Nutrition PDF

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Nutrition and Related

National Health Programs
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Chapter 3 ► Nutrition and Related National Health Programs Conceptual Review of PSM
PHYSIOLOGICAL ENERGY VALUE OF INDIAN FOODS

Carbohydrate Fats
4 Kcal/g 9 Kcal/g
50–70% of total diet 10–30% of the diet (ideal fat is 20% intake)
Free sugar should be less than 10% of Cholesterol intake < 1000 mg/1000 Kcal/day
the total energy intake
16
High Yield Points Proteins Fiber
4 Kcal/g 2 Kcal/g
1 Kcal = 4.184 KJ
10–15% of the energy intake Should be the major bulk of the diet
1 KJ = 0.239 kcal
Daily requirement is approximately Shorten the transit time of the food and
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1 MJ = 239 kcal
1 g/kg/day increases the food bulk
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Reduce postprandial blood sugars, LDL
cholesterol
Reduce the chances of CAD, diverticulitis,
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irritable bowel syndrome and colon cancer.
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RECOMMENDED ENERGY REQUIREMENT
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Man and woman in Indian reference
Man in between 18–29 years of age and weighs 60 kg, height 1.73 m, BMI 20.3
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Woman in between 18–29 years of age, healthy and weighs 55 kg, height 1.61 m, BMI 21.2
General occupation : 8 hours
Sleep time : 8 hours

Light activity
Active recreation
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:
4–6 hours
2 hours
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Adult Male
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For light work (Sedentary work) : 2,320 Kcal/day

Moderate work : 2,730 Kcal/day
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Heavy work : 3,490 Kcal/day
Adult Female
For light work (Sedentary work) : 1900 Kcal/day
&
Moderate work : 2,230 Kcal/day

Heavy work : 2,850 Kcal/day
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Extra Energy
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Pregnancy : + 350 Kcal/day

Lactation (First 6 months) : + 600 Kcal/day
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Lactation (6–12 months) : +520 Kcal/day

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Table 1: Recommended daily allowances for Indians —2010

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Group [Male = 60 kg, Net Protein Visible Calcium Iron (mg/ Vitamin A Ascorbic Folate
Female = 55 kg] Energy (g/day) Fat (mg/day) day) (Retinol) Acid (mg/ (mcg/
(Kcal/ (g/day) mcg/day day) day)
day)
Sedentary worker male 2,320 60 25 600 17 600 40 200
Moderate worker male 2,730 30
Heavy worker male 3,490 40
Sedentary worker female 1,900 55 20 600 21 600 40 200
Contd...
Theory 57
Chapter 3 ► Nutrition and Related National Health Programs

Group [Male = 60 kg, Net Protein Visible Calcium Iron (mg/ Vitamin A Ascorbic Folate
Female = 55 kg] Energy (g/day) Fat (mg/day) day) (Retinol) Acid (mg/ (mcg/
(Kcal/ (g/day) mcg/day day) day)
day)
Moderate worker female 2,230 25
Heavy worker female 2,850 30
Pregnant women +350 78 30 1200 35 800 60 500
Lactating women 0–6 months +600 74 30 1200 21 950 80 300
Lactating women 6–12 months +520 68
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Infant [0–6 months] 92 Kcal/ 1.16 g/ kg/ – 500 46 350 25 25
kg/day day mcg/ kg/
1/
day
Infant [6–12 months] 80 Kcal/ 1.69 g/ kg/ 19 05
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kg/day day
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Table 2: Calorie coefficient consumption per person
Person Calorie Coefficient Consumption Unit
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Adult male (Sedentary/ Moderate/Heavy worker) 1/1.2/1.6 respectively.
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Adult female (Sedentary/ Moderate/Heavy worker) 0.8/0.9/1.2 respectively
Adolescent 1
Children (1–3/3–5 /5–7/7–9 years) M
0.4/0.5/0.6/0.7 respectively
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PROTEINS
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Complex organic nitrogenous compounds

Composed of carbon, hydrogen, oxygen, nitrogen, sulfur, phosphorus and iron
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Differ from carbohydrates and fats as it contains 16% of nitrogen
Essential amino acids (EAA):
5 Good to remember
•• Cannot be synthesized in body in required amount, so must be obtained from diet. The amino acids are needed for
•• There are nine essential amino acids
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synthesis of tissue proteins.

Leucine Essential amino acids (EAA):
Isoleucine Formation of niacin
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Lysine Methionine donor of methyl

Methionine
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group
Phenylalanine Formation of new tissues
Threonine
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Valine
Tryptophan
Histidine
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Nonessential amino acids : Synthesized in body. There are six nonessential amino acid.
•• Arginine
•• Asparaginic acids 17
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•• Serine
•• Glutamic acid
High Yield Points
•• Proline Limiting amino acids:
•• Glycine Cereals : Threonine + lysine
Animal proteins are rated superior to vegetable proteins because they are biologically Pulses : Methionine + cysteine
complete, i.e. contains all the EAA in amounts required Maize : Tryptophan + lysine
Egg proteins are “reference proteins” because of high biological value and digestibility Conditionally essential amino acids:
Tyrosine and cysteine for premature
babies.
58
Assessment of Protein
Protein Quality
Assessed by comparison to “reference protein”.
Following are the methods to assess protein quality
•• Digestible indispensable amino acid score (DIAAS):**
DIAAS% = 100 × [(mg of digestible dietary indispensable amino acid in 1 g of
the dietary protein) / (mg of same dietary indispensable amino acid in 1 g of the
reference protein)]
11 Must remember Currently accepted best to measure protein quality
•• Protein digestibility corrected amino acid score (PDCAAS):
The best indicator for protein
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PDCAAS% = (mg of limiting amino acid in 1 g of test protein / mg of same amino
quality is:
acid in 1 g of reference protein) × fecal true digestibility%
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DIAAS > PDCAAS > NPU
PDCAAS value of 1 is highest and 0 is the lowest
•• Amino acid score (AAS):
AAS = (mg of amino acid per g of test protein / mg of the same amino acid per g
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of reference protein) ×100
The lowest score indicates limiting amino acid
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•• Digestibility coefficient
Amount of amino acid absorbed from the food
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Amount of protein ingested
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It is an indicator for the external protein quality of the food product
•• Biological value
12 Must remember
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Amount of nitrogen retained for body mass
Amount of amino acid absorbed from the food
It is an indicator for internal quality of the protein
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NPU of egg- 97% (~100%), meat– •• Net protein utilization (NPU):
80% and milk–70%. N
PU = Digestibility coefficient (DC) × Biological value (BV) / 100
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Or NPU = Nitrogen retained / Protein ingested × 100

In calculating the protein quality, 1 g of protein is assumed to be equivalent to
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6.25g of nitrogen.
18 P
rotein Quantity
High Yield Points
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Protein Energy ratio or %:

•• PE ratio or % = energy from protein / total energy in diet x 100
Maximum protein energy ratio - Egg
Protein Efficiency Ratio
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•• PER = weight gain (g) / protein intake (g) × 100

