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GLOSSECTOMY
VIDHI SHAH R.D INTERN
INTRODUCTION
CANCER
▸Cancer is a generic term for a large group of diseases characterized by the
growth of abnormal cells beyond their usual boundaries that can then invade
adjoining parts of the body and/or spread to other organs. It is the second
leadingcause of death globally (WHO)
▸ Oral cancer is a major problem in the Indian subcontinent where it ranks
among the top three types of cancer in the country
▸Age-adjusted rates of oral cancer in India is high, that is, 20 per 100,000
population and accounts for over 30% of all cancers in the country
ORAL CANCER
Cancer that starts in the mouth is
oral cavity cancer –
•Includes lips-
•Inside lining of cheeks (buccal
mucosa)
•Gingiva (gums )
•Floor of the mouth
•Anterior 2/3 rd of the tongue
•Hard palate
Malnutrition or a diet lacking in chemo-
protective vitamins namely A, C & E has been
shown to be a
predisposing factor
TREATMENT
▸Surgery
▸Chemotherapy
▸Radiotherapy
Glossectomy:
Partial Glossectomy- This is the removal of
any part of the tongue, from a small part of
the side or tip, an entire half of the tongue or
even more.
Total Glossectomy- This is the removal of the
entire tongue, including the base of the
tongue. This results in severe dysfunction
with swallowing and resultant aspiration
(food and liquids falling into the lungs)
NUTRITIONAL IMPLICATION OF SURGERY
•Negative nitrogen balance
• Post treatment under nutrition may be due to various factors
Surgery
Depending on the tumor site
Procedure and approach
•Swallowing
•Inability to chew
•Agluttion (inability to swallow)
•Dysphagia
•Mucositis
•Communication impairment
•Aspiration
May significantly alter the
anatomy and lead to scarring that
negatively impacts
CASE STUDY
Patient profile ▸Name: Abc
▸Age: 63 years old
▸Gender: Female
▸Community: Maharashtrian
▸Economic Status: Middle Income Group
▸Food Preference: Non Vegetarian
▸No of Family Members: 5
▸Residential Area: Maharashtra
▸Date of Admission : 27.12.2016
▸Date of discharge: 09.01.2017
▸Length of hospital stay : 15 days
▸Addictions: Nil
▸SGA Score: A
ANTHROPOMETRIC MEASUREMENTS
Measurements Values
Height 165cms
Weight 55 kgs
5 kgs underweight
Body mass index (BMI) 20.2 kg/m2
Ideal Body Weight (IBW) 60 kgs
CLINICAL PRESENTATION
Present Complaints:
Patient have the complaints of ulcerating lesion on the right lateral border of
tongue (leukoplakia) associated with pain since one month
Past Medical History:
k/c/o Urinary tract infection since 7 years , appendectomy done 30 years
Final Medical Diagnosis: Cancer FOM + Right Tongue
Surgery Done: Right Composite Resection of Tongue (Wide Glossectomy) +
Modified Neck Dissection + Submentel Flap Reconstruction
BIOCHEMICAL PARAMETERS
Investigation 27.12.2016 31.12.2016 5.1.2017 Normal Range
HAEMOGLOBIN 11.1 12 12.8 12.5-16g/dL
RBC COUNT 4.38 4.36 5.02 3.8-4.8 x 10e12/L
HAEMATOCRIT 34.6 34.6 40.2 36-46 %
PLATELETS 288 304 378 150-400 x 10e9/L
MPV 8.0 8.1 7.9 7.5-10.5 fL
PDW 42.5 43.1 31.8 25-65 %
PCT 0.23 0.25 0.30 0.12-0.36 %
WBC COUNT 10.14 7.27 8.30 4.0-10.0 x 10e9/L
NEUTROPHIL % 81.6 72.2 70.5 40.0-80.0 %
LYMPHOCYTE % 11.6 16.4 20.6 20.0-40.0 %
MONOCYTE % 4.4 5.9 4.6 2.0-10.0 %
EOSINOPHIL % 1.2 2.1 2.5 1.0-6.0 %
BASOPHIL % 0.2 0.4 0.3 1.0-2.0 %
SERUM SODIUM 137 136 141 136-145 mmol/L
SERUM POTASSIUM 3.7 3.9 4.2 3.5-5.1 mmol/L
SERUM CHLORIDES 99 97 105 98-107 mmol/L
SERUM BICARBONATES 28.4 27.6 25.1 22-29 mmol/L
SERUM CREATININE
0.7 - 0.7 0.7-1.3 mg/dL
MEDICATIONS
MEDICATION DOSAGE MECHANISM OF ACTION SIDE SIDES
Inj fentanyl 150mg Is used as part of anesthesia to help prevent pain
after surgery or other medical procedure.
