Nutrition & Health

What people eat is not calories but food, and

consideration of fads, flavors and variations of
appetite can make nonsense of the dietician’s
theories
 Classification of Foods
1. Classification by origin:
1. Foods of animal origin
2. Foods of vegetable origin
2. Classification by chemical composition:
a) Proteins b)Fats c) Carbohydrates
d) Vitamins e) Minerals
3. Classification by predominant function:
1. Body building foods
2. Energy giving foods
3. Protective foods
4. Classification by nutritive value: a. Cereals & millets
b. Pulses c. Vegetables d. Nuts & Oilseeds
e. Fruits f. Animal foods g. Fats & Oils
i. Sugar & Jaggery j. Condiments & Spices k. Miscellaneous
• Carbs, Prots & Fats: Macronutrients or proximate
principles
• Carbs: 4 Kcal/g (17 KJ/g); Prots: 4 Kcal/g (17 KJ/g);
Fats: 9 Kcal/g (37 KJ/g)
• Balanced diet: Proteins (10-15% of total daily
energy intake); Fats (15-30%); Carbs rich in fibre
(55-75%)
• Minerals & Vitamins: Micronutrients
 Proteins & AAs
• Assessment of protein quality is its comparison
with egg protein (1 Unit hen’s egg: 60g / 70 Kcal / 6
g protein / 6 g fat/ 30 mg Ca / 1.5 mg Fe / 250 mg
Cholesterol).
1. Amino acid score = mg of AA per g prot / mg of AA
per g of egg X 100
2. NPU: Nitrogen retained by body / Nitrogen intake
X 100 (ICMR recommendations 2010 assume NPU
of 65 for Indian sources of protein)
3. Protein efficiency ratio: Gain in wt of young
animals per unit of prot consumed. Outdated now.
• Limiting AAs (present in the least quantity in a food):
Cereals-Threonine; Pulses-Methionine; Maize-
Tryptophan
• Essential AAs: Leucine, Isoleucine, Lysine, Methionine,
Phenylalanine, Threonine, Valine, Tryptophan &
Histidine
• Conditionally EAAs: Non-EAAs may turn essential if their
precursors are limited in the body – Tyrosine (from
Phenylalanine) & Cysteine (Methionine)
• Protein content (gram %): Soyabean 43; Pulses 22-25;
Fish 21; Meat 20; Egg 13; Wheat 12; Rice 7; Milk (cow) 3
• NPU of selected foods: Hen Egg-96 (taken as 100 for
reference); Cow Milk-81; Meat-79; Fish-77; Rice-65;
Soyabean-55; Pulses-45-50; Groundnut-50
 Assessment of Protein status
1. Arm muscle circumference
2. Creatinine-height index
3. Serum albumin & transferrin
1. Serum Albumin is the best measure:
1. > 3.5 gm% - Normal
2. 3.0 – 3.5 gm% - Mild malnutrition
3. < 3.0 gm% - Severe malnutrition
4. Total body nitrogen
 Fats
• Fats are solid at 20 deg C; They are known as oils if
they are liquid at this temp
• In normal human subjects, adipose tissue (99%
TGs) constitutes 10-15% of body weight
• Three types:
1. Simple lipids e.g. Triglycerides
2. Compound lipids e.g. Phospholipids
3. Derived lipids e.g. Cholesterol
 Fatty acids
• Saturated FAs (Common in Animal fats)
– Lauric, Palmitic & Stearic acid
• Unsaturated FAs
– Mono-unsaturated FAs:
• Oleic acid
– PUFAs (Mostly in vegetable oils)
• Linoleic acid
• Linolenic acid
 Essential FAs
• Cannot be synthesized by the body; Required in
the diet
• Linoleic acid, Arachidonic acid, Linolenic acid,
Eicosapentanoic acid
• Linoleic acid is the most important EFA: Serves as
a precursor for other EFAs
• Safflower oil is richest in Linoleic acid (73%)
• EFA deficiency leads to Phrenoderma (Toad skin)
 FAs
Fats SFA MUFA PUFA
Coconut Oil 92 6 2
Safflower 10 15 75
Sunflower 8 27 65
Soyabean 14 24 62
Margarine 25 25 50
Groundnut 19 50 31
Palm 46 44 10
Butter 60 37 3

