{"patient_id": "42316f92-48f2-4ea7-9460-2dba915b7465", "patient_data": {"id": "42316f92-48f2-4ea7-9460-2dba915b7465", "name": "Jermaine Soto", "age": 45, "age_group": "adult_31_50y", "gender": "male", "region": "Nigeria", "language": "en", "occupation": "Student (university)", "conditions": "Obesity Class I (BMI 30-34.9), Insulin Resistance", "allergies": "Mollusks (clams, mussels, oysters)", "goals": "Weight loss (5-10%), Weight gain (healthy), PKU phenylalanine management", "preferences": "Ayurvedic (Pitta-balancing)", "weight": 105.0, "height": 180.3, "bmi": 32.3, "activity_level": "very_active", "muac": 42.0, "waist_circumference": 118.4, "hip_circumference": 109.7, "triceps_skinfold": 21.1, "suprailiac_skinfold": 32.7, "subscapular_skinfold": 40.6, "meals_per_day": 3, "cooking_time": "15-30 minutes", "water_intake_per_day": "2-2.5L", "coffee_cups_per_day": 4, "eating_habits": "Emotional eating", "food_preferences": "Prefers mild flavors only, Prefers savory/umami flavors", "food_aversions": "Avoids organ meats, Dislikes fish", "appetite_assessment": "Increased", "prompt_mode": "standard", "clinical_analysis_depth": "basic"}, "prompt": "You are a clinical nutritionist creating a diet plan. Generate all content in ENGLISH.\n\nSTRICT RULES:\n1. Output ONLY markdown - no preamble, no \"Here is...\", no greetings, no sign-offs\n2. Be CONCISE - use tables, bullets, short sentences\n3. Use TABLES for meal plans (mandatory)\n4. NO lengthy explanations unless customInstructions requests detail\n5. Start directly with the H1 title\n6. USE ALL patient data provided to personalize the plan\n7. EVERY DAY must have UNIQUE meals - NO \"repeat day X\" or \"same as above\" - write out ALL 28 days completely.\n8. Provide VARIETY - different foods each day, rotate proteins, vegetables, grains\n\n\n\n\n**Patient:** Name: Jermaine Soto | Age: 45 | Gender: male | Conditions: Obesity Class I (BMI 30-34.9), Insulin Resistance | Allergies: Mollusks (clams, mussels, oysters) | Region: Nigeria | Occupation: Student (university)\n**Anthropometrics:** Wt: 105.0kg | Ht: 180.3cm | BMI: 32.3 | Activity: very active\n**Body Circumferences:** MUAC: 42.0cm | Waist: 118.4cm | Hip: 109.7cm\n**Body Composition:** Triceps: 21.1mm | Suprailiac: 32.7mm | Subscapular: 40.6mm\n**Eating Patterns:** Meals/day: 3 | Cooking time: 15-30 minutes | Coffee: 4 | Water: 2-2.5L\n**Food Preferences:** Likes: Prefers mild flavors only, Prefers savory/umami flavors | Dislikes: Avoids organ meats, Dislikes fish | Habits: Emotional eating\n**Appetite:** Appetite: Increased\n**Goals:** Weight loss (5-10%), Weight gain (healthy), PKU phenylalanine management\n**Additional Notes:** Ayurvedic (Pitta-balancing)\n\n\n\n\n---\n\nOUTPUT FORMAT (follow exactly):\n\n# Diet Plan - Jermaine Soto\n\n## Summary\n- Target: [kcal] kcal/day\n- Macros: P [g]g | C [g]g | F [g]g\n- Key focus: [2-3 bullet points max based on patient data]\n\n\n## Weekly Meal Plan\n\nCRITICAL: You MUST write out EVERY meal for ALL 28 days across ALL 4 weeks. Each day must be unique.\n\n### Week 1\n\n| Day | Breakfast | Lunch | Dinner | Snacks | kcal |\n|-----|-----------|-------|--------|--------|------|\n| Mon | [unique meal] | [unique meal] | [unique meal] | [snack] | [total] |\n| Tue | [unique meal] | [unique meal] | [unique meal] | [snack] | [total] |\n| Wed | [unique meal] | [unique meal] | [unique meal] | [snack] | [total] |\n| Thu | [unique meal] | [unique meal] | [unique meal] | [snack] | [total] |\n| Fri | [unique meal] | [unique meal] | [unique meal] | [snack] | [total] |\n| Sat | [unique meal] | [unique meal] | [unique meal] | [snack] | [total] |\n| Sun | [unique meal] | [unique meal] | [unique meal] | [snack] | [total] |\n\n### Week 2\n\n| Day | Breakfast | Lunch | Dinner | Snacks | kcal |\n|-----|-----------|-------|--------|--------|------|\n| Mon | [unique meal] | [unique meal] | [unique meal] | [snack] | [total] |\n| Tue | [unique meal] | [unique meal] | [unique meal] | [snack] | [total] |\n| Wed | [unique meal] | [unique meal] | [unique meal] | [snack] | [total] |\n| Thu | [unique meal] | [unique meal] | [unique meal] | [snack] | [total] |\n| Fri | [unique meal] | [unique meal] | [unique meal] | [snack] | [total] |\n| Sat | [unique meal] | [unique meal] | [unique meal] | [snack] | [total] |\n| Sun | [unique meal] | [unique meal] | [unique meal] | [snack] | [total] |\n\n### Week 3\n\n| Day | Breakfast | Lunch | Dinner | Snacks | kcal |\n|-----|-----------|-------|--------|--------|------|\n| Mon | [unique meal] | [unique meal] | [unique meal] | [snack] | [total] |\n| Tue | [unique meal] | [unique meal] | [unique meal] | [snack] | [total] |\n| Wed | [unique meal] | [unique meal] | [unique meal] | [snack] | [total] |\n| Thu | [unique meal] | [unique meal] | [unique meal] | [snack] | [total] |\n| Fri | [unique meal] | [unique meal] | [unique meal] | [snack] | [total] |\n| Sat | [unique meal] | [unique meal] | [unique meal] | [snack] | [total] |\n| Sun | [unique meal] | [unique meal] | [unique meal] | [snack] | [total] |\n\n### Week 4\n\n| Day | Breakfast | Lunch | Dinner | Snacks | kcal |\n|-----|-----------|-------|--------|--------|------|\n| Mon | [unique meal] | [unique meal] | [unique meal] | [snack] | [total] |\n| Tue | [unique meal] | [unique meal] | [unique meal] | [snack] | [total] |\n| Wed | [unique meal] | [unique meal] | [unique meal] | [snack] | [total] |\n| Thu | [unique meal] | [unique meal] | [unique meal] | [snack] | [total] |\n| Fri | [unique meal] | [unique meal] | [unique meal] | [snack] | [total] |\n| Sat | [unique meal] | [unique meal] | [unique meal] | [snack] | [total] |\n| Sun | [unique meal] | [unique meal] | [unique meal] | [snack] | [total] |\n\n\n## Foods\n\n### Include\n- [food]: [portion] - [brief reason based on labs/conditions]\n\n### Avoid\n- [food]: [brief reason based on labs/conditions]\n\n## Notes\n- [2-4 practical tips based on patient's eating patterns/lifestyle]\n\n---\nEND OF PLAN", "diet": {"content": "# Diet Plan - Jermaine Soto\n\n## Summary\n- Target: 2700 kcal/day\n- Macros: P 105g | C 340g | F 100g\n- Key focus: \n    - Low-glycemic complex carbohydrates to manage insulin resistance.\n    - Controlled protein intake for PKU management.\n    - Pitta-balancing (cooling) foods to mitigate inflammation.\n\n## Weekly Meal Plan\n\n### Week 1\n\n| Day | Breakfast | Lunch | Dinner | Snacks | kcal |\n|-----|-----------|-------|--------|--------|------|\n| Mon | Millet porridge w/ coconut milk | Boiled yam & mild veggie stew | Roasted plantain & sautéed spinach | Sliced cucumber | 2650 |\n| Tue | Oat bran w/ banana & seeds | Jollof rice (mild) & steamed carrots | Sweet potato mash & zucchini | Apple slices | 2710 |\n| Wed | Cornmeal mush w/ coconut | Cassava flakes & okra soup | Rice & sautéed eggplant | Melon chunks | 2680 |\n| Thu | Sorghum porridge w/ pear | Plantain & mild bean stew | Steamed rice & cabbage | Carrot sticks | 2720 |\n| Fri | Tapioca pudding w/ mango | Boiled yam & sautéed greens | Rice & roasted pumpkin | Avocado slices | 2690 |\n| Sat | Banana & oat pancakes | Couscous & roasted bell peppers | Sweet potato & green beans | Coconut flakes | 2750 |\n| Sun | Millet & coconut smoothie | Cassava & mild vegetable curry | Rice & steamed broccoli | Pear slices | 2660 |\n\n### Week 2\n\n| Day | Breakfast | Lunch | Dinner | Snacks | kcal |\n|-----|-----------|-------|--------|--------|------|\n| Mon | Chia seed pudding w/ papaya | Bulgur wheat & cucumber salad | Roasted yam & sautéed zucchini | Walnuts (small) | 2700 |\n| Tue | Rye toast w/ avocado | Rice & mild lentil dahl | Sweet potato & cauliflower | Banana | 2730 |\n| Wed | Oat bran w/ berries | Cassava & spinach stew | Plantain & roasted peppers | Cucumber | 2670 |\n| Thu | Cornmeal porridge | Jollof rice & steamed okra | Yam & sautéed cabbage | Apple | 2710 |\n| Fri | Sorghum & coconut bowl | Couscous & roasted carrots | Rice & eggplant mash | Melon | 2690 |\n| Sat | Tapioca w/ sliced mango | Boiled plantain & veggie sauce | Sweet potato & green beans | Carrot sticks | 2740 |\n| Sun | Millet porridge | Rice & mild pumpkin stew | Cassava & sautéed spinach | Pear | 2650 |\n\n### Week 3\n\n| Day | Breakfast | Lunch | Dinner | Snacks | kcal |\n|-----|-----------|-------|--------|--------|------|\n| Mon | Oat bran w/ coconut | Bulgur & roasted zucchini | Yam & steamed broccoli | Avocado | 2720 |\n| Tue | Banana & millet smoothie | Rice & mild vegetable stir-fry | Plantain & cauliflower | Apple slices | 2680 |\n| Wed | Chia pudding w/ pear | Cassava & okra | Sweet potato & cabbage | Cucumber | 2700 |\n| Thu | Cornmeal porridge | Couscous & bell peppers | Rice & sautéed eggplant | Melon | 2710 |\n| Fri | Sorghum & coconut milk | Boiled yam & spinach | Plantain & roasted pumpkin | Carrot sticks | 2690 |\n| Sat | Tapioca & mango | Rice & mild lentil stew | Sweet potato & green beans | Coconut | 2750 |\n| Sun | Oat pancakes | Cassava & veggie curry | Yam & steamed zucchini | Pear | 2660 |\n\n### Week 4\n\n| Day | Breakfast | Lunch | Dinner | Snacks | kcal |\n|-----|-----------|-------|--------|--------|------|\n| Mon | Millet & banana bowl | Rice & roasted carrots | Plantain & sautéed greens | Apple | 2700 |\n| Tue | Chia pudding w/ coconut | Bulgur & cucumber salad | Sweet potato & cauliflower | Avocado | 2730 |\n| Wed | Oat bran w/ pear | Cassava & mild veggie stew | Rice & eggplant | Melon | 2670 |\n| Thu | Cornmeal porridge | Jollof rice & okra | Yam & cabbage | Carrot sticks | 2710 |\n| Fri | Sorghum porridge | Couscous & zucchini | Plantain & pumpkin | Cucumber | 2690 |\n| Sat | Tapioca w/ berries | Boiled yam & spinach | Rice & green beans | Banana | 2740 |\n| Sun | Banana oats | Cassava & mild curry | Sweet potato & broccoli | Pear | 2650 |\n\n## Foods\n\n### Include\n- Complex Carbs (Yam, Millet, Sorghum): Low GI to manage insulin resistance.\n- Healthy Fats (Avocado, Coconut): Satiety and hormone support.\n- Cooling Veggies (Cucumber, Zucchini): Pitta-balancing properties.\n- High Fiber (Oats, Beans): Weight management and digestion.\n\n### Avoid\n- Mollusks: Strict allergy prevention.\n- Fish/Organ Meats: Personal preference/dislike.\n- High Sugar/Refined Carbs: To prevent insulin spikes.\n- Spicy Peppers: To maintain Pitta-balancing Ayurvedic principles.\n\n## Notes\n- **PKU Management:** This plan prioritizes complex carbs and healthy fats. Monitor protein grams strictly as per your clinical specialist's specific phenylalanine limits.\n- **Meal Prep:** As a student, cook large batches of grains (rice, millet) and roasted vegetables on Sundays to keep daily prep under 15 minutes.\n- **Hydration:** Increase water intake to 3L during high activity periods to support metabolism.\n- **Emotional Eating:** When feeling stress, opt for hydrating snacks like cucumber or melon rather than processed snacks.\n\n---\nEND OF PLAN", "temperature": 0.4, "model": "gemma-4-26b-a4b-it", "provider": "gemini", "reasoning": true}, "meethealth": {"package": "meethealth-sample-v1", "package_version": "1.0.0", "source_corpus": "gemma_diets", "source_line": 14497, "contract": "diet_plan@1.0.0", "contract_fingerprint": "1a6c5cf6b9d37193", "gate_rules_evaluated": 45, "gate_failures": [], "package_checks": {"plan_language": {"pass": true, "detail": "english markers=4"}, "completeness_28_days": {"pass": true, "detail": "day_rows=28 weeks=4 terminated=True"}, "no_duplicate_days": {"pass": true, "detail": "duplicate_days=0"}, "macro_arithmetic": {"pass": true, "detail": "target=2700 kcal, 4P+4C+9F=2680 kcal, deviation=0.7%"}, "energy_dose_plausible": {"pass": true, "detail": "25.7 kcal/kg (screen 15-45)"}, "protein_dose_plausible": {"pass": true, "detail": "1.00 g/kg (screen 0.8-1.6)"}, "daily_energy_on_target": {"pass": true, "detail": "days_outside_10pct=0 of 28"}, "allergen_screen": {"pass": true, "detail": "screened=['mollusk'] hits=[]"}, "hyperkalemia_food_screen": {"pass": true, "detail": "not applicable (K <= 5.0 or absent)"}, "scenario_coherence": {"pass": true, "detail": "ok"}}, "evidence_level": "L2_automated_checks_passed", "expert_review": "not_performed"}}
{"patient_id": "4f3df5a0-c493-4343-8f7c-8932416ecf9b", "patient_data": {"id": "4f3df5a0-c493-4343-8f7c-8932416ecf9b", "name": "Joann Grant", "age": 56, "age_group": "middle_age_51_65y", "gender": "female", "region": "Jamaica", "language": "en", "occupation": "Teacher", "conditions": "Overweight (BMI 25-29.9), Hypertension Stage 1", "allergies": "Fish (all)", "goals": "Glycemic control optimization, Gut health optimization / microbiome support", "preferences": "Organic-only preference", "weight": 63.6, "height": 149.6, "bmi": 28.4, "activity_level": "sedentary", "triceps_skinfold": 42.1, "suprailiac_skinfold": 13.3, "subscapular_skinfold": 8.2, "hemoglobin": 15.9, "blood_glucose": 111.3, "total_cholesterol": 229.4, "hdl_cholesterol": 93.3, "prealbumin": 32.6, "creatinine": 0.7, "past_medical_history": "Gastric sleeve (2018)", "meals_per_day": 2, "cooking_time": "<5 minutes (microwave/ready-made)", "water_intake_per_day": "1-1.5L", "coffee_cups_per_day": 0, "appetite_assessment": "Decreased", "dietary_supplements": "Pediatric multivitamin (gummy)", "prompt_mode": "clinical", "clinical_analysis_depth": "comprehensive", "has_disability": true, "disability_details": "Tremor-related Feeding Difficulty", "feeding_assistance": "Requires full feeding assistance"}, "prompt": "You are a senior clinical nutritionist with expertise in medical nutrition therapy creating a diet plan. Generate all content in ENGLISH.\n\n## ADVANCED CLINICAL MODE ENABLED\nThis dietary plan requires a clinically-driven approach with structured analysis of the nutritional anamnesis.\nYou MUST explicitly analyze and integrate key patient parameters before generating recommendations.\nAnalysis Depth: COMPREHENSIVE\n\nSTRICT RULES:\n1. Output ONLY markdown - no preamble, no \"Here is...\", no greetings, no sign-offs\n2. Be CONCISE - use tables, bullets, short sentences\n3. Use TABLES for meal plans (mandatory)\n4. NO lengthy explanations unless customInstructions requests detail\n5. Start directly with the H1 title\n6. USE ALL patient data provided to personalize the plan\n7. EVERY DAY must have UNIQUE meals - NO \"repeat day X\" or \"same as above\" - write out ALL 28 days completely.\n8. Provide VARIETY - different foods each day, rotate proteins, vegetables, grains\n\n9. PERFORM complete clinical anamnesis analysis BEFORE generating the meal plan\n10. JUSTIFY each major dietary recommendation with clinical rationale\n11. USE PES (Problem-Etiology-Signs/Symptoms) format for nutritional diagnoses\n12. INCLUDE monitoring parameters and follow-up indicators\n\n\n## CLINICAL NUTRITIONAL ANAMNESIS ANALYSIS\n\nYou MUST perform a structured, systematic analysis of the patient's nutritional anamnesis before generating the diet plan.\n\n**Analysis Depth:** Provide a thorough clinical analysis covering all major domains with clinical correlations.\n\n### 1. BIOCHEMICAL DATA ANALYSIS\n**Hematological Profile:**\n  - Hemoglobin: 15.9 g/dL\n  - Clinical interpretation: Assess iron status, anemia risk, and need for iron-rich foods or absorption enhancers\n\n**Glycemic Control:**\n  - Fasting Glucose: 111.3 mg/dL\n  - Clinical interpretation: Evaluate glycemic control, carbohydrate tolerance, and glycemic index considerations\n\n**Lipid Profile:**\n  - TC: 229.4 | HDL: 93.3 mg/dL\n  - Clinical interpretation: Assess cardiovascular risk, dietary fat modifications, and omega-3 requirements\n\n**Protein Status:**\n  - Prealbumin: 32.6 mg/dL\n  - Clinical interpretation: Evaluate protein-calorie malnutrition risk and protein requirements\n\n**Renal Function:**\n  - Creatinine: 0.7 mg/dL\n  - Clinical interpretation: Assess renal function and protein/electrolyte restrictions if needed\n\n### 2. CLINICAL DATA ANALYSIS\n**Current Medical Conditions:** Overweight (BMI 25-29.9), Hypertension Stage 1\n  - Nutritional implications: Disease-specific dietary modifications, nutrient-drug interactions\n**Allergies & Intolerances:** Fish (all)\n  - CRITICAL: Strict avoidance required, cross-reactivity considerations\n\n### 3. ANTHROPOMETRIC DATA ANALYSIS\n**Primary Measurements:**\n  - Weight: 63.6 kg | Height: 149.6 cm | BMI: 28.4 kg/m²\n  - BMI Classification: Overweight\n  - Activity Level: sedentary\n\n### 4. DIETARY DATA ANALYSIS\nNo 24h recall available.\n\n### 5. CLINICAL SYNTHESIS & NUTRITIONAL DIAGNOSIS\n**Patient Goals:** Glycemic control optimization, Gut health optimization / microbiome support\n\n**REQUIRED OUTPUT FOR CLINICAL MODE:**\n1. **Problem List (PES Format):** Identify 2-4 nutrition diagnoses using Problem-Etiology-Signs/Symptoms format\n2. **Priority Ranking:** Rank nutritional problems by clinical urgency\n3. **Intervention Rationale:** For each dietary recommendation, provide clinical justification\n4. **Monitoring Parameters:** Specify what should be monitored\n\n---\n\n**Patient:** Name: Joann Grant | Age: 56 | Gender: female | Conditions: Overweight (BMI 25-29.9), Hypertension Stage 1 | Allergies: Fish (all) | Region: Jamaica | Occupation: Teacher\n**Anthropometrics:** Wt: 63.6kg | Ht: 149.6cm | BMI: 28.4 | Activity: sedentary\n**Body Composition:** Triceps: 42.1mm | Suprailiac: 13.3mm | Subscapular: 8.2mm\n**Blood/Iron:** Hb: 15.9g/dL\n**Metabolic Labs:** Glucose: 111.3mg/dL | TC: 229.4 | HDL: 93.3\n**Protein/Kidney:** Prealbumin: 32.6mg/dL | Creatinine: 0.7mg/dL\n**Medical History:** Past Medical: Gastric sleeve (2018)\n**Eating Patterns:** Meals/day: 2 | Cooking time: <5 minutes (microwave/ready-made) | Water: 1-1.5L\n**Restrictions:** Supplements: Pediatric multivitamin (gummy)\n**Appetite:** Appetite: Decreased\n**Goals:** Glycemic control optimization, Gut health optimization / microbiome support\n**Additional Notes:** Organic-only preference\n\n\n\nSPECIAL POPULATION CONTEXT:\nPATIENT WITH DISABILITY/LIMITATION\nDetails: Tremor-related Feeding Difficulty\nFeeding Assistance: Requires full feeding assistance\nIMPORTANT: Ensure all meals are appropriate for the patient's physical capabilities, texture requirements, and feeding method. Adjust recipes and preparation methods accordingly.\n\n\n---\n\nOUTPUT FORMAT (follow exactly):\n\n# Diet Plan - Joann Grant\n\n## Clinical Nutritional Anamnesis Analysis\n\n### 1. Biochemical Data Analysis\n[Interpret lab values]\n\n### 2. Clinical Data Analysis\n[Medical conditions and dietary implications]\n\n### 3. Anthropometric Data Analysis\n[BMI classification and body composition]\n\n### 4. Dietary Data Analysis\n[24h recall interpretation and nutrient gap analysis]\n\n### 5. Nutritional Diagnosis (PES Format)\n| Priority | Problem | Etiology | Signs/Symptoms |\n|----------|---------|----------|----------------|\n| 1 | [Nutrition problem] | related to [etiology] | as evidenced by [S/S] |\n\n### 6. Intervention Rationale\n[Key intervention decisions with clinical justification]\n\n---\n\n## Summary\n- Target: [kcal] kcal/day\n- Macros: P [g]g | C [g]g | F [g]g\n- Key focus: [2-3 bullet points max based on patient data]\n- Clinical priorities: [Based on PES diagnoses above]\n\n## Weekly Meal Plan\n\nCRITICAL: You MUST write out EVERY meal for ALL 28 days across ALL 4 weeks. Each day must be unique.\n\n### Week 1\n\n| Day | Breakfast | Lunch | Dinner | Snacks | kcal |\n|-----|-----------|-------|--------|--------|------|\n| Mon | [unique meal] | [unique meal] | [unique meal] | [snack] | [total] |\n| Tue | [unique meal] | [unique meal] | [unique meal] | [snack] | [total] |\n| Wed | [unique meal] | [unique meal] | [unique meal] | [snack] | [total] |\n| Thu | [unique meal] | [unique meal] | [unique meal] | [snack] | [total] |\n| Fri | [unique meal] | [unique meal] | [unique meal] | [snack] | [total] |\n| Sat | [unique meal] | [unique meal] | [unique meal] | [snack] | [total] |\n| Sun | [unique meal] | [unique meal] | [unique meal] | [snack] | [total] |\n\n### Week 2\n\n| Day | Breakfast | Lunch | Dinner | Snacks | kcal |\n|-----|-----------|-------|--------|--------|------|\n| Mon | [unique meal] | [unique meal] | [unique meal] | [snack] | [total] |\n| Tue | [unique meal] | [unique meal] | [unique meal] | [snack] | [total] |\n| Wed | [unique meal] | [unique meal] | [unique meal] | [snack] | [total] |\n| Thu | [unique meal] | [unique meal] | [unique meal] | [snack] | [total] |\n| Fri | [unique meal] | [unique meal] | [unique meal] | [snack] | [total] |\n| Sat | [unique meal] | [unique meal] | [unique meal] | [snack] | [total] |\n| Sun | [unique meal] | [unique meal] | [unique meal] | [snack] | [total] |\n\n### Week 3\n\n| Day | Breakfast | Lunch | Dinner | Snacks | kcal |\n|-----|-----------|-------|--------|--------|------|\n| Mon | [unique meal] | [unique meal] | [unique meal] | [snack] | [total] |\n| Tue | [unique meal] | [unique meal] | [unique meal] | [snack] | [total] |\n| Wed | [unique meal] | [unique meal] | [unique meal] | [snack] | [total] |\n| Thu | [unique meal] | [unique meal] | [unique meal] | [snack] | [total] |\n| Fri | [unique meal] | [unique meal] | [unique meal] | [snack] | [total] |\n| Sat | [unique meal] | [unique meal] | [unique meal] | [snack] | [total] |\n| Sun | [unique meal] | [unique meal] | [unique meal] | [snack] | [total] |\n\n### Week 4\n\n| Day | Breakfast | Lunch | Dinner | Snacks | kcal |\n|-----|-----------|-------|--------|--------|------|\n| Mon | [unique meal] | [unique meal] | [unique meal] | [snack] | [total] |\n| Tue | [unique meal] | [unique meal] | [unique meal] | [snack] | [total] |\n| Wed | [unique meal] | [unique meal] | [unique meal] | [snack] | [total] |\n| Thu | [unique meal] | [unique meal] | [unique meal] | [snack] | [total] |\n| Fri | [unique meal] | [unique meal] | [unique meal] | [snack] | [total] |\n| Sat | [unique meal] | [unique meal] | [unique meal] | [snack] | [total] |\n| Sun | [unique meal] | [unique meal] | [unique meal] | [snack] | [total] |\n\n\n## Foods\n\n### Include\n- [food]: [portion] - [brief reason based on labs/conditions]\n\n### Avoid\n- [food]: [brief reason based on labs/conditions]\n\n## Notes\n- [2-4 practical tips based on patient's eating patterns/lifestyle]\n\n## Monitoring Parameters\n\n### Indicators to Evaluate\n| Parameter | Current Value | Target | Timeline |\n|-----------|---------------|--------|----------|\n| [parameter] | [current] | [goal] | [weeks] |\n\n### Recommended Follow-up\n- Next appointment: [timeframe]\n- Follow-up labs: [which tests, when]\n- Warning signs: [symptoms requiring immediate attention]\n\n---\nEND OF PLAN", "diet": {"content": "# Diet Plan - Joann Grant\n\n## Clinical Nutritional Anamnesis Analysis\n\n### 1. Biochemical Data Analysis\n*   **Hematological Profile:** Hb 15.9 g/dL is within normal limits, suggesting adequate iron stores and no immediate risk of anemia.\n*   **Glycemic Control:** Fasting Glucose 111.3 mg/dL indicates impaired fasting glucose (prediabetes range). Requires carbohydrate management and low-glycemic index (GI) foods.\n*   **Lipid Profile:** TC 229.4 mg/dL is elevated (Hypercholesterolemia). HDL 93.3 mg/dL is excellent (cardioprotective). Focus on reducing saturated fats and increasing soluble fiber.\n*   **Protein Status:** Prealbumin 32.6 mg/dL is within normal range, suggesting adequate recent protein intake despite gastric sleeve history.\n*   **Renal Function:** Creatinine 0.7 mg/dL is normal, indicating healthy renal filtration and no immediate need for protein restriction.\n\n### 2. Clinical Data Analysis\n*   **Hypertension Stage 1:** Requires DASH-style approach (low sodium, high potassium/magnesium).\n*   **Overweight (BMI 28.4):** Requires caloric deficit for weight management.\n*   **Gastric Sleeve History (2018):** Requires nutrient density in small volumes; risk of dumping syndrome if high simple sugars are consumed.\n*   **Allergies:** **STRICT FISH AVOIDANCE** due to high allergy risk.\n*   **Physical Limitation:** Tremors require soft, easy-to-manage textures (mechanical soft/pureed options) to facilitate feeding assistance.\n\n### 3. Anthropometric Data Analysis\n*   **BMI:** 28.4 kg/m² (Overweight).\n*   **Body Composition:** Triceps 42.1mm indicates moderate subcutaneous fat.\n*   **Activity:** Sedentary; metabolic rate is low, necessitating controlled caloric intake.\n\n### 4. Dietary Data Analysis\n*   **Current Pattern:** 2 meals/day, low water intake (1-1.5L), high reliance on microwave/ready-made foods.\n*   **Gaps:** Potential lack of fiber for gut health, insufficient hydration, and high risk of processed food sodium/sugar intake.\n\n### 5. Nutritional Diagnosis (PES Format)\n| Priority | Problem | Etiology | Signs/Symptoms |\n|----------|---------|----------|----------------|\n| 1 | Altered blood glucose regulation | Related to sedentary lifestyle and dietary patterns | As evidenced by fasting glucose of 111.3 mg/dL |\n| 2 | Excessive energy intake | Related to high-calorie processed food reliance | As evidenced by BMI of 28.4 kg/m² |\n| 3 | Impaired nutrient density | Related to gastric sleeve history and limited meal frequency | As evidenced by potential for micronutrient gaps |\n\n### 6. Intervention Rationale\n*   **Low Glycemic Index (GI) Carbohydrates:** To stabilize blood glucose and manage prediabetic state.\n*   **High Fiber (Prebiotic) Focus:** To support gut microbiome and improve satiety/cholesterol.\n*   **Sodium Restriction:** To manage Stage 1 Hypertension.\n*   **Soft/Mechanical Textures:** To accommodate tremor-related feeding difficulties and ensure safety during assistance.\n*   **Organic Preference Integration:** To align with patient values and reduce pesticide exposure.\n\n---\n\n## Summary\n- Target: 1,450 kcal/day\n- Macros: P 85g | C 155g | F 48g\n- Key focus: Glycemic stability, Gut microbiome support, Hypertension management.\n- Clinical priorities: Blood glucose normalization and weight reduction.\n\n## Weekly Meal Plan\n\n### Week 1\n\n| Day | Breakfast | Lunch | Dinner | Snacks | kcal |\n|-----|-----------|-------|--------|--------|------|\n| Mon | Soft scrambled organic eggs with avocado | Lentil and spinach puree | Slow-cooked organic chicken with mashed sweet potato | Greek yogurt with chia seeds | 1440 |\n| Tue | Overnight organic oats with flaxseed | Soft turkey meatballs with zucchini mash | Stewed organic beef with carrots | Sliced soft pear | 1460 |\n| Wed | Chia seed pudding with organic berries | Red kidney bean mash with avocado | Soft poached chicken with steamed broccoli | Cottage cheese | 1420 |\n| Thu | Organic Greek yogurt with hemp seeds | Pureed vegetable and lentil soup | Soft tofu scramble with sautéed spinach | Soft banana | 1450 |\n| Fri | Mashed avocado on soft whole-grain toast | Slow-cooked organic chicken stew | Soft ground turkey with mashed cauliflower | Hummus with soft cucumber | 1470 |\n| Sat | Soft boiled eggs with mashed avocado | Black bean puree with organic corn | Stewed organic beef with soft squash | Organic apple sauce | 1430 |\n| Sun | Organic oat porridge with cinnamon | Soft chicken and vegetable mash | Lentil dahl (soft texture) | Almond butter on soft toast | 1455 |\n\n### Week 2\n\n| Day | Breakfast | Lunch | Dinner | Snacks | kcal |\n|-----|-----------|-------|--------|--------|------|\n| Mon | Soft tofu with organic turmeric | Pureed butternut squash soup | Soft organic turkey mince with zucchini | Chia pudding | 1410 |\n| Tue | Scrambled eggs with soft spinach | Mashed chickpeas with avocado | Slow-cooked chicken thighs (shredded) | Soft peach | 1465 |\n| Wed | Organic yogurt with mashed berries | Soft lentil stew | Ground beef with mashed sweet potato | Hard boiled egg (mashed) | 1440 |\n| Thu | Chia pudding with coconut milk | Pureed vegetable soup | Soft organic chicken with mashed peas | Cottage cheese | 1425 |\n| Fri | Soft avocado and egg mash | Black bean and corn mash | Stewed turkey with soft carrots | Greek yogurt | 1450 |\n| Sat | Oat porridge with flax | Soft chicken salad (finely chopped) | Lentil and vegetable mash | Soft pear | 1435 |\n| Sun | Scrambled organic eggs | Pureed kidney bean soup | Soft beef stew with soft potatoes | Almond butter | 1470 |\n\n### Week 3\n\n| Day | Breakfast | Lunch | Dinner | Snacks | kcal |\n|-----|-----------|-------|--------|--------|------|\n| Mon | Greek yogurt with chia | Soft turkey and avocado mash | Pureed lentil soup | Soft banana | 1420 |\n| Tue | Soft scrambled eggs | Mashed sweet potato and black beans | Shredded organic chicken with squash | Apple sauce | 1445 |\n| Wed | Overnight oats with flax | Soft beef and vegetable stew | Pureed cauliflower and chicken | Cottage cheese | 1460 |\n| Thu | Chia seed pudding | Soft lentil dahl | Ground turkey with mashed zucchini | Greek yogurt | 1430 |\n| Fri | Mashed avocado on soft bread | Pureed vegetable soup | Soft organic chicken with mashed peas | Soft peach | 1455 |\n| Sat | Soft boiled eggs | Black bean mash | Slow-cooked beef with soft carrots | Chia pudding | 1440 |\n| Sun | Organic oat porridge | Soft turkey meatballs | Pureed butternut squash and chicken | Almond butter | 1475 |\n\n### Week 4\n\n| Day | Breakfast | Lunch | Dinner | Snacks | kcal |\n|-----|-----------|-------|--------|--------|------|\n| Mon | Scrambled eggs with avocado | Soft lentil mash | Shredded chicken with sweet potato | Greek yogurt | 1450 |\n| Tue | Chia pudding with berries | Pureed bean soup | Soft ground beef with zucchini | Soft pear | 1435 |\n| Wed | Organic yogurt with hemp | Soft turkey and veggie mash | Slow-cooked chicken stew | Cottage cheese | 1460 |\n| Thu | Soft tofu scramble | Mashed chickpeas | Pureed vegetable and lentil soup | Soft banana | 1420 |\n| Fri | Oat porridge with cinnamon | Soft beef stew | Ground turkey with mashed cauliflower | Chia seeds | 1445 |\n| Sat | Mashed avocado and egg | Soft chicken and squash mash | Black bean and veggie puree | Apple sauce | 1455 |\n| Sun | Scrambled eggs | Pureed butternut squash | Soft organic beef with mashed peas | Almond butter | 1470 |\n\n## Foods\n\n### Include\n- **Organic Legumes (Lentils, Beans):** High fiber for gut health and glycemic control.\n- **Organic Lean Proteins (Chicken, Turkey, Beef, Tofu):** Essential for maintaining prealbumin levels.\n- **Avocado & Seeds (Chia, Flax):** Healthy fats for cardiovascular health (HDL support).\n- **Soft Vegetables (Squash, Zucchini, Carrots):** Easy to consume with tremors; high micronutrient density.\n\n### Avoid\n- **All Fish/Seafood:** Critical allergy risk.\n- **Refined Sugars/White Flour:** To prevent glycemic spikes and dumping syndrome.\n- **High-Sodium Processed Foods:** To manage Stage 1 Hypertension.\n- **Hard/Crunchy Foods:** To accommodate feeding assistance and tremor-related difficulties.\n\n## Notes\n- **Texture Modification:** All meals should be prepared to a \"soft\" or \"mashable\" consistency to assist with feeding.\n- **Small, Frequent Feedings:** Given the gastric sleeve history and decreased appetite, focus on nutrient density in every bite.\n- **Hydration:** Aim to increase water intake from 1.5L to 2L daily, sipping slowly between meals.\n- **Organic Sourcing:** Prioritize organic labels to meet patient preference and reduce chemical load.\n\n## Monitoring Parameters\n\n### Indicators to Evaluate\n| Parameter | Current Value | Target | Timeline |\n|-----------|---------------|--------|----------|\n| Fasting Glucose | 111.3 mg/dL | < 100 mg/dL | 12 weeks |\n| Total Cholesterol | 229.4 mg/dL | < 200 mg/dL | 16 weeks |\n| Weight (BMI) | 28.4 | 24.9 - 27.0 | 12 weeks |\n| Blood Pressure | Stage 1 HTN | < 130/80 mmHg | 8 weeks |\n\n### Recommended Follow-up\n- **Next appointment:** 4 weeks.\n- **Follow-up labs:** HbA1c, Lipid Panel, and Fasting Glucose in 3 months.\n- **Warning signs:** Dizziness, extreme fatigue, or significant weight loss (>1kg/week) should be reported immediately.\n\n---\nEND OF PLAN", "temperature": 0.4, "model": "gemma-4-26b-a4b-it", "provider": "gemini", "reasoning": true}, "meethealth": {"package": "meethealth-sample-v1", "package_version": "1.0.0", "source_corpus": "gemma_diets", "source_line": 20709, "contract": "diet_plan@1.0.0", "contract_fingerprint": "1a6c5cf6b9d37193", "gate_rules_evaluated": 45, "gate_failures": [], "package_checks": {"plan_language": {"pass": true, "detail": "english markers=4"}, "completeness_28_days": {"pass": true, "detail": "day_rows=28 weeks=4 terminated=True"}, "no_duplicate_days": {"pass": true, "detail": "duplicate_days=0"}, "macro_arithmetic": {"pass": true, "detail": "target=1450 kcal, 4P+4C+9F=1392 kcal, deviation=4.0%"}, "energy_dose_plausible": {"pass": true, "detail": "22.8 kcal/kg (screen 15-45)"}, "protein_dose_plausible": {"pass": true, "detail": "1.34 g/kg (screen 0.8-1.6)"}, "daily_energy_on_target": {"pass": true, "detail": "days_outside_10pct=0 of 28"}, "allergen_screen": {"pass": true, "detail": "screened=['fish'] hits=[]"}, "hyperkalemia_food_screen": {"pass": true, "detail": "not applicable (K <= 5.0 or absent)"}, "scenario_coherence": {"pass": true, "detail": "ok"}}, "evidence_level": "L2_automated_checks_passed", "expert_review": "not_performed"}}
{"patient_id": "355e8733-ae1c-418c-8c26-a3a7d0b91281", "patient_data": {"id": "355e8733-ae1c-418c-8c26-a3a7d0b91281", "name": "Beatriz Zaragoza Reyes", "age": 76, "age_group": "elderly_76_85y", "gender": "female", "region": "Cuba", "language": "es", "occupation": "Retired", "conditions": "Overweight (BMI 25-29.9)", "goals": "Fracture prevention in elderly, Circadian rhythm synchronization, LDL reduction", "preferences": "Seventh-day Adventist", "weight": 67.2, "height": 156.0, "bmi": 27.6, "activity_level": "very_active", "past_medical_history": "Bilateral mastectomy (2023)", "meals_per_day": 6, "meal_times": {"breakfast": "7:00 AM", "lunch": "1:00 PM", "dinner": "6:00 PM", "snacks": "10:00 AM"}, "cooking_time": "<5 minutes (microwave/ready-made)", "water_intake_per_day": "1.5-2L", "coffee_cups_per_day": 0, "appetite_assessment": "Increased", "ethical_food_restrictions": "Vegan for ethical reasons", "prompt_mode": "clinical", "clinical_analysis_depth": "comprehensive", "is_geriatric": true, "living_situation": "With spouse/partner"}, "prompt": "You are a senior clinical nutritionist with expertise in medical nutrition therapy creating a diet plan. IMPORTANTE: Genera todo el contenido en ESPAÑOL.\n\n## ADVANCED CLINICAL MODE ENABLED\nThis dietary plan requires a clinically-driven approach with structured analysis of the nutritional anamnesis.\nYou MUST explicitly analyze and integrate key patient parameters before generating recommendations.\nAnalysis Depth: COMPREHENSIVE\n\nSTRICT RULES:\n1. Output ONLY markdown - no preamble, no \"Here is...\", no greetings, no sign-offs\n2. Be CONCISE - use tables, bullets, short sentences\n3. Use TABLES for meal plans (mandatory)\n4. NO lengthy explanations unless customInstructions requests detail\n5. Start directly with the H1 title\n6. USE ALL patient data provided to personalize the plan\n7. EVERY DAY must have UNIQUE meals - NO \"repeat day X\" or \"same as above\" - write out ALL 28 days completely.\n8. Provide VARIETY - different foods each day, rotate proteins, vegetables, grains\n\n9. PERFORM complete clinical anamnesis analysis BEFORE generating the meal plan\n10. JUSTIFY each major dietary recommendation with clinical rationale\n11. USE PES (Problem-Etiology-Signs/Symptoms) format for nutritional diagnoses\n12. INCLUDE monitoring parameters and follow-up indicators\n\n\n## CLINICAL NUTRITIONAL ANAMNESIS ANALYSIS\n\nYou MUST perform a structured, systematic analysis of the patient's nutritional anamnesis before generating the diet plan.\n\n**Analysis Depth:** Provide a thorough clinical analysis covering all major domains with clinical correlations.\n\n### 1. BIOCHEMICAL DATA ANALYSIS\nNo biochemical data available - recommend baseline laboratory assessment.\n\n### 2. CLINICAL DATA ANALYSIS\n**Current Medical Conditions:** Overweight (BMI 25-29.9)\n  - Nutritional implications: Disease-specific dietary modifications, nutrient-drug interactions\n\n\n### 3. ANTHROPOMETRIC DATA ANALYSIS\n**Primary Measurements:**\n  - Weight: 67.2 kg | Height: 156.0 cm | BMI: 27.6 kg/m²\n  - BMI Classification: Overweight\n  - Activity Level: very active\n\n### 4. DIETARY DATA ANALYSIS\nNo 24h recall available.\n\n### 5. CLINICAL SYNTHESIS & NUTRITIONAL DIAGNOSIS\n**Patient Goals:** Fracture prevention in elderly, Circadian rhythm synchronization, LDL reduction\n\n**REQUIRED OUTPUT FOR CLINICAL MODE:**\n1. **Problem List (PES Format):** Identify 2-4 nutrition diagnoses using Problem-Etiology-Signs/Symptoms format\n2. **Priority Ranking:** Rank nutritional problems by clinical urgency\n3. **Intervention Rationale:** For each dietary recommendation, provide clinical justification\n4. **Monitoring Parameters:** Specify what should be monitored\n\n---\n\n**Patient:** Name: Beatriz Zaragoza Reyes | Age: 76 | Gender: female | Conditions: Overweight (BMI 25-29.9) | Region: Cuba | Occupation: Retired\n**Anthropometrics:** Wt: 67.2kg | Ht: 156.0cm | BMI: 27.6 | Activity: very active\n**Medical History:** Past Medical: Bilateral mastectomy (2023)\n**Eating Patterns:** Meals/day: 6 | Breakfast: 7:00 AM | Lunch: 1:00 PM | Dinner: 6:00 PM | Snacks: 10:00 AM | Cooking time: <5 minutes (microwave/ready-made) | Water: 1.5-2L\n**Restrictions:** Ethical: Vegan for ethical reasons\n**Appetite:** Appetite: Increased\n**Goals:** Fracture prevention in elderly, Circadian rhythm synchronization, LDL reduction\n**Additional Notes:** Seventh-day Adventist\n\n\n\nSPECIAL POPULATION CONTEXT:\nGERIATRIC PATIENT\nLiving Situation: With spouse/partner\nIMPORTANT: Prioritize protein intake (1.0-1.2g/kg/day minimum) for sarcopenia prevention. Consider dysphagia risk, dental status, medication interactions, and realistic cooking/shopping ability. Avoid overly restrictive diets in the very elderly — quality of life matters.\n\n\n---\n\nOUTPUT FORMAT (follow exactly):\n\n# Plan de Dieta - Beatriz Zaragoza Reyes\n\n## Análisis Clínico de la Anamnesis Nutricional\n\n### 1. Biochemical Data Analysis\n[Interpret lab values]\n\n### 2. Clinical Data Analysis\n[Medical conditions and dietary implications]\n\n### 3. Anthropometric Data Analysis\n[BMI classification and body composition]\n\n### 4. Dietary Data Analysis\n[24h recall interpretation and nutrient gap analysis]\n\n### 5. Nutritional Diagnosis (PES Format)\n| Priority | Problem | Etiology | Signs/Symptoms |\n|----------|---------|----------|----------------|\n| 1 | [Nutrition problem] | related to [etiology] | as evidenced by [S/S] |\n\n### 6. Intervention Rationale\n[Key intervention decisions with clinical justification]\n\n---\n\n## Resumen\n- Target: [kcal] kcal/day\n- Macros: P [g]g | C [g]g | F [g]g\n- Key focus: [2-3 bullet points max based on patient data]\n- Clinical priorities: [Based on PES diagnoses above]\n\n## Plan Semanal\n\nCRITICAL: You MUST write out EVERY meal for ALL 28 days across ALL 4 weeks. Each day must be unique.\n\n### Semana 1\n\n| Day | Breakfast | Lunch | Dinner | Snacks | kcal |\n|-----|-----------|-------|--------|--------|------|\n| Mon | [unique meal] | [unique meal] | [unique meal] | [snack] | [total] |\n| Tue | [unique meal] | [unique meal] | [unique meal] | [snack] | [total] |\n| Wed | [unique meal] | [unique meal] | [unique meal] | [snack] | [total] |\n| Thu | [unique meal] | [unique meal] | [unique meal] | [snack] | [total] |\n| Fri | [unique meal] | [unique meal] | [unique meal] | [snack] | [total] |\n| Sat | [unique meal] | [unique meal] | [unique meal] | [snack] | [total] |\n| Sun | [unique meal] | [unique meal] | [unique meal] | [snack] | [total] |\n\n### Semana 2\n\n| Day | Breakfast | Lunch | Dinner | Snacks | kcal |\n|-----|-----------|-------|--------|--------|------|\n| Mon | [unique meal] | [unique meal] | [unique meal] | [snack] | [total] |\n| Tue | [unique meal] | [unique meal] | [unique meal] | [snack] | [total] |\n| Wed | [unique meal] | [unique meal] | [unique meal] | [snack] | [total] |\n| Thu | [unique meal] | [unique meal] | [unique meal] | [snack] | [total] |\n| Fri | [unique meal] | [unique meal] | [unique meal] | [snack] | [total] |\n| Sat | [unique meal] | [unique meal] | [unique meal] | [snack] | [total] |\n| Sun | [unique meal] | [unique meal] | [unique meal] | [snack] | [total] |\n\n### Semana 3\n\n| Day | Breakfast | Lunch | Dinner | Snacks | kcal |\n|-----|-----------|-------|--------|--------|------|\n| Mon | [unique meal] | [unique meal] | [unique meal] | [snack] | [total] |\n| Tue | [unique meal] | [unique meal] | [unique meal] | [snack] | [total] |\n| Wed | [unique meal] | [unique meal] | [unique meal] | [snack] | [total] |\n| Thu | [unique meal] | [unique meal] | [unique meal] | [snack] | [total] |\n| Fri | [unique meal] | [unique meal] | [unique meal] | [snack] | [total] |\n| Sat | [unique meal] | [unique meal] | [unique meal] | [snack] | [total] |\n| Sun | [unique meal] | [unique meal] | [unique meal] | [snack] | [total] |\n\n### Semana 4\n\n| Day | Breakfast | Lunch | Dinner | Snacks | kcal |\n|-----|-----------|-------|--------|--------|------|\n| Mon | [unique meal] | [unique meal] | [unique meal] | [snack] | [total] |\n| Tue | [unique meal] | [unique meal] | [unique meal] | [snack] | [total] |\n| Wed | [unique meal] | [unique meal] | [unique meal] | [snack] | [total] |\n| Thu | [unique meal] | [unique meal] | [unique meal] | [snack] | [total] |\n| Fri | [unique meal] | [unique meal] | [unique meal] | [snack] | [total] |\n| Sat | [unique meal] | [unique meal] | [unique meal] | [snack] | [total] |\n| Sun | [unique meal] | [unique meal] | [unique meal] | [snack] | [total] |\n\n\n## Alimentos\n\n### Incluir\n- [food]: [portion] - [brief reason based on labs/conditions]\n\n### Evitar\n- [food]: [brief reason based on labs/conditions]\n\n## Notas\n- [2-4 practical tips based on patient's eating patterns/lifestyle]\n\n## Parámetros de Monitoreo\n\n### Indicators to Evaluate\n| Parameter | Current Value | Target | Timeline |\n|-----------|---------------|--------|----------|\n| [parameter] | [current] | [goal] | [weeks] |\n\n### Recommended Follow-up\n- Next appointment: [timeframe]\n- Follow-up labs: [which tests, when]\n- Warning signs: [symptoms requiring immediate attention]\n\n---\nEND OF PLAN", "diet": {"content": "# Plan de Dieta - Beatriz Zaragoza Reyes\n\n## Análisis Clínico de la Anamnesis Nutricional\n\n### 1. Biochemical Data Analysis\nNo se dispone de datos bioquímicos. Se recomienda realizar un perfil lipídico completo (colesterol total, LDL, HDL, triglicéridos), niveles de Vitamina B12, Vitamina D, Calcio sérico y hemoglobina glicosilada para establecer una línea base.\n\n### 2. Clinical Data Analysis\n*   **Sobrepeso (BMI 27.6):** Requiere control calórico moderado para prevenir progresión a obesidad, considerando su edad.\n*   **Post-Mastectomía (2023):** Monitorización de la salud ósea y posible linfedema; la nutrición debe apoyar la recuperación tisular.\n*   **Perfil Vegano:** Riesgo inherente de deficiencia de Vitamina B12, Calcio, Vitamina D, Hierro y Zinc. Es crítico asegurar la biodisponibilidad de proteínas para evitar sarcopenia.\n*   **Riesgo de Fractura:** Necesidad de optimizar la ingesta de calcio, magnesio y vitamina D.\n\n### 3. Anthropometric Data Analysis\n*   **Peso:** 67.2 kg | **Talla:** 156.0 cm | **IMC:** 27.6 kg/m² (Sobrepeso).\n*   **Nivel de Actividad:** Muy activo (requiere mayor aporte energético para mantener masa muscular).\n\n### 4. Dietary Data Analysis\n*   **Patrón:** 6 comidas/día. Tiempo de preparación muy limitado (<5 min), lo que sugiere dependencia de alimentos procesados o precocinados. Riesgo de ingesta de sodio y grasas saturadas si no se seleccionan productos veganos de alta calidad.\n\n### 5. Nutritional Diagnosis (PES Format)\n| Priority | Problem | Etiology | Signs/Symptoms |\n|----------|---------|----------|----------------|\n| 1 | Riesgo de sarcopenia | Ingesta proteica potencialmente insuficiente para edad y nivel de actividad | Edad (76 años) y dieta vegana |\n| 2 | Riesgo de deficiencia de micronutrientes | Restricción dietética estricta (veganismo) | Patrón alimentario vegano |\n| 3 | Ingesta excesiva de energía (potencial) | Relación entre IMC y apetito aumentado | IMC 27.6 kg/m² |\n\n### 6. Intervention Rationale\n*   **Proteína (1.2g/kg):** Para contrarrestar la pérdida de masa muscular propia de la edad (sarcopenia).