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SUBJECTS NOTES
BSC NURSING PART – I
SUBJECT: NUTRITION
UNIT – I INTRODUCTION
NUTRITION
 Nutrition is the process by which body utilizes food for growth and maintenance and
healthy living.
 A science of food and its relationship to health and concerned with the part played by
food factor (nutrients) in body growth, development and maintenance.
 Nutrition is the combination of processes by which the living organism receives & uses
the food materials necessary for growth, maintenance of functions & repair of component
parts.
HISTORY OF NUTRITION
 400 B.C. -- Hippocrates, the "Father of Medicine", said to his students, "Let thy food be
thy medicine and thy medicine be thy food". He also said a wise man should consider that
health is the greatest of human blessings. One story describes the treatment of eye
disease, now known to be due to a vitamin A deficiency, by squeezing the juice of liver
onto the eye. Vitamin A is stored in large amounts in the liver.
 1747 Dr. James Lind, a physician in the British Navy, performed the first scientific experiment in
nutrition. At that time, sailors were sent on long voyages for years and they developed scurvy. In
his experiment, Lind gave some of the sailors sea water, others vinegar, and the rest limes. Those
given the limes were saved from scurvy. As Vitamin C wasn’t discovered until the 1930s, Lind
didn’t know it was the vital nutrient.
 Early 1800s It was discovered that foods are composed primarily of four elements: carbon,
nitrogen, hydrogen and oxygen, and methods were developed for determining the amounts of
these elements.
 1930s William Ross discovered the essential amino acids, the building blocks of protein.
 1940s The water soluble B and C vitamins were identified
 1950s to the Present -- The roles of essential nutrients as part of bodily processes have been
brought to light. For example, more became known about the role of vitamins and minerals as
components of enzymes and hormones that work within the body
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ROLE OF NUTRITION IN MAINTAINING HEALTH

GROWTH AND DEVELOPMENT
 Good nutrition is essential for attainment of normal growth and development during fetal
life and childhood. Physical growth, intellectual development, learning and behavior are
affected by malnutrition.
 Adequate nutrition is needed for adult life maintenance for optimum health and
efficiency.
 Elder people need special nutrition due to their physiological and chronological changes.
Pregnant and lactating mothers require more proteins and nutrients to prevent abortion,
growth retardation and low birth weight babies and provide adequate breast feeding for
their babies.
SPECIFIC DEFICIENCY DISEASES
 The most common deficiencies find in Indians are Protein energy malnutrition,
blindness, goiter, anemia, beriberi, rickets etc. There is increased incidence of abortion,
prematurity, still birth and low birth weight babies in malnourished mothers.
 Hence, good nutrition is essential to prevent nutritional deficiency diseases, promotion of
health and treatment of deficiency diseases.
RESISTANCE TO INFECTION
 A well balanced nutrition prevents infections like tuberculosis. Good nutrition enhances
wound healing. Improves resistance of an individual towards infections.
MORTALITY AND MORBIDITY
 Malnutrition leads to increased death rate, infant mortality rate, still births and premature
deliveries. Prematurity is the major cause of deaths.
 ·Over nutrition causes diseases like Obesity, diabetes, hypertension, cardiovascular and
renal diseases and causes death.
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NUTRITIONAL PROBLEMS IN INDIA

 PROTEIN ENERGY MALNUTRITION
 LOW BIRTH WEIGHT
 XEROPHTHALMIA
 NUTRITIONAL ANEMIA
 IODINE DEFICIENCY DISORDERS
 FLUROSIS
 LATHYRISM
 OBESITY
 CARDIO VASCULAR DISEASES
 DIABETES
 CANCER

 75 percent of preschool children suffer from iron deficiency anemia (IDA)

 57 percent of preschool children have sub-clinical Vitamin A deficiency (VAD)
 Iodine deficiency is endemic in 85 percent of districts
 11% of Indian population in India are over-nourished
 over 30 million people with diabetics in 1985 and by next year (2010) India is projected
to have 50.8 million diabetics India is hence considered as the country with the largest
population of diabetic

PROTEIN ENERGY MALNUTRITION

 PEM refers to the deficiency of energy and protein in the body.
 1-2% of preschool children in India suffer from PEM.

MAIN CAUSES OF PEM

 Inadequate intake of food both in quantity and quality

 Infections (Diarrhea, Respiratory infections, measles, intestinal worms)

RISK FACTOR OF PEM

 Poor environmental conditions,

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 Large family size,

 Poor maternal health,

 Failure of lactation,

 Premature termination of breast feeding,

 Adverse cultural practices related to child rearing and weaning,

 Delayed supplementary feeding

FORMS OF PEM

 MARASMUS

 KWASHIORKER

MARASMUS

 Common type of PEM observed among children below 1 year of age.

