس ماك املفرومة‬
‫الخالي ة من ال دهون‪ ،‬جبن الق ريش‪ ،‬ال بيض املخف وق الن اعم‪ ،‬حب وب اإلفط ار املطبوخة‪ ،‬الفواك ه اللين ة والخض راوات املطهي ة‪،‬‬
‫الحساء الكريمي املقشود‬

‫َمل‬
‫اخل ط األطعم ة الص لبة م ع س ائل‪ ،‬مث ل‪ :‬املاء‪ ،‬الحليب م نزوع الدس م‪ ،‬العص ير ب دون س كر مض اف‪ ،‬ا َر ق‪ ،‬األطعم ة اللين ة‪ ،‬بع د‬
‫بضعة أسابيع من األطعمة املهروسة وبعد موافقة طبيبك‪ ،‬يمكنك إضافة األطعمة اللينة إلى نظامك الغذائي‪ .‬ويجب أن تكون هذه‬
‫األطعمة صغيرة الحجم وطرية وسهلة املضغ‪.‬‬
‫يمكنك تناول ما بين ثالث وخمس وجبات صغيرة يومًي ا‪ .‬يجب أن تتكون كل وجبة من ثلث إلى نصف كوب من الطعام‪ .‬امضغ كل‬
‫قطعة حتى يتخذ الطعام قواًم ا مهروًس ا قبل بلعه‪.‬‬
‫تشمل األطعمة اللينة‪ :‬اللحوم أو الدواجن الخالية من الدهن‪ ،‬السمك املتفتت‪ ،‬البيض‪ ،‬جبن القريش‪ ،‬حبوب اإلفطار املطبوخة أو‬
‫املجففة‪ ،‬األرز‪ ،‬الفاكهة املعلبة أو الطازجة اللينة دون بذور أو قشر‪ ،‬الخضراوات املطهية‪ ،‬بدون قشر‪ ،‬األطعمة الصلبة‬
‫‪67‬‬
‫بعد مرور ثمانية أسابيع على اتباع النظام الغذائي الخاص بعملية تحويل مسار املعدة‪ ،‬يمكنك العودة تدريجًي ا إلى تناول أطعمة‬
‫أكثر صالبة‪ .‬ابدأ بتناول ثالث وجبات في اليوم‪ ،‬بحيث تتكون كل وجبة من كوب إلى كوب ونصف من الطعام‪ .‬من املهم التوقف عن‬
‫األكل قبل أن تشعر بالشبع التام‪.‬‬
‫وبناء على تحمل جسمك الطعام الصلب‪ ،‬يمكنك تغيير عدد الوجبات وكمية الطعام في كل وجبة‪ .‬تحدث إلى اختصاصي النظم‬
‫الغذائي ة عن األس لوب األفض ل ل ك‪ ،‬ج رب أن واع األطعم ة الجدي دة‪ ،‬ن وع واح د في كل م رة‪ .‬فبعض األطعم ة ق د يسبب األلم أو‬
‫الغثيان أو القيء بعد إجراء عملية تحويل مسار املعدة‪.‬‬
‫ومن األطعمة التي يمكن أن تسبب مشاكل في هذه املرحلة‪ :‬أنواع الخبز‪ ،‬املشروبات الغازية‪ ،‬الخض راوات غير املطهية‪ ،‬الخض راوات‬
‫الليفي ة املطبوخة مث ل الك رفس أو ال بروكلي أو ال ذرة أو الك رنب‪ ،‬اللح وم الص لبة أو اللح وم ال تي تحت وي على غض اريف‪ ،‬اللح وم‬
‫الحمراء‪ ،‬األطعمة املقلية‪ ،‬األطعمة الحارة وكثيرة التوابل‪ ،‬املكَّس رات والبذور‪ ،‬الفشار‪ ،‬قد يمكنك بمرور الوقت تجربة بعض هذه‬
‫األطعمة مرة أخرى‪ ،‬بتوجيه من طبيبك‪.‬‬
‫تناُو ل الطعام والش راب ببطء‪ .‬استغرق حوالي ‪ 30‬دقيقة على األقل لتناول وجباتك ومن ‪ 30‬إلى ‪ 60‬دقيقة لشرب كوب واحد من‬
‫السوائل لتجنب متالزمة اإلغراق‪ .‬انتظر ‪ 30‬دقيقة قبل أو بعد كل وجبة لشرب السوائل‪.‬‬
‫جعل كميات الوجبات صغيرة‪ .‬تناول وجبات صغيرة عدة مرات في اليوم‪ .‬قد تبدأ بتناول ست وجبات صغيرة في اليوم‪ ،‬ثم تنتقل إلى‬
‫أربع وجب ات ثم أخ يًر ا ‪ -‬بع د اتباع ك نظاًم ا غ ذائًي ا منتظًم ا ‪ -‬ثالث وجب ات في الي وم‪ .‬يجب أن تتكون كل وجب ة من نص ف كوب إلى‬
‫كوب من الطعام‪.‬‬
‫شرب سوائل بين الوجبات‪ .‬لتجنب الجفاف‪ ،‬ستحتاج إلى شرب ‪ 8‬أكواب على األقل (‪ 1.9‬لتر) من السوائل يومًي ا‪ .‬لكن شرب الكثير‬
‫من الس وائل في وقت الوجب ة أو ب القرب من ه ق د يجعل ك تش عر بالش بع املف رط ويمنع ك من تن اول م ا يكفي من الطع ام الغ ني‬
‫باملغذيات‪.‬‬
‫التركيز على األطعمة الغنية بالبروتين‪ .‬تناول هذه األطعمة قبل تناولك األطعمة األخرى في وجبتك‪ ،.‬تجُّن ب األطعمة مرتفعة املحتوى‬
‫الدهني والسكري‪ .‬تنتقل هذه األطعمة بسرعة عبر الجهاز الهضمي وتسبب متالزمة اإلغراق‪.‬‬
‫َّك‬
‫تن اُو ل املكمالت الغذائي ة املحتوية على الفيتامين ات واملع ادن املوصي به ا‪ .‬بع د الجراح ة‪ ،‬ق د ال يتم ن جس مك من امتص اص‬
‫العناصر املغذية بالشكل الكافي من طعامك‪ .‬ومن املرَّج ح أن تحتاج إلى تناول مكمل غذائي يحتوي على فيتامينات متعددة كل يوم‬
‫طوال حياتك‪.‬‬
‫‪:‬إرشادات غذائية ملرضى النقرس‬
‫‪68‬‬
‫فقدان الوزن‪ .‬تزيد السمنة من أخطار إصابتك بالنقرس‪ ،‬ويساعد فقدان الوزن على تقليل مخاطر اإلصابة به‪ .‬تشير األبحاث‬
‫إلى أن تقلي ل ع دد الس عرات الحراري ة وفق دان ال وزن ‪ -‬ح تى دون نظ ام غ ذائي مقي د الُب ورين ‪ -‬س يخفض مس تويات حمض‬
‫اليوريك ويقلل عدد نوبات النقرس‪ .‬قد يقلل فقدان الوزن أيًض ا من الضغط الكلي على املفاصل‪.‬‬
‫الكربوهيدرات املركبة‪ .‬تناول مزي ًد ا من الفواكه‪ ،‬والخضروات والحبوب الكاملة‪ ،‬ما يوفر لك الكربوهيدرات املركبة‪ .‬تجنب‬
‫تناول األطعمة واملشروبات املضاف إليها شراب ذرة ذو تركيزات عالية من سكر الفركتوز‪ ،‬مع الحد من تناول عصائر الفاكهة‬
‫حلوة املذاق بطبيعتها‪.‬‬
‫املاء‪ .‬حافظ على ترطيب جسمك جيًد ا بتناول املاء بانتظام‪.‬‬
‫الدهون‪ .‬قلل من الدهون املشبعة املوجودة في اللحوم الحمراء والدواجن الدهنية ومشتقات الحليب الغنية بالدهون‪.‬‬
‫البروتينات‪ .‬رِّك ز على تناول اللحوم والدواجن خفيفة الدهن‪ ،‬ومشتقات األلبان قليلة الدسم‪ ،‬والعدس كمصادر للبروتين‪.‬‬
‫تتضمن التوصيات بأطعمة أو مكمالت غذائية محَّد دة ما يأتي‪:‬‬

