271

NUTRITION
:CONCEPTS AND MACRONUTRIENTS ----- Active space

DIET

Proximate principles : % in diet

enerqy providing Yood products. energy SO-70%

4 Kcals
- IKcal= 4184 K. Carbohydrates IO-a0%
Proteins 4 Kcals
- IKJ = 0.a39 Kcal. a0-30%
Fats 9 Kcals

Prudent diet Balanced diet Staple diet

Contains all nutrients in Cuturaly oacceptable
Adhering to dietary goals
diet consumed by
Adequate quantity). required quantity to prevent
from excess detciency, majority of population.

Additional Energy giving Pood products

RDA
Enerqy
Fibres a kcalg 40qof Abre/aooo kcal
Alcohol 7 Kcal/a
Water

Substance added to food product

Tnutritive value
Jnutritive value No chanqe in nutritive
Value, but ‘shelf lfe/
egi Brick powder Consumability Adding substance not Adding substance which
to chilipowder, enhances value of a
water in milk eq: Flavouring agents, originally present in Substance present in the
the food.
preseryatives
Eq: lodine fortited food.
Aduteration
Additive sat, Vit AD in oil. E.g, Iron in biscuits

FortiAcation Enrichment

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Community Medicine "
272
Nutrition

Active space Proteins

00:1:47
Functions :
" Muscle maSS T.

Act as enzymes.
INTAKE, uTILIZATION DEFICIENCY
Amino acid in a Pood product
Amino acid seore: = (e
Amount of same amino acid in reterence protein
a. Ingested level: Amount of protein ingested.
b. Absorptive level: Amount of amino acid absorbed
C. Retained level : Amount of N retained.

Amount of N absorbed
Digestivituy co-eficient =
Amount of protein ingested
Amount of N retained
Siological value = Amount of aminoacid absorbed

Net protein utilization (NPu):

Digestibility co-efficient x Biological value.
Amount of N, retained to body mass function
Amount of protein ingested
max NPU:Eqa = 97.
PDCAAS:
" protein diqestibilits Co-eicient corrected
aminoacid score.
" Obsolete.

DIAAS (a0ao NIND:

Diqestible Indispensable amino acid indicator.
Best indicator.

Denotes ileal digestiblity of food products.

Protein Enerqy ratio (PE
" Amournt o enerqy rom protein in food Protein eficiency ratio(e4
Total eneray trom tood products Amount of weight qain per
" max :Fish 80%. unit of protein.
" Lab indicator.
 273
Nutrition: Concepts and Macronutrients

Limiting amino acid: Active space

Food items Limiting aminoacid

Cereals
Pulses
Threonine, ysine Lysine :most defcient
aminoacid.
Custeine, methionine
Maize
|Tryptophan, Lusine
pellagrai
Xlma niacin
Nia cin deHciency in maize predominance. bo mg Tryptophan
Pathophysiology
detcient
Rich in leucine.
" Corn :
oetcient in truptophan. maize Leucine Pellagra
Leucinogenic food products -> Pellagenic.
00:40:23
Fats

CLASSIFICATION
mUFA monounsaturated fatty acid
Saturated foty acid
unsaturated fatty acid
MUFA
Omega 3
PUFA: Polyunsaturated Patty acid
>PUFA
Omega lo
Saturated vs unsaturated Patty acids:

Saturated fatty unsaturated fatty

acid (SFA) acid (uFA
Bond Single bonds Triple bonds
Sources Animal Sources Plant sOurces

Fats Oils.
AKA
mUFA
SFA Omegas Omegalo
" Lauric acid
a-linolenic
Stearic acid Oleic acid Linoleic acid
Example acid
Paimitic acid
" mustard
Animal sourcesS
" Groundnut Flax seeds Saflowers
Richest sources
" menomonic : Oma