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•• PER >2.5 assigned to proteins that are efficient in promoting growth (animal proteins).
•• PER 0.5-2.5 assigned to proteins that are efficient in supporting life but not growth
(vegetable proteins).
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Requirement
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1.0 g protein/kg body weight for an Indian Adult, assuming NPU of 65 for dietary protein.
19
High Yield Points FATS
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Fat contents among cereals and

millet - Bajra [5 g per 100 g grain, Essential fatty acids: Sources (in order of frequency)
highest] > Maize >Jowar > whole •• Linoleic acid (omega 6 fatty acid) - Safflower oil, corn oil, sunflower oil and soybean oil
Wheat > Ragi > Rice. •• Arachidonic acid: Meat, eggs and milk
•• Alpha - Linolenic acid (omega 3 fatty acid) – Flaxseed, canola oil, soybean oil, walnut.
•• Eicosapentaenoic acid: Fish oil
Saturated fatty acids are present in high quantities in coconut oil, palm oil and butter
Polyunsaturated fatty acids are present in high quantities in safflower oil, corn oil, sunflower
oil, soybean oil, cotton seed oil and margarine
Theory 59

Requirements
13 Must Remember
20–40 g/day for an adult man and for pregnant and lactating mothers at least 30 g/day.
Corn has the highest “Glycemic
CARBOHYDRATES Index” (GI).
Cornflakes have high glycemic
Glycemic Index index
•• It measures how fast the food is likely to raise the blood sugar and helps in managing Most fruits have low to moderate
the blood sugar in diabetic patients glycemic index.
•• It indirectly measures effect of foods on blood sugar Melon and grapes have high
•• It indicates area under blood glucose curve. glycemic index compared to other
Table 3: Classification based on the glycemic index fruits
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Dates, guava, Indian jujube,
Classification GI range Examples acai berry, black berry are lower
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glycemic index compared to other
Low GI 55 or less Whole grains, pasta foods, beans and lentils
fruits
Medium GI 56–69 Sucrose, basmati rice, brown rice
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Avocado have high fat content
High GI 70 or more Corn flakes, baked potato, white bread, candy compared to other fruits
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bar and syrupy foods
Requirement: 400–500 g/day
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MICRONUTRIENTS 14 Must Remember
Micronutrient deficiency is also known as hidden hunger
PHVO: Partially hydrogenated
Most common micronutrient deficiency is iron.
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•• Vanaspati” is hydrogenated
VITAMINS
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vegetable oil (semi solid or
solid).
Vitamins are broadly categorized into following two:
•• During hydrogenation,
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Fat-soluble vitamins: A, D, E and K unsaturated fatty acids are

Water-soluble vitamins: B group and C
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converted into saturated

fatty acids and EFA content
Fat Soluble Vitamins is reduced. It is fortified with
vitamins A (2500 IU) and
Vitamin A
&
vitamin D (175 IU per 100 g) by

Richest animal source: Fish liver oil government regulation.
Richest vegetable source: Red palm oil,* spinach, amaranth
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First symptom in vitamin A deficiency: Night blindness

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First clinical sign of vitamin A deficiency: Conjunctival xerosis
Requirements 6 Good to Remember

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Recommended daily allowances (RDA): 600 mcg for adults, children 7–9 years and
adolescents; 350 mcg for infants; 400 children 1–6 years ; 800 mcg for pregnant females. All animals, except Fish are good
sources of saturated fatty acids
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Vitamin A toxicity All plants, except Coconut are

good sources of unsaturated fatty
Repeated moderately high dose causes teratogenicity
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acids.
Acute high dose: Nausea, headache, raised intracranial pressure (pseudotumor cerebri),
skin desquamation and hepatomegaly
Chronic high dose causes liver damage and hyperostosis.
Deficiency Disorder
Xerophthalmia
Refers to all ocular manifestations of vitamin A deficiency
Most common in children aged 1–3 years
5.7% children in India suffer from eye signs of VAD
60
WHO classification of xerophthalmia:

•• Primary changes
X1A Conjunctival xerosis
X1B Bitot’s spots
X2 Corneal xerosis
X3A Corneal ulceration / Keratomalacia (<1/3)
7 Good to Remember X3B Corneal ulceration / Keratomalacia (>1/3)
•• Secondary changes
Night blindness is the earliest
XN Night blindness (1st symptom)
symptom of xerophthalmia, but is
XF Fundal changes
not the primary feature of Vitamin A
XS Corneal scarring
deficiency
Prevention and Control
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•• Short-term action
Treatment: Administer 2 lakh IU orally on 2 successive days
1/
8 Good to Remember
Prophylactic: For children <1 year - 1 lakh IU
For children >1 year- 2 lakh IU every 6 months up to 5 years of age
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Remember: 2,500 IU of vitamin A •• Medium-term action
and 175 IU of vitamin D is present in Fortification of foods such as Vanaspati ghee and toned milk
in
100 mL of Dalda (Vanaspati ghee) •• Long-term action
Change in nutritional habits with inclusion of vitamin A rich foods
Breastfeeding for as long as possible
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Immunization against infectious diseases such as measles
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Prompt treatment of diarrhea and other associated infections.
Vitamin D
9 Good to Remember M
Nutritionally important and present in two forms:
•• Calciferol (Vitamin D2): Derived from plant source
Milk, margarine, Vanaspati and
•• Cholecalciferol (Vitamin D3): Derived from animal source and exposure to UV rays
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infant foods are artificially fortified
of sunlight.
with vitamin D.
Vitamin D is also considered as kidney hormone.
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Richest source: Fish liver oil

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Recurements
Daily requirement: 400 IU (10 mcg) in children, pregnancy and lactation, 100 IU (2.5 mcg)
in adults.
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Deficiency Disorders
10 Good to Remember
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•• Rickets in young children (6 months- 2 years)

•• Osteomalacia in adults (F>M)
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Vitamin D and B12 have only animal

origin sources. Vitamin D Toxicity
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Large doses cause hypercalcemia (serum CA >10.5 mg %) characterized by nausea, vomiting,

constipation, renal failure, metastatic calcification in arteries, kidneys and result in cardiac
arrhythmias and renal failure.
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Water-Soluble Vitamins
11 Good to Remember
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Magenta red tongue: Riboflavin Vitamin B1 – Thiamine

Beefy-red tongue: B12 deficiency Cereals are the main source in diet of Indian people.
Strawberry or raspberry tongue: Thiamine losses in the following conditions:
Scarlet fever •• Washing and cooking of rice
•• In highly polished rice
•• Prolong storage of fruits and vegetables
Theory 61

Deficiency Disorders
•• Beriberi
Dry form: Nerve involvement
Wet form: Heart involvement
Infantile beriberi:
– Infants 2–4 months
– Due to breastfeeding by thiamine deficient mother
– Signs of peripheral neuropathy
•• Wernick’s encephalopathy: In alcoholics and people who fast.
Requirements
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RDA: 1–2 mg/day (0.5 mg/1,000 kcal)*
1/
Vitamin B2 – Riboflavin
Cereals and pulses are poor source but because of bulk in which they are consumed, it fulfills
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the requirement
Germination increases the content in pulses and cereals