 Caused by severe deficiency of nearly all nutrients especially protein and calories

Conditions are characterized by extreme wasting of the muscles and a daunt expression.

MARASMUS CLINICAL MANIFESTATION

 Extensive tissue and muscle wasting

 Dry skin

 Loose skin folds hanging over glutei and axilla,

 Fat wasting

 small for age

 sparse hair that is dull brown or reddish yellow,

 mental retardation

 behavioral retardation,

 low body temperature (hypothermia),

 Slow pulse and breathing rates.

 Absence of edema
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KWASHIORKER

 Kwashiorkor occurs in children between 2-3 years of age

 Acute form of PEM due to deficiency of protein in the diet (Both in quantity and quality)

 Deficiency of micronutrients (Fe, Folic acid, Iodine, Selenium, and Vitamin C)

 Deficiency of antioxidants (albumin, Vitamin E, PUFA, Glutathione).

 kwashiorkor is identified as swelling of the extremities and belly, which is deceiving to

their actual nutritional status

KWASHIORKER

Malnourished child with pedal edemas,

Growth failure,

Moon face,

Distended abdomen,

Ascitis (abnormal accumulation of fluid)

Enlarged liver with fatty infiltrates, thinning of hair,

Loss of teeth,

Skin depigmentation

Dermatitis,

Irritability

ASSESSMENT OF PEM

 Weight for age = Weight of the child X 100

Weight of normal child of the same age 

 Between 90 – 110% Normal Nutritional Status

 Between 75 – 89% Mild malnutrition (1st degree)
 Between 60 – 74% Moderate Malnutrition (2nd degree)
 Under 60% Severe Malnutrition (3rd degree)

PREVENTION OF PEM
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 Health promotion Measures

 Promotion of breast feeding, low cost weaning food, nutrition education, family planning
and birth spacing,

 Protein energy rich food,(milk, egg, fresh fruits), immunization, food fortification

 Early diagnosis and treatment

 Rehabilitation

LOW BIRTH WEIGHT

Birth weight less than 2500 gm of babies born in India called LBW.

CAUSED

 Maternal malnutrition and anemia.

 Illness and infections during pregnancy,

 High parity,

 Close birth intervals

FACTORS MODIFYING PREVALENCE OF LBW

 More Institutional deliveries

 Improving No. of ANCs (minimum: >5)

 Improving Quality of ANC

 Includes: No. of ANCs, TT, weight, BP, examination of blood, examination of urine

XEROPHTHALMIA (DRY EYE)

 Disease due to deficiency of Vitamin A

 Also Called Xeroma

 Absence of tears

 Xerophthalmia is most common in children aged 1-3 years

 Cornea and conjunctiva become horny and necrosis.

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BITOT’S SPOTS

• Collection of dried epithelium, micro organisms etc. forming shiny grayish white
spot on the cornea

• A sign of Vitamin A deficiency

KERATOMALACIA

Ulceration and softening of Cornea due to deficiency of vitamin A

RISK FACTORS
 Ignorance
 Faulty feeding practices
 Infections
 Diarrhea
 Use of skimmed milk(totally devoid of vitamin a)
PREVENTION
 Short term action – oral Administration of large dose of Vitamin A (retinol Palmitate)
 Medium term action – Food fortification with Vitamin A. Eg:Dalda,Sugar,Salt,Tea etc
 Long term action – Promote BF, consumption of Green Leafy Vegetables,
Immunization to infections
NUTRITIONAL ANEMIA
 A Condition in which the Hb content of blood lower than normal as a result of a
deficiency of one or more essential nutrients.
 Primarily due to lack of absorbable iron in the diet.

CAUSES OF IRON DEFICIENCY ANEMIA

 Inadequate intake of iron
 Poor bioavailability (only less than 5 percent is absorbed)
 Excessive loss of iron (menstruation, rapid pregnancies, hookworm infestations, other
illnesses)
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EFFECTS OF ANEMIA
 Increases the risk of maternal and fetal mortality and morbidity

 Increase susceptibility to infection due to impaired cellular response and immune

functions

 Reduction of work performance and productivity

INTERVENTIONS

 Iron and folic acid supplementation

 Nutritional anemia prophylaxis programme (daily Fe & folic acid supplementation to

Pregnant Women lactating mothers & Children under 12 years)

 Iron fortification - Fortification of salt with iron

 Control of parasite and nutrition education

IODINE DEFICIENCY DISORDERS (IDD)

 IDD refers to a spectrum of disabling conditions arising from an inadequate dietary

intake of iodine.