Eicosa
Long/complex pentaenic
Arachidonic acid :
chain derivative i
acid : Fish
richest source
Coconut oi : Sustained fatty acia
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Nutrition
----- Active space RECommENDED DAILY ALLOWANC2:
SFA:<I0% *muFA : /3
Fats (ao% of diet) uFA:<90% >Omega 3:/a
PUFA: al3
+Omega lb i /a

Partial hydrogenated vegetable oil PHVO)

Oil Partial hydrogenation Fat (solid)
Egi Vanaspati ahee
Use:

easy storage f handling

- ‘ shelf life.
FortiAcotion of oil :
" Vit A: asoo Iu
per ioOmlof oil.
" Vit D: |75 IU

DEFICIENCY:
Detciency of essential Patty acid : Phrunoderma.
Features : Toad skin.

Note :

Glycemic Index :Rate of change of blood qlucose per unit of tood consumed.
Glycemic index of common tood substance

Glycemic index Examples

Hiah Artitcial oods, white bread, Rice, Cornakes.
moderate
Fruits, DairyProducts.
LOw
Veqetables, auava, cereals, oats, pulses, quinoa.

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 275

--- Active space

NUTRITION:MICRONUTRIENTS

Hidden hunger imicronutrient deHciency.

" me: ron.
me vitoamin : Vitamin A.

Vitamins 00:01:20

VITAMINA:

" Imcq of retinol =Iretinol equivalent =3.32 \u of vit A.

" | s VitA= 0.3 mc of retinol.
" Retinol : Active component of vit A.
SOurces:
Halibert liver oil (Richest). " Dates
Cod liver oil. Orange Yellow colored ruits
" palm oil.
vegetables Pumphin, papaya, mango.
Functions: Associated factors :
Vision, epithelialisation, Immunity measles, malnutrition, louwimmunity
Requirements:
males : IO00 \u Preanant females : 900 Iu,
Females : 850 IU. Lactating females : 50\u.
Defciencies:
Xerophthalnia
Levels in
Stage wHO) arade Features
community

Night blirndness <1% Psumptom,non specitc Peature

Conjunctival xerosis XI clinical sian
Bitots spots X1 <0.S%
epidemioloogicalmarker
Corneal xerosis X)

Coneal ulcers X <0.0%

Keratomalacia X1\)
Irreversible changes

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276
Nutrition

---- Active space -----

National Vit-A prophylais program: Given by
Dose of vitA
Age Vaccinator along with measles at
Ilakh v
omonths -I year Anganwadiiworker, every b
Tyear -5year a lakh IV months
total in 9 doses.
should get i lakhluin
ENery child <S yr

Storage
"Amber colored botHle (ot heat f light sensitivit.
" Stored in anganwodi centres. amL =a lakh lu.
Spoon of vit A >mL =|lakh lu.

VITAMIN B ComPLEX:
Source i Orqan meat, coverings of qrains, nuts.
Thiamine (Vitamin e)
Parboiing : Reverse osmosis
Sweling o
Aleurone lauer of vit Bl rupture
(Rich in vit B)
aleurone layer of aleurone lauer.
Soak

Grain

Parboiled rice Steamedi

(Brounish rich in vit B) dried
Note :Polishing o arain ’ Removes aleurone lauer +white shiny qrain of rice
with vit B,
vit ba'
Source : meat, milk (Less), no veqetable sources.

Iron
00:1748

Iam of Hb = 3.34 mg of iron.

" |mL loss o blo0d =0.4-0.6 ma o iron loss.
uses i Hemoglobin sunthesis.
SOurces :
Heme Non-Heme

Animal Source Plant source :

Pumpkin seeds (Rich
Pista.
Dates.
areen leafu vegetabes
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 277
Nutrition : Micronutrients

Jaggery : -----Active space

Dense SOurce of iron (From the utensil it is made rom).
Not a direct SOurce ofiron rom plants.
12ON AsORPTION :

Ferrie forn (ngestion)

Promoter :Vit C.
Ferrous form (Absorption
inhibitor : Phytates, tannin, oxalates, calcium.
Absorption ot iron : part of duodenum.
JRON DEFICIENCY:
" Dtutritional cause.
" Leads to anemia

