Nutrition

- By Sunny Biswas
 Nutrition science
• ‘Nutrition is the branch of science that studies
the process by which living organisms take in
and use food for the maintenance of life,
growth, reproduction, the functioning of
organs and tissues, and the production of
energy.’
 Nutrition deffinatiom
• Nutrition has been defined as food at work in the
body. Nutrition includes everything that happens to
food from the time it is eaten until it is used for
various functions in the body.
• Nutrients are components of food that are needed by
the body in adequate amounts in order to grow,
reproduce and lead a normal, healthy life.
• Nutrients include water, proteins, fats, carbohydrates,
minerals and vitamins. There are over 40 essential
nutrients supplied by food,
 Defination of terms
• Diet refers to whatever you eat and drink each day.
• Diets are composed of nutrients: macronutrients (protein, fats,
carbohydrates, and alcohol) and the micronutrients (vitamins, minerals,
and trace elements).
• Diet may also be modified and used for ill persons as part of their
therapy (therapeutic diets).
• Malnutrition means an undesirable kind of nutrition leading to ill-
health. It results from a lack, excess or imbalance of nutrients in the
diet.
• Undernutrition is a state of an insufficient supply of essential nutrients.
• Overnutrition refers to an excessive intake of one or more nutrients,
which creates a stress in the bodily function.
Functions of food
Contd…
Food groups
6 food groups
RDA (Recommended Dietary Allowances)
• To determine what nutrients we need each day and
how much, to keep us in good health, a lot of
research has been done. The results of these studies
have been used to work out the nutritional
requirements of Indian people. After adding a factor
of safety, the Recommended Dietary Allowances
(RDAs) for Indians have been set-up.
• An advisory committee of the Indian Council of
Medical Research (ICMR) is responsible for the setting
up; review and revision of these RDAs.
• India was one of the first countries to set-up
Recommended Dietary Allowances in 1944.
Why were the Recommendations Set-up?

• In a number of studies the harmful effects of

nutrient deficiencies on the human body and
its functions were observed. These were so
revealing that the League of Nations thought it
necessary to set-up a committee to review
available experimental data and recommend
daily dietary allowances for each of the
nutrients that were known at that time.
• These recommendations have been revised four times and fifth revision is expected in
the near future.

• 1958: the recommendations for energy were revised.

• 1968: additional recommendations were made for four B vitamins, namely riboflavin,
nicotinic acid, folic acid and vitamin B12.
• 1978, the requirements for a one more B vitamin, pyridoxine (B6) were included. The
unit of energy joule was adopted too similar to top International Union of Sciences and
IUNS (International Union of Nutritional Sciences)
• The 1978 revision was entitled Recommended Dietary Intake (RDI)
• The last revision was made in 1988. The important features of the 1988 revision are:
• the revision of body weight standards for Indians
• complete revision of energy requirements
• definition of quantum and type of fat intakes
• modification of RDAs of vitamin A and D
• inclusion of several nutrients and dietary factors not considered earlier, such as
fibre, electrolytes (sodium, potassium), magnesium, phosphorus, vitamin E and K, and
• for the first time a provisional recommendation on trace elements was made.
• No substantial changes were made in the RDAs for protein, B-complex vitamins, iron
and calcium.
 General Principles of Deriving RDA
• A number of general principles are used to arrive at nutritional requirements of an
individual or the RDA for a population. These are:
• Dietary intakes: This approach has been used to arrive at the energy needs of
children.
• Growth: To define requirements of any particular nutrient for satisfactory growth in
early infancy, it has been utilized.
• Nutrient balance: nutrient for equilibrium (intake = output) in adults, and nutrient
retention consistent with satisfactory growth in children, it have been used widely.
• Obligatory loss of nutrients: is the minimal loss of the nutrient or its metabolic
product through normal routes of elimination (viz., urine, faeces and sweat).
• Factorial method: In this method, the needs for various functions are assessed
separately(daily requirements).
• Nutrient turnover: Data collected by studying turnover of certain nutrients in
healthy persons.
• Depletion-repletion studies: by contrast, measure nutrient status while subjects
are maintained on diets containing marginally low or deficient levels of a nutrient;
then the deficit is corrected with measured amounts of that nutrient.
• Reference Body Reference Person
Weights of Indians Our nutrient needs vary with the size and age of
our body. Therefore an individual of given age
and size has been designated as a reference. The
reference man and reference woman in the
Indian RDA have been defined as–
Reference Woman Age 20–39 years and weight
50 kg
Reference Man Age 20–39 years and weight 60
kg
Reference woman is healthy. She may be
engaged in 8 hours of moderately active work,
in light industry or in general household work.
Apart from 8 hours in bed, she spends 4 to 6
hours in light leisure activities and 2 hours in
active household work, recreation or walking.
Reference man is healthy, free from disease and
fit for work. He is employed in moderately active
occupation for 8 hours, spends 8 hours in bed, 4
to 6 hours in leisure activities, sitting and moving
about and 2 hours in active recreation, walking or
household duties.
Recommended Dietary Allowances for Indians
 Limitations of RDAs