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Angular stomatitis due to deficiency of vitamin B2
RDA: 0.6 mg/1,000 Kcal*
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Vitamin B3 – Niacin
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Differs from other B group vitamins:
•• EAA tryptophan serves as its precursor
•• As water-soluble vitamin, not excreted in urine but metabolized
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Milk is the poor source of niacin but its proteins are rich in tryptophan which is converted in
the body into niacin (about 60 mg of tryptophan is required to form 1 mg of niacin).
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Deficiency Disorder 15 Must Remember
Only dependent on maize or jowar (sorghum) due to excess of leucine interfere in conversion
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Pellagra
(most common)
Due to low tryptophan, which is
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Pellagra- 3 Ds’- disease of poverty

Diarrhea precursor for niacin formation
Dermatitis Due to high leucine, which is
Dementia potent inhibitor of tryptophan
&
RDA: 6.0 mg/1000 Kcal* metabolism
Vitamin B6 – Pyridoxine
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Patient on Isoniazide treatment (ATT drug) provided with the supplement of 10 mg/day.
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RDA:
•• Adults: 2.0 mg/day
12 Good to Remember
•• Pregnancy and lactation: 2.5 mg/day
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Antioxidant properties
Vitamin C – Ascorbic Acid Nutrients: Vit. E, Vit. B2, Vit. C, Zinc,

Selenium, β-carotene
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Most heat sensitive. Non- nutrients: flavonoids, caffeic

Amla or Indian gooseberry: Richest source both fresh and dry form and ferulic
Guavas another richest source.
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Enzymes: Superoxide dismutase and

Deficiency: Scurvy catalase superoxides mutase
RDA: 40 mg/day for adults.
MINERALS
Major minerals: Calcium, phosphorus, sodium, potassium and magnesium
Trace elements: Iron, iodine, fluorine, zinc, copper, cobalt, chromium, manganese,
molybdenum, selenium, nickel, tin, silicon and vanadium
Trace contaminants with no known function: Lead, mercury, barium, boron and aluminum.
62
Iron
13 Good to Remember Total daily iron loss of an adult – 1 mg
Menstruating women- 12.5 mg per 28 days cycle
Rice is the poorest source of calcium Daily recommended iron intake:
due to presence of phytic acid which •• Adult male = 15 mg/day
leads to poor bioavailability •• Adult women = 30 mg/day
•• Pregnancy= 35 mg/day
•• Lactation = 21 mg/day
•• Infants = 46 mcg/kg/day (0–6 m), 05 mg/day (6–12 m)
RDA: 10–30 mg/day in adults, 20–35 mg/day in pregnancy and lactation and adolescent.
14 Good to Remember
(Note: females have higher daily requirement of iron due to physiological reasons)
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Evaluation of iron status
Rice is devoid of vitamin A, D, C •• Hb concentration
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and poor source of calcium and •• Serum iron concentration:
iron More useful index than Hb concentration
Rice protein is richer in lysine Normal range: 0.80–1.80 mg/L
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Iron deficiency: below 0.50 mg/L
•• Serum ferritin:**
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Most sensitive tool
Below 10 mcg/L probably indicate an absence of stored iron
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•• Serum transferrin saturation:
Should be above 16%
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Normal value- 30%.
Nutritional Anemia
15 Good to Remember
Anemia cut-off
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Table 4: Anemia among children and adults
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Children age 6–59 months who are anemic (<11.0 g/dL) (%) 55.9 59.4 58.5 69.4
g/dL (venous Nonpregnant women age 15–49 years who are anemic 51.0 54.3 53.1 55.2
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blood) (12.0 g/dL) (%)

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Adult males 13 Pregnant women age 15–49 years who are anemic (<11.0 g/dL) 45.7 52.1 50.3 57.9
Adult females, 12 (%)
nonpregnant All women age 15–49 years who are anaemic (%) 50.8 54.2 53.0 55.3
Adult females, 11
&
Men age 15–49 years who are anaemic (<13.0 g/dL) (%) 18.4 25.2 22.7 24.2
pregnant
Children (6 11 Interventions:
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months- 6 years) •• Iron and folic acid supplementation:

If Hb is 10–12 g/dL of blood
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Children 12
In pregnant women, IFA tablets are given prophylactically containing 100 mg
(6–14 years)
elemental iron (ferrous sulfate) and 500 mcg folic acid for 6 months before
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delivery and 6 months in postnatal period. (Start the intervention only in second
trimester).
The dosage for children (6 months–2 years) contains 20 mg of elemental iron (60
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mg of ferrous sulfate) and 100 mcg folic acid per day for 100 days in a year
Children (6–10 years) 30 mg of elemental iron and 250 mcg of folic acid per day
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for 100 days

Adolescents are given same dosage and duration as per adults.
•• Iron fortification:
Addition of ferrous sulfate with sodium bisulfate or ferric orthophosphate to salt
has been done. When consumed for 12–18 months, can reduce the prevalence.
Twelve by Twelve Initiative

Motive: Every child across the country should have at least 12 g% Hb by 12 years of age.
Theory 63

Iron Plus Initiative
Under National Iron+ Initiative, the following age groups are covered for lifelong supplementation
of iron from the age of 6 months onward:
16 Good to Remember
Biweekly 20 mg elemental iron and 100 microgram (mcg) folic acid per mL of liquid Double fortified salt or two-in-one
formulation and age appropriate deworming for preschool children of 6–59 months. salt contains both iodine and iron.
Weekly supplementation of 45 mg elemental iron and 400 mcg folic acid per child per day for
children from 1st to 5th grade in government and government aided schools, and at AWC
for out of school children (6–10 years).
Weekly dose of 100 mg elemental iron and 500 mcg folic acid with biannual deworming in
adolescents (10–19 years) under WIFS
Weekly supplementation for women in reproductive age, pregnant and lactating women
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Table 5: IFA supplementation program and service delivery
Age group Intervention/Dose Regime Service delivery
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6–60 months 1 mL of IFA syrup containing 20 mg Biweekly throughout the period Inclusion in MCP card
of elemental iron and 100 mcg of 6–80 months of age and deworming Through ASHA/ANM
in
folic acid for children 12 months and above
5–10 years Tablets of 45 mg elemental iron and Weekly throughout the period In school through teachers and
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400 mcg of folic acid 5–10 years of age and biannual de- for out-of-school children through
worming Anganwadi centre (AWC)
ed
10–19 years 100 mg elemental iron and 500 mcg Weekly throughout the period In school through teachers and for
of folic acid 10–19 years of age and biannual those out-of-school through AWC
Pregnant and
lactating women
100 mg elemental iron and 500 mcg
of folic acid
de-worming
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1 tablet daily is provided starting
from 2nd trimester until delivery
ANC/ANM/ASHA
Inclusion in MCP card
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and for another 180 days in the
postpartum period.
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Women in 100 mg elemental iron and 500 mcg Weekly throughout the reproductive Through FHW during house visit for
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reproductive age of folic acid period contraceptive distribution

(WRA) group
The main objective of providing the iron folic acid tablets is to combat nutritional anemia which is a grave public health problem in India.
&
Iodine
Daily requirement of iodine is 150 mcg/day for adult and during pregnancy is 250 mcg/day.
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It is required for synthesis of Thyroid hormones-T4 &T3.