‫ُغ‬
‫اللح وم العض وية وال ِّد ي ة‪ .‬تجنب لح وم الكب د والكلى والبنكري اس‪ ،‬ال تي تحت وي على مس تويات عالي ة من الُب ورين وتس هم في‬
‫ارتفاع مستويات حمض اليوريك في الدم‪.‬‬
‫اللحوم الحمراء‪ .‬قلل أحجام حصص الطعام من اللحم البقري‪ ،‬ولحم الضأن‪ ،‬ولحم الخنزير‪.‬‬
‫املأكوالت البحرية‪ .‬بعض أنواع املأكوالت البحرية ‪ -‬مثل أسماك األنشوجة‪ ،‬واألسماك القشرية‪ ،‬والسردين‪ ،‬والتونة ‪ -‬ترتفع‬
‫فيها نسبة البورين عن باقي األنواع األخرى‪ .‬لكن الفوائد الصحية اإلجمالية الناتجة عن تناول األسماك تفوق املخاطر بالنسبة‬
‫إلى األشخاص املصابين بالنقرس‪ .‬يمكن أن يكون تناول حصص معتدلة من األسماك جزًء ا من النظام الغذائي الخاص باملصابين‬
‫بالنقرس‪.‬‬
‫الخضراوات الغنية بالُب ورين‪ .‬أظهرت الدراسات أن الخضراوات التي تحتوي على نسبة عالية من الُب ورين ‪ -‬مثل نبات الهليون‬
‫والسبانخ ‪ -‬ال تزيد من مخاطر اإلصابة بالنقرس أو التعرض لنوبات النقرس املتكررة‪.‬‬
‫املشروبات الكحولية‪ .‬يرتبط تناول مشروب البيرة واملشروبات الكحولية املقطرة بارتفاع مخاطر اإلصابة بالنقرس أو التعرض‬
‫لنوباته املتكررة‪ .‬ال يبدو أن تناول النبيذ باعتدال يزيد من مخاطر التعرض لنوبات النقرس‪ .‬تجنب تناول املشروبات الكحولية‬
‫في أثناء التعرض لنوبات النقرس‪ ،‬وقلل من تناولها خاصة مشروب البيرة في الفترة بين النوبة واألخرى‪.‬‬
‫‪69‬‬
‫األطعمة واملشروبات السكرية‪ .‬تجنب أو قلل من تناول األطعمة املحالة بالسكر مثل حبوب اإلفطار‪ ،‬واملخبوزات‪ ،‬والحلوى‬
‫املحالة بالسكر‪ .‬قلل من تناول عصائر الفواكه املحالة طبيعًي ا‪.‬‬
‫فيت امين ‪ .C‬ق د يس اعد فيت امين ‪ C‬على خفض مس تويات حمض اليوري ك‪ .‬تح دث م ع طبيب ك بش أن إذا م ا كان املكم ل الغ ذائي‬
‫لفيتامين ‪ C‬بمقدار ‪ 500‬ملليغرام يالئم نظامك الغذائي وخطة عالجك أم ال‪.‬‬
‫القه وة‪ .‬تش ير بعض الدراس ات إلى أن تن اول القه وة بانتظ ام‪ ،‬خصوًص ا القه وة العادي ة ال تي تحت وي على الكافيين‪ ،‬ق د يرتب ط‬
‫بانخفاض خطر اإلصابة بالنقرس‪ .‬قد يكون شرب القهوة غير مالئم إذا كنت تعاني من حاالت مرضية طبية أخرى‪ .‬تحدث مع‬
‫طبيبك بشأن كمية القهوة املناسبة لك‪.‬‬
‫الكرز‪ .‬توجد بعض األدلة على أن تناول الكرز يرتبط بانخفاض مخاطر اإلصابة بنوبات النقرس‪.‬‬
‫تغذية املرأة الحامل‪:‬‬

‫ًة‬
‫تع د التغذي ة الجي دة مهم خالل ف ترة الحم ل؛ للمحافظ ة على صحة األم والج نين؛ حيث إن نوعي ة الطع ام أهم من كميت ه‪ ،‬ل ذلك ينصح‬
‫باختي ار األطعم ة الصحية ذات القيم ة الغذائية العالية‪ ،‬وتجُّن ب املأكوالت غ ير الصحية‪ ،‬كم ا أن التغذية الجيدة تس اعد على التعامل مع‬
‫املتطلبات اإلضافية للجسم مع تقدم الحمل؛ حيث إن الهدف هو تحقيق التوازن في الحصول على العناصر الغذائية الكافية لدعم نمو‬
‫الجنين والحفاظ على وزن صحي‪.‬‬
‫أهمية التغذية الجيدة في فترة الحمل‪:‬‬
‫بناء العظام وخاليا الدم للجنين‪.‬‬ ‫‪‬‬

‫تقليل متاعب الحمل ومشاكله‪.‬‬ ‫‪‬‬
‫َي‬ ‫ْع‬ ‫ُمل‬
‫تعزيز املناعة للوقاية من األمراض ا ِد ة‪.‬‬ ‫‪‬‬
‫الوقاية من اإلصابة بأنيميا نقص الحديد‪.‬‬ ‫‪‬‬
‫تقوية الجسد استعداًد ا للوالدة‪.‬‬ ‫‪‬‬
‫تعزيز تكوين الحليب للرضاعة الطبيعية‪.‬‬ ‫‪‬‬
‫كمية العناصر الغذائية التي تحتاجها الحامل‪:‬‬
‫الكمية املوصى بها‬

‫املادة الغذائية‬ ‫املصادر‬
‫يومًّي ا‬
‫البروتينات‬ ‫‪ 70‬جراًم ا‬ ‫اللحوم‪ ،‬األسماك‪ ،‬الدواجن‪ ،‬البيض‪ ،‬منتجات األلبان‪ ،‬البقول‪ ،‬واملكسرات‬
‫الكالسيوم‬ ‫‪ 1000‬ملجم‬ ‫منتجات األلبان‪ ،‬الخضراوات الورقية الخضراء‪ ،‬عصير البرتقال‪ ،‬واللوز‬
‫اللحوم‪ ،‬األسماك‪ ،‬الدواجن‪ ،‬الحبوب والخبز من الحبوب الكاملة‪ ،‬البقول‪ ،‬الخضراوات ذات األوراق الخضراء‪ ،‬الخوخ‬
‫الحديد‬ ‫‪ 27‬ملجم‬
‫املجفف‪ ،‬املشمش والزبيب‬
‫الفوالسين‬
‫‪ 600‬ميكروجرام‬ ‫الخضراوات ذات األوراق الخضراء‪ ،‬البقول‪ ،‬الحبوب الكاملة‪ ،‬عصير البرتقال‪ ،‬والهليون‬
‫(حمض الفوليك)‬
‫بيريدوكسين‬ ‫جنين القمح‪ ،‬اللحوم‪ ،‬الحبوب الكاملة‪ ،‬القنبيط‪ ،‬املوز‪ ،‬األفوكادو‪ ،‬الفول السوداني‪ ،‬بذور عباد الشمس‪ ،‬فول الصويا‪،‬‬
‫‪ 1.9‬ملجم‬
‫(ب‪)6‬‬ ‫والذرة‬
‫‪70‬‬
‫‪ 770‬مايكروجرام‬ ‫الجزر والبطاطا الحلوة‪.‬‬
‫فيتامين (أ)‬
‫باليوم‬
‫فيتامين سي (ج)‬ ‫‪ 85‬ملجم‪.‬‬ ‫في الفواكه الحمضية‪ ،‬والبروكلي‪ ،‬والطماطم‪ ،‬والفراولة‪.‬‬
‫فيتامين ‪D‬‬
‫‪ 600‬وحدة دولية‬ ‫التعرض ألشعة الشمس في األوقات املناسبة‪ ،‬ويوجد في الحليب املعزز‪ ،‬واألسماك الدهنية كالساملون والسردين‪.‬‬
‫األطعمة التي ينصح بتناولها‪:‬‬
‫البروتين ات‪ :‬ينصح بالحص ول عليه ا من اللح وم الخالي ة من ال دهون (مث ل‪ :‬ال دجاج‪ ،‬واألس ماك‪ ،‬وال بيض‪ ،‬واللح وم‪ ،‬والبق ول‬ ‫‪‬‬
‫وغيرها) كل يوم‪.‬‬
‫ًّي‬
‫يجب استهداف حصتين أسبوع ا من األسماك‪ ،‬مع الحرص على جعل إحداها من األسماك الزيتية (مثل‪ :‬الساملون)‪ ،‬أما سمك‬ ‫‪‬‬
‫املاكريل‪ ،‬والسردين ُي نَص ح أن ال تزيد على حصتين أسبوعًّي ا‪.‬‬
‫الكربوهيدرات (مثل‪ :‬الخبز‪ ،‬والحبوب‪ ،‬والبطاطا‪ ،‬واألرز واملعكرونة)‪.‬‬ ‫‪‬‬
‫ًض‬
‫الدهون‪ :‬ينصح بالحصول عليها من املصادر النباتية (مثل‪ :‬زيت الزيتون)‪ ،‬يمكن أي ا الحصول عليها من بعض األطعمة (مثل‪:‬‬ ‫‪‬‬
‫بعض األسماك‪ ،‬واألفوكادو‪ ،‬واملكسرات‪ ،‬والزيتون)‪ ،‬وتجُّن ب الدهون املشبعة‪.‬‬
‫منتجات األلبان املبسترة‪( :‬مثل‪ :‬الزبادي‪ ،‬والحليب‪ ،‬والجبن)‪ ،‬ويفضل اختيار األنواع قليلة الدسم‪.‬‬ ‫‪‬‬
‫الفواك ه والخض روات‪ :‬ينبغي اس تهداف ‪ 5‬حص ص يومًّي ا منه ا‪ ،‬م ع تجنب املض اف إليه ا س كر أو ملح؛ وذل ك للحص ول على‬ ‫‪‬‬
‫الفيتامينات واملعادن الالزمة‪.‬‬
‫اإلكثار من األلياف‪.‬‬ ‫‪‬‬
‫األطعمة التي يجب تجنبها‪:‬‬
‫تجُّن ب اللحم أو ال بيض غ ير املطب وخ؛ حيث إنه ا ق د تحت وي على جرثوم ة الليس تيريا ال تي تنتق ل إلى الج نين من خالل املش يمة‬ ‫‪‬‬
‫مسببة اإلجهاض‪ ،‬أو والدة جنين متوفى‪.‬‬
‫األسماك‪:‬‬ ‫‪‬‬
‫تجنب تناول السمك النيء أو املحار غير املطبوخ الذي قد يحتوي على الجراثيم (البكتيريا‪ ،‬الفيروسات أو الطفيليات)‪.‬‬ ‫‪‬‬
‫تجنب بعض أنواع األسماك؛ الحتوائها على مستوى عال من الزئبق الذي يمكن أن ُي لِح ق الضرر بالجهاز العصبي للجنين (مثل‪:‬‬ ‫‪‬‬
‫سمك القرش‪ ،‬سمك أبو السيف‪ ،‬سمك املارلين)‪.‬‬
‫الحد من تناول التونة البيضاء إلى ‪ 186‬جراًم ا في األسبوع‪.‬‬ ‫‪‬‬
‫الكافيين‪ :‬هي م ادة توج د بش كل ط بيعي في األطعم ة (مث ل‪ :‬الش اي‪ ،‬والقه وة‪ ،‬والش وكوالتة)‪ ،‬وبعض املش روبات الغازي ة‪،‬‬ ‫‪‬‬
‫ومشروبات الطاقة أو بعض املسكنات‪ ،‬وينصح بالحد من تناوله أثناء الحمل؛ حيث إن كثرته تزيد من خطر حدوث اإلجهاض‪،‬‬
‫وانخفاض وزن الطفل عند الوالدة‪.‬‬
‫‪71‬‬
‫الحليب غير املبستر وجميع منتجاته (مثل‪ :‬الجبن وغيره)‪.‬‬ ‫‪‬‬
‫املكمالت الغذائية‪:‬‬
‫املكمالت الغذائية الجيدة‪:‬‬
‫الحدي د‪ :‬لوقاي ة األم من اإلص ابة بأنيمي ا نقص الحدي د‪ ،‬باإلض افة إلى املس اعدة على نق ل ال دم ألك بر كمي ة من األكسجين إلى‬ ‫‪‬‬
‫الجنين‪.‬‬
‫حمض الفوليك‪ :‬لوقاية الجنين من اإلصابة بالصلب املشقوق‪.‬‬ ‫‪‬‬
‫املكمالت الغذائية الضارة‪:‬‬ ‫‪‬‬
‫تجنب اإلكثار من فيتامين (أ) سواٌء بالغذاء أو باملكمالت الغذائية؛ ألنها قد تضر بالجنين‪.‬‬ ‫‪‬‬
‫املكمالت الغذائية ال تغني عن التغذية الصحية‪.‬‬ ‫‪‬‬
‫التسمم الغذائي‪:‬‬
‫ُّن‬
‫هو ألم في البطن يصاحبه إسهال وقيء‪ ،‬يحدث بسبب عدوى بكتيرية أو جراثيم في املعدة‪ ،‬ولتج ب التسمم الغذائي ينصح بالتالي‪:‬‬
‫طهي الطعام واللحوم جيًد ا‪.‬‬ ‫‪‬‬