• It is important to note the limitations in the use of RDAs. These are:

• (a) RDAs are estimates of intakes. of nutrients, which population
groups need to consume to meet the physiological needs of all
persons in that group.
• (b) RDAs are not meant to be used as standards to determine
nutrient adequacy of an individual’s intake.
• (c) It is implied that intake of nutrients at RDA level will involve very
little risk of inadequacy.
• (d) Individuals, whose intake of nutrients is below that given as RDA
are not necessarily at risk of deficiency, since many individuals in a
population may have requirements well below the RDA.
 Diet and planning
• Balanced diet: A diet, which provides all the essential nutrients in sufficient quantities to meet your
needs, is an adequate or balanced diet.

• Food Guide in Meal Planning and Evaluation

• The food guide is a practical tool to use in meal planning and evaluation. Please note the following
important points when using the food guide in meal planning:
• 1. Select foods from each of the five broad food groups.(Group 1: Cereals and Breads, Group 2:
Protein Foods, Group 3: Protective Vegetables and Fruits, Group 4: Other Vegetables and Fruits,
Group 5: Oils, Fats and Sugars)
• 2. Choose at least the minimum number of servings from each of the food groups.
• 3. Make choices within each group. Please remember that foods in each group are similar but not
identical in food values.
• 4. Try to include at least one food from Group 2(Protein Foods) in each meal.
• 5. Use seasonal vegetables and fruits to ensure good nutrition at low cost.
• The nutrient content of the menu is equal should be equal or greater than the recommended
dietary allowances (RDA) for an adult woman and man.
• Limitations of food guide: Only measures energy intake.
Nutrient Density
Several investigators are individually studying ways to develop an easy-to-use index of nutritive
quality of individual foods. One of these is nutrient density. It is the ratio of the percentage of the
recommended allowance of the nutrient to the percentage of the energy requirement in a
serving of the food. For example, a serving of cow’s milk (150 ml) provides 100 kcal, 180 mg
calcium and 2.9 mg of riboflavin.
• Dietary Score Card: This dietary score card can be used to evaluate any menu or diet plan by following
the following steps:
• 1. Check if all five groups are included in the meals.
• 2. Add up the score for each group.
• 3. If the total score for any group is higher than the maximum permissible score, count only the maximum score for
that group.
• 4. Add the total score and evaluate as follows:
100 Excellent
90 Good
Less than 90 Need to include the missing groups.
• You can add more foods from all groups to the minimum servings suggested, in order to make the
• meals satisfying. One word of caution. Be moderate in the amount of food you take from each group, even if you like
a particular food very much. Otherwise, you may not be able to include sufficient amounts of foods from all the food
groups.
• Also, snacks are an important part of meal planning. The term snack is applied to a wide variety of foods, which are
eaten between meals. A number of snacks are offered and eaten at tea, social meetings or get–togethers. The choice
of these foods can be important in meeting one’s nutritional needs.
 Anthropometrics methods
• Height measurement by standing erect & bare footed on a stadiometer with a movable head piece.
• Weight measurement in light clothes, no shoes
• The international standard for assessing body size in adults is the body mass index (BMI).
BMI = Weight (kg)/ Height (m²)