\n*   **Control de LDL:** Dieta rica en fibra soluble (avena, legumbres) para reducir la absorción de colesterol.\n*   **Sincronización Circadiana:** Cenas ligeras y tempranas para mejorar la calidad del sueño y el metabolismo nocturno.\n*   **Densidad de Calcio/Vit D:** Crucial para la prevención de fracturas en paciente geriátrica.\n\n---\n\n## Resumen\n- Target: 1850 kcal/día\n- Macros: P 90g | C 230g | F 60g\n- Key focus: Proteína vegetal de alta calidad, salud ósea y control de lípidos.\n- Clinical priorities: Prevención de sarcopenia y optimización de micronutrientes esenciales.\n\n## Plan Semanal\n\n### Semana 1\n\n| Day | Breakfast | Lunch | Dinner | Snacks | kcal |\n|-----|-----------|-------|--------|--------|------|\n| Mon | Tofu revuelto con cúrcuma y espinacas | Lentejas con arroz integral y brócoli | Crema de calabaza con semillas de cáñamo | Nueces y manzana | 1840 |\n| Tue | Avena con leche de soja y semillas de chía | Garbanzos salteados con kale y quinoa | Ensalada de tempeh con aguacate | Yogur de soja con bayas | 1860 |\n| Wed | Pudding de chía con leche de almendras | Chili de frijoles negros con maíz | Sopa de miso con tofu y algas | Hummus con zanahoria | 1830 |\n| Thu | Pan integral con aguacate y semillas | Guiso de soja texturizada con verduras | Ensalada de lentejas y pepino | Almendras y pera | 1855 |\n| Fri | Batido de proteína vegetal y plátano | Pasta integral con salsa de levadura nutricional | Salteado de tofu y champiñones | Edamames al vapor | 1870 |\n| Sat | Tostadas de masa madre con hummus | Curry de garbanzos y espinacas | Crema de verduras verdes con semillas | Nueces de Brasil | 1820 |\n| Sun | Yogur de soja con granola sin azúcar | Ensalada de quinoa, frijoles y pimientos | Tofu al horno con espárragos | Manzana con crema de cacahuete | 1850 |\n\n### Semana 2\n\n| Day | Breakfast | Lunch | Dinner | Snacks | kcal |\n|-----|-----------|-------|--------|--------|------|\n| Mon | Avena con nueces y arándanos | Estofado de alubias blancas y acelgas | Tofu con salsa de tahini y brócoli | Semillas de calabaza | 1845 |\n| Tue | Tostada integral con crema de almendras | Ensalada de garbanzos y tomate | Sopa de verduras con cubos de tofu | Batido de soja | 1865 |\n| Wed | Smoothie bowl de espinaca y mango | Lentejas con calabaza y cúrcuma | Salteado de seitán y verduras | Nueces y uvas | 1835 |\n| Thu | Pudding de chía con coco y fresas | Quinoa con frijoles rojos y aguacate | Crema de calabacín con semillas | Hummus y apio | 1850 |\n| Fri | Tofu revuelto con tomate y cebolla | Pasta de lentejas con pesto de albahaca | Ensalada de tempeh y rúcula | Yogur de soja | 1875 |\n| Sat | Pan integral con aguacate y semillas | Guiso de soja y patata | Sopa de miso y tofu | Almendras | 1825 |\n| Sun | Avena con semillas de lino y pera | Garbanzos con espinacas y piñones | Tofu marinado con verduras | Edamames | 1855 |\n\n### Semana 3\n\n| Day | Breakfast | Lunch | Dinner | Snacks | kcal |\n|-----|-----------|-------|--------|--------|------|\n| Mon | Batido de proteína, avena y bayas | Lentejas con arroz y zanahoria | Crema de zanahoria y jengibre | Nueces | 1840 |\n| Tue | Tostada de masa madre con hummus | Ensalada de quinoa y edamame | Tofu con judías verdes | Manzana | 1860 |\n| Wed | Yogur de soja con semillas de chía | Chili vegano de frijoles | Sopa de verduras y tofu | Semillas de girasol | 1830 |\n| Thu | Avena con leche de soja y canela | Garbanzos con brócoli y quinoa | Salteado de seitán y pimientos | Almendras | 1855 |\n| Fri | Tofu con cúrcuma y pan integral | Pasta integral con soja texturizada | Crema de calabaza y semillas | Yogur de soja | 1870 |\n| Sat | Pudding de chía y coco | Estofado de alubias y kale | Ensalada de tempeh y aguacate | Frutos secos | 1820 |\n| Sun | Smoothie de plátano y proteína | Lentejas con verduras mixtas | Tofu al vapor con espinacas | Hummus y pepino | 1850 |\n\n### Semana 4\n\n| Day | Breakfast | Lunch | Dinner | Snacks | kcal |\n|-----|-----------|-------|--------|--------|------|\n| Mon | Tostadas con aguacate y semillas | Garbanzos con arroz integral | Sopa de miso y tofu | Nueces | 1845 |\n| Tue | Avena con arándanos y chía | Ensalada de quinoa y frijoles | Salteado de verduras y tempeh | Yogur de soja | 1865 |\n| Wed | Batido de soja y fruta | Lentejas con espinacas | Crema de verduras y semillas | Almendras | 1835 |\n| Thu | Tofu revuelto con champiñones | Pasta de lentejas con verduras | Tofu con brócoli | Edamames | 1850 |\n| Fri | Yogur de soja con granola | Chili de frijoles negros | Ensalada de garbanzos | Semillas de calabaza | 1875 |\n| Sat | Pan integral con crema de cacahuete | Guiso de soja y patata | Sopa de verduras y tofu | Fruta fresca | 1825 |\n| Sun | Pudding de chía y fresas | Quinoa con vegetales y tofu | Crema de calabacín | Nueces | 1855 |\n\n## Alimentos\n\n### Incluir\n- **Tofu/Tempeh/Seitán:** 150-200g/día - Fuente principal de proteína para prevenir sarcopenia.\n- **Legumbres (Lentejas/Garbanzos):** 1 taza - Fibra para control de LDL y proteína.\n- **Semillas (Chía/Lino/Cáñamo):** 2 cdas/día - Omega-3 y calcio.\n- **Verduras de hoja verde:** Ilimitado - Calcio y magnesio para salud ósea.\n- **Avena integral:** 40-50g - Fibra soluble para reducción de LDL.\n\n### Evitar\n- **Aceites refinados/Grasas trans:** Para control de perfil lipídico.\n- **Ultraprocesados veganos (embutidos):** Por alto contenido de sodio y aditivos.\n- **Azúcares añadidos:** Para control de peso y salud metabólica.\n\n## Notas\n- **Preparación rápida:** Utilice legumbres ya cocidas (en conserva, lavadas) y verduras congeladas para cumplir con su tiempo de cocina <5 min.\n- **Suplementación:** Dado el veganismo y la edad, es imperativo consultar con su médico sobre suplementación de B12 y Vitamina D.\n- **Hidratación:** Mantenga sus 1.5-2L de agua, preferiblemente fuera de las comidas principales para no saciarla prematuramente.\n\n## Parámetros de Monitoreo\n\n### Indicators to Evaluate\n| Parameter | Current Value | Target | Timeline |\n|-----------|---------------|--------|----------|\n| IMC | 27.6 | 24.9-26.9 | 3-6 meses |\n| Colesterol LDL | No disponible | <100 mg/dL | 3 meses |\n| Masa Muscular | No disponible | Mantener/Aumentar | 6 meses |\n\n### Recommended Follow-up\n- Next appointment: 4 semanas.\n- Follow-up labs: Perfil lipídico, Vitamina B12, Vitamina D, Calcio a las 12 semanas.\n- Warning signs: Debilidad muscular extrema, fatiga persistente, pérdida de peso involuntaria.\n\n---\nEND OF PLAN", "temperature": 0.4, "model": "gemma-4-26b-a4b-it", "provider": "gemini", "reasoning": true}, "meethealth": {"package": "meethealth-sample-v1", "package_version": "1.0.0", "source_corpus": "gemma_diets", "source_line": 47004, "contract": "diet_plan@1.0.0", "contract_fingerprint": "1a6c5cf6b9d37193", "gate_rules_evaluated": 45, "gate_failures": [], "package_checks": {"plan_language": {"pass": true, "detail": "spanish markers=3"}, "completeness_28_days": {"pass": true, "detail": "day_rows=28 weeks=4 terminated=True"}, "no_duplicate_days": {"pass": true, "detail": "duplicate_days=0"}, "macro_arithmetic": {"pass": true, "detail": "target=1850 kcal, 4P+4C+9F=1820 kcal, deviation=1.6%"}, "energy_dose_plausible": {"pass": true, "detail": "27.5 kcal/kg (screen 15-45)"}, "protein_dose_plausible": {"pass": true, "detail": "1.34 g/kg (screen 0.8-1.6)"}, "daily_energy_on_target": {"pass": true, "detail": "days_outside_10pct=0 of 28"}, "allergen_screen": {"pass": true, "detail": "no declared allergies"}, "hyperkalemia_food_screen": {"pass": true, "detail": "not applicable (K <= 5.0 or absent)"}, "scenario_coherence": {"pass": true, "detail": "ok"}}, "evidence_level": "L2_automated_checks_passed", "expert_review": "not_performed"}}
{"patient_id": "d5ded006-a5a4-4b70-b880-dcbd4f959cf4", "patient_data": {"id": "d5ded006-a5a4-4b70-b880-dcbd4f959cf4", "name": "Matthew Bell", "age": 27, "age_group": "young_adult_18_30y", "gender": "male", "region": "Ireland", "language": "en", "occupation": "Factory worker", "conditions": "Obesity Class I (BMI 30-34.9), Hepatic Steatosis Grade I", "allergies": "Fish (all), Red meat allergy (Alpha-gal syndrome)", "goals": "Immune system support, Gut health optimization / microbiome support", "preferences": "Buddhist vegetarian", "weight": 99.5, "height": 178.9, "bmi": 31.1, "activity_level": "sedentary", "muac": 26.3, "waist_circumference": 80.7, "hip_circumference": 126.0, "calf_circumference": 30.4, "ldl_cholesterol": 159.9, "vitamin_d": 99.2, "vitamin_b12": 886.0, "sodium": 139.5, "chloride": 100.2, "prealbumin": 17.7, "bun": 16.3, "dietary_recall_24h": "Breakfast: 1 cup oatmeal with banana and honey\nLunch: Chicken breast with rice and salad\nDinner: Soup with bread\nSnacks: Ice cream (1 cup)", "total_calories": 1560, "total_protein": 65.5, "total_carbohydrates": 169.5, "total_fat": 68.9, "total_fiber": 11.6, "total_sugar": 33.6, "total_saturated_fat": 16.2, "total_sodium": 2343, "bmr_formula": "Mifflin-St Jeor", "bmr": 1983, "tdee": 2380, "macro_split": {"carbsPercent": 20, "proteinPercent": 30, "fatPercent": 50}, "meals_per_day": 2, "meal_times": {"breakfast": "10:00 AM", "lunch": "2:00 PM", "dinner": "6:00 PM", "snacks": "Late night"}, "cooking_time": "15-30 minutes", "water_intake_per_day": "2.5-3L", "coffee_cups_per_day": 0, "food_aversions": "Avoids organ meats", "appetite_assessment": "Variable", "prompt_mode": "standard", "clinical_analysis_depth": "detailed", "is_athlete": true, "sport_type": "Diving", "position": "Springboard 3m", "season_phase": "in-season", "meal_context": "weigh-in-day", "training_time": "10:00 AM", "nutrient_timing": true, "competition_level": "professional"}, "prompt": "You are a clinical nutritionist creating a diet plan. Generate all content in ENGLISH.\n\nSTRICT RULES:\n1. Output ONLY markdown - no preamble, no \"Here is...\", no greetings, no sign-offs\n2. Be CONCISE - use tables, bullets, short sentences\n3. Use TABLES for meal plans (mandatory)\n4. NO lengthy explanations unless customInstructions requests detail\n5. Start directly with the H1 title\n6. USE ALL patient data provided to personalize the plan\n7. EVERY DAY must have UNIQUE meals - NO \"repeat day X\" or \"same as above\" - write out ALL 28 days completely.\n8. Provide VARIETY - different foods each day, rotate proteins, vegetables, grains\n\n\n\n\n**Patient:** Name: Matthew Bell | Age: 27 | Gender: male | Conditions: Obesity Class I (BMI 30-34.9), Hepatic Steatosis Grade I | Allergies: Fish (all), Red meat allergy (Alpha-gal syndrome) | Region: Ireland | Occupation: Factory worker\n**Anthropometrics:** Wt: 99.5kg | Ht: 178.9cm | BMI: 31.1 | Activity: sedentary\n**Body Circumferences:** MUAC: 26.3cm | Waist: 80.7cm | Hip: 126.0cm | Calf: 30.4cm\n**Metabolic Labs:** LDL: 159.9\n**Vitamins/Electrolytes:** VitD: 99.2ng/mL | B12: 886.0pg/mL | Na: 139.5 | Cl: 100.2\n**Protein/Kidney:** Prealbumin: 17.7mg/dL | BUN: 16.3mg/dL\n**Energy Targets:** Formula: Mifflin-St Jeor | BMR: 1983kcal | TDEE: 2380kcal | Macro Target: C20/P30/F50%\n**Current Intake (24h):** Cal: 1560 | P: 65.5g | C: 169.5g | F: 68.9g | Fiber: 11.6g | Sugar: 33.6g | SatFat: 16.2g | Na: 2343mg\n**24h Recall:** Breakfast: 1 cup oatmeal with banana and honey\nLunch: Chicken breast with rice and salad\nDinner: Soup with bread\nSnacks: Ice cream (1 cup)\n**Eating Patterns:** Meals/day: 2 | Breakfast: 10:00 AM | Lunch: 2:00 PM | Dinner: 6:00 PM | Snacks: Late night | Cooking time: 15-30 minutes | Water: 2.5-3L\n**Food Preferences:** Dislikes: Avoids organ meats\n**Appetite:** Appetite: Variable\n**Goals:** Immune system support, Gut health optimization / microbiome support\n**Additional Notes:** Buddhist vegetarian\n\nSPORT-SPECIFIC CONTEXT:\nSport: Diving | Position: Springboard 3m | Season: In-season\nMeal Context: weigh-in-day\nTraining Time: 10:00 AM — Optimize nutrient timing around this session\n- Pre-training meal: 2-3 hours before (complex carbs, moderate protein)\n- Post-training meal: within 30-60 minutes (fast carbs, high protein)\nSeason Adjustments: In-season — maintain weight, prioritize recovery nutrition\n\n\n\n---\n\nOUTPUT FORMAT (follow exactly):\n\n# Diet Plan - Matthew Bell\n\n## Summary\n- Target: [kcal] kcal/day\n- Macros: P [g]g | C [g]g | F [g]g\n- Key focus: [2-3 bullet points max based on patient data]\n\n\n## Weekly Meal Plan\n\nCRITICAL: You MUST write out EVERY meal for ALL 28 days across ALL 4 weeks. Each day must be unique.\n\n### Week 1\n\n| Day | Breakfast | Lunch | Dinner | Snacks | kcal |\n|-----|-----------|-------|--------|--------|------|\n| Mon | [unique meal] | [unique meal] | [unique meal] | [snack] | [total] |\n| Tue | [unique meal] | [unique meal] | [unique meal] | [snack] | [total] |\n| Wed | [unique meal] | [unique meal] | [unique meal] | [snack] | [total] |\n| Thu | [unique meal] | [unique meal] | [unique meal] | [snack] | [total] |\n| Fri | [unique meal] | [unique meal] | [unique meal] | [snack] | [total] |\n| Sat | [unique meal] | [unique meal] | [unique meal] | [snack] | [total] |\n| Sun | [unique meal] | [unique meal] | [unique meal] | [snack] | [total] |\n\n### Week 2\n\n| Day | Breakfast | Lunch | Dinner | Snacks | kcal |\n|-----|-----------|-------|--------|--------|------|\n| Mon | [unique meal] | [unique meal] | [unique meal] | [snack] | [total] |\n| Tue | [unique meal] | [unique meal] | [unique meal] | [snack] | [total] |\n| Wed | [unique meal] | [unique meal] | [unique meal] | [snack] | [total] |\n| Thu | [unique meal] | [unique meal] | [unique meal] | [snack] | [total] |\n| Fri | [unique meal] | [unique meal] | [unique meal] | [snack] | [total] |\n| Sat | [unique meal] | [unique meal] | [unique meal] | [snack] | [total] |\n| Sun | [unique meal] | [unique meal] | [unique meal] | [snack] | [total] |\n\n### Week 3\n\n| Day | Breakfast | Lunch | Dinner | Snacks | kcal |\n|-----|-----------|-------|--------|--------|------|\n| Mon | [unique meal] | [unique meal] | [unique meal] | [snack] | [total] |\n| Tue | [unique meal] | [unique meal] | [unique meal] | [snack] | [total] |\n| Wed | [unique meal] | [unique meal] | [unique meal] | [snack] | [total] |\n| Thu | [unique meal] | [unique meal] | [unique meal] | [snack] | [total] |\n| Fri | [unique meal] | [unique meal] | [unique meal] | [snack] | [total] |\n| Sat | [unique meal] | [unique meal] | [unique meal] | [snack] | [total] |\n| Sun | [unique meal] | [unique meal] | [unique meal] | [snack] | [total] |\n\n### Week 4\n\n| Day | Breakfast | Lunch | Dinner | Snacks | kcal |\n|-----|-----------|-------|--------|--------|------|\n| Mon | [unique meal] | [unique meal] | [unique meal] | [snack] | [total] |\n| Tue | [unique meal] | [unique meal] | [unique meal] | [snack] | [total] |\n| Wed | [unique meal] | [unique meal] | [unique meal] | [snack] | [total] |\n| Thu | [unique meal] | [unique meal] | [unique meal] | [snack] | [total] |\n| Fri | [unique meal] | [unique meal] | [unique meal] | [snack] | [total] |\n| Sat | [unique meal] | [unique meal] | [unique meal] | [snack] | [total] |\n| Sun | [unique meal] | [unique meal] | [unique meal] | [snack] | [total] |\n\n\n## Foods\n\n### Include\n- [food]: [portion] - [brief reason based on labs/conditions]\n\n### Avoid\n- [food]: [brief reason based on labs/conditions]\n\n## Notes\n- [2-4 practical tips based on patient's eating patterns/lifestyle]\n\n---\nEND OF PLAN", "diet": {"content": "# Diet Plan - Matthew Bell\n\n## Summary\n- Target: 2380 kcal/day\n- Macros: P 179g | C 119g | F 132g\n- Key focus: \n    - Hepatic Steatosis management via low glycemic index and high fiber.\n    - Buddhist Vegetarian (No meat/fish/eggs/dairy/honey) with high plant protein.\n    - Nutrient timing for 10:00 AM diving sessions.\n\n## Weekly Meal Plan\n\n### Week 1\n\n| Day | Breakfast (Pre-Training 08:00) | Lunch (Post-Training 12:00) | Dinner (18:00) | Snacks (Late Night) | kcal |\n|-----|-----------|-------|--------|--------|------|\n| Mon | Overnight oats with soy milk, chia, & berries | Tofu stir-fry with broccoli, quinoa, & sesame | Lentil dahl with spinach & brown rice | Almonds & soy yogurt | 2370 |\n| Tue | Buckwheat porridge with soy milk & walnuts | Chickpea salad with avocado, cucumber, & hemp seeds | Tempeh tacos with corn tortillas & cabbage slaw | Apple slices with peanut butter | 2390 |\n| Wed | Tofu scramble with nutritional yeast & spinach | Edamame & buckwheat noodle salad with tahini | Red lentil soup with sourdough bread | Pumpkin seeds & soy milk | 2365 |\n| Thu | Chia seed pudding with soy milk & flaxseed | Seitan stir-fry with bell peppers & jasmine rice | Black bean chili with avocado & corn | Walnuts & dried apricots | 2385 |\n| Fri | Steel-cut oats with soy milk & hemp hearts | Tempeh Buddha bowl with sweet potato & kale | Miso soup with tofu, seaweed, & buckwheat | Soy yogurt with blueberries | 2375 |\n| Sat | Soy yogurt parfait with granola & chia | Chickpea & avocado wrap in whole grain tortilla | Red lentil pasta with tomato & basil sauce | Cashews & dark chocolate (vegan) | 2395 |\n| Sun | Buckwheat pancakes (soy milk based) & berries | Tofu & vegetable curry with cauliflower rice | Lentil stew with root vegetables | Soy milk & sunflower seeds | 2360 |\n\n### Week 2\n\n| Day | Breakfast (Pre-Training 08:00) | Lunch (Post-Training 12:00) | Dinner (18:00) | Snacks (Late Night) | kcal |\n|-----|-----------|-------|--------|--------|------|\n| Mon | Quinoa porridge with soy milk & almonds | Tempeh salad with mixed greens & sunflower seeds | Chickpea stew with coconut milk & spinach | Soy yogurt & flaxseeds | 2380 |\n| Tue | Chia pudding with soy milk & sliced banana | Tofu Buddha bowl with edamame & brown rice | Lentil bolognese with zucchini noodles | Almond butter on rice cakes | 2370 |\n| Wed | Buckwheat bowl with soy milk & pumpkin seeds | Seitan stir-fry with snap peas & quinoa | Black bean soup with avocado & lime | Walnuts & soy milk | 2390 |\n| Thu | Overnight oats with soy milk & hemp seeds | Chickpea curry with cauliflower & spinach | Tofu steaks with roasted sweet potato | Peanut butter & celery | 2375 |\n| Fri | Tofu scramble with mushrooms & kale | Tempeh wrap with hummus & shredded carrots | Red lentil dahl with millet | Soy yogurt & chia seeds | 2385 |\n| Sat | Soy milk smoothie with protein powder & oats | Buckwheat salad with tofu & cucumber | Vegetable & lentil shepherd's pie (vegan) | Cashews & dried figs | 2365 |\n| Sun | Chia seed porridge with soy milk & walnuts | Edamame & quinoa power bowl | Tempeh stir-fry with bok choy | Pumpkin seeds & soy milk | 2380 |\n\n### Week 3\n\n| Day | Breakfast (Pre-Training 08:00) | Lunch (Post-Training 12:00) | Dinner (18:00) | Snacks (Late Night) | kcal |\n|-----|-----------|-------|--------|--------|------|\n| Mon | Steel-cut oats with soy milk & flax | Tofu & broccoli stir-fry with brown rice | Lentil soup with kale & sourdough | Almonds & soy yogurt | 2375 |\n| Tue | Buckwheat porridge with soy milk & chia | Chickpea & avocado salad with quinoa | Tempeh with roasted Mediterranean veggies | Peanut butter & apple | 2390 |\n| Wed | Soy yogurt with hemp seeds & berries | Seitan salad with mixed greens & tahini | Black bean & corn tacos (corn shells) | Walnuts & soy milk | 2360 |\n| Thu | Chia pudding with soy milk & almonds | Tofu Buddha bowl with sweet potato | Red lentil curry with cauliflower | Soy yogurt & sunflower seeds | 2385 |\n| Fri | Overnight oats with soy milk & walnuts | Tempeh stir-fry with bell peppers & millet | Chickpea stew with spinach | Cashews & dark chocolate | 2370 |\n| Sat | Tofu scramble with nutritional yeast | Buckwheat noodles with edamame & tofu | Lentil pasta with veggie marinara | Soy milk & pumpkin seeds | 2395 |\n| Sun | Quinoa breakfast bowl with soy milk | Seitan & veggie wrap with hummus | Miso tofu soup with seaweed & rice | Almonds & dried berries | 2365 |\n\n### Week 4\n\n| Day | Breakfast (Pre-Training 08:00) | Lunch (Post-Training 12:00) | Dinner (18:00) | Snacks (Late Night) | kcal |\n|-----|-----------|-------|--------|--------|------|\n| Mon | Chia pudding with soy milk & flaxseed | Tempeh & quinoa salad with avocado | Red lentil dahl with spinach | Soy yogurt & hemp hearts | 2380 |\n| Tue | Buckwheat porridge with soy milk & berries | Chickpea curry with brown rice | Tofu stir-fry with mixed vegetables | Peanut butter & banana | 2375 |\n| Wed | Soy yogurt with granola & chia seeds | Seitan Buddha bowl with sweet potato | Black bean soup with avocado | Walnuts & soy milk | 2390 |\n| Thu | Overnight oats with soy milk & hemp | Tofu & vegetable skewers with quinoa | Lentil stew with root vegetables | Almonds & dried apricots | 2365 |\n| Fri | Tofu scramble with spinach & mushrooms | Tempeh wrap with avocado & greens | Chickpea pasta with pesto (vegan) | Soy milk & pumpkin seeds | 2385 |\n| Sat | Quinoa porridge with soy milk & walnuts | Edamame & buckwheat salad | Tofu curry with cauliflower rice | Cashews & soy yogurt | 2370 |\n| Sun | Chia seed pudding with soy milk & berries | Seitan stir-fry with broccoli & rice | Lentil & vegetable soup | Sunflower seeds & soy milk | 2380 |\n\n## Foods\n\n### Include\n- Tofu/Tempeh/Seitan: High plant protein to meet 179g target without meat/fish.\n- Lentils/Chickpeas: High fiber for gut health and hepatic steatosis management.\n- Chia/Flax/Hemp: Omega-3 fatty acids for inflammation and liver health.\n- Soy Milk: Unsweetened, for protein and calcium without dairy.\n- Leafy Greens: Micronutrients and fiber for microbiome support.\n\n### Avoid\n- Red Meat/Fish: Due to Alpha-gal syndrome and fish allergy.\n- Honey/Dairy/Eggs: Per Buddhist vegetarian requirements.\n- Refined Sugars: To manage Hepatic Steatosis and LDL levels.\n- Saturated Fats (High): To address elevated LDL (159.9).\n\n## Notes\n- **Nutrient Timing:** Consume breakfast 2 hours before diving to ensure complex carbs are available for energy.\n- **Post-Training:** Ensure lunch is eaten within 60 minutes of training to maximize protein synthesis and glycogen replenishment.\n- **Liver Health:** Prioritize high-fiber legumes and cruciferous vegetables to assist in reducing hepatic fat.\n- **Hydration:** Continue current 2.5-3L water intake; ensure electrolytes are maintained during training.\n\n---\nEND OF PLAN", "temperature": 0.4, "model": "gemma-4-26b-a4b-it", "provider": "gemini", "reasoning": true}, "meethealth": {"package": "meethealth-sample-v1", "package_version": "1.0.0", "source_corpus": "gemma_diets", "source_line": 48336, "contract": "diet_plan@1.0.0", "contract_fingerprint": "1a6c5cf6b9d37193", "gate_rules_evaluated": 45, "gate_failures": [], "package_checks": {"plan_language": {"pass": true, "detail": "english markers=4"}, "completeness_28_days": {"pass": true, "detail": "day_rows=28 weeks=4 terminated=True"}, "no_duplicate_days": {"pass": true, "detail": "duplicate_days=0"}, "macro_arithmetic": {"pass": true, "detail": "target=2380 kcal, 4P+4C+9F=2380 kcal, deviation=0.0%"}, "energy_dose_plausible": {"pass": true, "detail": "23.9 kcal/kg (screen 15-45)"}, "protein_dose_plausible": {"pass": true, "detail": "1.80 g/kg (screen 0.8-2.0)"}, "daily_energy_on_target": {"pass": true, "detail": "days_outside_10pct=0 of 28"}, "allergen_screen": {"pass": true, "detail": "screened=['fish', 'alpha_gal'] hits=[]"}, "hyperkalemia_food_screen": {"pass": true, "detail": "not applicable (K <= 5.0 or absent)"}, "scenario_coherence": {"pass": true, "detail": "ok"}}, "evidence_level": "L2_automated_checks_passed", "expert_review": "not_performed"}}
{"patient_id": "1425abb0-b911-4de7-b7dc-4ccafaeabb5c", "patient_data": {"id": "1425abb0-b911-4de7-b7dc-4ccafaeabb5c", "name": "Andrea Rodriguez", "age": 59, "age_group": "middle_age_51_65y", "gender": "female", "region": "South_Africa", "language": "en", "occupation": "Military personnel", "conditions": "Overweight (BMI 25-29.9), Avoidant/Restrictive Food Intake Disorder (ARFID)", "goals": "Transition from tube feeding to oral, Renal protection (low protein/phosphorus/potassium), Sports performance optimization, Anti-inflammatory diet protocol", "preferences": "Dairy-free (preference)", "weight": 75.5, "height": 169.4, "bmi": 26.3, "activity_level": "moderately_active", "muac": 38.5, "waist_circumference": 119.6, "hip_circumference": 104.1, "hemoglobin": 10.5, "hematocrit": 40.0, "hdl_cholesterol": 55.4, "triglycerides": 171.8, "vitamin_d": 146.7, "vitamin_b12": 88.0, "sodium": 140.3, "albumin": 2.3, "prealbumin": 18.0, "creatinine": 1.0, "meals_per_day": 4, "cooking_time": "No cooking ability (caregiver prepares)", "water_intake_per_day": "<1L", "coffee_cups_per_day": 3, "eating_habits": "Eats quickly, often distracted", "appetite_assessment": "Normal", "prompt_mode": "clinical", "clinical_analysis_depth": "basic"}, "prompt": "You are a senior clinical nutritionist with expertise in medical nutrition therapy creating a diet plan. Generate all content in ENGLISH.\n\n## ADVANCED CLINICAL MODE ENABLED\nThis dietary plan requires a clinically-driven approach with structured analysis of the nutritional anamnesis.\nYou MUST explicitly analyze and integrate key patient parameters before generating recommendations.\nAnalysis Depth: BASIC\n\nSTRICT RULES:\n1. Output ONLY markdown - no preamble, no \"Here is...\", no greetings, no sign-offs\n2. Be CONCISE - use tables, bullets, short sentences\n3. Use TABLES for meal plans (mandatory)\n4. NO lengthy explanations unless customInstructions requests detail\n5. Start directly with the H1 title\n6. USE ALL patient data provided to personalize the plan\n7. EVERY DAY must have UNIQUE meals - NO \"repeat day X\" or \"same as above\" - write out ALL 28 days completely.\n8. Provide VARIETY - different foods each day, rotate proteins, vegetables, grains\n\n9. PERFORM complete clinical anamnesis analysis BEFORE generating the meal plan\n10. JUSTIFY each major dietary recommendation with clinical rationale\n11. USE PES (Problem-Etiology-Signs/Symptoms) format for nutritional diagnoses\n12. INCLUDE monitoring parameters and follow-up indicators\n\n\n## CLINICAL NUTRITIONAL ANAMNESIS ANALYSIS\n\nYou MUST perform a structured, systematic analysis of the patient's nutritional anamnesis before generating the diet plan.\n\n**Analysis Depth:** Provide a concise clinical analysis focusing on the most critical parameters.\n\n### 1. BIOCHEMICAL DATA ANALYSIS\n**Hematological Profile:**\n  - Hemoglobin: 10.5 g/dL | Hematocrit: 40.0%\n  - Clinical interpretation: Assess iron status, anemia risk, and need for iron-rich foods or absorption enhancers\n\n**Lipid Profile:**\n  - HDL: 55.4 | TG: 171.8 mg/dL\n  - Clinical interpretation: Assess cardiovascular risk, dietary fat modifications, and omega-3 requirements\n\n**Micronutrient Status:**\n  - Vitamin D: 146.7 ng/mL | B12: 88.0 pg/mL\n  - Clinical interpretation: Identify deficiencies requiring dietary intervention or supplementation\n\n**Electrolyte Balance:**\n  - Na: 140.3 mEq/L\n  - Clinical interpretation: Assess fluid-electrolyte status and dietary sodium/potassium modifications\n\n**Protein Status:**\n  - Albumin: 2.3 g/dL | Prealbumin: 18.0 mg/dL\n  - Clinical interpretation: Evaluate protein-calorie malnutrition risk and protein requirements\n\n**Renal Function:**\n  - Creatinine: 1.0 mg/dL\n  - Clinical interpretation: Assess renal function and protein/electrolyte restrictions if needed\n\n### 2. CLINICAL DATA ANALYSIS\n**Current Medical Conditions:** Overweight (BMI 25-29.9), Avoidant/Restrictive Food Intake Disorder (ARFID)\n  - Nutritional implications: Disease-specific dietary modifications, nutrient-drug interactions\n\n\n### 3. ANTHROPOMETRIC DATA ANALYSIS\n**Primary Measurements:**\n  - Weight: 75.5 kg | Height: 169.4 cm | BMI: 26.3 kg/m²\n  - BMI Classification: Overweight\n  - Activity Level: moderately active\n\n### 4. DIETARY DATA ANALYSIS\nNo 24h recall available.\n\n### 5. CLINICAL SYNTHESIS & NUTRITIONAL DIAGNOSIS\n**Patient Goals:** Transition from tube feeding to oral, Renal protection (low protein/phosphorus/potassium), Sports performance optimization, Anti-inflammatory diet protocol\n\n**REQUIRED OUTPUT FOR CLINICAL MODE:**\n1. **Problem List (PES Format):** Identify 2-4 nutrition diagnoses using Problem-Etiology-Signs/Symptoms format\n2. **Priority Ranking:** Rank nutritional problems by clinical urgency\n3. **Intervention Rationale:** For each dietary recommendation, provide clinical justification\n4. **Monitoring Parameters:** Specify what should be monitored\n\n---\n\n**Patient:** Name: Andrea Rodriguez | Age: 59 | Gender: female | Conditions: Overweight (BMI 25-29.9), Avoidant/Restrictive Food Intake Disorder (ARFID) | Region: South_Africa | Occupation: Military personnel\n**Anthropometrics:** Wt: 75.5kg | Ht: 169.4cm | BMI: 26.3 | Activity: moderately active\n**Body Circumferences:** MUAC: 38.5cm | Waist: 119.6cm | Hip: 104.1cm\n**Blood/Iron:** Hb: 10.5g/dL | Hct: 40.0%\n**Metabolic Labs:** HDL: 55.4 | TG: 171.8\n**Vitamins/Electrolytes:** VitD: 146.7ng/mL | B12: 88.0pg/mL | Na: 140.3\n**Protein/Kidney:** Albumin: 2.3g/dL | Prealbumin: 18.0mg/dL | Creatinine: 1.0mg/dL\n**Eating Patterns:** Meals/day: 4 | Cooking time: No cooking ability (caregiver prepares) | Coffee: 3 | Water: <1L\n**Food Preferences:** Habits: Eats quickly, often distracted\n**Appetite:** Appetite: Normal\n**Goals:** Transition from tube feeding to oral, Renal protection (low protein/phosphorus/potassium), Sports performance optimization, Anti-inflammatory diet protocol\n**Additional Notes:** Dairy-free (preference)\n\n\n\n\n---\n\nOUTPUT FORMAT (follow exactly):\n\n# Diet Plan - Andrea Rodriguez\n\n## Clinical Nutritional Anamnesis Analysis\n\n### 1. Biochemical Data Analysis\n[Interpret lab values]\n\n### 2. Clinical Data Analysis\n[Medical conditions and dietary implications]\n\n### 3. Anthropometric Data Analysis\n[BMI classification and body composition]\n\n### 4. Dietary Data Analysis\n[24h recall interpretation and nutrient gap analysis]\n\n### 5. Nutritional Diagnosis (PES Format)\n| Priority | Problem | Etiology | Signs/Symptoms |\n|----------|---------|----------|----------------|\n| 1 | [Nutrition problem] | related to [etiology] | as evidenced by [S/S] |\n\n### 6. Intervention Rationale\n[Key intervention decisions with clinical justification]\n\n---\n\n## Summary\n- Target: [kcal] kcal/day\n- Macros: P [g]g | C [g]g | F [g]g\n- Key focus: [2-3 bullet points max based on patient data]\n- Clinical priorities: [Based on PES diagnoses above]\n\n## Weekly Meal Plan\n\nCRITICAL: You MUST write out EVERY meal for ALL 28 days across ALL 4 weeks. Each day must be unique.\n\n### Week 1\n\n| Day | Breakfast | Lunch | Dinner | Snacks | kcal |\n|-----|-----------|-------|--------|--------|------|\n| Mon | [unique meal] | [unique meal] | [unique meal] | [snack] | [total] |\n| Tue | [unique meal] | [unique meal] | [unique meal] | [snack] | [total] |\n| Wed | [unique meal] | [unique meal] | [unique meal] | [snack] | [total] |\n| Thu | [unique meal] | [unique meal] | [unique meal] | [snack] | [total] |\n| Fri | [unique meal] | [unique meal] | [unique meal] | [snack] | [total] |\n| Sat | [unique meal] | [unique meal] | [unique meal] | [snack] | [total] |\n| Sun | [unique meal] | [unique meal] | [unique meal] | [snack] | [total] |\n\n### Week 2\n\n| Day | Breakfast | Lunch | Dinner | Snacks | kcal |\n|-----|-----------|-------|--------|--------|------|\n| Mon | [unique meal] | [unique meal] | [unique meal] | [snack] | [total] |\n| Tue | [unique meal] | [unique meal] | [unique meal] | [snack] | [total] |\n| Wed | [unique meal] | [unique meal] | [unique meal] | [snack] | [total] |\n| Thu | [unique meal] | [unique meal] | [unique meal] | [snack] | [total] |\n| Fri | [unique meal] | [unique meal] | [unique meal] | [snack] | [total] |\n| Sat | [unique meal] | [unique meal] | [unique meal] | [snack] | [total] |\n| Sun | [unique meal] | [unique meal] | [unique meal] | [snack] | [total] |\n\n### Week 3\n\n| Day | Breakfast | Lunch | Dinner | Snacks | kcal |\n|-----|-----------|-------|--------|--------|------|\n| Mon | [unique meal] | [unique meal] | [unique meal] | [snack] | [total] |\n| Tue | [unique meal] | [unique meal] | [unique meal] | [snack] | [total] |\n| Wed | [unique meal] | [unique meal] | [unique meal] | [snack] | [total] |\n| Thu | [unique meal] | [unique meal] | [unique meal] | [snack] | [total] |\n| Fri | [unique meal] | [unique meal] | [unique meal] | [snack] | [total] |\n| Sat | [unique meal] | [unique meal] | [unique meal] | [snack] | [total] |\n| Sun | [unique meal] | [unique meal] | [unique meal] | [snack] | [total] |\n\n### Week 4\n\n| Day | Breakfast | Lunch | Dinner | Snacks | kcal |\n|-----|-----------|-------|--------|--------|------|\n| Mon | [unique meal] | [unique meal] | [unique meal] | [snack] | [total] |\n| Tue | [unique meal] | [unique meal] | [unique meal] | [snack] | [total] |\n| Wed | [unique meal] | [unique meal] | [unique meal] | [snack] | [total] |\n| Thu | [unique meal] | [unique meal] | [unique meal] | [snack] | [total] |\n| Fri | [unique meal] | [unique meal] | [unique meal] | [snack] | [total] |\n| Sat | [unique meal] | [unique meal] | [unique meal] | [snack] | [total] |\n| Sun | [unique meal] | [unique meal] | [unique meal] | [snack] | [total] |\n\n\n## Foods\n\n### Include\n- [food]: [portion] - [brief reason based on labs/conditions]\n\n### Avoid\n- [food]: [brief reason based on labs/conditions]\n\n## Notes\n- [2-4 practical tips based on patient's eating patterns/lifestyle]\n\n## Monitoring Parameters\n\n### Indicators to Evaluate\n| Parameter | Current Value | Target | Timeline |\n|-----------|---------------|--------|----------|\n| [parameter] | [current] | [goal] | [weeks] |\n\n### Recommended Follow-up\n- Next appointment: [timeframe]\n- Follow-up labs: [which tests, when]\n- Warning signs: [symptoms requiring immediate attention]\n\n---\nEND OF PLAN", "diet": {"content": "# Diet Plan - Andrea Rodriguez\n\n## Clinical Nutritional Anamnesis Analysis\n\n### 1. Biochemical Data Analysis\n- **Hematological:** Hb 10.5 g/dL indicates mild to moderate anemia. Given the B12 level, this is likely megaloblastic.\n- **Lipid Profile:** TG 171.8 mg/dL is elevated (hypertriglyceridemia), increasing cardiovascular risk. HDL is within a healthy range.\n- **Micronutrients:** B12 88.0 pg/mL is severely deficient; Vitamin D 146.7 ng/mL is critically high (potential toxicity/hypervitaminosis D).\n- **Protein Status:** Albumin 2.3 g/dL and Prealbumin 18.0 mg/dL indicate severe protein-calorie malnutrition and systemic inflammation.\n- **Renal/Electrolytes:** Creatinine 1.0 mg/dL and Na 140.3 mEq/L are stable, but the request for renal protection necessitates limiting phosphorus and potassium.\n\n### 2. Clinical Data Analysis\n- **ARFID & Tube Feeding:** Transitioning to oral intake requires a gradual increase in texture and volume. ARFID implies a need for sensory-friendly, non-threatening food presentations.\n- **Military Occupation:** Requires sustained energy for moderate activity and cognitive focus.\n- **Dairy-Free:** Preference requires alternative calcium and protein sources.\n\n### 3. Anthropometric Data Analysis\n- **BMI:** 26.3 kg/m² (Overweight).\n- **Body Composition:** Waist circumference (119.6 cm) is significantly high, indicating central obesity and high metabolic risk despite the low albumin (sarcopenic obesity pattern).\n\n### 4. Dietary Data Analysis\n- **Hydration:** <1L water/day is insufficient; risk of dehydration and renal strain.\n- **Behavior:** Fast eating and distraction can impair satiety signals and digestion.\n- **Support:** Total reliance on caregiver for meal preparation.\n\n### 5. Nutritional Diagnosis (PES Format)\n| Priority | Problem | Etiology | Signs/Symptoms |\n|----------|---------|----------|----------------|\n| 1 | Severe Protein-Calorie Malnutrition | related to ARFID and transition from tube feeding | as evidenced by Albumin 2.3 g/dL and Prealbumin 18.0 mg/dL |\n| 2 | Micronutrient Deficiency (B12) | related to restrictive food intake | as evidenced by B12 88.0 pg/mL and Hb 10.5 g/dL |\n| 3 | Hypervitaminosis D | related to excessive supplementation | as evidenced by Vitamin D 146.7 ng/mL |\n| 4 | Excessive Central Adiposity | related to dietary patterns and metabolic dysfunction | as evidenced by Waist 119.6 cm and BMI 26.3 |\n\n### 6. Intervention Rationale\n- **Controlled Protein (0.8g/kg):** Balanced to address hypoalbuminemia while maintaining renal protection (avoiding uremic toxin buildup).\n- **B12 Repletion:** Focus on animal-based proteins (eggs, fish) to treat anemia and neurological risk.\n- **Vitamin D Cessation:** Immediate stop of Vit D supplements to lower serum levels to safe ranges.\n- **Low Potassium/Phosphorus:** Limitation of high-K+ foods (bananas, spinach) and phosphate additives to protect renal function.\n- **Anti-Inflammatory Focus:** High Omega-3 (fatty fish, olive oil) to lower TG and reduce systemic inflammation.\n- **Hydration Increase:** Target 2L+ to support renal clearance.\n\n---\n\n## Summary\n- **Target:** 1900 kcal/day\n- **Macros:** P 65g | C 220g | F 75g\n- **Key focus:** Transition to oral intake, B12 repletion, and central obesity reduction.\n- **Clinical priorities:** Correct hypoalbuminemia, resolve B12 deficiency, and lower Vitamin D levels.\n\n## Weekly Meal Plan\n\n### Week 1 (Soft Textures & Transition)\n| Day | Breakfast | Lunch | Dinner | Snacks | kcal |\n|-----|-----------|-------|--------|--------|------|\n| Mon | Scrambled eggs, avocado | Poached salmon, steamed carrots | Pureed chicken, mashed cauliflower | Apple slices | 1850 |\n| Tue | Oat porridge (water), berries | Baked cod, boiled zucchini | Ground turkey, mashed sweet potato | Pear slices | 1900 |\n| Wed | Soft boiled egg, steamed pear | Tuna salad (olive oil), cucumber | Pureed beef, boiled pumpkin | Almond butter on rice cake | 1880 |\n| Thu | Chia pudding (almond milk), mango | Steamed tilapia, boiled green beans | Shredded chicken, mashed parsnip | Papaya cubes | 1920 |\n| Fri | Omelet (no cheese), sautéed mushrooms | Poached trout, boiled cauliflower | Ground turkey, mashed squash | Melon chunks | 1870 |\n| Sat | Mashed avocado on white sourdough | Baked hake, steamed carrots | Pureed chicken, boiled turnip | Blueberries | 1910 |\n| Sun | Poached egg, steamed zucchini | Salmon mousse, boiled asparagus | Ground beef, mashed cauliflower | Peach slices | 1890 |\n\n### Week 2 (Increasing Texture & Anti-Inflammatory)\n| Day | Breakfast | Lunch | Dinner | Snacks | kcal |\n|-----|-----------|-------|--------|--------|------|\n| Mon | Quinoa porridge, blueberries | Grilled salmon, steamed broccoli | Roasted chicken breast, zucchini | Walnuts | 1900 |\n| Tue | Hard boiled eggs, sliced cucumber | Baked cod, sautéed cabbage | Turkey meatballs, boiled carrots | Orange slices | 1880 |\n| Wed | Almond flour pancakes, strawberries | Tuna steak, steamed cauliflower | Lean beef strips, sautéed peppers | Pumpkin seeds | 1920 |\n| Thu | Rice porridge, sliced mango | Steamed snapper, boiled leeks | Chicken thighs, roasted pumpkin | Kiwi fruit | 1870 |\n| Fri | Egg muffins (spinach-free), pear | Poached trout, steamed zucchini | Ground turkey, boiled cabbage | Cashews | 1910 |\n| Sat | Overnight oats (water), raspberries | Baked hake, boiled carrots | Shredded beef, mashed cauliflower | Apricot | 1890 |\n| Sun | Scrambled eggs, avocado | Grilled shrimp, steamed asparagus | Roasted chicken, sautéed zucchini | Grapes | 1930 |\n\n### Week 3 (Sports Performance & Renal Protection)\n| Day | Breakfast | Lunch | Dinner | Snacks | kcal |\n|-----|-----------|-------|--------|--------|------|\n| Mon | Buckwheat pancakes, blueberries | Grilled tuna, boiled carrots | Baked chicken, steamed cauliflower | Almonds | 1950 |\n| Tue | Poached eggs, toasted sourdough | Baked salmon, sautéed zucchini | Turkey breast, boiled parsnip | Apple | 1900 |\n| Wed | Amaranth porridge, sliced peach | Steamed cod, boiled green beans | Lean steak, roasted pumpkin | Sunflower seeds | 1920 |\n| Thu | Egg white omelet, avocado | Grilled tilapia, steamed cabbage | Chicken breast, boiled turnip | Pear | 1880 |\n| Fri | Rice cakes, almond butter, berries | Poached trout, boiled cauliflower | Ground turkey, sautéed peppers | Walnuts | 1910 |\n| Sat | Oat bran, sliced mango | Baked hake, steamed zucchini | Roasted beef, mashed squash | Melon | 1870 |\n| Sun | Scrambled eggs, steamed carrots | Grilled shrimp, boiled asparagus | Chicken thighs, sautéed cabbage | Blueberries | 1940 |\n\n### Week 4 (Variety & Maintenance)\n| Day | Breakfast | Lunch | Dinner | Snacks | kcal |\n|-----|-----------|-------|--------|--------|------|\n| Mon | Chia seeds, almond milk, berries | Baked salmon, steamed broccoli | Turkey mince, boiled cauliflower | Pecans | 1900 |\n| Tue | Poached eggs, avocado toast | Grilled cod, sautéed zucchini | Roasted chicken, boiled carrots | Orange | 1880 |\n| Wed | Quinoa bowl, sliced pear | Tuna fillet, steamed asparagus | Lean beef, mashed pumpkin | Pistachios | 1920 |\n| Thu | Egg muffins, sliced cucumber | Steamed snapper, boiled leeks | Chicken breast, sautéed cabbage | Papaya | 1870 |\n| Fri | Oat porridge, raspberries | Poached trout, boiled carrots | Ground turkey, steamed zucchini | Almonds | 1910 |\n| Sat | Rice porridge, mango cubes | Baked hake, steamed cauliflower | Shredded beef, boiled parsnip | Apple | 1890 |\n| Sun | Scrambled eggs, sautéed mushrooms | Grilled shrimp, boiled green beans | Roasted chicken, mashed squash | Kiwi | 1930 |\n\n## Foods\n\n### Include\n- **Fatty Fish (Salmon, Trout, Mackerel):** 150g 3x/week - Omega-3 for TG reduction and B12 for anemia.\n- **Eggs:** 1-2 daily - High biological value protein for albumin, B12 source.\n- **Olive Oil:** 2-3 tbsp daily - Anti-inflammatory and calorie density.\n- **Berries/Pears/Apples:** 2 portions daily - Low potassium, high antioxidant.\n- **Cruciferous Veg (Cauliflower, Cabbage):** 1-2 cups daily - Low potassium, renal friendly.\n\n### Avoid\n- **Dairy Products:** Preference/Intolerance.\n- **High Potassium Foods:** Bananas, Spinach, Potatoes, Tomatoes (Renal protection).\n- **Processed Meats:** Sausages, Deli meats (High phosphorus/sodium).\n- **Vitamin D Supplements:** Current serum levels are toxic.\n- **Refined Sugars:** To lower Triglycerides.\n\n## Notes\n- **Mindful Eating:** Caregiver should encourage slower chewing and remove distractions (TV/Phone) to improve digestion.\n- **Hydration Strategy:** Set a timer every 2 hours to drink 250ml of water to reach 2L goal.\n- **Texture Progression:** If ARFID triggers occur, revert to pureed versions of the same meal.\n- **B12 Monitoring:** Ensure animal proteins are well-cooked but not charred.\n\n## Monitoring Parameters\n\n### Indicators to Evaluate\n| Parameter | Current Value | Target | Timeline |\n|-----------|---------------|--------|----------|\n| Albumin | 2.3 g/dL | > 3.5 g/dL | 8 weeks |\n| B12 | 88.0 pg/mL | > 300 pg/mL | 4 weeks |\n| Vitamin D | 146.7 ng/mL | 30-60 ng/mL | 12 weeks |\n| Triglycerides | 171.8 mg/dL | < 150 mg/dL | 8 weeks |\n| Waist Circ. | 119.6 cm | < 88 cm | 6 months |\n| Water Intake | < 1L/day | 2L/day | 2 weeks |\n\n### Recommended Follow-up\n- **Next appointment:** 2 weeks for texture tolerance and weight check.\n- **Follow-up labs:** B12 and Hb in 4 weeks; Albumin and Vitamin D in 8 weeks.\n- **Warning signs:** Edema (swelling in ankles), extreme fatigue, or sudden refusal of oral intake.\n\n---\nEND OF PLAN", "temperature": 0.4, "model": "gemma-4-31b-it", "provider": "gemini", "reasoning": true}, "meethealth": {"package": "meethealth-sample-v1", "package_version": "1.0.0", "source_corpus": "gemma_diets", "source_line": 62408, "contract": "diet_plan@1.0.0", "contract_fingerprint": "1a6c5cf6b9d37193", "gate_rules_evaluated": 45, "gate_failures": [], "package_checks": {"plan_language": {"pass": true, "detail": "english markers=4"}, "completeness_28_days": {"pass": true, "detail": "day_rows=28 weeks=4 terminated=True"}, "no_duplicate_days": {"pass": true, "detail": "duplicate_days=0"}, "macro_arithmetic": {"pass": true, "detail": "target=1900 kcal, 4P+4C+9F=1815 kcal, deviation=4.5%"}, "energy_dose_plausible": {"pass": true, "detail": "25.2 kcal/kg (screen 15-45)"}, "protein_dose_plausible": {"pass": true, "detail": "0.86 g/kg (screen 0.8-1.6)"}, "daily_energy_on_target": {"pass": true, "detail": "days_outside_10pct=0 of 28"}, "allergen_screen": {"pass": true, "detail": "no declared allergies"}, "hyperkalemia_food_screen": {"pass": true, "detail": "not applicable (K <= 5.0 or absent)"}, "scenario_coherence": {"pass": true, "detail": "ok"}}, "evidence_level": "L2_automated_checks_passed", "expert_review": "not_performed"}}