Sources: Seafood (e.g., Seaweeds, sea fish, salt) Cod liver oil.
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•• Seaweeds are the richest source of iodine

•• Potato, onions and cranberries
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About 90% of iodine comes from foods eaten and rest from drinking water (about 1-50
micrograms/L.)
Iodine content of soil determines its presence in water and locally grown foods 17 Good to Remember
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Daily requirement for adults (>12 years) is 150 micrograms per day. (250 mcg per day during
pregnancy) Goitrogens (Cyanoglycoside and
Thiocyanate.) are chemicals that
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Fluorine interfere with Iodine utilization by

thyroid gland leading to goiter.
Prolonged ingestion of > 1 mg/L fluoride- dental and skeletal fluorosis
Brassica group of vegetables (e.g.
< 0.5 mg/L of ingestion—dental caries
cabbage cauliflower) may contain
Indicator of dental caries in community: DMF- Index (D = Decayed, M = Mottled,
goitrogens
F = Fallen)
Recommended level: 0.5-0.8 mg/L of drinking water
Nalgonda technique:
•• For defluoridation of water
•• Recommended by National Environmental Engineering Research Institute, Nagpur
•• Involves the addition of alum, lime and bleaching powder followed by flocculation,
sedimentation and filtration.
64
Endemic Fluorosis
This occurs in places with high levels of fluorine in water (3 – 5 mg/L)
However the Safe limit of Flourine in drinking water in India is – 0.5 to 0.8 mg / dL.
Remember: Dental fluorosis if F2 above 1.5 mg/L
Skeletal fluorosis if F2 3-6 mg/L
Crippling (Genu valgum) if F2 above 10 mg/L
Intervention:
•• Change the source of water
•• Nalgonda technique: mentioned above in fluorine
•• Avoid using fluoride toothpaste in endemic areas in children up to 6 years of age.
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FOOD PRODUCTS
1/
16 Must Remember Cereals
e,
Common cooking methods Provide about 350 Kcal per 100 g (70–80% of total energy intake) and more than 50% of
protein intake in typical Indian diet. Cereal proteins are deficient in essential amino acid–
Parboiling: The food items are
in
Lysine.
added to boiling water and Rice protein content varies from 6% to 9% (Rich in lysine compared to other cereals, hence
cooked until they start to soften,
ic
considered to be of better quality). Rice is a good source of group B vitamins, especially
then removed before they are Thiamine.
fully cooked. Parboiling is usually
ed
Milling leads to loss of Thiamine [up to 75% loss], Riboflavin [60% loss] and protein [15%
used to partially cook an item loss]
which will then be cooked another Parboiling (partial cooking in steam) is an ancient Indian technique to preserve nutritive
way such as braising, grilling or
stir-frying.
Parboiling differs from blanching

value of rice
M
Wheat protein content varies from 9% to 16%.Limiting amino acids are lysine and threonine.
Maize proteins are deficient in tryptophan and lysine and contain an excess of leucine that
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in that one does not cool the interferes in conversion of tryptophan to niacin, aggravating pellagragenic action of maize.
items using cold water or ice after It is rich in fat
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removing them from the boiling Pulses “poor man’s meat” contain 20–25% protein (Soybean–40%). Pulse proteins are poor
water. in methionine and cysteine, but rich in lysine. Pulses are rich in minerals and B-group
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Steeping: Steeping is the soaking vitamins.

in liquid (usually water) of a solid
so as to extract flavors or to soften
it. The specific process of teas
Fish
&
being prepared for drinking by It is rich in proteins (15–25%) of good biological value and amino acid balance, but poor in
leaving the leaves in heated water carbohydrateQ
Fish liver oils (unsaturated fatty acids) are rich source of vitamins A and D.Q
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to release the flavor and nutrients

is known as steeping. Fish bones are a good source of calcium, phosphorus and fluorides. Sea fish also contains
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iodine.
Fish is a poor source of iron (0.7-3 mg/100 g) than meat.
Diet survey duration may vary from 1 to 21 days, but most commonly it is 7 days or “one
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dietary cycle”.
Alcohol
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Alcohol content in beverage is 5–6% in Beer, 40–45% in Whisky, Rum, Gin and Brandy.
Alcohol supplies 7 Kcal/mL.
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20 Milk
High Yield Points Animal milk has three times more protein content than human milk (buffalo >cow >human)
Human milk contains more Animal milk has 10 times more calcium content than human milk (buffalo >cow >human)
tryptophan, sulfur containing AA Fat content is more in buffalo milk (it is double in comparison to human milk)
(esp. cysteine), linoleic acid, oleic Milk fat is rich in retinol and vitamin D
acid, sugar (lactose) and water as Poor source of vitamin C and iron
compared to animal milk Chief protein is casein; others lactalbumin and lactoglobulin
Ration of casein to albumin in human milk is 1:1
Theory 65

Pasteurization of Milk
SNF testing – for assessment of Solid Non Fat in the milk
Methylene blue reduction test is done to confirm heavy contamination of animal milk
(before pasteurization). **
Types of pasteurization
•• Holder (VAT Method): 63-66°C for at least 30 minutes, and then quickly cooled to 5°C
•• High temperature, short time (HTST) method: Rapidly heated to a temperature of
nearly 72°C, is held at that temperature for not less than 15 seconds, and is then rapidly
cooled to 4°C.
•• Ultra high temperature (UHT) method: Rapid heating to very high temperature
of 125°C for few seconds. A second phase of pasteurization takes place under high
18 Good to Remember
pressure. UHT is the most modern method and used in large milk production factories Types of milk
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Tests of pasteurized milk •• Standard milk : 6% fat
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•• Phosphatase test – should be absent in milk •• Toned milk : 3% fat
•• Standard plate test - < 30,000 bacterial colony •• Double toned milk : 1.5% fat
•• Coliform count – 0/mL •• Skimmed milk : <0.5% fat
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Breast Milk
in
Per 100 g or 100 mL contains:
•• 65 Kcal 21
ic
•• 7.4 g carbohydrate
•• 3.4 g fat
High Yield Points
ed
•• 1.1 g protein Skimmed milk powder is an
important ingredient of ‘Hyderabadi
Colostrum: First milk after delivery. Usually within first 3 days of delivery, the milk is rich in
mix’ - a supplementary food.
immunoglobulins (IgA), essential amino acids and maternal antibodies.
M
Mature milk: is the milk after > 12–16 days after delivery. It is an approximation of complete diet.
The mature milk contains almost all nutrients required for adequate growth of a neonate. The
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initial milk during every feed may be thinner and more watery (foremilk), which becomes more
fatty and thick later on in the feeding session (known as hind milk).
ci
So
19 Good to Remember
Difference between Cow Milk and Human Milk
&
The mature milk grossly resembles a cow milk in terms of energy, nutrients and fat content, however..
Human milk has only one-third of the protein concentration compared to cow milk
Human milk contains a lipase enzyme because of which human milk fat is digested easily
e
Human milk has almost double the amount of lactose compared to cow milk. Lactose provides an easily digestible source of energy
tiv
High lactose content helps in myelination in the growing nerve tissue of the baby. Also, part of lactose is converted to lactic acid in
the intestine, which prevents growth of undesirable bacteria in the intestine.
Human milk contains the bifidus factor, which is a nitrogen-containing carbohydrate. Bifidus factor is necessary for the growth of
en
Lactobacillus bifidus, which converts lactose to lactic acid

