CM 5.
1 NUTRITION
REVISION
Dr. Sonal Deshpande
MD, DNB (Community Medicine)
Learning objectives
• What is Nutrition?
• What is diet?
• What is dietetics?
• How food is classified according to IYCF?
• What is meant by limiting amino acids?
• How do we measure quality of proteins?
• What is Glycaemic index?
• What are the Commonly asked spotters?
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Nutrition
• Latin word nutritic (nourishment)
• Nutrition: Definition*-
• “The science of food and its relationship to health.”
• Nutrients- organic & inorganic complexes contained in food
Nutrition session 1 * WHO TRS NO 477
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DIETETICS
• Diet – What we habitually eat or drink
• Dietetics is the practical application of the principles of nutrition.
• Planning of meals
• Dietary assessment v/s Nutritional assessment
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Nutritional epidemiology
Epidemiological assessment of the nutritional status of communities
• Nutritional and dietary surveys
• Nutritional surveillance
• Nutritional and growth monitoring
• Nutritional rehabilitation
• Nutritional indicators
• Nutritional interventions
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MCQ
Q.1. The practical application of principles of nutrition is called
A. Nutritional epidemiology
B. Dietetics
C. Dietary Assessment
D. Nutritional Assessment
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CLASSIFICATION OF FOODS
1. Origin
2. Chemical composition
3. Predominant function
4. Nutritive value
5. IYCF
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IYCF classification of foods
1. Breast milk
2. Grains, roots and tubers
3. Legumes and nuts
4. Dairy products
5. Flesh foods
6. Eggs
7. Vitamin A-rich fruits and vegetables
8. Other fruits and vegetables.
Minimum dietary diversity, iron supplementation
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MCQ
Q.2. IYCF food groups include all except
A. Breast milk
B. Grains, roots and tubers
C. Legumes and nuts
D. Iron rich fruits and vegetables
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MCQ
Q.3. Proteins, fats and carbohydrates are termed as
a) Macronutrients
b) Proximate principles
c) Vital elements
d) Vital principles
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Proteins
Key points:
• Limiting amino acids
• Cereals: Lysine & Threonine
• Pulses: Methionine
• Supplementary action of proteins
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MCQ
Q.4 The limiting amino acid in wheat is____ and in tuvar dal it is____
A. lysine, methionine
B. methionine, lysine
C. cysteine, lysine
D. lysine, cysteine
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MCQ
Q.8. Which amino acid interferes with the conversion of tryptophan to
niacin?
a) Lysine
b) Leucine
c) Histidine
d) Alanine
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MCQ
Q.9. Total dependence on which cereal will lead to pellagra?
a) Jowar
b) Rice
c) Wheat
d) Maize
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LIMITING AA and cereals/MILLETS
• Cereals – lysine and threonine
• Jowar - lysine and threonine + excess leucine
• Maize – lysine and tryptophan + excess leucine
Tryptophan Leucine X Niacin vit B3
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Proteins CONT.
evaluation of proteins
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MCQ
Q.5. Which of the following statements is true regarding NPU?
A. It is the ratio of energy from proteins and total energy intake
B. It is the ratio of nitrogen retained to the nitrogen intake multiplied
by hundred
C. It is the ratio of nitrogen retained to the nitrogen absorbed
multiplied by hundred
D. It is the ratio of nitrogen absorbed to the nitrogen intake multiplied
by hundred
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Proteins CONT.
• Assessment of protein nutritional status:
• Arm muscle circumference
• Serum Albumin
• Serum transferrin
• Lean protein
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Pulses
1) Mention the nutritive value of the food.
2) Which amino acid is limiting in pulses?
3) Write preparations/ uses of soyabean.
4) What is soy milk?
5) Which toxin causes lathyrism?
6) What are prevention measures for lathyrism?