Cut-o tor anemia:

Pregnant Pemales : <l gm%. 98-99% of reproductive age qroup emales : Iron detcient.
Females : <la a . SO% oP female among them : lron detciency anemia.
males: <13 gm%.
Anemia as public health problem:
Anemia Prevalence Public heath problem
<4.9% No

S- 19.9% mild
ao-39.9% moderate
>40% Severe

Initiatives:
Iron Folic acid (IFA) to adolescents. under Anemia mukt Bharat.
IFA to ANC Pemales.
Biannual deworming
Double fortifed sats: Iron + lodine.
Dietary supplements.
Indicators of iron levels:
Hb levels : Sest epidemiological indicator.
Serum Ferritin : me used, denitive $ best clinical indicator.
Serum iron.
Iranserrin saturation:most sensitive clinical indicator.

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278
Nutrition

Active space Iodine

Use : Synthesis of thuroid hormones (T, T.
Sources:
l Japanese sea weed, tsh, prauns.
a. Onion, potato, tomato, bell pepper.
Note : erassica (Caulifower, broccolD are aoitrogens.
Indicators of iodine detciency:
Goitre rate should be <S% :Long term impact indicator.
urinary iodine excretion rate : most important epidemiological indicator,
" lodine in household salt levels : Process/operational indicator.
Neonatal hupothuroidisn rates : Environmental iodine deBciency indicator.
T, T, TSH levels : Not considered as indicator d/t high cost.
Requirement
Adults :I50-l0 mca/ douy Preananti aso meg/doy
Lactating a80-a90 mco/dau
Other Micronutrients
00:34:10
Fluorides
Levels :o.S-0.8 ma/ day.
Detciencu:Dental caries mx :Fluoride supplement).
Excess Fluorosis (mx : Nalqonda
Nalgondoa technique : technique).
"
Deluoridation of water.
Aluminium salt +
water|-lime +bleaching Mix the
pouder
Flocculation Defuoridation
solution
Zinc:
sedimentation ot water

Immuno-modulator,
Delciency: oantioxidant, helps epithelialisation.
in
Recurrent intection,rashes, poor wound
Copper : healina.
Detciencyi Neutropenia -
severity than 2inc). Delayed wound healina, recurrent infection T
Excess : 0rqan failure,
Hyperthyroidism, myocardal infarction, Skinchanges.
Community Medicine w
 279
Nutrition : Micronutrients

Active space
Chromium:
Involved in carbohydrate metalbolism (Requlation of insulin levels).
Defciency' Nutritional related diabetes melitus (NRDm).
Selenium:
Involved in conduction inotropic action of heart.
Detciency iCoronary artery disease, muyocardial infarction
molybdenum:
ASSocioted with Gl cancer.
Bone mineral deiciency
Antioxidants:
Vitamins : Vit A, 6, C, .
Helps in revitalization of body,
en2ymes i Superoxide dismutase.
Savonoids.
minerals: Zine, selenium, copper,
 Nutrition
Active space ---
NUTRITION:RECOMMENDED DIETARY
ALLOWANCE AND MILLETS

Kecommended Dietary Allowance (RDA)

00:00:09
kDH given by National Institute of Nutrition WIND in aoao.
NIN iS under IcmR.

Allowance:
Avg. dails nutrient intake to meet requirement ot

o8% population so% population

Recommended dietary allowance estimated averaqe allowance
Reference male female :
male Female
Aqe 19-39 rs
weight oSka SSKg
Height (9sth centile) I77 cmn Iod cm
ao.75 ao.95

8 hrs of sleep
Other features 8-0 hrS ot work
4-6 hrs of sitting, leisure activities
a-4 hrs of active work, exercise