 IDD affects the health of humans from fetal stage to adulthood

CAUSES OF IDD

 Deficient iodine Intake – Consuming foods with low Iodine content, Crops grown in
iodine depleted soil

 Increased demand for Iodine in the body – Demand of Iodine is increased during the
stage of rapid growth (Infancy, Puberty, pregnancy, lactation), Demand exceeds supply
results in deficiency.

 Presence of Goitrogens – goiter producing substances naturally present in some foods

(cabbage, cauliflower etc.) interfere with Iodine utilization
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IODINE DEFICIENCY DISORDERS (IDD)

 Endemic Goiter

 Cretinism

ENDEMIC GOITER:

Also called Derbyshire Neck

 Enlargement of thyroid gland causing swelling in front part of the neck

 Due to lack of iodine in the diet

 Goiter belt – Himalayan region

 Graded from 0 – 4

 Common among girls than boys

CRETINISM

 Severe form of IDD

 Occurs during fetal stage

 Interfere with brain development causing brain damage and death

 Result in Growth failure, MR, Speech and hearing defects

FLUROSIS

 Occurs due to consumption of excessive amount of fluorine through drinking water

 Two types of flurosis

Dental Flurosis
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Skeletal flurosis

DENTAL FLUROSIS

 Seen in children 5- 7 years of age

 Teeth lose their shiny appearance and chalk white patches develop on them

 Changes are called mottling of enamel

 In severe cases loss of enamel gives teeth a corroded appearance

 Dental flurosis is confined to permanent teeth and develops only during the period of
formation

SKELETAL FLUROSIS

 Seen in older adults

 Heavy fluoride deposition on skeleton

 Manifested as pain numbness &tingling sensation of the extremities, stiffness of neck

Genu Valgum

 A form of skeletal deformity associated with flurosis

 The lower limbs appear as knock kneed due to osteoporosis.

PREVENTION OF FLUROSIS

 Keep the drinking water fluorine level below 1mg/lit

 Deflouridation of water using Nalgonda Technique (Flocculation, Sedimentation &

filtration)

 Prevent use of fluoride toothpaste in areas of endemic flurosis

 Deficiency of fluorine?
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LATHYRISM

 Disease occur by consuming large quantities of Lathyrus sativus (Kesari dhal)

 Lathyrism in human is referred as Neurolathyrism

 The disease presents as Crippling disease of nervous system characterized by gradually

developing spastic paralysis of lower limbs

 It contains a toxin called Beta oxalyl amino Alanine (BOAA)

 Lathyrus Kesari Dhal) is good source of protein.

 It is relatively cheaper.

INTERVENTION

REMOVAL OF TOXIN

 Steeping method

 Soaking the pulse in hot water for about 2 hours and the soaked water is
drained off completely

 Genetic Approach

 Development of low toxin varieties of Lathyrus

 Banning the crop

 The Prevention of food adulteration act in India has banned Lathyrus in all
forms
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OBESITY

 Most Prevalent form of malnutrition

 Abnormal growth of adipose tissue due to enlargement of fat

cells(Hypertrophic),Increase in no. of fat cells (hyperplasic)or Combination of both

 Obesity - When the body weight is 20% more than the desirable weight.

 Over weight - When the body weight is between 10-20% more than the desirable weight

FACTORS CONTRIBUTING TO OBESITY

 Age

 Sex

 Genetic factors

 Physical Inactivity

 Socio economic status

 Eating habits

 Psycho social factors

 Alcohol

The direct cause of overweight in India is

 lack of physical activity due to sedentary life style,

 loss of traditional diet,

 faulty diet,
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 high stress

 high rate of economic growth

Weight in kg BMI

BMI = (Height in Meter) 2

20-25 IDEAL

26-30 OVERWEIGHT

31-40 OBESE

40+ VERY OBESE

CONTROL OF OBESITY

 Eat food according to body’s requirement

 At least 3-4 hrs intervals between meals

 Avoid in between snacks

 Eat more leafy vegetables which contain high fiber

 Avoid intake of fatty and fried foods

 Regular Physical exercise

CARDIO VASCULAR DISEASES

 Classified as one of the Food habit related Illness

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 Change in food habits and lifestyle has increased the risk of CVD in Indian population
mostly in Middle Class and upper middle class groups.

CANCER

80 % of cancer due to environmental factors

 Dietary fat – positive correlation with Colon cancer, breast cancer

 Dietary fiber – Risk of colon cancer is inversely related

 Micro nutrients – Lack of Vitamin C & Vitamin A arise the risk of stomach cancer and
lung cancer.

 Food additives – Saccharin, cyclamate, Coffee, aflatoxin associated with bladder cancer