Fever, respiratory depression,
nausea, vomiting,
Inj sucol 100 mg Is used for the treatment of muscular relaxation
during anesthesia, mechanical ventilation
Muscle pains, acute
rhabdomyolysis, transient ocular
hypertension, constipation, and
changes in cardiac rhythm.
Inj. Tramazac 50 mg Used for the treatment of long time pain, intense
sudden pain
Vomiting, nausea, abdominal
cramps, hallucinations,
Inj paracip 1 gm Treatment of headache, toothache, ear pain,
joint pain, periods pain, fever
Feeling of sickness, skin
reddening, allergic reactions,
shortness of breath,
Inj pantodac 40 gm Used for the treatment of heartburn, back flow
of acid from stomach, difficulty in swallowing,
inflammation of esophagus, excess acid
secretion by stomach, intestinal or stomach
ulcers and other conditions.
Increased risk of bone fractures,
severe itching of skin, rash body
temperature, diarrhea, and blurred
vision.
MEDICATIONS
MEDICATION DOSAGE MECHANISM OF ACTION
SIDE SIDES
Inj emeset 4 mg Treatment of nausea and vomiting Uneven heartbeats, headache,
low blood pressure leading to
fainting or dizziness,
Inj augmentin 1.2 gm is antibiotic used to treat a wide variety of
bacterial infections.
Diarrhea, nausea, or vomiting
may occur
Tab chymoral forte 1 Swelling (edema), especially those caused by
inflammation (e.g. Swelling of the tooth or
swelling of the gums). After surgical trauma.
Skin rash,
Redness of the skin,
Itching of the skin,
Tab resiyl 0.25 mg Is used to relieve excess anxiety and to treat
anxiety-associated disorders
Headache, dizziness, hiccup,
abnormal involuntary
movements,
Syp. Duphalac 10 ml Is a laxative used to treat constipation.. It may
help to increase the number of bowel movements
per day and the number of days you have a bowel
movement.
Gas, bloating, burping, stomach
rumbling/pain, nausea
24 HOUR HOME RECALL
Menu
Ingredien
ts Amounts
Household
measure
Energy
(kcals)
CHO
(g)
Proteins
(g) Fat (g)
Na
(mg) Fe (mg) TDF(g) IDF(g) SDF (g) Zn Ca
9.30 am BREAKFAST
Tea Milk 50 ml ½ cup 33.3 3 2.5 3 36.5 0.1
Sugar 5 gms 1 tsp 20 4.8
Digestive biscuits 3 no 3 122.4 16.7 1.83 2.67 1.83
12.30 pm LUNCH
Bhat Rice 45 gms 1 ½ katori 150 31.5 3.75 0.75 0.31 1.84 1.44 0.4
Dal Tur dal 15 gms 1 katori 50 8.5 3.5 0.25 8.55 0.81 2.73 2.04 0.69
Tomato 25gms ¼ katori 6.25 1.5 0.25 3.22 0.16 0.42 0.3 0.12
Onion 25gms ¼ katori 10 2.5 0.25 1 0.15
Oil 5 ml 1 tsp 45 5
Baida Kadi Egg 1 no 1 no 90 7 7 1.05
Tomato 50 gms ½ katori 12.5 3 0.5 6.45 0.32 0.85 0.6 0.25
Onion 100 gms 1 katori 40 10 1 4 0.6
Coconut 10 gms 2 tsp 40 0.3 0.35 0.8 0.17 1.36 1.27 0.25
Oil 10 ml 2 tsp 90 10
4.30 am TEA TIME
Tea Milk 50 ml ½ cup 33.3 3 2.5 3 36.5 0.1
Sugar 5 gms 1 tsp
Digestive biscuits 3 no 3 no 122.4 16.7 1.83 2.67 1.83
7.30 am DINNER
Bhat Rice 45 gms 1 ½ katori 150 31.5 3.75 0.75 0.31 1.84 1.44 0.4
Dal Tur dal 15 gms 1 katori 50 8.5 3.5 0.25 8.55 0.81 2.73 2.04 0.69
Tomato 25 gms ¼ katori 6.25 1.5 0.25 3.22 0.16 0.42 0.3 0.12