Energy intake:
male Female Infants Children Adolescent
Sedentary allo looo
SS0-670 IOO0-1700 aao0-3300
moderate a700 a130
Heavy 3470

hcal/kldauy 40-l60 35-55

80-90 70-80 SO-70

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 281
NUtrition:Recommended Dietarv allowance &MilletS

Active space
males Females Pregnant Lactating
ron (ma/ da) ao 30 a3
vit A(mea/ dau) IO00 85O 900 950
lodine (meg/ da) SO ISO aso a80
1a00
calcium (ng/dau) IO00
(Also in post-menopausa)
Sodium Grgday) a300

Potassium (mg dau) S3500

Carbohycrate(a/da) 130 I75

Arotein (gday) S4 45
O83 /Ka/ day
aS-40
Fat (o/day
Fibre 40g/a000 Kcal/ day

Note : Salt <5 ma/da

00:14:28

Millets

International year of millets :a0a3. Karnataka.

India : Rajasthan, Gujarat, maharashtra,
millets producing states in
jouar/sorahum.
millets in India : Ragi, bajra,
Properties :
" Gluten ree.
index
" Low qlycemic
Consumed as whole qrains.
Less expensive. resilient to climatic changes.
requirement $
Less water
Nutritionally superior.
282
Nutrition
---- Active space NUTRITION :FOOD PRODUCTS, ADULTERANTS
AND STANDARDS

Nutritive Substances 00:00:39

CEREALS
Bajra: ‘ protein, fat
" Cereals (arains): max:Iron
350 Kcal/1o0g
b-9% of protein " Ragi:
- MaK: Cat
" maize:‘ leucine, fat
Lowfat
Jouwar : ‘ carbohydrate
RICE:
Staple food in India.
TLysine, vit A, C, D, iron, calcium.
" Outer cover: Rich in Vite S n g loss of Vit .

Parboiling Hot soaking process Steam for

Rice soaked in o0-70°c water3-4 hrsdrain woter
S-IO min dry
EGG:
" white : oO% ot eqa
YolK : 30% of eag Salient eatures:
" max. NPUof 9%
Shell : 0-13% of weignt of egg
" Richest source cholesterol.
Composition in b0gmot egg: " Rich DHA (docosa hexaenoic acid)
" Contains avidin:
Component Anount
Protein
- Can cause biotin deiciency
Fat Destroyed by heating
" LOwVit C and iron.
Calcium 30 ma
Cholesterol
Testing viability' Floats : rotten
Iron
\18 mg. Egg in water
Sinks: fresh

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 283
Nutrition:Food Products, Adulterants and Standards

FISH: ----- Active space

" Rich: Protein, Vit A, vit D, iodine.
*Low in carbohydrate.
" max protein enerqy ratio. Bones rich in Ca,phosphorus.
Testingreshness of Ash: Diseases:
> Clear :fresh. " Fish tapeworm
. eyes vibrio parahaemolyticus
Salmonella
*Cloudy stale.
a. Gills :Bright red
3.Stiffness (rigor mortis) :Hard > Fresh.

mILK:

Sources:

Protein Lactose
Kca/ioomL Fot (a) Caat

Buffalo 41 4.4

Cow lo7 4.) 3.1 4.8

Human 3.1 1.8 a8

Breast milk :
I. Protein =/4 x buffalo, i/3x cow milk.
Best quality
Richest source of custeine, taurine, lg A, 6:
Custeine :Development ot bocyconditional essential amino acid
- Taurine : Development ot axon Required in children
a. Fat - /a buffolo milk.

GoOd quality
Rich in PUFA,:-linolenic acid (ALA), linoleic acid and arachidonic acid.