• W3 (derived from alpha linolenic), w6 (derived

from Linoleic) & w9 (Non essential in humans,
derived from Oleic acid) fatty acids
• w3 are known to reduce the incidence of CHD
 Carbohydrates
• Dietary fibre:
– Complex carbohydrates / Non-starch polysachharides
– Insoluble : Cellulose / Hemi-cellulose / Lignin
– Soluble : Pectin / Gums / Mucilage
– Help decrease blood sugar & cholesterol
– Highest fibre content - Fenugreek seed (40% gum)
– Recommended daily intake – 40 gm / 2000 KCal
– Typical Indian diet – 50-100 gm
 Classification of Carbohydrates
Classification GI Range Examples

Low Glycemic Index 55 or less Most fruits & Vegetables,

lentils, beans

Medium GI 55 – 69 Sucrose, Rice

High GI 70 or more Potato, Corn, Syrupy foods,

Water melon
Vit Chemical name(s) RDA Deficiency

A Retinol 600 mcg Xerophthalmia; VADDs

B1 Thiamine 0.5 mg / 1000 C Beri beri; Wernickes Korsakoff psychosis
B2 Riboflavin 0.6 mg / 1000 C Ariboflavinosis (Cheilosis, glositis, stomatitis)
B3 Niacin; Niacinamide 0.6 mg / 1000 C Pallegra (4Ds); Skin rash around neck (Casal’s
necklace)

B5 Pantothenic acid 10 mg Burning feet syndrome (Grierson-Gopalan

synd)
B6 Pyridoxine (amine), 2 mg Anemia
Pyridoxal
B7 Biotin 1 mg Dermatitis, Enteritis
B9 Folic acid, Folinic 100 mcg Megaloblastic anemia, Neural tube defects
acid
B12 Cyanocobalamin 1 mcg Megaloblastic anemia
C Ascorbic acid 40-60 mg Scurvy
D Cholecalciferol 100 IU Rickets & Osteomalacia
E Tocopherol 0.8 mg / gm EFA Haemolytic anemia in Newborns
K Menaquinone, 0.03 mg / Kg Hemorrhagic disease of newborn
Phylloquinon
 Vitamin A
• Daily requirement: 600 mcg (X4 = beta carotene)
• Different requirement for: Pregnancy- 800 mcg;
lactation-950; Infants-350 & 1 to 6 years-400
• Xerophthalmia: All the ocular manifestations of
vit.A deficiency put together
• 1st clinical sign-Conjunctival xerosis; 1st symptom-
Night blindness
Xerophthalmia: WHO classification
Stage Clinical features

XN Night Blindness
X1A Conjunctival Xerosis (Without Bitot’s spots)
X1B Conjunctival Xerosis (With Bitot’s spots)
X2 Corneal Xerosis
X3A Corneal xerosis with ulceration
X3B Keratomalacia
XF Xerophthalmia Fundus
XS Corneal scar
 Vitamin A: Halibut liver oil is the richest source
• A public health problem if prevalence of bitot’s spots is > 0.5
% among children 6 mo-6 yrs; Night blindness > 1.0 %; serum
retinol (< 10 mcg/dl) > 5%; corneal ulcer >0.05% & corneal
xerosis > 0.01%
• WHO recommended strategy for prevention: Short-term: Vit
A prophylaxis to vulnerable groups; Medium term:
Fortification of certain foods; Long-term: Promotion of
consumption of green leafy veggies
• Treatment Schedule :
• 1. Infants < 6 months: 50,000 units
• 2. 6-12 months: 100,000 units
• 3. Child over 1 year and adults: 200,000 units
• *The WHO guideline is immediate dosing, with the same
dose repeated next day and then after 2 weeks.
 Other requirements
• Calcium: 1200 mg/day in Pregnancy & Lactation
• Folic acid: 500 mcg / day in preg & 300 mcg /
day in Lactation
 Iodine
• Daily requirement: 150 mcg adults; 250 P & L; 120 School
age; 90 pre-school
• Indicators for epidemiological assessment of Iodine
deficiency: Prevalence of goiter (>10% in school age children
indicates endemicity); Prevalence of cretinism; Urinary
iodine excretion; TFTs & thyroid volume; prevalence of
neonatal hypothyroidism; Salt iodine content.
• Twin fortified salt: Iron(1mg) + Iodine(40 mcg) / gram of salt
• Iodized salt: 30 PPM at production & 15 PPM at consumer
level
• DEC medicated salt: 1-4 gm DEC / Kg salt for 6-9 months for
mass t/t
• Iodized oil (Poppy seed oil): I/m – 1 ml injection prevents for
4 years; Oral 2ml effective for 2 years
 Iron
• Requirement: 28 mg (males) ; 30 mg (females)
Age To be absorbed
Menstruating women 1.65
Pregnancy 2.80
Infants
0-6 months 46 mcg/kg/d
6-12 months 87 mcg/kg/d
Lactation / Adolescent 1.65
Men 0.84