Onion 25 gms ¼ katori 10 2.5 0.25 1 0.15
Oil 5 ml 1 tsp 45 5
Batate chi
bhaji Potato 50 gms ½ katori 50 12 0.5 5.5 0.24 0.85 0.55 0.3
Tomato 50 gms ½ katori 12.5 3 0.5 6.45 0.32 0.85 0.6 0.25
Onion 50 gms ½ katori 20 5 0.5 2 0.3
Oil 10 ml 2 tsp 90 10
TOTAL 1298.9 165.5 34.51 51.14 122.94 6.06 17.55 10.58 3.47
INTERPRETATION
Energy –
23% calories/kg bd wt
Protein –
0.6g/kg bd wt
Fat –
35 % of total calories
Fruits and vegetables intake -
Fluid intake-
Changes In Dietary Patterns
▸Frequency of meals
▸Quantity of food meals
▸Ability to chew and swallow was
reduced
▸Changes in texture
▸Length of time and effort taken to eat
▸Changes in appetite
▸Use of supplements
GOALS OF NUTRITIONAL MANAGEMENT
▸ Early recovery from the surgery
▸Maintenance of body weight, minimizing weight loss
▸Preventing or minimizing nutritional deficiencies
▸Preserving muscle tissue
▸Minimizing nutrition-impact symptoms such as decreased appetite,
nausea, bowel function changes
▸Maximizing health related quality of life (HRQOL)
MEDICAL NUTRITION THERAPY
WEIGHT LOSS AND MALNUTRITION
•Weight loss during treatment for HNSCC is a major concern;
substantial weight loss in 75-80% of patients has been widely reported.
The common treatments for HNSCC, including surgery, radiotherapy
(RT), and chemotherapy, also lead to changes that further complicate
and challenge oral intake.
•Patients with head and neck cancer are at risk of malnutrition as a result
of the site of their cancer, the disease process and the treatment.
(Hunter KU, Jolly S. Clinical review of physical activity and functional considerations in head and
neck cancer patients. Support Care Cancer 2013;21:1475-1479.)
ENERGY
•Daily calories for cancer patients vary between 25 to 35 calories per kg body
weight (k.b.w) depending on the physical activity i.e, whether the patient is
bedridden or ambulant. Namratha PK, Urooj A,Nutritional Implications In Head And Neck Cancer - A Review. Indian J Nutri.
2014;1(1): 103.
PROTEIN
•1.2-1.6g per k.b.w daily for hypercatabolic cancer patients and 1.5-2.5g per
k.b.w daily for severely stressed cancer patients.
•Muscle protein anabolism in patients with cancer Namratha PK, Urooj A,Nutritional Implications In Head And Neck Cancer - A Review. Indian J Nutri.
2014;1(1): 103.
FAT
N-3 polyunsaturated fatty acids and eicosapentanoic acid are reported to
be beneficial in preventing weight loss and improve immunity. (Namratha PK, Urooj A. Nutritional Implications In Head And Neck Cancer - A Review. Indian J Nutri.
2014;1(1): 103.)
Preliminary data suggest that in the peri-operative period, N-3 enriched
nutrition support may improve nutritional outcomes including weight,
lean body mass and fat mass, reduce post-operative infections and reduce
hospital stay. (Stableforth WD, Thomas S, Lewis SJ. A systematic review of the role of immunonutrition in patients
undergoing surgery for head and neck cancer. Int J Oral Maxillofac Surg 2009;38:103–10.)