{"patient_id": "c5547344-03db-40ec-aaf4-680c2120f0cb", "patient_data": {"id": "c5547344-03db-40ec-aaf4-680c2120f0cb", "name": "Adam Hunter", "age": 19, "age_group": "young_adult_18_30y", "gender": "transgender male", "region": "Nigeria", "language": "en", "occupation": "Military personnel", "conditions": "Obesity Class I (BMI 30-34.9), GERD", "allergies": "Eggs", "goals": "Pre-operative nutrition optimization", "preferences": "Buddhist vegetarian", "weight": 94.5, "height": 171.6, "bmi": 32.1, "activity_level": "sedentary", "skin_condition": "Jaundice", "hair_condition": "Alopecia patches", "oral_health": "Thrush/candidiasis", "dehydration_signs": "Decreased skin turgor, dry mucous membranes", "weight_change": "Rapid weight gain on corticosteroids", "family_medical_history": "Mother: T2DM, Hypertension. Father: CAD.", "dietary_recall_24h": "Breakfast: Coffee with cream and a pastry\nLunch: Pasta with meat sauce and bread\nDinner: Pasta with pesto and salad\nSnacks: Cookies (3) and milk", "total_calories": 1800, "total_protein": 85.6, "total_carbohydrates": 238.3, "total_fat": 56.1, "total_fiber": 7.5, "total_sugar": 74.9, "total_saturated_fat": 16.7, "total_sodium": 2888, "bmr_formula": "Mifflin-St Jeor", "bmr": 1928, "tdee": 2313, "macro_split": {"carbsPercent": 55, "proteinPercent": 20, "fatPercent": 25}, "meals_per_day": 3, "meal_times": {"breakfast": "10:00 AM", "lunch": "3:00 PM", "dinner": "9:00 PM", "snacks": "Late night"}, "cooking_time": "<5 minutes (microwave/ready-made)", "water_intake_per_day": "2-2.5L", "coffee_cups_per_day": 1, "appetite_assessment": "Decreased", "prompt_mode": "standard", "clinical_analysis_depth": "comprehensive"}, "prompt": "You are a clinical nutritionist creating a diet plan. Generate all content in ENGLISH.\n\nSTRICT RULES:\n1. Output ONLY markdown - no preamble, no \"Here is...\", no greetings, no sign-offs\n2. Be CONCISE - use tables, bullets, short sentences\n3. Use TABLES for meal plans (mandatory)\n4. NO lengthy explanations unless customInstructions requests detail\n5. Start directly with the H1 title\n6. USE ALL patient data provided to personalize the plan\n7. EVERY DAY must have UNIQUE meals - NO \"repeat day X\" or \"same as above\" - write out ALL 28 days completely.\n8. Provide VARIETY - different foods each day, rotate proteins, vegetables, grains\n\n\n\n\n**Patient:** Name: Adam Hunter | Age: 19 | Gender: transgender male | Conditions: Obesity Class I (BMI 30-34.9), GERD | Allergies: Eggs | Region: Nigeria | Occupation: Military personnel\n**Anthropometrics:** Wt: 94.5kg | Ht: 171.6cm | BMI: 32.1 | Activity: sedentary\n**Clinical Signs:** Skin: Jaundice | Hair: Alopecia patches | Oral: Thrush/candidiasis | Dehydration: Decreased skin turgor, dry mucous membranes | Weight Change: Rapid weight gain on corticosteroids\n**Medical History:** Family Hx: Mother: T2DM, Hypertension. Father: CAD.\n**Energy Targets:** Formula: Mifflin-St Jeor | BMR: 1928kcal | TDEE: 2313kcal | Macro Target: C55/P20/F25%\n**Current Intake (24h):** Cal: 1800 | P: 85.6g | C: 238.3g | F: 56.1g | Fiber: 7.5g | Sugar: 74.9g | SatFat: 16.7g | Na: 2888mg\n**24h Recall:** Breakfast: Coffee with cream and a pastry\nLunch: Pasta with meat sauce and bread\nDinner: Pasta with pesto and salad\nSnacks: Cookies (3) and milk\n**Eating Patterns:** Meals/day: 3 | Breakfast: 10:00 AM | Lunch: 3:00 PM | Dinner: 9:00 PM | Snacks: Late night | Cooking time: <5 minutes (microwave/ready-made) | Coffee: 1 | Water: 2-2.5L\n**Appetite:** Appetite: Decreased\n**Goals:** Pre-operative nutrition optimization\n**Additional Notes:** Buddhist vegetarian\n\n\n\n\n---\n\nOUTPUT FORMAT (follow exactly):\n\n# Diet Plan - Adam Hunter\n\n## Summary\n- Target: [kcal] kcal/day\n- Macros: P [g]g | C [g]g | F [g]g\n- Key focus: [2-3 bullet points max based on patient data]\n\n\n## Weekly Meal Plan\n\nCRITICAL: You MUST write out EVERY meal for ALL 28 days across ALL 4 weeks. Each day must be unique.\n\n### Week 1\n\n| Day | Breakfast | Lunch | Dinner | Snacks | kcal |\n|-----|-----------|-------|--------|--------|------|\n| Mon | [unique meal] | [unique meal] | [unique meal] | [snack] | [total] |\n| Tue | [unique meal] | [unique meal] | [unique meal] | [snack] | [total] |\n| Wed | [unique meal] | [unique meal] | [unique meal] | [snack] | [total] |\n| Thu | [unique meal] | [unique meal] | [unique meal] | [snack] | [total] |\n| Fri | [unique meal] | [unique meal] | [unique meal] | [snack] | [total] |\n| Sat | [unique meal] | [unique meal] | [unique meal] | [snack] | [total] |\n| Sun | [unique meal] | [unique meal] | [unique meal] | [snack] | [total] |\n\n### Week 2\n\n| Day | Breakfast | Lunch | Dinner | Snacks | kcal |\n|-----|-----------|-------|--------|--------|------|\n| Mon | [unique meal] | [unique meal] | [unique meal] | [snack] | [total] |\n| Tue | [unique meal] | [unique meal] | [unique meal] | [snack] | [total] |\n| Wed | [unique meal] | [unique meal] | [unique meal] | [snack] | [total] |\n| Thu | [unique meal] | [unique meal] | [unique meal] | [snack] | [total] |\n| Fri | [unique meal] | [unique meal] | [unique meal] | [snack] | [total] |\n| Sat | [unique meal] | [unique meal] | [unique meal] | [snack] | [total] |\n| Sun | [unique meal] | [unique meal] | [unique meal] | [snack] | [total] |\n\n### Week 3\n\n| Day | Breakfast | Lunch | Dinner | Snacks | kcal |\n|-----|-----------|-------|--------|--------|------|\n| Mon | [unique meal] | [unique meal] | [unique meal] | [snack] | [total] |\n| Tue | [unique meal] | [unique meal] | [unique meal] | [snack] | [total] |\n| Wed | [unique meal] | [unique meal] | [unique meal] | [snack] | [total] |\n| Thu | [unique meal] | [unique meal] | [unique meal] | [snack] | [total] |\n| Fri | [unique meal] | [unique meal] | [unique meal] | [snack] | [total] |\n| Sat | [unique meal] | [unique meal] | [unique meal] | [snack] | [total] |\n| Sun | [unique meal] | [unique meal] | [unique meal] | [snack] | [total] |\n\n### Week 4\n\n| Day | Breakfast | Lunch | Dinner | Snacks | kcal |\n|-----|-----------|-------|--------|--------|------|\n| Mon | [unique meal] | [unique meal] | [unique meal] | [snack] | [total] |\n| Tue | [unique meal] | [unique meal] | [unique meal] | [snack] | [total] |\n| Wed | [unique meal] | [unique meal] | [unique meal] | [snack] | [total] |\n| Thu | [unique meal] | [unique meal] | [unique meal] | [snack] | [total] |\n| Fri | [unique meal] | [unique meal] | [unique meal] | [snack] | [total] |\n| Sat | [unique meal] | [unique meal] | [unique meal] | [snack] | [total] |\n| Sun | [unique meal] | [unique meal] | [unique meal] | [snack] | [total] |\n\n\n## Foods\n\n### Include\n- [food]: [portion] - [brief reason based on labs/conditions]\n\n### Avoid\n- [food]: [brief reason based on labs/conditions]\n\n## Notes\n- [2-4 practical tips based on patient's eating patterns/lifestyle]\n\n---\nEND OF PLAN", "diet": {"content": "# Diet Plan - Adam Hunter\n\n## Summary\n- Target: 2313 kcal/day\n- Macros: P 116g | C 318g | F 64g\n- Key focus: \n    - Liver-supportive (low fat) and GERD-friendly (non-acidic, non-spicy) nutrition.\n    - High-fiber, low-sugar intake to manage obesity and oral candidiasis.\n    - Egg-free, Buddhist vegetarian protein sources (soy, legumes, nuts).\n\n## Weekly Meal Plan\n\n### Week 1\n\n| Day | Breakfast | Lunch | Dinner | Snacks | kcal |\n|-----|-----------|-------|--------|--------|------|\n| Mon | Soy milk oats with banana | Brown rice with black beans and steamed plantain | Tofu and vegetable stir-fry with millet | Almonds and an apple | 2310 |\n| Tue | Millet porridge with soy milk | Boiled yam with mild peanut sauce and spinach | Lentil stew with steamed rice | Plain yogurt with sunflower seeds | 2295 |\n| Wed | Sweet potato with peanut butter | Lentil and vegetable soup with whole grain bread | Tofu curry (mild) with couscous | Pear and walnuts | 2320 |\n| Thu | Fruit salad with soy yogurt | Cassava mash with bean stew | Rice and mixed vegetable medley | Rice cakes and banana | 2305 |\n| Fri | Sorghum porridge with milk | Plantain and black bean mash | Tofu and steamed broccoli with rice | Apple and soy milk | 2315 |\n| Sat | Oats with sliced peaches | Yam and vegetable stew | Lentil soup with millet | Cashews and a pear | 2280 |\n| Sun | Millet with soy milk and nuts | Rice and bean medley with steamed greens | Tofu stir-fry with sweet potato | Yogurt and seeds | 2330 |\n\n### Week 2\n\n| Day | Breakfast | Lunch | Dinner | Snacks | kcal |\n|-----|-----------|-------|--------|--------|------|\n| Mon | Banana soy smoothie with oats | Black bean stew with boiled yam | Tofu and vegetable rice bowl | Apple and almonds | 2300 |\n| Tue | Oats with peanut butter | Lentil stew with brown rice | Plantain and tofu sauté | Yogurt and pear | 2310 |\n| Wed | Sweet potato and soy milk | Rice and beans with steamed spinach | Tofu and couscous with zucchini | Banana and sunflower seeds | 2290 |\n| Thu | Millet porridge with fruit | Cassava and lentil stew | Vegetable and tofu stir-fry with rice | Nuts and an apple | 2325 |\n| Fri | Soy yogurt with oats and seeds | Yam and bean mash | Tofu with millet and carrots | Peach and rice cakes | 2305 |\n| Sat | Fruit and soy milk smoothie | Rice and vegetable medley | Black bean and plantain stew | Banana and soy milk | 2315 |\n| Sun | Sorghum porridge with nuts | Tofu and rice with steamed greens | Lentil and vegetable soup | Pear and walnuts | 2285 |\n\n### Week 3\n\n| Day | Breakfast | Lunch | Dinner | Snacks | kcal |\n|-----|-----------|-------|--------|--------|------|\n| Mon | Oats with soy milk and banana | Black beans with steamed plantain | Tofu and vegetable stir-fry with rice | Almonds and an apple | 2310 |\n| Tue | Millet porridge with soy milk | Yam and lentil stew | Rice and mixed vegetable medley | Yogurt and pear | 2300 |\n| Wed | Sweet potato with soy milk | Rice and bean medley | Tofu and couscous with spinach | Banana and seeds | 2320 |\n| Thu | Soy yogurt with fruit | Cassava and vegetable stew | Lentil soup with millet | Nuts and an apple | 2295 |\n| Fri | Sorghum porridge with banana | Plantain and bean stew | Tofu and steamed broccoli with rice | Peach and soy milk | 2315 |\n| Sat | Oats with nuts and peaches | Rice and lentil stew | Yam and vegetable medley | Apple and rice cakes | 2305 |\n| Sun | Millet with soy milk | Beans and rice with steamed greens | Tofu and sweet potato mash | Banana and walnuts | 2325 |\n\n### Week 4\n\n| Day | Breakfast | Lunch | Dinner | Snacks | kcal |\n|-----|-----------|-------|--------|--------|------|\n| Mon | Yogurt with oats and berries | Yam with mild peanut sauce | Rice and lentil stew | Pear and almonds | 2300 |\n| Tue | Oats with banana and soy milk | Black beans and plantain | Tofu and vegetable rice bowl | Apple and seeds | 2315 |\n| Wed | Sweet potato and peanut butter | Millet and vegetable stew | Rice and bean medley | Banana and yogurt | 2290 |\n| Thu | Smoothie with soy milk and oats | Cassava and tofu stew | Lentil and vegetable soup | Peach and nuts | 2320 |\n| Fri | Sorghum porridge with fruit | Plantain and bean mash | Tofu and rice with steamed greens | Pear and rice cakes | 2310 |\n| Sat | Millet with soy milk and nuts | Rice and tofu stir-fry | Yam and lentil stew | Apple and soy milk | 2305 |\n| Sun | Oats with soy milk and peaches | Beans and rice with vegetables | Tofu and millet with carrots | Banana and sunflower seeds | 2325 |\n\n## Foods\n\n### Include\n- Legumes (Beans, Lentils, Soy): High protein for muscle maintenance and satiety.\n- Whole Grains (Oats, Millet, Sorghum, Brown Rice): High fiber for weight management and GERD.\n- Root Vegetables (Yam, Sweet Potato, Cassava): Complex carbohydrates for sustained energy.\n- Soy Products (Tofu, Soy Milk): Essential egg-free protein source.\n- Water: Essential to correct dehydration and support liver function.\n\n### Avoid\n- Eggs: Strict allergy risk.\n- Meat/Fish: Buddhist vegetarian requirement.\n- Spicy Peppers/Chili: Triggers GERD symptoms.\n- Refined Sugars (Cookies, Pastries): Exacerbates oral thrush and obesity.\n- Fried/Oily Foods: Triggers GERD and increases caloric density.\n- Citrus Fruits: High acidity triggers GERD.\n\n## Notes\n- **GERD Management:** Eat smaller, frequent meals; avoid lying down immediately after dinner (9:00 PM).\n- **Thrush Control:** Minimize refined sugar intake to prevent fungal overgrowth.\n- **Efficiency:** Use batch-cooking for beans, grains, and roasted vegetables to meet <5 min prep needs.\n- **Hydration:** Aim for consistent water intake throughout the day to improve skin turgor.\n\n---\nEND OF PLAN", "temperature": 0.4, "model": "gemma-4-26b-a4b-it", "provider": "gemini", "reasoning": true}, "meethealth": {"package": "meethealth-sample-v1", "package_version": "1.0.0", "source_corpus": "gemma_diets", "source_line": 67446, "contract": "diet_plan@1.0.0", "contract_fingerprint": "1a6c5cf6b9d37193", "gate_rules_evaluated": 45, "gate_failures": [], "package_checks": {"plan_language": {"pass": true, "detail": "english markers=4"}, "completeness_28_days": {"pass": true, "detail": "day_rows=28 weeks=4 terminated=True"}, "no_duplicate_days": {"pass": true, "detail": "duplicate_days=0"}, "macro_arithmetic": {"pass": true, "detail": "target=2313 kcal, 4P+4C+9F=2312 kcal, deviation=0.0%"}, "energy_dose_plausible": {"pass": true, "detail": "24.5 kcal/kg (screen 15-45)"}, "protein_dose_plausible": {"pass": true, "detail": "1.23 g/kg (screen 0.8-1.6)"}, "daily_energy_on_target": {"pass": true, "detail": "days_outside_10pct=0 of 28"}, "allergen_screen": {"pass": true, "detail": "screened=['egg'] hits=[]"}, "hyperkalemia_food_screen": {"pass": true, "detail": "not applicable (K <= 5.0 or absent)"}, "scenario_coherence": {"pass": true, "detail": "ok"}}, "evidence_level": "L2_automated_checks_passed", "expert_review": "not_performed"}}
{"patient_id": "6d718826-6a2b-45d6-a9c1-cfb1f89941a1", "patient_data": {"id": "6d718826-6a2b-45d6-a9c1-cfb1f89941a1", "name": "Stephanie Glenn", "age": 32, "age_group": "adult_31_50y", "gender": "female", "region": "Kenya", "language": "en", "occupation": "Childcare provider", "conditions": "Obesity Class I (BMI 30-34.9), Hypertension Stage 1", "allergies": "Tree Nuts (walnuts only)", "goals": "Post-bariatric surgery nutrition, Seizure reduction (ketogenic therapy), Anti-inflammatory diet protocol", "preferences": "Seventh-day Adventist", "weight": 91.2, "height": 173.5, "bmi": 30.3, "activity_level": "extremely_active", "muac": 40.1, "waist_circumference": 73.8, "hip_circumference": 91.8, "hemoglobin": 14.4, "hematocrit": 37.8, "serum_ferritin": 112.6, "blood_glucose": 102.8, "hba1c": 5.4, "hdl_cholesterol": 50.6, "ldl_cholesterol": 111.3, "vitamin_d": 90.9, "vitamin_b12": 13.4, "sodium": 140.8, "potassium": 5.0, "chloride": 113.2, "albumin": 1.6, "prealbumin": 5.6, "creatinine": 1.0, "skin_condition": "Jaundice", "hair_condition": "Brittle", "oral_health": "Dental caries", "dietary_recall_24h": "Breakfast: Smoothie with protein powder, banana, milk\nLunch: Fish tacos with beans and salsa\nDinner: Pasta with pesto and salad\nSnacks: Cookies (3) and milk", "total_calories": 1720, "total_protein": 82.2, "total_carbohydrates": 238.9, "total_fat": 48.4, "total_fiber": 11.3, "total_sugar": 56.5, "total_saturated_fat": 9.6, "total_sodium": 1874, "bmr_formula": "Katch-McArdle", "bmr": 1749, "tdee": 2711, "macro_split": {"carbsPercent": 60, "proteinPercent": 15, "fatPercent": 25}, "meals_per_day": 6, "cooking_time": "30-60 minutes", "water_intake_per_day": "1-1.5L", "coffee_cups_per_day": 0, "food_aversions": "Avoids spicy food, Dislikes eggs", "appetite_assessment": "Normal", "recent_appetite_changes": "Lost appetite due to stress", "dietary_supplements": "Pediatric multivitamin (gummy)", "prompt_mode": "standard", "clinical_analysis_depth": "detailed", "is_athlete": true, "sport_type": "Wrestling", "position": "125kg", "season_phase": "transition", "meal_context": "post-game", "training_time": "4:00 PM", "competition_level": "high_school"}, "prompt": "You are a clinical nutritionist creating a diet plan. Generate all content in ENGLISH.\n\nSTRICT RULES:\n1. Output ONLY markdown - no preamble, no \"Here is...\", no greetings, no sign-offs\n2. Be CONCISE - use tables, bullets, short sentences\n3. Use TABLES for meal plans (mandatory)\n4. NO lengthy explanations unless customInstructions requests detail\n5. Start directly with the H1 title\n6. USE ALL patient data provided to personalize the plan\n7. EVERY DAY must have UNIQUE meals - NO \"repeat day X\" or \"same as above\" - write out ALL 28 days completely.\n8. Provide VARIETY - different foods each day, rotate proteins, vegetables, grains\n\n\n\n\n**Patient:** Name: Stephanie Glenn | Age: 32 | Gender: female | Conditions: Obesity Class I (BMI 30-34.9), Hypertension Stage 1 | Allergies: Tree Nuts (walnuts only) | Region: Kenya | Occupation: Childcare provider\n**Anthropometrics:** Wt: 91.2kg | Ht: 173.5cm | BMI: 30.3 | Activity: extremely active\n**Body Circumferences:** MUAC: 40.1cm | Waist: 73.8cm | Hip: 91.8cm\n**Blood/Iron:** Hb: 14.4g/dL | Hct: 37.8% | Ferritin: 112.6ng/mL\n**Metabolic Labs:** Glucose: 102.8mg/dL | HbA1c: 5.4% | HDL: 50.6 | LDL: 111.3\n**Vitamins/Electrolytes:** VitD: 90.9ng/mL | B12: 13.4pg/mL | Na: 140.8 | K: 5.0 | Cl: 113.2\n**Protein/Kidney:** Albumin: 1.6g/dL | Prealbumin: 5.6mg/dL | Creatinine: 1.0mg/dL\n**Clinical Signs:** Skin: Jaundice | Hair: Brittle | Oral: Dental caries\n**Energy Targets:** Formula: Katch-McArdle | BMR: 1749kcal | TDEE: 2711kcal | Macro Target: C60/P15/F25%\n**Current Intake (24h):** Cal: 1720 | P: 82.2g | C: 238.9g | F: 48.4g | Fiber: 11.3g | Sugar: 56.5g | SatFat: 9.6g | Na: 1874mg\n**24h Recall:** Breakfast: Smoothie with protein powder, banana, milk\nLunch: Fish tacos with beans and salsa\nDinner: Pasta with pesto and salad\nSnacks: Cookies (3) and milk\n**Eating Patterns:** Meals/day: 6 | Cooking time: 30-60 minutes | Water: 1-1.5L\n**Food Preferences:** Dislikes: Avoids spicy food, Dislikes eggs\n**Restrictions:** Supplements: Pediatric multivitamin (gummy)\n**Appetite:** Appetite: Normal | Recent Changes: Lost appetite due to stress\n**Goals:** Post-bariatric surgery nutrition, Seizure reduction (ketogenic therapy), Anti-inflammatory diet protocol\n**Additional Notes:** Seventh-day Adventist\n\nSPORT-SPECIFIC CONTEXT:\nSport: Wrestling | Position: 125kg | Season: Transition\nMeal Context: Post-Game\nTraining Time: 4:00 PM\n\n\n\n---\n\nOUTPUT FORMAT (follow exactly):\n\n# Diet Plan - Stephanie Glenn\n\n## Summary\n- Target: [kcal] kcal/day\n- Macros: P [g]g | C [g]g | F [g]g\n- Key focus: [2-3 bullet points max based on patient data]\n\n\n## Weekly Meal Plan\n\nCRITICAL: You MUST write out EVERY meal for ALL 28 days across ALL 4 weeks. Each day must be unique.\n\n### Week 1\n\n| Day | Breakfast | Lunch | Dinner | Snacks | kcal |\n|-----|-----------|-------|--------|--------|------|\n| Mon | [unique meal] | [unique meal] | [unique meal] | [snack] | [total] |\n| Tue | [unique meal] | [unique meal] | [unique meal] | [snack] | [total] |\n| Wed | [unique meal] | [unique meal] | [unique meal] | [snack] | [total] |\n| Thu | [unique meal] | [unique meal] | [unique meal] | [snack] | [total] |\n| Fri | [unique meal] | [unique meal] | [unique meal] | [snack] | [total] |\n| Sat | [unique meal] | [unique meal] | [unique meal] | [snack] | [total] |\n| Sun | [unique meal] | [unique meal] | [unique meal] | [snack] | [total] |\n\n### Week 2\n\n| Day | Breakfast | Lunch | Dinner | Snacks | kcal |\n|-----|-----------|-------|--------|--------|------|\n| Mon | [unique meal] | [unique meal] | [unique meal] | [snack] | [total] |\n| Tue | [unique meal] | [unique meal] | [unique meal] | [snack] | [total] |\n| Wed | [unique meal] | [unique meal] | [unique meal] | [snack] | [total] |\n| Thu | [unique meal] | [unique meal] | [unique meal] | [snack] | [total] |\n| Fri | [unique meal] | [unique meal] | [unique meal] | [snack] | [total] |\n| Sat | [unique meal] | [unique meal] | [unique meal] | [snack] | [total] |\n| Sun | [unique meal] | [unique meal] | [unique meal] | [snack] | [total] |\n\n### Week 3\n\n| Day | Breakfast | Lunch | Dinner | Snacks | kcal |\n|-----|-----------|-------|--------|--------|------|\n| Mon | [unique meal] | [unique meal] | [unique meal] | [snack] | [total] |\n| Tue | [unique meal] | [unique meal] | [unique meal] | [snack] | [total] |\n| Wed | [unique meal] | [unique meal] | [unique meal] | [snack] | [total] |\n| Thu | [unique meal] | [unique meal] | [unique meal] | [snack] | [total] |\n| Fri | [unique meal] | [unique meal] | [unique meal] | [snack] | [total] |\n| Sat | [unique meal] | [unique meal] | [unique meal] | [snack] | [total] |\n| Sun | [unique meal] | [unique meal] | [unique meal] | [snack] | [total] |\n\n### Week 4\n\n| Day | Breakfast | Lunch | Dinner | Snacks | kcal |\n|-----|-----------|-------|--------|--------|------|\n| Mon | [unique meal] | [unique meal] | [unique meal] | [snack] | [total] |\n| Tue | [unique meal] | [unique meal] | [unique meal] | [snack] | [total] |\n| Wed | [unique meal] | [unique meal] | [unique meal] | [snack] | [total] |\n| Thu | [unique meal] | [unique meal] | [unique meal] | [snack] | [total] |\n| Fri | [unique meal] | [unique meal] | [unique meal] | [snack] | [total] |\n| Sat | [unique meal] | [unique meal] | [unique meal] | [snack] | [total] |\n| Sun | [unique meal] | [unique meal] | [unique meal] | [snack] | [total] |\n\n\n## Foods\n\n### Include\n- [food]: [portion] - [brief reason based on labs/conditions]\n\n### Avoid\n- [food]: [brief reason based on labs/conditions]\n\n## Notes\n- [2-4 practical tips based on patient's eating patterns/lifestyle]\n\n---\nEND OF PLAN", "diet": {"content": "# Diet Plan - Stephanie Glenn\n\n## Summary\n- Target: 2711 kcal/day\n- Macros: P 102g | C 407g | F 75g\n- Key focus: \n    - High-quality protein density to address critically low Albumin (1.6g/dL) and Prealbumin.\n    - Complex carbohydrate loading for wrestling recovery and glucose stability.\n    - Anti-inflammatory, low-sodium, and non-spicy nutrient-dense whole foods.\n\n## Weekly Meal Plan\n\n### Week 1\n\n| Day | Breakfast | Lunch | Dinner | Snacks | kcal |\n|-----|-----------|-------|--------|--------|------|\n| Mon | Millet porridge with milk and banana | Grilled Tilapia, Ugali, and Sukuma Wiki | Chicken stew with brown rice and peas | Greek yogurt with honey | 2715 |\n| Tue | Oats with soy milk and sliced mango | Lentil dhal with quinoa and steamed carrots | Beef strips with sweet potato and spinach | Apple slices with sunflower butter | 2690 |\n| Wed | Tapioca with avocado and seeds | Githeri (Maize and Beans) with cabbage | Baked fish with cassava and green beans | Banana and milk smoothie | 2730 |\n| Thu | Smoothie (Oats, milk, berries, protein powder) | Chicken salad with chickpeas and corn | Lentil soup with whole grain bread | Roasted maize kernels | 2705 |\n| Fri | Cornmeal porridge with coconut milk | Fish curry (mild) with rice and peas | Beef and vegetable stir-fry with noodles | Pear and cheese slices | 2720 |\n| Sat | Pancakes (no egg) with maple syrup and fruit | Bean and vegetable stew with Ugali | Grilled chicken with mashed potatoes | Yogurt with chia seeds | 2685 |\n| Sun | Fruit salad with yogurt and oats | Steamed fish with rice and sautéed kale | Lentil and vegetable stew with sweet potato | Mango slices | 2710 |\n\n### Week 2\n\n| Day | Breakfast | Lunch | Dinner | Snacks | kcal |\n|-----|-----------|-------|--------|--------|------|\n| Mon | Buckwheat porridge with milk | Chicken and vegetable wrap (whole wheat) | Fish with quinoa and roasted zucchini | Banana with peanut butter | 2725 |\n| Tue | Sweet potato with avocado | Lentil stew with brown rice | Beef stew with cauliflower and corn | Orange slices and crackers | 2695 |\n| Wed | Oats with flaxseeds and blueberries | Grilled fish with couscous and peas | Chicken with baked yam and broccoli | Milk and honey | 2715 |\n| Thu | Banana and oat pancakes | Chickpea curry (mild) with rice | Beef with mashed sweet potato | Apple and sunflower seeds | 2740 |\n| Fri | Millet porridge with honey | Chicken and rice soup with vegetables | Fish with boiled cassava and spinach | Yogurt with berries | 2680 |\n| Sat | Smoothie (Banana, milk, oats, protein) | Bean stew with Ugali and cabbage | Chicken with quinoa and carrots | Roasted chickpeas | 2700 |\n| Sun | Tapioca with honey and fruit | Beef with rice and steamed green beans | Lentil dhal with whole grain toast | Peach and yogurt | 2720 |\n\n### Week 3\n\n| Day | Breakfast | Lunch | Dinner | Snacks | kcal |\n|-----|-----------|-------|--------|--------|------|\n| Mon | Oats with soy milk and sliced pear | Fish with Ugali and Sukuma Wiki | Chicken stew with brown rice | Banana and milk | 2710 |\n| Tue | Cornmeal porridge with milk | Lentil and vegetable stew with quinoa | Beef with sweet potato and peas | Mango and yogurt | 2735 |\n| Wed | Banana smoothie with oats and milk | Githeri with avocado | Grilled fish with rice and carrots | Apple slices | 2690 |\n| Thu | Tapioca with avocado | Chicken and vegetable pasta (mild) | Bean stew with Ugali and spinach | Roasted maize | 2715 |\n| Fri | Millet porridge with berries | Beef with mashed potatoes and broccoli | Fish with couscous and green beans | Yogurt and honey | 2705 |\n| Sat | Fruit bowl with yogurt and seeds | Lentil curry with rice and cabbage | Chicken with baked cassava | Pear and cheese | 2725 |\n| Sun | Oats with milk and honey | Fish with rice and steamed zucchini | Beef and vegetable stew with quinoa | Banana | 2685 |\n\n### Week 4\n\n| Day | Breakfast | Lunch | Dinner | Snacks | kcal |\n|-----|-----------|-------|--------|--------|------|\n| Mon | Sweet potato and avocado | Chicken with rice and peas | Lentil stew with Ugali and kale | Milk and fruit | 2710 |\n| Tue | Smoothie (Oats, milk, mango) | Fish with quinoa and steamed carrots | Beef with sweet potato and spinach | Yogurt and seeds | 2740 |\n| Wed | Millet porridge with banana | Bean and corn stew with rice | Chicken with mashed potatoes and peas | Apple and peanut butter | 2700 |\n| Thu | Oats with blueberries and milk | Lentil dhal with whole grain bread | Fish with cassava and cabbage | Banana and yogurt | 2720 |\n| Fri | Tapioca with honey and fruit | Chicken and vegetable soup | Beef with rice and green beans | Roasted chickpeas | 2695 |\n| Sat | Pancakes (no egg) with fruit | Githeri with avocado | Fish with Ugali and Sukuma Wiki | Mango slices | 2715 |\n| Sun | Banana and oat porridge | Beef stew with quinoa and carrots | Chicken with baked yam and broccoli | Milk and honey | 2730 |\n\n## Foods\n\n### Include\n- **Fish (Tilapia/Nile Perch):** High-quality protein and Omega-3s to support anti-inflammatory goals and albumin.\n- **Legumes (Beans/Lentils/Chickpeas):** High fiber for glucose control and plant-based protein.\n- **Complex Carbs (Ugali/Oats/Sweet Potato):** Sustained energy for wrestling and high activity levels.\n- **Leafy Greens (Sukuma Wiki/Spinach):** Micronutrients to support liver health and combat jaundice/brittleness.\n- **Greek Yogurt/Milk:** High bioavailability protein for albumin recovery.\n\n### Avoid\n- **Walnuts:** Strict allergy risk.\n- **Pork/Shellfish:** Seventh-day Adventist dietary restrictions.\n- **Spicy Foods:** Patient preference and gastrointestinal comfort.\n- **Eggs:** Patient preference.\n- **High-Sodium Processed Foods:** To manage Stage 1 Hypertension.\n- **Refined Sugars:** To manage elevated glucose levels.\n\n## Notes\n- **Protein Timing:** Distribute protein evenly across all 6 meals/day to maximize protein synthesis and address low albumin.\n- **Hydration:** Increase water intake from 1.5L toward 2.5-3L given extremely high activity (wrestling) and childcare duties.\n- **Liver Support:** Focus on whole, unprocessed foods to reduce metabolic load on the liver (addressing jaundice).\n- **Post-Training:** Ensure the 4:00 PM post-training meal is high in both carbohydrates and protein for muscle glycogen and tissue repair.\n\n---\nEND OF PLAN", "temperature": 0.4, "model": "gemma-4-26b-a4b-it", "provider": "gemini", "reasoning": true}, "meethealth": {"package": "meethealth-sample-v1", "package_version": "1.0.0", "source_corpus": "gemma_diets", "source_line": 70231, "contract": "diet_plan@1.0.0", "contract_fingerprint": "1a6c5cf6b9d37193", "gate_rules_evaluated": 45, "gate_failures": [], "package_checks": {"plan_language": {"pass": true, "detail": "english markers=4"}, "completeness_28_days": {"pass": true, "detail": "day_rows=28 weeks=4 terminated=True"}, "no_duplicate_days": {"pass": true, "detail": "duplicate_days=0"}, "macro_arithmetic": {"pass": true, "detail": "target=2711 kcal, 4P+4C+9F=2711 kcal, deviation=0.0%"}, "energy_dose_plausible": {"pass": true, "detail": "29.7 kcal/kg (screen 15-45)"}, "protein_dose_plausible": {"pass": true, "detail": "1.12 g/kg (screen 0.8-2.0)"}, "daily_energy_on_target": {"pass": true, "detail": "days_outside_10pct=0 of 28"}, "allergen_screen": {"pass": true, "detail": "screened=['tree_nut'] hits=[]"}, "hyperkalemia_food_screen": {"pass": true, "detail": "not applicable (K <= 5.0 or absent)"}, "scenario_coherence": {"pass": true, "detail": "ok"}}, "evidence_level": "L2_automated_checks_passed", "expert_review": "not_performed"}}
{"patient_id": "ff390fc1-41b2-4aa5-b590-f4bac2baac45", "patient_data": {"id": "ff390fc1-41b2-4aa5-b590-f4bac2baac45", "name": "Timothy Adkins", "age": 21, "age_group": "young_adult_18_30y", "gender": "male", "region": "New_Zealand", "language": "en", "occupation": "Accountant", "conditions": "Overweight (BMI 25-29.9), Migraine (dietary trigger-related)", "goals": "Reduce medication side effects through diet, Sports performance optimization, Triglyceride reduction", "preferences": "Vegan", "weight": 96.6, "height": 182.2, "bmi": 29.1, "activity_level": "moderately_active", "muac": 34.6, "waist_circumference": 84.0, "hip_circumference": 93.9, "meals_per_day": 4, "cooking_time": "Institutional meals (hospital/nursing home)", "water_intake_per_day": "<1L", "coffee_cups_per_day": 1, "eating_habits": "Eats at desk during work", "appetite_assessment": "Poor", "cultural_religious_restrictions": "Hindu vegetarian (no meat, no eggs)", "prompt_mode": "clinical", "clinical_analysis_depth": "basic"}, "prompt": "You are a senior clinical nutritionist with expertise in medical nutrition therapy creating a diet plan. Generate all content in ENGLISH.\n\n## ADVANCED CLINICAL MODE ENABLED\nThis dietary plan requires a clinically-driven approach with structured analysis of the nutritional anamnesis.\nYou MUST explicitly analyze and integrate key patient parameters before generating recommendations.\nAnalysis Depth: BASIC\n\nSTRICT RULES:\n1. Output ONLY markdown - no preamble, no \"Here is...\", no greetings, no sign-offs\n2. Be CONCISE - use tables, bullets, short sentences\n3. Use TABLES for meal plans (mandatory)\n4. NO lengthy explanations unless customInstructions requests detail\n5. Start directly with the H1 title\n6. USE ALL patient data provided to personalize the plan\n7. EVERY DAY must have UNIQUE meals - NO \"repeat day X\" or \"same as above\" - write out ALL 28 days completely.\n8. Provide VARIETY - different foods each day, rotate proteins, vegetables, grains\n\n9. PERFORM complete clinical anamnesis analysis BEFORE generating the meal plan\n10. JUSTIFY each major dietary recommendation with clinical rationale\n11. USE PES (Problem-Etiology-Signs/Symptoms) format for nutritional diagnoses\n12. INCLUDE monitoring parameters and follow-up indicators\n\n\n## CLINICAL NUTRITIONAL ANAMNESIS ANALYSIS\n\nYou MUST perform a structured, systematic analysis of the patient's nutritional anamnesis before generating the diet plan.\n\n**Analysis Depth:** Provide a concise clinical analysis focusing on the most critical parameters.\n\n### 1. BIOCHEMICAL DATA ANALYSIS\nNo biochemical data available - recommend baseline laboratory assessment.\n\n### 2. CLINICAL DATA ANALYSIS\n**Current Medical Conditions:** Overweight (BMI 25-29.9), Migraine (dietary trigger-related)\n  - Nutritional implications: Disease-specific dietary modifications, nutrient-drug interactions\n\n\n### 3. ANTHROPOMETRIC DATA ANALYSIS\n**Primary Measurements:**\n  - Weight: 96.6 kg | Height: 182.2 cm | BMI: 29.1 kg/m²\n  - BMI Classification: Overweight\n  - Activity Level: moderately active\n\n### 4. DIETARY DATA ANALYSIS\nNo 24h recall available.\n\n### 5. CLINICAL SYNTHESIS & NUTRITIONAL DIAGNOSIS\n**Patient Goals:** Reduce medication side effects through diet, Sports performance optimization, Triglyceride reduction\n\n**REQUIRED OUTPUT FOR CLINICAL MODE:**\n1. **Problem List (PES Format):** Identify 2-4 nutrition diagnoses using Problem-Etiology-Signs/Symptoms format\n2. **Priority Ranking:** Rank nutritional problems by clinical urgency\n3. **Intervention Rationale:** For each dietary recommendation, provide clinical justification\n4. **Monitoring Parameters:** Specify what should be monitored\n\n---\n\n**Patient:** Name: Timothy Adkins | Age: 21 | Gender: male | Conditions: Overweight (BMI 25-29.9), Migraine (dietary trigger-related) | Region: New_Zealand | Occupation: Accountant\n**Anthropometrics:** Wt: 96.6kg | Ht: 182.2cm | BMI: 29.1 | Activity: moderately active\n**Body Circumferences:** MUAC: 34.6cm | Waist: 84.0cm | Hip: 93.9cm\n**Eating Patterns:** Meals/day: 4 | Cooking time: Institutional meals (hospital/nursing home) | Coffee: 1 | Water: <1L\n**Food Preferences:** Habits: Eats at desk during work\n**Restrictions:** Cultural/Religious: Hindu vegetarian (no meat, no eggs)\n**Appetite:** Appetite: Poor\n**Goals:** Reduce medication side effects through diet, Sports performance optimization, Triglyceride reduction\n**Additional Notes:** Vegan\n\n\n\n\n---\n\nOUTPUT FORMAT (follow exactly):\n\n# Diet Plan - Timothy Adkins\n\n## Clinical Nutritional Anamnesis Analysis\n\n### 1. Biochemical Data Analysis\n[Interpret lab values]\n\n### 2. Clinical Data Analysis\n[Medical conditions and dietary implications]\n\n### 3. Anthropometric Data Analysis\n[BMI classification and body composition]\n\n### 4. Dietary Data Analysis\n[24h recall interpretation and nutrient gap analysis]\n\n### 5. Nutritional Diagnosis (PES Format)\n| Priority | Problem | Etiology | Signs/Symptoms |\n|----------|---------|----------|----------------|\n| 1 | [Nutrition problem] | related to [etiology] | as evidenced by [S/S] |\n\n### 6. Intervention Rationale\n[Key intervention decisions with clinical justification]\n\n---\n\n## Summary\n- Target: [kcal] kcal/day\n- Macros: P [g]g | C [g]g | F [g]g\n- Key focus: [2-3 bullet points max based on patient data]\n- Clinical priorities: [Based on PES diagnoses above]\n\n## Weekly Meal Plan\n\nCRITICAL: You MUST write out EVERY meal for ALL 28 days across ALL 4 weeks. Each day must be unique.\n\n### Week 1\n\n| Day | Breakfast | Lunch | Dinner | Snacks | kcal |\n|-----|-----------|-------|--------|--------|------|\n| Mon | [unique meal] | [unique meal] | [unique meal] | [snack] | [total] |\n| Tue | [unique meal] | [unique meal] | [unique meal] | [snack] | [total] |\n| Wed | [unique meal] | [unique meal] | [unique meal] | [snack] | [total] |\n| Thu | [unique meal] | [unique meal] | [unique meal] | [snack] | [total] |\n| Fri | [unique meal] | [unique meal] | [unique meal] | [snack] | [total] |\n| Sat | [unique meal] | [unique meal] | [unique meal] | [snack] | [total] |\n| Sun | [unique meal] | [unique meal] | [unique meal] | [snack] | [total] |\n\n### Week 2\n\n| Day | Breakfast | Lunch | Dinner | Snacks | kcal |\n|-----|-----------|-------|--------|--------|------|\n| Mon | [unique meal] | [unique meal] | [unique meal] | [snack] | [total] |\n| Tue | [unique meal] | [unique meal] | [unique meal] | [snack] | [total] |\n| Wed | [unique meal] | [unique meal] | [unique meal] | [snack] | [total] |\n| Thu | [unique meal] | [unique meal] | [unique meal] | [snack] | [total] |\n| Fri | [unique meal] | [unique meal] | [unique meal] | [snack] | [total] |\n| Sat | [unique meal] | [unique meal] | [unique meal] | [snack] | [total] |\n| Sun | [unique meal] | [unique meal] | [unique meal] | [snack] | [total] |\n\n### Week 3\n\n| Day | Breakfast | Lunch | Dinner | Snacks | kcal |\n|-----|-----------|-------|--------|--------|------|\n| Mon | [unique meal] | [unique meal] | [unique meal] | [snack] | [total] |\n| Tue | [unique meal] | [unique meal] | [unique meal] | [snack] | [total] |\n| Wed | [unique meal] | [unique meal] | [unique meal] | [snack] | [total] |\n| Thu | [unique meal] | [unique meal] | [unique meal] | [snack] | [total] |\n| Fri | [unique meal] | [unique meal] | [unique meal] | [snack] | [total] |\n| Sat | [unique meal] | [unique meal] | [unique meal] | [snack] | [total] |\n| Sun | [unique meal] | [unique meal] | [unique meal] | [snack] | [total] |\n\n### Week 4\n\n| Day | Breakfast | Lunch | Dinner | Snacks | kcal |\n|-----|-----------|-------|--------|--------|------|\n| Mon | [unique meal] | [unique meal] | [unique meal] | [snack] | [total] |\n| Tue | [unique meal] | [unique meal] | [unique meal] | [snack] | [total] |\n| Wed | [unique meal] | [unique meal] | [unique meal] | [snack] | [total] |\n| Thu | [unique meal] | [unique meal] | [unique meal] | [snack] | [total] |\n| Fri | [unique meal] | [unique meal] | [unique meal] | [snack] | [total] |\n| Sat | [unique meal] | [unique meal] | [unique meal] | [snack] | [total] |\n| Sun | [unique meal] | [unique meal] | [unique meal] | [snack] | [total] |\n\n\n## Foods\n\n### Include\n- [food]: [portion] - [brief reason based on labs/conditions]\n\n### Avoid\n- [food]: [brief reason based on labs/conditions]\n\n## Notes\n- [2-4 practical tips based on patient's eating patterns/lifestyle]\n\n## Monitoring Parameters\n\n### Indicators to Evaluate\n| Parameter | Current Value | Target | Timeline |\n|-----------|---------------|--------|----------|\n| [parameter] | [current] | [goal] | [weeks] |\n\n### Recommended Follow-up\n- Next appointment: [timeframe]\n- Follow-up labs: [which tests, when]\n- Warning signs: [symptoms requiring immediate attention]\n\n---\nEND OF PLAN", "diet": {"content": "# Diet Plan - Timothy Adkins\n\n## Clinical Nutritional Anamnesis Analysis\n\n### 1. Biochemical Data Analysis\nNo biochemical data available. **Recommendation:** Baseline assessment of fasting lipids (Triglycerides, HDL, LDL), HbA1c, Vitamin B12, Vitamin D, and Iron/Ferritin due to vegan diet and goal of triglyceride reduction.\n\n### 2. Clinical Data Analysis\n*   **Overweight (BMI 29.1):** Requires caloric deficit and macronutrient optimization for weight management.\n*   **Migraine (Dietary Trigger-related):** Requires identification and elimination of common triggers (e.g., tyramine, nitrates, excessive caffeine, artificial sweeteners).\n*   **Triglyceride Reduction Goal:** Requires reduction in refined carbohydrates and simple sugars, and increase in Omega-3 fatty acids.\n*   **Vegan/Hindu Vegetarian:** High risk for B12, Iron, Calcium, and Protein deficiencies; requires strategic plant-based protein planning.\n\n### 3. Anthropometric Data Analysis\n*   **BMI:** 29.1 kg/m² (Overweight).\n*   **Waist-to-Hip Ratio:** 0.89 (Low risk for central adiposity, but weight management is indicated).\n*   **Activity Level:** Moderately active (requires sufficient carbohydrate for performance).\n\n### 4. Dietary Data Analysis\n*   **Hydration:** Critically low (<1L/day). Dehydration is a major migraine trigger.\n*   **Eating Pattern:** Desk-based eating (sedentary behavior during meals) may lead to mindless overconsumption or poor satiety signaling.\n*   **Nutrient Gaps:** Likely low protein, low B12, low Omega-3, and low fluid intake.\n\n### 5. Nutritional Diagnosis (PES Format)\n| Priority | Problem | Etiology | Signs/Symptoms |\n|----------|---------|----------|----------------|\n| 1 | Inadequate fluid intake | Insufficient dietary habits/awareness | Water intake <1L/day; potential migraine triggers |\n| 2 | Excessive energy intake | Sedentary eating habits/Desk eating | BMI 29.1 (Overweight) |\n| 3 | Risk for micronutrient deficiency | Strict vegan/Hindu vegetarian diet | Potential B12, Iron, and Protein inadequacy |\n| 4 | Altered nutrition-related laboratory values | High carbohydrate/low healthy fat intake | Goal: Triglyceride reduction |\n\n### 6. Intervention Rationale\n*   **Low Glycemic Load:** To reduce triglycerides and stabilize blood sugar to prevent migraine triggers.\n*   **Increased Hydration:** To mitigate dehydration-induced migraines and support metabolic function.\n*   **Plant-Based Protein Optimization:** Using legumes, tofu, and tempeh to support sports performance and muscle maintenance.\n*   **Migraine Trigger Elimination:** Avoiding aged foods, fermented products (high tyramine), and processed vegan substitutes.\n\n---\n\n## Summary\n- Target: 2400 kcal/day\n- Macros: P 120g | C 300g | F 80g\n- Key focus: Triglyceride reduction, Migraine management, Hydration.\n- Clinical priorities: Fluid optimization, Protein adequacy, Glycemic control.\n\n## Weekly Meal Plan\n\n### Week 1\n\n| Day | Breakfast | Lunch | Dinner | Snacks | kcal |\n|-----|-----------|-------|--------|--------|------|\n| Mon | Tofu Scramble w/ Spinach & Turmeric | Lentil Soup with Quinoa | Chickpea & Vegetable Curry | Almonds & Apple | 2410 |\n| Tue | Overnight Oats with Chia & Berries | Tempeh Salad with Tahini | Black Bean & Sweet Potato Tacos | Hummus & Carrots | 2380 |\n| Wed | Buckwheat Porridge with Flaxseeds | Red Lentil Dahl with Brown Rice | Tofu Stir-fry with Broccoli | Walnuts & Pear | 2420 |\n| Thu | Chia Seed Pudding with Soy Milk | Quinoa & Roasted Veggie Bowl | Chickpea Pasta with Tomato Sauce | Pumpkin Seeds | 2390 |\n| Fri | Smoothies (Soy, Banana, Spinach) | Mung Bean Stew | Tempeh & Sautéed Kale | Edamame | 2405 |\n| Sat | Avocado on Whole Grain Toast | Lentil & Spinach Salad | Tofu Curry with Cauliflower | Peanut Butter & Celery | 2430 |\n| Sun | Soy Yogurt with Granola & Seeds | Chickpea Salad Sandwich | Vegetable & Tofu Stew | Roasted Chickpeas | 2375 |\n\n### Week 2\n\n| Day | Breakfast | Lunch | Dinner | Snacks | kcal |\n|-----|-----------|-------|--------|--------|------|\n| Mon | Quinoa Breakfast Bowl with Berries | Tempeh Buddha Bowl | Lentil Shepherd's Pie (Vegan) | Brazil Nuts & Orange | 2415 |\n| Tue | Tofu & Mushroom Omelet (Vegan) | Black Bean Soup | Tofu & Green Bean Stir-fry | Sunflower Seeds | 2395 |\n| Wed | Chia Pudding with Mango | Chickpea Mediterranean Salad | Red Lentil Pasta with Pesto | Apple & Almond Butter | 2400 |\n| Thu | Steel Cut Oats with Walnuts | Tofu & Veggie Wrap | Mung Bean Curry | Soy Yogurt | 2425 |\n| Fri | Buckwheat Pancakes (Vegan) | Quinoa & Black Bean Salad | Tempeh Stir-fry | Dried Apricots | 2385 |\n| Sat | Smoothie Bowl (Protein/Berry) | Lentil Bolognese | Tofu Skewers & Veggies | Cashews | 2410 |\n| Sun | Soy Yogurt & Flaxseed Parfait | Chickpea & Avocado Salad | Vegetable Chili | Rice Cakes & Tahini | 2390 |\n\n### Week 3\n\n| Day | Breakfast | Lunch | Dinner | Snacks | kcal |\n|-----|-----------|-------|--------|--------|------|\n| Mon | Tofu Scramble w/ Bell Peppers | Lentil & Kale Salad | Tempeh & Broccoli Bowl | Walnuts | 2405 |\n| Tue | Overnight Oats w/ Hemp Seeds | Chickpea Curry | Tofu & Zucchini Noodles | Pear & Almonds | 2390 |\n| Wed | Chia Pudding w/ Blueberries | Quinoa & Roasted Beet Salad | Black Bean Stew | Pumpkin Seeds | 2415 |\n| Thu | Buckwheat w/ Soy Milk & Seeds | Tempeh Salad | Lentil Soup & Whole Grain Bread | Hummus & Cucumber | 2420 |\n| Fri | Smoothie (Peanut Butter/Banana) | Tofu & Veggie Buddha Bowl | Chickpea Stir-fry | Edamame | 2380 |\n| Sat | Avocado & Seed Toast | Red Lentil Dahl | Tempeh Tacos | Apple | 2430 |\n| Sun | Soy Yogurt w/ Chia & Berries | Mung Bean Salad | Tofu & Vegetable Stew | Roasted Soybeans | 2370 |\n\n### Week 4\n\n| Day | Breakfast | Lunch | Dinner | Snacks | kcal |\n|-----|-----------|-------|--------|--------|------|\n| Mon | Quinoa & Nut Porridge | Chickpea & Spinach Wrap | Tofu & Cauliflower Curry | Almonds | 2410 |\n| Tue | Tofu Scramble w/ Herbs | Lentil & Quinoa Bowl | Tempeh & Sautéed Greens | Banana & Walnuts | 2395 |\n| Wed | Chia Seed Pudding w/ Peach | Black Bean Salad | Tofu & Vegetable Stir-fry | Sunflower Seeds | 2405 |\n| Thu | Steel Cut Oats w/ Flax | Tempeh Buddha Bowl | Chickpea Pasta | Soy Yogurt | 2425 |\n| Fri | Smoothie (Spinach/Soy/Berry) | Lentil Soup | Tofu & Broccoli Bake | Cashews | 2385 |\n| Sat | Buckwheat w/ Berries | Quinoa & Chickpea Salad | Mung Bean Stew | Rice Cakes | 2415 |\n| Sun | Soy Yogurt & Granola | Tofu & Veggie Salad | Tempeh & Sweet Potato | Pumpkin Seeds | 2390 |\n\n## Foods\n\n### Include\n- **Tofu/Tempeh/Edamame:** High-quality plant protein for muscle maintenance.\n- **Lentils/Beans:** Fiber for triglyceride reduction and satiety.\n- **Chia/Flax/Walnuts:** Omega-3 fatty acids for brain health and inflammation.\n- **Leafy Greens:** Magnesium and folate for migraine prevention.\n- **Whole Grains (Quinoa/Oats):** Low glycemic index for stable energy.\n\n### Avoid\n- **Aged/Fermented Foods (e.g., certain soy products):** High tyramine can trigger migraines.\n- **Refined Sugars:** Increases triglycerides and promotes inflammation.\n- **Processed Vegan Meats:** Often high in sodium and additives (migraine triggers).\n- **Excessive Caffeine:** Can trigger or cause rebound migraines.\n\n## Notes\n- **Hydration Strategy:** Carry a 1L reusable bottle; aim to finish 3 bottles per day to reach >3L.\n- **Mindful Eating:** Avoid eating at your desk; take a 20-minute break away from screens to improve digestion.\n- **Meal Prep:** Since you use institutional meals, focus on adding portable healthy snacks (nuts/seeds) to bridge gaps.\n\n## Monitoring Parameters\n\n### Indicators to Evaluate\n| Parameter | Current Value | Target | Timeline |\n|-----------|---------------|--------|----------|\n| Body Weight | 96.6 kg | 90.0 kg (Initial) | 12 weeks |\n| Triglycerides | Unknown | <150 mg/dL | 3 months |\n| Hydration | <1L/day | >2.5L/day | 2 weeks |\n| Migraine Frequency | Unspecified | Reduction in episodes | 4 weeks |\n\n### Recommended Follow-up\n- **Next appointment:** 4 weeks.\n- **Follow-up labs:** Lipid profile, B12, Ferritin, HbA1c (in 3 months).\n- **Warning signs:** Severe dehydration, sudden weight loss, or increase in migraine intensity/frequency.\n\n---\nEND OF PLAN", "temperature": 0.4, "model": "gemma-4-26b-a4b-it", "provider": "gemini", "reasoning": true}, "meethealth": {"package": "meethealth-sample-v1", "package_version": "1.0.0", "source_corpus": "gemma_diets", "source_line": 74542, "contract": "diet_plan@1.0.0", "contract_fingerprint": "1a6c5cf6b9d37193", "gate_rules_evaluated": 45, "gate_failures": [], "package_checks": {"plan_language": {"pass": true, "detail": "english markers=4"}, "completeness_28_days": {"pass": true, "detail": "day_rows=28 weeks=4 terminated=True"}, "no_duplicate_days": {"pass": true, "detail": "duplicate_days=0"}, "macro_arithmetic": {"pass": true, "detail": "target=2400 kcal, 4P+4C+9F=2400 kcal, deviation=0.0%"}, "energy_dose_plausible": {"pass": true, "detail": "24.8 kcal/kg (screen 15-45)"}, "protein_dose_plausible": {"pass": true, "detail": "1.24 g/kg (screen 0.8-1.6)"}, "daily_energy_on_target": {"pass": true, "detail": "days_outside_10pct=0 of 28"}, "allergen_screen": {"pass": true, "detail": "no declared allergies"}, "hyperkalemia_food_screen": {"pass": true, "detail": "not applicable (K <= 5.0 or absent)"}, "scenario_coherence": {"pass": true, "detail": "ok"}}, "evidence_level": "L2_automated_checks_passed", "expert_review": "not_performed"}}
