Plan a diet for a 50-year-old man with cirrhosis of the liver and ascites, and calculate its nutritive value.
How to lay out the answer. Follow the frame, then write it in your own words.
1 · Aim. To plan, prepare and calculate a diet for Mr. M with cirrhosis and ascites.
2 · Principles.
Energy about 35 kcal/kg; protein 1.2-1.5 g/kg, not restricted
Sodium about 2 g for ascites; fluid only if serum sodium is very low
Meals every 3-4 hours and a late evening snack
Soft food if varices; no alcohol
3 · Nutrient prescription. Dry weight = 68 − 10% ≈ 61 kg; energy 61 × 35 ≈ 2100 kcal; protein 61 × 1.2 ≈ 75 g; sodium about 2 g.
4 · Foods to include and avoid. Include milk, curd, dals, egg, rice, ragi, fruits and vegetables; avoid salt at the table, pickles, papad, bakery snacks and alcohol.
5 · Sample menu. [Table: Time | Menu | Amount, with the 10 pm ragi porridge]
6 · Calculation. [Table: food group | amount | energy | protein] Total about 2080 kcal and 75 g protein (99% and 100%).
7 · Result. The diet gives about 2080 kcal and 75 g protein with about 2 g sodium and meets Mr. M's needs.
8 · Preparation tips. Measure the day's salt, flavour with lemon and herbs, send the bedtime snack, serve soft food if varices.
Scoring tip: Write 'protein is NOT restricted' and 'late evening snack' in bold; they are the two points examiners hunt for.