MICRONUTRIENTS
Supplies of immunomodulatory and antioxidantmicronutrients(e.g.,
vitamin D,selenium,L-carnitine) and of those with little storage or
reservecapacity (e.g., vitamin B1, vitamin C, folic acid, and vitamin K) are
particularly critical An inadequate supply of antioxidant micronutrients in
patients with cancer is reflected, amongother things, in raised markers of
oxidative stress Gröber U, Holzhauer P, Kisters K, Holick MF, Adamietz IA. Micronutrients in Oncological Intervention.
Nutrients. 2016;8(3):163. doi:10.3390/nu8030163.
ENTERAL FORMULA
Immunonutrition are feeds containing amino acids, nucleotides and lipids.
It has been suggested that immunonutrition may reduce post-operative
infective complications. Multidisciplinary-Management-Guidelines-for-Head-and-Neck-Cancer.pdfhttp://bahno.org.uk/wp-
content/uploads/2014/03/
CASE PROGRESSION
DATE CASE PROGRESSION
27.12.2016 NBM
28.12.2016 NBM For Surgery
29.12.2016 Clear Liquids
30.12.2016 Ryles Tube Feed
31.12.2016 Ryles Tube Feed
01.01.2017 Ryles Tube Feed
02.01.2017 Ryles Tube Feed + Full Liquids
03.01.2017 Ryles Tube Feed + Full Liquids
04.01.2017 Ryles Tube Feed + Full Liquids
05.01.2017 Ryles Tube Feed + Soft Diet
06.01.2017 Ryles Tube Feed + Soft Diet
07.01.2017- 09.01.2017 Soft Diet
HOSPITAL DIET
NUTRITIONAL CALCULATION
▸2400 ml RT feed (9 feeds - 2 hourly feed)
▸Calories- 1986 kcals (35 calories / kg bd wt)
▸Carbohydrate - 289.7gms
▸Proteins –77.15g (1.4g/kg bd wt)
▸HBV – 53gms
▸Fat -56.45gms
▸Calorie to Nitrogen Ratio- 160:1N
RYLES TUBE FEED
TIME AMOUNT RT FEEDS
6:00 am 200 ml Milk + 3 Scoops Prosure supplement
8:00 am 200 ml Porridge Puree
10:00 am 200 ml Fruit Juice + 3 Scoops Prosure supplement
12:00 pm 250 ml
Boil Potato Puree (200ml) + Barley Water (50ml) + 3 Scoops Prosure
supplement
2:00pm 250 ml Rice Puree (150ml) + Dal (100ml ) + 15 ml Oil
4:00 pm 200 ml Curd (150ml)
6:00 pm 250 ml Rice Puree (150 ml ) + Dal (100ml) + 10 ml Oil
8:00 pm 250 ml Paneer Puree
10:00 pm 200 ml Milk + 3 Scoops Prosure supplement
200ml Washing
Meta Gluta ZS 1 sachet added in the feed
Food Item Amounts
Energy
[kcal]
CHO
[gms]
Proteins
[gms]
Fat
[gms]
Calcium
[mgs]
Iron
[mgs]
Sodiu
m
[mgs] K[mgs]
Zinc
[mgs]
TDF
[gms]
IDF
[gms]
SDF
[gms]
Vitamin
C[mgs]
Milk (Low
Fat ) 4 ex 400 ml 116 18.4 10 0.4
480
0.8
292
560 -
8
Porridge
Puree 15 gms 200 ml 50 10.5 1.2 0.2 1.2 1.55 0.45 0.94
Fruit Juice 4 ex 200 ml 200 40 80 1.4 980 100
Boil Potato
Puree 200g 200 ml 200 48 2
20
0.96
22
494
3.4
2.2
1.2
34
Rice Puree 90 gms 300 ml 300 63 7.5 1.5 9 0.63 - - 0.0036 3.69 2.88 0.81 -