‫غسل الفواكه والخضروات جيًد ا‪.‬‬ ‫‪‬‬
‫املحافظة على نظافة املطبخ‪ ،‬وأدوات األكل والطهي‪.‬‬ ‫‪‬‬
‫غسل اليدين بعد الخروج من دورات املياه‪ ،‬وقبل وبعد تناول الطعام‪ ،‬وبعد التعامل مع اللحوم النيئة‪ ،‬وبعد ملس الحيوانات‪.‬‬ ‫‪‬‬
‫إرشادات عامة‪:‬‬
‫تجُّن ب األطعمة املقلية واستبدالها باملشوية‪.‬‬ ‫‪‬‬

‫ُي نَص ح بتناول الفواكه والخضروات املغسولة جيًد ا‪.‬‬ ‫‪‬‬
‫تجُّن ب البدء بالحمية الغذائية إلنقاص الوزن (الرجيم) في فترة الحمل؛ حيث يؤثر ذلك على حصول األم والطفل على العناصر‬ ‫‪‬‬
‫الغذائية املهمة‪.‬‬
‫التقليل من امللح في الطعام؛ حيث إنه يسبب احتباس السوائل مما يؤدي إلى ارتفاع ضغط الدم‪.‬‬ ‫‪‬‬
‫‪72‬‬
‫إرشادات تغذوية ملرضى كسل الغدة الدرقية‪:‬‬
‫تكون اإلرشادات الغذائية ملرضى كسل الغدة الدرقية مهمة ملساعدتهم في تحسين أعراضهم والتعامل مع هذا‬
‫املرض‪ .‬إليك بعض النصائح الغذائية التي يمكن أن تساعد‪:‬‬
‫زيادة تناول اليود‪ :‬اليود هو عنصر مهم لصحة الغدة الدرقية‪ ،‬لذا يجب تضمين األطعمة الغنية ب اليود في النظام الغذائي‪ .‬منها‬ ‫‪.1‬‬
‫األسماك البحرية (مثل السلمون والتونة) ومنتجات األلبان (مثل الحليب والزبادي) وملح الطعام امللحق به اليود‪.‬‬
‫تناول األغذية الغنية بالسيلينيوم‪ :‬السيلينيوم هو معدن مهم لوظيفة الغدة الدرقية‪ .‬يمكن العثور على السيلينيوم في األطعمة مثل‬ ‫‪.2‬‬
‫العدس واملكسرات (خاصة الكاشو) والدجاج والبيض‪.‬‬
‫تجنب الكربوهيدرات البسيطة‪ :‬قد يؤدي تناول كمي ات كبيرة من الكربوهيدرات البسيطة إلى زيادة في الوزن‪ ،‬مم ا يمكن أن يزيد‬ ‫‪.3‬‬
‫ًال‬
‫من أعراض كسل الغدة الدرقية‪ .‬يفضل تناول الكربوهيدرات الكاملة مثل الحبوب الكاملة والخضروات بد من السكر واملنتجات‬
‫املصنعة‪.‬‬
‫تناول كميات كافية من البروتين‪ :‬يجب ضمان تناول كميات كافية من البروتين في النظام الغذائي لدعم وظيفة الغدة الدرقية‬ ‫‪.4‬‬
‫والحفاظ على العضالت‪.‬‬
‫تقليل تناول الغذاء الثري بالجوع‪ :‬قد يزيد تناول الطعام الثري بالجوع من الشعور بالتعب والوزن الزائد‪ .‬من املفضل تناول وجبات‬ ‫‪.5‬‬
‫صغيرة ومتعددة على مدار اليوم‪.‬‬
‫‪73‬‬
‫تناول األطعمة الغنية باأللياف‪ :‬األلياف تساعد في تحسين عملية الهضم والسيطرة على مستويات السكر في الدم‪ .‬يمكن العثور‬ ‫‪.6‬‬
‫على األلياف في الخضروات والفواكه والحبوب الكاملة‪.‬‬
‫التحكم في مستوى الصوديوم‪ :‬تناول كميات منخفضة من الصوديوم يمكن أن يساعد في التحكم في احتباس السوائل والتورم‪.‬‬ ‫‪.7‬‬
‫ًا‬
‫تجنب الكح ول‪ :‬يجب تجنب تن اول الكح ول أو تقلي ل اس تهالكه إلى الح د األدنى‪ ،‬حيث يمكن أن ي ؤثر س لب على وظيف ة الغ دة‬ ‫‪.8‬‬
‫الدرقية‪.‬‬
‫االستشارة الدورية مع طبيب أو أخصائي تغذية‪ :‬يجب أن تكون هناك استشارات دورية مع محترفي الرعاية الصحية ملراقبة وتقييم‬ ‫‪.9‬‬
‫التغييرات في وظيفة الغدة الدرقية وضبط النظام الغذائي حسب الحاجة‪.‬‬
‫االل تزام بتوصيات العالج‪ :‬إذا كان ُي وصى بتن اول أدوية لعالج كس ل الغ دة الدرقي ة‪ ،‬فيجب على املريض االل تزام بتعليم ات الط بيب‬ ‫‪.10‬‬
‫بشكل دقيق‪.‬‬
‫من املهم مراجعة الطبيب أو أخصائي التغذية لتقديم نصائح وتوجيهات مخصصة استناًد ا إلى حالة املريض الفردية واحتياجاته الغذائية‪.‬‬
‫‪:‬االرشادات التغذوية ملرضى القلب والكبد الدهني‬
‫تقلي ل ال دهون املش بعة والكوليس ترول‪ :‬يجب الح د من تن اول ال دهون املش بعة والكوليس ترول في النظ ام الغ ذائي‪ .‬ه ذه ال دهون‬ ‫‪.1‬‬
‫ترتب ط بارتف اع مس تويات الكولس ترول في ال دم وزي ادة خط ر األم راض القلبي ة‪ .‬تجنب اللح وم الدهني ة ومنتج ات األلب ان الكامل ة‬
‫الدسم والزبدة‪ ،‬واستبدلها باألسماك الدهنية مثل السلمون وزيت الزيتون‪.‬‬
‫زيادة تن اول األلي اف‪ :‬األلي اف تلعب دوًر ا مهًم ا في تحس ين صحة القلب‪ .‬توجد األلي اف بش كل ط بيعي في الخض روات والفواك ه‬ ‫‪.2‬‬
‫والحبوب الكاملة‪ ،‬وهي تساعد في خفض مستويات الكولسترول في الدم وتعزيز صحة األوعية الدموية‪.‬‬
‫الحف اظ على وزن ص حي‪ :‬الس يطرة على ال وزن والحف اظ على وزن ص حي يس اعد في تقلي ل الض غط على القلب‪ .‬اتب ع نظ ام غ ذائي‬ ‫‪.3‬‬
‫متوازن ومنخفض السعرات الحرارية إذا كنت بحاجة إلى فقدان الوزن‪.‬‬
‫الحد من الصوديوم‪ :‬قلل من استهالك الصوديوم للمساعدة في تنظيم ضغط الدم‪ .‬تجنب املأكوالت املصنعة واألطعمة اململحة‪،‬‬ ‫‪.4‬‬
‫واستخدم التوابل األخرى لتحسين نكهة الطعام‪.‬‬
‫التحكم في السكري‪ :‬إذا كان لديك مرض السكري‪ ،‬فحافظ على مستويات السكر في الدم ضمن النطاق املستهدف‪ ،‬حيث يرتبط‬ ‫‪.5‬‬
‫ارتفاع السكر بمشاكل صحية قلبية‪.‬‬
‫تناول األسماك‪ :‬تناول األسماك الدهنية مثل السلمون والتونة بانتظام‪ .‬تحتوي هذه األسماك على أحماض دهنية أوميغا‪ 3-‬التي‬ ‫‪.6‬‬
‫تعزز صحة القلب‪.‬‬
‫‪74‬‬
‫التقليل من الكحول‪ :‬تجنب تناول الكحول بكميات كبيرة‪ ،‬حيث يمكن أن يرفع استهالك الكحول خطر األمراض القلبية‪.‬‬ ‫‪.7‬‬
‫املراقبة الدورية‪ :‬تواصل مع طبيبك بانتظام ملراقبة صحة قلبك ومتابعة ت أثير التغذية عليه‪ .‬ضع خطة تغذية مناسبة لحالتك‬ ‫‪.8‬‬
‫الصحية الفردية‪.‬‬
‫التقلي ل من تن اول امللح‪ :‬تقلي ل اس تهالك امللح يمكن أن يس اعد في التحكم في ض غط ال دم‪ .‬اق رأ عالم ات األطعم ة وابحث عن‬ ‫‪.9‬‬
‫الخيارات منخفضة امللح‪.‬‬
‫التمت ع بوجب ات صحية ومتنوعة‪ :‬اخ تر مجموعة متنوعة من األطعم ة الصحية للحص ول على مجموعة متنوعة من العناص ر‬ ‫‪.10‬‬
‫الغذائية واملغذيات‪.‬‬
‫االلتزام بنمط حياة صحي يتضمن التغذية الصحية وممارسة النشاط البدني واالبتعاد عن عوامل الخطر املحتملة مثل التدخين هو مفتاح‬
‫للحفاظ على صحة القلب‪ .‬تأكد من مراجعة طبيبك لتطوير خطة تغذية تناسب احتياجاتك الصحية‬
‫االرشادات الغذائية ملرضى الذئبة الحمراء‪:‬‬
‫الذئبة الحم راء‪ ،‬واملعروفة أيًض ا باسم "الذئبة الحم راء الجناحية" أو "التهاب األوعية الدموية الناجم عن الذئبة" هي حالة تتميز‬