{"patient_id": "cf11c5a5-fab2-45de-898c-8001e7634a5e", "patient_data": {"id": "cf11c5a5-fab2-45de-898c-8001e7634a5e", "name": "Yesenia Price", "age": 54, "age_group": "middle_age_51_65y", "gender": "female", "region": "Singapore", "language": "en", "occupation": "Shift worker (rotating)", "conditions": "Overweight (BMI 25-29.9)", "allergies": "Tree Nuts (cashews only)", "goals": "Wound healing optimization, Weight gain (muscle building), Lipid profile improvement, Pre-operative nutrition optimization", "preferences": "Jain vegetarian (no root vegetables)", "weight": 57.7, "height": 150.1, "bmi": 25.6, "activity_level": "lightly_active", "past_medical_history": "Ileostomy creation (2021)", "family_medical_history": "Family history of Crohn's disease (mother, uncle).", "dietary_recall_24h": "Breakfast: Cereal with milk and a piece of fruit\nLunch: Fish tacos with beans and salsa\nDinner: Chicken stir-fry with rice\nSnacks: Fruit (banana, orange)", "total_calories": 1410, "total_protein": 57.9, "total_carbohydrates": 159.7, "total_fat": 60.0, "total_fiber": 25.9, "total_sugar": 26.1, "total_saturated_fat": 21.7, "total_sodium": 954, "bmr_formula": "Katch-McArdle", "bmr": 1242, "tdee": 1708, "macro_split": {"carbsPercent": 60, "proteinPercent": 15, "fatPercent": 25}, "meals_per_day": 2, "meal_times": {"breakfast": "9:00 AM", "lunch": "1:00 PM", "dinner": "7:00 PM", "snacks": "None"}, "cooking_time": "<5 minutes (microwave/ready-made)", "water_intake_per_day": "<1L", "coffee_cups_per_day": 0, "food_aversions": "Cannot stand bitter vegetables (broccoli, kale), Meat aversion (chemo-related)", "appetite_assessment": "Variable", "prompt_mode": "standard", "clinical_analysis_depth": "comprehensive"}, "prompt": "You are a clinical nutritionist creating a diet plan. Generate all content in ENGLISH.\n\nSTRICT RULES:\n1. Output ONLY markdown - no preamble, no \"Here is...\", no greetings, no sign-offs\n2. Be CONCISE - use tables, bullets, short sentences\n3. Use TABLES for meal plans (mandatory)\n4. NO lengthy explanations unless customInstructions requests detail\n5. Start directly with the H1 title\n6. USE ALL patient data provided to personalize the plan\n7. EVERY DAY must have UNIQUE meals - NO \"repeat day X\" or \"same as above\" - write out ALL 28 days completely.\n8. Provide VARIETY - different foods each day, rotate proteins, vegetables, grains\n\n\n\n\n**Patient:** Name: Yesenia Price | Age: 54 | Gender: female | Conditions: Overweight (BMI 25-29.9) | Allergies: Tree Nuts (cashews only) | Region: Singapore | Occupation: Shift worker (rotating)\n**Anthropometrics:** Wt: 57.7kg | Ht: 150.1cm | BMI: 25.6 | Activity: lightly active\n**Medical History:** Past Medical: Ileostomy creation (2021) | Family Hx: Family history of Crohn's disease (mother, uncle).\n**Energy Targets:** Formula: Katch-McArdle | BMR: 1242kcal | TDEE: 1708kcal | Macro Target: C60/P15/F25%\n**Current Intake (24h):** Cal: 1410 | P: 57.9g | C: 159.7g | F: 60.0g | Fiber: 25.9g | Sugar: 26.1g | SatFat: 21.7g | Na: 954mg\n**24h Recall:** Breakfast: Cereal with milk and a piece of fruit\nLunch: Fish tacos with beans and salsa\nDinner: Chicken stir-fry with rice\nSnacks: Fruit (banana, orange)\n**Eating Patterns:** Meals/day: 2 | Breakfast: 9:00 AM | Lunch: 1:00 PM | Dinner: 7:00 PM | Snacks: None | Cooking time: <5 minutes (microwave/ready-made) | Water: <1L\n**Food Preferences:** Dislikes: Cannot stand bitter vegetables (broccoli, kale), Meat aversion (chemo-related)\n**Appetite:** Appetite: Variable\n**Goals:** Wound healing optimization, Weight gain (muscle building), Lipid profile improvement, Pre-operative nutrition optimization\n**Additional Notes:** Jain vegetarian (no root vegetables)\n\n\n\n\n---\n\nOUTPUT FORMAT (follow exactly):\n\n# Diet Plan - Yesenia Price\n\n## Summary\n- Target: [kcal] kcal/day\n- Macros: P [g]g | C [g]g | F [g]g\n- Key focus: [2-3 bullet points max based on patient data]\n\n\n## Weekly Meal Plan\n\nCRITICAL: You MUST write out EVERY meal for ALL 28 days across ALL 4 weeks. Each day must be unique.\n\n### Week 1\n\n| Day | Breakfast | Lunch | Dinner | Snacks | kcal |\n|-----|-----------|-------|--------|--------|------|\n| Mon | [unique meal] | [unique meal] | [unique meal] | [snack] | [total] |\n| Tue | [unique meal] | [unique meal] | [unique meal] | [snack] | [total] |\n| Wed | [unique meal] | [unique meal] | [unique meal] | [snack] | [total] |\n| Thu | [unique meal] | [unique meal] | [unique meal] | [snack] | [total] |\n| Fri | [unique meal] | [unique meal] | [unique meal] | [snack] | [total] |\n| Sat | [unique meal] | [unique meal] | [unique meal] | [snack] | [total] |\n| Sun | [unique meal] | [unique meal] | [unique meal] | [snack] | [total] |\n\n### Week 2\n\n| Day | Breakfast | Lunch | Dinner | Snacks | kcal |\n|-----|-----------|-------|--------|--------|------|\n| Mon | [unique meal] | [unique meal] | [unique meal] | [snack] | [total] |\n| Tue | [unique meal] | [unique meal] | [unique meal] | [snack] | [total] |\n| Wed | [unique meal] | [unique meal] | [unique meal] | [snack] | [total] |\n| Thu | [unique meal] | [unique meal] | [unique meal] | [snack] | [total] |\n| Fri | [unique meal] | [unique meal] | [unique meal] | [snack] | [total] |\n| Sat | [unique meal] | [unique meal] | [unique meal] | [snack] | [total] |\n| Sun | [unique meal] | [unique meal] | [unique meal] | [snack] | [total] |\n\n### Week 3\n\n| Day | Breakfast | Lunch | Dinner | Snacks | kcal |\n|-----|-----------|-------|--------|--------|------|\n| Mon | [unique meal] | [unique meal] | [unique meal] | [snack] | [total] |\n| Tue | [unique meal] | [unique meal] | [unique meal] | [snack] | [total] |\n| Wed | [unique meal] | [unique meal] | [unique meal] | [snack] | [total] |\n| Thu | [unique meal] | [unique meal] | [unique meal] | [snack] | [total] |\n| Fri | [unique meal] | [unique meal] | [unique meal] | [snack] | [total] |\n| Sat | [unique meal] | [unique meal] | [unique meal] | [snack] | [total] |\n| Sun | [unique meal] | [unique meal] | [unique meal] | [snack] | [total] |\n\n### Week 4\n\n| Day | Breakfast | Lunch | Dinner | Snacks | kcal |\n|-----|-----------|-------|--------|--------|------|\n| Mon | [unique meal] | [unique meal] | [unique meal] | [snack] | [total] |\n| Tue | [unique meal] | [unique meal] | [unique meal] | [snack] | [total] |\n| Wed | [unique meal] | [unique meal] | [unique meal] | [snack] | [total] |\n| Thu | [unique meal] | [unique meal] | [unique meal] | [snack] | [total] |\n| Fri | [unique meal] | [unique meal] | [unique meal] | [snack] | [total] |\n| Sat | [unique meal] | [unique meal] | [unique meal] | [snack] | [total] |\n| Sun | [unique meal] | [unique meal] | [unique meal] | [snack] | [total] |\n\n\n## Foods\n\n### Include\n- [food]: [portion] - [brief reason based on labs/conditions]\n\n### Avoid\n- [food]: [brief reason based on labs/conditions]\n\n## Notes\n- [2-4 practical tips based on patient's eating patterns/lifestyle]\n\n---\nEND OF PLAN", "diet": {"content": "# Diet Plan - Yesenia Price\n\n## Summary\n- Target: 1708 kcal/day\n- Macros: P 64g | C 256g | F 47g\n- Key focus: \n    - High-protein vegetarian sources for muscle building and wound healing.\n    - Jain-compliant (no root vegetables) and cashew-free.\n    - Hydration support for ileostomy management.\n\n## Weekly Meal Plan\n\n### Week 1\n\n| Day | Breakfast | Lunch | Dinner | Snacks | kcal |\n|-----|-----------|-------|--------|--------|------|\n| Mon | Soy milk oats with chia seeds | Chickpea and cucumber salad | Tofu stir-fry with bell peppers and rice | Banana | 1710 |\n| Tue | Greek yogurt with mango slices | Lentil dal with steamed spinach | Paneer and zucchini curry with quinoa | Pumpkin seeds | 1705 |\n| Wed | Cornmeal porridge with soy milk | Black bean and corn salad | Tempeh with sautéed okra and rice | Apple | 1715 |\n| Thu | Chia seed pudding with soy milk | Tofu and bell pepper wrap (corn tortilla) | Red lentil stew with cauliflower | Sunflower seeds | 1695 |\n| Fri | Rice cakes with avocado and seeds | Chickpea curry with steamed peas | Paneer and bell pepper sauté with millet | Pear | 1720 |\n| Sat | Fruit bowl with soy yogurt | Quinoa and edamame salad | Tempeh and zucchini stir-fry with rice | Orange | 1700 |\n| Sun | Millet porridge with berries | Bean and corn salad with bell peppers | Tofu and cauliflower curry with rice | Soy yogurt | 1712 |\n\n### Week 2\n\n| Day | Breakfast | Lunch | Dinner | Snacks | kcal |\n|-----|-----------|-------|--------|--------|------|\n| Mon | Oats with sliced banana and soy milk | Lentil soup with diced zucchini | Paneer and peas with quinoa | Pumpkin seeds | 1708 |\n| Tue | Soy yogurt with blueberries | Chickpea and bell pepper salad | Tempeh and corn stir-fry with rice | Apple | 1715 |\n| Wed | Chia pudding with peach slices | Tofu and spinach salad with quinoa | Black bean stew with bell peppers | Sunflower seeds | 1690 |\n| Thu | Corn porridge with soy milk | Paneer and cucumber salad | Lentil curry with cauliflower and rice | Banana | 1725 |\n| Fri | Rice cakes with mashed avocado | Tempeh and pea salad | Tofu and zucchini with millet | Pear | 1705 |\n| Sat | Millet porridge with soy milk | Bean and bell pepper tacos (corn) | Chickpea and spinach curry with rice | Soy yogurt | 1710 |\n| Sun | Fruit smoothie with soy protein | Quinoa and tofu bowl with corn | Paneer and okra with rice | Pumpkin seeds | 1718 |\n\n### Week 3\n\n| Day | Breakfast | Lunch | Dinner | Snacks | kcal |\n|-----|-----------|-------|--------|--------|------|\n| Mon | Oats with soy milk and chia | Chickpea and corn salad | Tempeh and bell pepper with rice | Orange | 1702 |\n| Tue | Greek yogurt with papaya | Lentil and zucchini stew | Tofu and peas with quinoa | Sunflower seeds | 1715 |\n| Wed | Chia pudding with mango | Paneer and bell pepper salad | Black bean and corn bowl with rice | Apple | 1695 |\n| Thu | Corn porridge with berries | Tofu and cucumber salad | Lentil dal with cauliflower and rice | Banana | 1720 |\n| Fri | Rice cakes with avocado | Tempeh and spinach salad | Chickpea and zucchini curry with millet | Soy yogurt | 1708 |\n| Sat | Soy milk and fruit bowl | Bean and bell pepper salad | Paneer and corn stir-fry with rice | Pumpkin seeds | 1712 |\n| Sun | Millet porridge with soy milk | Quinoa and chickpea bowl | Tofu and okra with rice | Pear | 1705 |\n\n### Week 4\n\n| Day | Breakfast | Lunch | Dinner | Snacks | kcal |\n|-----|-----------|-------|--------|--------|------|\n| Mon | Oats with sunflower seeds | Lentil and bell pepper salad | Paneer and zucchini with rice | Banana | 1710 |\n| Tue | Soy yogurt with peach | Tofu and corn salad | Tempeh and cauliflower with quinoa | Apple | 1705 |\n| Wed | Chia pudding with berries | Chickpea and spinach salad | Black bean and bell pepper stew | Pumpkin seeds | 1698 |\n| Thu | Corn porridge with soy milk | Paneer and peas salad | Tofu and zucchini with rice | Orange | 1715 |\n| Fri | Rice cakes with avocado | Tempeh and cucumber bowl | Lentil curry with corn and rice | Soy yogurt | 1722 |\n| Sat | Millet porridge with mango | Bean and corn salad | Paneer and bell pepper with millet | Sunflower seeds | 1700 |\n| Sun | Fruit smoothie with soy milk | Tofu and cauliflower salad | Chickpea and okra with rice | Pear | 1710 |\n\n## Foods\n\n### Include\n- Tofu/Tempeh/Paneer: High protein for muscle building and wound healing.\n- Lentils/Chickpeas/Beans: Plant protein and fiber for lipid profile.\n- Soy Milk/Greek Yogurt: Protein and calcium for bone health.\n- Zucchini/Bell Peppers/Peas: Non-bitter, non-root vitamins for healing.\n- Seeds (Pumpkin/Sunflower): Healthy fats and zinc for wound repair.\n- Quinoa/Oats/Millet: Complex carbs for sustained energy during shifts.\n\n### Avoid\n- Cashews: Strict allergy risk.\n- Onions/Garlic/Potatoes/Carrots: Jain dietary restrictions (root vegetables).\n- Broccoli/Kale: Patient dislike (bitter profile).\n- Meat/Fish/Eggs: Patient aversion and Jain vegetarianism.\n\n## Notes\n- **Hydration:** Aim for >2L water daily to support ileostomy function and prevent dehydration.\n- **Shift Work:** Keep nutrient-dense snacks (seeds, fruit) ready to manage variable appetite.\n- **Meal Prep:** Use canned beans (rinsed) and pre-cooked grains to meet <5 min cooking goal.\n- **Consistency:** Eat protein at every meal to meet muscle-building targets.\n\n---\nEND OF PLAN", "temperature": 0.4, "model": "gemma-4-26b-a4b-it", "provider": "gemini", "reasoning": true}, "meethealth": {"package": "meethealth-sample-v1", "package_version": "1.0.0", "source_corpus": "gemma_diets", "source_line": 77206, "contract": "diet_plan@1.0.0", "contract_fingerprint": "1a6c5cf6b9d37193", "gate_rules_evaluated": 45, "gate_failures": [], "package_checks": {"plan_language": {"pass": true, "detail": "english markers=4"}, "completeness_28_days": {"pass": true, "detail": "day_rows=28 weeks=4 terminated=True"}, "no_duplicate_days": {"pass": true, "detail": "duplicate_days=0"}, "macro_arithmetic": {"pass": true, "detail": "target=1708 kcal, 4P+4C+9F=1703 kcal, deviation=0.3%"}, "energy_dose_plausible": {"pass": true, "detail": "29.6 kcal/kg (screen 15-45)"}, "protein_dose_plausible": {"pass": true, "detail": "1.11 g/kg (screen 0.8-1.6)"}, "daily_energy_on_target": {"pass": true, "detail": "days_outside_10pct=0 of 28"}, "allergen_screen": {"pass": true, "detail": "screened=['tree_nut'] hits=[]"}, "hyperkalemia_food_screen": {"pass": true, "detail": "not applicable (K <= 5.0 or absent)"}, "scenario_coherence": {"pass": true, "detail": "ok"}}, "evidence_level": "L2_automated_checks_passed", "expert_review": "not_performed"}}
{"patient_id": "4f266754-4548-4a39-b338-4b66ec623318", "patient_data": {"id": "4f266754-4548-4a39-b338-4b66ec623318", "name": "Whitney Avila", "age": 58, "age_group": "middle_age_51_65y", "gender": "female", "region": "Singapore", "language": "en", "occupation": "Homeless/Housing insecure", "conditions": "Overweight (BMI 25-29.9)", "allergies": "Tree Nuts (almonds only)", "goals": "Dialysis-compatible nutrition, Sleep quality improvement", "preferences": "No restrictions", "weight": 77.8, "height": 168.2, "bmi": 27.5, "activity_level": "moderately_active", "triceps_skinfold": 41.9, "suprailiac_skinfold": 6.8, "subscapular_skinfold": 44.1, "blood_glucose": 96.2, "folate": 7.4, "sodium": 142.6, "potassium": 3.9, "dietary_recall_24h": "Breakfast: 2 scrambled eggs with toast and coffee\nLunch: Salad with grilled chicken and dressing\nDinner: Grilled salmon with vegetables and quinoa\nSnacks: Protein bar", "total_calories": 1480, "total_protein": 80.6, "total_carbohydrates": 166.0, "total_fat": 54.9, "total_fiber": 18.3, "total_sugar": 42.0, "total_saturated_fat": 5.4, "total_sodium": 941, "bmr_formula": "WHO/FAO", "bmr": 1546, "tdee": 2397, "macro_split": {"carbsPercent": 10, "proteinPercent": 20, "fatPercent": 70}, "meals_per_day": 3, "cooking_time": "15-30 minutes", "water_intake_per_day": "<1L", "coffee_cups_per_day": 4, "food_aversions": "Dislikes beans/legumes, Avoids anything green (pediatric)", "appetite_assessment": "Good", "dietary_supplements": "Whey protein isolate post-workout", "prompt_mode": "standard", "clinical_analysis_depth": "basic"}, "prompt": "You are a clinical nutritionist creating a diet plan. Generate all content in ENGLISH.\n\nSTRICT RULES:\n1. Output ONLY markdown - no preamble, no \"Here is...\", no greetings, no sign-offs\n2. Be CONCISE - use tables, bullets, short sentences\n3. Use TABLES for meal plans (mandatory)\n4. NO lengthy explanations unless customInstructions requests detail\n5. Start directly with the H1 title\n6. USE ALL patient data provided to personalize the plan\n7. EVERY DAY must have UNIQUE meals - NO \"repeat day X\" or \"same as above\" - write out ALL 28 days completely.\n8. Provide VARIETY - different foods each day, rotate proteins, vegetables, grains\n\n\n\n\n**Patient:** Name: Whitney Avila | Age: 58 | Gender: female | Conditions: Overweight (BMI 25-29.9) | Allergies: Tree Nuts (almonds only) | Region: Singapore | Occupation: Homeless/Housing insecure\n**Anthropometrics:** Wt: 77.8kg | Ht: 168.2cm | BMI: 27.5 | Activity: moderately active\n**Body Composition:** Triceps: 41.9mm | Suprailiac: 6.8mm | Subscapular: 44.1mm\n**Metabolic Labs:** Glucose: 96.2mg/dL\n**Vitamins/Electrolytes:** Folate: 7.4ng/mL | Na: 142.6 | K: 3.9\n**Energy Targets:** Formula: WHO/FAO | BMR: 1546kcal | TDEE: 2397kcal | Macro Target: C10/P20/F70%\n**Current Intake (24h):** Cal: 1480 | P: 80.6g | C: 166.0g | F: 54.9g | Fiber: 18.3g | Sugar: 42.0g | SatFat: 5.4g | Na: 941mg\n**24h Recall:** Breakfast: 2 scrambled eggs with toast and coffee\nLunch: Salad with grilled chicken and dressing\nDinner: Grilled salmon with vegetables and quinoa\nSnacks: Protein bar\n**Eating Patterns:** Meals/day: 3 | Cooking time: 15-30 minutes | Coffee: 4 | Water: <1L\n**Food Preferences:** Dislikes: Dislikes beans/legumes, Avoids anything green (pediatric)\n**Restrictions:** Supplements: Whey protein isolate post-workout\n**Appetite:** Appetite: Good\n**Goals:** Dialysis-compatible nutrition, Sleep quality improvement\n**Additional Notes:** No restrictions\n\n\n\n\n---\n\nOUTPUT FORMAT (follow exactly):\n\n# Diet Plan - Whitney Avila\n\n## Summary\n- Target: [kcal] kcal/day\n- Macros: P [g]g | C [g]g | F [g]g\n- Key focus: [2-3 bullet points max based on patient data]\n\n\n## Weekly Meal Plan\n\nCRITICAL: You MUST write out EVERY meal for ALL 28 days across ALL 4 weeks. Each day must be unique.\n\n### Week 1\n\n| Day | Breakfast | Lunch | Dinner | Snacks | kcal |\n|-----|-----------|-------|--------|--------|------|\n| Mon | [unique meal] | [unique meal] | [unique meal] | [snack] | [total] |\n| Tue | [unique meal] | [unique meal] | [unique meal] | [snack] | [total] |\n| Wed | [unique meal] | [unique meal] | [unique meal] | [snack] | [total] |\n| Thu | [unique meal] | [unique meal] | [unique meal] | [snack] | [total] |\n| Fri | [unique meal] | [unique meal] | [unique meal] | [snack] | [total] |\n| Sat | [unique meal] | [unique meal] | [unique meal] | [snack] | [total] |\n| Sun | [unique meal] | [unique meal] | [unique meal] | [snack] | [total] |\n\n### Week 2\n\n| Day | Breakfast | Lunch | Dinner | Snacks | kcal |\n|-----|-----------|-------|--------|--------|------|\n| Mon | [unique meal] | [unique meal] | [unique meal] | [snack] | [total] |\n| Tue | [unique meal] | [unique meal] | [unique meal] | [snack] | [total] |\n| Wed | [unique meal] | [unique meal] | [unique meal] | [snack] | [total] |\n| Thu | [unique meal] | [unique meal] | [unique meal] | [snack] | [total] |\n| Fri | [unique meal] | [unique meal] | [unique meal] | [snack] | [total] |\n| Sat | [unique meal] | [unique meal] | [unique meal] | [snack] | [total] |\n| Sun | [unique meal] | [unique meal] | [unique meal] | [snack] | [total] |\n\n### Week 3\n\n| Day | Breakfast | Lunch | Dinner | Snacks | kcal |\n|-----|-----------|-------|--------|--------|------|\n| Mon | [unique meal] | [unique meal] | [unique meal] | [snack] | [total] |\n| Tue | [unique meal] | [unique meal] | [unique meal] | [snack] | [total] |\n| Wed | [unique meal] | [unique meal] | [unique meal] | [snack] | [total] |\n| Thu | [unique meal] | [unique meal] | [unique meal] | [snack] | [total] |\n| Fri | [unique meal] | [unique meal] | [unique meal] | [snack] | [total] |\n| Sat | [unique meal] | [unique meal] | [unique meal] | [snack] | [total] |\n| Sun | [unique meal] | [unique meal] | [unique meal] | [snack] | [total] |\n\n### Week 4\n\n| Day | Breakfast | Lunch | Dinner | Snacks | kcal |\n|-----|-----------|-------|--------|--------|------|\n| Mon | [unique meal] | [unique meal] | [unique meal] | [snack] | [total] |\n| Tue | [unique meal] | [unique meal] | [unique meal] | [snack] | [total] |\n| Wed | [unique meal] | [unique meal] | [unique meal] | [snack] | [total] |\n| Thu | [unique meal] | [unique meal] | [unique meal] | [snack] | [total] |\n| Fri | [unique meal] | [unique meal] | [unique meal] | [snack] | [total] |\n| Sat | [unique meal] | [unique meal] | [unique meal] | [snack] | [total] |\n| Sun | [unique meal] | [unique meal] | [unique meal] | [snack] | [total] |\n\n\n## Foods\n\n### Include\n- [food]: [portion] - [brief reason based on labs/conditions]\n\n### Avoid\n- [food]: [brief reason based on labs/conditions]\n\n## Notes\n- [2-4 practical tips based on patient's eating patterns/lifestyle]\n\n---\nEND OF PLAN", "diet": {"content": "# Diet Plan - Whitney Avila\n\n## Summary\n- Target: 2397 kcal/day\n- Macros: P 120g | C 60g | F 187g\n- Key focus: \n    - High-fat, low-carbohydrate distribution (C10/P20/F70) to meet metabolic targets.\n    - Strict avoidance of green vegetables and legumes per patient preference.\n    - Allergy-safe, calorie-dense meals to address energy deficit and housing insecurity.\n\n## Weekly Meal Plan\n\n### Week 1\n\n| Day | Breakfast | Lunch | Dinner | Snacks | kcal |\n|-----|-----------|-------|--------|--------|------|\n| Mon | 3 Scrambled eggs with bacon & butter | Grilled chicken thighs with cauliflower | Pan-seared salmon with butter & carrots | Whey protein shake | 2410 |\n| Tue | Full-fat Greek yogurt with blueberries | Beef patty with melted cheddar & onions | Roasted pork belly with cauliflower | Hard-boiled eggs (2) | 2385 |\n| Wed | Omelet with cheese & mushrooms | Tuna salad with heavy mayo & peppers | Steak with garlic butter & mushrooms | Whey protein shake | 2405 |\n| Thu | 3 Eggs with sausage & butter | Chicken breast with cream sauce & carrots | White fish with lemon butter & onions | Cheese sticks (2) | 2390 |\n| Fri | Smoked salmon with cream cheese | Beef strips with red peppers & oil | Pork chops with sautéed mushrooms | Whey protein shake | 2420 |\n| Sat | Egg muffins with bacon & cheese | Shrimp with garlic butter & cauliflower | Roast chicken with buttered carrots | Beef jerky | 2375 |\n| Sun | Scrambled eggs with mushrooms & cream | Steak with fried eggs | Salmon with avocado (yellow flesh) | Whey protein shake | 2415 |\n\n### Week 2\n\n| Day | Breakfast | Lunch | Dinner | Snacks | kcal |\n|-----|-----------|-------|--------|--------|------|\n| Mon | 3 Boiled eggs with bacon & butter | Chicken thighs with cheese sauce | Beef stir-fry (no green) with onions | Full-fat yogurt | 2395 |\n| Tue | Omelet with ham & cheese | Pork chop with cauliflower mash | White fish with butter & peppers | Whey protein shake | 2400 |\n| Wed | Greek yogurt with strawberries | Beef burger (no bun) with cheese | Chicken with heavy cream & mushrooms | Hard-boiled eggs (2) | 2380 |\n| Thu | 3 Eggs with sausage & butter | Salmon with mayo & red peppers | Steak with buttered cauliflower | Whey protein shake | 2410 |\n| Fri | Scrambled eggs with cheddar | Pork belly with onions | Chicken thighs with garlic butter | Cheese sticks (2) | 2390 |\n| Sat | Omelet with mushrooms & bacon | Beef strips with peppers & oil | White fish with butter & carrots | Whey protein shake | 2405 |\n| Sun | 3 Eggs with bacon & sausage | Chicken with cream sauce & onions | Steak with mushrooms & butter | Full-fat yogurt | 2425 |\n\n### Week 3\n\n| Day | Breakfast | Lunch | Dinner | Snacks | kcal |\n|-----|-----------|-------|--------|--------|------|\n| Mon | Greek yogurt with raspberries | Pork with red peppers & oil | Salmon with butter & cauliflower | Whey protein shake | 2385 |\n| Tue | Scrambled eggs with ham & cheese | Beef patty with onions & butter | Chicken with heavy cream & carrots | Hard-boiled eggs (2) | 2400 |\n| Wed | Egg muffins with cheese & bacon | White fish with garlic butter | Steak with sautéed mushrooms | Whey protein shake | 2395 |\n| Thu | Omelet with sausage & butter | Chicken with cauliflower & cheese | Pork chops with onions & oil | Cheese sticks (2) | 2410 |\n| Fri | Smoked salmon with eggs | Beef with melted cheese & peppers | White fish with butter & cauliflower | Whey protein shake | 2380 |\n| Sat | Scrambled eggs with sausage | Pork belly with carrots | Chicken thighs with cream sauce | Full-fat yogurt | 2405 |\n| Sun | Greek yogurt with blueberries | Steak with mushrooms & butter | Salmon with garlic & onions | Whey protein shake | 2420 |\n\n### Week 4\n\n| Day | Breakfast | Lunch | Dinner | Snacks | kcal |\n|-----|-----------|-------|--------|--------|------|\n| Mon | Omelet with cheese & mushrooms | Chicken with heavy cream & peppers | Beef with butter & cauliflower | Whey protein shake | 2390 |\n| Tue | 3 Eggs with bacon & butter | White fish with mayo & carrots | Pork chops with onions & oil | Hard-boiled eggs (2) | 2405 |\n| Wed | Greek yogurt with strawberries | Beef strips with cheese & peppers | Chicken with garlic butter & cauliflower | Whey protein shake | 2385 |\n| Thu | Scrambled eggs with ham & cheese | Salmon with butter & onions | Steak with carrots & mushrooms | Cheese sticks (2) | 2415 |\n| Fri | Egg muffins with bacon & sausage | Pork belly with cauliflower | Chicken thighs with butter & peppers | Whey protein shake | 2395 |\n| Sat | Omelet with mushrooms & cheese | Beef burger with cheese & onions | White fish with butter & carrots | Full-fat yogurt | 2400 |\n| Sun | Scrambled eggs with sausage & butter | Chicken with cream sauce & peppers | Steak with mushrooms & cauliflower | Whey protein shake | 2425 |\n\n## Foods\n\n### Include\n- Fatty Fish (Salmon/Mackerel): High Omega-3 for inflammation and calorie density.\n- Eggs: High-quality protein and fats; easy to prepare.\n- Cauliflower/Carrots: Non-green vegetable sources for micronutrients.\n- Whey Protein Isolate: Essential for meeting protein targets post-workout.\n- Butter/Olive Oil: Necessary to reach high fat (70%) and calorie targets.\n\n### Avoid\n- Almonds: Strict allergy risk.\n- Green Vegetables (Spinach/Broccoli): Patient preference/avoidance.\n- Beans/Legumes: Patient preference/avoidance.\n- Sugary Drinks: To maintain glucose stability.\n\n## Notes\n- **Hydration:** Increase water intake from <1L to at least 2L daily to support kidney function and metabolic processes.\n- **Caloric Density:** Since the target is high (2400 kcal) and the patient is housing insecure, prioritize calorie-dense fats (butter, oils, cheese) to ensure energy needs are met with smaller food volumes.\n- **Preparation:** Focus on one-pan meals (e.g., pan-seared meats and cauliflower) to minimize cooking time and equipment needs.\n- **Sleep Quality:** Avoid large meals or heavy caffeine (currently 4 coffees) within 4 hours of bedtime to improve sleep hygiene.\n\n---\nEND OF PLAN", "temperature": 0.4, "model": "gemma-4-26b-a4b-it", "provider": "gemini", "reasoning": true}, "meethealth": {"package": "meethealth-sample-v1", "package_version": "1.0.0", "source_corpus": "gemma_diets", "source_line": 88712, "contract": "diet_plan@1.0.0", "contract_fingerprint": "1a6c5cf6b9d37193", "gate_rules_evaluated": 45, "gate_failures": [], "package_checks": {"plan_language": {"pass": true, "detail": "english markers=4"}, "completeness_28_days": {"pass": true, "detail": "day_rows=28 weeks=4 terminated=True"}, "no_duplicate_days": {"pass": true, "detail": "duplicate_days=0"}, "macro_arithmetic": {"pass": true, "detail": "target=2397 kcal, 4P+4C+9F=2403 kcal, deviation=0.3%"}, "energy_dose_plausible": {"pass": true, "detail": "30.8 kcal/kg (screen 15-45)"}, "protein_dose_plausible": {"pass": true, "detail": "1.54 g/kg (screen 0.8-1.6)"}, "daily_energy_on_target": {"pass": true, "detail": "days_outside_10pct=0 of 28"}, "allergen_screen": {"pass": true, "detail": "screened=['tree_nut'] hits=[]"}, "hyperkalemia_food_screen": {"pass": true, "detail": "not applicable (K <= 5.0 or absent)"}, "scenario_coherence": {"pass": true, "detail": "ok"}}, "evidence_level": "L2_automated_checks_passed", "expert_review": "not_performed"}}
{"patient_id": "f90b371e-8fb9-4765-82c0-e0e98fdaf397", "patient_data": {"id": "f90b371e-8fb9-4765-82c0-e0e98fdaf397", "name": "James Hill", "age": 63, "age_group": "middle_age_51_65y", "gender": "male", "region": "South_Africa", "language": "en", "occupation": "Shift worker (nights)", "conditions": "Overweight (BMI 25-29.9)", "allergies": "Red meat allergy (Alpha-gal syndrome)", "goals": "Gut healing (leaky gut/intestinal permeability)", "preferences": "Ayurvedic (Pitta-balancing)", "weight": 85.2, "height": 179.0, "bmi": 26.6, "activity_level": "moderately_active", "muac": 29.8, "waist_circumference": 74.0, "hip_circumference": 104.7, "calf_circumference": 43.8, "skin_condition": "Acanthosis nigricans", "hair_condition": "Alopecia patches", "oral_health": "Thrush/candidiasis", "weight_change": "Lost 10 kg intentionally in last year", "meals_per_day": 2, "cooking_time": "30-60 minutes", "water_intake_per_day": "2-2.5L", "coffee_cups_per_day": 0, "food_preferences": "Enjoys soups and stews, Prefers raw/fresh vegetables", "appetite_assessment": "Poor", "dietary_supplements": "Folate 5mg/day (high-dose)", "prompt_mode": "standard", "clinical_analysis_depth": "detailed"}, "prompt": "You are a clinical nutritionist creating a diet plan. Generate all content in ENGLISH.\n\nSTRICT RULES:\n1. Output ONLY markdown - no preamble, no \"Here is...\", no greetings, no sign-offs\n2. Be CONCISE - use tables, bullets, short sentences\n3. Use TABLES for meal plans (mandatory)\n4. NO lengthy explanations unless customInstructions requests detail\n5. Start directly with the H1 title\n6. USE ALL patient data provided to personalize the plan\n7. EVERY DAY must have UNIQUE meals - NO \"repeat day X\" or \"same as above\" - write out ALL 28 days completely.\n8. Provide VARIETY - different foods each day, rotate proteins, vegetables, grains\n\n\n\n\n**Patient:** Name: James Hill | Age: 63 | Gender: male | Conditions: Overweight (BMI 25-29.9) | Allergies: Red meat allergy (Alpha-gal syndrome) | Region: South_Africa | Occupation: Shift worker (nights)\n**Anthropometrics:** Wt: 85.2kg | Ht: 179.0cm | BMI: 26.6 | Activity: moderately active\n**Body Circumferences:** MUAC: 29.8cm | Waist: 74.0cm | Hip: 104.7cm | Calf: 43.8cm\n**Clinical Signs:** Skin: Acanthosis nigricans | Hair: Alopecia patches | Oral: Thrush/candidiasis | Weight Change: Lost 10 kg intentionally in last year\n**Eating Patterns:** Meals/day: 2 | Cooking time: 30-60 minutes | Water: 2-2.5L\n**Food Preferences:** Likes: Enjoys soups and stews, Prefers raw/fresh vegetables\n**Restrictions:** Supplements: Folate 5mg/day (high-dose)\n**Appetite:** Appetite: Poor\n**Goals:** Gut healing (leaky gut/intestinal permeability)\n**Additional Notes:** Ayurvedic (Pitta-balancing)\n\n\n\n\n---\n\nOUTPUT FORMAT (follow exactly):\n\n# Diet Plan - James Hill\n\n## Summary\n- Target: [kcal] kcal/day\n- Macros: P [g]g | C [g]g | F [g]g\n- Key focus: [2-3 bullet points max based on patient data]\n\n\n## Weekly Meal Plan\n\nCRITICAL: You MUST write out EVERY meal for ALL 28 days across ALL 4 weeks. Each day must be unique.\n\n### Week 1\n\n| Day | Breakfast | Lunch | Dinner | Snacks | kcal |\n|-----|-----------|-------|--------|--------|------|\n| Mon | [unique meal] | [unique meal] | [unique meal] | [snack] | [total] |\n| Tue | [unique meal] | [unique meal] | [unique meal] | [snack] | [total] |\n| Wed | [unique meal] | [unique meal] | [unique meal] | [snack] | [total] |\n| Thu | [unique meal] | [unique meal] | [unique meal] | [snack] | [total] |\n| Fri | [unique meal] | [unique meal] | [unique meal] | [snack] | [total] |\n| Sat | [unique meal] | [unique meal] | [unique meal] | [snack] | [total] |\n| Sun | [unique meal] | [unique meal] | [unique meal] | [snack] | [total] |\n\n### Week 2\n\n| Day | Breakfast | Lunch | Dinner | Snacks | kcal |\n|-----|-----------|-------|--------|--------|------|\n| Mon | [unique meal] | [unique meal] | [unique meal] | [snack] | [total] |\n| Tue | [unique meal] | [unique meal] | [unique meal] | [snack] | [total] |\n| Wed | [unique meal] | [unique meal] | [unique meal] | [snack] | [total] |\n| Thu | [unique meal] | [unique meal] | [unique meal] | [snack] | [total] |\n| Fri | [unique meal] | [unique meal] | [unique meal] | [snack] | [total] |\n| Sat | [unique meal] | [unique meal] | [unique meal] | [snack] | [total] |\n| Sun | [unique meal] | [unique meal] | [unique meal] | [snack] | [total] |\n\n### Week 3\n\n| Day | Breakfast | Lunch | Dinner | Snacks | kcal |\n|-----|-----------|-------|--------|--------|------|\n| Mon | [unique meal] | [unique meal] | [unique meal] | [snack] | [total] |\n| Tue | [unique meal] | [unique meal] | [unique meal] | [snack] | [total] |\n| Wed | [unique meal] | [unique meal] | [unique meal] | [snack] | [total] |\n| Thu | [unique meal] | [unique meal] | [unique meal] | [snack] | [total] |\n| Fri | [unique meal] | [unique meal] | [unique meal] | [snack] | [total] |\n| Sat | [unique meal] | [unique meal] | [unique meal] | [snack] | [total] |\n| Sun | [unique meal] | [unique meal] | [unique meal] | [snack] | [total] |\n\n### Week 4\n\n| Day | Breakfast | Lunch | Dinner | Snacks | kcal |\n|-----|-----------|-------|--------|--------|------|\n| Mon | [unique meal] | [unique meal] | [unique meal] | [snack] | [total] |\n| Tue | [unique meal] | [unique meal] | [unique meal] | [snack] | [total] |\n| Wed | [unique meal] | [unique meal] | [unique meal] | [snack] | [total] |\n| Thu | [unique meal] | [unique meal] | [unique meal] | [snack] | [total] |\n| Fri | [unique meal] | [unique meal] | [unique meal] | [snack] | [total] |\n| Sat | [unique meal] | [unique meal] | [unique meal] | [snack] | [total] |\n| Sun | [unique meal] | [unique meal] | [unique meal] | [snack] | [total] |\n\n\n## Foods\n\n### Include\n- [food]: [portion] - [brief reason based on labs/conditions]\n\n### Avoid\n- [food]: [brief reason based on labs/conditions]\n\n## Notes\n- [2-4 practical tips based on patient's eating patterns/lifestyle]\n\n---\nEND OF PLAN", "diet": {"content": "# Diet Plan - James Hill\n\n## Summary\n- Target: 2300 kcal/day\n- Macros: P 115g | C 258g | F 89g\n- Key focus: \n    - Gut mucosal repair via bone broths and cooked, easy-to-digest vegetables.\n    - Pitta-balancing (cooling) foods to reduce inflammation and manage insulin resistance.\n    - Strict avoidance of red meat (Alpha-gal) and refined sugars (Candidiasis/Acanthosis nigricans).\n\n## Weekly Meal Plan\n\n### Week 1\n\n| Day | Breakfast | Lunch | Dinner | Snacks | kcal |\n|-----|-----------|-------|--------|--------|------|\n| Mon | Poached eggs & avocado | Chicken & vegetable stew | Grilled salmon with quinoa | Coconut yogurt | 2310 |\n| Tue | Overnight oats with chia | Turkey & cucumber wrap | Lentil & spinach soup | Walnuts | 2280 |\n| Wed | Scrambled eggs with spinach | Tuna salad with olive oil | Baked cod with sweet potato | Almonds | 2340 |\n| Thu | Coconut milk porridge | Chicken & pumpkin soup | Grilled trout with zucchini | Pumpkin seeds | 2290 |\n| Fri | Chia seed pudding | Turkey & avocado salad | Chickpea & coconut stew | Brazil nuts | 2320 |\n| Sat | Egg & avocado mash | Fish & vegetable broth | Chicken & quinoa bowl | Blueberries | 2270 |\n| Sun | Mackerel on sourdough | Lentil & carrot soup | Roasted turkey & greens | Sunflower seeds | 2350 |\n\n### Week 2\n\n| Day | Breakfast | Lunch | Dinner | Snacks | kcal |\n|-----|-----------|-------|--------|--------|------|\n| Mon | Scrambled eggs & kale | Chicken & sweet potato stew | Baked salmon & asparagus | Coconut flakes | 2300 |\n| Tue | Quinoa breakfast bowl | Turkey & veggie soup | Cod with steamed broccoli | Cashews | 2290 |\n| Wed | Poached eggs & tomato | Lentil & vegetable stew | Grilled chicken & quinoa | Pear slices | 2310 |\n| Thu | Chia pudding with berries | Tuna & avocado salad | Turkey & vegetable broth | Flaxseeds | 2285 |\n| Fri | Oat porridge with flax | Chicken & zucchini soup | Fish & cauliflower rice | Almond butter | 2330 |\n| Sat | Egg & spinach omelet | Chickpea & cucumber salad | Roasted turkey & pumpkin | Yogurt | 2260 |\n| Sun | Smoked trout & avocado | Chicken & lentil soup | Baked cod & sweet potato | Walnuts | 2340 |\n\n### Week 3\n\n| Day | Breakfast | Lunch | Dinner | Snacks | kcal |\n|-----|-----------|-------|--------|--------|------|\n| Mon | Coconut yogurt & chia | Turkey & quinoa salad | Chicken & vegetable stew | Pumpkin seeds | 2295 |\n| Tue | Scrambled eggs & mushrooms | Fish & vegetable soup | Lentil & spinach curry | Almonds | 2315 |\n| Wed | Avocado & poached egg | Chicken & pumpkin stew | Grilled salmon & greens | Blueberries | 2305 |\n| Thu | Overnight oats | Turkey & avocado wrap | Cod & sweet potato mash | Brazil nuts | 2280 |\n| Fri | Chia seed pudding | Lentil & carrot soup | Chicken & zucchini stew | Sunflower seeds | 2325 |\n| Sat | Egg & spinach scramble | Tuna & cucumber salad | Turkey & vegetable soup | Coconut yogurt | 2275 |\n| Sun | Mackerel & avocado | Chicken & quinoa bowl | Fish & steamed vegetables | Walnuts | 2350 |\n\n### Week 4\n\n| Day | Breakfast | Lunch | Dinner | Snacks | kcal |\n|-----|-----------|-------|--------|--------|------|\n| Mon | Poached eggs & greens | Turkey & lentil soup | Baked salmon & quinoa | Cashews | 2310 |\n| Tue | Chia pudding | Chicken & vegetable stew | Cod & cauliflower soup | Pear slices | 2285 |\n| Wed | Oat porridge | Fish & avocado salad | Turkey & sweet potato | Almonds | 2320 |\n| Thu | Scrambled eggs | Lentil & veggie stew | Chicken & zucchini bowl | Pumpkin seeds | 2290 |\n| Fri | Coconut yogurt & seeds | Turkey & cucumber salad | Salmon & steamed greens | Walnuts | 2330 |\n| Sat | Egg & avocado toast | Chicken & pumpkin soup | Fish & quinoa stew | Blueberries | 2270 |\n| Sun | Smoked salmon & egg | Chickpea & veggie stew | Turkey & vegetable broth | Flaxseeds | 2340 |\n\n## Foods\n\n### Include\n- Poultry/Fish: High-quality protein for muscle maintenance and Alpha-gal safety.\n- Bone Broth: Rich in amino acids (glycine/proline) for gut lining repair.\n- Cooked Vegetables: Easier to digest for poor appetite and gut permeability.\n- Coconut/Cucumber: Cooling foods to balance Pitta dosha.\n- Chia/Flaxseeds: Fiber for gut motility and Omega-3s for inflammation.\n\n### Avoid\n- Red Meat: Strict avoidance due to Alpha-gal syndrome.\n- Refined Sugar: To manage oral candidiasis and insulin resistance (Acanthosis nigricans).\n- Spicy/Acidic Foods: To prevent Pitta aggravation and stomach irritation.\n- Highly Processed Grains: To manage glycemic load and insulin levels.\n\n## Notes\n- **Meal Timing:** Since you are a night shift worker, try to anchor your two main meals around your waking hours to stabilize insulin.\n- **Digestibility:** Focus on the soups and stews provided; warm, cooked foods are better for your \"poor appetite\" and gut healing.\n- **Hydration:** Continue your 2-2.5L water intake, but avoid drinking large amounts during meals to aid digestion.\n- **Small Bites:** If appetite is very low, break the \"Snacks\" into smaller, more frequent portions throughout your shift.\n\n---\nEND OF PLAN", "temperature": 0.4, "model": "gemma-4-26b-a4b-it", "provider": "gemini", "reasoning": true}, "meethealth": {"package": "meethealth-sample-v1", "package_version": "1.0.0", "source_corpus": "gemma_diets", "source_line": 101482, "contract": "diet_plan@1.0.0", "contract_fingerprint": "1a6c5cf6b9d37193", "gate_rules_evaluated": 45, "gate_failures": [], "package_checks": {"plan_language": {"pass": true, "detail": "english markers=4"}, "completeness_28_days": {"pass": true, "detail": "day_rows=28 weeks=4 terminated=True"}, "no_duplicate_days": {"pass": true, "detail": "duplicate_days=0"}, "macro_arithmetic": {"pass": true, "detail": "target=2300 kcal, 4P+4C+9F=2293 kcal, deviation=0.3%"}, "energy_dose_plausible": {"pass": true, "detail": "27.0 kcal/kg (screen 15-45)"}, "protein_dose_plausible": {"pass": true, "detail": "1.35 g/kg (screen 0.8-1.6)"}, "daily_energy_on_target": {"pass": true, "detail": "days_outside_10pct=0 of 28"}, "allergen_screen": {"pass": true, "detail": "screened=['alpha_gal'] hits=[]"}, "hyperkalemia_food_screen": {"pass": true, "detail": "not applicable (K <= 5.0 or absent)"}, "scenario_coherence": {"pass": true, "detail": "ok"}}, "evidence_level": "L2_automated_checks_passed", "expert_review": "not_performed"}}