Brain myelin formation

3. Carbohydrate :
Richest in lactose
- Brain function *Anti-infective
- Lactobacillus bifdus
promotes qut Hora

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284
Nutrition
form.
Active space : water soluble
Rich in vit and selenium.
copper
Richest in vit C A, 2inc,
iron (70%).
max bioavailabilits of
Nephroprotective : d/ Na.
milk.
Hygiene and pasteurization :
Lactometertests density of
Quality of milk technique.
SNF)
solidnot-fat
Gross contamination
test :Done prior to pasteurization
blue reductase (meRT)
methylerne
Pasteurization :
Disinfection :
methods

Flash
Vat (holder)
" used in rural areas. High temperature ultra High temperature
areas (UHT): most modern
loo° for 30 mins. " used in urban
Short time (HTST) " 1as°c for a tew sec.
Obsolete.
1a°c for few mins, /b rapid cooling
cooled rapdy " High pressure
" Best method

Check for pasteurization : milk.

+ Absent in pasteuri2ed
phosphatase : Destroyed by heat <30,oo0colonies/mL.
Standard platecournt/colony count:
Coliform test: Zero

Packaged milk:
milk Fat

Standard

Reqular 4.5%

Toned 3%

DOuble toned
Skimmed <0.5%
 285
Nutrition: Food Products Adulterants and Standards

Homogenised milk: Active space

. Fot molecules are homoqenised.

"etter type predominantiy Yor young children.
other tupesof milk:
Evaporated milk : S0% reduction in volume.
" Condensed milk : a% reduction in volume.

Nutrition Related Diseases 00:31:56

NEUROLATHYRISm

"Toxin :8OAA (Beta oxyly amino alanine); Seen in Lathurus sativus (khesri da
" Food intoxication.

Clinical Features : Prevention:

Neurologic disease affecting joints(knee>hip) Sleeping with ine

Parboiing
Stages : " vit Cprophylaxis
Features
" Avoid consumption
Stage
Latent Asunptomatic
No stick Jerky steps, limpin aait
One stick Clumsy qait
Two stick
Inablity to stand, walk
Crawler
" Atrophy of thighs, bent Knee

ENDEMC ASCITIS
"Toxin : Purrolizadine from
crotolaria seeds. clinical feature :Hepatotoxic
Adultered in millets Prevention:Sievina/Hteration

ePIDemC DROPSY
Aroqemonemexicana.
TOxin : Sanquinarine from
" Adultered in mustard oil
Prevention :
Clinical Peatures :
Deueeding
alaucoma "Nitric acid chromatography
Congestive cardiac failure test :checks toxicity
" Diarrhea
Pleural effusion
Pedal edema Marrow 8.0 2024
Community Medicine v3.0
 Nutrition
-o- Active space

AFLATOXI
Toxin :CAlatoxin,
" Infects
OSIS Seen in Asperqillus lavus.
stored food products : Groudnuts(m/c), grains, rice.
dinical Peatures : Hepatotoxicity, cirrhosis.
Prevention: ventilation, Jmoisture.
ERGOTIsm
AKA plant Reld fungus.
TOxin : Erqot alkaloid.
AHects jouwar, rye, sorghum.
Clinical Peatures : Gl sumptomS
Prevention : Float the plant in ao% salt solution.
Food Quality and Standards
00:44:24
FSSAL: Food safetuy Standards Autthority of India
" Autonomous boduy under mOHFW.
Established in aO0% under PFA act)
Any tood product consumed for nutritional purpose should be FsSAl
approved
AGmAR5:
Standardisation for quality of raw tood, seeds and plants.
Codex Alimentarus:
International standards for qualits of food products.
NUTRITIONAL SURVEILLANCE AND ASSESSMENT
In children:
Biochemical tests:
weight tor aqe :most sensitive. Proteins :S. albumin
weiant or height: ASSessment of acute
Heighnt Por age : Assessment of chronic
malnutrition. (most sensitive).
Shakir's tape: mid-arm cirCumferencemalnutrition.
assessment
Vit A, 6,8, h.

Functional indicators :
Function Tests Important Nutrient
Structural intearity erythrocyte ragility Vit &, selenium

Haemostasis Capilary tragility Vit C

Protthrombin time Vit h
Reproduction Sperm COunt Zn, Vit E
Nerve unction Nerve conduction
Vit 6,
Dark adaptation Vit A

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