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Bengal gram - chana
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Black gram- Urad
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Red gram - tur
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Green gram- moong
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Horse gram- Kulith
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1)
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Lathyrus sativus – Khesari dal
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Lathyrism
• Humans- Neurolathyrism - spastic paralysis of lower limbs
• Animals – Osteolathyrism
• 5) Beta Oxalyl Amino Alanine (BOAA)
• Latent, no stick, one stick, two stick, crippling
• 6) Removal of toxin – stepping method and parboiling
• Other preventive measures – Vit C prophylaxis, banning of crop, genetic
method, education
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Questions on Egg
1) Which nutrients are deficient in egg?
2) Write about the nutritional value of egg.
3) What is NPU of Egg?
4) Why egg protein is called reference protein?
5) Cholesterol content of egg?
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Egg
1) All the nutrients except carbohydrate & vitamin C
2)An egg weighing 60 grams contains
• 6 g of protein,
• 6 g of fat,
• 30 mg of calcium and
• 1.5 mg of iron,
• 70 kcal of energy.
• 5) Cholesterol 250 mg/egg
4) All the nine essential amino acids needed by the body in
right proportions.
• 3) Net Protein Utilization (NPU) is 100.
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CARBOHYDRATES
1. Sources: Animal/ Plant
2. Key points:
• Starch, sugars
• Available carbohydrates- Glycemic Index
• Cellulose – indigestible component
• Fibre
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DIETARY FIBRE
• Unavailable carbohydrates or dietary fibre, which are difficult to
digest.
• Carbohydrate fibres --- NSP, ROS
• Noncarbohydrate fibres------Lignin
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Dietary fibre
Total fibre content of common foods (g/100 g)
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MCQ
Q.7. What is available carbohydrate?
A. Fibre content of food
B. Starch content of food
C. Sugar content of food
D. Total carbohydrate minus dietary fibre
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Cereals & Millets
1) Write the nutritional value of this cereal per 100 gm.
2) Write two advantages of parboiling of rice.
3) Proteins of wheat are deficient in which two amino acids?
4) Proteins of maize are deficient in which two amino acids?
5) Mention disease caused by excessive consumption of maize.
6) Mention two conditions related to jowar.
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1)
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Cereals & Millets cont.
Rice-
• Milling
• Parboiling
• Nutrients are not removed due to milling
• Hardens grain- resistant to insect invasion & more
suitable for storage
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• Starch gets gelatinized – improves keeping quality
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Questions on milk
1) Mention calories provided by 100 ml of cow’s milk and buffalo’s milk.
2) Mention lactose content of cow milk and human milk.
3) Mention any two sources for vegetable milk.
4) What is toned milk?
5) Milk borne diseases.
6) Pasteurization of milk.
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Milk
• Skimmed milk
• Milk from which fat has been removed
• Toned milk:
• 1 part of water + 1 part of natural milk + 1/8 part of skim milk powder.
• Vegetable milk:
• Milk prepared from certain vegetable foods (viz. groundnut, soyabean).
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Milk borne diseases
• Infections of animals that can be transmitted to man- Tuberculosis,
Brucellosis, Streptococcal infections Staphylococcal enterotoxin poisoning Salmonellosis Q fever
• Infections primary to man that can be transmitted through milk-
• Typhoid and paratyphoid fevers Shigellosis Cholera Enteropathogenic Escherichiacoli (EEC)
• Clean & safe milk: healthy and clean animal to storage till
consumption
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Questions on milk cont.
Which of the following is not a test of pasteurized milk?
a) Phospahatase test
b) Standard plate count
c) Coliform count
d) Methylene blue reductase test
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Pasteurization
• Heating of milk to such temperatures and for such periods of time as
are required to destroy any pathogens that may be present while
causing minimal changes in composition, flavour and nutritive value.
• Methylene blue reductase test – test before accepting milk for
pasteurization.
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Pasteurization cont.
