Professional Documents
Culture Documents
4 Pps
4 Pps
Dr.M.Manivasagam, Professor
Rajah Muthiah Medical College & Hospital
Annamalai University
Nutrition
• The process by which the organism utilizes food
• National nutrition week – 1st – 7th Sept
• Energy – Carbohydrates and Fats
• Body building – Protein
• Protective foods – Vitamins & Minerals
Energy
• Food – Supplies energy for physical activity and metabolic
needs
• Nutrients – for maintaining growth and repair or worn out /
ageing tissues
• Calories – heat required to raise the temperature of 1 gm of
water from 14.5 to 15.5 C
• Caloric requirement –
– 1 – 10 kg – 100 kcal / kg / day
– 11 – 20 kg – 1000 + 50 kcal / kg / day
– > 20 kg – 1500 + 20 kcal / kg / day
– Simple formula – till one year 1000 kcal, add 100 kcal for every
year from then.
Carbohydrates
• Provide energy, taste, preserve foods
• Types
– Monosaccharides – glucose
– Disaccharides – sucrose
– Polysaccharides – glycogen
• Glucose
– Fuel for brain and muscle
– Converted to glycogen, stored in liver and muscles
• 55 – 60% of total calories
Fiber
• Constituent of plant cell wall
• Contribute to the bulk and very little to the energy of food
• Includes cellulose, pectins, gums, lignins
• Water holding capacity, bile binding capacity, growth of
normal intestine microflora
• Lowers cholesterol and limit glucose absorption
• Softening of stools and acceleration of intestinal time
• High fiber can cause reduced bioavailability of minerals,
flatulency and decreased appetite
Protein
• Second most abundant substance in body
• 24 amino acid, 8 essential AA
• Helps the child to grow and formation of body fluids
• Requirement – 1.5 gm / kg / day
• Complete protein – contain all the Essential AA
• Reference protein : provides amino acid pattern
close to tissue protein - EGG
Fat
• Concentrated source of energy
• Triglycerides (fats & oils) phospholipids (lecithin), sterols (cholesterol)
• Saturated FA – Animal source except coconut oil
• Unsaturated FA – Essential FA
• Visible and non visible fats
• Omega 6 FA
– Linoleic / Arachidonic acid
– Defi – skin changes
• Omega 6 FA
– Linolenic / Eicosapentanoic acid
– Defi – neurological and visual symptoms
Minerals
• Small inorganic elements
• Calcium, Phosphorous, Sodium, Chloride, Magnesium,
• Trace elements
– Essential – iron, iodine, zinc, selenium, copper, molybdenum
– Probably essential – manganese, silicon, nickel, boron
– Potentially toxic – fluorine, lead, cadmium, mercury, arsenic
Periods of growth
• Prenatal period
– Ovum – 0 – 14 days
– Embryo – 14 days to 9 weeks
– Fetus – 9 weeks to birth
• Perinatal period
– 22 weeks to 7 days after birth
• Postnatal period
– Newborn first 4 weeks after birth
– Infancy – first year
– Toddler – 1 – 3 year
– Preschool – 3 – 5 years
– School child – 6 – 10 years (girls), 6 – 12 years (boys)
Periods of growth – contd..
• Adolescence
– Early Adolescence : 10 – 13 years
– Middle Adolescence : 14 – 16 years
– Late Adolescence : 17 – 20 year
Assessment of Growth
• Anthropometry
• Assessment of Tissue growth
• Bone age
• Dental Age
• Biochemical & Histological
Parameters – age dependent
• Weight
• Length / height
• Head circumference
• Chest circumference
• Mid arm circumference
• Skin fold thickness
• Upper segment – lower segment ratio
• Arm span
• Mid parental height
Parameters – age independent
• Bangle test
• Shakir’s tape
• Quack stick
• Body mass index
• Ponderal index
Low birth weight
• Low Birth weight - < 2500 gms
• Very LBW - < 1500 gms
• Extremely LBW - < 1000 gms
Classification for weight – GOMEZ
Wt / age in % Grade of malnutrition
>90 Normal
76 – 90 I
61 – 75 II
<60 III
Classification for weight – WELCOME
TRUST
60-80% - Under wt
<60 - Marasmus
71-80% Grade I
61-70% Grade II
<50% Grade IV
Classification of PEM by Height
• Acute – Marasmus
• Chronic – Kwashiorkor
• Adaptation – Marasums
• Dysadaptation – Kwashiorkor
Management of PEM
• Assessment – History, Anthropometry
• Classification – Wellcome trust and IAP
• Investigation
– Sr.Albumin
– Urinary urea & Creatinine
– Urinary Hydroxyproline
– Sr. essential amino acid index
– Peripheral smear
– Liver biopsy
Management of Acute emergency
• Hypothermia
• Hypoglycemia
• Specific infection
• Dehydration & electrolyte disturbances
• Chronic renal failure
• Anemia
• Vitamin & Mineral supplements
Restoration / Nutritional Management