Human milk, especially the colostrum, contains large amounts of immunoglobulin A, which is not absorbed but acts in the intestine
against certain bacteria (such as E. coli) and viruses
ev
Lysozyme, an enzyme, is present in human milk in concentrations several thousand times that of cow milk. Lysozyme breaks down
certain harmful bacteria and also protects against various viruses.
Pr
Eggs
An average egg (60 g) contains:
•• 70 Kcal of energy
•• 6 g of protein
•• 6 g of fat
•• 30 mg of Ca
•• 1.8 mg of iron
•• All vitamins except vitamin C
*100 g of egg yields 145 Kcal of energy.
66
FOOD PRODUCT MIXING

decreases the nutritive value or Food adulteration Brick powder – chilly powder
harms the body Argemone oil/mustard oil
Water/honey/milk/juice/chemical/
cumin seeds/tea leaves/many food
products
Any substance which is does not alter the nutritive value Food additive Preservative/color to many food
added to a food product but increases the shelf life or products
which consumption
increases the nutritive value and was Food fortification Iodine/salt
e
not present in food initially Vitamins/Vegetable oils
1/
enhances the nutritive value and was Food enrichment
present in lower quantity initially
e,
Table 6: Food adulterants
Diseases Foods Toxicants Clinical features
in
Neurolathyrism (mentioned
ic
below)
Aflatoxicosis Food grains (groundnuts* maize Aflatoxins produced by Liver cirrhosis
ed
(storage fungus) and jowar) Aspergillus flavus and
A. parasiticus
Ergotism
(field fungus) and wheat) M
Food grains (bajra, rye, sorghum Ergot fungus-
Claviceps purpurea
Acute cases- Nausea, vomiting,
giddiness, drowsiness
Chronic cases- Painful cramps
al
and peripheral gangrene
Epidemic dropsy Mustard oil contaminated with Toxic alkaloid sanguinarine in Sudden. Noninflammatory,
ci
argemone oil argemone oil bilateral swelling of legs with

diarrhea, dyspnea and cardiac
So
failure and glaucoma

Endemic ascitis Millets contaminated with weed Pyrrolizidine alkaloids in weeds Hepatotoxic
seeds of crotalaria (Jhunjhunu)
&
Fusarium toxins Sorghum Fungus Fusarium incarnatum Nausea, vomiting, diarrhea are
which produces the toxic predominant features
e
metabolites
tiv
* Nitric acid paper chromatography test is the most sensitive test to detect argemone oil contamination
en
LATHYRISM
22 This pulse (Lathyrus sativus- khesari dal) contains the toxin Beta oxalyl amino alanine
High Yield Points
ev
(BOAA) that leads to neurolathyrism in humans and osteolathyrism in animals.

Local names of dal: Teora dal, Lak dal, Batra, Gharas and Matraetc
Neurolathyrism risk factors: Neurolathyrism is a crippling disease of the nervous system resulting in spastic paralysis of
Pr
Heavy physical activity lower limbs (latent stage-no stick-one stick-two stick-crawler stage).
Male gender Interventions:
Young age (15-25 years) •• Vitamin C prophylaxis (500–1000 mg for a week or so)
Micronutrient deficiency (Zn, Cu, •• Removal of toxin by steeping or parboiling
Vit C, Vit A) •• Health education
Ingestion of the dal beyond critical •• Genetic approach
level of 400 g/day •• Banning of crop
Theory 67

Severity of Neurolathyrism
23
High Yield Points
Clinical features:
Latent: no features.
Stage I (No stick stage) - Jerky
Steps
Stage II (One stick stage) - Altered
gait
Stage III (Two sticks stage) -
A B C Crossed Gait
e
Stage IV (Crawler stage) - inability
Figs 1A to C: Severity of neurolathyrism (A) One stick stage; (B) Two sticks stage;
to walk
1/
(c) Crawler stage
NUTRITIONAL DISTURBANCES
e,
Low Birthweight (LBW)
in
Defined as one with a birthweight below 2.5 kg (2,500 g) regardless of gestational
ic
age.*Preferably measured within in first hour of life, before significant postnatal weight
loss has occurred
ed
28% of newborns in India are LBW (NFHS 3).
Intrauterine growth retardation (IUGR) is the most common reason
Leading causes of death in LBW babies:
•• Atelectasis
•• Malformation
•• Pulmonary hemorrhage
M
al
•• Intracranial bleeding secondary to anoxia or birth trauma
•• Pneumonia and other infection. 20 Good to Remember
ci
Kangaroo mother care:

•• Introduced in Columbia in 1979
So
In neurolathyrism:
•• Includes:
Skin to skin positioning of a baby on mother’s chest Upper motor neuron disorder
Adequate nutrition through breastfeeding with symmetrical spastic paralysis.
Ambulatory care as a result of earlier discharge from hospital Sensation and sphincters are
&
Support for the mother and her family in caring for the baby. spared.
The neuronal damages are
e
permanent.
Protein Energy Malnutrition (PEM) Symptomatic treatment with muscle
tiv
Incidence in preschool children is around 1–2%. relaxants help.

Gomez classification:
•• It compares the weight of a child with a normal child of the same age. The "normal"
en
reference child is in the 50th centile of Boston standards

•• It is based on weight retardation
ev
•• It is as follows:
90 – 110% of normal: normal nutritional status
75 – 89% of normal: 1st degree, mild malnutrition
Pr
60 – 74% of normal: 2nd degree, moderate malnutrition

Under 60% of normal: 3rd degree, severe malnutrition
Mclaren’s classification:
•• It uses height as the measuring criteria
> 93% height for expected age – Normal
80 – 93% height for expected age – Short
< 80% height for expected age – Dwarf
Waterlow’s classification: It combines height for age (H/A) and weight for height (W/H)
68
W/H → H/A > Mean-2SD < Mean-2SD

> Mean-2SD Normal Wasted
<Mean-2SD Stunted Wasted and stunted
Table 7: Master chart of classification of protein energy malnutrition
Grade/Degree (Weight for age in percentage) Waterlow