{"patient_id": "008726ad-f7bd-43d7-a96e-5df724d996d2", "patient_data": {"id": "008726ad-f7bd-43d7-a96e-5df724d996d2", "name": "Brittany Smith", "age": 36, "age_group": "adult_31_50y", "gender": "female", "region": "Philippines", "language": "en", "occupation": "Nurse", "conditions": "Obesity Class II (BMI 35-39.9), Insulin Resistance", "allergies": "Fish (all)", "goals": "Transition from tube feeding to oral, Hepatic offloading / liver health, Gout flare prevention, Dumping syndrome management", "preferences": "Vegan", "weight": 106.9, "height": 163.9, "bmi": 39.8, "activity_level": "sedentary", "hemoglobin": 7.2, "serum_ferritin": 410.0, "blood_glucose": 116.1, "hba1c": 7.1, "total_cholesterol": 286.8, "ldl_cholesterol": 216.5, "vitamin_d": 50.7, "vitamin_b12": 842.8, "chloride": 100.3, "albumin": 2.9, "bun": 10.3, "meals_per_day": 4, "cooking_time": "<15 minutes", "water_intake_per_day": "2-2.5L", "coffee_cups_per_day": 2, "eating_habits": "Emotional eating", "food_preferences": "Prefers spicy food", "food_aversions": "Meat aversion (chemo-related), Dislikes tofu/tempeh", "appetite_assessment": "Normal", "dietary_supplements": "Whey protein isolate post-workout", "prompt_mode": "clinical", "clinical_analysis_depth": "basic"}, "prompt": "You are a senior clinical nutritionist with expertise in medical nutrition therapy creating a diet plan. Generate all content in ENGLISH.\n\n## ADVANCED CLINICAL MODE ENABLED\nThis dietary plan requires a clinically-driven approach with structured analysis of the nutritional anamnesis.\nYou MUST explicitly analyze and integrate key patient parameters before generating recommendations.\nAnalysis Depth: BASIC\n\nSTRICT RULES:\n1. Output ONLY markdown - no preamble, no \"Here is...\", no greetings, no sign-offs\n2. Be CONCISE - use tables, bullets, short sentences\n3. Use TABLES for meal plans (mandatory)\n4. NO lengthy explanations unless customInstructions requests detail\n5. Start directly with the H1 title\n6. USE ALL patient data provided to personalize the plan\n7. EVERY DAY must have UNIQUE meals - NO \"repeat day X\" or \"same as above\" - write out ALL 28 days completely.\n8. Provide VARIETY - different foods each day, rotate proteins, vegetables, grains\n\n9. PERFORM complete clinical anamnesis analysis BEFORE generating the meal plan\n10. JUSTIFY each major dietary recommendation with clinical rationale\n11. USE PES (Problem-Etiology-Signs/Symptoms) format for nutritional diagnoses\n12. INCLUDE monitoring parameters and follow-up indicators\n\n\n## CLINICAL NUTRITIONAL ANAMNESIS ANALYSIS\n\nYou MUST perform a structured, systematic analysis of the patient's nutritional anamnesis before generating the diet plan.\n\n**Analysis Depth:** Provide a concise clinical analysis focusing on the most critical parameters.\n\n### 1. BIOCHEMICAL DATA ANALYSIS\n**Hematological Profile:**\n  - Hemoglobin: 7.2 g/dL | Ferritin: 410.0 ng/mL\n  - Clinical interpretation: Assess iron status, anemia risk, and need for iron-rich foods or absorption enhancers\n\n**Glycemic Control:**\n  - Fasting Glucose: 116.1 mg/dL | HbA1c: 7.1%\n  - Clinical interpretation: Evaluate glycemic control, carbohydrate tolerance, and glycemic index considerations\n\n**Lipid Profile:**\n  - TC: 286.8 | LDL: 216.5 mg/dL\n  - Clinical interpretation: Assess cardiovascular risk, dietary fat modifications, and omega-3 requirements\n\n**Micronutrient Status:**\n  - Vitamin D: 50.7 ng/mL | B12: 842.8 pg/mL\n  - Clinical interpretation: Identify deficiencies requiring dietary intervention or supplementation\n\n**Electrolyte Balance:**\n  - Cl: 100.3 mEq/L\n  - Clinical interpretation: Assess fluid-electrolyte status and dietary sodium/potassium modifications\n\n**Protein Status:**\n  - Albumin: 2.9 g/dL\n  - Clinical interpretation: Evaluate protein-calorie malnutrition risk and protein requirements\n\n**Renal Function:**\n  - BUN: 10.3 mg/dL\n  - Clinical interpretation: Assess renal function and protein/electrolyte restrictions if needed\n\n### 2. CLINICAL DATA ANALYSIS\n**Current Medical Conditions:** Obesity Class II (BMI 35-39.9), Insulin Resistance\n  - Nutritional implications: Disease-specific dietary modifications, nutrient-drug interactions\n**Allergies & Intolerances:** Fish (all)\n  - CRITICAL: Strict avoidance required, cross-reactivity considerations\n\n### 3. ANTHROPOMETRIC DATA ANALYSIS\n**Primary Measurements:**\n  - Weight: 106.9 kg | Height: 163.9 cm | BMI: 39.8 kg/m²\n  - BMI Classification: Obese\n  - Activity Level: sedentary\n\n### 4. DIETARY DATA ANALYSIS\nNo 24h recall available.\n\n### 5. CLINICAL SYNTHESIS & NUTRITIONAL DIAGNOSIS\n**Patient Goals:** Transition from tube feeding to oral, Hepatic offloading / liver health, Gout flare prevention, Dumping syndrome management\n\n**REQUIRED OUTPUT FOR CLINICAL MODE:**\n1. **Problem List (PES Format):** Identify 2-4 nutrition diagnoses using Problem-Etiology-Signs/Symptoms format\n2. **Priority Ranking:** Rank nutritional problems by clinical urgency\n3. **Intervention Rationale:** For each dietary recommendation, provide clinical justification\n4. **Monitoring Parameters:** Specify what should be monitored\n\n---\n\n**Patient:** Name: Brittany Smith | Age: 36 | Gender: female | Conditions: Obesity Class II (BMI 35-39.9), Insulin Resistance | Allergies: Fish (all) | Region: Philippines | Occupation: Nurse\n**Anthropometrics:** Wt: 106.9kg | Ht: 163.9cm | BMI: 39.8 | Activity: sedentary\n**Blood/Iron:** Hb: 7.2g/dL | Ferritin: 410.0ng/mL\n**Metabolic Labs:** Glucose: 116.1mg/dL | HbA1c: 7.1% | TC: 286.8 | LDL: 216.5\n**Vitamins/Electrolytes:** VitD: 50.7ng/mL | B12: 842.8pg/mL | Cl: 100.3\n**Protein/Kidney:** Albumin: 2.9g/dL | BUN: 10.3mg/dL\n**Eating Patterns:** Meals/day: 4 | Cooking time: <15 minutes | Coffee: 2 | Water: 2-2.5L\n**Food Preferences:** Likes: Prefers spicy food | Dislikes: Meat aversion (chemo-related), Dislikes tofu/tempeh | Habits: Emotional eating\n**Restrictions:** Supplements: Whey protein isolate post-workout\n**Appetite:** Appetite: Normal\n**Goals:** Transition from tube feeding to oral, Hepatic offloading / liver health, Gout flare prevention, Dumping syndrome management\n**Additional Notes:** Vegan\n\n\n\n\n---\n\nOUTPUT FORMAT (follow exactly):\n\n# Diet Plan - Brittany Smith\n\n## Clinical Nutritional Anamnesis Analysis\n\n### 1. Biochemical Data Analysis\n[Interpret lab values]\n\n### 2. Clinical Data Analysis\n[Medical conditions and dietary implications]\n\n### 3. Anthropometric Data Analysis\n[BMI classification and body composition]\n\n### 4. Dietary Data Analysis\n[24h recall interpretation and nutrient gap analysis]\n\n### 5. Nutritional Diagnosis (PES Format)\n| Priority | Problem | Etiology | Signs/Symptoms |\n|----------|---------|----------|----------------|\n| 1 | [Nutrition problem] | related to [etiology] | as evidenced by [S/S] |\n\n### 6. Intervention Rationale\n[Key intervention decisions with clinical justification]\n\n---\n\n## Summary\n- Target: [kcal] kcal/day\n- Macros: P [g]g | C [g]g | F [g]g\n- Key focus: [2-3 bullet points max based on patient data]\n- Clinical priorities: [Based on PES diagnoses above]\n\n## Weekly Meal Plan\n\nCRITICAL: You MUST write out EVERY meal for ALL 28 days across ALL 4 weeks. Each day must be unique.\n\n### Week 1\n\n| Day | Breakfast | Lunch | Dinner | Snacks | kcal |\n|-----|-----------|-------|--------|--------|------|\n| Mon | [unique meal] | [unique meal] | [unique meal] | [snack] | [total] |\n| Tue | [unique meal] | [unique meal] | [unique meal] | [snack] | [total] |\n| Wed | [unique meal] | [unique meal] | [unique meal] | [snack] | [total] |\n| Thu | [unique meal] | [unique meal] | [unique meal] | [snack] | [total] |\n| Fri | [unique meal] | [unique meal] | [unique meal] | [snack] | [total] |\n| Sat | [unique meal] | [unique meal] | [unique meal] | [snack] | [total] |\n| Sun | [unique meal] | [unique meal] | [unique meal] | [snack] | [total] |\n\n### Week 2\n\n| Day | Breakfast | Lunch | Dinner | Snacks | kcal |\n|-----|-----------|-------|--------|--------|------|\n| Mon | [unique meal] | [unique meal] | [unique meal] | [snack] | [total] |\n| Tue | [unique meal] | [unique meal] | [unique meal] | [snack] | [total] |\n| Wed | [unique meal] | [unique meal] | [unique meal] | [snack] | [total] |\n| Thu | [unique meal] | [unique meal] | [unique meal] | [snack] | [total] |\n| Fri | [unique meal] | [unique meal] | [unique meal] | [snack] | [total] |\n| Sat | [unique meal] | [unique meal] | [unique meal] | [snack] | [total] |\n| Sun | [unique meal] | [unique meal] | [unique meal] | [snack] | [total] |\n\n### Week 3\n\n| Day | Breakfast | Lunch | Dinner | Snacks | kcal |\n|-----|-----------|-------|--------|--------|------|\n| Mon | [unique meal] | [unique meal] | [unique meal] | [snack] | [total] |\n| Tue | [unique meal] | [unique meal] | [unique meal] | [snack] | [total] |\n| Wed | [unique meal] | [unique meal] | [unique meal] | [snack] | [total] |\n| Thu | [unique meal] | [unique meal] | [unique meal] | [snack] | [total] |\n| Fri | [unique meal] | [unique meal] | [unique meal] | [snack] | [total] |\n| Sat | [unique meal] | [unique meal] | [unique meal] | [snack] | [total] |\n| Sun | [unique meal] | [unique meal] | [unique meal] | [snack] | [total] |\n\n### Week 4\n\n| Day | Breakfast | Lunch | Dinner | Snacks | kcal |\n|-----|-----------|-------|--------|--------|------|\n| Mon | [unique meal] | [unique meal] | [unique meal] | [snack] | [total] |\n| Tue | [unique meal] | [unique meal] | [unique meal] | [snack] | [total] |\n| Wed | [unique meal] | [unique meal] | [unique meal] | [snack] | [total] |\n| Thu | [unique meal] | [unique meal] | [unique meal] | [snack] | [total] |\n| Fri | [unique meal] | [unique meal] | [unique meal] | [snack] | [total] |\n| Sat | [unique meal] | [unique meal] | [unique meal] | [snack] | [total] |\n| Sun | [unique meal] | [unique meal] | [unique meal] | [snack] | [total] |\n\n\n## Foods\n\n### Include\n- [food]: [portion] - [brief reason based on labs/conditions]\n\n### Avoid\n- [food]: [brief reason based on labs/conditions]\n\n## Notes\n- [2-4 practical tips based on patient's eating patterns/lifestyle]\n\n## Monitoring Parameters\n\n### Indicators to Evaluate\n| Parameter | Current Value | Target | Timeline |\n|-----------|---------------|--------|----------|\n| [parameter] | [current] | [goal] | [weeks] |\n\n### Recommended Follow-up\n- Next appointment: [timeframe]\n- Follow-up labs: [which tests, when]\n- Warning signs: [symptoms requiring immediate attention]\n\n---\nEND OF PLAN", "diet": {"content": "# Diet Plan - Brittany Smith\n\n## Clinical Nutritional Anamnesis Analysis\n\n### 1. Biochemical Data Analysis\n*   **Hematological Profile:** Severe anemia (Hb 7.2 g/dL) despite high Ferritin (410 ng/mL), suggesting iron sequestration/inflammation (Anemia of Chronic Disease).\n*   **Glycemic Control:** Poor glycemic control (HbA1c 7.1%, Glucose 116.1 mg/dL) consistent with Type 2 Diabetes/Insulin Resistance.\n*   **Lipid Profile:** Severe hyperlipidemia (TC 286.8, LDL 216.5 mg/dL) indicating high cardiovascular risk.\n*   **Protein Status:** Hypoalbuminemia (Albumin 2.9 g/dL) indicating significant protein-calorie malnutrition or systemic inflammation.\n*   **Micronutrients:** Vitamin D and B12 are within adequate ranges.\n*   **Electrolytes/Renal:** Chloride and BUN are within normal limits.\n\n### 2. Clinical Data Analysis\n*   **Obesity Class II & Insulin Resistance:** Requires calorie-controlled, low-glycemic index (GI) diet to manage weight and insulin sensitivity.\n*   **Vegan Diet & Meat Aversion:** High risk for protein deficiency (confirmed by Albumin); requires strategic plant-based protein pairing.\n*   **Fish Allergy:** Strict avoidance required; must ensure Omega-3 via plant sources (ALA).\n*   **Gout/Hepatic Goals:** Requires low-purine, low-fructose, and liver-supportive nutrient density.\n*   **Dumping Syndrome Risk:** Requires small, frequent, complex carbohydrate meals to avoid rapid glucose spikes.\n\n### 3. Anthropometric Data Analysis\n*   **BMI:** 39.8 kg/m² (Obese Class II).\n*   **Status:** High risk for metabolic syndrome and cardiovascular complications.\n\n### 4. Dietary Data Analysis\n*   **Transition Status:** Moving from enteral to oral nutrition; requires texture-appropriate, nutrient-dense, easily digestible foods.\n*   **Lifestyle:** Sedentary occupation (Nurse) with emotional eating patterns and limited cooking time (<15 min).\n\n### 5. Nutritional Diagnosis (PES Format)\n| Priority | Problem | Etiology | Signs/Symptoms |\n|----------|---------|----------|----------------|\n| 1 | Protein-calorie malnutrition | Inadequate oral intake and meat aversion | Albumin 2.9 g/dL |\n| 2 | Altered nutrition-related laboratory values | Insulin resistance and high saturated fat intake | HbA1c 7.1%, LDL 216.5 mg/dL |\n| 3 | Anemia | Potential iron sequestration/inflammation | Hb 7.2 g/dL |\n\n### 6. Intervention Rationale\n*   **High-Protein Vegan Focus:** To address hypoalbuminemia using legumes, seeds, and whey (as per patient supplement use).\n*   **Low Glycemic Load:** To manage insulin resistance and prevent dumping syndrome.\n*   **Low Purine/Low Fructose:** To prevent gout flares and support hepatic offloading.\n*   **Iron-Rich Plant Pairing:** Combining non-heme iron (legumes/greens) with Vitamin C to optimize absorption.\n\n---\n\n## Summary\n- Target: 1,800 kcal/day\n- Macros: P 105g | C 200g | F 65g\n- Key focus: High plant-based protein, Low Glycemic Index, Iron bioavailability.\n- Clinical priorities: Correct anemia, raise albumin, manage glucose/lipids.\n\n## Weekly Meal Plan\n\n### Week 1\n\n| Day | Breakfast | Lunch | Dinner | Snacks | kcal |\n|-----|-----------|-------|--------|--------|------|\n| Mon | Chia seed pudding w/ berries | Lentil soup w/ spinach | Chickpea curry w/ cauliflower | Handful almonds | 1780 |\n| Tue | Overnight oats w/ flax | Quinoa salad w/ black beans | Tempeh stir-fry w/ broccoli | Apple w/ peanut butter | 1810 |\n| Wed | Scrambled tofu w/ turmeric | Hummus & veggie wrap | Red lentil pasta w/ marinara | Roasted chickpeas | 1790 |\n| Thu | Smoothie (Whey, spinach, berry) | Edamame & buckwheat bowl | Black bean tacos (corn tortilla) | Walnuts | 1820 |\n| Fri | Buckwheat porridge w/ hemp | Chickpea salad sandwich | Mushroom & lentil stew | Pumpkin seeds | 1770 |\n| Sat | Avocado toast (whole grain) | Split pea soup | Tofu veggie skewers | Soy yogurt | 1805 |\n| Sun | Chia pudding w/ mango | Quinoa & roasted veg bowl | Lentil Bolognese (zucchini noodles) | Almonds | 1795 |\n\n### Week 2\n\n| Day | Breakfast | Lunch | Dinner | Snacks | kcal |\n|-----|-----------|-------|--------|--------|------|\n| Mon | Protein smoothie (Whey/Banana) | Black bean & corn salad | Tofu curry w/ brown rice | Sunflower seeds | 1815 |\n| Tue | Steel cut oats w/ walnuts | Lentil & kale salad | Chickpea stew w/ sweet potato | Pear | 1785 |\n| Wed | Tofu scramble w/ peppers | Quinoa veggie bowl | Tempeh stir-fry | Peanut butter on celery | 1830 |\n| Thu | Chia pudding w/ almond milk | Hummus & cucumber wrap | Red lentil dahl | Edamame | 1790 |\n| Fri | Buckwheat w/ berries | Chickpea & spinach soup | Tofu & broccoli stir-fry | Walnuts | 1800 |\n| Sat | Avocado & hemp seed toast | Lentil salad w/ lemon | Black bean veggie burger (no bun) | Soy yogurt | 1775 |\n| Sun | Smoothie (Whey/Spinach) | Quinoa & black bean bowl | Mushroom lentil stew | Almonds | 1810 |\n\n### Week 3\n\n| Day | Breakfast | Lunch | Dinner | Snacks | kcal |\n|-----|-----------|-------|--------|--------|------|\n| Mon | Overnight oats w/ chia | Chickpea salad wrap | Tofu & green bean stir-fry | Pumpkin seeds | 1795 |\n| Tue | Tofu scramble w/ mushrooms | Lentil soup w/ carrots | Quinoa & roasted chickpeas | Apple | 1820 |\n| Wed | Chia pudding w/ berries | Black bean veggie bowl | Tempeh w/ sautéed kale | Almonds | 1780 |\n| Thu | Protein smoothie (Whey) | Hummus & veggie plate | Lentil pasta w/ veggies | Soy yogurt | 1810 |\n| Fri | Buckwheat w/ flaxseed | Quinoa & edamame salad | Chickpea curry | Walnuts | 1805 |\n| Sat | Avocado toast w/ seeds | Split pea soup | Tofu veggie stew | Roasted chickpeas | 1790 |\n| Sun | Chia pudding w/ hemp | Lentil & beet salad | Black bean & sweet potato bowl | Peanut butter | 1825 |\n\n### Week 4\n\n| Day | Breakfast | Lunch | Dinner | Snacks | kcal |\n|-----|-----------|-------|--------|--------|------|\n| Mon | Steel cut oats w/ chia | Chickpea & avocado salad | Tofu stir-fry w/ peppers | Almonds | 1800 |\n| Tue | Smoothie (Whey/Berry) | Lentil & veggie wrap | Quinoa & black bean chili | Edamame | 1815 |\n| Wed | Tofu scramble w/ spinach | Quinoa veggie salad | Tempeh & broccoli | Walnuts | 1790 |\n| Thu | Chia pudding w/ flax | Black bean soup | Chickpea & cauliflower curry | Apple | 1805 |\n| Fri | Buckwheat w/ nuts | Hummus & veggie bowl | Lentil Bolognese | Soy yogurt | 1785 |\n| Sat | Avocado toast w/ hemp | Chickpea salad | Tofu & mushroom sauté | Pumpkin seeds | 1810 |\n| Sun | Protein smoothie (Whey) | Quinoa & lentil bowl | Black bean tacos | Almond butter | 1830 |\n\n## Foods\n\n### Include\n- **Lentils/Beans:** 1/2 cup - High protein and iron for anemia/albumin.\n- **Leafy Greens (Spinach/Kale):** 1-2 cups - Non-heme iron and fiber.\n- **Chia/Flax/Hemp Seeds:** 2 tbsp - Omega-3 (ALA) and protein.\n- **Tofu/Tempeh:** 100g - High-quality plant protein for albumin.\n- **Berries/Citrus:** 1/2 cup - Vitamin C to enhance iron absorption.\n- **Whey Protein Isolate:** 1 scoop - Essential for rapid protein replenishment.\n\n### Avoid\n- **All Fish/Seafood:** Strict allergy risk.\n- **Refined Sugars/Sodas:** To manage insulin resistance and gout.\n- **High-Fructose Corn Syrup:** To support hepatic health and gout prevention.\n- **White Bread/White Rice:** To prevent dumping syndrome and glucose spikes.\n\n## Notes\n- **Iron Absorption:** Always pair iron sources (beans/greens) with Vitamin C (lemon/peppers) and avoid tea/coffee during meals.\n- **Small/Frequent:** To manage dumping syndrome, do not skip meals; keep portions consistent.\n- **Prep Hack:** Batch-cook lentils and quinoa to meet the <15 min cooking requirement.\n- **Hydration:** Continue 2-2.5L water; avoid sugary beverages to manage gout/insulin.\n\n## Monitoring Parameters\n\n### Indicators to Evaluate\n| Parameter | Current Value | Target | Timeline |\n|-----------|---------------|--------|----------|\n| Hemoglobin | 7.2 g/dL | >12.0 g/dL | 8-12 weeks |\n| Albumin | 2.9 g/dL | >3.5 g/dL | 4-8 weeks |\n| HbA1c | 7.1% | <6.5% | 3 months |\n| LDL Cholesterol | 216.5 mg/dL | <100 mg/dL | 3 months |\n\n### Recommended Follow-up\n- **Next appointment:** 4 weeks.\n- **Follow-up labs:** CBC (Hb/Hct), Albumin, HbA1c, Lipid Panel in 3 months.\n- **Warning signs:** Extreme fatigue, shortness of breath (anemia), sudden joint pain (gout), or severe dizziness after eating (dumping syndrome).\n\n---\nEND OF PLAN", "temperature": 0.4, "model": "gemma-4-26b-a4b-it", "provider": "gemini", "reasoning": true}, "meethealth": {"package": "meethealth-sample-v1", "package_version": "1.0.0", "source_corpus": "gemma_diets", "source_line": 110051, "contract": "diet_plan@1.0.0", "contract_fingerprint": "1a6c5cf6b9d37193", "gate_rules_evaluated": 45, "gate_failures": [], "package_checks": {"plan_language": {"pass": true, "detail": "english markers=4"}, "completeness_28_days": {"pass": true, "detail": "day_rows=28 weeks=4 terminated=True"}, "no_duplicate_days": {"pass": true, "detail": "duplicate_days=0"}, "macro_arithmetic": {"pass": true, "detail": "target=1800 kcal, 4P+4C+9F=1805 kcal, deviation=0.3%"}, "energy_dose_plausible": {"pass": true, "detail": "16.8 kcal/kg (screen 15-45)"}, "protein_dose_plausible": {"pass": true, "detail": "0.98 g/kg (screen 0.8-1.6)"}, "daily_energy_on_target": {"pass": true, "detail": "days_outside_10pct=0 of 28"}, "allergen_screen": {"pass": true, "detail": "screened=['fish'] hits=[]"}, "hyperkalemia_food_screen": {"pass": true, "detail": "not applicable (K <= 5.0 or absent)"}, "scenario_coherence": {"pass": true, "detail": "ok"}}, "evidence_level": "L2_automated_checks_passed", "expert_review": "not_performed"}}
{"patient_id": "ef3f323c-9334-4bf7-814a-d9d13711bb0c", "patient_data": {"id": "ef3f323c-9334-4bf7-814a-d9d13711bb0c", "name": "Dr. Benjamín Casas", "age": 42, "age_group": "adult_31_50y", "gender": "male", "region": "Venezuela", "language": "es", "occupation": "Farmer/Agricultural worker", "goals": "Sleep quality improvement, Circadian rhythm synchronization, Triglyceride reduction, Reduce bloating and GI distress", "preferences": "Vegetarian", "weight": 67.2, "height": 182.4, "bmi": 20.2, "activity_level": "lightly_active", "triceps_skinfold": 32.7, "suprailiac_skinfold": 5.5, "subscapular_skinfold": 26.9, "hemoglobin": 14.6, "hematocrit": 37.7, "albumin": 3.2, "prealbumin": 30.6, "bun": 9.9, "clinical_history": "History of yo-yo dieting", "dietary_recall_24h": "Breakfast: Jugo de frutas y galletas\nLunch: Pollo a la plancha con arroz y ensalada\nDinner: Pescado al horno con vegetales y quinua\nSnacks: Handful of mixed nuts", "total_calories": 1490, "total_protein": 42.0, "total_carbohydrates": 192.2, "total_fat": 61.5, "total_fiber": 18.4, "total_sugar": 39.0, "total_saturated_fat": 27.4, "total_sodium": 3635, "bmr_formula": "Katch-McArdle", "bmr": 1531, "tdee": 2105, "macro_split": {"carbsPercent": 30, "proteinPercent": 35, "fatPercent": 35}, "meals_per_day": 6, "cooking_time": "Institutional meals (hospital/nursing home)", "water_intake_per_day": "1.5-2L", "coffee_cups_per_day": 5, "appetite_assessment": "Normal", "dietary_supplements": "Whey protein isolate post-workout", "prompt_mode": "clinical", "clinical_analysis_depth": "detailed", "food_exchange_plan": {"region": "Venezuela", "targetCalories": 1600, "carbsPercent": 50, "proteinPercent": 15, "fatPercent": 35, "totalExchanges": {"cereals": 7, "fruits": 2, "vegetables": 5, "dairy": 1, "meat": 6, "fat": 6, "sugar": 3}}}, "prompt": "You are a senior clinical nutritionist with expertise in medical nutrition therapy creating a diet plan. IMPORTANTE: Genera todo el contenido en ESPAÑOL.\n\n## ADVANCED CLINICAL MODE ENABLED\nThis dietary plan requires a clinically-driven approach with structured analysis of the nutritional anamnesis.\nYou MUST explicitly analyze and integrate key patient parameters before generating recommendations.\nAnalysis Depth: DETAILED\n\nSTRICT RULES:\n1. Output ONLY markdown - no preamble, no \"Here is...\", no greetings, no sign-offs\n2. Be CONCISE - use tables, bullets, short sentences\n3. Use TABLES for meal plans (mandatory)\n4. NO lengthy explanations unless customInstructions requests detail\n5. Start directly with the H1 title\n6. USE ALL patient data provided to personalize the plan\n7. EVERY DAY must have UNIQUE meals - NO \"repeat day X\" or \"same as above\" - write out ALL 28 days completely.\n8. Provide VARIETY - different foods each day, rotate proteins, vegetables, grains\n9. FOLLOW the food exchange allocations exactly as specified\n10. PERFORM complete clinical anamnesis analysis BEFORE generating the meal plan\n11. JUSTIFY each major dietary recommendation with clinical rationale\n12. USE PES (Problem-Etiology-Signs/Symptoms) format for nutritional diagnoses\n13. INCLUDE monitoring parameters and follow-up indicators\n\n\n## CLINICAL NUTRITIONAL ANAMNESIS ANALYSIS\n\nYou MUST perform a structured, systematic analysis of the patient's nutritional anamnesis before generating the diet plan.\n\n**Analysis Depth:** Provide an exhaustive clinical analysis with detailed interpretation of each parameter, pathophysiological connections, and evidence-based nutritional implications.\n\n### 1. BIOCHEMICAL DATA ANALYSIS\n**Hematological Profile:**\n  - Hemoglobin: 14.6 g/dL | Hematocrit: 37.7%\n  - Clinical interpretation: Assess iron status, anemia risk, and need for iron-rich foods or absorption enhancers\n\n**Protein Status:**\n  - Albumin: 3.2 g/dL | Prealbumin: 30.6 mg/dL\n  - Clinical interpretation: Evaluate protein-calorie malnutrition risk and protein requirements\n\n**Renal Function:**\n  - BUN: 9.9 mg/dL\n  - Clinical interpretation: Assess renal function and protein/electrolyte restrictions if needed\n\n### 2. CLINICAL DATA ANALYSIS\n\n\n\n### 3. ANTHROPOMETRIC DATA ANALYSIS\n**Primary Measurements:**\n  - Weight: 67.2 kg | Height: 182.4 cm | BMI: 20.2 kg/m²\n  - BMI Classification: Normal\n  - Activity Level: lightly active\n\n### 4. DIETARY DATA ANALYSIS\n**24-Hour Dietary Recall:**\nBreakfast: Jugo de frutas y galletas\nLunch: Pollo a la plancha con arroz y ensalada\nDinner: Pescado al horno con vegetales y quinua\nSnacks: Handful of mixed nuts\n\n### 5. CLINICAL SYNTHESIS & NUTRITIONAL DIAGNOSIS\n**Patient Goals:** Sleep quality improvement, Circadian rhythm synchronization, Triglyceride reduction, Reduce bloating and GI distress\n\n**REQUIRED OUTPUT FOR CLINICAL MODE:**\n1. **Problem List (PES Format):** Identify 2-4 nutrition diagnoses using Problem-Etiology-Signs/Symptoms format\n2. **Priority Ranking:** Rank nutritional problems by clinical urgency\n3. **Intervention Rationale:** For each dietary recommendation, provide clinical justification\n4. **Monitoring Parameters:** Specify what should be monitored\n\n---\n\n**Patient:** Name: Dr. Benjamín Casas | Age: 42 | Gender: male | Region: Venezuela | Occupation: Farmer/Agricultural worker\n**Anthropometrics:** Wt: 67.2kg | Ht: 182.4cm | BMI: 20.2 | Activity: lightly active\n**Body Composition:** Triceps: 32.7mm | Suprailiac: 5.5mm | Subscapular: 26.9mm\n**Blood/Iron:** Hb: 14.6g/dL | Hct: 37.7%\n**Protein/Kidney:** Albumin: 3.2g/dL | Prealbumin: 30.6mg/dL | BUN: 9.9mg/dL\n**Medical History:** History: History of yo-yo dieting\n**Energy Targets:** Formula: Katch-McArdle | BMR: 1531kcal | TDEE: 2105kcal | Macro Target: C30/P35/F35%\n**Current Intake (24h):** Cal: 1490 | P: 42.0g | C: 192.2g | F: 61.5g | Fiber: 18.4g | Sugar: 39.0g | SatFat: 27.4g | Na: 3635mg\n**24h Recall:** Breakfast: Jugo de frutas y galletas\nLunch: Pollo a la plancha con arroz y ensalada\nDinner: Pescado al horno con vegetales y quinua\nSnacks: Handful of mixed nuts\n**Eating Patterns:** Meals/day: 6 | Cooking time: Institutional meals (hospital/nursing home) | Coffee: 5 | Water: 1.5-2L\n**Restrictions:** Supplements: Whey protein isolate post-workout\n**Appetite:** Appetite: Normal\n**Goals:** Sleep quality improvement, Circadian rhythm synchronization, Triglyceride reduction, Reduce bloating and GI distress\n**Additional Notes:** Vegetarian\n**Food Exchange Plan:** Region: Venezuela | Target: 1600 kcal | Macros: C50%/P15%/F35% | Exchanges: cereals: 7, fruits: 2, vegetables: 5, dairy: 1, meat: 6, fat: 6, sugar: 3\n\n\n\n\nFOOD EXCHANGE SYSTEM INSTRUCTIONS:\nThe nutritionist has configured a food exchange plan. You MUST follow these exchange allocations when creating the meal plan:\n\nTarget Calories: 1600 kcal\nMacro Distribution: 50% Carbs, 15% Protein, 35% Fat\nRegion: Venezuela (use region-appropriate foods)\n\nExchange Allocations:\n- cereals: 7 exchanges\n- fruits: 2 exchanges\n- vegetables: 5 exchanges\n- dairy: 1 exchanges\n- meat: 6 exchanges\n- fat: 6 exchanges\n- sugar: 3 exchanges\n\nMeal Distribution:\n\n\nIMPORTANT: The meal plan MUST reflect these exact exchange allocations. Each meal should contain the specified number of exchanges from each food group.\n\n\n---\n\nOUTPUT FORMAT (follow exactly):\n\n# Plan de Dieta - Dr. Benjamín Casas\n\n## Análisis Clínico de la Anamnesis Nutricional\n\n### 1. Biochemical Data Analysis\n[Interpret lab values]\n\n### 2. Clinical Data Analysis\n[Medical conditions and dietary implications]\n\n### 3. Anthropometric Data Analysis\n[BMI classification and body composition]\n\n### 4. Dietary Data Analysis\n[24h recall interpretation and nutrient gap analysis]\n\n### 5. Nutritional Diagnosis (PES Format)\n| Priority | Problem | Etiology | Signs/Symptoms |\n|----------|---------|----------|----------------|\n| 1 | [Nutrition problem] | related to [etiology] | as evidenced by [S/S] |\n\n### 6. Intervention Rationale\n[Key intervention decisions with clinical justification]\n\n---\n\n## Resumen\n- Target: [kcal] kcal/day\n- Macros: P [g]g | C [g]g | F [g]g\n- Key focus: [2-3 bullet points max based on patient data]\n- Clinical priorities: [Based on PES diagnoses above]\n\n## Plan Semanal\n\nCRITICAL: You MUST write out EVERY meal for ALL 28 days across ALL 4 weeks. Each day must be unique.\n\n### Semana 1\n\n| Day | Breakfast | Lunch | Dinner | Snacks | kcal |\n|-----|-----------|-------|--------|--------|------|\n| Mon | [unique meal] | [unique meal] | [unique meal] | [snack] | [total] |\n| Tue | [unique meal] | [unique meal] | [unique meal] | [snack] | [total] |\n| Wed | [unique meal] | [unique meal] | [unique meal] | [snack] | [total] |\n| Thu | [unique meal] | [unique meal] | [unique meal] | [snack] | [total] |\n| Fri | [unique meal] | [unique meal] | [unique meal] | [snack] | [total] |\n| Sat | [unique meal] | [unique meal] | [unique meal] | [snack] | [total] |\n| Sun | [unique meal] | [unique meal] | [unique meal] | [snack] | [total] |\n\n### Semana 2\n\n| Day | Breakfast | Lunch | Dinner | Snacks | kcal |\n|-----|-----------|-------|--------|--------|------|\n| Mon | [unique meal] | [unique meal] | [unique meal] | [snack] | [total] |\n| Tue | [unique meal] | [unique meal] | [unique meal] | [snack] | [total] |\n| Wed | [unique meal] | [unique meal] | [unique meal] | [snack] | [total] |\n| Thu | [unique meal] | [unique meal] | [unique meal] | [snack] | [total] |\n| Fri | [unique meal] | [unique meal] | [unique meal] | [snack] | [total] |\n| Sat | [unique meal] | [unique meal] | [unique meal] | [snack] | [total] |\n| Sun | [unique meal] | [unique meal] | [unique meal] | [snack] | [total] |\n\n### Semana 3\n\n| Day | Breakfast | Lunch | Dinner | Snacks | kcal |\n|-----|-----------|-------|--------|--------|------|\n| Mon | [unique meal] | [unique meal] | [unique meal] | [snack] | [total] |\n| Tue | [unique meal] | [unique meal] | [unique meal] | [snack] | [total] |\n| Wed | [unique meal] | [unique meal] | [unique meal] | [snack] | [total] |\n| Thu | [unique meal] | [unique meal] | [unique meal] | [snack] | [total] |\n| Fri | [unique meal] | [unique meal] | [unique meal] | [snack] | [total] |\n| Sat | [unique meal] | [unique meal] | [unique meal] | [snack] | [total] |\n| Sun | [unique meal] | [unique meal] | [unique meal] | [snack] | [total] |\n\n### Semana 4\n\n| Day | Breakfast | Lunch | Dinner | Snacks | kcal |\n|-----|-----------|-------|--------|--------|------|\n| Mon | [unique meal] | [unique meal] | [unique meal] | [snack] | [total] |\n| Tue | [unique meal] | [unique meal] | [unique meal] | [snack] | [total] |\n| Wed | [unique meal] | [unique meal] | [unique meal] | [snack] | [total] |\n| Thu | [unique meal] | [unique meal] | [unique meal] | [snack] | [total] |\n| Fri | [unique meal] | [unique meal] | [unique meal] | [snack] | [total] |\n| Sat | [unique meal] | [unique meal] | [unique meal] | [snack] | [total] |\n| Sun | [unique meal] | [unique meal] | [unique meal] | [snack] | [total] |\n\n\n## Alimentos\n\n### Incluir\n- [food]: [portion] - [brief reason based on labs/conditions]\n\n### Evitar\n- [food]: [brief reason based on labs/conditions]\n\n## Notas\n- [2-4 practical tips based on patient's eating patterns/lifestyle]\n\n## Parámetros de Monitoreo\n\n### Indicators to Evaluate\n| Parameter | Current Value | Target | Timeline |\n|-----------|---------------|--------|----------|\n| [parameter] | [current] | [goal] | [weeks] |\n\n### Recommended Follow-up\n- Next appointment: [timeframe]\n- Follow-up labs: [which tests, when]\n- Warning signs: [symptoms requiring immediate attention]\n\n---\nEND OF PLAN", "diet": {"content": "# Plan de Dieta - Dr. Benjamín Casas\n\n## Análisis Clínico de la Anamnesis Nutricional\n\n### 1. Biochemical Data Analysis\n*   **Perfil Hematológico:** La Hemoglobina (14.6 g/dL) y el Hematocrito (37.7%) se encuentran dentro de rangos normales, lo que indica un estado de hierro adecuado actualmente. No se requiere suplementación inmediata de hierro, pero se debe mantener el aporte dietético.\n*   **Estado Proteico:** La Albúmina (3.2 g/dL) está **baja** (rango normal ~3.5-5.0 g/dL) y la Prealbúmina (30.6 mg/dL) está en el límite inferior. Esto sugiere un riesgo de desnutrición proteica o inflamación sistémica. Es crítico aumentar la densidad proteica.\n*   **Función Renal:** El BUN (9.9 mg/dL) es normal, lo que indica que la función renal es adecuada para procesar el aporte proteico planificado.\n\n### 2. Clinical Data Analysis\n*   **Historial de Dietas Yo-yo:** Riesgo de alteración metabólica y desajuste en la regulación del apetito. Requiere un enfoque de alimentación sostenible.\n*   **Síntomas GI:** Reporte de hinchazón (bloating) y malestar gastrointestinal. Se requiere control de FODMAPs y fibra soluble/insoluble para mejorar la digestión.\n*   **Ritmo Circadiano/Sueño:** El consumo de 5 cafés al día es un factor disruptor clave para la calidad del sueño y la sincronización circadiana.\n\n### 3. Anthropometric Data Analysis\n*   **IMC:** 20.2 kg/m² (Clasificación: Normal, pero en el límite inferior del rango saludable).\n*   **Composición Corporal:** Los pliegues sugieren una distribución de grasa moderada, pero el peso es bajo para la estatura (182.4 cm), lo que refuerza la necesidad de un superávit controlado o mantenimiento con alta densidad nutricional.\n\n### 4. Dietary Data Analysis\n*   **Déficit Calórico:** El consumo actual (1490 kcal) es significativamente inferior al TDEE (2105 kcal), lo que contribuye a la baja albúmina.\n*   **Desequilibrio de Macronutrientes:** Consumo de proteína insuficiente (42g) para un hombre de su estatura y actividad.\n*   **Exceso de Sodio:** El consumo de sodio (3635 mg) es elevado, lo que puede contribuir a la retención de líquidos y sensación de hinchazón.\n*   **Patrón de Consumo:** Desayuno pobre en nutrientes (jugo y galletas) y alto consumo de cafeína.\n\n### 5. Nutritional Diagnosis (PES Format)\n| Priority | Problem | Etiology | Signs/Symptoms |\n|----------|---------|----------|----------------|\n| 1 | Ingesta proteica insuficiente | Relacionado con patrones de alimentación inadecuados y falta de densidad nutricional | Evidenciado por Albúmina de 3.2 g/dL y Prealbúmina de 30.6 mg/dL |\n| 2 | Desequilibrio de la ingesta de micronutrientes (Sodio) | Relacionado con hábitos alimentarios actuales | Evidenciado por consumo de 3635 mg de Na |\n| 3 | Alteración del patrón de sueño | Relacionado con consumo excesivo de estimulantes (5 cafés/día) | Evidenciado por reporte de mala calidad de sueño |\n\n### 6. Intervention Rationale\n*   **Aumento de Proteína (15% del total):** Para revertir la hipoalbuminemia y promover la síntesis proteica.\n*   **Control de Triglicéridos:** Selección de grasas monoinsaturadas y poliinsaturadas (aceite de oliva, aguacate, frutos secos) y reducción de azúcares simples.\n*   **Sincronización Circadiana:** Restricción de cafeína después del mediodía para permitir la producción natural de melatonina.\n*   **Gestión de Hinchazón:** Introducción de carbohidratos complejos de fácil digestión y reducción de sodio.\n\n---\n\n## Resumen\n- Target: 1600 kcal/day\n- Macros: P 60g | C 200g | F 62g (Aprox. según distribución 50/15/35)\n- Key focus: Aumento de densidad proteica, reducción de sodio y control de estimulantes.\n- Clinical priorities: Corregir niveles de albúmina y mejorar higiene del sueño.\n\n## Plan Semanal\n\n### Semana 1\n\n| Day | Breakfast | Lunch | Dinner | Snacks | kcal |\n|-----|-----------|-------|--------|--------|------|\n| Mon | Arepa de maíz con queso blanco y aguacate | Pollo al horno con arroz integral y vegetales salteados | Pescado a la plancha con puré de calabaza y quinua | Yogur natural con 1/2 banano | 1605 |\n| Tue | Avena con leche descremada y semillas de chía | Lentejas guisadas con arroz y ensalada de tomate/pepino | Tortilla de huevo con espinacas y una rebanada de pan integral | Manzana con 5 almendras | 1590 |\n| Wed | Huevo revuelto con tomate y una arepa pequeña | Pescado al vapor con batata (camote) y brócoli | Ensalada de garbanzos con atún, cebolla y pimiento | 1 porción de papaya | 1610 |\n| Thu | Pan integral con aguacate y huevo poché | Pollo salteado con vegetales y quinoa | Crema de verduras (sin lácteos) con trozos de queso | Mix de frutos secos (pequeño) | 1585 |\n| Fri | Yogur griego con avena y fresas | Carne magra con arroz y ensalada de zanahoria | Pescado al horno con espárragos y una papa pequeña | 1 naranja | 1620 |\n| Sat | Arepa con revoltillo de claras y vegetales | Pasta integral con salsa de tomate natural y pollo | Sopa de vegetales con trozos de tofu o queso | 1 pera | 1595 |\n| Sun | Pancakes de avena y banano | Pollo asado con yuca cocida y ensalada verde | Ensalada de quinoa con vegetales y huevo duro | Yogur natural | 1615 |\n\n### Semana 2\n\n| Day | Breakfast | Lunch | Dinner | Snacks | kcal |\n|-----|-----------|-------|--------|--------|------|\n| Mon | Tostada integral con queso cottage y fruta | Pescado con arroz y ensalada de aguacate | Salteado de vegetales con tofu y quinoa | 1 banano | 1590 |\n| Tue | Avena con leche y trozos de mango | Lentejas con arroz y ensalada de repollo | Pollo a la plancha con puré de papa | Nueces (6 unidades) | 1605 |\n| Wed | Huevo con espinacas y arepa | Carne magra con batata y vegetales | Pescado con ensalada de pepino y tomate | Yogur con semillas | 1610 |\n| Thu | Batido de proteína (Whey) con avena y fruta | Pollo con quinoa y vegetales al vapor | Crema de calabacín con queso blanco | 1 manzana | 1580 |\n| Fri | Arepa con queso y aguacate | Pescado con arroz integral y brócoli | Tortilla de vegetales y una rebanada de pan | Frutos rojos | 1625 |\n| Sat | Yogur con granola casera y papaya | Pasta con atún, tomate y aceitunas | Pollo con ensalada de vainitas (ejotes) | 1 naranja | 1595 |\n| Sun | Huevo revuelto con champiñones y pan | Garbanzos con arroz y ensalada mixta | Pescado al horno con vegetales | Almendras | 1610 |\n\n### Semana 3\n\n| Day | Breakfast | Lunch | Dinner | Snacks | kcal |\n|-----|-----------|-------|--------|--------|------|\n| Mon | Avena con leche y semillas de linaza | Pollo con batata y ensalada de zanahoria | Sopa de lentejas con vegetales | 1 pera | 1585 |\n| Tue | Tostada con aguacate y huevo | Pescado con arroz y ensalada de tomate | Quinoa con vegetales salteados y queso | Yogur natural | 1615 |\n| Wed | Arepa con queso y huevo | Carne magra con pasta integral y brócoli | Pollo con puré de calabaza | Manzana | 1600 |\n| Thu | Yogur griego con fresas y avena | Lentejas con arroz y aguacate | Pescado con espárragos | Mix de frutos secos | 1620 |\n| Fri | Pan integral con huevo y tomate | Pollo con quinoa y ensalada verde | Tortilla de espinacas y una papa | 1 banano | 1590 |\n| Sat | Batido de proteína y fruta | Pescado con batata y vegetales | Ensalada de garbanzos y atún | Queso blanco pequeño | 1605 |\n| Sun | Pancakes de avena y huevo | Pollo asado con arroz y vegetales | Crema de verduras y huevo duro | Papaya | 1595 |\n\n### Semana 4\n\n| Day | Breakfast | Lunch | Dinner | Snacks | kcal |\n|-----|-----------|-------|--------|--------|------|\n| Mon | Arepa con aguacate y queso | Pescado con arroz y ensalada de pepino | Pollo con vegetales y quinoa | Yogur con chía | 1610 |\n| Tue | Avena con leche y banano | Lentejas con arroz y ensalada | Pescado al horno con papa | 1 naranja | 1585 |\n| Wed | Huevo con pan integral y fruta | Pollo con batata y brócoli | Ensalada de quinoa y vegetales | Almendras | 1605 |\n| Thu | Yogur con avena y mango | Carne magra con arroz y vegetales | Sopa de vegetales con pollo | 1 manzana | 1590 |\n| Fri | Tostada con huevo y aguacate | Pescado con pasta integral y tomate | Tortilla de vegetales y queso | Frutos secos | 1620 |\n| Sat | Arepa con revoltillo de claras | Pollo con quinoa y ensalada | Pescado con puré de calabaza | 1 pera | 1595 |\n| Sun | Batido de proteína y avena | Garbanzos con arroz y vegetales | Pollo a la plancha con ensalada | Yogur natural | 1615 |\n\n## Alimentos\n\n### Incluir\n- **Proteínas magras (Pollo, Pescado, Huevo, Tofu):** Para elevar la albúmina y mantener masa muscular.\n- **Granos Integrales (Quinoa, Avena, Arroz integral):** Para control glucémico y fibra.\n- **Grasas Saludables (Aguacate, Aceite de oliva, Frutos secos):** Para reducir triglicéridos.\n- **Vegetales de hoja verde:** Para micronutrientes y saciedad.\n\n### Evitar\n- **Azúcares refinados y jugos de fruta:** Para reducir triglicéridos y evitar picos de insulina.\n- **Exceso de cafeína (especialmente tarde):** Para mejorar la higiene del sueño.\n- **Alimentos ultraprocesados/altos en sodio:** Para reducir la hinchazón abdominal.\n\n## Notas\n- **Higiene del sueño:** Limite el consumo de café a máximo 2 tazas antes de las 12:00 PM.\n- **Hidratación:** Mantenga el consumo de agua constante, pero evite grandes volúmenes durante las comidas para reducir la hinchazón.\n- **Preparación:** Prefiera métodos de cocción al horno, vapor o plancha para evitar grasas saturadas.\n\n## Parámetros de Monitoreo\n\n### Indicators to Evaluate\n| Parameter | Current Value | Target | Timeline |\n|-----------|---------------|--------|----------|\n| Albúmina | 3.2 g/dL | > 3.5 g/dL | 4-8 semanas |\n| Peso | 67.2 kg | 68-70 kg (Mantenimiento/Ganancia) | 4 semanas |\n| Calidad de Sueño | No especificado | Mejora subjetiva | 2 semanas |\n| Digestión | Hinchazón/Malestar | Reducción de síntomas | 2 semanas |\n\n### Recommended Follow-up\n- **Next appointment:** 4 semanas.\n- **Follow-up labs:** Albúmina, Prealbúmina y Perfil Lipídico (Triglicéridos) en 8 semanas.\n- **Warning signs:** Debilidad extrema, edema (hinchazón) persistente en piernas, o pérdida de peso involuntaria.\n\n---\nEND OF PLAN", "temperature": 0.4, "model": "gemma-4-26b-a4b-it", "provider": "gemini", "reasoning": true}, "meethealth": {"package": "meethealth-sample-v1", "package_version": "1.0.0", "source_corpus": "gemma_diets", "source_line": 116001, "contract": "diet_plan@1.0.0", "contract_fingerprint": "1a6c5cf6b9d37193", "gate_rules_evaluated": 45, "gate_failures": [], "package_checks": {"plan_language": {"pass": true, "detail": "spanish markers=3"}, "completeness_28_days": {"pass": true, "detail": "day_rows=28 weeks=4 terminated=True"}, "no_duplicate_days": {"pass": true, "detail": "duplicate_days=0"}, "macro_arithmetic": {"pass": true, "detail": "target=1600 kcal, 4P+4C+9F=1598 kcal, deviation=0.1%"}, "energy_dose_plausible": {"pass": true, "detail": "23.8 kcal/kg (screen 15-45)"}, "protein_dose_plausible": {"pass": true, "detail": "0.89 g/kg (screen 0.8-1.6)"}, "daily_energy_on_target": {"pass": true, "detail": "days_outside_10pct=0 of 28"}, "allergen_screen": {"pass": true, "detail": "no declared allergies"}, "hyperkalemia_food_screen": {"pass": true, "detail": "not applicable (K <= 5.0 or absent)"}, "scenario_coherence": {"pass": true, "detail": "ok"}}, "evidence_level": "L2_automated_checks_passed", "expert_review": "not_performed"}}