Dal 60 gms 200ml 200 34 14 1
43.8
1.62
17.1
662.4
5.46
4.08
1.38
-
Curd (Low
Fat) 150gms 200 ml 43.5 6.9 3.75 0.15
223.5
0.3
48
195 -
-
-
-
1.5
Paneer Puree 80 gms 200 ml 250 4 17.5 20
166.4
2.4
Oil 2 ½ 25ml 225 - - 25 - - - - - - - - -
Prosure
12
scoops 100 gms 402 64.9 21.2 8.2
474 480 640 7.9 3.1
110.2
Total 1986 kcals 289.7g 77.15g 56.45g 1496mg 6.91mgs 859mg 3531mg 7.9mgs 17.2g 10.06g 4.33g 256mgs
RT + LIQUIDS
Time Amount RT Feeds Orally Liquids
7:00 am 200 ml Orally
Milk + 3 Sccops Prosure
(200 ml)
8:00 am 200 ml Porridge Puree
10:00 am 200 ml Orally Fruit Juice (200 ml)
11.00 am Barley Water (100ml)
12:00 pm 250 ml
Boil Potato Puree (200ml) + Barley Water
(50ml) + 3 Scoops Prosure
2:00 pm 250 ml
Rice Puree (150ml) + Dal (100ml ) + 15
ml Oil + 3 Scoops Prosure
3.00pm Dal Water (100ml)
4:00 pm 200 ml Orally Buttermilk (200 ml )
6:00 pm 250 ml
Rice Puree (150ml ) + Dal (100ml) + 10ml
Oil
7.00 pm Rice Kanji (100ml)
8:00 pm 250 ml Paneer Puree
10:00 pm 200 ml Orally
Milk + 3 Scoop Prosure
(200ml)
200ml Washing
RT + SOFT DIET
Time Amount RT Feeds Soft Orally
6:00 AM 200 ml Orally
Milk + 3 Scoops Prosure
8:00 AM 200 ml Porridge Puree
10:00 AM 200 ml Orally Banana Milk Shake
12:00 PM 250 ml
Boil Potato Puree (200ml) + Barley Water
(50ml) + 3 Scoops Prosure
2:00 PM 250 ml Orally Soft Rice , Dal
4:00 PM 200 ml Orally Buttermilk
6:00 PM 250 ml Orally Soft Khichdi
8:00 PM 250 ml Paneer Puree
10:00 PM 200 ml Orally Milk + 3 Scoops Prosure
200ml Washing
SOFT DIET
Menu Amounts
Energy
[kcal]
CHO
[gms]
Proteins[
gms] Fat [gms]
Calcium
[mgs]
Iron
[mgs]
Sodium
[mgs] K[mgs]
Zinc
[mgs]
TDF
[gms] IDF [gms]
SDF
[gms]
8.00 am BREAKFAST
Milk Milk 150 ml 43.5 6.9 3.75 0.15 180 0.3 109.5 240
Prosure 15 gms 60.3 9.7 3.19 1.23 71.1 72 96 1.18 0.4
Bread
White
Bread 40 gms 100 21 2.5 0.5 4.4 0.44 3.72 52
Butter Butter 10 gms 70 10
Porridge
Puree Oats 30 gms 100 22 5 3 1.2 1.3 0.6 3.11 1.28 1.88
Milk 150 ml 43.5 6.9 3.75 0.15 180 0.3 109.5 240
Sugar 5 gms 20 4.8
Papaya Mash Papaya
1 ex / 150
gms 50 10 25.5 0.75 9 103.5 3.9 1.95 1.95
10.00 am MID MORNING
Buttermilk Curd 100gms 29 4.6 2.5 0.1 149 0.2 73 160
1.00 pm LUNCH
Green Pea
Soup
Green
Peas 50 gms 20 5 0.5 10 0.75 3.9 39.5
Oil 5ml 45 5
Soft Khichdi Rice 45 gms 150 31.5 3.75 0.75 21.9 0.31 0.58 1.84 1.44 0.4
Dal 30gms 100 17 7 0.5 1.62 17.1 662.4 0.27 5.46 4.08 1.38
Oil 5 ml 45 5
Plain Custard Milk 100 ml 29 4.6 2.5 0.1 120 0.2 73 160
Sugar 5 gms 20 4.8
Buttermilk Curd 100gms 29 4.6 2.5 0.5 0.2 73 160
3.30pm TEA TIME
Banana Milk
Shake Banana