Gomez Jelliffe IAP Height for age (stunting) Weight for height (wasting)
Normal 90-110 >90 100-80 >95% >90%
Mild (1 )
0
89-75 90-81 79-70 94-87.5 90-80
e
Moderate (20) 74-60 80-71 69-60 87.4-80 80-70
1/
Severe (30) <60 70-61 59-50 <80 <70
Very severe (4 ) 0
- <60 <50 - -
e,
Table 8: Clinical features of protein energy malnutrition
in
Features Marasmus Kwashiorkor
(Always present)
ic
Muscle wasting Obvious Sometimes hidden by fat and edema
ed
Edema None Present mainly in lowerlimb, face and fore arms
Mental changes Quite and apathetic Irritable , moaning, apathetic
Fat wasting
Weight for height Very Low
M
Severe loss of subcutaneous fat Fat often retained but not firm
Low but masked by edema
al
(Sometimes present)
Hair changes Seldom Sparse, silky, easily pulled out, ‘flag sign’
ci
Appetite Good Poor

So
Diarrhea Often Often

Liver enlargement Not present Present due to accumulation of fat
Skin changes None Diffuse pigmented skin, "flaky skin dermatosis"
&
Biochemical
Plasma/Amino acid ratio Normal Elevated
e
Serum albumin Normal/slightly decreased Low (<3 g/100 mL blood)

tiv
Urinary urea per g creatinine Normal/decreased Low

Hydroxyproline/creatinine ratio Low Low
en
Obesity
ev
Indicators to measure obesity:

Broca's index**:Height (cm) 100 = Weight (in kg)
Quetelet's index/ Body mass index (BMI) = weight (kg)/ height2 (m)
Pr
Table 9: WHO classification (International classification)
Classification BMI
Underweight <18.50
Normal range 18.50–24.99
Overweight ≥25.00
Pre-obese 25.00–29.99
Obese class I 30.00–34.99
Obese class II 35.00–39.99
Obese class III ≥40.00
Theory 69

For many Asian populations, additional trigger points for public health action were identified as:
23 kg/m2 or higher, representing increased risk
27·5 kg/m2 or higher as representing high risk.
For Asian population, the suggested categories are as follows:
1. Less than 18·49 kg/m2 underweight
2. 18·5–22.9 kg/m2 increasing but acceptable risk
3. 23–27·49 kg/m2 increased risk
4. 27·5 kg/m2 or higher high risk
Corpulence index:- Actual weight (in kg) / desirable weight (in kg) (This should not exceed
1.2)
Ponderal index:- Height (in cm) / Cube root of body weight (kg)
Lorentz’s formula:
e
Male = [ht (cm) - 100] - [ht (cm) - 150] / 4
1/
Female = [ht (cm) - 100] - [ht (cm) - 150] / 2
Fat fold thickness (skin fold thickness)
•• Measured by skin callipers
e,
•• Sites: Mid-triceps, biceps, subscapular and suprailliac regions
•• Sum of the above four site measurements should not be less than 40 mm in boys and
in
50 mm in girls
Waist-hip Ratio (WHR)
ic
•• WHR >1 in men and >0.85 in women indicates abdominal fat.
ed
NUTRITION RELATED ACTS
Codex: The “Codex Alimentarius” international food standards, guidelines and codes
M
of practice contribute to the safety, quality and fairness of this international food trade.
Consumers can trust the safety and quality of the food products they buy and importers can
trust that the food they ordered will be in accordance with their specifications
al
FSSAI: The Food Safety and Standards Authority of India (FSSAI) has been established
under Food Safety and Standards , 2006 which consolidates various acts and orders related
ci
to food and nutrition. The FSSAI would provide standards for articles of food and to regulate
So
their manufacture, storage, distribution, sale and import to ensure availability of safe and
wholesome food for human consumption
BIS: The Bureau of Indian Standards has evolved from the older organization of the Indian
standards institute. It is primarily responsible for providing quality assurance and guidelines
&
for hallmark, service delivery, metals, devices and instruments

AGMARK: It is a certification mark employed on agricultural products in India, assuring
that they conform to a set of standards
e
IYCF Substitution Act: Early initiation of breastfeeding within first hour of birth, exclusive
tiv
breastfeeding for the first 6 months followed by continued breastfeeding for up to 2 years
and beyond with appropriate complementary foods after completion of 6 months is the
most appropriate feeding strategy. Prohibits promotion of milk substitutes formula milk for
en
children less than 6 months of age

Antyodaya Yojana: Additional 25 kg food grain are provided to the poorest of poor families
at a highly subsidized rate of Rs 2 per kg for wheat and Rs 3 per kg for rice.
ev
Meat Hygiene
Pr
Floor and walls to be impermeable up to 3 ft

Food stored overnight in temperature below 5°.
Features of Fresh Fish

State of stiffness or rigor mortis
Bright red gills
Eyes are clear and prominent
Fish – public health importance:
Intermediate host for Dibothriocephalus latus
Vibrio para hemolyticus
Salmonella species
70
Meat public health:

Tapeworm infestation: T. solium, T. saginata, Trichinella spiralis
Bacterial infections: Anthrax, tuberculosis and food poisoning
NUTRITION-RELATED NATIONAL HEALTH PROGRAMS
Mid Day Meal Scheme

Also known as nutritional support to primary education
Objective is to decrease the school dropout rate
Cooked food is provided every day for promoting school attendance
e
Integrated Child Development Scheme (ICDS)
1/
Beneficiaries: The beneficiaries under the Scheme are children in the age group of 0–6 years,
pregnant women and lactating mothers
e,
Objectives:
To improve the nutritional and health status of children in the age group 0–6 years
To lay the foundation for proper psychological, physical and social development
in
of the child
To reduce the incidence of mortality, morbidity, malnutrition and school dropout
ic
To achieve effective coordination of policy and implementation amongst the
ed
various departments to promote child development; and
To enhance the capability of the mother to look after the normal health and
nutritional needs of the child through proper nutrition and health education.
•• Organization: M
One Anganwadi for 800–1,000 population (for AWC in rural / urban projects)
Thereafter in multiple of 800
al
Mini-AWC for 150 – 300 population
Anganwadi on demand (AOD): Settlement has 40 children under 6 years of age
ci
but no AWC
One Anganwadi supervisor for 25 Anganwadi
So
One Child development project officer for 100,000 population (one Block)
•• Benefits
Supplementary nutrition
Pre-school, nonformal education
&
Health education and awareness

Facilitating immunization
e
Family planning
Health check-up, basic health care
tiv
Referral services to various public health centers

Adolescent health, vocational training, food and health program.
en
Table 10: Revised nutritional norms
Beneficiaries Calories Protein (g) Cost approved by GOI

ev
(source MoWCD, 2017

guidelines)
Pr
Children (6 months to 72 months) 500 12–15 `8

Severely malnourished children 800 20–25 ` 12.5
(SAM)
Pregnant women and lactating 600 18–20 ` 9.5
mothers
Kishori Shakti Yojana

Kishori Shakti Yojana (KSY) in ICDS, was started in the year 2000 and is being implemented via
ICDS.
Theory 71