{"patient_id": "e9594659-b56c-4ebf-abd1-d384f77ef37c", "patient_data": {"id": "e9594659-b56c-4ebf-abd1-d384f77ef37c", "name": "Deborah Ramirez", "age": 28, "age_group": "young_adult_18_30y", "gender": "female", "region": "Ghana", "language": "en", "occupation": "Factory worker", "conditions": "Anemia of Chronic Disease, Hemophilia", "goals": "Postpartum/lactation nutrition, Dental health improvement", "preferences": "Local/seasonal preference", "weight": 63.9, "height": 165.2, "bmi": 23.4, "activity_level": "sedentary", "total_cholesterol": 334.2, "chloride": 100.5, "creatinine": 0.5, "skin_condition": "Dermatitis", "hair_condition": "Dull/lackluster", "oral_health": "Bleeding gums", "family_medical_history": "Family history of PKU (sibling affected).", "meals_per_day": 3, "cooking_time": ">60 minutes", "water_intake_per_day": "1-1.5L", "coffee_cups_per_day": 0, "appetite_assessment": "Poor", "recent_appetite_changes": "Decreased appetite over last 2 weeks", "dietary_supplements": "Multivitamin daily", "prompt_mode": "standard", "clinical_analysis_depth": "comprehensive"}, "prompt": "You are a clinical nutritionist creating a diet plan. Generate all content in ENGLISH.\n\nSTRICT RULES:\n1. Output ONLY markdown - no preamble, no \"Here is...\", no greetings, no sign-offs\n2. Be CONCISE - use tables, bullets, short sentences\n3. Use TABLES for meal plans (mandatory)\n4. NO lengthy explanations unless customInstructions requests detail\n5. Start directly with the H1 title\n6. USE ALL patient data provided to personalize the plan\n7. EVERY DAY must have UNIQUE meals - NO \"repeat day X\" or \"same as above\" - write out ALL 28 days completely.\n8. Provide VARIETY - different foods each day, rotate proteins, vegetables, grains\n\n\n\n\n**Patient:** Name: Deborah Ramirez | Age: 28 | Gender: female | Conditions: Anemia of Chronic Disease, Hemophilia | Region: Ghana | Occupation: Factory worker\n**Anthropometrics:** Wt: 63.9kg | Ht: 165.2cm | BMI: 23.4 | Activity: sedentary\n**Metabolic Labs:** TC: 334.2\n**Vitamins/Electrolytes:** Cl: 100.5\n**Protein/Kidney:** Creatinine: 0.5mg/dL\n**Clinical Signs:** Skin: Dermatitis | Hair: Dull/lackluster | Oral: Bleeding gums\n**Medical History:** Family Hx: Family history of PKU (sibling affected).\n**Eating Patterns:** Meals/day: 3 | Cooking time: >60 minutes | Water: 1-1.5L\n**Restrictions:** Supplements: Multivitamin daily\n**Appetite:** Appetite: Poor | Recent Changes: Decreased appetite over last 2 weeks\n**Goals:** Postpartum/lactation nutrition, Dental health improvement\n**Additional Notes:** Local/seasonal preference\n\n\n\n\n---\n\nOUTPUT FORMAT (follow exactly):\n\n# Diet Plan - Deborah Ramirez\n\n## Summary\n- Target: [kcal] kcal/day\n- Macros: P [g]g | C [g]g | F [g]g\n- Key focus: [2-3 bullet points max based on patient data]\n\n\n## Weekly Meal Plan\n\nCRITICAL: You MUST write out EVERY meal for ALL 28 days across ALL 4 weeks. Each day must be unique.\n\n### Week 1\n\n| Day | Breakfast | Lunch | Dinner | Snacks | kcal |\n|-----|-----------|-------|--------|--------|------|\n| Mon | [unique meal] | [unique meal] | [unique meal] | [snack] | [total] |\n| Tue | [unique meal] | [unique meal] | [unique meal] | [snack] | [total] |\n| Wed | [unique meal] | [unique meal] | [unique meal] | [snack] | [total] |\n| Thu | [unique meal] | [unique meal] | [unique meal] | [snack] | [total] |\n| Fri | [unique meal] | [unique meal] | [unique meal] | [snack] | [total] |\n| Sat | [unique meal] | [unique meal] | [unique meal] | [snack] | [total] |\n| Sun | [unique meal] | [unique meal] | [unique meal] | [snack] | [total] |\n\n### Week 2\n\n| Day | Breakfast | Lunch | Dinner | Snacks | kcal |\n|-----|-----------|-------|--------|--------|------|\n| Mon | [unique meal] | [unique meal] | [unique meal] | [snack] | [total] |\n| Tue | [unique meal] | [unique meal] | [unique meal] | [snack] | [total] |\n| Wed | [unique meal] | [unique meal] | [unique meal] | [snack] | [total] |\n| Thu | [unique meal] | [unique meal] | [unique meal] | [snack] | [total] |\n| Fri | [unique meal] | [unique meal] | [unique meal] | [snack] | [total] |\n| Sat | [unique meal] | [unique meal] | [unique meal] | [snack] | [total] |\n| Sun | [unique meal] | [unique meal] | [unique meal] | [snack] | [total] |\n\n### Week 3\n\n| Day | Breakfast | Lunch | Dinner | Snacks | kcal |\n|-----|-----------|-------|--------|--------|------|\n| Mon | [unique meal] | [unique meal] | [unique meal] | [snack] | [total] |\n| Tue | [unique meal] | [unique meal] | [unique meal] | [snack] | [total] |\n| Wed | [unique meal] | [unique meal] | [unique meal] | [snack] | [total] |\n| Thu | [unique meal] | [unique meal] | [unique meal] | [snack] | [total] |\n| Fri | [unique meal] | [unique meal] | [unique meal] | [snack] | [total] |\n| Sat | [unique meal] | [unique meal] | [unique meal] | [snack] | [total] |\n| Sun | [unique meal] | [unique meal] | [unique meal] | [snack] | [total] |\n\n### Week 4\n\n| Day | Breakfast | Lunch | Dinner | Snacks | kcal |\n|-----|-----------|-------|--------|--------|------|\n| Mon | [unique meal] | [unique meal] | [unique meal] | [snack] | [total] |\n| Tue | [unique meal] | [unique meal] | [unique meal] | [snack] | [total] |\n| Wed | [unique meal] | [unique meal] | [unique meal] | [snack] | [total] |\n| Thu | [unique meal] | [unique meal] | [unique meal] | [snack] | [total] |\n| Fri | [unique meal] | [unique meal] | [unique meal] | [snack] | [total] |\n| Sat | [unique meal] | [unique meal] | [unique meal] | [snack] | [total] |\n| Sun | [unique meal] | [unique meal] | [unique meal] | [snack] | [total] |\n\n\n## Foods\n\n### Include\n- [food]: [portion] - [brief reason based on labs/conditions]\n\n### Avoid\n- [food]: [brief reason based on labs/conditions]\n\n## Notes\n- [2-4 practical tips based on patient's eating patterns/lifestyle]\n\n---\nEND OF PLAN", "diet": {"content": "# Diet Plan - Deborah Ramirez\n\n## Summary\n- Target: 2000 kcal/day\n- Macros: P 95g | C 280g | F 55g\n- Key focus: \n    - Increase iron and Vitamin C to address anemia and gum bleeding.\n    - High-fiber, low-saturated fat intake to manage high Total Cholesterol (TC).\n    - Nutrient-dense, frequent meals to support lactation and poor appetite.\n\n## Weekly Meal Plan\n\n### Week 1\n\n| Day | Breakfast | Lunch | Dinner | Snacks | kcal |\n|-----|-----------|-------|--------|--------|------|\n| Mon | Hausa Koko with milk | Waakye with fried fish | Fufu with Light Soup | Fresh Mango | 2010 |\n| Tue | Oats with banana | Banku with Okra & Mackerel | Plantain with Egg stew | Papaya slices | 1980 |\n| Wed | Tom Brown with milk | Jollof Rice with Chicken | Yam with Garden Egg stew | Orange | 2020 |\n| Thu | Boiled Yam with Egg | Kenkey with Fried Fish | Rice with Beans | Watermelon | 1990 |\n| Fri | Millet Porridge | Fufu with Groundnut Soup | Plantain with Fish stew | Guava | 2050 |\n| Sat | Corn Porridge | Red-Red (Beans & Plantain) | Fish with Rice | Yogurt | 1970 |\n| Sun | Fruit & Yogurt | Rice with Vegetable stew | Chicken with Yam | Apple | 1995 |\n\n### Week 2\n\n| Day | Breakfast | Lunch | Dinner | Snacks | kcal |\n|-----|-----------|-------|--------|--------|------|\n| Mon | Oats with Mango | Banku with Tilapia & Okra | Cassava with Fish stew | Banana | 2005 |\n| Tue | Hausa Koko with peanuts | Jollof Rice with Lean Beef | Plantain with Fish | Papaya | 2030 |\n| Wed | Tom Brown with nuts | Waakye with Egg | Fufu with Okra soup | Orange | 1985 |\n| Thu | Boiled Plantain with Egg | Kenkey with Sardines | Rice with Beans | Watermelon | 2010 |\n| Fri | Millet Porridge with milk | Fufu with Light Soup | Yam with Stew | Guava | 1990 |\n| Sat | Corn Porridge with milk | Red-Red with Egg | Fish with Cassava | Yogurt | 2020 |\n| Sun | Fruit & Yogurt | Rice with Chicken | Plantain with Stew | Apple | 1980 |\n\n### Week 3\n\n| Day | Breakfast | Lunch | Dinner | Snacks | kcal |\n|-----|-----------|-------|--------|--------|------|\n| Mon | Oats with Papaya | Jollof Rice with Fish | Rice with Beans | Mango | 2015 |\n| Tue | Hausa Koko with milk | Banku with Okra & Egg | Yam with Egg stew | Banana | 1975 |\n| Wed | Tom Brown with milk | Waakye with Fish | Plantain with Stew | Orange | 2040 |\n| Thu | Boiled Yam with Egg | Kenkey with Tilapia | Fufu with Light Soup | Watermelon | 2000 |\n| Fri | Millet Porridge with milk | Fufu with Groundnut Soup | Rice with Vegetables | Guava | 1990 |\n| Sat | Corn Porridge with milk | Red-Red with Egg | Fish with Yam | Yogurt | 2010 |\n| Sun | Fruit & Yogurt | Rice with Beef | Plantain with Chicken | Apple | 2025 |\n\n### Week 4\n\n| Day | Breakfast | Lunch | Dinner | Snacks | kcal |\n|-----|-----------|-------|--------|--------|------|\n| Mon | Oats with Banana | Banku with Okra & Fish | Yam with Egg stew | Mango | 1995 |\n| Tue | Hausa Koko with milk | Jollof Rice with Chicken | Plantain with Egg | Papaya | 2010 |\n| Wed | Tom Brown with nuts | Waakye with Egg | Rice with Beans | Banana | 1985 |\n| Thu | Boiled Plantain with Egg | Kenkey with Mackerel | Fufu with Light Soup | Orange | 2005 |\n| Fri | Millet Porridge with milk | Fufu with Groundnut Soup | Yam with Stew | Watermelon | 1990 |\n| Sat | Corn Porridge with milk | Red-Red with Egg | Fish with Rice | Guava | 2030 |\n| Sun | Fruit & Yogurt | Rice with Vegetables | Chicken with Plantain | Apple | 1980 |\n\n## Foods\n\n### Include\n- Kontomire (Spinach): 1 cup - High iron and Vit K for anemia and gum health.\n- Mackerel/Sardines: 100g - Omega-3 for skin (dermatitis) and protein for lactation.\n- Citrus (Mango/Orange): 1 medium - Vit C to aid iron absorption and gum healing.\n- Beans/Legumes: 1/2 cup - Soluble fiber to lower TC and plant protein.\n- Oats/Millet: 1 bowl - Complex carbs for sustained energy and fiber for cholesterol.\n\n### Avoid\n- Palm Oil/Butter: Excessive use due to high Total Cholesterol (TC).\n- Refined Sugars: To prevent inflammation and support dental health.\n- Highly Processed Meats: To manage cholesterol and maintain nutrient density.\n\n## Notes\n- **Hydration:** Increase water intake from 1.5L to at least 2.5-3L daily to support lactation.\n- **Small Meals:** Since appetite is poor, prioritize the nutrient-dense snacks if full during main meals.\n- **Cooking Method:** Prefer steaming, boiling, or light sautéing over deep-frying to manage cholesterol.\n- **PKU Precaution:** While focusing on lactation protein, prioritize high-quality sources (fish, poultry, eggs) rather than excessive red meat.\n\n---\nEND OF PLAN", "temperature": 0.4, "model": "gemma-4-26b-a4b-it", "provider": "gemini", "reasoning": true}, "meethealth": {"package": "meethealth-sample-v1", "package_version": "1.0.0", "source_corpus": "gemma_diets", "source_line": 122510, "contract": "diet_plan@1.0.0", "contract_fingerprint": "1a6c5cf6b9d37193", "gate_rules_evaluated": 45, "gate_failures": [], "package_checks": {"plan_language": {"pass": true, "detail": "english markers=4"}, "completeness_28_days": {"pass": true, "detail": "day_rows=28 weeks=4 terminated=True"}, "no_duplicate_days": {"pass": true, "detail": "duplicate_days=0"}, "macro_arithmetic": {"pass": true, "detail": "target=2000 kcal, 4P+4C+9F=1995 kcal, deviation=0.2%"}, "energy_dose_plausible": {"pass": true, "detail": "31.3 kcal/kg (screen 15-45)"}, "protein_dose_plausible": {"pass": true, "detail": "1.49 g/kg (screen 0.8-1.6)"}, "daily_energy_on_target": {"pass": true, "detail": "days_outside_10pct=0 of 28"}, "allergen_screen": {"pass": true, "detail": "no declared allergies"}, "hyperkalemia_food_screen": {"pass": true, "detail": "not applicable (K <= 5.0 or absent)"}, "scenario_coherence": {"pass": true, "detail": "ok"}}, "evidence_level": "L2_automated_checks_passed", "expert_review": "not_performed"}}
{"patient_id": "4b6e5e67-d951-46d8-9076-3b078f6fcfbc", "patient_data": {"id": "4b6e5e67-d951-46d8-9076-3b078f6fcfbc", "name": "Robert Barnes", "age": 40, "age_group": "adult_31_50y", "gender": "male", "region": "India_English", "language": "en", "occupation": "Taxi/Ride-share driver", "conditions": "Obesity Class I (BMI 30-34.9), GERD", "allergies": "Tree Nuts (all)", "goals": "Lipid profile improvement, Renal protection (low protein/phosphorus/potassium), Glycemic control optimization, Bone health / osteoporosis prevention", "preferences": "Hindu vegetarian (lacto-vegetarian)", "weight": 89.5, "height": 167.5, "bmi": 31.9, "activity_level": "lightly_active", "triceps_skinfold": 16.0, "suprailiac_skinfold": 35.0, "subscapular_skinfold": 12.1, "hemoglobin": 11.3, "serum_ferritin": 10.0, "blood_glucose": 73.9, "hba1c": 4.2, "hdl_cholesterol": 43.6, "ldl_cholesterol": 43.8, "triglycerides": 191.3, "vitamin_d": 88.9, "vitamin_b12": 180.7, "folate": 24.5, "sodium": 136.0, "chloride": 105.9, "albumin": 4.4, "prealbumin": 27.0, "bun": 22.2, "past_medical_history": "Knee surgery (ACL repair, 2022)", "family_medical_history": "Both parents: T2DM. Sibling: Celiac disease.", "dietary_recall_24h": "Breakfast: Yogurt parfait with granola and berries\nLunch: Salad with grilled chicken and dressing\nDinner: Pizza (3 slices) with soda\nSnacks: Trail mix", "total_calories": 1730, "total_protein": 93.7, "total_carbohydrates": 218.5, "total_fat": 53.5, "total_fiber": 23.6, "total_sugar": 34.8, "total_saturated_fat": 6.9, "total_sodium": 3860, "bmr_formula": "WHO/FAO", "bmr": 1917, "tdee": 2635, "macro_split": {"carbsPercent": 55, "proteinPercent": 20, "fatPercent": 25}, "meals_per_day": 2, "meal_times": {"breakfast": "9:00 AM", "lunch": "3:00 PM", "dinner": "5:00 PM", "snacks": "10:00 AM"}, "cooking_time": "Institutional meals (hospital/nursing home)", "water_intake_per_day": "<0.5L", "coffee_cups_per_day": 4, "appetite_assessment": "Decreased", "ethical_food_restrictions": "Fair trade only", "prompt_mode": "clinical", "clinical_analysis_depth": "comprehensive", "food_exchange_plan": {"region": "India_English", "targetCalories": 2450, "carbsPercent": 45, "proteinPercent": 20, "fatPercent": 35, "totalExchanges": {"cereals": 6, "fruits": 1, "vegetables": 2, "dairy": 3, "meat": 7, "fat": 6, "sugar": 0}}}, "prompt": "You are a senior clinical nutritionist with expertise in medical nutrition therapy creating a diet plan. Generate all content in ENGLISH.\n\n## ADVANCED CLINICAL MODE ENABLED\nThis dietary plan requires a clinically-driven approach with structured analysis of the nutritional anamnesis.\nYou MUST explicitly analyze and integrate key patient parameters before generating recommendations.\nAnalysis Depth: COMPREHENSIVE\n\nSTRICT RULES:\n1. Output ONLY markdown - no preamble, no \"Here is...\", no greetings, no sign-offs\n2. Be CONCISE - use tables, bullets, short sentences\n3. Use TABLES for meal plans (mandatory)\n4. NO lengthy explanations unless customInstructions requests detail\n5. Start directly with the H1 title\n6. USE ALL patient data provided to personalize the plan\n7. EVERY DAY must have UNIQUE meals - NO \"repeat day X\" or \"same as above\" - write out ALL 28 days completely.\n8. Provide VARIETY - different foods each day, rotate proteins, vegetables, grains\n9. FOLLOW the food exchange allocations exactly as specified\n10. PERFORM complete clinical anamnesis analysis BEFORE generating the meal plan\n11. JUSTIFY each major dietary recommendation with clinical rationale\n12. USE PES (Problem-Etiology-Signs/Symptoms) format for nutritional diagnoses\n13. INCLUDE monitoring parameters and follow-up indicators\n\n\n## CLINICAL NUTRITIONAL ANAMNESIS ANALYSIS\n\nYou MUST perform a structured, systematic analysis of the patient's nutritional anamnesis before generating the diet plan.\n\n**Analysis Depth:** Provide a thorough clinical analysis covering all major domains with clinical correlations.\n\n### 1. BIOCHEMICAL DATA ANALYSIS\n**Hematological Profile:**\n  - Hemoglobin: 11.3 g/dL | Ferritin: 10.0 ng/mL\n  - Clinical interpretation: Assess iron status, anemia risk, and need for iron-rich foods or absorption enhancers\n\n**Glycemic Control:**\n  - Fasting Glucose: 73.9 mg/dL | HbA1c: 4.2%\n  - Clinical interpretation: Evaluate glycemic control, carbohydrate tolerance, and glycemic index considerations\n\n**Lipid Profile:**\n  - HDL: 43.6 | LDL: 43.8 | TG: 191.3 mg/dL\n  - Clinical interpretation: Assess cardiovascular risk, dietary fat modifications, and omega-3 requirements\n\n**Micronutrient Status:**\n  - Vitamin D: 88.9 ng/mL | B12: 180.7 pg/mL | Folate: 24.5 ng/mL\n  - Clinical interpretation: Identify deficiencies requiring dietary intervention or supplementation\n\n**Electrolyte Balance:**\n  - Na: 136.0 | Cl: 105.9 mEq/L\n  - Clinical interpretation: Assess fluid-electrolyte status and dietary sodium/potassium modifications\n\n**Protein Status:**\n  - Albumin: 4.4 g/dL | Prealbumin: 27.0 mg/dL\n  - Clinical interpretation: Evaluate protein-calorie malnutrition risk and protein requirements\n\n**Renal Function:**\n  - BUN: 22.2 mg/dL\n  - Clinical interpretation: Assess renal function and protein/electrolyte restrictions if needed\n\n### 2. CLINICAL DATA ANALYSIS\n**Current Medical Conditions:** Obesity Class I (BMI 30-34.9), GERD\n  - Nutritional implications: Disease-specific dietary modifications, nutrient-drug interactions\n**Allergies & Intolerances:** Tree Nuts (all)\n  - CRITICAL: Strict avoidance required, cross-reactivity considerations\n\n### 3. ANTHROPOMETRIC DATA ANALYSIS\n**Primary Measurements:**\n  - Weight: 89.5 kg | Height: 167.5 cm | BMI: 31.9 kg/m²\n  - BMI Classification: Obese\n  - Activity Level: lightly active\n\n### 4. DIETARY DATA ANALYSIS\n**24-Hour Dietary Recall:**\nBreakfast: Yogurt parfait with granola and berries\nLunch: Salad with grilled chicken and dressing\nDinner: Pizza (3 slices) with soda\nSnacks: Trail mix\n\n### 5. CLINICAL SYNTHESIS & NUTRITIONAL DIAGNOSIS\n**Patient Goals:** Lipid profile improvement, Renal protection (low protein/phosphorus/potassium), Glycemic control optimization, Bone health / osteoporosis prevention\n\n**REQUIRED OUTPUT FOR CLINICAL MODE:**\n1. **Problem List (PES Format):** Identify 2-4 nutrition diagnoses using Problem-Etiology-Signs/Symptoms format\n2. **Priority Ranking:** Rank nutritional problems by clinical urgency\n3. **Intervention Rationale:** For each dietary recommendation, provide clinical justification\n4. **Monitoring Parameters:** Specify what should be monitored\n\n---\n\n**Patient:** Name: Robert Barnes | Age: 40 | Gender: male | Conditions: Obesity Class I (BMI 30-34.9), GERD | Allergies: Tree Nuts (all) | Region: India_English | Occupation: Taxi/Ride-share driver\n**Anthropometrics:** Wt: 89.5kg | Ht: 167.5cm | BMI: 31.9 | Activity: lightly active\n**Body Composition:** Triceps: 16.0mm | Suprailiac: 35.0mm | Subscapular: 12.1mm\n**Blood/Iron:** Hb: 11.3g/dL | Ferritin: 10.0ng/mL\n**Metabolic Labs:** Glucose: 73.9mg/dL | HbA1c: 4.2% | HDL: 43.6 | LDL: 43.8 | TG: 191.3\n**Vitamins/Electrolytes:** VitD: 88.9ng/mL | B12: 180.7pg/mL | Folate: 24.5ng/mL | Na: 136.0 | Cl: 105.9\n**Protein/Kidney:** Albumin: 4.4g/dL | Prealbumin: 27.0mg/dL | BUN: 22.2mg/dL\n**Medical History:** Past Medical: Knee surgery (ACL repair, 2022) | Family Hx: Both parents: T2DM. Sibling: Celiac disease.\n**Energy Targets:** Formula: WHO/FAO | BMR: 1917kcal | TDEE: 2635kcal | Macro Target: C55/P20/F25%\n**Current Intake (24h):** Cal: 1730 | P: 93.7g | C: 218.5g | F: 53.5g | Fiber: 23.6g | Sugar: 34.8g | SatFat: 6.9g | Na: 3860mg\n**24h Recall:** Breakfast: Yogurt parfait with granola and berries\nLunch: Salad with grilled chicken and dressing\nDinner: Pizza (3 slices) with soda\nSnacks: Trail mix\n**Eating Patterns:** Meals/day: 2 | Breakfast: 9:00 AM | Lunch: 3:00 PM | Dinner: 5:00 PM | Snacks: 10:00 AM | Cooking time: Institutional meals (hospital/nursing home) | Coffee: 4 | Water: <0.5L\n**Restrictions:** Ethical: Fair trade only\n**Appetite:** Appetite: Decreased\n**Goals:** Lipid profile improvement, Renal protection (low protein/phosphorus/potassium), Glycemic control optimization, Bone health / osteoporosis prevention\n**Additional Notes:** Hindu vegetarian (lacto-vegetarian)\n**Food Exchange Plan:** Region: India_English | Target: 2450 kcal | Macros: C45%/P20%/F35% | Exchanges: cereals: 6, fruits: 1, vegetables: 2, dairy: 3, meat: 7, fat: 6\n\n\n\n\nFOOD EXCHANGE SYSTEM INSTRUCTIONS:\nThe nutritionist has configured a food exchange plan. You MUST follow these exchange allocations when creating the meal plan:\n\nTarget Calories: 2450 kcal\nMacro Distribution: 45% Carbs, 20% Protein, 35% Fat\nRegion: India_English (use region-appropriate foods)\n\nExchange Allocations:\n- cereals: 6 exchanges\n- fruits: 1 exchanges\n- vegetables: 2 exchanges\n- dairy: 3 exchanges\n- meat: 7 exchanges\n- fat: 6 exchanges\n\nMeal Distribution:\n\n\nIMPORTANT: The meal plan MUST reflect these exact exchange allocations. Each meal should contain the specified number of exchanges from each food group.\n\n\n---\n\nOUTPUT FORMAT (follow exactly):\n\n# Diet Plan - Robert Barnes\n\n## Clinical Nutritional Anamnesis Analysis\n\n### 1. Biochemical Data Analysis\n[Interpret lab values]\n\n### 2. Clinical Data Analysis\n[Medical conditions and dietary implications]\n\n### 3. Anthropometric Data Analysis\n[BMI classification and body composition]\n\n### 4. Dietary Data Analysis\n[24h recall interpretation and nutrient gap analysis]\n\n### 5. Nutritional Diagnosis (PES Format)\n| Priority | Problem | Etiology | Signs/Symptoms |\n|----------|---------|----------|----------------|\n| 1 | [Nutrition problem] | related to [etiology] | as evidenced by [S/S] |\n\n### 6. Intervention Rationale\n[Key intervention decisions with clinical justification]\n\n---\n\n## Summary\n- Target: [kcal] kcal/day\n- Macros: P [g]g | C [g]g | F [g]g\n- Key focus: [2-3 bullet points max based on patient data]\n- Clinical priorities: [Based on PES diagnoses above]\n\n## Weekly Meal Plan\n\nCRITICAL: You MUST write out EVERY meal for ALL 28 days across ALL 4 weeks. Each day must be unique.\n\n### Week 1\n\n| Day | Breakfast | Lunch | Dinner | Snacks | kcal |\n|-----|-----------|-------|--------|--------|------|\n| Mon | [unique meal] | [unique meal] | [unique meal] | [snack] | [total] |\n| Tue | [unique meal] | [unique meal] | [unique meal] | [snack] | [total] |\n| Wed | [unique meal] | [unique meal] | [unique meal] | [snack] | [total] |\n| Thu | [unique meal] | [unique meal] | [unique meal] | [snack] | [total] |\n| Fri | [unique meal] | [unique meal] | [unique meal] | [snack] | [total] |\n| Sat | [unique meal] | [unique meal] | [unique meal] | [snack] | [total] |\n| Sun | [unique meal] | [unique meal] | [unique meal] | [snack] | [total] |\n\n### Week 2\n\n| Day | Breakfast | Lunch | Dinner | Snacks | kcal |\n|-----|-----------|-------|--------|--------|------|\n| Mon | [unique meal] | [unique meal] | [unique meal] | [snack] | [total] |\n| Tue | [unique meal] | [unique meal] | [unique meal] | [snack] | [total] |\n| Wed | [unique meal] | [unique meal] | [unique meal] | [snack] | [total] |\n| Thu | [unique meal] | [unique meal] | [unique meal] | [snack] | [total] |\n| Fri | [unique meal] | [unique meal] | [unique meal] | [snack] | [total] |\n| Sat | [unique meal] | [unique meal] | [unique meal] | [snack] | [total] |\n| Sun | [unique meal] | [unique meal] | [unique meal] | [snack] | [total] |\n\n### Week 3\n\n| Day | Breakfast | Lunch | Dinner | Snacks | kcal |\n|-----|-----------|-------|--------|--------|------|\n| Mon | [unique meal] | [unique meal] | [unique meal] | [snack] | [total] |\n| Tue | [unique meal] | [unique meal] | [unique meal] | [snack] | [total] |\n| Wed | [unique meal] | [unique meal] | [unique meal] | [snack] | [total] |\n| Thu | [unique meal] | [unique meal] | [unique meal] | [snack] | [total] |\n| Fri | [unique meal] | [unique meal] | [unique meal] | [snack] | [total] |\n| Sat | [unique meal] | [unique meal] | [unique meal] | [snack] | [total] |\n| Sun | [unique meal] | [unique meal] | [unique meal] | [snack] | [total] |\n\n### Week 4\n\n| Day | Breakfast | Lunch | Dinner | Snacks | kcal |\n|-----|-----------|-------|--------|--------|------|\n| Mon | [unique meal] | [unique meal] | [unique meal] | [snack] | [total] |\n| Tue | [unique meal] | [unique meal] | [unique meal] | [snack] | [total] |\n| Wed | [unique meal] | [unique meal] | [unique meal] | [snack] | [total] |\n| Thu | [unique meal] | [unique meal] | [unique meal] | [snack] | [total] |\n| Fri | [unique meal] | [unique meal] | [unique meal] | [snack] | [total] |\n| Sat | [unique meal] | [unique meal] | [unique meal] | [snack] | [total] |\n| Sun | [unique meal] | [unique meal] | [unique meal] | [snack] | [total] |\n\n\n## Foods\n\n### Include\n- [food]: [portion] - [brief reason based on labs/conditions]\n\n### Avoid\n- [food]: [brief reason based on labs/conditions]\n\n## Notes\n- [2-4 practical tips based on patient's eating patterns/lifestyle]\n\n## Monitoring Parameters\n\n### Indicators to Evaluate\n| Parameter | Current Value | Target | Timeline |\n|-----------|---------------|--------|----------|\n| [parameter] | [current] | [goal] | [weeks] |\n\n### Recommended Follow-up\n- Next appointment: [timeframe]\n- Follow-up labs: [which tests, when]\n- Warning signs: [symptoms requiring immediate attention]\n\n---\nEND OF PLAN", "diet": {"content": "# Diet Plan - Robert Barnes\n\n## Clinical Nutritional Anamnesis Analysis\n\n### 1. Biochemical Data Analysis\n*   **Hematological Profile:** Hb (11.3 g/dL) and Ferritin (10.0 ng/mL) are significantly low, indicating **Iron Deficiency Anemia**. This requires increased dietary iron and absorption enhancers (Vitamin C).\n*   **Glycemic Control:** Glucose (73.9 mg/dL) and HbA1c (4.2%) are within normal limits, but the patient has a strong family history of T2DM; glycemic stability via complex carbohydrates is vital.\n*   **Lipid Profile:** Triglycerides (191.3 mg/dL) are elevated (Hypertriglyceridemia), and HDL (43.6 mg/dL) is borderline low. Focus on reducing refined sugars and increasing MUFA/PUFA.\n*   **Micronutrient Status:** B12 (180.7 pg/mL) is deficient, which is common in lacto-vegetarians. Vitamin D is adequate. Folate is normal.\n*   **Electrolyte/Renal Status:** Na (136.0) and Cl (105.9) are at the lower end of normal. BUN (22.2 mg/dL) is slightly elevated, suggesting a need for improved hydration and monitoring of protein quality.\n*   **Protein Status:** Albumin (4.4 g/dL) and Prealbumin (27.0 mg/dL) are normal, indicating adequate current protein stores despite low caloric intake.\n\n### 2. Clinical Data Analysis\n*   **Obesity Class I:** Requires a controlled caloric deficit to manage weight while maintaining nutrient density.\n*   **GERD:** Requires avoidance of highly spicy, acidic, or fried foods, and smaller, more frequent meal patterns.\n*   **Lacto-Vegetarianism:** Requires careful planning to ensure B12 and Iron adequacy without meat.\n*   **Tree Nut Allergy:** **CRITICAL.** Strict avoidance of all tree nuts (almonds, cashews, walnuts, etc.) is mandatory.\n\n### 3. Anthropometric Data Analysis\n*   **BMI:** 31.9 kg/m² (Obese Class I).\n*   **Body Composition:** Elevated subcutaneous fat (Suprailiac 35.0mm).\n*   **Activity Level:** Lightly active; requires energy balance to prevent further weight gain.\n\n### 4. Dietary Data Analysis\n*   **Current Intake:** 1730 kcal (below TDEE of 2635 kcal).\n*   **Nutrient Gaps:** High sodium (3860mg), low hydration (<0.5L), low B12, low iron, and high triglycerides (likely from the pizza/soda/trail mix pattern).\n*   **Pattern Issues:** Irregular meal timing and high sodium/sugar intake in the evening.\n\n### 5. Nutritional Diagnosis (PES Format)\n| Priority | Problem | Etiology | Signs/Symptoms |\n|----------|---------|----------|----------------|\n| 1 | Iron Deficiency Anemia | Inadequate intake of iron-rich foods | Hb 11.3 g/dL, Ferritin 10.0 ng/mL |\n| 2 | Altered Blood Lipid Profile | Excessive intake of simple sugars and saturated fats | TG 191.3 mg/dL |\n| 3 | Micronutrient Deficiency (B12) | Inadequate intake of B12-rich foods (lacto-vegetarian) | B12 180.7 pg/mL |\n| 4 | Overweight/Obesity | Positive energy balance and sedentary occupation | BMI 31.9 kg/m² |\n\n### 6. Intervention Rationale\n*   **Iron Optimization:** Increase consumption of lentils, spinach, and fortified cereals paired with Vitamin C (citrus/fruit) to enhance non-heme iron absorption.\n*   **B12 Support:** Maximize dairy exchanges (Milk, Curd, Paneer) to address deficiency.\n*   **Lipid Management:** Replace saturated fats with MUFA/PUFA (Mustard/Sunflower oil) and increase fiber to lower triglycerides.\n*   **GERD Management:** Avoid deep-fried foods and excessive spices; ensure adequate hydration to assist digestion.\n*   **Weight Management:** Target 2450 kcal to provide a controlled surplus/maintenance relative to current low intake, ensuring satiety through protein and fiber.\n\n---\n\n## Summary\n- Target: 2450 kcal/day\n- Macros: P 122g | C 276g | F 95g (Targeting 45/20/35 ratio)\n- Key focus: Iron & B12 replenishment, Triglyceride reduction, GERD-friendly preparation.\n- Clinical priorities: Correcting anemia, managing lipids, and weight stabilization.\n\n## Weekly Meal Plan\n\n### Week 1\n\n| Day | Breakfast | Lunch | Dinner | Snacks | kcal |\n|-----|-----------|-------|--------|--------|------|\n| Mon | Moong Dal Chilla (2C, 2P, 1D, 1F) | Roti (2C), Dal (2P), Bhindi (1V), Oil (2F) | Paneer (3P), Rice (2C), Curd (2D), Mix Veg (1V), Oil (2F) | Apple (1F), Sunflower Seeds (1F) | 2450 |\n| Tue | Vegetable Upma (2C, 1V, 1P, 1D, 1F) | Roti (2C), Rajma (2P), Gobi (1V), Oil (2F) | Soya Chunks (3P), Dalia (2C), Curd (2D), Beans (1V), Oil (2F) | Papaya (1F), Pumpkin Seeds (1F) | 2450 |\n| Wed | Oats with Milk (2C, 1D, 2P, 1F) | Poha (2C), Sprouts (2P), Peas (1V), Oil (2F) | Paneer (3P), Roti (2C), Dal (1P), Curd (2D), Veg (1V), Oil (2F) | Guava (1F), Sunflower Seeds (1F) | 2450 |\n| Thu | Besan Chilla (2C, 2P, 1D, 1F) | Rice (2C), Chana Masala (2P), Palak (1V), Oil (2F) | Tofu (3P), Roti (2C), Dal (1P), Curd (2D), Veg (1V), Oil (2F) | Banana (1F), Pumpkin Seeds (1F) | 2450 |\n| Fri | Idli (2C, 1D, 2P, 1F) | Roti (2C), Moong Dal (2P), Carrot (1V), Oil (2F) | Paneer (3P), Rice (2C), Curd (2D), Beans (1V), Oil (2F) | Pear (1F), Sunflower Seeds (1F) | 2450 |\n| Sat | Dalia (2C, 1D, 2P, 1F) | Roti (2C), Soya (2P), Cauliflower (1V), Oil (2F) | Dal (3P), Rice (2C), Curd (2D), Spinach (1V), Oil (2F) | Orange (1F), Pumpkin Seeds (1F) | 2450 |\n| Sun | Poha (2C, 1D, 2P, 1F) | Rice (2C), Rajma (2P), Okra (1V), Oil (2F) | Paneer (3P), Roti (2C), Curd (2D), Veg (1V), Oil (2F) | Mango (1F), Sunflower Seeds (1F) | 2450 |\n\n### Week 2\n\n| Day | Breakfast | Lunch | Dinner | Snacks | kcal |\n|-----|-----------|-------|--------|--------|------|\n| Mon | Ragi Porridge (2C, 1D, 2P, 1F) | Roti (2C), Dal (2P), Gobi (1V), Oil (2F) | Soya (3P), Rice (2C), Curd (2D), Veg (1V), Oil (2F) | Apple (1F), Pumpkin Seeds (1F) | 2450 |\n| Tue | Moong Dal Chilla (2C, 2P, 1D, 1F) | Poha (2C), Chana (2P), Peas (1V), Oil (2F) | Paneer (3P), Roti (2C), Curd (2D), Mix Veg (1V), Oil (2F) | Papaya (1F), Sunflower Seeds (1F) | 2450 |\n| Wed | Oats (2C, 1D, 2P, 1F) | Roti (2C), Rajma (2P), Spinach (1V), Oil (2F) | Dal (3P), Rice (2C), Curd (2D), Beans (1V), Oil (2F) | Guava (1F), Pumpkin Seeds (1F) | 2450 |\n| Thu | Idli (2C, 1D, 2P, 1F) | Rice (2C), Soya (2P), Okra (1V), Oil (2F) | Paneer (3P), Roti (2C), Curd (2D), Gobi (1V), Oil (2F) | Banana (1F), Sunflower Seeds (1F) | 2450 |\n| Fri | Besan Chilla (2C, 2P, 1D, 1F) | Roti (2C), Dal (2P), Carrot (1V), Oil (2F) | Tofu (3P), Rice (2C), Curd (2D), Spinach (1V), Oil (2F) | Pear (1F), Pumpkin Seeds (1F) | 2450 |\n| Sat | Dalia (2C, 1D, 2P, 1F) | Poha (2C), Sprouts (2P), Peas (1V), Oil (2F) | Paneer (3P), Roti (2C), Curd (2D), Mix Veg (1V), Oil (2F) | Orange (1F), Sunflower Seeds (1F) | 2450 |\n| Sun | Ragi Dosa (2C, 1D, 2P, 1F) | Roti (2C), Chana (2P), Beans (1V), Oil (2F) | Dal (3P), Rice (2C), Curd (2D), Gobi (1V), Oil (2F) | Mango (1F), Pumpkin Seeds (1F) | 2450 |\n\n### Week 3\n\n| Day | Breakfast | Lunch | Dinner | Snacks | kcal |\n|-----|-----------|-------|--------|--------|------|\n| Mon | Moong Dal Chilla (2C, 2P, 1D, 1F) | Roti (2C), Soya (2P), Bhindi (1V), Oil (2F) | Paneer (3P), Rice (2C), Curd (2D), Spinach (1V), Oil (2F) | Apple (1F), Sunflower Seeds (1F) | 2450 |\n| Tue | Oats (2C, 1D, 2P, 1F) | Rice (2C), Dal (2P), Cauliflower (1V), Oil (2F) | Rajma (3P), Roti (2C), Curd (2D), Mix Veg (1V), Oil (2F) | Papaya (1F), Pumpkin Seeds (1F) | 2450 |\n| Wed | Upma (2C, 1D, 2P, 1F) | Roti (2C), Chana (2P), Okra (1V), Oil (2F) | Paneer (3P), Rice (2C), Curd (2D), Beans (1V), Oil (2F) | Guava (1F), Sunflower Seeds (1F) | 2450 |\n| Thu | Besan Chilla (2C, 2P, 1D, 1F) | Poha (2C), Sprouts (2P), Peas (1V), Oil (2F) | Soya (3P), Roti (2C), Curd (2D), Gobi (1V), Oil (2F) | Banana (1F), Pumpkin Seeds (1F) | 2450 |\n| Fri | Idli (2C, 1D, 2P, 1F) | Roti (2C), Rajma (2P), Spinach (1V), Oil (2F) | Paneer (3P), Rice (2C), Curd (2D), Carrot (1V), Oil (2F) | Pear (1F), Sunflower Seeds (1F) | 2450 |\n| Sat | Dalia (2C, 1D, 2P, 1F) | Rice (2C), Dal (2P), Mix Veg (1V), Oil (2F) | Tofu (3P), Roti (2C), Curd (2D), Beans (1V), Oil (2F) | Orange (1F), Pumpkin Seeds (1F) | 2450 |\n| Sun | Ragi Porridge (2C, 1D, 2P, 1F) | Roti (2C), Soya (2P), Bhindi (1V), Oil (2F) | Paneer (3P), Rice (2C), Curd (2D), Okra (1V), Oil (2F) | Mango (1F), Sunflower Seeds (1F) | 2450 |\n\n### Week 4\n\n| Day | Breakfast | Lunch | Dinner | Snacks | kcal |\n|-----|-----------|-------|--------|--------|------|\n| Mon | Moong Dal Chilla (2C, 2P, 1D, 1F) | Roti (2C), Chana (2P), Gobi (1V), Oil (2F) | Dal (3P), Rice (2C), Curd (2D), Spinach (1V), Oil (2F) | Apple (1F), Pumpkin Seeds (1F) | 2450 |\n| Tue | Oats (2C, 1D, 2P, 1F) | Poha (2C), Rajma (2P), Peas (1V), Oil (2F) | Paneer (3P), Roti (2C), Curd (2D), Mix Veg (1V), Oil (2F) | Papaya (1F), Sunflower Seeds (1F) | 2450 |\n| Wed | Besan Chilla (2C, 2P, 1D, 1F) | Rice (2C), Soya (2P), Beans (1V), Oil (2F) | Tofu (3P), Rice (2C), Curd (2D), Okra (1V), Oil (2F) | Guava (1F), Pumpkin Seeds (1F) | 2450 |\n| Thu | Idli (2C, 1D, 2P, 1F) | Roti (2C), Dal (2P), Carrot (1V), Oil (2F) | Paneer (3P), Roti (2C), Curd (2D), Gobi (1V), Oil (2F) | Banana (1F), Sunflower Seeds (1F) | 2450 |\n| Fri | Dalia (2C, 1D, 2P, 1F) | Roti (2C), Sprouts (2P), Spinach (1V), Oil (2F) | Rajma (3P), Rice (2C), Curd (2D), Mix Veg (1V), Oil (2F) | Pear (1F), Pumpkin Seeds (1F) | 2450 |\n| Sat | Poha (2C, 1D, 2P, 1F) | Rice (2C), Chana (2P), Bhindi (1V), Oil (2F) | Paneer (3P), Roti (2C), Curd (2D), Beans (1V), Oil (2F) | Orange (1F), Sunflower Seeds (1F) | 2450 |\n| Sun | Ragi Dosa (2C, 1D, 2P, 1F) | Roti (2C), Dal (2P), Cauliflower (1V), Oil (2F) | Soya (3P), Rice (2C), Curd (2D), Peas (1V), Oil (2F) | Mango (1F), Pumpkin Seeds (1F) | 2450 |\n\n## Foods\n\n### Include\n- Lentils/Dal/Chana/Rajma: High iron and protein for anemia and satiety.\n- Spinach/Green Leafy Veg: Essential for non-heme iron.\n- Curd/Milk/Paneer: Key sources of B12 and calcium for bone health.\n- Sunflower/Pumpkin Seeds: Healthy fats and minerals (Tree nut-free).\n- Whole Grains (Oats, Ragi, Dalia): Low GI for glycemic control.\n\n### Avoid\n- Tree Nuts (Almonds, Cashews, etc.): Strict allergy risk.\n- Refined Sugar/Soda: To manage high triglycerides.\n- Deep-fried foods: To manage GERD and lipids.\n- Highly spicy masalas: To prevent GERD flare-ups.\n\n## Notes\n- **Hydration:** Aim for 2.5L of water daily to support renal function and digestion.\n- **Meal Timing:** Avoid eating heavy meals within 3 hours of bedtime to manage GERD.\n- **Iron Absorption:** Always pair your lentils or spinach with a squeeze of lemon (Vitamin C) to maximize iron uptake.\n- **Safety:** Always check labels on processed items to ensure no \"may contain tree nuts\" warnings.\n\n## Monitoring Parameters\n\n### Indicators to Evaluate\n| Parameter | Current Value | Target | Timeline |\n|-----------|---------------|--------|----------|\n| Hemoglobin | 11.3 g/dL | >13.0 g/dL | 12 weeks |\n| Ferritin | 10.0 ng/mL | >30 ng/mL | 12 weeks |\n| Triglycerides | 191.3 mg/dL | <150 mg/dL | 8 weeks |\n| B12 | 180.7 pg/mL | >400 pg/mL | 12 weeks |\n| BMI | 31.9 kg/m² | <29.9 kg/m² | 16 weeks |\n\n### Recommended Follow-up\n- Next appointment: 4 weeks\n- Follow-up labs: CBC (Hb, Ferritin), Lipid Profile, B12, and Fasting Glucose in 3 months.\n- Warning signs: Severe epigastric pain (GERD), extreme fatigue (Anemia), or dizziness.\n\n---\nEND OF PLAN", "temperature": 0.4, "model": "gemma-4-26b-a4b-it", "provider": "gemini", "reasoning": true}, "meethealth": {"package": "meethealth-sample-v1", "package_version": "1.0.0", "source_corpus": "gemma_diets", "source_line": 157412, "contract": "diet_plan@1.0.0", "contract_fingerprint": "1a6c5cf6b9d37193", "gate_rules_evaluated": 45, "gate_failures": [], "package_checks": {"plan_language": {"pass": true, "detail": "english markers=4"}, "completeness_28_days": {"pass": true, "detail": "day_rows=28 weeks=4 terminated=True"}, "no_duplicate_days": {"pass": true, "detail": "duplicate_days=0"}, "macro_arithmetic": {"pass": true, "detail": "target=2450 kcal, 4P+4C+9F=2447 kcal, deviation=0.1%"}, "energy_dose_plausible": {"pass": true, "detail": "27.4 kcal/kg (screen 15-45)"}, "protein_dose_plausible": {"pass": true, "detail": "1.36 g/kg (screen 0.8-1.6)"}, "daily_energy_on_target": {"pass": true, "detail": "days_outside_10pct=0 of 28"}, "allergen_screen": {"pass": true, "detail": "screened=['tree_nut'] hits=[]"}, "hyperkalemia_food_screen": {"pass": true, "detail": "not applicable (K <= 5.0 or absent)"}, "scenario_coherence": {"pass": true, "detail": "ok"}}, "evidence_level": "L2_automated_checks_passed", "expert_review": "not_performed"}}
{"patient_id": "15d5b6c1-63f0-48e8-8910-f96989f99c6f", "patient_data": {"id": "15d5b6c1-63f0-48e8-8910-f96989f99c6f", "name": "Tiffany Krause", "age": 51, "age_group": "middle_age_51_65y", "gender": "female", "region": "South_Africa", "language": "en", "occupation": "Homebound/Bedridden", "conditions": "Overweight (BMI 25-29.9)", "allergies": "Shellfish (shrimp, crab, lobster)", "goals": "Seizure reduction (ketogenic therapy), Gout flare prevention, Weight gain (healthy), Weight gain (recovery from illness)", "preferences": "Hindu vegetarian (lacto-vegetarian)", "weight": 82.4, "height": 168.6, "bmi": 29.0, "activity_level": "lightly_active", "hematocrit": 44.7, "serum_ferritin": 285.8, "hdl_cholesterol": 52.3, "ldl_cholesterol": 246.7, "triglycerides": 139.2, "folate": 1.3, "sodium": 141.9, "chloride": 106.0, "albumin": 4.3, "prealbumin": 33.6, "creatinine": 0.8, "bun": 12.7, "skin_condition": "Pruritic erythematous rash", "hair_condition": "Brittle", "oral_health": "Normal", "clinical_history": "Diagnosed 2 years ago, no prior nutritional counseling", "meals_per_day": 4, "meal_times": {"breakfast": "7:30 AM", "lunch": "12:00 PM", "dinner": "7:00 PM", "snacks": "10:00 AM"}, "cooking_time": "<15 minutes", "water_intake_per_day": "<0.5L", "coffee_cups_per_day": 1, "eating_habits": "Regular meal times", "food_aversions": "Avoids anything green (pediatric)", "appetite_assessment": "Normal", "recent_appetite_changes": "Appetite decreased during chemo cycle", "dietary_supplements": "Iron IV infusions monthly", "prompt_mode": "standard", "clinical_analysis_depth": "detailed"}, "prompt": "You are a clinical nutritionist creating a diet plan. Generate all content in ENGLISH.\n\nPATIENT DATA VALIDITY CHECK (perform silently BEFORE writing the plan):\nBefore recommending anything, screen the patient record for biologically-impossible or logically-contradictory entries. Common red flags:\n  - Sex-specific conditions on the wrong sex (e.g. PCOS, endometriosis, ovarian/cervical/uterine/menopause conditions on a male patient; prostate, BPH, testicular, erectile conditions on a female patient)\n  - Pregnancy-related fields on a male patient (is_pregnant=true, gestational diabetes, preeclampsia, hyperemesis, lactation, postpartum)\n  - Pregnancy in a patient outside the plausible age range (under 12 or over 55)\n  - Adult-onset chronic conditions on very young patients (coronary artery disease, Parkinson's, Alzheimer's/dementia, menopause, BPH, osteoporosis, COPD, sarcopenia in patients under the typical onset age)\n  - Eating disorders (anorexia, bulimia, BED, ARFID adult form) on patients under 10\n  - Bariatric surgery history on patients under 14\n  - Occupation/age mismatch (retired at 25, elementary school student at 30, toddler listed as lawyer, etc.)\n  - Impossible anthropometrics (BMI under 11 or over 70, infant weight over 15 kg, toddler weight over 25 kg)\n  - Mutually exclusive conditions present together (Obesity + Underweight, Type 1 + Type 2 diabetes)\n  - Allergies that contradict declared dietary patterns\n\nIf you detect any such issue:\n  1. Do NOT silently \"play along\" with the impossibility.\n  2. Add a short `## Data Consistency Notes` block right after the Summary, listing each flagged issue in one line.\n  3. Choose the safest clinically-defensible interpretation (e.g. ignore the sex-mismatched condition; use the nearest reasonable age band; drop contradictory conditions) and generate the plan on that basis.\n  4. Never recommend a therapy driven by an impossible condition (e.g. do not prescribe ketogenic therapy for \"epilepsy\" if the record also implies contraindications like active breastfeeding, hepatic steatosis, or pregnancy unless a seizure disorder is clearly present).\n  5. For any declared allergy, the meal tables MUST NOT contain that food or its common derivatives. Allergens may only appear inside the `### Avoid` section with explicit avoidance wording.\n\nSTRICT RULES:\n1. Output ONLY markdown - no preamble, no \"Here is...\", no greetings, no sign-offs\n2. Be CONCISE - use tables, bullets, short sentences\n3. Use TABLES for meal plans (mandatory)\n4. NO lengthy explanations unless customInstructions requests detail\n5. Start directly with the H1 title\n6. USE ALL patient data provided to personalize the plan\n7. EVERY DAY must have UNIQUE meals - NO \"repeat day X\" or \"same as above\" - write out ALL 28 days completely.\n8. Provide VARIETY - different foods each day, rotate proteins, vegetables, grains\n\n\n\n\n**Patient:** Name: Tiffany Krause | Age: 51 | Gender: female | Conditions: Overweight (BMI 25-29.9) | Allergies: Shellfish (shrimp, crab, lobster) | Region: South_Africa | Occupation: Homebound/Bedridden\n**Anthropometrics:** Wt: 82.4kg | Ht: 168.6cm | BMI: 29.0 | Activity: lightly active\n**Blood/Iron:** Hct: 44.7% | Ferritin: 285.8ng/mL\n**Metabolic Labs:** HDL: 52.3 | LDL: 246.7 | TG: 139.2\n**Vitamins/Electrolytes:** Folate: 1.3ng/mL | Na: 141.9 | Cl: 106.0\n**Protein/Kidney:** Albumin: 4.3g/dL | Prealbumin: 33.6mg/dL | Creatinine: 0.8mg/dL | BUN: 12.7mg/dL\n**Clinical Signs:** Skin: Pruritic erythematous rash | Hair: Brittle | Oral: Normal\n**Medical History:** History: Diagnosed 2 years ago, no prior nutritional counseling\n**Eating Patterns:** Meals/day: 4 | Breakfast: 7:30 AM | Lunch: 12:00 PM | Dinner: 7:00 PM | Snacks: 10:00 AM | Cooking time: <15 minutes | Coffee: 1 | Water: <0.5L\n**Food Preferences:** Dislikes: Avoids anything green (pediatric) | Habits: Regular meal times\n**Restrictions:** Supplements: Iron IV infusions monthly\n**Appetite:** Appetite: Normal | Recent Changes: Appetite decreased during chemo cycle\n**Goals:** Seizure reduction (ketogenic therapy), Gout flare prevention, Weight gain (healthy), Weight gain (recovery from illness)\n**Additional Notes:** Hindu vegetarian (lacto-vegetarian)\n\n\n\n\n---\n\nOUTPUT FORMAT (follow exactly):\n\n# Diet Plan - Tiffany Krause\n\n## Summary\n- Target: [kcal] kcal/day\n- Macros: P [g]g | C [g]g | F [g]g\n- Key focus: [2-3 bullet points max based on patient data]\n\n\n## Weekly Meal Plan\n\nCRITICAL: You MUST write out EVERY meal for ALL 28 days across ALL 4 weeks. Each day must be unique.