1 ex / 50
gms 50 10 8.5 18.3 44 0.075 1.6 0.55 0.35
Milk 150 ml 43.5 6.9 3.75 0.15 180 0.3 109.5 240
Sugar 5 gms 20 4.8
Prosure 15 gms 60.3 9.7 3.19 1.23 71.1 72 96 1.18 0.4
Menu Amounts
Energy
[kcal]
CHO
[gms]
Proteins[g
ms] Fat [gms]
Calcium
[mgs]
Iron
[mgs]
Sodium
[mgs] K[mgs]
Zinc
[mgs]
TDF
[gms]
IDF
[gms]
SDF
[gms]
5.30pm EVENING
Jelly Jelly 1 cup 90 23
7.30 pm DINNER
Green Pea
Soup Green Peas 50 gms 20 5 0.5 0.75 3.9 39.5
Oil 5ml 45 5
Soft Rice Rice 30gms 100 21 2.5 0.5 0.21 0.58 1.23 0.96 0.27
Dal Dal 30 gms 100 17 7 0.5 21.9 1.62 17.1 662.4 0.27 5.46 4.08 1.38
Oil 10 ml 90 10
Minced
Chicken
With Ffsauce Chicken 50 gms 50 10 0.5 12.5
Milk 50 ml 29 4.6 2.5 0.5 60 0.1 36.5 80
Plain Custard Milk 150ml 43.5 6.9 3.75 0.15 180 0.3 109.5 240
Sugar 5 gms 20 4.8
10.30 pm BED TIME
Milk Milk 150ml 43.5 6.9 3.75 0.15 180 0.3 109.5 240
Prosure 30 gms 60.3 9.7 3.19 1.23 71.1 0 72 96 1.18 0.4 0 0
TOTAL 1819.4 283.7 77.07 46.89 1547 9.85 1093.32 3651.3 5.915 23.8 14.34 7.61
COMPLIANCE
`
DATE CASE PROGRESSION
COMPLIANCE
27.12.2016 NBM -
28.12.2016 NBM For Surgery -
29.12.2016 Clear Liquids -
30.12.2016 Ryles Tube Feed 100% compliance
31.12.2016 Ryles Tube Feed 100 % compliance
01.01.2017 Ryles Tube Feed 100% compliance
02.01.2017 Ryles Tube Feed + Full Liquids 100% compliance
03.01.2017 Ryles Tube Feed + Full Liquids 100% compliance
04.01.2017 Ryles Tube Feed + Full Liquids 100% compliance
05.01.2017 Ryles Tube Feed + Soft Diet 100% compliance
06.01.2017 Ryles Tube Feed + Soft Diet 100% compliance
07.01.2017 Soft Diet
Energy 86%
Protein 96%
08.01.2017 Soft Diet
Energy 90%
Protein 98%
09.01.2017 Soft Diet
Energy 90%
Protein 98%
DISCHARGE DIET
NUTRITIONAL CALCULATION
SOFT DIET
▸Calories- 1933 Kcals (35 calories/ kg bd wt)
▸Carbohydrate - 289 gms
▸Proteins –71 gms (1.3g/bg bd wt )
▸HBV – 35gms
▸Fat -59.49 gms
▸Calorie to Nitrogen Ratio-170:1N
EXCHANGE LIST
Food group No of
exchanges
Amounts
[gms/ml]
Calories
[Kcals]
CHO
[gms]
Proteins[gms] Fats [gms]
Cereal 4 120gms 400 84 10 2
Oats 1 30gms 100 31.4 5.2 3.8
Pulse 2 60gms 200 34 14 1
Milk
(skimmed)
2 ½ 350 ml 116.6 14 11.66 -
Eggs 2 2 no 180 - 14 14
Veg A 1 ½ 150 gms 50 9 1.5 -
Veg B 1 ½ 150gms 80 15 1.5 -
Veg C 1 100 gms 100 24 1 -
Fruits 3 3 ex 150 30 - -
Oil 3 ½ 35 ml 315 - - 35
Sugar ¼ 15 gms 60 - -
Prosure 45 gms 45 gms 10.9 29.2 9.5 3.69
Total 1933 Kcals 289 gms 71 gms 59.49 gms
Menu Amounts
Energy
[kcal]
CHO
[gms]
Proteins
[gms] Fat [gms]
Calcium
[mgs]
Iron
[mgs]
Sodium
[mgs]
Zinc
[mgs]
TDF
[gms]
IDF
[gms]
SDF[gms
]
Vitamin
C [mgs
8.00 am BREAKFAST