‫بالته اب األوعي ة الدموية الص غيرة واملتوسطة الحجم في الجل د واألعض اء الداخلي ة‪ .‬يجب على مرضى الذئب ة الحم راء اتب اع نظ ام‬
‫غذائي صحي ومتوازن للمساعدة في إدارة الحالة وتقليل األعراض‪ .‬إليك بعض النصائح الغذائية الهامة ملرضى الذئبة الحمراء‪:‬‬
‫‪** .1‬تجنب العوام ل املحف زة لالته اب‪ ** :‬بعض األطعم ة واملكمالت الغذائي ة يمكن أن تزيد من التهاب ات الجل د واألوعي ة الدموية‪.‬‬
‫من املهم تجنب هذه العوامل املحفزة‪ ،‬مثل الح رارة الزائدة‪ ،‬والكحول‪ ،‬واألطعمة الحارة‪**.‬تجنب األطعمة املثيرة‪ ** :‬يمكن أن تزيد‬
‫بعض األطعمة واملكمالت من التهابات الجلد‪ ،‬مثل الفلفل الحار والبهارات والقهوة‪ُ .‬ي فضل تجنب هذه األطعمة إذا كانت تزيد من‬
‫أعراض الذئبة الحمراء‪.‬‬
‫‪** .3‬تن اول األطعمة املض ادة لاللتهاب ات‪ :‬تن اول األطعم ة ال تي تحت وي على مض ادات االلته اب الطبيعي ة مث ل الفواك ه والخضروات‬
‫الطازجة وزيت الزيتون يمكن أن يساعد في تقليل االلتهابات‪.‬‬
‫‪** . 4‬الترطيب‪ :‬شرب الكثير من املاء يساعد في الحفاظ على ترطيب الجلد واملساهمة في صحة الجلد‪.‬‬
‫‪75‬‬
‫ تناول الفواكه والخضروات الغنية‬.‫ ** فيتامين سي يلعب دوًر ا هاًم ا في تقليل االلتهابات‬:‫ **تناول األطعمة غنية بفيتامين سي‬.5
.‫بهذا الفيتامين مثل البرتقال والفلفل األحمر‬
‫ ** بعض األشخاص يج دون أن تحكم في حميتهم وتجنب بعض األطعم ة يمكن أن يس اعد في تقلي ل‬:‫ **التحكم في الحمي ة‬.6
.‫ يمكنك العمل مع أخصائي تغذية للحصول على توجيهات مخصصة‬.‫األعراض‬
‫ ** من املهم استش ارة طبيب ك أو أخص ائي الجل د قب ل إدخ ال أي تغي يرات كب يرة في نظام ك الغ ذائي أو‬:‫ **االستش ارة الطبي ة‬.7
.‫استخدام مكمالت غذائية‬
‫ ** قم بمراقبة األع راض وتسجيل أي تغيرات تحدث على الجلد أو األوعية الدموية وقم بمشاركتها مع فريق‬:‫ **مراقبة األع راض‬.8
.‫الرعاية الصحية الخاص بك‬
‫ لذا يجب العمل مع األطباء وأخصائيي التغذية لتطوير خطة‬،‫التغذية ملرضى الذئبة الحم راء قد تكون مختلفة من شخص آلخر‬
.‫غذائية تلبي احتياجاتك الفردية وتساعد في إدارة الحالة بشكل فعال‬
References:
1- Microsoft. Open OneDrive and upload files - Microsoft Support. (n.d.). https://support.microsoft.com/en-us/office/open-
onedrive-and-upload-files-6e90fbe7-6c874eba-bc1b-1b91f59936f0
2- Current dietary guidelines. Food Sources of Potassium | Dietary Guidelines for Americans. (n.d.).
https://www.dietaryguidelines.gov/food-sources-potassium
3- Content map terms. Food Sources of Sodium | HealthLink BC. (n.d.). https://www.healthlinkbc.ca/healthy-eating-physical-
activity/food-and-nutrition/sodium/food-sources-sodium
4- Oh, C., Keats, E. C., & Bhutta, Z. A. (2020). Vitamin and mineral supplementation during pregnancy on maternal, birth,
Child Health and Development Outcomes in low- and middle-income countries: A systematic review and meta-analysis.
Nutrients. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7071347/
5- U.S. Department of Health and Human Services. (n.d.). Office of dietary supplements - iron. NIH Office of Dietary
Supplements. https://ods.od.nih.gov/factsheets/Iron-HealthProfessional/
6- ‫&من قبل‬nbsp; ‫ جود شحالتوغ‬.‫&د‬nbsp;
& - 2020 ‫ تش رين الث اني‬24 ‫الثالث اء‬, & 2021 ‫آخ ر تع ديل‬. (n.d.). ‫إرش ادات الغ ذاء ملرضى القص ور الكل وي‬. Webteb.
https://www.webteb.com/articles/%D8%A7%D8%B1%D8%B4%D8%A7%D8%AF%D8%A7%D8%AA-
76
%D8%A7%D9%84%D8%BA%D8%B0%D8%A7%D8%A1-%D9%84%D9%85%D8%B1%D8%B6%D9%89-
%D8%A7%D9%84%D9%82%D8%B5%D9%88%D8%B1-
%D8%A7%D9%84%D9%83%D9%84%D9%88%D9%8A_26551
7- ‫من إعداد فريق مايو‬. (n.d.). )‫ األطعمة التي تتناولها بعد إجراء الجراحة (مايو كلينك‬:‫النظام الغذائي بعد تحويل مسار املعدة‬. Mayo
Clinic. https://www.mayoclinic.org/ar/tests-procedures/gastric-bypass-surgery/in-depth/gastric-bypass-diet/art-
20048472
8- ‫من إع داد فري ق م ايو‬. (n.d.-b). ‫ه ل يمكن أن يس اعدك م ا تأكل ه من طع ام في التحكم ب النقرس؟‬. Mayo Clinic.
https://www.mayoclinic.org/ar/healthy-lifestyle/nutrition-and-healthy-eating/in-depth/gout-diet/art-20048524
9- Mayo Foundation for Medical Education and Research. (2023, August 18). Can certain foods improve thyroid function in
people with hypothyroidism?. Mayo Clinic. https://www.mayoclinic.org/diseases-conditions/hypothyroidism/expert-
answers/hypothyroidism-diet/faq-20058554
10- Microsoft. Microsoft Support. (n.d.). https://support.microsoft.com/en-us/office/onedrive-desktop-app-for-windows-
579d71c9-fbdd-4d6a-80ba-d0fac3920aac
( .‫ أشهر‬3 ‫; منذ‬nbsp&: ‫ أشهر آخر تحديث‬3 ‫; منذ‬nbsp; &nbsp&‫; نور دنورة‬nbsp; &nbsp&:‫تمت الكتابة بواسطة‬ -11
.‫ الفه رس الص حي‬.‫ نص ائح غذائي ة في ه‬7 ‫ النظ ام الغ ذائي ملرضى الذئب ة الحم راء؛ وأهم‬.)June 12 ,2023
/https://health.faharas.net/lupus-erythematosus-diet
Eat these 7 foods to get the best sleep of your life. CNET. (n.d.). https://www.cnet.com/health/sleep/eat-these-seven- -12
/foods-to-get-the-best-sleep-of-your-life
13- MedicineNet. (2023). 12 foods that help wake you up in the morning and give you instant energy. MedicineNet.
https://www.medicinenet.com/12_foods_wake_you_morning_give_instant_energy/article.htm
77
Appendices
Appendix-1-
"The new vocabulary learned during the previous training period has been put together in this annex, with a simple explanation."
Forms for nutrition: Hospital departments:

- MNA: Mini Nutrition Assessment.
- ICU: The Intensive Care Unit
- NRS: Nutritional Risk Screening.
- HAACP: Hazard Analysis Critical - CCU: critical care unit
Control Point - Department of childbirth and preterm
- NCP: Nutrition care process.
- FRS: Framingham risk score for cardio infants
vascular disease. - private section.
78
Word abbreviations: Word abbreviations:
- RTA: route traffic accident - Hypothyroidism

- Bone Cancer - Hyperthyroidism
- HF: heart failure - Gestational diabetes
- Diabetic foot - Mixing formula
- Prostatic cancer - Urinary tract infection
- DkA: diabetic keto acidosis - Cabbage
- Pulmonary edema - Thermic effect of food
- IHD: ischemic heart disease - Dry weight
- Septic shock - Ideal body weight
- CKD: Chronic kidney disease - Stress factor
- Stab wounds - Insulin resistant
- COPD: Chronic obstructive pulmonary disease - Liposuction
- Laminotomy - Epilepsy
- HTN: hypertension - Anemia
- Steatorrhea - Lung fibrosis
-
- Angioplasty - Atherosclerosis
- Hypokalemia - Ascites
- Kidney stones - Asthma
- RBS: regular blood sugar - Knee atherosclerosis
- MT: multiple tracks - Ibs prostate ipss
- RD: regular diet - Ovarian cyst
- P Cath.: post catheterization - Lasix pump
- For Cath.: before catheterization - TAH: total abdominal hysterectomy
- Deep C/w: cut down - Hysterectomy TA
- Aplastic anemia - Termination
- cerebral DM - Open cholecystectomy
- CVA: cerebrovascular accident - Enteral nutrition
- Foot dressing - Parenteral nutrition
- Liver disease - NPO (nothing by mouth)
- Gout - Dialysis
- GRED
Appendix-2- “Lab data result. “ - diabetic nephropathy
- Renal failure - esophageal dysphagia
79
80
Appendix -3- (food rich in potassium)
Food STANDARD Portion CALORIES POTASSIUM

(mg)
Vegetables
Beet greens, cooked 1 cup 39 1309
Fufu, cooked 1 cup 398 1080
Lima beans, cooked 1 cup 209 969
Swiss chard, cooked 1 cup 35 961
Potato, baked, with skin 1 medium 161 926
Yam, cooked 1 cup 158 911
Acorn squash, cooked 1 cup 115 896
Amaranth leaves, cooked 1 cup 28 846
Spinach, cooked 1 cup 41 839
Breadfruit, cooked 1 cup 170 808
Bamboo shoots, raw 1 cup 41 805
Water chestnuts 1 cup 120 724
Carrot juice, 100% 1 cup 94 689
Taro leaves, cooked 1 cup 35 667
Plantains, cooked 1 cup 215 663
Taro root (dasheen or yautia), cooked 1 cup 187 639
Adzuki beans, cooked 1/2 cup 147 612
Cress, raw 2 cups 32 606
Butternut squash, cooked 1 cup 82 582
Parsnips, cooked 1 cup 110 572
Sweet potato, cooked 1 cup 190 572
81
Luffa gourd, cooked 1 cup 100 571
Chrysanthemum leaves, cooked 1 cup 20 569
Purslane, cooked 1 cup 21 561
Kohlrabi, cooked 1 cup 48 561
Broccoli rabe (rapini), cooked 1 cup 40 550
Drumstick pods (moringa), cooked 1 cup 42 539
Mushrooms, portabella, cooked 1 cup 35 529
Stewed tomatoes, canned 1 cup 66 528
Tomato juice, 100% 1 cup 41 527
Vegetable juice, 100% 1 cup 48 518
Mustard spinach, cooked 1 cup 29 513
Pumpkin, canned 1 cup 83 505
White beans, cooked 1/2 cup 125 502
Winter squash, cooked 1 cup 76 494
Artichoke, cooked 1 cup 89 480
Celeriac, raw 1 cup 66 468
Dandelion greens, cooked 1 cup 35 455
Cassava (yucca), cooked 1 cup 267 451
Burdock root, cooked 1 cup 110 450
Bok choy, cooked 1 cup 24 445
Soybeans, cooked 1/2 cup 148 443
Lotus root, cooked 1 cup 108 440
Poi (taro root) 1 cup 269 439
Pink beans, cooked 1/2 cup 126 430
82
Small white beans, cooked 1/2 cup 127 415
Carrots, raw 1 cup 52 410
Black turtle beans, cooked 1/2 cup 120 401
Snow peas, cooked 1 cup 67 384
Corn, cooked 1 cup 134 384
Salsify, cooked 1 cup 92 382
Pinto beans, cooked 1/2 cup 123 373
Escarole, cooked 1 cup 22 368
Rutabaga, cooked 1 cup 51 367
Lentils, cooked 1/2 cup 115 366
Avocado 1/2 cup 120 364
Fennel bulb, raw 1 cup 27 360
Onions, cooked 1 cup 92 359
Kidney beans, cooked 1/2 cup 113 359
Split peas, cooked 1/2 cup 116 355
Navy beans, cooked 1/2 cup 128 354
Great northern beans, cooked 1/2 cup 105 346
Cowpeas, dried and cooked 1/2 cup 80 345
Cranberry (roman) beans, cooked 1/2 cup 121 343
Edamame, cooked 1/2 cup 94 338
French beans, cooked 1/2 cup 114 328
Hyacinth beans, cooked 1/2 cup 114 327
Pigeon peas, cooked 1/2 cup 102 323
83
Cauliflower, raw 1 cup 27 320
Red bell pepper, raw 1 cup 39 314
Black beans, cooked 1/2 cup 114 306
Nettles, cooked 1 cup 37 297
Summer squash, cooked 1 cup 18 296
Turnip greens, cooked 1 cup 29 292
Nopales, cooked 1 cup 22 291
Yellow beans, cooked 1/2 cup 128 288
Fava beans, cooked 1/2 cup 94 228
Collard greens, cooked 1 cup 63 222
Fruit
Durian 1 cup 357 1059
Sapote or Sapodilla 1 cup 217 794
Jackfruit 1 cup 157 739
Prune juice, 100% 1 cup 182 707
Guava 1 cup 112 688
Passion-fruit juice, 100% 1 cup 126 687
Soursop 1 cup 148 626
Kiwifruit 1 cup 110 562
Pomegranate juice, 100% 1 cup 134 533
Orange juice, 100% 1 cup 112 496
Melon, cantaloupe 1 cup 60 473
Cherimoya 1 cup 120 459
Banana 1 medium 112 451
84
Tangerine juice, 100% 1 cup 106 440
Grapefruit 1 fruit 130 415
Pummelo or pomelo 1 cup 72 410
Apricots 1 cup 74 401
Peaches, dried 1/4 cup 96 399
Loquats 1 cup 70 396
Melon, honeydew 1 cup 61 388
Apricots, dried 1/4 cup 78 378
Grapefruit juice, 100% 1 cup 95 362
Lychee 1 cup 125 325
Pineapple juice, 100% 1 cup 132 325
Mandarin orange 1 cup 103 324
Tangerine (tangelo) 1 cup 103 324
Prunes or dried plum 1/4 cup 105 319
Melon, casaba 1 cup 48 309
Raisins 1/4 cup 123 307
Cherries 1 cup 87 306
Gooseberries 1 cup 66 297
Peach 1 cup 60 293
Dairy and Fortified Soy Alternatives