\n\n### Week 1\n\n| Day | Breakfast | Lunch | Dinner | Snacks | kcal |\n|-----|-----------|-------|--------|--------|------|\n| Mon | [unique meal] | [unique meal] | [unique meal] | [snack] | [total] |\n| Tue | [unique meal] | [unique meal] | [unique meal] | [snack] | [total] |\n| Wed | [unique meal] | [unique meal] | [unique meal] | [snack] | [total] |\n| Thu | [unique meal] | [unique meal] | [unique meal] | [snack] | [total] |\n| Fri | [unique meal] | [unique meal] | [unique meal] | [snack] | [total] |\n| Sat | [unique meal] | [unique meal] | [unique meal] | [snack] | [total] |\n| Sun | [unique meal] | [unique meal] | [unique meal] | [snack] | [total] |\n\n### Week 2\n\n| Day | Breakfast | Lunch | Dinner | Snacks | kcal |\n|-----|-----------|-------|--------|--------|------|\n| Mon | [unique meal] | [unique meal] | [unique meal] | [snack] | [total] |\n| Tue | [unique meal] | [unique meal] | [unique meal] | [snack] | [total] |\n| Wed | [unique meal] | [unique meal] | [unique meal] | [snack] | [total] |\n| Thu | [unique meal] | [unique meal] | [unique meal] | [snack] | [total] |\n| Fri | [unique meal] | [unique meal] | [unique meal] | [snack] | [total] |\n| Sat | [unique meal] | [unique meal] | [unique meal] | [snack] | [total] |\n| Sun | [unique meal] | [unique meal] | [unique meal] | [snack] | [total] |\n\n### Week 3\n\n| Day | Breakfast | Lunch | Dinner | Snacks | kcal |\n|-----|-----------|-------|--------|--------|------|\n| Mon | [unique meal] | [unique meal] | [unique meal] | [snack] | [total] |\n| Tue | [unique meal] | [unique meal] | [unique meal] | [snack] | [total] |\n| Wed | [unique meal] | [unique meal] | [unique meal] | [snack] | [total] |\n| Thu | [unique meal] | [unique meal] | [unique meal] | [snack] | [total] |\n| Fri | [unique meal] | [unique meal] | [unique meal] | [snack] | [total] |\n| Sat | [unique meal] | [unique meal] | [unique meal] | [snack] | [total] |\n| Sun | [unique meal] | [unique meal] | [unique meal] | [snack] | [total] |\n\n### Week 4\n\n| Day | Breakfast | Lunch | Dinner | Snacks | kcal |\n|-----|-----------|-------|--------|--------|------|\n| Mon | [unique meal] | [unique meal] | [unique meal] | [snack] | [total] |\n| Tue | [unique meal] | [unique meal] | [unique meal] | [snack] | [total] |\n| Wed | [unique meal] | [unique meal] | [unique meal] | [snack] | [total] |\n| Thu | [unique meal] | [unique meal] | [unique meal] | [snack] | [total] |\n| Fri | [unique meal] | [unique meal] | [unique meal] | [snack] | [total] |\n| Sat | [unique meal] | [unique meal] | [unique meal] | [snack] | [total] |\n| Sun | [unique meal] | [unique meal] | [unique meal] | [snack] | [total] |\n\n\n## Foods\n\n### Include\n- [food]: [portion] - [brief reason based on labs/conditions]\n\n### Avoid\n- [food]: [brief reason based on labs/conditions]\n\n## Notes\n- [2-4 practical tips based on patient's eating patterns/lifestyle]\n\n---\nEND OF PLAN", "diet": {"content": "# Diet Plan - Tiffany Krause\n\n## Summary\n- Target: 2200 kcal/day\n- Macros: P 110g | C 30g | F 185g\n- Key focus: \n    - High-fat ketogenic ratio to support seizure reduction and recovery.\n    - Nutrient-dense, non-green, lacto-vegetarian foods to manage folate deficiency and dietary preferences.\n    - High-calorie, easy-to-prepare meals to support healthy weight gain during recovery.\n\n## Data Consistency Notes\n- Goal conflict: Patient is categorized as Overweight (BMI 29) but requests Weight Gain; plan prioritizes weight gain for recovery from illness/chemo.\n\n## Weekly Meal Plan\n\n### Week 1\n\n| Day | Breakfast | Lunch | Dinner | Snacks | kcal |\n|-----|-----------|-------|--------|--------|------|\n| Mon | Full-fat Greek yogurt with walnuts | Paneer sautéed with red bell peppers | Cauliflower rice in heavy cream | Macadamia nuts | 2180 |\n| Tue | Chia pudding with coconut cream | Halloumi cheese with olives | Creamy mushroom soup (no herbs) | Cheddar cheese slices | 2210 |\n| Wed | Cottage cheese with raspberries | Tofu with sesame oil and garlic | Cauliflower mash with butter | Almonds | 2150 |\n| Thu | Coconut yogurt with sunflower seeds | Roasted cauliflower with parmesan | Paneer in tomato cream sauce | Pecans | 2230 |\n| Fri | Ricotta cheese with blueberries | Eggplant sautéed in olive oil | Cauliflower au gratin with cheese | Walnuts | 2190 |\n| Sat | Full-fat milk with whey protein | Mushroom and feta sauté | Cauliflower and cheese bake | Brazil nuts | 2205 |\n| Sun | Whipped cream with strawberries | Tofu with peanut sauce | Paneer tikka (tomato base) | Cheese cubes | 2175 |\n\n### Week 2\n\n| Day | Breakfast | Lunch | Dinner | Snacks | kcal |\n|-----|-----------|-------|--------|--------|------|\n| Mon | Greek yogurt with sliced almonds | Halloumi and tomato salad | Cauliflower with melted butter | Cashews | 2220 |\n| Tue | Chia pudding with raspberries | Paneer with sautéed mushrooms | Creamy tomato and coconut soup | Pecans | 2195 |\n| Wed | Cottage cheese with peach slices | Tofu with garlic and sesame | Eggplant with melted mozzarella | Walnuts | 2160 |\n| Thu | Coconut yogurt with flax seeds | Cauliflower with olive oil | Paneer in heavy cream sauce | Macadamia nuts | 2240 |\n| Fri | Ricotta with crushed walnuts | Mushroom and feta stir-fry | Cauliflower cheese bake | Almonds | 2185 |\n| Sat | Milk with chia seeds | Tofu with peanut butter sauce | Red bell pepper and cheese bake | Brazil nuts | 2215 |\n| Sun | Yogurt with sunflower seeds | Paneer with sautéed onions | Cauliflower in cream sauce | Cheddar cheese | 2190 |\n\n### Week 3\n\n| Day | Breakfast | Lunch | Dinner | Snacks | kcal |\n|-----|-----------|-------|--------|--------|------|\n| Mon | Chia pudding with coconut milk | Halloumi with red peppers | Mushroom and cream stew | Pecans | 2205 |\n| Tue | Cottage cheese with strawberries | Tofu with sesame seeds | Cauliflower with parmesan | Walnuts | 2170 |\n| Wed | Coconut yogurt with almonds | Paneer with tomato sauce | Eggplant with garlic and oil | Macadamia nuts | 2225 |\n| Thu | Ricotta with blueberries | Cauliflower with garlic butter | Mushroom and cheese sauté | Almonds | 2180 |\n| Fri | Milk with protein powder | Tofu in peanut sauce | Paneer in creamy tomato sauce | Brazil nuts | 2210 |\n| Sat | Yogurt with walnuts | Halloumi with olives | Cauliflower au gratin | Cashews | 2195 |\n| Sun | Chia pudding with raspberries | Paneer with mushrooms | Creamy tomato soup | Pecan halves | 2235 |\n\n### Week 4\n\n| Day | Breakfast | Lunch | Dinner | Snacks | kcal |\n|-----|-----------|-------|--------|--------|------|\n| Mon | Cottage cheese with peaches | Tofu with garlic oil | Cauliflower with butter | Walnuts | 2165 |\n| Tue | Coconut yogurt with flax | Halloumi with bell peppers | Paneer in tomato sauce | Macadamia nuts | 2245 |\n| Wed | Ricotta with walnuts | Mushroom and feta bake | Cauliflower with cheese | Almonds | 2190 |\n| Thu | Milk with chia seeds | Tofu with peanut sauce | Red pepper and cheese sauté | Brazil nuts | 2200 |\n| Fri | Yogurt with sunflower seeds | Paneer with onions | Cauliflower in heavy cream | Cheddar cheese | 2185 |\n| Sat | Chia pudding with coconut | Halloumi with olives | Eggplant with garlic | Cashews | 2215 |\n| Sun | Cottage cheese with berries | Tofu with sesame oil | Cauliflower with parmesan | Pecans | 2175 |\n\n## Foods\n\n### Include\n- Paneer: High protein and fat for keto/weight gain\n- Full-fat Greek Yogurt: Protein, fat, and folate support\n- Walnuts/Macadamias: Monounsaturated fats for LDL management\n- Cauliflower: Low-carb vegetable alternative\n- Red Lentils (small amounts): Folate source\n- Olive Oil: Heart-healthy fat for LDL management\n- Mushrooms: Low-carb, nutrient-dense volume\n\n### Avoid\n- Shellfish (shrimp, crab, lobster): Severe allergy\n- Green vegetables (spinach, broccoli, peas): Patient preference\n- High-carb grains (rice, wheat, corn): Ketogenic requirement\n- High-sugar fruits: Ketogenic requirement\n- Green herbs (parsley, cilantro): Patient preference\n\n## Notes\n- **Preparation:** Focus on \"assembly\" meals (yogurt, cheese, nuts) to meet the <15 minute cooking requirement.\n- **Hydration:** Increase water intake significantly; low hydration can trigger gout flares during ketogenic dieting.\n- **Folate:** Since folate is low, prioritize dairy and small amounts of red lentils as listed.\n- **LDL Management:** While keto is high-fat, prioritize olive oil and nut fats over excessive butter to help manage high LDL levels.\n\n---\nEND OF PLAN", "temperature": 0.4, "model": "gemma-4-26b-a4b-it", "provider": "gemini", "reasoning": true}, "meethealth": {"package": "meethealth-sample-v1", "package_version": "1.0.0", "source_corpus": "gemma_diets", "source_line": 168524, "contract": "diet_plan@1.0.0", "contract_fingerprint": "1a6c5cf6b9d37193", "gate_rules_evaluated": 45, "gate_failures": [], "package_checks": {"plan_language": {"pass": true, "detail": "english markers=4"}, "completeness_28_days": {"pass": true, "detail": "day_rows=28 weeks=4 terminated=True"}, "no_duplicate_days": {"pass": true, "detail": "duplicate_days=0"}, "macro_arithmetic": {"pass": true, "detail": "target=2200 kcal, 4P+4C+9F=2225 kcal, deviation=1.1%"}, "energy_dose_plausible": {"pass": true, "detail": "26.7 kcal/kg (screen 15-45)"}, "protein_dose_plausible": {"pass": true, "detail": "1.33 g/kg (screen 0.8-1.6)"}, "daily_energy_on_target": {"pass": true, "detail": "days_outside_10pct=0 of 28"}, "allergen_screen": {"pass": true, "detail": "screened=['shellfish', 'fish'] hits=[]"}, "hyperkalemia_food_screen": {"pass": true, "detail": "not applicable (K <= 5.0 or absent)"}, "scenario_coherence": {"pass": true, "detail": "ok"}}, "evidence_level": "L2_automated_checks_passed", "expert_review": "not_performed"}}
{"patient_id": "a81013c3-ef8c-4188-bfcf-bbe2fe7c4493", "patient_data": {"id": "a81013c3-ef8c-4188-bfcf-bbe2fe7c4493", "name": "James Butler", "age": 55, "age_group": "middle_age_51_65y", "gender": "male", "region": "Singapore", "language": "en", "occupation": "Homeless/Housing insecure", "conditions": "Overweight (BMI 25-29.9)", "allergies": "Fish (specific: salmon, tuna)", "goals": "Dumping syndrome management, Pressure ulcer prevention/healing", "preferences": "Ovo-vegetarian", "weight": 86.3, "height": 172.8, "bmi": 28.9, "activity_level": "moderately_active", "muac": 22.1, "waist_circumference": 141.6, "hip_circumference": 134.1, "calf_circumference": 28.7, "skin_condition": "Pruritic erythematous rash", "hair_condition": "Premature graying", "oral_health": "Glossitis", "clinical_history": "Post-COVID recovery, persistent fatigue", "weight_change": "Gained 8 kg in last 6 months", "dietary_recall_24h": "Breakfast: 1 cup oatmeal with banana and honey\nLunch: Fish tacos with beans and salsa\nDinner: Grilled salmon with vegetables and quinoa\nSnacks: Protein bar", "total_calories": 1610, "total_protein": 58.9, "total_carbohydrates": 185.4, "total_fat": 70.3, "total_fiber": 10.9, "total_sugar": 38.6, "total_saturated_fat": 28.0, "total_sodium": 2633, "bmr_formula": "Mifflin-St Jeor", "bmr": 1673, "tdee": 2593, "macro_split": {"carbsPercent": 60, "proteinPercent": 15, "fatPercent": 25}, "meals_per_day": 3, "cooking_time": "No cooking ability (caregiver prepares)", "water_intake_per_day": ">3L", "coffee_cups_per_day": 0, "food_aversions": "Cannot tolerate strong smells, Dislikes eggs", "appetite_assessment": "Normal", "prompt_mode": "standard", "clinical_analysis_depth": "basic", "food_security": "moderate_insecurity", "socioeconomic_context": "Low-income household, relies on government food assistance"}, "prompt": "You are a clinical nutritionist creating a diet plan. Generate all content in ENGLISH.\n\nPATIENT DATA VALIDITY CHECK (perform silently BEFORE writing the plan):\nBefore recommending anything, screen the patient record for biologically-impossible or logically-contradictory entries. Common red flags:\n  - Sex-specific conditions on the wrong sex (e.g. PCOS, endometriosis, ovarian/cervical/uterine/menopause conditions on a male patient; prostate, BPH, testicular, erectile conditions on a female patient)\n  - Pregnancy-related fields on a male patient (is_pregnant=true, gestational diabetes, preeclampsia, hyperemesis, lactation, postpartum)\n  - Pregnancy in a patient outside the plausible age range (under 12 or over 55)\n  - Adult-onset chronic conditions on very young patients (coronary artery disease, Parkinson's, Alzheimer's/dementia, menopause, BPH, osteoporosis, COPD, sarcopenia in patients under the typical onset age)\n  - Eating disorders (anorexia, bulimia, BED, ARFID adult form) on patients under 10\n  - Bariatric surgery history on patients under 14\n  - Occupation/age mismatch (retired at 25, elementary school student at 30, toddler listed as lawyer, etc.)\n  - Impossible anthropometrics (BMI under 11 or over 70, infant weight over 15 kg, toddler weight over 25 kg)\n  - Mutually exclusive conditions present together (Obesity + Underweight, Type 1 + Type 2 diabetes)\n  - Allergies that contradict declared dietary patterns\n\nIf you detect any such issue:\n  1. Do NOT silently \"play along\" with the impossibility.\n  2. Add a short `## Data Consistency Notes` block right after the Summary, listing each flagged issue in one line.\n  3. Choose the safest clinically-defensible interpretation (e.g. ignore the sex-mismatched condition; use the nearest reasonable age band; drop contradictory conditions) and generate the plan on that basis.\n  4. Never recommend a therapy driven by an impossible condition (e.g. do not prescribe ketogenic therapy for \"epilepsy\" if the record also implies contraindications like active breastfeeding, hepatic steatosis, or pregnancy unless a seizure disorder is clearly present).\n  5. For any declared allergy, the meal tables MUST NOT contain that food or its common derivatives. Allergens may only appear inside the `### Avoid` section with explicit avoidance wording.\n\nSTRICT RULES:\n1. Output ONLY markdown - no preamble, no \"Here is...\", no greetings, no sign-offs\n2. Be CONCISE - use tables, bullets, short sentences\n3. Use TABLES for meal plans (mandatory)\n4. NO lengthy explanations unless customInstructions requests detail\n5. Start directly with the H1 title\n6. USE ALL patient data provided to personalize the plan\n7. EVERY DAY must have UNIQUE meals - NO \"repeat day X\" or \"same as above\" - write out ALL 28 days completely.\n8. Provide VARIETY - different foods each day, rotate proteins, vegetables, grains\n\n\n\n\n**Patient:** Name: James Butler | Age: 55 | Gender: male | Conditions: Overweight (BMI 25-29.9) | Allergies: Fish (specific: salmon, tuna) | Region: Singapore | Occupation: Homeless/Housing insecure\n**Anthropometrics:** Wt: 86.3kg | Ht: 172.8cm | BMI: 28.9 | Activity: moderately active\n**Body Circumferences:** MUAC: 22.1cm | Waist: 141.6cm | Hip: 134.1cm | Calf: 28.7cm\n**Clinical Signs:** Skin: Pruritic erythematous rash | Hair: Premature graying | Oral: Glossitis | Weight Change: Gained 8 kg in last 6 months\n**Medical History:** History: Post-COVID recovery, persistent fatigue\n**Energy Targets:** Formula: Mifflin-St Jeor | BMR: 1673kcal | TDEE: 2593kcal | Macro Target: C60/P15/F25%\n**Current Intake (24h):** Cal: 1610 | P: 58.9g | C: 185.4g | F: 70.3g | Fiber: 10.9g | Sugar: 38.6g | SatFat: 28.0g | Na: 2633mg\n**24h Recall:** Breakfast: 1 cup oatmeal with banana and honey\nLunch: Fish tacos with beans and salsa\nDinner: Grilled salmon with vegetables and quinoa\nSnacks: Protein bar\n**Eating Patterns:** Meals/day: 3 | Cooking time: No cooking ability (caregiver prepares) | Water: >3L\n**Food Preferences:** Dislikes: Cannot tolerate strong smells, Dislikes eggs\n**Appetite:** Appetite: Normal\n**Goals:** Dumping syndrome management, Pressure ulcer prevention/healing\n**Additional Notes:** Ovo-vegetarian\n\n\n\nSPECIAL POPULATION CONTEXT:\nFOOD SECURITY STATUS: moderate insecurity\nContext: Low-income household, relies on government food assistance\nIMPORTANT: Recommend affordable, accessible foods. Prioritize staple foods with high nutritional density. Include budget-friendly protein sources and shelf-stable options. Consider food bank/assistance program availability.\n\n\n---\n\nOUTPUT FORMAT (follow exactly):\n\n# Diet Plan - James Butler\n\n## Summary\n- Target: [kcal] kcal/day\n- Macros: P [g]g | C [g]g | F [g]g\n- Key focus: [2-3 bullet points max based on patient data]\n\n\n## Weekly Meal Plan\n\nCRITICAL: You MUST write out EVERY meal for ALL 28 days across ALL 4 weeks. Each day must be unique.\n\n### Week 1\n\n| Day | Breakfast | Lunch | Dinner | Snacks | kcal |\n|-----|-----------|-------|--------|--------|------|\n| Mon | [unique meal] | [unique meal] | [unique meal] | [snack] | [total] |\n| Tue | [unique meal] | [unique meal] | [unique meal] | [snack] | [total] |\n| Wed | [unique meal] | [unique meal] | [unique meal] | [snack] | [total] |\n| Thu | [unique meal] | [unique meal] | [unique meal] | [snack] | [total] |\n| Fri | [unique meal] | [unique meal] | [unique meal] | [snack] | [total] |\n| Sat | [unique meal] | [unique meal] | [unique meal] | [snack] | [total] |\n| Sun | [unique meal] | [unique meal] | [unique meal] | [snack] | [total] |\n\n### Week 2\n\n| Day | Breakfast | Lunch | Dinner | Snacks | kcal |\n|-----|-----------|-------|--------|--------|------|\n| Mon | [unique meal] | [unique meal] | [unique meal] | [snack] | [total] |\n| Tue | [unique meal] | [unique meal] | [unique meal] | [snack] | [total] |\n| Wed | [unique meal] | [unique meal] | [unique meal] | [snack] | [total] |\n| Thu | [unique meal] | [unique meal] | [unique meal] | [snack] | [total] |\n| Fri | [unique meal] | [unique meal] | [unique meal] | [snack] | [total] |\n| Sat | [unique meal] | [unique meal] | [unique meal] | [snack] | [total] |\n| Sun | [unique meal] | [unique meal] | [unique meal] | [snack] | [total] |\n\n### Week 3\n\n| Day | Breakfast | Lunch | Dinner | Snacks | kcal |\n|-----|-----------|-------|--------|--------|------|\n| Mon | [unique meal] | [unique meal] | [unique meal] | [snack] | [total] |\n| Tue | [unique meal] | [unique meal] | [unique meal] | [snack] | [total] |\n| Wed | [unique meal] | [unique meal] | [unique meal] | [snack] | [total] |\n| Thu | [unique meal] | [unique meal] | [unique meal] | [snack] | [total] |\n| Fri | [unique meal] | [unique meal] | [unique meal] | [snack] | [total] |\n| Sat | [unique meal] | [unique meal] | [unique meal] | [snack] | [total] |\n| Sun | [unique meal] | [unique meal] | [unique meal] | [snack] | [total] |\n\n### Week 4\n\n| Day | Breakfast | Lunch | Dinner | Snacks | kcal |\n|-----|-----------|-------|--------|--------|------|\n| Mon | [unique meal] | [unique meal] | [unique meal] | [snack] | [total] |\n| Tue | [unique meal] | [unique meal] | [unique meal] | [snack] | [total] |\n| Wed | [unique meal] | [unique meal] | [unique meal] | [snack] | [total] |\n| Thu | [unique meal] | [unique meal] | [unique meal] | [snack] | [total] |\n| Fri | [unique meal] | [unique meal] | [unique meal] | [snack] | [total] |\n| Sat | [unique meal] | [unique meal] | [unique meal] | [snack] | [total] |\n| Sun | [unique meal] | [unique meal] | [unique meal] | [snack] | [total] |\n\n\n## Foods\n\n### Include\n- [food]: [portion] - [brief reason based on labs/conditions]\n\n### Avoid\n- [food]: [brief reason based on labs/conditions]\n\n## Notes\n- [2-4 practical tips based on patient's eating patterns/lifestyle]\n\n---\nEND OF PLAN", "diet": {"content": "# Diet Plan - James Butler\n\n## Summary\n- Target: 2593 kcal/day\n- Macros: P 97g | C 389g | F 72g\n- Key focus: \n    - High-protein plant staples to support pressure ulcer healing and tissue repair.\n    - Complex, low-glycemic carbohydrates to manage dumping syndrome and stabilize energy.\n    - Micronutrient-dense, affordable foods to address clinical signs of deficiency (glossitis, rash).\n\n## Weekly Meal Plan\n\n### Week 1\n\n| Day | Breakfast | Lunch | Dinner | Snacks | kcal |\n|-----|-----------|-------|--------|--------|------|\n| Mon | Oats with soy milk, banana, and chia seeds | Tofu stir-fry with brown rice and bok choy | Lentil stew with whole wheat bread | Apple with peanut butter | 2590 |\n| Tue | Chia pudding with soy milk and berries | Chickpea and cucumber salad wrap | Tempeh with steamed sweet potato and carrots | Soy yogurt with walnuts | 2600 |\n| Wed | Whole wheat toast with avocado and hemp seeds | Black bean and corn salad with quinoa | Whole wheat pasta with white beans and spinach | Banana with almond butter | 2585 |\n| Thu | Muesli with soy milk and sliced pear | Tofu and vegetable noodle soup | Lentil soup with whole grain crackers | Orange and roasted peanuts | 2595 |\n| Fri | Quinoa porridge with coconut milk and fruit | Black bean tacos with corn tortillas and salsa | Tempeh with brown rice and broccoli | Soy milk and a banana | 2610 |\n| Sat | Millet porridge with soy milk and nuts | Chickpea curry (mild) with brown rice | Tofu with quinoa and steamed zucchini | Pear and cashew nuts | 2580 |\n| Sun | Buckwheat porridge with berries and seeds | Bean and vegetable medley with couscous | Whole wheat pasta with lentil bolognese | Peach and walnuts | 2590 |\n\n### Week 2\n\n| Day | Breakfast | Lunch | Dinner | Snacks | kcal |\n|-----|-----------|-------|--------|--------|------|\n| Mon | Oats with soy milk and diced apple | Tofu and sweet potato hash | Lentil pasta with mixed vegetables | Banana and peanut butter | 2595 |\n| Tue | Chia seed pudding with mango | Chickpea and quinoa salad bowl | Tempeh stir-fry with brown rice | Almonds and a pear | 2605 |\n| Wed | Whole wheat toast with nut butter | Black bean and rice bowl | Tofu noodle bowl with cabbage | Soy yogurt and sunflower seeds | 2585 |\n| Thu | Soy milk with muesl and banana | Lentil stew with brown rice | Tempeh with broccoli and quinoa | Apple and walnuts | 2590 |\n| Fri | Quinoa with soy milk and berries | Chickpea wrap with avocado | Bean and vegetable soup with bread | Banana and soy milk | 2600 |\n| Sat | Millet porridge with soy milk and peach | Tofu and spinach rice bowl | Lentil curry with brown rice | Cashews and an orange | 2585 |\n| Sun | Buckwheat with soy milk and nuts | Black bean and quinoa salad | Tempeh and whole wheat pasta | Soy yogurt and almonds | 2590 |\n\n### Week 3\n\n| Day | Breakfast | Lunch | Dinner | Snacks | kcal |\n|-----|-----------|-------|--------|--------|------|\n| Mon | Oats with walnuts and soy milk | Chickpea and rice bowl with carrots | Tofu and vegetable stew | Apple and peanut butter | 2595 |\n| Tue | Chia pudding with banana | Lentil salad with whole wheat bread | Tempeh with brown rice and peas | Soy yogurt and berries | 2600 |\n| Wed | Whole wheat toast with avocado | Bean and corn salad with quinoa | Pasta with chickpea and veggie sauce | Pear and mixed nuts | 2580 |\n| Thu | Muesli with soy milk and berries | Tofu and vegetable noodle soup | Lentil soup with whole grain toast | Banana and almonds | 2590 |\n| Fri | Quinoa with soy milk and sliced pear | Chickpea and vegetable wrap | Tempeh with brown rice and carrots | Walnuts and an apple | 2610 |\n| Sat | Millet porridge with soy milk and nuts | Black bean and rice bowl | Tofu with sweet potato and broccoli | Soy milk and a banana | 2585 |\n| Sun | Buckwheat with soy milk and fruit | Lentil and quinoa bowl | Bean and vegetable pasta | Almonds and a pear | 2590 |\n\n### Week 4\n\n| Day | Breakfast | Lunch | Dinner | Snacks | kcal |\n|-----|-----------|-------|--------|--------|------|\n| Mon | Oats with soy milk and banana | Tofu and rice with green peas | Chickpea stew with whole wheat bread | Peanut butter and apple | 2595 |\n| Tue | Chia pudding with berries | Tempeh and brown rice with spinach | Lentil soup with quinoa | Soy yogurt and seeds | 2600 |\n| Wed | Whole wheat toast with almond butter | Black bean and quinoa salad | Tofu and vegetable pasta | Banana and walnuts | 2585 |\n| Thu | Muesli with soy milk and peach | Chickpea and sweet potato bowl | Tempeh noodle bowl | Pear and almonds | 2590 |\n| Fri | Quinoa with soy milk and berries | Lentil and rice bowl with carrots | Bean and tofu stir-fry | Apple and cashews | 2605 |\n| Sat | Millet porridge with banana | Tofu and rice with cabbage | Chickpea pasta with vegetables | Soy yogurt and seeds | 2580 |\n| Sun | Buckwheat with soy milk and nuts | Tempeh and brown rice with bok choy | Lentil stew with whole wheat toast | Banana and peanut butter | 2590 |\n\n## Foods\n\n### Include\n- Tofu/Tempeh: High-quality plant protein for pressure ulcer healing.\n- Lentils/Beans/Chickpeas: Protein and fiber to manage dumping syndrome and support satiety.\n- Oats/Brown Rice/Quinoa: Complex carbohydrates to prevent rapid glucose spikes.\n- Soy Milk: Affordable, nutrient-dense protein and calcium source.\n- Leafy Greens (Bok Choy/Spinach): Essential micronutrients (Iron, B-vitamins) for skin and oral health.\n- Nuts/Seeds: Healthy fats and zinc for skin/hair health and calorie density.\n\n### Avoid\n- Salmon/Tuna: Declared fish allergy.\n- Eggs: Patient preference/dislike.\n- Simple Sugars (Honey/Syrups): To manage dumping syndrome.\n- Strong Spices/Aromatics: To accommodate smell sensitivity.\n\n## Notes\n- **Small, Frequent Meals:** To manage dumping syndrome, ensure meals are eaten slowly and avoid drinking large amounts of liquid during meals.\n- **Budget Strategy:** Focus on bulk-buying dried lentils, beans, rice, and oats, which are highly nutritious and cost-effective in Singapore.\n- **Texture & Smell:** Since the patient is sensitive to smells, serve meals at room temperature and avoid reheating foods that produce strong aromas.\n- **Pressure Ulcer Care:** Ensure the caregiver prioritizes the protein portions (tofu, beans, lentils) in every meal to facilitate wound healing.\n\n---\nEND OF PLAN", "temperature": 0.4, "model": "gemma-4-26b-a4b-it", "provider": "gemini", "reasoning": true}, "meethealth": {"package": "meethealth-sample-v1", "package_version": "1.0.0", "source_corpus": "gemma_diets", "source_line": 170250, "contract": "diet_plan@1.0.0", "contract_fingerprint": "1a6c5cf6b9d37193", "gate_rules_evaluated": 45, "gate_failures": [], "package_checks": {"plan_language": {"pass": true, "detail": "english markers=4"}, "completeness_28_days": {"pass": true, "detail": "day_rows=28 weeks=4 terminated=True"}, "no_duplicate_days": {"pass": true, "detail": "duplicate_days=0"}, "macro_arithmetic": {"pass": true, "detail": "target=2593 kcal, 4P+4C+9F=2592 kcal, deviation=0.0%"}, "energy_dose_plausible": {"pass": true, "detail": "30.0 kcal/kg (screen 15-45)"}, "protein_dose_plausible": {"pass": true, "detail": "1.12 g/kg (screen 0.8-1.6)"}, "daily_energy_on_target": {"pass": true, "detail": "days_outside_10pct=0 of 28"}, "allergen_screen": {"pass": true, "detail": "screened=['fish'] hits=[]"}, "hyperkalemia_food_screen": {"pass": true, "detail": "not applicable (K <= 5.0 or absent)"}, "scenario_coherence": {"pass": true, "detail": "ok"}}, "evidence_level": "L2_automated_checks_passed", "expert_review": "not_performed"}}
{"patient_id": "931c99ac-a76c-41cd-8056-5cf02134a68c", "patient_data": {"id": "931c99ac-a76c-41cd-8056-5cf02134a68c", "name": "Stacy Johnson", "age": 36, "age_group": "adult_31_50y", "gender": "female", "region": "Ireland", "language": "en", "occupation": "Sales representative", "conditions": "Sjögren's Syndrome, Systemic Lupus Erythematosus (SLE)", "goals": "Gout flare prevention, Autoimmune flare reduction", "preferences": "Traditional Chinese Medicine dietary therapy", "weight": 51.8, "height": 156.3, "bmi": 21.2, "activity_level": "very_active", "past_medical_history": "Tonsillectomy (childhood)", "dietary_recall_24h": "Breakfast: Coffee with cream and a pastry\nLunch: Pasta with meat sauce and bread\nDinner: Grilled salmon with vegetables and quinoa\nSnacks: Crackers with cheese", "total_calories": 1640, "total_protein": 47.3, "total_carbohydrates": 226.8, "total_fat": 60.4, "total_fiber": 26.5, "total_sugar": 46.3, "total_saturated_fat": 6.5, "total_sodium": 2918, "bmr_formula": "Schofield", "bmr": 1153, "tdee": 1989, "macro_split": {"carbsPercent": 60, "proteinPercent": 15, "fatPercent": 25}, "meals_per_day": 2, "cooking_time": "<15 minutes", "water_intake_per_day": "<0.5L", "coffee_cups_per_day": 5, "appetite_assessment": "Variable", "dietary_supplements": "Calcium 600mg + Vitamin D 400IU BID", "prompt_mode": "clinical", "clinical_analysis_depth": "basic"}, "prompt": "You are a senior clinical nutritionist with expertise in medical nutrition therapy creating a diet plan. Generate all content in ENGLISH.\n\n## ADVANCED CLINICAL MODE ENABLED\nThis dietary plan requires a clinically-driven approach with structured analysis of the nutritional anamnesis.\nYou MUST explicitly analyze and integrate key patient parameters before generating recommendations.\nAnalysis Depth: BASIC\n\nPATIENT DATA VALIDITY CHECK (perform silently BEFORE writing the plan):\nBefore recommending anything, screen the patient record for biologically-impossible or logically-contradictory entries. Common red flags:\n  - Sex-specific conditions on the wrong sex (e.g. PCOS, endometriosis, ovarian/cervical/uterine/menopause conditions on a male patient; prostate, BPH, testicular, erectile conditions on a female patient)\n  - Pregnancy-related fields on a male patient (is_pregnant=true, gestational diabetes, preeclampsia, hyperemesis, lactation, postpartum)\n  - Pregnancy in a patient outside the plausible age range (under 12 or over 55)\n  - Adult-onset chronic conditions on very young patients (coronary artery disease, Parkinson's, Alzheimer's/dementia, menopause, BPH, osteoporosis, COPD, sarcopenia in patients under the typical onset age)\n  - Eating disorders (anorexia, bulimia, BED, ARFID adult form) on patients under 10\n  - Bariatric surgery history on patients under 14\n  - Occupation/age mismatch (retired at 25, elementary school student at 30, toddler listed as lawyer, etc.)\n  - Impossible anthropometrics (BMI under 11 or over 70, infant weight over 15 kg, toddler weight over 25 kg)\n  - Mutually exclusive conditions present together (Obesity + Underweight, Type 1 + Type 2 diabetes)\n  - Allergies that contradict declared dietary patterns\n\nIf you detect any such issue:\n  1. Do NOT silently \"play along\" with the impossibility.\n  2. Add a short `## Data Consistency Notes` block right after the Summary, listing each flagged issue in one line.\n  3. Choose the safest clinically-defensible interpretation (e.g. ignore the sex-mismatched condition; use the nearest reasonable age band; drop contradictory conditions) and generate the plan on that basis.\n  4. Never recommend a therapy driven by an impossible condition (e.g. do not prescribe ketogenic therapy for \"epilepsy\" if the record also implies contraindications like active breastfeeding, hepatic steatosis, or pregnancy unless a seizure disorder is clearly present).\n  5. For any declared allergy, the meal tables MUST NOT contain that food or its common derivatives. Allergens may only appear inside the `### Avoid` section with explicit avoidance wording.\n\nSTRICT RULES:\n1. Output ONLY markdown - no preamble, no \"Here is...\", no greetings, no sign-offs\n2. Be CONCISE - use tables, bullets, short sentences\n3. Use TABLES for meal plans (mandatory)\n4. NO lengthy explanations unless customInstructions requests detail\n5. Start directly with the H1 title\n6. USE ALL patient data provided to personalize the plan\n7. EVERY DAY must have UNIQUE meals - NO \"repeat day X\" or \"same as above\" - write out ALL 28 days completely.\n8. Provide VARIETY - different foods each day, rotate proteins, vegetables, grains\n\n9. PERFORM complete clinical anamnesis analysis BEFORE generating the meal plan\n10. JUSTIFY each major dietary recommendation with clinical rationale\n11. USE PES (Problem-Etiology-Signs/Symptoms) format for nutritional diagnoses\n12. INCLUDE monitoring parameters and follow-up indicators\n\n\n## CLINICAL NUTRITIONAL ANAMNESIS ANALYSIS\n\nYou MUST perform a structured, systematic analysis of the patient's nutritional anamnesis before generating the diet plan.\n\n**Analysis Depth:** Provide a concise clinical analysis focusing on the most critical parameters.\n\n### 1. BIOCHEMICAL DATA ANALYSIS\nNo biochemical data available - recommend baseline laboratory assessment.\n\n### 2. CLINICAL DATA ANALYSIS\n**Current Medical Conditions:** Sjögren's Syndrome, Systemic Lupus Erythematosus (SLE)\n  - Nutritional implications: Disease-specific dietary modifications, nutrient-drug interactions\n\n\n### 3. ANTHROPOMETRIC DATA ANALYSIS\n**Primary Measurements:**\n  - Weight: 51.8 kg | Height: 156.3 cm | BMI: 21.2 kg/m²\n  - BMI Classification: Normal\n  - Activity Level: very active\n\n### 4. DIETARY DATA ANALYSIS\n**24-Hour Dietary Recall:**\nBreakfast: Coffee with cream and a pastry\nLunch: Pasta with meat sauce and bread\nDinner: Grilled salmon with vegetables and quinoa\nSnacks: Crackers with cheese\n\n### 5. CLINICAL SYNTHESIS & NUTRITIONAL DIAGNOSIS\n**Patient Goals:** Gout flare prevention, Autoimmune flare reduction\n\n**REQUIRED OUTPUT FOR CLINICAL MODE:**\n1. **Problem List (PES Format):** Identify 2-4 nutrition diagnoses using Problem-Etiology-Signs/Symptoms format\n2. **Priority Ranking:** Rank nutritional problems by clinical urgency\n3. **Intervention Rationale:** For each dietary recommendation, provide clinical justification\n4. **Monitoring Parameters:** Specify what should be monitored\n\n---\n\n**Patient:** Name: Stacy Johnson | Age: 36 | Gender: female | Conditions: Sjögren's Syndrome, Systemic Lupus Erythematosus (SLE) | Region: Ireland | Occupation: Sales representative\n**Anthropometrics:** Wt: 51.8kg | Ht: 156.3cm | BMI: 21.2 | Activity: very active\n**Medical History:** Past Medical: Tonsillectomy (childhood)\n**Energy Targets:** Formula: Schofield | BMR: 1153kcal | TDEE: 1989kcal | Macro Target: C60/P15/F25%\n**Current Intake (24h):** Cal: 1640 | P: 47.3g | C: 226.8g | F: 60.4g | Fiber: 26.5g | Sugar: 46.3g | SatFat: 6.5g | Na: 2918mg\n**24h Recall:** Breakfast: Coffee with cream and a pastry\nLunch: Pasta with meat sauce and bread\nDinner: Grilled salmon with vegetables and quinoa\nSnacks: Crackers with cheese\n**Eating Patterns:** Meals/day: 2 | Cooking time: <15 minutes | Coffee: 5 | Water: <0.5L\n**Restrictions:** Supplements: Calcium 600mg + Vitamin D 400IU BID\n**Appetite:** Appetite: Variable\n**Goals:** Gout flare prevention, Autoimmune flare reduction\n**Additional Notes:** Traditional Chinese Medicine dietary therapy\n\n\n\n\n---\n\nOUTPUT FORMAT (follow exactly):\n\n# Diet Plan - Stacy Johnson\n\n## Clinical Nutritional Anamnesis Analysis\n\n### 1. Biochemical Data Analysis\n[Interpret lab values]\n\n### 2. Clinical Data Analysis\n[Medical conditions and dietary implications]\n\n### 3. Anthropometric Data Analysis\n[BMI classification and body composition]\n\n### 4. Dietary Data Analysis\n[24h recall interpretation and nutrient gap analysis]\n\n### 5. Nutritional Diagnosis (PES Format)\n| Priority | Problem | Etiology | Signs/Symptoms |\n|----------|---------|----------|----------------|\n| 1 | [Nutrition problem] | related to [etiology] | as evidenced by [S/S] |\n\n### 6. Intervention Rationale\n[Key intervention decisions with clinical justification]\n\n---\n\n## Summary\n- Target: [kcal] kcal/day\n- Macros: P [g]g | C [g]g | F [g]g\n- Key focus: [2-3 bullet points max based on patient data]\n- Clinical priorities: [Based on PES diagnoses above]\n\n## Weekly Meal Plan\n\nCRITICAL: You MUST write out EVERY meal for ALL 28 days across ALL 4 weeks. Each day must be unique.\n\n### Week 1\n\n| Day | Breakfast | Lunch | Dinner | Snacks | kcal |\n|-----|-----------|-------|--------|--------|------|\n| Mon | [unique meal] | [unique meal] | [unique meal] | [snack] | [total] |\n| Tue | [unique meal] | [unique meal] | [unique meal] | [snack] | [total] |\n| Wed | [unique meal] | [unique meal] | [unique meal] | [snack] | [total] |\n| Thu | [unique meal] | [unique meal] | [unique meal] | [snack] | [total] |\n| Fri | [unique meal] | [unique meal] | [unique meal] | [snack] | [total] |\n| Sat | [unique meal] | [unique meal] | [unique meal] | [snack] | [total] |\n| Sun | [unique meal] | [unique meal] | [unique meal] | [snack] | [total] |\n\n### Week 2\n\n| Day | Breakfast | Lunch | Dinner | Snacks | kcal |\n|-----|-----------|-------|--------|--------|------|\n| Mon | [unique meal] | [unique meal] | [unique meal] | [snack] | [total] |\n| Tue | [unique meal] | [unique meal] | [unique meal] | [snack] | [total] |\n| Wed | [unique meal] | [unique meal] | [unique meal] | [snack] | [total] |\n| Thu | [unique meal] | [unique meal] | [unique meal] | [snack] | [total] |\n| Fri | [unique meal] | [unique meal] | [unique meal] | [snack] | [total] |\n| Sat | [unique meal] | [unique meal] | [unique meal] | [snack] | [total] |\n| Sun | [unique meal] | [unique meal] | [unique meal] | [snack] | [total] |\n\n### Week 3\n\n| Day | Breakfast | Lunch | Dinner | Snacks | kcal |\n|-----|-----------|-------|--------|--------|------|\n| Mon | [unique meal] | [unique meal] | [unique meal] | [snack] | [total] |\n| Tue | [unique meal] | [unique meal] | [unique meal] | [snack] | [total] |\n| Wed | [unique meal] | [unique meal] | [unique meal] | [snack] | [total] |\n| Thu | [unique meal] | [unique meal] | [unique meal] | [snack] | [total] |\n| Fri | [unique meal] | [unique meal] | [unique meal] | [snack] | [total] |\n| Sat | [unique meal] | [unique meal] | [unique meal] | [snack] | [total] |\n| Sun | [unique meal] | [unique meal] | [unique meal] | [snack] | [total] |\n\n### Week 4\n\n| Day | Breakfast | Lunch | Dinner | Snacks | kcal |\n|-----|-----------|-------|--------|--------|------|\n| Mon | [unique meal] | [unique meal] | [unique meal] | [snack] | [total] |\n| Tue | [unique meal] | [unique meal] | [unique meal] | [snack] | [total] |\n| Wed | [unique meal] | [unique meal] | [unique meal] | [snack] | [total] |\n| Thu | [unique meal] | [unique meal] | [unique meal] | [snack] | [total] |\n| Fri | [unique meal] | [unique meal] | [unique meal] | [snack] | [total] |\n| Sat | [unique meal] | [unique meal] | [unique meal] | [snack] | [total] |\n| Sun | [unique meal] | [unique meal] | [unique meal] | [snack] | [total] |\n\n\n## Foods\n\n### Include\n- [food]: [portion] - [brief reason based on labs/conditions]\n\n### Avoid\n- [food]: [brief reason based on labs/conditions]\n\n## Notes\n- [2-4 practical tips based on patient's eating patterns/lifestyle]\n\n## Monitoring Parameters\n\n### Indicators to Evaluate\n| Parameter | Current Value | Target | Timeline |\n|-----------|---------------|--------|----------|\n| [parameter] | [current] | [goal] | [weeks] |\n\n### Recommended Follow-up\n- Next appointment: [timeframe]\n- Follow-up labs: [which tests, when]\n- Warning signs: [symptoms requiring immediate attention]\n\n---\nEND OF PLAN", "diet": {"content": "# Diet Plan - Stacy Johnson\n\n## Clinical Nutritional Anamnesis Analysis\n\n### 1. Biochemical Data Analysis\nNo biochemical data provided. Baseline laboratory assessment is urgently recommended, specifically: Serum Uric Acid (for gout), Serum Creatinine/eGFR (renal function for SLE/Gout), CRP/ESR (inflammation markers), and a complete metabolic panel.\n\n### 2. Clinical Data Analysis\n- **Sjögren's Syndrome:** Characterized by xerostomia (dry mouth). Requires high fluid intake and \"moist\" food textures to facilitate swallowing and prevent oral infections.\n- **Systemic Lupus Erythematosus (SLE):** Systemic autoimmune inflammation. Requires an anti-inflammatory dietary pattern (rich in Omega-3 and antioxidants) to reduce flare frequency.\n- **Gout:** Requires a low-purine diet to prevent the crystallization of uric acid in joints. This necessitates the restriction of red meats, organ meats, and certain seafood.\n\n### 3. Anthropometric Data Analysis\n- **BMI:** 21.2 kg/m² (Normal).\n- **Body Composition:** Weight is stable; however, \"very active\" status combined with a caloric deficit (1640 kcal vs 1989 kcal TDEE) may lead to lean muscle loss if protein intake is not optimized.\n\n### 4. Dietary Data Analysis\n- **Caloric Gap:** Current intake is ~350 kcal below TDEE.\n- **Hydration:** Critically low (<0.5L water/day). This is a high-risk factor for both Gout flares (concentrated uric acid) and Sjögren's symptoms.\n- **Sodium:** Elevated (2918mg), likely from processed snacks (crackers/pastries), which may exacerbate SLE-related edema or hypertension.\n- **Meal Pattern:** 2 meals/day is insufficient for a \"very active\" individual, leading to energy dips and variable appetite.\n\n### 5. Nutritional Diagnosis (PES Format)\n| Priority | Problem | Etiology | Signs/Symptoms |\n|----------|---------|----------|----------------|\n| 1 | Inadequate fluid intake | related to poor habits and Sjögren's syndrome | as evidenced by water intake <0.5L/day |\n| 2 | Excessive sodium intake | related to frequent consumption of processed foods | as evidenced by 24h recall Na 2918mg |\n| 3 | Risk of Gout flare | related to potential purine intake and dehydration | as evidenced by patient's stated goals |\n| 4 | Inadequate meal frequency | related to demanding occupation (Sales Rep) | as evidenced by 2 meals/day pattern |\n\n### 6. Intervention Rationale\n- **Low Purine Protocol:** Elimination of red meat and organ meats to lower serum uric acid and prevent gout flares.\n- **Hydration Strategy:** Increase water to >2.5L/day to facilitate uric acid excretion and alleviate xerostomia.\n- **Anti-Inflammatory Focus:** Increase Omega-3 (flaxseed, walnuts, fatty fish) and antioxidants to manage SLE inflammation.\n- **Texture Modification:** Incorporate sauces, soups, and smoothies to assist with Sjögren's-related dry mouth.\n- **Meal Frequency:** Shift to 3 meals and 2 snacks to stabilize energy for high activity levels.\n\n---\n\n## Summary\n- Target: 1989 kcal/day\n- Macros: P 75g | C 298g | F 55g\n- Key focus: Aggressive hydration, low-purine protein sources, and anti-inflammatory fats.\n- Clinical priorities: Prevent gout flares, manage autoimmune inflammation, and treat xerostomia.\n\n## Weekly Meal Plan\n\n### Week 1\n| Day | Breakfast | Lunch | Dinner | Snacks | kcal |\n|-----|-----------|-------|--------|--------|------|\n| Mon | Overnight oats with chia, blueberries, almond milk | Quinoa salad with chickpeas, cucumber, lemon-tahini | Baked cod with steamed bok choy and brown rice | Greek yogurt with honey | 1980 |\n| Tue | Avocado toast on sourdough with poached egg | Turkey wrap with hummus, spinach, and shredded carrots | Tofu stir-fry with broccoli, ginger, and jasmine rice | Sliced apple with almond butter | 1995 |\n| Wed | Smoothie: Spinach, banana, flaxseeds, soy milk | Lentil soup with carrots and a slice of rye bread | Grilled salmon with asparagus and quinoa | Cottage cheese with pineapple | 1970 |\n| Thu | Greek yogurt parfait with granola and raspberries | Egg salad sandwich on whole grain with lettuce | Chicken breast with sautéed zucchini and sweet potato | Hummus and carrot sticks | 1985 |\n| Fri | Chia seed pudding with mango and coconut milk | Pasta salad with pesto, cherry tomatoes, and mozzarella | Steamed sea bass with ginger, soy, and steamed kale | Pear slices and walnuts | 1990 |\n| Sat | Scrambled eggs with spinach and whole-wheat toast | Roasted vegetable wrap with feta and tzatziki | Turkey meatballs with zucchini noodles and marinara | Edamame with sea salt | 1975 |\n| Sun | Buckwheat pancakes with maple syrup and strawberries | Quinoa bowl with black beans, corn, and avocado | Baked trout with roasted cauliflower and wild rice | Orange slices and almonds | 1990 |\n\n### Week 2\n| Day | Breakfast | Lunch | Dinner | Snacks | kcal |\n|-----|-----------|-------|--------|--------|------|\n| Mon | Smoothie: Kale, pineapple, hemp seeds, oat milk | Tuna salad (light mayo) with celery on rye | Lemon chicken with sautéed spinach and farro | Rice cakes with avocado | 1980 |\n| Tue | Poached eggs on steamed asparagus and toast | Chickpea \"tuna\" salad wrap with arugula | Baked tofu with sesame, snap peas, and brown rice | Grapes and low-fat cheese | 1990 |\n| Wed | Steel-cut oats with walnuts and sliced pear | Turkey and swiss cheese sandwich on multigrain | Grilled shrimp with quinoa and sautéed peppers | Greek yogurt with seeds | 1985 |\n| Thu | Cottage cheese bowl with peaches and cinnamon | Lentil and spinach stew with a whole grain roll | Roasted chicken breast with carrots and polenta | Celery with peanut butter | 1970 |\n| Fri | Smoothie: Blueberry, almond butter, soy milk, oats | Caprese salad with quinoa and balsamic glaze | Cod fillets with lemon-caper sauce and steamed peas | Dried apricots and cashews | 1995 |\n| Sat | Whole grain waffles with blueberries and yogurt | Egg and avocado wrap with spinach | Turkey chili with kidney beans and brown rice | Sliced cucumber with hummus | 1980 |\n| Sun | Omelet with mushrooms, onions, and whole grain toast | Salmon salad with mixed greens and lemon vinaigrette | Tofu curry with cauliflower and basmati rice | Melon chunks with lime | 1990 |\n\n### Week 3\n| Day | Breakfast | Lunch | Dinner | Snacks | kcal |\n|-----|-----------|-------|--------|--------|------|\n| Mon | Overnight oats with raspberries and pumpkin seeds | Turkey breast salad with apple slices and walnuts | Baked halibut with sautéed swiss chard and quinoa | Low-fat kefir with berries | 1985 |\n| Tue | Smoothie: Mango, spinach, chia, coconut water | Hummus and roasted veggie pita with sprouts | Chicken skewers with bell peppers and couscous | Almonds and dark chocolate | 1990 |\n| Wed | Scrambled tofu with turmeric, kale, and toast | Quinoa and black bean bowl with lime-cilantro | Grilled salmon with steamed broccoli and wild rice | Apple slices with cottage cheese | 1975 |\n| Thu | Greek yogurt with sliced almonds and honey | Turkey and avocado sandwich on sourdough | Lentil pasta with spinach and lemon-garlic sauce | Roasted chickpeas | 1980 |\n| Fri | Chia pudding with blueberries and almond milk | Egg salad with avocado on whole grain crackers | Poached cod with sautéed leeks and brown rice | Pear and walnuts | 1995 |\n| Sat | Whole grain toast with ricotta and sliced strawberries | Chicken and vegetable soup with quinoa | Tofu steaks with roasted Brussels sprouts and farro | Sliced bell peppers and dip | 1980 |\n| Sun | Smoothie: Banana, peanut butter, soy milk, flax | Salmon wrap with cucumber, dill, and yogurt | Turkey breast with mashed cauliflower and green beans | Orange and pistachios | 1990 |\n\n### Week 4\n| Day | Breakfast | Lunch | Dinner | Snacks | kcal |\n|-----|-----------|-------|--------|--------|------|\n| Mon | Steel-cut oats with apricots and flaxseeds | Chickpea salad with feta, olives, and lemon | Baked chicken with roasted root vegetables and rice | Greek yogurt with honey | 1980 |\n| Tue | Poached eggs with sautéed spinach and rye toast | Turkey and cranberry wrap with mixed greens | Grilled trout with asparagus and quinoa | Apple and almond butter | 1990 |\n| Wed | Smoothie: Raspberry, kale, hemp seeds, oat milk | Lentil and vegetable curry with brown rice | Tofu stir-fry with bok choy and buckwheat noodles | Cottage cheese and pineapple | 1985 |\n| Thu | Greek yogurt with pomegranate and walnuts | Egg and avocado toast with microgreens | Baked cod with lemon, garlic, and steamed carrots | Hummus and celery | 1970 |\n| Fri | Overnight oats with mango and chia seeds | Tuna wrap with spinach, cucumber, and yogurt | Chicken breast with sautéed kale and sweet potato | Dried figs and almonds | 1995 |\n| Sat | Whole grain pancakes with banana and maple syrup | Quinoa salad with roasted beets and goat cheese | Turkey burgers (no bun) with avocado and salad | Edamame and sea salt | 1980 |\n| Sun | Omelet with bell peppers, spinach, and toast | Salmon and avocado bowl with brown rice | Tofu and vegetable stew with barley | Sliced pear and cheese | 1990 |\n\n## Foods\n\n### Include\n- **Fatty Fish (Salmon, Trout, Cod):** 100-150g (2-3x/week) - Omega-3s for SLE inflammation.\n- **Plant Proteins (Tofu, Lentils, Chickpeas):** 1/2 cup - Low-purine alternatives to red meat.\n- **Berries & Leafy Greens:** 1-2 cups - Antioxidants for autoimmune support.\n- **Healthy Fats (Avocado, Olive Oil, Walnuts):** 1-2 tbsp - Anti-inflammatory properties.\n- **Water/Herbal Teas:** >2.5L - Essential for uric acid clearance and Sjögren's.\n\n### Avoid\n- **Red Meat & Organ Meats:** High purine content; triggers gout flares.\n- **High-Fructose Corn Syrup/Sugary Pastries:** Increases uric acid levels.\n- **Excessive Salt/Processed Snacks:** Exacerbates SLE-related edema.\n- **Alcohol:** Inhibits uric acid excretion.\n\n## Notes\n- **Hydration Hack:** Carry a 1L bottle and set alarms every 2 hours to sip water; this is critical for your dry mouth and gout prevention.\n- **Texture Tip:** Since you have Sjögren's, add a tablespoon of olive oil, lemon juice, or low-sodium broth to any \"dry\" meal (like chicken or rice) to make swallowing easier.\n- **Quick Prep:** Use pre-washed spinach and frozen vegetable mixes to keep cooking time under 15 minutes.\n- **Coffee Limit:** Reduce coffee from 5 cups to 1-2; replace the rest with water or caffeine-free herbal teas to avoid dehydration.\n\n## Monitoring Parameters\n\n### Indicators to Evaluate\n| Parameter | Current Value | Target | Timeline |\n|-----------|---------------|--------|----------|\n| Water Intake | <0.5 L/day | >2.5 L/day | 2 weeks |\n| Sodium Intake | 2918 mg | <2300 mg | 4 weeks |\n| Meal Frequency | 2 meals/day | 3 meals + 2 snacks | 2 weeks |\n| Gout Flares | Patient reported | 0 flares | Ongoing |\n\n### Recommended Follow-up\n- **Next appointment:** 4 weeks for weight and symptom review.\n- **Follow-up labs:** Serum Uric Acid, CRP, and Creatinine in 6 weeks.\n- **Warning signs:** Sudden joint swelling/pain (Gout flare), severe fatigue, or increased oral dryness requiring medical intervention.\n\n---\nEND OF PLAN", "temperature": 0.4, "model": "gemma-4-31b-it", "provider": "gemini", "reasoning": true}, "meethealth": {"package": "meethealth-sample-v1", "package_version": "1.0.0", "source_corpus": "gemma_diets", "source_line": 184461, "contract": "diet_plan@1.0.0", "contract_fingerprint": "1a6c5cf6b9d37193", "gate_rules_evaluated": 45, "gate_failures": [], "package_checks": {"plan_language": {"pass": true, "detail": "english markers=4"}, "completeness_28_days": {"pass": true, "detail": "day_rows=28 weeks=4 terminated=True"}, "no_duplicate_days": {"pass": true, "detail": "duplicate_days=0"}, "macro_arithmetic": {"pass": true, "detail": "target=1989 kcal, 4P+4C+9F=1987 kcal, deviation=0.1%"}, "energy_dose_plausible": {"pass": true, "detail": "38.4 kcal/kg (screen 15-45)"}, "protein_dose_plausible": {"pass": true, "detail": "1.45 g/kg (screen 0.8-1.6)"}, "daily_energy_on_target": {"pass": true, "detail": "days_outside_10pct=0 of 28"}, "allergen_screen": {"pass": true, "detail": "no declared allergies"}, "hyperkalemia_food_screen": {"pass": true, "detail": "not applicable (K <= 5.0 or absent)"}, "scenario_coherence": {"pass": true, "detail": "ok"}}, "evidence_level": "L2_automated_checks_passed", "expert_review": "not_performed"}}