Aim
To improve the nutritional and health status of adolescent girls (Age 11-18 years).
Provide literacy and numeracy skills via nonformal education, stimulate desire for more
social exposure and knowledge and help improve decision making
Train and equip to improve home based and vocational skills
Promote self-development, awareness of health, hygiene, nutrition, family life and child care,
literacy and vocational skills and home management.
Delay marriage to after 18 years or later.
To gain better understanding of environment related social issues and its impact on lives
and to encourage adolescent girls to initiate activities to be productive and useful members
of society.
e
Scheme I → Girl to Girl Approach
1/
Designed for adolescent girls (Age 11–15 years) belonging to families with income < Rs
6,400 per annum and school drop outs in urban and rural areas.
3 girls are selected per AWC for 6 months duration and are provided supplementary nutrition
e,
equivalent to 500 calories and 20 g protein for 6 days a week.
Learning on preventive health, hygiene, nutrition and family life education by initial 3-day
in
training programme and 6 continuing education session of 1 day each month
These girls act as resource persons for other girls in the neighborhood
ic
AWC is the focal point of services.
ed
Scheme II → Balika Mandal
Designed for all adolescent girls (11–18 years, preferable 11–15 years) irrespective of income

of family.
M
10% of total AWC in each community development block and urban ICDS area are selected
to serve as Balika mandals.
al
20 girls (age 11–18 years) are enrolled for a duration of 6 months in Balika mandal.
ci
Social Welfare Measures under the Anganwadi Scheme

So
Under the Wheat Based Nutrition Program (WBNP), food grains viz., wheat, rice and other
coarse grains are allocated at below poverty line (BPL) rates to the States/UTs through the
Department of Food & Public Distribution (D/o Food & Public Distribution), for preparation
of supplementary food in ICDS
&
Anganwadi Karyakartri Bima Yojana (AKBY): Insurance scheme for accidental death,
disability or accidents
Sneha shivir: Community-based care program for undernourished children less than 6 years
e
of age. It includes
tiv
•• During the 12 days, children are fed additional high calorie local foods, provided under
ICDS and from contribution of care givers and community. During 12 days, children
regain appetite and visible changes are seen as also indicated by gain in weight, a gain
en
of 200–400 g is expected
•• Weight monitoring of the selected children
•• Deworming of these children
ev
•• Ensure IFA and complete immunization for these children

•• 12 days hands-on practice sessions for mothers and care givers to promote improved
Pr
feeding and child care practices

•• Recording of weight on first day, 12th day and after 18 days
•• Theme based education using IEC on feeding, health, hygiene and psychosocial care on
each of the 12 days, using mother child protection card package
•• Health check-up and referral services
•• 18 days home-based practices
•• Repeat of session for each child till child becomes normal
•• Monitoring progress: Child-wise, AWC-wise as well as at the block and district levels.
72
National Iodine Deficiency Disorder Control Program (NIDDCP)

17 Must Remember Timeline
Spectrum of IDD includes National goiter control program – 1962
National iodine deficiency disorder control program – 1986
Goiter (most common)
Hypothyroidism
Objectives of Program
Subnormal intelligence including
delayed mile stones, mental Surveys to assess the magnitude of the iodine deficiency disorders.
deficiency, hearing defects, Supply of iodated salt in place of common salt
speech defects Resurvey after every 5 years to assess the extent of iodine deficiency disorders and the impact
Squint (Strabismus) of iodated salt.
Nystagmus Laboratory monitoring of iodated salt and urinary iodine excretion
e
Spasticity (Extrapyramidal type) Health education and publicity.
1/
Neuromuscular weakness Control of IDD by:
Endemic cretinism Iodized Salt:
IUD (Spontaneous abortion,
e,
miscarriage) Moisture Not more than 6.0% by weight of the
sample salt
in
Sodium chloride Not less than 96.0% by weight on dry basis
Matter insoluble in water Not more than 1.0% by weight on dry
ic
21 Good to Remember basis
ed
Matter soluble in water other than sodium Not more than 3.0% by the weight on dry
Iodized oil: Intramuscular
chloride basis
injection of iodized oil (mostly
poppy-seed oil) which provides a Iodine content at:
protection for 4 years with 1 mL
average dose. NIN, Hyderabad Manufacturing level
M Not less than 30 parts per million (ppm)
on dry weight basis
successfully developed the
al
process to produce iodized oil in Distribution level Not less than 15 parts per million on dry
safflower or saffola oil. weight basis
ci
Iodized oil oral: Iodized oil or

IDD Monitoring: Most sensitive indicator to environmental iodine deficiency is Neonatal
So
Sodium Iodate tablets.

‘Smiling Sun’ is a symbol used for hypothyroidism, followed by urinary iodine excretion.
Iodized salt Programmatic goal of IDD by 2010:
•• <5% prevalence of IDD in 10–14 years of age
•• <10% of incidence of IDD
&
IDD survey
•• Annual survey to be conducted at district levels
e
•• Sample size for IDD survey is as under

tiv
18 Must Remember
Total sample is calculated as: selection of villages / wards using population proportionate to size (PPS) sampling method
en
Sample size = 30 villages / wards. From each village selection is as under:

90 children will be selected (45 boys and 45 girls) of age group 6–12 years using the proportionate sample for the enrollment rates in
ev
the school
The examination should be for
•• 100% children to be examined for iodine in house hold salt levels
Pr
•• All children to be examined for goiter rate in children (6–12 years age).
Grade 0- Neither Palpable nor visible—No Goiter
Grade 1- Goiter palpable but not visible when the neck is in normal position
Grade 2- A swelling in the neck that is visible when the neck is in a normal position.
•• The Goiter rate (grade 1 and Grade 2) is classified as under:
5–19% goiter rate IDD is a Mild Public health problem
20–29.9% goiter rate IDD is a Moderate Public health problem
>30 % goiter rate IDD is a Severe Public health problem
•• 50% children (every alternate child) to be examined for Urinary Iodine Excretion rate (UIE). Median UIE is
50–99 mcg / L IDD is a Mild Public health problem
20–49 mcg / L IDD is a Moderate Public health problem
< 20 mcg / L IDD is a Severe Public health problem
Theory 73

Indicators to Monitor IDD Control Program
Impact indicator:
19 Must Remember
•• Chronic impact indicator – long term indicator – Goiter rate Iodine-Induced Thyroid
Epidemiological indicator/principal impact indicator/most important indicator/ Dysfunctions
sustainability indicator: Urinary iodine levels
Wolff-chaikoff effect
Process indicator: iodine levels in salt (at packaging and at household level)
•• Hypothyroidism
•• Due to: High dose, acute intake
24
High Yield Points of iodine
Jod Basedow effect
Most common type of goitre – euthyroid goiter •• Hyperthyroidism
Most common thyroid dysfunction – hypothyroidism (Hashimoto’s or autoimmune •• Due to: Low dose, chronic
e
thyroiditis) intake of iodine
1/
Endemic goiter – kangra belt (sub-Himalayan region)
e,
22 Good to Remember
in
Ma-konbu and Kizami-konbu are Japanese seaweed (used in salads). It contains 12–24 mg
of iodine, which is maximum in any food product. Other iodine-rich sea foods as fish, crabs,
ic
octopus contain iodine ranging from 10 mcg to 100 mcg only.
ed

