Nutritional Assessment & Recommendations

S.No._____________

Date:_____________

Nutritional Assessment (Protein & Mcro Nutrients) To help assess and prevent lifestyle diseases like Heart Disease, Osteoporosis, Cancer, Diabetes etc. Name:______________________________ Weight:___________

Age:______________Height:_____________________

Sex: Male / Female

Address:_______________________________________________________________________________ _________________________________________________________________________________________ _________________________________________________________________________________________ Mobile Number:_______________________ Category:

Adult / Child /Pregnant or Lactating Mother/ ody Builder/ Heavy Exerciser

Meal of the Day

Standard Serving Size

Egg 3 Bread Slices Roti Dosa 2 Idlys Milk Parantha Puri Rice Flakes Rice Puffed Semolina

57 g 50 g 35 g 50 g 75 g 200 ml 50 g 25 g 100 g 100 g 50 g

Salad Roti Rice Dal Sambhar Vegetable Fish Curd Curhi Khichri Roti Rice Dal Sambhar Vegetable Chicken/ Mutton Chholey

35 g 125 g 75 g 100 g 50 g 75 g 100 g 100 g 35 g 125 g 75 g 100 g 1 pc 100 g

Protein Gms/ Serving* Food (gms) Taken Break Fast 7.0 4.4 3.0 2.1 2.1 7.0 4.1 2.0 6.6 7.5 5.2 Lunch Nil 3.0 2.8 3.0 2.1 Nil 8.8 2.6 3.1 4.3 Dinner 3.0 2.8 3.0 2.1 Nil 8.0 4.2

Protein Intake

Remarks/ Recommendation

Total protein requirement as per Indian Council of Medical research (ICMR) (1gm/KG/body wt.)- _______________________ Total protein intake per day -______________________________________________________________________________ Protein supplementation required - _________________________________________________________________________ Recommended servings of fresh fruits and vegetables taken per day - ____________________________________________ Total Number of fresh fruits and vegetables taken per day - _____________________________________________________ Natural Multivitamin & Multimineral Required- ________________________________________________________________

Wellness Solutions Yes

No

PROTEIN INTAKE Is your protein intake less than the ICMR RECOMMENDATIONS. [ (Adult 1.0 g), (Child 1.5 g), (Pregnant / Lactating Mother 1.75 g), (Heavy Exercise Oriented 2.0 g) per kg body weight per day? Is you protein intake primarily from ANIMAL SOURCES (non-veg & diary products which are also rich in fats and cholestrol) and do you want to SUBSTITUTE it with a plant based product which is high protein, low fat and a zero cholestrol source ?

Yes

No

Yes

No

NEUTRACEUTICAL RECOMMENDATIONS Do you often SKIP meals? If you answered YES to 2 or more of the statements, you may benefit from taking Do you often reduce CALORIE INTAKE to try and lose weight? a Neutraceutical Do you Not eat fruits and vegetables of different colours on most days? MULTIVITAMIN/MINERAL Supplement Do you often eat less than six servings of WHOLE GRAINS such as whole wheat bread, cereal, with ANTIOXIDANTS - VITAMIN-C to fill rice each day (same for adolscents, lesser for younger kids). One serving = 1 chapati/ your/ your family or your kids nutritional slice bread, 1/2 cup rice/ cereal etc ? gap DAILY. Do you often eat the same foods every day without thinking about whether you are eating a BALANCED DIET? Do you eat "FAST FOODS" or convenience style foods that are high in FAT CONTENT (samosa , anything deep fried etc) three or more times a week? Do you eat SNACKS with low nutritional content (sodas, chips, sweets, processed foods ) almost every day? NUTRITIONAL INTAKE

KIDS ENERGY LEVEL Is the childs daily SCHEDULE very demanding physically/ mentally? Does your child come back from school completely TIRED with no energy left to study or play?

Yes

No

NEUTRACEUTICAL RECOMMENDATIONS If you answered YES to any or both the statement, you may benefit from Protein Powder supplement to fill in the nutritional gap.

LIFE STYLE Do you SMOKE or often breathe other people's smoke? Do you live in an URBAN or highly POPULATED area? Your place of work or the way to work - Is it highly POLLUTED ? Do you EXERCISE less than for 1 hour daily or atleast 3 days in a week? Are you exposed to a lot of SUNLIGHT, i.e - more thaan one hour of mid day sun several times a week? Do you consume ALCOHOL? Do you consume fried, fatty or processed FOODS three or more times a week?