{"patient_id": "f1934ff7-290d-468f-bb86-b0bee5b436f6", "patient_data": {"id": "f1934ff7-290d-468f-bb86-b0bee5b436f6", "name": "Joshua Garcia", "age": 58, "age_group": "middle_age_51_65y", "gender": "male", "region": "Ireland", "language": "en", "occupation": "Shift worker (rotating)", "conditions": "Hypertension Stage 1", "allergies": "Fish (specific: salmon, tuna)", "goals": "Bone health / osteoporosis prevention", "preferences": "Hindu vegetarian (lacto-vegetarian)", "weight": 68.3, "height": 173.4, "bmi": 22.7, "activity_level": "moderately_active", "family_medical_history": "Mother: Breast cancer. Father: Hypertension, Hyperlipidemia.", "meals_per_day": 4, "meal_times": {"breakfast": "7:00 AM", "lunch": "12:30 PM", "dinner": "11:00 PM", "snacks": "3:00 PM"}, "cooking_time": "<5 minutes (microwave/ready-made)", "water_intake_per_day": ">3L", "coffee_cups_per_day": 0, "appetite_assessment": "Increased", "prompt_mode": "clinical", "clinical_analysis_depth": "comprehensive"}, "prompt": "You are a senior clinical nutritionist with expertise in medical nutrition therapy creating a diet plan. Generate all content in ENGLISH.\n\n## ADVANCED CLINICAL MODE ENABLED\nThis dietary plan requires a clinically-driven approach with structured analysis of the nutritional anamnesis.\nYou MUST explicitly analyze and integrate key patient parameters before generating recommendations.\nAnalysis Depth: COMPREHENSIVE\n\nPATIENT DATA VALIDITY CHECK (perform silently BEFORE writing the plan):\nBefore recommending anything, screen the patient record for biologically-impossible or logically-contradictory entries. Common red flags:\n  - Sex-specific conditions on the wrong sex (e.g. PCOS, endometriosis, ovarian/cervical/uterine/menopause conditions on a male patient; prostate, BPH, testicular, erectile conditions on a female patient)\n  - Pregnancy-related fields on a male patient (is_pregnant=true, gestational diabetes, preeclampsia, hyperemesis, lactation, postpartum)\n  - Pregnancy in a patient outside the plausible age range (under 12 or over 55)\n  - Adult-onset chronic conditions on very young patients (coronary artery disease, Parkinson's, Alzheimer's/dementia, menopause, BPH, osteoporosis, COPD, sarcopenia in patients under the typical onset age)\n  - Eating disorders (anorexia, bulimia, BED, ARFID adult form) on patients under 10\n  - Bariatric surgery history on patients under 14\n  - Occupation/age mismatch (retired at 25, elementary school student at 30, toddler listed as lawyer, etc.)\n  - Impossible anthropometrics (BMI under 11 or over 70, infant weight over 15 kg, toddler weight over 25 kg)\n  - Mutually exclusive conditions present together (Obesity + Underweight, Type 1 + Type 2 diabetes)\n  - Allergies that contradict declared dietary patterns\n\nIf you detect any such issue:\n  1. Do NOT silently \"play along\" with the impossibility.\n  2. Add a short `## Data Consistency Notes` block right after the Summary, listing each flagged issue in one line.\n  3. Choose the safest clinically-defensible interpretation (e.g. ignore the sex-mismatched condition; use the nearest reasonable age band; drop contradictory conditions) and generate the plan on that basis.\n  4. Never recommend a therapy driven by an impossible condition (e.g. do not prescribe ketogenic therapy for \"epilepsy\" if the record also implies contraindications like active breastfeeding, hepatic steatosis, or pregnancy unless a seizure disorder is clearly present).\n  5. For any declared allergy, the meal tables MUST NOT contain that food or its common derivatives. Allergens may only appear inside the `### Avoid` section with explicit avoidance wording.\n\nSTRICT RULES:\n1. Output ONLY markdown - no preamble, no \"Here is...\", no greetings, no sign-offs\n2. Be CONCISE - use tables, bullets, short sentences\n3. Use TABLES for meal plans (mandatory)\n4. NO lengthy explanations unless customInstructions requests detail\n5. Start directly with the H1 title\n6. USE ALL patient data provided to personalize the plan\n7. EVERY DAY must have UNIQUE meals - NO \"repeat day X\" or \"same as above\" - write out ALL 28 days completely.\n8. Provide VARIETY - different foods each day, rotate proteins, vegetables, grains\n\n9. PERFORM complete clinical anamnesis analysis BEFORE generating the meal plan\n10. JUSTIFY each major dietary recommendation with clinical rationale\n11. USE PES (Problem-Etiology-Signs/Symptoms) format for nutritional diagnoses\n12. INCLUDE monitoring parameters and follow-up indicators\n\n\n## CLINICAL NUTRITIONAL ANAMNESIS ANALYSIS\n\nYou MUST perform a structured, systematic analysis of the patient's nutritional anamnesis before generating the diet plan.\n\n**Analysis Depth:** Provide a thorough clinical analysis covering all major domains with clinical correlations.\n\n### 1. BIOCHEMICAL DATA ANALYSIS\nNo biochemical data available - recommend baseline laboratory assessment.\n\n### 2. CLINICAL DATA ANALYSIS\n**Current Medical Conditions:** Hypertension Stage 1\n  - Nutritional implications: Disease-specific dietary modifications, nutrient-drug interactions\n**Allergies & Intolerances:** Fish (specific: salmon, tuna)\n  - CRITICAL: Strict avoidance required, cross-reactivity considerations\n\n### 3. ANTHROPOMETRIC DATA ANALYSIS\n**Primary Measurements:**\n  - Weight: 68.3 kg | Height: 173.4 cm | BMI: 22.7 kg/m²\n  - BMI Classification: Normal\n  - Activity Level: moderately active\n\n### 4. DIETARY DATA ANALYSIS\nNo 24h recall available.\n\n### 5. CLINICAL SYNTHESIS & NUTRITIONAL DIAGNOSIS\n**Patient Goals:** Bone health / osteoporosis prevention\n\n**REQUIRED OUTPUT FOR CLINICAL MODE:**\n1. **Problem List (PES Format):** Identify 2-4 nutrition diagnoses using Problem-Etiology-Signs/Symptoms format\n2. **Priority Ranking:** Rank nutritional problems by clinical urgency\n3. **Intervention Rationale:** For each dietary recommendation, provide clinical justification\n4. **Monitoring Parameters:** Specify what should be monitored\n\n---\n\n**Patient:** Name: Joshua Garcia | Age: 58 | Gender: male | Conditions: Hypertension Stage 1 | Allergies: Fish (specific: salmon, tuna) | Region: Ireland | Occupation: Shift worker (rotating)\n**Anthropometrics:** Wt: 68.3kg | Ht: 173.4cm | BMI: 22.7 | Activity: moderately active\n**Medical History:** Family Hx: Mother: Breast cancer. Father: Hypertension, Hyperlipidemia.\n**Eating Patterns:** Meals/day: 4 | Breakfast: 7:00 AM | Lunch: 12:30 PM | Dinner: 11:00 PM | Snacks: 3:00 PM | Cooking time: <5 minutes (microwave/ready-made) | Water: >3L\n**Appetite:** Appetite: Increased\n**Goals:** Bone health / osteoporosis prevention\n**Additional Notes:** Hindu vegetarian (lacto-vegetarian)\n\n\n\n\n---\n\nOUTPUT FORMAT (follow exactly):\n\n# Diet Plan - Joshua Garcia\n\n## Clinical Nutritional Anamnesis Analysis\n\n### 1. Biochemical Data Analysis\n[Interpret lab values]\n\n### 2. Clinical Data Analysis\n[Medical conditions and dietary implications]\n\n### 3. Anthropometric Data Analysis\n[BMI classification and body composition]\n\n### 4. Dietary Data Analysis\n[24h recall interpretation and nutrient gap analysis]\n\n### 5. Nutritional Diagnosis (PES Format)\n| Priority | Problem | Etiology | Signs/Symptoms |\n|----------|---------|----------|----------------|\n| 1 | [Nutrition problem] | related to [etiology] | as evidenced by [S/S] |\n\n### 6. Intervention Rationale\n[Key intervention decisions with clinical justification]\n\n---\n\n## Summary\n- Target: [kcal] kcal/day\n- Macros: P [g]g | C [g]g | F [g]g\n- Key focus: [2-3 bullet points max based on patient data]\n- Clinical priorities: [Based on PES diagnoses above]\n\n## Weekly Meal Plan\n\nCRITICAL: You MUST write out EVERY meal for ALL 28 days across ALL 4 weeks. Each day must be unique.\n\n### Week 1\n\n| Day | Breakfast | Lunch | Dinner | Snacks | kcal |\n|-----|-----------|-------|--------|--------|------|\n| Mon | [unique meal] | [unique meal] | [unique meal] | [snack] | [total] |\n| Tue | [unique meal] | [unique meal] | [unique meal] | [snack] | [total] |\n| Wed | [unique meal] | [unique meal] | [unique meal] | [snack] | [total] |\n| Thu | [unique meal] | [unique meal] | [unique meal] | [snack] | [total] |\n| Fri | [unique meal] | [unique meal] | [unique meal] | [snack] | [total] |\n| Sat | [unique meal] | [unique meal] | [unique meal] | [snack] | [total] |\n| Sun | [unique meal] | [unique meal] | [unique meal] | [snack] | [total] |\n\n### Week 2\n\n| Day | Breakfast | Lunch | Dinner | Snacks | kcal |\n|-----|-----------|-------|--------|--------|------|\n| Mon | [unique meal] | [unique meal] | [unique meal] | [snack] | [total] |\n| Tue | [unique meal] | [unique meal] | [unique meal] | [snack] | [total] |\n| Wed | [unique meal] | [unique meal] | [unique meal] | [snack] | [total] |\n| Thu | [unique meal] | [unique meal] | [unique meal] | [snack] | [total] |\n| Fri | [unique meal] | [unique meal] | [unique meal] | [snack] | [total] |\n| Sat | [unique meal] | [unique meal] | [unique meal] | [snack] | [total] |\n| Sun | [unique meal] | [unique meal] | [unique meal] | [snack] | [total] |\n\n### Week 3\n\n| Day | Breakfast | Lunch | Dinner | Snacks | kcal |\n|-----|-----------|-------|--------|--------|------|\n| Mon | [unique meal] | [unique meal] | [unique meal] | [snack] | [total] |\n| Tue | [unique meal] | [unique meal] | [unique meal] | [snack] | [total] |\n| Wed | [unique meal] | [unique meal] | [unique meal] | [snack] | [total] |\n| Thu | [unique meal] | [unique meal] | [unique meal] | [snack] | [total] |\n| Fri | [unique meal] | [unique meal] | [unique meal] | [snack] | [total] |\n| Sat | [unique meal] | [unique meal] | [unique meal] | [snack] | [total] |\n| Sun | [unique meal] | [unique meal] | [unique meal] | [snack] | [total] |\n\n### Week 4\n\n| Day | Breakfast | Lunch | Dinner | Snacks | kcal |\n|-----|-----------|-------|--------|--------|------|\n| Mon | [unique meal] | [unique meal] | [unique meal] | [snack] | [total] |\n| Tue | [unique meal] | [unique meal] | [unique meal] | [snack] | [total] |\n| Wed | [unique meal] | [unique meal] | [unique meal] | [snack] | [total] |\n| Thu | [unique meal] | [unique meal] | [unique meal] | [snack] | [total] |\n| Fri | [unique meal] | [unique meal] | [unique meal] | [snack] | [total] |\n| Sat | [unique meal] | [unique meal] | [unique meal] | [snack] | [total] |\n| Sun | [unique meal] | [unique meal] | [unique meal] | [snack] | [total] |\n\n\n## Foods\n\n### Include\n- [food]: [portion] - [brief reason based on labs/conditions]\n\n### Avoid\n- [food]: [brief reason based on labs/conditions]\n\n## Notes\n- [2-4 practical tips based on patient's eating patterns/lifestyle]\n\n## Monitoring Parameters\n\n### Indicators to Evaluate\n| Parameter | Current Value | Target | Timeline |\n|-----------|---------------|--------|----------|\n| [parameter] | [current] | [goal] | [weeks] |\n\n### Recommended Follow-up\n- Next appointment: [timeframe]\n- Follow-up labs: [which tests, when]\n- Warning signs: [symptoms requiring immediate attention]\n\n---\nEND OF PLAN", "diet": {"content": "# Diet Plan - Joshua Garcia\n\n## Clinical Nutritional Anamnesis Analysis\n\n### 1. Biochemical Data Analysis\nNo biochemical data provided. Baseline laboratory assessment is strongly recommended to evaluate:\n- **Bone Metabolism:** Serum Calcium, Phosphorus, 25-hydroxyvitamin D, and Alkaline Phosphatase.\n- **Renal Function & Electrolytes:** Creatinine, Urea, Potassium, and Sodium (crucial for Hypertension management).\n- **Lipid Profile:** LDL, HDL, and Triglycerides (given paternal history of hyperlipidemia).\n- **Glycemic Status:** HbA1c and Fasting Glucose.\n\n### 2. Clinical Data Analysis\n- **Hypertension Stage 1:** Requires a sodium-restricted, potassium-rich approach (DASH-style). Focus on reducing processed \"ready-made\" sodium levels.\n- **Fish Allergy (Salmon, Tuna):** Strict avoidance of these species. As a lacto-vegetarian, this is naturally managed, but cross-contamination in processed foods must be monitored.\n- **Rotating Shift Work:** Late dinner (11:00 PM) increases risk of metabolic disruption and GERD. Nutrient timing must be optimized to maintain energy levels without compromising sleep quality.\n- **Lacto-Vegetarianism:** Risk of protein insufficiency and Vitamin B12 deficiency. Emphasis on high-biological-value dairy and legumes.\n\n### 3. Anthropometric Data Analysis\n- **BMI:** 22.7 kg/m² (Normal range).\n- **Weight Status:** Stable.\n- **Activity Level:** Moderately active.\n- **Clinical Correlation:** Normal BMI reduces the risk of obesity-related hypertension complications, but bone density must be protected as he enters the late 50s.\n\n### 4. Dietary Data Analysis\n- **Cooking Constraints:** < 5 minutes preparation time indicates a high reliance on ultra-processed foods, which typically contain excessive sodium (detrimental to HTN).\n- **Hydration:** Excellent (> 3L water/day).\n- **Appetite:** Increased, allowing for the integration of nutrient-dense, high-volume vegetables to manage satiety and blood pressure.\n\n### 5. Nutritional Diagnosis (PES Format)\n| Priority | Problem | Etiology | Signs/Symptoms |\n|----------|---------|----------|----------------|\n| 1 | Risk of inadequate mineral intake for bone health | related to age and dietary pattern | as evidenced by patient goal of osteoporosis prevention |\n| 2 | Excessive sodium intake | related to reliance on microwave/ready-made meals | as evidenced by < 5 min cooking time and HTN Stage 1 |\n| 3 | Altered nutrient timing | related to rotating shift work | as evidenced by 11:00 PM dinner time |\n\n### 6. Intervention Rationale\n- **Calcium & Vitamin D Optimization:** Increased intake of fortified dairy, tofu, and leafy greens to maximize bone mineral density (BMD).\n- **Sodium Reduction (DASH approach):** Replacing high-sodium ready-meals with \"assembly-style\" meals (pre-washed greens, canned low-sodium beans, pre-cooked grains) to lower BP.\n- **Protein Distribution:** Spreading protein across 4 meals to prevent muscle wasting (sarcopenia prevention) and manage increased appetite.\n- **Late-Night Meal Modification:** Dinner at 11 PM should be nutrient-dense but easily digestible (lower fat, moderate protein) to avoid sleep disruption.\n\n---\n\n## Summary\n- **Target:** 2300 kcal/day\n- **Macros:** P 100g | C 315g | F 70g\n- **Key focus:** High Calcium/Vitamin D, Low Sodium, Lacto-Vegetarian protein sources.\n- **Clinical priorities:** Blood pressure control and bone matrix support.\n\n## Weekly Meal Plan\n\n### Week 1\n| Day | Breakfast (7:00 AM) | Lunch (12:30 PM) | Dinner (11:00 PM) | Snacks (3:00 PM) | kcal |\n|-----|-----------|-------|--------|--------|------|\n| Mon | Greek yogurt, honey, walnuts | Quinoa salad, chickpeas, feta | Lentil dal, brown rice, spinach | Apple, almond butter | 2280 |\n| Tue | Overnight oats, chia, berries | Tofu wrap, avocado, sprouts | Paneer stir-fry, broccoli, quinoa | Cottage cheese, pineapple | 2310 |\n| Wed | Cottage cheese on rye toast | Black bean bowl, corn, salsa | Vegetable korma, basmati rice | Pear, walnuts | 2250 |\n| Thu | Smoothie: Spinach, banana, soy | Hummus, whole-grain pita, veg | Red kidney bean curry, cauliflower | Greek yogurt, seeds | 2320 |\n| Fri | Ricotta, sliced peaches, oats | Lentil soup, whole-grain roll | Tofu cubes, steamed kale, rice | Orange, cashews | 2270 |\n| Sat | Poha (flattened rice), peas | Chickpea salad, cucumber, tofu | Vegetable stew, barley, carrots | Banana, peanut butter | 2300 |\n| Sun | Yogurt parfait, granola, seeds | Caprese salad, mozzarella, pesto | Dal makhani (low salt), brown rice | Dried apricots, almonds | 2290 |\n\n### Week 2\n| Day | Breakfast (7:00 AM) | Lunch (12:30 PM) | Dinner (11:00 PM) | Snacks (3:00 PM) | kcal |\n|-----|-----------|-------|--------|--------|------|\n| Mon | Chia pudding, mango, coconut | Tempeh salad, mixed greens | Vegetable khichdi, yogurt | Celery, hummus | 2260 |\n| Tue | Whole-grain cereal, soy milk | Chickpea wrap, spinach, tahini | Paneer tikka, sautéed peppers | Grapes, walnuts | 2330 |\n| Wed | Greek yogurt, flaxseeds, pear | Quinoa, black beans, avocado | Lentil soup, steamed cabbage | Apple, cottage cheese | 2280 |\n| Thu | Avocado toast, tomato, feta | Tofu stir-fry, snap peas, rice | Vegetable curry, quinoa | Melon, pumpkin seeds | 2310 |\n| Fri | Smoothie: Kale, blueberry, soy | Lentil salad, feta, olives | Paneer and pea curry, brown rice | Peach, almonds | 2270 |\n| Sat | Upma (semolina), carrots, peas | Bean burrito bowl, brown rice | Tofu stew, carrots, potatoes | Yogurt, berries | 2300 |\n| Sun | Ricotta toast, sliced banana | Greek salad, chickpeas, olives | Dal tadka, steamed spinach, rice | Kiwi, cashews | 2290 |\n\n### Week 3\n| Day | Breakfast (7:00 AM) | Lunch (12:30 PM) | Dinner (11:00 PM) | Snacks (3:00 PM) | kcal |\n|-----|-----------|-------|--------|--------|------|\n| Mon | Overnight oats, almond butter | Tofu salad, sesame, edamame | Chickpea curry, brown rice | Plum, walnuts | 2270 |\n| Tue | Greek yogurt, honey, apricot | Lentil wrap, avocado, lettuce | Paneer sauté, zucchini, quinoa | Cottage cheese, melon | 2320 |\n| Wed | Smoothie: Mango, soy, chia | Quinoa, roasted veg, feta | Red lentil soup, whole-grain toast | Apple, peanut butter | 2260 |\n| Thu | Cottage cheese, berries, oats | Black bean salad, corn, lime | Tofu curry, cauliflower, rice | Orange, almonds | 2310 |\n| Fri | Rye toast, avocado, sprouts | Hummus bowl, chickpeas, kale | Vegetable pilaf, raita (yogurt) | Pear, sunflower seeds | 2280 |\n| Sat | Poha, peanuts, curry leaves | Tempeh sandwich, whole-grain | Dal palak (spinach), brown rice | Banana, greek yogurt | 2300 |\n| Sun | Yogurt, granola, pomegranate | Tofu wrap, shredded carrots | Paneer and mushroom curry, rice | Dried figs, walnuts | 2290 |\n\n### Week 4\n| Day | Breakfast (7:00 AM) | Lunch (12:30 PM) | Dinner (11:00 PM) | Snacks (3:00 PM) | kcal |\n|-----|-----------|-------|--------|--------|------|\n| Mon | Smoothie: Spinach, pear, soy | Chickpea salad, feta, lemon | Lentil stew, quinoa, carrots | Apple, cashews | 2280 |\n| Tue | Greek yogurt, seeds, blueberries | Tofu bowl, brown rice, broccoli | Paneer curry, steamed cabbage | Cottage cheese, peach | 2310 |\n| Wed | Overnight oats, raspberries | Black bean wrap, avocado | Vegetable korma, basmati rice | Orange, walnuts | 2270 |\n| Thu | Ricotta, honey, whole-grain toast | Lentil soup, sourdough bread | Tofu stir-fry, bok choy, rice | Banana, almond butter | 2330 |\n| Fri | Chia pudding, pineapple, soy | Quinoa, chickpeas, cucumber | Dal makhani (low salt), spinach | Grapes, pumpkin seeds | 2260 |\n| Sat | Upma, mixed vegetables | Tempeh salad, avocado, corn | Paneer and bell pepper, quinoa | Yogurt, apricot | 2300 |\n| Sun | Smoothie: Banana, almond milk | Greek salad, tofu, olives | Vegetable curry, brown rice | Pear, walnuts | 2290 |\n\n---\n\n## Foods\n\n### Include\n- **Fortified Dairy/Soy:** Greek yogurt, Paneer, Tofu, Fortified Soy Milk - High calcium and protein for bone health.\n- **Leafy Greens:** Spinach, Kale, Bok Choy - Vitamin K and Calcium.\n- **Legumes:** Lentils, Chickpeas, Black beans - Plant-based protein and fiber.\n- **Whole Grains:** Quinoa, Brown Rice, Oats - Complex carbs for sustained energy during shifts.\n- **Potassium-Rich Foods:** Bananas, Avocado, Spinach - To counteract sodium and lower BP.\n\n### Avoid\n- **Salmon & Tuna:** Severe allergy.\n- **High-Sodium Ready-Meals:** Excess salt exacerbates Hypertension.\n- **Eggs & Meat:** Hindu lacto-vegetarian restriction.\n- **Refined Sugars:** To maintain metabolic health during rotating shifts.\n\n## Notes\n- **Quick Prep Strategy:** Use pre-washed bagged salads, frozen steamed vegetables, and canned beans (rinsed thoroughly to remove 40% of sodium).\n- **Shift Work Tip:** Since dinner is very late (11 PM), prioritize the \"Dinner\" proteins (Tofu/Lentils) and keep portions of heavy grains moderate to prevent acid reflux.\n- **Bone Health:** Ensure adequate sunlight exposure or a Vitamin D3 supplement (as per physician's dose) since diet alone often fails to meet requirements.\n- **Sodium Hack:** Use lemon juice, vinegars, and fresh herbs instead of salt to flavor microwave meals.\n\n## Monitoring Parameters\n\n### Indicators to Evaluate\n| Parameter | Current Value | Target | Timeline |\n|-----------|---------------|--------|----------|\n| Systolic BP | Stage 1 | < 130 mmHg | 4-8 weeks |\n| Diastolic BP | Stage 1 | < 80 mmHg | 4-8 weeks |\n| Vitamin D | Unknown | > 30 ng/mL | 8 weeks |\n| Serum Calcium | Unknown | Normal Range | 8 weeks |\n| Weight | 68.3 kg | Maintain | Monthly |\n\n### Recommended Follow-up\n- **Next appointment:** 4 weeks for BP review and dietary adherence check.\n- **Follow-up labs:** Full lipid panel and Vitamin D/Calcium levels in 8 weeks.\n- **Warning signs:** Sudden weight gain, edema (swelling in ankles), or persistent dizziness (potential BP fluctuations).\n\n---\nEND OF PLAN", "temperature": 0.4, "model": "gemma-4-31b-it", "provider": "gemini", "reasoning": true}, "meethealth": {"package": "meethealth-sample-v1", "package_version": "1.0.0", "source_corpus": "gemma_diets", "source_line": 196986, "contract": "diet_plan@1.0.0", "contract_fingerprint": "1a6c5cf6b9d37193", "gate_rules_evaluated": 45, "gate_failures": [], "package_checks": {"plan_language": {"pass": true, "detail": "english markers=4"}, "completeness_28_days": {"pass": true, "detail": "day_rows=28 weeks=4 terminated=True"}, "no_duplicate_days": {"pass": true, "detail": "duplicate_days=0"}, "macro_arithmetic": {"pass": true, "detail": "target=2300 kcal, 4P+4C+9F=2290 kcal, deviation=0.4%"}, "energy_dose_plausible": {"pass": true, "detail": "33.7 kcal/kg (screen 15-45)"}, "protein_dose_plausible": {"pass": true, "detail": "1.46 g/kg (screen 0.8-1.6)"}, "daily_energy_on_target": {"pass": true, "detail": "days_outside_10pct=0 of 28"}, "allergen_screen": {"pass": true, "detail": "screened=['fish'] hits=[]"}, "hyperkalemia_food_screen": {"pass": true, "detail": "not applicable (K <= 5.0 or absent)"}, "scenario_coherence": {"pass": true, "detail": "ok"}}, "evidence_level": "L2_automated_checks_passed", "expert_review": "not_performed"}}
{"patient_id": "83d2179c-055f-4eb7-b035-fe0f9bc4e16b", "patient_data": {"id": "83d2179c-055f-4eb7-b035-fe0f9bc4e16b", "name": "Holly Mcpherson", "age": 56, "age_group": "middle_age_51_65y", "gender": "female", "region": "USA", "language": "en", "occupation": "Office worker", "conditions": "Overweight (BMI 25-29.9)", "allergies": "Dairy/Lactose, Tree Nuts (all)", "goals": "Gut healing (leaky gut/intestinal permeability)", "preferences": "Local/seasonal preference", "weight": 76.0, "height": 165.6, "bmi": 27.7, "activity_level": "lightly_active", "serum_ferritin": 10.0, "blood_glucose": 77.5, "hdl_cholesterol": 51.4, "ldl_cholesterol": 45.9, "vitamin_d": 94.7, "folate": 13.6, "sodium": 137.4, "prealbumin": 6.2, "skin_condition": "Bruising easily", "hair_condition": "Normal", "oral_health": "Glossitis", "weight_change": "Growth-appropriate weight gain (pediatric)", "dietary_recall_24h": "Breakfast: Coffee with cream and a pastry\nLunch: Fast food burger, fries, soda\nDinner: Soup with bread\nSnacks: Nothing", "total_calories": 1580, "total_protein": 97.6, "total_carbohydrates": 181.7, "total_fat": 51.4, "total_fiber": 12.1, "total_sugar": 59.1, "total_saturated_fat": 6.7, "total_sodium": 1768, "bmr_formula": "WHO/FAO", "bmr": 1519, "tdee": 2089, "macro_split": {"carbsPercent": 60, "proteinPercent": 15, "fatPercent": 25}, "meals_per_day": 1, "cooking_time": "No cooking ability (caregiver prepares)", "water_intake_per_day": ">3L", "coffee_cups_per_day": 1, "appetite_assessment": "Good", "recent_appetite_changes": "Appetite varies with depressive episodes", "dietary_supplements": "Omega-3 fish oil 1000mg/day", "prompt_mode": "standard", "clinical_analysis_depth": "basic"}, "prompt": "You are a clinical nutritionist creating a diet plan. Generate all content in ENGLISH.\n\nPATIENT DATA VALIDITY CHECK (perform silently BEFORE writing the plan):\nBefore recommending anything, screen the patient record for biologically-impossible or logically-contradictory entries. Common red flags:\n  - Sex-specific conditions on the wrong sex (e.g. PCOS, endometriosis, ovarian/cervical/uterine/menopause conditions on a male patient; prostate, BPH, testicular, erectile conditions on a female patient)\n  - Pregnancy-related fields on a male patient (is_pregnant=true, gestational diabetes, preeclampsia, hyperemesis, lactation, postpartum)\n  - Pregnancy in a patient outside the plausible age range (under 12 or over 55)\n  - Adult-onset chronic conditions on very young patients (coronary artery disease, Parkinson's, Alzheimer's/dementia, menopause, BPH, osteoporosis, COPD, sarcopenia in patients under the typical onset age)\n  - Eating disorders (anorexia, bulimia, BED, ARFID adult form) on patients under 10\n  - Bariatric surgery history on patients under 14\n  - Occupation/age mismatch (retired at 25, elementary school student at 30, toddler listed as lawyer, etc.)\n  - Impossible anthropometrics (BMI under 11 or over 70, infant weight over 15 kg, toddler weight over 25 kg)\n  - Mutually exclusive conditions present together (Obesity + Underweight, Type 1 + Type 2 diabetes)\n  - Allergies that contradict declared dietary patterns\n\nIf you detect any such issue:\n  1. Do NOT silently \"play along\" with the impossibility.\n  2. Add a short `## Data Consistency Notes` block right after the Summary, listing each flagged issue in one line.\n  3. Choose the safest clinically-defensible interpretation (e.g. ignore the sex-mismatched condition; use the nearest reasonable age band; drop contradictory conditions) and generate the plan on that basis.\n  4. Never recommend a therapy driven by an impossible condition (e.g. do not prescribe ketogenic therapy for \"epilepsy\" if the record also implies contraindications like active breastfeeding, hepatic steatosis, or pregnancy unless a seizure disorder is clearly present).\n  5. For any declared allergy, the meal tables MUST NOT contain that food or its common derivatives. Allergens may only appear inside the `### Avoid` section with explicit avoidance wording.\n\nSTRICT RULES:\n1. Output ONLY markdown - no preamble, no \"Here is...\", no greetings, no sign-offs\n2. Be CONCISE - use tables, bullets, short sentences\n3. Use TABLES for meal plans (mandatory)\n4. NO lengthy explanations unless customInstructions requests detail\n5. Start directly with the H1 title\n6. USE ALL patient data provided to personalize the plan\n7. EVERY DAY must have UNIQUE meals - NO \"repeat day X\" or \"same as above\" - write out ALL 28 days completely.\n8. Provide VARIETY - different foods each day, rotate proteins, vegetables, grains\n\n\n\n\n**Patient:** Name: Holly Mcpherson | Age: 56 | Gender: female | Conditions: Overweight (BMI 25-29.9) | Allergies: Dairy/Lactose, Tree Nuts (all) | Region: USA | Occupation: Office worker\n**Anthropometrics:** Wt: 76.0kg | Ht: 165.6cm | BMI: 27.7 | Activity: lightly active\n**Blood/Iron:** Ferritin: 10.0ng/mL\n**Metabolic Labs:** Glucose: 77.5mg/dL | HDL: 51.4 | LDL: 45.9\n**Vitamins/Electrolytes:** VitD: 94.7ng/mL | Folate: 13.6ng/mL | Na: 137.4\n**Protein/Kidney:** Prealbumin: 6.2mg/dL\n**Clinical Signs:** Skin: Bruising easily | Hair: Normal | Oral: Glossitis | Weight Change: Growth-appropriate weight gain (pediatric)\n**Energy Targets:** Formula: WHO/FAO | BMR: 1519kcal | TDEE: 2089kcal | Macro Target: C60/P15/F25%\n**Current Intake (24h):** Cal: 1580 | P: 97.6g | C: 181.7g | F: 51.4g | Fiber: 12.1g | Sugar: 59.1g | SatFat: 6.7g | Na: 1768mg\n**24h Recall:** Breakfast: Coffee with cream and a pastry\nLunch: Fast food burger, fries, soda\nDinner: Soup with bread\nSnacks: Nothing\n**Eating Patterns:** Meals/day: 1 | Cooking time: No cooking ability (caregiver prepares) | Coffee: 1 | Water: >3L\n**Restrictions:** Supplements: Omega-3 fish oil 1000mg/day\n**Appetite:** Appetite: Good | Recent Changes: Appetite varies with depressive episodes\n**Goals:** Gut healing (leaky gut/intestinal permeability)\n**Additional Notes:** Local/seasonal preference\n\n\n\n\n---\n\nOUTPUT FORMAT (follow exactly):\n\n# Diet Plan - Holly Mcpherson\n\n## Summary\n- Target: [kcal] kcal/day\n- Macros: P [g]g | C [g]g | F [g]g\n- Key focus: [2-3 bullet points max based on patient data]\n\n\n## Weekly Meal Plan\n\nCRITICAL: You MUST write out EVERY meal for ALL 28 days across ALL 4 weeks. Each day must be unique.\n\n### Week 1\n\n| Day | Breakfast | Lunch | Dinner | Snacks | kcal |\n|-----|-----------|-------|--------|--------|------|\n| Mon | [unique meal] | [unique meal] | [unique meal] | [snack] | [total] |\n| Tue | [unique meal] | [unique meal] | [unique meal] | [snack] | [total] |\n| Wed | [unique meal] | [unique meal] | [unique meal] | [snack] | [total] |\n| Thu | [unique meal] | [unique meal] | [unique meal] | [snack] | [total] |\n| Fri | [unique meal] | [unique meal] | [unique meal] | [snack] | [total] |\n| Sat | [unique meal] | [unique meal] | [unique meal] | [snack] | [total] |\n| Sun | [unique meal] | [unique meal] | [unique meal] | [snack] | [total] |\n\n### Week 2\n\n| Day | Breakfast | Lunch | Dinner | Snacks | kcal |\n|-----|-----------|-------|--------|--------|------|\n| Mon | [unique meal] | [unique meal] | [unique meal] | [snack] | [total] |\n| Tue | [unique meal] | [unique meal] | [unique meal] | [snack] | [total] |\n| Wed | [unique meal] | [unique meal] | [unique meal] | [snack] | [total] |\n| Thu | [unique meal] | [unique meal] | [unique meal] | [snack] | [total] |\n| Fri | [unique meal] | [unique meal] | [unique meal] | [snack] | [total] |\n| Sat | [unique meal] | [unique meal] | [unique meal] | [snack] | [total] |\n| Sun | [unique meal] | [unique meal] | [unique meal] | [snack] | [total] |\n\n### Week 3\n\n| Day | Breakfast | Lunch | Dinner | Snacks | kcal |\n|-----|-----------|-------|--------|--------|------|\n| Mon | [unique meal] | [unique meal] | [unique meal] | [snack] | [total] |\n| Tue | [unique meal] | [unique meal] | [unique meal] | [snack] | [total] |\n| Wed | [unique meal] | [unique meal] | [unique meal] | [snack] | [total] |\n| Thu | [unique meal] | [unique meal] | [unique meal] | [snack] | [total] |\n| Fri | [unique meal] | [unique meal] | [unique meal] | [snack] | [total] |\n| Sat | [unique meal] | [unique meal] | [unique meal] | [snack] | [total] |\n| Sun | [unique meal] | [unique meal] | [unique meal] | [snack] | [total] |\n\n### Week 4\n\n| Day | Breakfast | Lunch | Dinner | Snacks | kcal |\n|-----|-----------|-------|--------|--------|------|\n| Mon | [unique meal] | [unique meal] | [unique meal] | [snack] | [total] |\n| Tue | [unique meal] | [unique meal] | [unique meal] | [snack] | [total] |\n| Wed | [unique meal] | [unique meal] | [unique meal] | [snack] | [total] |\n| Thu | [unique meal] | [unique meal] | [unique meal] | [snack] | [total] |\n| Fri | [unique meal] | [unique meal] | [unique meal] | [snack] | [total] |\n| Sat | [unique meal] | [unique meal] | [unique meal] | [snack] | [total] |\n| Sun | [unique meal] | [unique meal] | [unique meal] | [snack] | [total] |\n\n\n## Foods\n\n### Include\n- [food]: [portion] - [brief reason based on labs/conditions]\n\n### Avoid\n- [food]: [brief reason based on labs/conditions]\n\n## Notes\n- [2-4 practical tips based on patient's eating patterns/lifestyle]\n\n---\nEND OF PLAN", "diet": {"content": "# Diet Plan - Holly Mcpherson\n\n## Summary\n- Target: 2089 kcal/day\n- Macros: P 78g | C 313g | F 58g\n- Key focus: \n    - High iron and protein density to address ferritin (10.0ng/mL) and prealbumin (6.2mg/dL) deficiencies.\n    - Gut-healing focus using high-fiber, cooked vegetables and easy-to-digest proteins.\n    - Strict avoidance of dairy and tree nuts to manage allergies.\n\n## Data Consistency Notes\n- Weight Change: \"Growth-appropriate weight gain (pediatric)\" is inconsistent with a 56-year-old patient.\n\n## Weekly Meal Plan\n\n### Week 1\n\n| Day | Breakfast | Lunch | Dinner | Snacks | kcal |\n|-----|-----------|-------|--------|--------|------|\n| Mon | Oat milk porridge w/ berries & sunflower seeds | Tuna & avocado salad on sourdough | Beef stir-fry w/ broccoli & jasmine rice | Apple | 2090 |\n| Tue | Scrambled eggs w/ spinach & rye toast | Chicken & quinoa bowl w/ cucumber | Baked salmon w/ sweet potato & green beans | Pear | 2085 |\n| Wed | Chia pudding (oat milk) w/ mango | Lentil & vegetable soup w/ crackers | Turkey meatballs w/ zucchini noodles | Banana | 2100 |\n| Thu | Berry smoothie (oat milk/spinach) | Beef & black bean salad w/ corn | Baked cod w/ roasted potatoes & peas | Grapes | 2075 |\n| Fri | Buckwheat pancakes (water/oat milk) | Chicken & veggie wrap (corn tortilla) | Shrimp pasta (olive oil & garlic) | Melon | 2095 |\n| Sat | Poached eggs w/ sautéed mushrooms | Turkey burger (no bun) w/ sweet potato fries | Roast pork w/ squash & quinoa | Orange | 2080 |\n| Sun | Fruit salad w/ pumpkin seeds | Beef & barley soup | Roasted chicken w/ carrots & rice | Berries | 2105 |\n\n### Week 2\n\n| Day | Breakfast | Lunch | Dinner | Snacks | kcal |\n|-----|-----------|-------|--------|--------|------|\n| Mon | Cinnamon oat milk porridge | Salmon & quinoa salad | Steak w/ spinach & baked potato | Peach | 2090 |\n| Tue | Egg muffins (spinach/onion) | Chicken & rice bowl w/ beans | Cod w/ broccoli & quinoa | Apple | 2080 |\n| Wed | Chia pudding (coconut milk) w/ berries | Turkey & avocado wrap | Beef & lentil stew | Pear | 2110 |\n| Thu | Rye toast w/ avocado & egg | Tuna & white bean salad | Salmon w/ asparagus & rice | Banana | 2070 |\n| Fri | Banana oat milk smoothie | Chicken & vegetable soup | Pork tenderloin w/ sweet potato | Melon | 2085 |\n| Sat | Scrambled eggs w/ smoked salmon | Beef taco bowl (corn/beans) | Shrimp & veggie stir-fry | Grapes | 2095 |\n| Sun | Oat porridge w/ sunflower seeds | Turkey & quinoa salad | Roasted chicken w/ parsnips & rice | Orange | 2080 |\n\n### Week 3\n\n| Day | Breakfast | Lunch | Dinner | Snacks | kcal |\n|-----|-----------|-------|--------|--------|------|\n| Mon | Mango chia pudding (oat milk) | Beef & veggie stir-fry | Salmon w/ quinoa & peas | Apple | 2095 |\n| Tue | Omelet w/ tomato & spinach | Chicken & lentil salad | Turkey meatballs w/ rice | Peach | 2085 |\n| Wed | Overnight oats (oat milk) w/ blueberries | Tuna & avocado salad | Beef & broccoli w/ rice | Pear | 2100 |\n| Thu | Egg & veggie hash (potato/onion) | Chicken & quinoa bowl | Cod w/ roasted carrots & rice | Banana | 2075 |\n| Fri | Berry smoothie (oat milk) | Shrimp & bean salad | Chicken curry (coconut milk) | Melon | 2115 |\n| Sat | Buckwheat porridge w/ seeds | Beef & potato stew | Salmon w/ green beans & rice | Grapes | 2090 |\n| Sun | Scrambled eggs w/ ham | Quinoa & veggie salad | Pork w/ apples & sweet potato | Orange | 2085 |\n\n### Week 4\n\n| Day | Breakfast | Lunch | Dinner | Snacks | kcal |\n|-----|-----------|-------|--------|--------|------|\n| Mon | Oat milk & banana smoothie | Chicken & rice bowl | Beef stew w/ veggies | Berries | 2080 |\n| Tue | Poached eggs on rye toast | Salmon & quinoa salad | Turkey & roasted veggie bowl | Apple | 2090 |\n| Wed | Chia pudding w/ mango | Lentil & vegetable soup | Chicken & rice w/ broccoli | Pear | 2105 |\n| Thu | Egg muffins w/ peppers | Tuna & avocado salad | Steak w/ sweet potato | Banana | 2075 |\n| Fri | Banana oat pancakes | Chicken wrap w/ veggies | Shrimp & rice | Melon | 2090 |\n| Sat | Avocado toast w/ egg | Beef taco salad (corn) | Cod w/ quinoa & carrots | Grapes | 2085 |\n| Sun | Fruit & oat bowl | Turkey burger w/ sweet potato | Salmon & asparagus | Orange | 2100 |\n\n## Foods\n\n### Include\n- Beef/Steak: 100-150g - High heme iron to address ferritin and glossitis.\n- Lentils/Beans: 1/2 cup - Non-heme iron and fiber for gut health.\n- Spinach/Leafy Greens: 1-2 cups - Iron and folate support.\n- Salmon/Cod: 120-150g - Protein for prealbumin and Omega-3s.\n- Eggs: 2 large - High-quality protein and B-vitamins.\n- Oats/Quinoa: 1/2 cup - Complex carbohydrates and fiber.\n- Seeds (Sunflower/Pumpkin): 2 tbsp - Healthy fats and minerals without tree nut risk.\n\n### Avoid\n- Dairy/Lactose: All milk, cheese, butter, and yogurt (Allergy).\n- Tree Nuts: All almonds, walnuts, cashews, etc. (Allergy).\n- Processed Sugars: To support gut healing and glycemic control.\n\n## Notes\n- **Caregiver Instruction:** Since cooking ability is limited, focus on one-pot meals (stews, soups, stir-fries) and batch-cooking grains (rice, quinoa) to simplify preparation.\n- **Iron Absorption:** Always pair iron-rich foods (meat, lentils) with Vitamin C (citrus, bell peppers, berries) to maximize absorption.\n- **Depressive Episodes:** During low-appetite periods, prioritize the high-protein snacks (eggs, tuna, or seeds) to maintain prealbumin levels.\n- **Hydration:** Continue current water intake (>3L) to support fiber digestion.\n\n---\nEND OF PLAN", "temperature": 0.4, "model": "gemma-4-26b-a4b-it", "provider": "gemini", "reasoning": true}, "meethealth": {"package": "meethealth-sample-v1", "package_version": "1.0.0", "source_corpus": "gemma_diets", "source_line": 236439, "contract": "diet_plan@1.0.0", "contract_fingerprint": "1a6c5cf6b9d37193", "gate_rules_evaluated": 45, "gate_failures": [], "package_checks": {"plan_language": {"pass": true, "detail": "english markers=4"}, "completeness_28_days": {"pass": true, "detail": "day_rows=28 weeks=4 terminated=True"}, "no_duplicate_days": {"pass": true, "detail": "duplicate_days=0"}, "macro_arithmetic": {"pass": true, "detail": "target=2089 kcal, 4P+4C+9F=2086 kcal, deviation=0.1%"}, "energy_dose_plausible": {"pass": true, "detail": "27.5 kcal/kg (screen 15-45)"}, "protein_dose_plausible": {"pass": true, "detail": "1.03 g/kg (screen 0.8-1.6)"}, "daily_energy_on_target": {"pass": true, "detail": "days_outside_10pct=0 of 28"}, "allergen_screen": {"pass": true, "detail": "screened=['dairy', 'tree_nut'] hits=[]"}, "hyperkalemia_food_screen": {"pass": true, "detail": "not applicable (K <= 5.0 or absent)"}, "scenario_coherence": {"pass": true, "detail": "ok"}}, "evidence_level": "L2_automated_checks_passed", "expert_review": "not_performed"}}