Oats Porridge Oats 30gms 100 31.42 5.2 3.8
Skim Milk 100 ml 33.3 4 3.33
120
0.2
73 2
Sugar 5 gms 20 4.8
Fruit Papaya 150 gms
50
10
25.5
0.75
9
3.9
1.95
1.95
85.5
11.00 am MID MORNING
Prosure
Boiled
Water
Prosure 45gms 180.9 29.2 9.5 3.69 49.59
1.00 pm LUNCH
Soup
Carrot
Soup 100 gms 40 10 1
80 1.03 35.6 0.36 4.4 3 1.4 3
Oil 5 ml 45 5
Khichdi Rice 45 gms 150 31.5 3.75 0.75 4.5 0.31 0.58 1.84 1.44 0.4
Tur Dal 30 gms 100 17 7 0.5 21.9 0.81 8.55 0.27 2.73 2.04 0.69
Oil 10 ml 90 10
Batata Chi
Bhaji Potato 100 gms 100 24 1 0 0.48 11 0.53 1.7 1.1 0.6 17
Curd Curd 50 gms 16.65 2 1.66 60 0.1 36.5 0.5
3.30 pm TEA TIME
Nachni And
Moong Dal
Satva (ARF)
Nachni 30 gms 100 21 2.5 0.5 103.2 1.17 3.3 0.69 3.45 2.97 0.48
Moong Dal 30 gms 100 17 7 0.5 2.25 0.117 0.816 0.084 0.246 0.195 0.051 2
Skim Milk 100 ml 33.3 4 3.33 120 0.2 73
Sugar 5 gms 20 4.8
Oil 5 ml 45 5
Menu
1933 Amounts
Energy
[kcal] CHO [gms]
Proteins[
gms] Fat [gms]
Calcium
[mgs]
Iron
[mgs]
Sodium
[mgs]
Zinc
[mgs]
TDF
[gms]
IDF
[gms]
SDF[gms
]
Vitamin
C [mgs]
5.30 pm EVENING
Milkshake Chickoo 50 gms 50 10 14 0.625 2.95 0.08 5.45 4.55 0.9 3
Skim
Milk 100 ml 33.3 4 3.33 120 0.2 73 2
8.00 pm DINNER
Soup Doodhi 100 gms 25 6 1 20 0.46 1.8 0.22 2 1.7 0.3
Oil 5 ml 45 5
Egg Pulao
Scramble
Egg 2 no 180 14 14
Rice 45 gms 150 31.5 3.75 0.75 4.5 0.31 0.58 1.84 1.44 0.4
Onion 50 gms 20 5 0.5 23.45 0.3 2 0.205 1.25 0.85 0.4 5.5
Tomato 50 gms 12.5 3 0.5 24 0.32 6.45 0.205 0.85 0.6 0.25 13.5
Oil 10 ml 90 10
10.00 pm BED TIME
Fruit Custard Banana 50 gms 50 10 8.5 0.18 18.3 0.075 0.9 0.55 0.35 3.5
Milk 100 ml 33.3 4 3.33 120 0.2 73 2
Sugar 5 gms 20 4.8 0 0 0 0 0 0 0 0
TOTAL 1933 289.02 71.68 59.49 872.28 19.482 419.096 5.649 33.066 23.165 9.451 189.09
MENU ALTERNATIVES PHYTONUTRIENTS
BREAKFAST
Oats porridge
Papaya
Oats milk shake
Muskmelon
Cinnamon powder
MID MORNING
Prosure supplement Flavours
LUNCH
Carrot Soup
Khichdi
Batata chi bhaji
Green pea soup
Soft rice with dal
Sauted sweet potato
Pepper, garlic
Turmeric
ginger
TEA TIME
Nachni ani moong dal cha satva Wheat ani moong dal cha satva
EVENING
Milkshake chickooo Banana milkshake Cinnamon powder
DINNER
Doodhi Soup
Egg pulao
Pumpkin soup
Bread
Akuri
Turmeric
Ginger
Garlic
BED TIME
Fruit custard (Banana) Chickoo, apple Cinnamon powder
FAT CALCULATION
Amounts SFA MUFA PUFA Omega 6 Omega 3
Rice 75 gms 0.33 0.3 0.38 0.37 0.0075
Ragi 30 gms 0.096 0.21 0.105 0.09 0.015
Moong Dhal 30 gms 0.135 0.015 0.24 0.18 0.06
Tur Dal 30 gms 0.144 0.03 0.3 0.3 0.03
Potato 100 gms 0.152 0.5 0.14 0.08 0.06
Total 0.857 1.055 1.165 1.02 0.1725