Yogurt, plain, nonfat 8 ounces 137 625
Yogurt, plain, low fat 8 ounces 154 573
Kefir, plain, low fat 1 cup 104 399
Milk, fat free (skim) 1 cup 83 382
85
Buttermilk, low fat 1 cup 98 370
Milk, low fat (1 %) 1 cup 102 366
Yogurt, Greek, plain, nonfat 8 ounces 134 320
Yogurt, Greek, plain, low fat 8 ounces 166 320
Soy beverage (soy milk), unsweetened 1 cup 80 292
Protein Foodse
Clams 3 ounces 126 534
Skipjack tuna 3 ounces 112 444
Shad 3 ounces 214 418
Mullet 3 ounces 128 389
Pollock 3 ounces 100 388
Rainbow trout, freshwater 3 ounces 142 383
Whiting 3 ounces 99 368
Herring 3 ounces 172 356
Goat 3 ounces 122 344
Tempeh 1/2 cup 160 342
Atlantic mackerel 3 ounces 223 341
Sardines, canned 3 ounces 177 338
Tilapia 3 ounces 108 323
Cod 3 ounces 71 316
Smelt 3 ounces 105 316
Catfish 3 ounces 122 311
Bison 3 ounces 122 307
Pork 3 ounces 171 303
86
Tofu, raw, firm, prepared with calcium sulfate 1/2 cup 181 299
Haddock 3 ounces 77 298
Beef 3 ounces 173 288
Pistachio nuts 1 ounce 162 286
Deer 3 ounces 134 285
Lamb 3 ounces 158 285
Salmon (various) 3 ounces ~115-175 ~280-535
Game meats (various) 3 ounces ~115-180 ~285-345
Other Sources
Coconut water, unsweetened 1 cup 43 396
Sodium in food:
87
Food Serving Size Sodium (mg)
Vegetables and fruit
Tomato sauce, canned 125mL (½ cup) 614
Sauerkraut, canned 125mL (½ cup) 496
Pizza sauce, ready to serve, canned 125mL (½ cup) 463
Pickles (sour) 1 small 447
Pepper, jalapeno, canned 1 pepper 368
Tomato juice, canned 125mL (½ cup) 325
Pickles (dill) 1 small 299
Olives, canned 4 olives 248
Tomatoes, canned 125mL (½ cup) 236
Potatoes, instant, mashed 125mL (½ cup) 191
Vegetables, mixed, canned 125mL (½ cup) 184
Tomato and vegetable juice, low sodium 125mL (½ cup) 89
Tomatoes, sundried 125mL (½ cup) 70
Tomato paste, no salt added 60mL (2 Tbsp) 41
Vegetables, any variety, no sodium added, 125mL (½ cup) 25

canned
Tomato juice, no salt added 125mL (½ cup) 13
88
Pepper, jalapeno, raw 1 medium 0
Fresh and most frozen vegetables contain very little sodium. All fruit including fresh,
frozen, dried and canned is low in sodium.
Grains
Bread stuffing, dry mix, prepared 125mL (½ cup) 506
Macaroni and cheese, box mix, prepared 125ml (½ cup) 459
Hot cereal, instant 175mL (¾ cup) 370-225
Rice mix, seasoned, prepared 125mL (½ cup) 365
Bagel ½ bagel 288
Crackers, saltine 10 saltines 282
Pancake mix 1 small pancake 239
Bread roll 1 roll 224
Muffin, commercial 1 small 222
Bread, whole wheat, commercial 1 slice 213
Breadcrumbs, plain, commercial 60mL (2 Tbsp) 200
Pancakes, frozen 1 pancake 189
Breadstick, plain 1 stick 71
Grains cooked without salt such as rice, barley, quinoa, oats, wheat and whole grain pasta
are low in sodium.
Meat, fish, poultry and eggs
89
Mackerel, salted 75g (2 ½ oz) 3337
Anchovies, canned 75g (2 ½ oz) 2751
Bacon, turkey, cooked 75g (2 ½ oz) 1516
Salami 75g (2 ½ oz) 1418
Bacon, pork, cooked 75g (2 ½ oz) 1263
Pepperoni 75g (2 ½ oz) 939
Bacon, pork, reduced sodium, cooked 75g (2 ½ oz) 773
Sausage, Italian, cooked 75g (2 ½ oz) 614
Chicken, rotisserie with seasoning 75g (2 ½ oz) 235-544
Sausage, chorizo, cooked 75g (2 ½ oz) 540
Chicken nugget, cooked 75g (2 ½ oz) 420
Crab, imitation (surimi) 75g (2 ½ oz) 397
Fish sticks, cooked 75g (2 ½ oz) 302
Salmon, canned, salted 75g (2 ½ oz) 293-306
Egg substitute 125mL (½ cup) 264
Sardines, canned 75g (2 ½ oz) 173
Egg, whole, cooked 2 large eggs 125
Mackerel, baked or broiled 75g (2 ½ oz) 62
Salmon, canned, unsalted 75g (2 ½ oz) 56
90
Fresh and unprocessed frozen meat, poultry and fish contain little sodium.
Legumes, nuts and seeds
Beans, baked, plain, canned 175mL (¾ cup) 644
Tofu, smoked 175mL (¾ cup) 423mg
Pumpkin seeds, salted 60mL (¼ cup) 412
Veggie burgers 1 patty (70g) 398
Chickpeas, canned, drained, rinsed 175mL (¾ cup) 225
Cashews, salted 60mL (¼ cup) 222
Almonds, salted 60mL (¼ cup) 174
Peanut butter 30mL (2 Tbsp) 139
Soy beverage, fortified 250mL (1 cup) 96
Edamame, raw 125mL (½ cup) 20
Tempeh 175mL (¾ cup) 14
Tofu, regular 175mL (¾ cup) 10
Chickpeas, no salt added , canned 175mL (¾ cup) 7
Cashews, unsalted 60mL (¼ cup) 6
Almonds, unsalted 60mL (¼ cup) 1
Dried beans and lentils, as well as unsalted nuts and seeds and 100% natural nut and seed
butter contain little sodium.
91
Milk, yogurt and cheese
Processed cheese slices (cheddar) 50g (1 ½ oz) 907
Feta cheese 50g (1 ½ oz) 458
Gouda cheese 50g (1 ½ oz) 410
Cottage cheese, regular 125mL (½ cup) 368
Mozzarella cheese 50g (1 ½ oz) 355
Cheddar cheese 50g (1 ½ oz) 322
Buttermilk 250mL (1 cup) 272
Chocolate milk, 2% 250mL (1 cup) 174
Milk, 2% 250mL (1 cup) 121
Yogurt, fruit flavoured 175mL (¾ cup) 67
Swiss (Emmental) cheese 50g (1 ½ oz) 35
Cottage cheese, dry curd 125mL (½ cup) 20
Soups
Broth, chicken 250mL (1 cup) 869
Broth, beef 250mL (1 cup) 812
Chicken noodle soup, canned 250mL (1 cup) 740
Chicken noodle soup, reduced sodium 250mL (1 cup) 529
Broth, beef, reduced sodium 250mL (1 cup) 516
92
Broth, beef, no salt added 250mL (1 cup) 38
Oils and fats
Salad dressing, Caesar 15mL (1 Tbsp) 180
Dip, cream cheese based 30mL (2 Tbsp) 182
Butter, regular 15mL (1 Tbsp) 93
Salad dressing, low sodium 15mL (1 Tbsp) 16
Butter, unsalted 15mL (1 Tbsp) 2
Vegetable oil 15mL (1 Tbsp) 0
Vinaigrette no salt added, homemade 15mL (1 Tbsp) 0
Other foods
Salt, table 5mL (1 tsp) 2373
Soy sauce 15mL (1 Tbsp) 1244
Salt substitute, with potassium, reduced 5mL (1 tsp) 1040

