NUTRITION PROBLEMS

Dr. Tewe U Kapfo

Senior Resident
1. Comment on the following
a) Only Breast milk should be given up to one year of
age
b) Milk is an ideal food for children
a) The statement is false.
• Breast milk is sufficient only up to the age of 6 months.
• After 6 months, there is need of extra proteins at the rate of 2-
3 g/ kg/ day and extra calories at the rate of 108 kcal/ kg/ day.
This cannot be fulfilled by the breast milk alone.
• So the child needs from 6 months onwards supplementary food
in addition to breast milk.
• Proper weaning is to be practiced by using correct weaning
practices in a phased manner starting from liquid foods
through semi-solid foods to solid foods. Only then will be the
growth proper.
b) Milk is the best and most complete food as it contains all the
nutrients necessary for the growth and development of
children.
• It is a good source of proteins, fats vitamins and minerals. It
contains all essential amino acids and milk proteins like casein
and lactalbumin which are easily digested and absorbed.
• The carbohydrate content in milk is lactose which provides
high calories to fulfill the demands of growth.
• It contains minerals like calcium, phosphorus, copper along
with other trace elements which are required for the growing
children. Hence Milk is an ideal food for children
2. Comment on the following
a. Butter and ghee should be given in large quantities
b. Ghee is of better nutritive value than groundnut oil
to elderly person
a) The above statement is false.
• Even though butter and ghee contain high calories, they
contain more of saturated fatty acids than unsaturated fatty
acids.
• They also contain high amount of cholesterol most of LDL and
VLDL type.
• More amounts of butter and ghee lead to childhood obesity
which will continue in the adolescence and adult life. Thus it
can lead to variety of disorders that are associated with obesity
b) The above statement is false.
• The elderly people have more health problems like DM, HTN,
IHD, vascular diseases, as well as urinary calculi which shows
increase in trend with food items rich in cholesterol and fatty
acids.
• The ground nut oil is rich in essential fatty acids which are
required in old age. Groundnut oil provides essential calorie
requirement without causing health problems as it is poor in
cholesterol. Hence it is preferred over ghee
3. Comment on the following
a. Food fortification and enrichment of food are
synonymous
b. Nutritional rehabilitation means feeding the
disabled
a) The above statement is false.
• Food fortification means the process of addition of nutrients to
foods in relatively small quantities to maintain and improve the
quality of diet of a group or a community to a large population,
e.g., iodine to common salt, iron to common salt, vitamin A to
milk, vitamin D to dalda and vanaspati.
• Food enrichment means addition of dietary essentials or
nutritive elements of food without compensating for the
deficiency by restoring the total contents of the food, e.g.
germination process or sprouting of pulses by adding water.
b)The above statement is false.
• Because nutritional rehabilitation means rehabilitating the
malnourished child by means of health education to the
mother to bring about a change in the family diet without any
external supplementation within the family diet constraints.
• There is no meaning of feeding of the disabled as nutritional
rehabilitation is given to the malnourished children and not for
the disabled.
4. Comment on the following
a. Iodised salt should be made available for all in the
community
b. Low concentration of iodine in water results in
dental caries.
a) The statement is true.
• Iodine deficiency is one of the nutritional problems of public
health importance in India. At first, the iodized salt was made
available only in endemic areas to those who were suffering
from iodine deficiency disorders.
• Now it is made compulsory by the government of India to
provide iodized salt to the whole community. In India, under
the PFA act iodization of salt should be done not less than
30ppm at the production level and not less than 15 ppm at the
consumer level.
b) This statement is false.
• Iodine deficiency has nothing to do with the dental caries. It is
low concentration of fluorine in water that results in dental
caries.
• Normally 0.5-0.8 mg/ L of fluorine should be present in water.
When the level decreases it leads to dental caries. Low iodine
causes goitre, myxedema, mental retardation, and cretinism in
children.
5. Comment on the following
a. Food additive are used in food adulteration.
b. Nutritional assessment and dietary survey are not the same.
a) The above statement is true.
• The food additives are not nutritious substances which are
added intentionally in small quantities to improve the
appearance, flavour, and taste or storage property.
• Food adulteration means adding substances in more than
quantity required without specification than the standard laid
down. Thus it is food adulteration when food additives are
added in quantity more than required.
b. The above statement is true.
• Diet survey means the method of assessing the nutritional status
of a community or a group or a population.
• It is done by weighing the raw or prepared food or by using
questionnaire method regarding the food intake and analyzing the
data in terms of various food items both in quality and quantity.
This helps in planning for comparison and for further
improvement.
• Nutritional assessment means measurement of the nutritional
status of an individual family or community or a group of people
by means of Anthropometry, Biochemical tests, Clinical
examination, Dietary intake assessment, Ecological assessment,
Functional Assessment, health and vital statistics.
6. Prescribe a diet for lactating women aged about 40 years
weighing 45 kgs.
 Sedentary female Extra for Total
lactation
Cereals 410 g 60 g 470 g
Pulses 40 g 30 g 70 g
Green leafy veg. 100 g 100 g
Other veg. 40 g 40 g
Roots & Tubers 50 g 50 g
Milk 100 g 100 g 200 g
Oil & Fat 20 g 10 g 30 g
Sugar &Jaggery 20 g 10 g 30 g
7. A Pregnant lady aged 25 years consuming following diet in her
third trimester. Comment on the diet and give your valuable
suggestions to improve diet.
• Cereals ------- -----------------300 gm
• Pulses -----------------------------50 gm
• Green leafy vegetables ----------------80 gm
• Milk ------------------------------50 ml
• Oil---------------------------------15 ml
• Sugar-----------------------------20 gm
• Fruits ----------------------------25 gm
 Sed. Extra for Total Consuming deficiency
female Pregnancy
Cereals 410 g 35 g 445 g 300 g 145 g
Pulses 40 g 15 g 55 g 50 g 5g
Green leafy 100 g 100 g 80 g 20 g
veg.
Other veg. 40 g 40 g 0g 40 g
Roots & 50 g 50 g 0g 50 g
Tubers
Milk 100 g 100 g 200 g 50 g 150 g
Oil & Fat 20 g 20 g 15 g 5g
Sugar & 20 g 10 g 30 g 20 g 10 g
Jaggery
Fruits 85 g 85 g 25 g 60 g