Olive Oil 10 ml 1.48 7.45 1 1
Rice Bran Oil 25 ml 5.52 10.25 8.9 8.57 0.35
Prosure 3.69ml 0.29
Total 7 17.7 9.9 9.57 0.64
Grand Total 8.714 19.81 12.23 11.61 0.985
SUPPLEMENT RECOMMENDATION
Nutrient Brand Cost Per Capsule
1 Iron Dexorange hematinic capsules Rs 2.68/-
2 Probiotic Bifilac Rs. 10/-
3 Omega 3 Sanofi triomega Rs 4/-
4 Vitamin C Celiin
Rs 1.5/-
5 Multi vitamin and multi
mineral
Inlife multivitamin & minerals tablet
Rs 8.5/-
RECOMMENDATIONS
Frequency and consistency of meals:
▸Moisten the food with gravy, soups.
▸Steamed or stewed dishes are easier to swallow.
▸Dry foods like biscuits and bread can be eaten by dipping them into
beverages
▸Choose smooth, soft, creamy textured food like cream soups, mashed
potatoes, porridge, yoghurt, puddings, custards.
▸Avoid foods that irritate the mouth. These include
▸Very spicy, sour or salty foods
▸Very hot or very cold foods and drinks
▸Caffeinated or highly sugared drinks
Cereals:
▸Eat whole grain cereals like wheat bran, oats, and whole wheat.
▸Avoid refined cereals like maida, rava, dalia, noodles (since whole
grains have high fiber and refined cereals have high amounts of
starch).
▸Mix different flours to make the dough (since fiber and protein will
increase).
▸Avoid eating breads like white or brown (since they are made of
maida).
Pulses:
▸Consume whole pulses like chole, rajmah and dals like moong,
masoor, toor and matki, chawli.
Milk and milk products:
▸Prefer cow’s milk over buffalo’s milk (since buffalo’s milk has high fat
content).
▸Prepare Skimmed milk at home by heating the milk and cooling it by
storing it in the refrigerator immediately. After some time separate the fat
(malai) from the surface of the milk and use it for other preparations.
Fruits and vegetables:
▸Eat 2- 3 serving of fruits for vitamins and minerals
▸Include more leafy vegetables atleast thrice per week in your diet for
adequate Iron and Calcium.
Fats and oils:
▸Use rice bran oil and olive oil for cooking.
▸Do not reuse oil.
▸Do not use or consume trans fats found in butter, biscuits, toast, khaari,
samosa, fried foods, cookies, cakes, pies, pizzas, chips, wafers etc.
OPD FOLLOW-UP
▸Patient came for the OPD follow up after 15 days month .
▸Patient was able to tolerate the soft foods.
▸To avoid any discomfort patient was advised to continue with the soft
diet.
▸Patients weight was maintained to 55kgs.
▸There was increase in the patients Hemoglobin levels which indicated
that anemia was resolved.
▸The patients swallowing capacity was improved .