Evidence shows that high BMI (obesity level) is associated with type 2 diabetes & high risk of cardiovascular
morbidity & mortality.
• Waist circumference is measured at the level of the umbilicus to the nearest 0.5 cm.
Level 1 is the maximum acceptable waist circumference irrespective of the adult age, and there should be no
further weight gain.
Level 2 denotes obesity and requires weight management to reduce the risk of type 2 diabetes &CVS
complications
LEVEL 1 : MALES > 94 cm , FEMALES > 80 cm
LEVEL 2: MALES > 102 cm, FEMALES> 88 cm
• Hip Circumference is measured at the point of greatest circumference around hips & buttocks to the nearest 0.5
cm.
• interpretation of Waist / Hip ratio (WHR)
• High risk WHR= > 0.80 for females & > 0.95 for males i.e. waist measurement > 80% of hip measurement for
women and > 95% for men indicates central (upper body) obesity and is considered high risk for diabetes & CVS
disorders. A WHR below these cut-off levels is considered low risk.
• Other anthropometric Measurements i.e. Mid-arm circumference, Skin fold thickness , Head circumference ,
Head/chest ratio .
Advantages and limitations of Anthropometry

• Advantages of Anthropometry
• Objective with high specificity & sensitivity
• Measures many variables of nutritional significance (Ht, Wt, MAC, HC,
skin fold thickness, waist & hip ratio & BMI).
• Readings are numerical & gradable on standard growth charts
• Readings are reproducible.
• Non-expensive & need minimal training
• Limitations of Anthropometry
• Inter-observers errors in measurement
• Limited nutritional diagnosis
• Problems with reference standards, i.e. local versus international
standards. Arbitrary statistical cut-off levels for what considered as
abnormal values.
 Clinical assessment
• It is an essential feature of all nutritional surveys. It is the simplest & most practical method of
ascertaining the nutritional status of a group of individuals. It utilizes a number of physical signs,
(specific & non specific), that are known to be associated with malnutrition and deficiency of
vitamins & micronutrients.
• Good nutritional history should be obtained, general clinical examination, with special attention to
organs like hair, angles of the mouth, gums, nails, skin, eyes, tongue, muscles, bones & thyroid
gland. Detection of relevant signs helps in establishing the nutritional diagnosis
• Examples of illnesses caused by improper nutrient consumption
• Vitamin-A deficiency – Xerophthalmia Bitot’s spot .
• Vitamin B1 (Thiamine) deficiency - Beriberi
• Vitamin B2 Deficiency - Ariboflavinosis
• Vitamin B3 ( Niacin) – Pellagra, Clinical-4 D’s: Dermatitis, Diarrhea, Dementia, Death
• Vitamin C Deficiency - Scurvy
• Vitamin D deficiency - Rickets
• Iodine deficiency disorder - Goitre
• protein energy malnutrition - Marasmus, Kwashiorkor
• ADVANTAGES
• Inexpensive
• Non-invasive
• LIMITATIONS
• Did not detect early cases
 Dietary assessment
• Nutritional intake of humans is assessed
by five different methods. These are:
• 24 Hours Dietary Recall
• Food Frequency Questionnaire
• Diet history
• Food Diary
• Observed Food Consumption
Advantage & limitations of Biochemical
Methods/ Laboratory Assessment
• Advantages of Biochemical Methods
• useful in detecting early changes in body metabolism & nutrition
before the appearance of overt clinical signs.
• It is precise, accurate and reproducible.
• Useful to validate data obtained from dietary methods e.g.
comparing salt intake with 24-hour urinary excretion.
• Limitations of Biochemical Methods
• Time consuming
• Expensive
• They cannot be applied on large scale
• Needs trained personnel & facilities