• Iron absorption in Indian diets is < 5%; Vit C enhances absorption

• Anemia Cut-off points: Adult males-13; Non preg females-12; Preg-
11; Children<6 yrs-11; >6 yrs-12
• MCHC is 34% across all ages
• Evaluation of Fe status: Hb; Serum Fe; Serum Ferritin (most
sensitive tool); Serum transferrin saturation (n-30%)
 Fluorine

• Requirement: 0.5-0.8 mg / litre (or PPM)

• Major source : Drinking water
• > 1.5 ppm: Dental fluorosis (mottling); Best seen in
upper central incisors & first molars; Occurs when
excess fluoride is ingested over first 7 years
• 3-6 ppm: Skeletal fluorosis
• > 10 ppm: crippling fluorosis
• Nalgonda technique: NEERI Nagpur; for de-
flouridation of water; involves addition of lime, alum
& bleaching powder f/b floculation, sedimentation &
filtration. Alimunium is the major de-flouridating
agent
 Reference population
Reference Indian Male Reference Indian Female
18-29 years 18-29 years; NPNL
60 Kg 55 Kg
Height 1.73 M & BMI 20.3 Height 1.61 M & BMI 21.2
Free from disease Do
Fit for active work Do
8 hours of moderate work 8 hours of general household work /
moderate work
8 hours in bed Do
4-6 hours Sitting & moving Do
2 hours in walking & active recreation Do
 Recommended daily energy intake:
Group Particulars Revision Proteins (g/day)
recommended
Adult Male Sedentary worker 2320 60

Moderate 2730 60

Heavy 3490 60

Adult Female Sedentary 1900 50

Moderate 2230 50

Heavy 2850 50

Pregnancy +350 + 15

Lactation (1st 6 +600 + 25

months)
Lactation (Next 6 +520 + 18
months)
Infants 0 – 6 months 92 / Kg / day 2.05 / Kg

6 – 12 months 80 / Kg / day 1.65 / Kg

 Consumption units
• A unit for dietary survey of family / community
Group Particulars CU Coefficient
Adult Male Sedentary worker 1.0
Moderate worker 1.2
Heavy worker 1.6
Adult Female Sedentary worker 0.8
Moderate worker 0.9
Heavy worker 1.2
Adolescents 12 -21 years 1.0
Children 9 – 12 years 0.8
7-9 0.7
5-7 0.6
3-5 0.5
1-3 0.4
 Childhood nutritional indicators
• Stunting (Height for age): - 2 SD from median of the
reference population are considered stunted; Indicates
chronic malnutrition
• Wasting (Weight for height): - 2 SD from median of the
reference population are considered wasted; Indicates
acute or recent malnutrition
• Underweight: Indicates both acute and chronic
malnutrition
• NFHS 3: Children < 3 years – Stunted: 44.9%; Wasted:
22.9% (Weight for height); Underweight: 40.4% (Weight
for age)
 MAC
• Bangle test: 4 cm diameter
• Quac stick: Measures malnutrition by comparing MAC
with height
• Shakir’s tape: useful field instrument for 1-5 years (MAC
remains practically unchanged during this period)

MAC Color Interpretation Management

>13.5 Green Satisfactory -
12.5 – 13.5 Yellow Mild-moderate At home through
dietary measures