• Not destroyed – thermoduric bacteria, spores
• Types
• Holder (vat method)
• HTST
• UHT
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Tests of pasteurized milk
• Phospahatase test
• Standard plate count
• Coliform count
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FATS
1. Sources: Animal/ Plant
2. Key points:
• Visible and Invisible fats
• Hydrogenation
• Assessment of fat intake in the diet
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Fats cont.
• amount of total fat intake to less than 30% of total energy intake
• The risk of developing NCDs is lowered by:
• saturated fats - less than 10%
• trans-fats to less than 1%
• replacing saturated fats & trans-fats with unsaturated fats – in
particular, polyunsaturated fats.
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Methods of Nutritional
Assessment
Direct Indirect
• Ecological
1. Anthropometry studies
2. Biochemical • Functional
3. Clinical assessment
4. Dietary • Vital and health
evaluation Statistics
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Anthropometry
The scientific study of the measurements and proportions of
the human body.
• Height
• Weight
• Mid-arm circumference
• Skin fold thickness
• Head circumference
• Head/chest ratio
• Hip/waist ratio
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Weight:
Weight- for- age:
The trend of growth - repeated measures.
Compare – reference standards
Adults
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Weight: How to measure?
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Weight:
1. Check calibration of the weighing scale
2. Place the scale on firm flooring (such as tile or wood) rather
than carpet.
3. Ask the subject to remove shoes and heavy clothing, such as
sweaters, mobile phones, keys
4. Ask the subject to stand with both feet in the center of the
scale.
5. Record the weight to the nearest decimal fraction
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Height
< 2 years - Recumbent Length - Infantometer.
Height – stadiometer/ wall-mounted scale
• Height(length)-for-age:
Low height for age i.e. Stunting, reflects past
or chronic malnutrition
• Weight- for – height:
Low weight for height i.e. Wasting, is a sign of
acute malnutrition.
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height
1. Remove shoes, bulky clothing, and hair ornaments, and unbraid hair that
interferes with the measurement.
2. Take the height measurement on flooring that is not carpeted and against a
flat surface such as a wall with no molding.
3. Have the child or teen stand with feet flat, together, and against the wall.
Make sure legs are straight, arms are at sides, and shoulders are level.
4. Make sure the child or teen is looking straight ahead and that the line of
sight is parallel with the floor.
5. Take the measurement while the child or teen stands with head, shoulders,
buttocks, and heels touching the flat surface (wall).
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height
6. Use a flat headpiece to form a right angle with the wall and lower the headpiece until it firmly
touches the crown of the head.
7. Make sure the measurer’s eyes are at the same level as the headpiece.
8. Lightly mark where the bottom of the headpiece meets the wall.
9. Then, use a metal tape to measure from the base on the floor to the marked measurement on the
wall to get the height measurement.
10. Accurately record the height to the nearest 1/8th inch or 0.1 centimeter.
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Head & chest
circumference:
• At birth- head cir- 34 cm
• 2 cm chest circumference
• By 6 to 9 months,
• two measurements become equal
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Mid upper arm circumference: Shakir’s Tape
Red: 0 – 11.5 cm
Yellow: 11.5 cm - 12.5 cm
Green: from 12.5 cm
•Easy, rapid method of assessment
•Age independent
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MUAC
1. Bend the left arm,
2. Find and mark with a pen the olecranon process and acromion.
3. Mark the mid-point between these two marks.
4. With the arm hanging straight down, wrap shakir’s tape around the
arm at the midpoint mark.
5. Measure to the nearest 1 mm.
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Nutritional Indices in Adults
• BMI: Body mass Index = wt (kg)/ ht2 (m)
•Underweight - < 18.5 kg/m2
•Normal weight - 18.5 to 24.9 kg/ m2
•Overweight – 25 to 29.9 kg/ m2
•Obesity – >30 kg/ m2
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Waist circumference & WHR
Index Males Females
Waist
102 cm 88 cm
circumference
WHR 1 0.85
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Waist circumference
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