Comments: this pregnant lady is consuming a diet which is deficient

both in quality and quantity.
Suggestions: to fulfil the growing demand, eat excess of cereals, pulses,
green leafy vegetables, milk, oil and jaggery.
8. On analysis was found that the diet of an adult male
doing moderate work contained following proximate
principles and nutrients.
• Comment on the nutritive value of this diet
• Carbohydrate -------------------250 gm
• Fat----------------------------------30 gm
• Protein----------------------------25 gm
• Vit A ------------------------------ 500 micrograms
• Thiamine ----------------------- 0.5 mg
• Vitamin C ---------------------- 50 mg
• Calcium ------------------------ 500 mg
• Iron ------------------------------10 mg
• Answer:- 1 CU ( Consumption unit) – Represents
Recommended Dietary Allowance of energy for a sedentary
man. (1CU = 2110 as per 2020 ICMR NIN guidelines)
• For a man doing moderate work, the energy required is 2532
kcal. (2110 * 1.2).
• Out of this, carbohydrates shall supply 70% of energy.
• 70% of 2532 kcal = 1772 kcal.
• 1g of carbohydrates supplies 4 kcal of energy. For 1772 kcal,
carbohydrates required = 1772/ 4 = 443g
• The person is consuming less carbohydrates - 250 g.
• 20% of calories are to be supplied through fats. 1g of fats
gives 9 kcal of energy.
• 20% of 2532 = 506 kcal
• Fats required = 506/ 9 = 56.2 ~ 56g
• Similarly, protein required = 54g
 Given Required Deficiency

Carbohydrate 250 g 443 g 193 g

Proteins 25 g 54 g 29g
Fats 30 g 56 g 26 g
Vitamin A 500 mcg 1000 mcg 500 mcg

Vitamin C 50 mg 80 mg 30 mg
Thiamine 0.5 mg 1.8 mg 1.3 mg

Calcium 500 mg 1000 mg 500 mg

Iron 10 mg 19 mg 9 mg

Conclusion: the diet of the man is deficient both in quality and quantity
9. Calculate the diet required for the family consisting of an
adult man doing heavy work, adult female doing moderate
work, child aged 5 years and an infant aged 6 months.
• Coefficient value for this family is = 3.0
• Adult heavy worker male = 1.6
• Adult moderate worker female = 0.9
• Child aged 5 years = 0.5
• Infant aged 6 months = 0.0
• Total = 3.0
• For CV of 3.0
Total Extra for Grand Total
lactation
Cereals 460 g * 3.0 1380 g 60 g 1440 g
Pulses 40 g* 3.0 120 g 30 g 150 g
Green leafy veg. 40 g* 3.0 120 g - 120 g
Other veg. 60 g* 3.0 180 g - 180 g
Roots & Tubers 50 g* 3.0 150 g - 150 g
Milk 150 g* 3.0 450 g 100 g 550 g
Oil & Fat 40 g* 3.0 120 g 10 g 130 g
Sugar & Jaggery 30 g* 3.0 90 g 10 g 100 g

• Total energy required is 2110 kcal * 3 = 6330 kcal

• 6330+ 600 (lactating) kcal = 6930 kcal.
10. A family consists of an adult male and an adult female who
are sedentary worker and a child aged 5 years. Prescribe a diet
for this family.
• Coefficient value for this family is = 2.3
• Adult sedentary worker male = 1.0
• Adult sedentary worker female = 0.8
• Child aged 5 years = 0.5
• Total = 2.3
• Balanced diet for this family is as follows
Cereals 460 g * 2.3 1058 g

Pulses 40 g * 2.3 92 g

Green leafy veg. 40 g * 2.3 92 g

Other veg. 60 g * 2.3 138 g

Roots & Tubers 50 g * 2.3 115 g

Milk 150 g * 2.3 345 g

Oil & Fat 40 g * 2.3 92 g

Sugar &Jaggery 30 g * 2.3 69 g

• Coefficient value 1 = 2110 kcal.

• 2.3 CV = 4853 kcal
11. A family consists of an adult male who is a sedentary worker
and an adult woman who also is a sedentary worker with three
children aged 3 years, 7 years, and 9 years. Prescribe the diet
for this family.
• Coefficient value for this family is = 3.7
• Adult sedentary worker male = 1.0
• Adult sedentary worker female = 0.8
• Child aged 3 years = 0.4
• Child aged 7 years = 0.7
• Child aged 9 years = 0.8
• Total = 3.7
 Cereals 460 g * 3.7 1702 g
Pulses 40 g * 3.7 148 g
Green leafy veg. 40 g * 3.7 148 g

Other veg. 60 g * 3.7 222 g

Roots & Tubers 50 g * 3.7 185 g
Milk 150 g * 3.7 555 g
Oil & Fat 40 g * 3.7 148 g
Sugar & Jaggery 30 g * 3.7 111 g

• Coefficient value 1 = 2110 kcal.

• 3.7 CV = 7807 kcal
THANK YOU