sodium*
Teriyaki sauce 15mL (1 Tbsp) 700
Taco seasoning 15mL (1 Tbsp) 625
Oyster sauce 15mL (1 Tbsp) 499
Salsa 60mL (¼ cup) 463
Soy sauce, reduced sodium 15mL (1 Tbsp) 425
93
Hot sauce 15mL (1 Tbsp) 381
Pretzel, soft 1 small pretzel 338
Gravy, canned 60mL (¼ cup) 331
Teriyaki sauce, reduced sodium 15mL (1 Tbsp) 325
Cake mix, prepared as directed 1/12 cake slice 315
Chocolate pudding, instant mix, prepared 125mL (½ cup) 275
Capers, canned 15mL (1 Tbsp) 205
Mustard, yellow 15mL (1 Tbsp) 174
Worcestershire sauce 15mL (1 Tbsp) 171
Relish 15mL (1 Tbsp) 166
Barbecue sauce 15mL (1 Tbsp) 163
Ketchup 15mL (1 Tbsp) 138
Chips, plain (potato, tortilla) 250mL (1 cup) 110
Horseradish 15mL (1 Tbsp) 64
Popcorn, microwave 250mL (1 cup) 64
Popcorn, air-popped, plain 250mL (1 cup) 1
Salt substitute, herb blend, no sodium 5 mL (1 tsp) 0
94
Appenidix-4-
Daily Recommended Dietary Allowance for Vitamins, Micronutrients and Macronutrients
for Pregnancy.
Vitamins, Micronutrients and Unit Institute of Medicine Recommended Dietary
Macronutrients Allowance (RDA) for Pregnancy
14–18 Years 19–30 Years 31–50 Years
Vitamin A (retinol) µg 750 770 770
Vitamin B1 (thiamin) mg 1.4 1.4 1.4
Vitamin B2 (riboflavin) mg 1.4 1.4 1.4
Vitamin B3 (niacin) mg 18 18 18
Vitamin B5 (pantothenic acid) mg 6 6 6
Vitamin B6 (pyridoxine) mg 1.9 1.9 1.9
Vitamin B7 (biotin) µg 30 30 30
Vitamin B9 (folate) µg 600 600 600
Vitamin B12 (cobalamine) µg 2.6 2.6 2.6
Vitamin C (ascorbate) mg 80 85 85
Vitamin D (cholecalciferol) IU 15 15 15
Vitamin E (tocopherol acetate) mg 15 15 15
Vitamin K (phytomenadione) µg 75 90 90
Choline mg 450 450 450
Calcium mg 1300 1000 1000
Chromium g 29 30 30
Copper µg 1000 1000 1000
Fluoride mg 3 3 3
Iodine µg 220 220 220
Iron mg 27 27 27
Magnesium mg 400 350 360
Phosphorus mg 1250 700 700
Selenium µg 60 60 60
Zinc mg 12 11 11
Potassium mg 2600 2900 2900
Sodium mg 1500 1500 1500
Chloride g 2.3 2.3 2.3
Carbohydrate g 175 175 175
Fat g Not determined Not determined Not determined
Linoleic Acid g 13 13 13
α-Linoleic Acid g 1.4 1.4 1.4
Protein g 71 71 71
95
Appendix-5: Iron Content of Selected Foods
Food Milligrams per serving Percent DV*
Breakfast cereals, fortified with 100% of the DV for iron, 1 serving 18 100
White beans, canned, 1 cup 8 44
Beef liver, pan fried, 3 ounces 5 28
Lentils, boiled and drained, ½ cup 3 17
Spinach, boiled and drained, ½ cup 3 17
Tofu, firm, ½ cup 3 17
Chocolate, dark, 45%–69% cacao solids, 1 ounce 2 11
Kidney beans, canned, ½ cup 2 11
Sardines, Atlantic, canned in oil, drained solids with bone, 3 ounces 2 11
Tomatoes, canned, stewed, ½ cup 2 11
Beef, braised bottom round, trimmed to 1/8” fat, 3 ounces 2 11
Potato, baked, flesh and skin, 1 medium potato 2 11
Cashew nuts, oil roasted, 1 ounce (18 nuts) 2 11
Green peas, boiled, ½ cup 1 6
Chicken, roasted, meat and skin, 3 ounces 1 6
Rice, white, long grain, enriched, parboiled, drained, ½ cup 1 6
Bread, whole wheat, 1 slice 1 6
Bread, white, 1 slice 1 6
Spaghetti, whole wheat, cooked, 1 cup 1 6
Tuna, light, canned in water, 3 ounces 1 6
Turkey, roasted, breast meat and skin, 3 ounces 1 6
Nuts, pistachio, dry roasted, 1 ounce (49 nuts) 1 6
Broccoli, boiled and drained, ½ cup 1 6
Egg, hard boiled, 1 large 1 6
Rice, brown, long or medium grain, cooked, 1 cup 1 6
Cheese, cheddar, 1.5 ounces 0 0
Mushrooms, white, sliced and stir-fried, ½ cup 0 0
Cheese, cottage, 2% milk fat, ½ cup 0 0
Milk, 1 cup 0 0
* DV = Daily Value. The U.S. Food and Drug Administration (FDA) developed DVs to help consumers compare the nutrient contents of foods
and dietary supplements within the context of a total diet. The DV for iron is 18 mg for adults and children age 4 years and older [26]. FDA
requires food labels to list iron content. Foods providing 20% or more of the DV are considered to be high sources of a nutrient, but foods
providing lower percentages of the DV also contribute to a healthful diet. The U.S. Department of Agriculture’s (USDA’s) FoodData Central
[25] lists the nutrient content of many foods and provides a comprehensive list of foods containing iron arranged by nutrient content and by food
name.
96
Appendix-6-
1. Aspiration Pneumonia: This is a type of pneumonia that occurs when foreign materials, such as
food, saliva, or stomach acid, enter the lungs. It's a common complication in individuals with
swallowing difficulties or GERD.
2. Emphysema: Emphysema is a lung condition characterized by the destruction of the lung's air
sacs, leading to shortness of breath and reduced lung function. It is often associated with chronic
obstructive pulmonary disease (COPD).
3. Barrett's Esophagus: Barrett's esophagus is a condition where the normal lining of the
esophagus is replaced by tissue similar to the lining of the intestine. It is associated with chronic
GERD and can increase the risk of esophageal cancer.
4. Belching: Belching, or burping, is the act of expelling air from the stomach through the mouth,
often accompanied by a sound. It's a normal bodily function but can be excessive in some cases.
5. Cancer Cachexia: Cancer cachexia is a wasting syndrome characterized by severe weight loss,
muscle atrophy, fatigue, and weakness in cancer patients. It is a result of the body's response to
the presence of cancer.
6. Chronic PEM (Protein-Energy Malnutrition): Chronic PEM is a condition where there is a
long-term deficiency of both calories and protein in the diet, leading to malnutrition.
7. COPD (Chronic Obstructive Pulmonary Disease): COPD is a progressive lung disease that
includes chronic bronchitis and emphysema. It leads to difficulty in breathing and reduced lung
function.
8. Cholecystectomy: Cholecystectomy is the surgical removal of the gallbladder, often performed
to treat gallstones or gallbladder disease.
9. Cystic Fibrosis: Cystic fibrosis is a genetic disorder that primarily affects the lungs and
digestive system. It leads to the production of thick and sticky mucus that can block airways and
ducts.
10. Gastroparesis: Gastroparesis is a condition where the stomach takes longer than usual to empty
its contents into the small intestine. It can lead to symptoms like nausea, vomiting, and
abdominal discomfort.
11. Gastrostomy: A gastrostomy is a surgical procedure to create an opening (stoma) through the
abdominal wall into the stomach. It's often done to provide nutrition and medications directly
into the stomach, typically through a feeding tube.
97
12. Goiter: A goiter is an enlarged thyroid gland, which can be caused by various conditions,
including iodine deficiency, thyroid nodules, or thyroid autoimmune diseases.
13. Hemochromatosis: Hemochromatosis is a genetic disorder that leads to excessive iron
absorption and accumulation in the body's tissues and organs
Appendix-7-
98
1. Black Pepper:
 Benefits: Black pepper is often used as a spice and for its potential health benefits. It may
aid digestion, act as an antioxidant, and have anti-inflammatory properties.
 Permissible Dose: It is generally safe when used as a spice in food. For supplements,
follow the recommended dosage on the product label.
 Caution: Individuals with gastrointestinal issues or sensitivity to spicy foods may need to
limit their intake.
2. Ginger:
 Benefits: Ginger is known for its anti-nausea, anti-inflammatory, and digestive
properties. It can also help with motion sickness and pain relief.
 Permissible Dose: Typically, 1-2 grams of ginger per day is considered safe. However,
consult a healthcare provider for specific dosing, especially in pregnancy or for certain
medical conditions.
 Caution: Ginger supplements should be used with caution if you're taking blood-thinning
medications.
3. Cinnamon:
 Benefits: Cinnamon is rich in antioxidants and has been associated with improved blood
sugar control and reduced inflammation.
 Permissible Dose: Cinnamon is generally safe when used in moderate amounts as a
spice. There is no established recommended dose for supplements, so consult a healthcare
provider.
 Caution: Cassia cinnamon, in particular, contains coumarin, which may be harmful in
large amounts.
4. Sagebrush (Artemisia spp.):
 Benefits: Sagebrush has been used traditionally in herbal medicine for various purposes,
including digestive complaints and as a mild sedative.
 Permissible Dose: Specific dosing guidelines can vary depending on the species and
preparation. Consult with a herbalist or healthcare provider.
 Caution: Some species of sagebrush may contain compounds that can be toxic in large
amounts, so it's essential to use it under guidance.
5. Cumin:
99
 Benefits: Cumin is often used as a spice and may have digestive and anti-inflammatory
benefits.
 Permissible Dose: There's no specific recommended dose, as it's commonly used in
culinary applications.
 Caution: Cumin is generally safe when used in food, but some individuals may be
sensitive to it.
6. Anise:
 Benefits: Anise is known for its sweet licorice-like flavor and may aid in digestion and
ease symptoms like bloating and gas.
 Permissible Dose: Use it as a spice or in tea. There's no established safe upper limit.
 Caution: Individuals with allergies to plants in the Apiaceae family (like celery or
carrots) should be cautious with anise.
7. Marjoram:
 Benefits: Marjoram is a herb used for culinary purposes and is known for its aromatic
and mild flavor.
 Permissible Dose: Use it as a spice or in cooking. There are no known safety concerns
when used in moderation.
8. Caraway:
 Benefits: Caraway seeds are used for their aromatic flavor and potential digestive
benefits.
 Permissible Dose: Use as a spice or in cooking. There are no established dose limits.
9. Hibiscus:
 Benefits: Hibiscus is often consumed as a tea and may have antioxidant properties and
potential blood pressure-lowering effects.
 Permissible Dose: When consumed as tea, there are no specific dose limits.
 Caution: Hibiscus may interact with certain medications, so consult a healthcare
provider if you're on medication.
100
Apendix-8-
Foods That Help Sleep:
1. Cherries: Cherries, especially tart cherries, are a natural source of melatonin, a hormone
that regulates sleep-wake cycles.
2. Fatty Fish: Salmon, mackerel, and trout are high in omega-3 fatty acids, which may help
improve sleep by reducing inflammation.
3. Warm Milk: Warm milk contains tryptophan, an amino acid that can promote sleep. It
also provides comfort and relaxation.
4. Leafy Greens: Vegetables like spinach and kale are rich in magnesium, which can help
relax muscles and improve sleep quality.
5. Nuts: Almonds and walnuts are good sources of magnesium and melatonin, making them
sleep-friendly snacks.
6. Bananas: Bananas contain magnesium and potassium, which can help relax muscles and
regulate sleep patterns.
7. Oats: Oats are a source of complex carbohydrates that can stabilize blood sugar levels
and promote a steady release of serotonin, which aids in sleep.
8. Herbal Teas: Chamomile, valerian root, and lavender teas are known for their calming
properties and can help induce sleep.
9. Turkey: Like warm milk, turkey contains tryptophan, which may contribute to post-
Thanksgiving meal drowsiness.
10. Whole Grains: Foods like whole-grain bread, rice, and pasta have a low glycemic index,
helping to maintain steady blood sugar levels and potentially improve sleep.
101
Foods That Help Wakefulness:
1. Coffee: Coffee contains caffeine, a stimulant that can increase alertness and wakefulness.
However, excessive caffeine intake can lead to jitteriness and disrupt sleep.
2. Green Tea: Green tea contains caffeine but in lower amounts than coffee. It also
provides other compounds like L-theanine, which can have a calming effect.
3. Dark Chocolate: Dark chocolate contains caffeine and theobromine, which can provide
a mild energy boost.
4. Fruits: Fruits like apples and citrus fruits contain natural sugars and can provide a quick
source of energy.
5. Eggs: Eggs are a good source of protein and B vitamins, which can help sustain energy
levels throughout the day.
6. Nuts: Nuts like almonds and cashews are rich in healthy fats and protein, providing
sustained energy.
7. Greek Yogurt: Greek yogurt is a protein-rich option that can help keep you feeling full
and alert.
8. Water: Dehydration can lead to fatigue, so staying hydrated with water can help
maintain wakefulness.
9. Spicy Foods: Foods with spicy ingredients like chili peppers can increase metabolism
and temporarily boost alertness.
10. Whole Grains: Foods like whole-grain cereal and bread provide a steady release of
energy due to their complex carbohydrates.
Appendix-9- “food drug interaction”
102
1. Heparin: Heparin is typically administered intravenously or subcutaneously and is not affected by
food interactions.
2. Sulfa Drugs: Some sulfa drugs may interact with food, causing gastrointestinal upset. Taking them
with food or milk can help reduce stomach irritation.
3. Clindamycin: Clindamycin should be taken with a full glass of water, and it can be taken with or
without food. It's generally well-tolerated with or without food.
4. Rifampicin: Rifampicin can interact with a variety of foods and drugs. It's often recommended to
take it on an empty stomach, at least one hour before or two hours after a meal. Avoid alcohol while
taking rifampicin.
5. Azithromycin: Azithromycin can be taken with or without food. It's generally well-tolerated with or
without food.
6. Plavix (Clopidogrel): Plavix should be taken with or without food. It's not significantly affected by
food interactions.
7. Amoxiclav: Amoxiclav (a combination of amoxicillin and clavulanic acid) can be taken with or
without food. Taking it with food may help reduce stomach upset.
8. Aspirin: Aspirin can be taken with or without food. However, taking it with food may help reduce
stomach irritation.
9. Insulin: The timing of insulin administration in relation to meals is crucial. The type and dose of
insulin will determine when it should be taken in relation to meals.
10. Vancomycin: Vancomycin is typically administered intravenously and is not influenced by food
interactions.
11. Rocephin (Ceftriaxone): Rocephin is usually administered intravenously or as an injection and is not
affected by food interactions.
12. Nexium (Esomeprazole): Nexium should be taken at least one hour before a meal. It works best
when the stomach is empty.
13. Clexan (Enoxaparin): Enoxaparin is typically administered by injection and is not influenced by
food interactions.
14. Lasix (Furosemide): Lasix can be taken with or without food. It's generally well-tolerated with or
without food.
15. Coumadin (Warfarin): Warfarin can interact with vitamin K-containing foods, so it's important to
maintain a consistent intake of vitamin K-rich foods (e.g., leafy greens) and monitor your INR levels.
103