NEUTRACEUTICAL RECOMMENDATIONS If you answered YES to any or both the statements, the child may benefit from taking KIDS Neutraceutical MULTIVITAMIN for KIDS and PROTEIN NEUTRACEUTICAL RECOMMENDATIONS If you anwered YES to 3 or more of the statements, you may benefit from taking a Neutraceutical VITAMIN-C product, and a SELENIUM with VITAMIN-E product to meet your antioxidant needs or a Neutraceutical MUTIVITAMIN with ANTIOXIDANTS DAILY.

Do you normally eat less than 5 servings of different FRUITS & VEGETABLES each day. (One Serving = 1 medium fruit, 1/2 cup cooked vegetables, 3/4 cup juice, 1 cup raw vegetables) ? Do you suffer from a family history of LIFE STYLE DISEASES such as Diabetes, Heart Attach, Stroke, Cancer, Asthma ? Do you have STRESS in your life? Yes

No

ADULT ENERGY LEVEL Do you often find yourself lacking ENERGY during the day?

NEUTRACEUTICAL RECOMMENDATIONS

If you answered YES to any statement, you may benefit from keeping a Do you find it difficult to cope with the physical and mental effects of STRESS in your daily life? SIBERIAN GINSENG with GINKO Do you want to enhance your ENERGY LEVEL for an important physically or mentally BILOBA and taking it when needed, to demanding event at Office, Play Ground/ Sport and / or at Home? meet your individual needs. NEUTRACEUTICAL IMMUNITY - NATURAL DEFENSE SYSTEM RECOMMENDATIONS If you anwered YES to 1 or more Are you prone to FALLING ILL due to change in WEATHER CONDITIONS and un expected statements, you may benefit from taking exposure to rain, cold, dust, pollution etc.? ECHINACEA. Are you prone to falling ill due to spreading of an INFECTIOUS disease? Are your prone to falling ill during an IMPORTANT EVENTS (exams, interviews, important travel, important event of the week, due to anxiety etc ?

Yes

No

Yes

No

WOMAN'S HEALTH Are you a women of CHILD BEARING AGE, and thinking about having a baby? Are you pregnant, or a NURSING MOTHER? Do you consume green LEAFY VEGETABLES less than 3 times a week? Do you often/ frequently feel TIRED and get EXHAUSTED easily? Are you an ADOLSCENT/ a young girl? Are you a complete VEGETARIAN?

Yes

No

BONE HEALTH Does your exercise routine regularly include WEIGHT BEARING ACTIVITIES (such as weightlifting or other resistance exercises), atleast twice a week?

NEUTRACEUTICAL RECOMMENDATIONS If you anwered YES to 2 or more of the statements, you may benefit from taking a IRON FOLIC product and a CALCIUMMAGNECIUM supplement.

NEUTRACEUTICAL RECOMMENDATIONS If you answered YES to 2 or more of the statement, you may benefit from taking a Does your daily routine regularly include WEIGHT BEARING ACTIVITIES including self weight, GLUCOSAMINE HCL with SOYA in turn causing STRAIN- when walking or while standing upright during the course of the day - is PROTEIN ISOLATE to meet your individual needs. the pain experienced atleast twice a week? Are you concerned about OSTEOPOROSIS ( for example a famaily history, alow calcium diet, small bone structure etc.) ? Do you or any one in your immediate family/ surrounding/ colleagues SMOKE? Do you drink more than 2 cups of COFFEE or TEA in a day? Are you hypertensive - HIGH BLOOD PRESURE? Do you frequently get LEG CRAMPS? Do you regularly feel PAIN or STIFFNESS in the JOINTS?

Yes

No

JOINTS HEALTH Are you over 35 years? Do you experience a mild stiffness or pain in the joints - in the morning or as and when you get up from a seat after sitting in a for some time at office or at home? Do you suffer from or are you concerned about OSTOEARTHRITIS (for example, due to family history, poor or compromising work posture etc.) ? Are your joints over burdened due to your weight/ intensive sports/ work/ other reasons?

NEUTRACEUTICAL RECOMMENDATIONS If you anwered YES to 1 or more of the statements, you may benefit from taking a GLUCOSAMINE HCL and CALCIUM MAGNESIUM with SOYA PROTEIN ISOLATE to meet your individual needs.