< 12.5 Red Severe Institutional

 Indices
• Ponderal Index: Wt / Height3; Used for children
• Broca’s Index (Ideal Weight) = Height (cm) – 100
{+ 10% for men & + 15% for women}
• Waist-Hip ratio: 0.7 for women & 0.85 for men
• Waist circumference cut-off: Indian males 90 cms
& females 80 cms (Globally 102 & 88 cms)
• Skin-fold thickness using Harpenden calipers: 7
sites – Triceps, biceps, subscapular, suprasinal,
abdominal, thigh & calf. {Males: 61-80 Excellent;
81-90 good & 150+ poor / Females: 70-90
excellent; 91-100 good and 150 + poor}
 BMI (Quetlet’s Index)
Classification BMI Indian population
Underweight < 18.5
Normal 18.5 – 24.99 18.5 – 22.99
Pre-obese 25 – 29.99 23 – 27.5
(Overweight)
Obese – Class I 30 – 34.99 > 27.5 Obese
Obese – Class II 35 – 39.99
Obese – Class III > 40

• For Indians the revised BMI norms suggest that normal is

18.5 – 22.99
• BMI prime: Ratio of actual BMI to upper limit normal (24.99)
• BMI prime: < 0.74 (under-wt); 0.74-0.99 (normal); >1 (over-
wt.)
 Recommended daily allowance (RDA)
• RDA: Level of intake corresponding to mean +
2 SD, which covers requirement of 97.5%
population
• Not used for Energy as excess energy intake is
undesirable
• RDA is decided by a panel of experts on the
basis of scientific research
 Milk: A poor source of Iron & Vitamin C
• Adequate pasteurization tests: Phosphatase test;
Standard plate count; Coliform count
• MBRT: Carried out on milk accepted for
pasteurization
• Cold pasteurization: Use of Ionizing radiation
Per 100 g Human Cow’s milk Buffalo’s milk Goat milk
milk
Lactose (g) 7.4 4.4 4.9 4.4
Proteins (g) 1.1 3.2 4.5 3.1
Fat (g) 3.4 4.1 8.0 3.5
Calcium (mg) 28 120 195 100
Iron (mg) 1.0 0.2 0.5 0.5
Water (g) 88 87 81 89
Energy (Kcal) 65 67 110 60
 Pasteurization
Method Temperature Time Remarks
Holder / Vat 63-66 C > 30 Min For small & rural
communities
HTST 72 >15 sec Most widely used; for large
quantities; Flash pastrzn
HHST (Higher heat 68 30 min Batch pasteurization
shorter time)
UHT 125 Few seconds 2 stage heating with the
second under pressure

Milk types and fat content

Full cream 6.0 % fat 9.0 % SNF

Standardized 4.5 % 8.5 %

Toned 3.0 % 8.5 %

Double toned 1.5 % 9.0 %

Skimmed 0.5 % 8.7 %

 Food adulteration diseases
Disease Toxin Adulterant
Lathyrism BOAA Kesari dal; Lathyrus sativus
Epidemic dropsy Sanguinarine Argemone mexicana oil in
mustard oil
Endemic ascites Pyrolizidine alkaloids Crotalaria seeds
Aflatoxicosis Aflatoxin Aspergillus flavus
Ergotism Clavine alkaloids Claviceps fusiformis

• Epidemic dropsy: Sanguinarine inhibits with the oxidation

of pyruvate -> Acidosis; manifests as sudden non-
inflammatory edema of b/l LL, diarrhea, dyspnea, cardiac
failure & death; Glaucoma is common; doesn’t occur in
breast-fed infants; mortality 5-50%
• Lathyrism: Neurolathyrism (Humans), Osteolathyrism
(Animals)
• Diets containing > 30% of Kesari dal consumed over
a period of 2-6 months; mostly affects 15-45 years
• Stages:
1. Latent: I
2. No stick: II
3. One stick: III
4. Two stick: IV
5. Crawler: V
• Prevention & control: Vit C prophylaxis; banning
the crop; removal of toxin (steeping & parboiling);
Education; Genetic approach; Poverty reduction
 Food standards
• Codex Alimentarius: Joint FAO/WHO standards
for international markets; Food standsrds in
India are based on this.
• PFA standards: Laid under PFA 1954; to obtain
a minimum level of quality of food stuffs
attainable under Indian conditions
• BIS & Agmark: Purely voluntary; express
degree of excellence above PFA standards.