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Final Report

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Table of contents:

Gender: Male Height: 173cm EER: 1795.2Calories.

Nutrition intervention - Type of diet: Dash and Consistent carbohydrate diet.

TOTAL FOR DAY 240g 96g 52g 1725

Lunch Carbs Protein Fat calories

Breakfast Carbs protein Fats Calories

Snack Carbs protein Fats Calories

- 3 oz grilled chicken breast 0g 20g 3g 110cal

- 1 small orange 15g 0g 0g 60cal

Dinner Carbs protein Fats Calories

Total 242 86 78 1900

Breakfast Carbs protein Fats Calories

Lunch Carbs protein Fats Calories

Snack Carbs protein Fats Calories

2 rice cakes 15g 1g 1g 60cal

Total 240 78 42 1730

1 cup of fruits cocktail (Orange, plum and milk) 30 1 0 100

Lunch Carbs Protein Fat calories

½ cup of cooked freekeh 22 5 0 70

1 cup of lentil soup

TOTAL FOR DAY 240g 96g 52g 1725

Days-4- 8Aug2023 Tuesday

Food Allergies/Intolerances None

Use of Medications None

PA & stress factor PA = (1.2) || Stress Factors: Surguy (1.3)

- Uric acid: 5 mg/dl (normal)

Physical examination None

- (Consistence carbohydrate diet and iron-rich food)

Breakfast Carbs Protein Fats calories Iron

Total 30 18 15 270 4.7

Breakfast Carbs Protein Fats calories Iron

Lunch Carbs Protein Fat calories Iron

Breakfast Carbs Protein Fats calories Iron

Lunch Carbs Protein Fat calories Iron

Breakfast Carbs Protein Fats calories Iron

Lunch Carbs Protein Fat calories Iron

Breakfast Carbs Protein Fats calories Iron

Physical examination At risk of Malnourished, mouth ulcer and abdominal pain.

- (Consistence carbohydrate diet and high protein high calorie diet)

Diet planning for 7 days:

TOTAL FOR DAY 227g 113g 50g 1700

Breakfast Carbs protein Fats Calories

Snack Carbs protein Fats Calories

- 6 oz grilled chicken breast 0g 40g 5g 250cal

- 1 small orange 15g 0g 0g 60cal

Dinner Carbs protein Fats Calories

Total 228 106 72 1900

Breakfast Carbs protein Fats Calories

Lunch Carbs protein Fats Calories

Snack Carbs protein Fats Calories

2 rice cakes 15g 1g 1g 60cal

Dinner Carbs protein Fats Calories

½ cup oatmeal 15g 5g 2g 150cal

Total 225 103 50 1770

TOTAL FOR DAY 227g 113g 50g 1700

Lunch Carbs Protein Fat calories

Day-7- 15Aug2023 Tuesday

Gender: Male Height: 168cm EER:.1130 calories/day

Medical History HTN.

Physical examination None

Diagnosis: - Restirected sodium requirement related to hypertension as evidence by medical history.

Diet planning for 3 days:

Total Total 75g

Daily Energy Requirements: BMRPALStress factor