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Medical nutrition therapy for Underweight Underweight is weight 10-15% below average.

It can be caused by Inadequate consumption

of nutritious food because of depression, disease, anorexia nervosa, bulimia, or poverty, or it can be genetically determined. Also excessive physical activity, tissue wasting of certain disease, poor absorption of nutrients, infection, hypercatabolic conditions like cancer, aids, Kochs or tuberculosis, fever or hyperthyroidism may lead to weight loss.

Assessment: - Ideal body weight- less than 20%

Clinical signs:- depleted fat levels, Low protein levels, poor concentration, more than 10% weight loss in 10 days Management: - Pharmacological management, nutritional management

Nutritional Management Aim: - To meet the calorie and protein requirement.

Objective: - To treat underweight and maintain present body weight. Underweight is treated by high- calorie diet or by a high calorie combined with psychological counseling if the condition is psychological in origin. The diet should be based on the food guide pyramid so that it can be easily adapted from the regular, family menus or to a soft textured diet. Energy:- the total number of calories prescribed per day will vary from person to person , depending on the persons activity, age weight, gender and physical condition. Table Sedentary Moderate Heavy Obesity Normal 20-25 30 30 35 35 40 Kcal as per the physical activity. Underweight 35 40 45

To gain weight the total caloric intake should be in excess of the energy requirement. Initially the calories should be calculated as per the present body weight for eg:- 35 or 40 or 45 x present body weight( see underweight column) and later as per Ideal body weight. Thus 35-40 kcal/present body weight and then increase the calories by stepping up in order to fulfill the caloric requirement as per the ideal body weight. These extra kcals needed may be achieved by giving small frequent meals such as snacks, between meals or making the recipe nutrient dense by increasing or adding

certain ingredient to it. The increase should be gradual over 1 or 2 weeks otherwise digestive disturbances may occur.
Carbohydrates:- not more than 65% of carbohydrates is recommended. Leafy vegetables should be restricted and preferences should be given to potato, yam, arbi. Dried fruits, sweets, nuts, dessert, and cereals, non-vegetarian foods are rich source of energy and can be liberally included in the diet.

Proteins:- Proteins help to build and repair body tissues. Muscle or tissue wasting can be a cause of underweight, taking this into consideration instead of 1 g /IBW initially 1.2g/kg present body weight protein is recommended for tissue building and later the same should be given as per the ideal body weight. Further if there is no weight gain than the amount of proteins can be increased up to i.5g/IBW and maximum upto 2g. for underweight children 3g protein is recommended. Good quality protein is completely utilized by the body. 50% of the total protein should be high biological value protein. If this is unable to achieve than a cereal protein combination is must. Proteins should be equally distributed in each meal Fats:- Not more than 25% of energy should come from fats. Of which 30 gms can be visible fats and saturated fats can be given in restricted amounts i.e upto 1 tsp. Easily digestible fats should be given, fried and fatty foods are not recommended as excessive fats may lead to gastric problems thus causing further negative energy balance. If underweight is due to inflammatory conditions then omega 3 fatty acid source should be incorporated in the diet. Vitamins and minerals:- The diet should consist of normal amount of vitamins and minerals. Vitamins and minerals play an important role while stepping up of recipes. As the intake is less, diet can be made nutrient dense by incorporating vitamin and mineral rich foods. Fluids:-Fluids should not be taken before or within a meal, but only after a meal, so that food intake is not reduced. Enough fluid must be taken in the form of juices, milkshakes, soups etc in order to avoid constipation.