M
al
ci
So
&
e
tiv
en
ev
Pr
74
Image-Based Questions
1. Identify the seeds shown in the figure: 4. Identify the condition depicted in the figure:
e
1/
e,
a. Goiter
b. Submandibular lymph node enlargement
in
a. Dhatura b. Argemone c. Ludwig’s angina
c. Bajra d. Jowar d. Hyoid bone displacement
ic
ed
2. The item (Jeevan Bindi) shown in the figure is used in: 5. Identify the cereal in shown in the figure:
M
al
ci
So
&
a. Iron deficiency b. Iodine deficiency a. Jowar b. Bajra

e
c. Skin sensitivity d. Folic acid deficiency c. Soya bean d. Lentils

tiv
3. Identify the item in the figure: 6. The logo shown depicts the national program for:
en
ev
Pr
a. Trachoma control b. Control of Blindness

a. Dhatura b. Argemone c. Vitamin A Prophylaxis d. Vision 20:20
c. Bajra d. Jowar
IBQs 75

7. The item shown in the figure is: 9. The condition depicted in figure is:
e
1/
e,
a. Shakir’s tape b. Triage tape
in
c. Multi purpose tape d. Wrist tape
ic
8. The symbol shown in figure is used to depict levels of:
ed
a. Kwashiorkor b. Marasmus
c. Nephrotic syndrome d. Epidemic Dropsy
M10. The condition depicted in figure is due to:

al
ci
So
&
a. Food toxicity in plastics

b. Biomedical waste
e
c. Pesticide toxicity
d. Cytotoxicity of hospital waste a. Trachoma b. Vitamin A deficiency
tiv
c. Foreign body injury d. Fat deposits

en
ev
Pr
76
Answers of Image-Based Questions
1. Ans. (b) Argemone
2. Ans. (b) Iodine deficiency
3. Ans. (a) Dhatura
4. Ans. (a) Goitre
e
5. Ans. (a) Jowar
1/
6. Ans. (b) Control of Blindness
e,
7. Ans. (c) Multipurpose tape
in
8. Ans. (c) Pesticide toxicity
ic
ed
9. Ans. (a) Kwashiorkor
10. Ans. (b) Vitamin A deficiency

M
al
ci
So
&
e
tiv
en
ev
Pr

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3

Nutrition and Related

PHYSIOLOGICAL ENERGY VALUE OF INDIAN FOODS

 For light work (Sedentary work) : 2,320 Kcal/day

 Heavy work : 3,490 Kcal/day

 Moderate work : 2,230 Kcal/day

 Pregnancy : + 350 Kcal/day

 Lactation (6–12 months) : +520 Kcal/day

Table 1: Recommended daily allowances for Indians —2010

Chapter 3 ► Nutrition and Related National Health Programs

Person Calorie Coefficient Consumption Unit

 Complex organic nitrogenous compounds

synthesis of tissue proteins.

 Lysine  Methionine donor of methyl

 Or NPU = Nitrogen retained / Protein ingested × 100

Protein Energy ratio or %:

•• PER = weight gain (g) / protein intake (g) × 100

 Fat contents among cereals and

Chapter 3 ► Nutrition and Related National Health Programs

 Requirement: 400–500 g/day

 Fat-soluble vitamins: A, D, E and K unsaturated fatty acids are

converted into saturated

vitamin D (175 IU per 100 g) by

 First symptom in vitamin A deficiency: Night blindness

 First clinical sign of vitamin A deficiency: Conjunctival xerosis

Requirements 6 Good to Remember

Vitamin A toxicity  All plants, except Coconut are

 WHO classification of xerophthalmia:

 Richest source: Fish liver oil

•• Rickets in young children (6 months- 2 years)

Vitamin D and B12 have only animal

 Large doses cause hypercalcemia (serum CA >10.5 mg %) characterized by nausea, vomiting,

 Magenta red tongue: Riboflavin Vitamin B1 – Thiamine

Chapter 3 ► Nutrition and Related National Health Programs

 Pellagra- 3 Ds’- disease of poverty

 RDA: 6.0 mg/1000 Kcal* metabolism

Vitamin C – Ascorbic Acid Nutrients: Vit. E, Vit. B2, Vit. C, Zinc,

 Most heat sensitive. Non- nutrients: flavonoids, caffeic

Enzymes: Superoxide dismutase and

blood) (12.0 g/dL) (%)

months- 6 years) •• Iron and folic acid supplementation:

for 100 days

Twelve by Twelve Initiative

Chapter 3 ► Nutrition and Related National Health Programs

Age group Intervention/Dose Regime Service delivery

reproductive age of folic acid period contraceptive distribution

 It is required for synthesis of Thyroid hormones-T4 &T3.

•• Seaweeds are the richest source of iodine

Fluorine interfere with Iodine utilization by

 Steeping: Steeping is the soaking vitamins.

to release the flavor and nutrients

Chapter 3 ► Nutrition and Related National Health Programs

Lactobacillus bifidus, which converts lactose to lactic acid

FOOD PRODUCT MIXING

Diseases Foods Toxicants Clinical features

argemone oil argemone oil bilateral swelling of legs with

failure and glaucoma

(BOAA) that leads to neurolathyrism in humans and osteolathyrism in animals.

Chapter 3 ► Nutrition and Related National Health Programs

 Kangaroo mother care:

 Incidence in preschool children is around 1–2%. relaxants help.

reference child is in the 50th centile of Boston standards

For light work (Sedentary work) : 2,320 Kcal/day

Heavy work : 3,490 Kcal/day

Moderate work : 2,230 Kcal/day

Pregnancy : + 350 Kcal/day

Lactation (6–12 months) : +520 Kcal/day

Complex organic nitrogenous compounds

Lysine Methionine donor of methyl

Or NPU = Nitrogen retained / Protein ingested × 100

Fat contents among cereals and

Requirement: 400–500 g/day

Fat-soluble vitamins: A, D, E and K unsaturated fatty acids are

First symptom in vitamin A deficiency: Night blindness

First clinical sign of vitamin A deficiency: Conjunctival xerosis

Vitamin A toxicity All plants, except Coconut are

WHO classification of xerophthalmia:

Richest source: Fish liver oil

Large doses cause hypercalcemia (serum CA >10.5 mg %) characterized by nausea, vomiting,

Magenta red tongue: Riboflavin Vitamin B1 – Thiamine

Pellagra- 3 Ds’- disease of poverty

RDA: 6.0 mg/1000 Kcal* metabolism

Most heat sensitive. Non- nutrients: flavonoids, caffeic

It is required for synthesis of Thyroid hormones-T4 &T3.

Steeping: Steeping is the soaking vitamins.

Kangaroo mother care:

Incidence in preschool children is around 1–2%. relaxants help.

60 – 74% of normal: 2nd degree, moderate malnutrition

Floor and walls to be impermeable up to 3 ft

Health education and awareness

Referral services to various public health centers

Iodized oil oral: Iodized oil or

Sample size = 30 villages / wards. From each village selection is as under: