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Dr. Gaurav Kamboj
JR
Department of Community Medicine
PGIMS, Rohtak
Contents
 Introduction
 Dietary Goals
 Classification of food
 Proximate principles of food
 Micronutrients
 Dietary...
Introduction
 Nutrient (Food Factor):
◦ Organic & inorganic complexes contained in food.
◦ There are about 50 different n...
DIETARY GOALS
Maintenance of a state of positive health & optimal performance in
populations at large by maintaining ideal...
Classification of Foods
Chemical
Composition
• Proteins
• Carbohydrat
es
• Fats
• Vitamins
• Minerals
Function
• Energy-
g...
NUTRIENTS
Micronutrients
• Vitamins
• Minerals
Macronutrients
(Proximate Principles)
• Carbohydrates (65-80%)
• Fats (10-3...
Proximate Principles of
food
Proteins
(=of first importance)
 Complex organic nitrogenous compounds
 Primary structural & functional component
of eve...
Sources of Proteins:
Animal: Milk and Milk Products, Eggs (reference
protein), Meat, Fish
Plants: Pulses, Cereals, Beans, ...
Functions of proteins
Major structural component of cellular membranes.
Help in body immunity.
Influence & control osmotic...
Protein contents of some foods
Food Protein
(g per 100g of food)
Animal foods
Milk 3.2-4.3
Meat 18.0-26.0
Egg 13.0
Fish 15...
PROTEINS
PROTEIN QUANTITY
Protein energy ratio =
Energy from protein × 100
Total energy in diet
Recommended protein
intake...
Fats
Concentrated sources of energy.
: Fats liquid at 20°C are called OILS.
: 10 – 15% of body weight.
: 9kcal /gm energy
...
FATTY ACIDS :
• SATURATED: lauric, palmitic, stearic acids
• UNSATURATED :
• Mono unsaturated Fatty acids(MUFA) :
oleic ac...
Sources of fat in Indian diets
Animal fat (saturated fats): ghee, butter, milk, cheese, eggs,
fat of meat and fish
Vegetab...
Function in the Body:
 MODULATION OF MEMBRANE
STRUCTURE AND FUNCTIONS-
 Fatty acids affect membrane fluidity and
lipid p...
◦ Recent studies have identified that PUFAs of
n-6 and n-3 series and their metabolic
products regulate the production of ...
ROLE OF AA AND DHA IN FETAL AND INFANT
EARLY GROWTH AND DEVELOPMENT
 Rapid accretion of AA and DHA in infant brain, DHA i...
C) ROLE OF DIETARY FATTY ACIDS IN
PREVENTING CHD AND OTHER DIET- RELATED
NON-COMMUNICABLE DISEASES (DR-NCD)
 Dietary fatt...
Hydrogenation
 When vegetable oils are hydrogenated
under conditions of optimum temp. &
pressure in the presence of catal...
Trans Fatty Acid
 Produced by partial hydrogenation of PUFA’s.
 Renders the plasma lipid profile even more
atherogenic t...
Recommendations of FAO and
WHO on dietary fats
 The FAO/WHO Expert Consultation on
fats and fatty acids in Human Nutritio...
1) SFAs
 Replacing SFAs with PUFAs decreases LDL cholesterol
concentration and the total/HDL cholesterol ratio. A similar...
2) MUFAs
 Replacing carbohydrates with MUFAs increases
HDL cholesterol concentrations
 Replacing SFA with MUFA reduces L...
4) TFAs
 TFA from commercial partially hydrogenated
vegetable oils (PHVO) increase CHD risk
factors and CHD events more s...
When promoting the removal of TFA, which
are predominantly a by-product of
industrial processing (partial
hydrogenation) u...
Choice of cooking oil
1. Use correct combination / blend of 2 or more vegetable oils (1:1) it is necessary
to increase the...
CARBOHYDRATES
: main source of energy.
: providing energy= 4kcal/g
TYPES -
A. Simple carbohydrates
1. Sugars (Simple carb....
Functions :
55% - 60 % of daily energy requirement
As a “ spare protein ”
Aid in fat metabolism.
Formation of structural e...
Glycaemic Index
 Area under the 2 hr. blood glucose
response curve following the ingestion of
50 gm test carbohydrate.
 ...
Dietary Fiber
 Fiber is the plant material that doesn’t break down
when we digest food.
 Examples: Cellulose, Hemicellul...
Function in the Body:
Aids in digestion.
May reduce the risk of developing some diseases like heart
disease, diabetes and ...
WATER
Electrolytes
◦ Regulates many processes in the body.
Homeostasis
◦ Process of maintaining a steady state in the
body...
WATER REQUIREMENT
AGE(in years) WATER(ml per kg
body weight)
INFANTS Birth-1 120-100
CHILDREN 0-10 60-80
ADOLESCENTS 11-18...
MICRONUTRIENTS
Vitamins and Minerals
VITAMINS
 Human body cannot synthesize it except for
vitamin D and K.
 Important for proper body functioning.
 Unlike c...
2 TYPES :
 FAT SOLUBLE-
A,D,E,K
 Fatsoluble vitamins
can be stored in the
body while water-
soluble vitamins are
not and...
(A)Fat Soluble
VITAMIN SOURCE FUNCTION
S
DEFICIENC
Y
DAILY
REQUIREME
NT
TOXICITY
VITAMIN
-A
(retinol,
β-carotene)
Fish liv...
(B) Water Soluble
VITAMIN SOURCES FUNCTIONS DEFICIENCY DAILY
REQUIREMENT
VITAMIN-
B1
Thiamine
Cereals(lost from rice
durin...
Water Soluble
Vitamins SOURCE FUNCTIONS DEFICIENCY DAILY
REQUIREMENT
VITAMIN-B5
Pantothenic
acid
All foods Adrenal cortica...
MINERALS
Required for :
growth, repair, and regulation of
vital body functions.
Two major groups :
Major minerals : calci...
ESSENTIAL MINERALS
MINERALS SOURCES FUNCTIONS DEFICIENCY DAILY
REQUIREMENT
IRON
HAEM
NON HAEM
Liver, meat,
poultry, fish
C...
ESSENTIAL MINERALS
MINERALS SOURCES FUNCTIONS DEFICIENCY/
EXCESS
DAILY
REQUIRE
MENT
SODIUM Processed
foods, salt
Osmotic s...
Other Trace Elements
 COPPER:
◦ Widely distributed in nature, deficiency/excess is rare
◦ Hypocupremia (in patients with ...
 SELENIUM:
◦ RDA: 55mcg
◦ Se deficiency: may occur in PEM, reduces antibody
production. Endemic cardiomyopathy (Keshan Ds...
NUTRITIVE VALUE OF SOME PLANT
FOODS
FOOD PRODUCTS
Per 100 g
Protein Fat Carbohy-
drates
Energy
(Kcal)
Vitamins Minerals
RA...
NUTRITIVE VALUE OF SOME ANIMAL
FOODS
FOOD PRODUCTS
PER 100 g
Proteins Fats Lactose Energy
(Kcal)
Vitamins Minerals
MILK :
...
Dietary Standards – What are
they?
 Recommended Dietary Allowance (RDA): the
average daily dietary nutrient intake level ...
 The RDA are based
on scientific
knowledge.
 Prepared by the
National Nutrition
Advisory Committee
(ICMR).
 The committ...
AN INDIAN REFERENCE MAN &
WOMAN
REFERENCE MAN REFERENCE WOMAN
 Age : 18 – 29 years.
 Weight : 60 kg, Ht-1.73m
 BMI-20.3...
Consumption Unit (C.U.)
 The energy requirement of ‘Reference
man’ who is aged 18-29 years, healthy,
weighing 60 kg doing...
BALANCED DIET
Defined as “ one which
contains a variety of foods in
such quantities and
proportions that the need of
energ...
Composition of Balanced Diet
 About 65-80% of energy requirements
should come from complex carbohydrates
 About 10-15% o...
PRUDENT DIET (Dietary Goals)
Recommended by Expert Committee of
WHO :
a) Dietary fat : 15 -30% of total daily intake.
b) S...
RDA IN INDIANS
RDA IN INDIANS
Diet recommendations for Children
AGE DIET RECOMMENDATIONS
0 – 6 months Only nourishment newborns need is mother’s
milk.
6...
Complementary foods for children
1. Kichidi
2. Malted Ragi Porridge
3. Kheer
4. Custard
5. Wheat Payasam
Note:
1. All thes...
Common Home Measures- Weight
& Volume Equivalents
 1 Medium size katori: 150-160 ml
 1 Table spoon (level): 15g or ml
(a...
Food Pyramid
FOOD GUIDE PYRAMID
1ST layer – GRAINS- eat most (6 or more servings)
Examples: rice, noodles, pasta, whole grain bread, pl...
2nd layer – Vegetables & Fruits (eat a lot)
Vegetables-3 to 5 servings & 2-4 servings of fruits
Examples: Different green ...
3rd layer – Meat, Poultry, Fish, Eggs, Beans,
Nuts (eat some – not too much)
Milk group-2servings
Meat group – 2 servings
...
4th Layer – Fat, Sugar & Salt (eat least ,use
sparingly)
Examples:
Cooking oils (eg peanut oil, corn oil, sunflower oil),
...
IMPORTANCE OF
DIET DURING
DIFFERENT
STAGES OF LIFE
NUTRITIONAL
PROBLEMS
PROTEIN ENERGY MALNUTRITION
FEATURES MARASMUS KWASHIORKOR
CLINICAL ALWAYS PRESENT
Muscle wasting Obvious Hidden by oedema ...
MALNUTRITION / INFECTION CYCLE
(PEM)
INADEQUATE DIETARY
INTAKE
• APPETITE LOSS
• NUTRITION LOSS
• MALABSORPTION
• ALTERED
...
CLASSIFICATION OF PEM
 GOMEZ CLASSIFICATION :
: based on weight retardation
: normal reference child is in 50th centile o...
XEROPHTHALMIA
VITAMIN-A DEFICIENCY IN INDIA
 5.7% children in India suffer from eye signs of VAD
 Most common in childre...
 PREVENTION :
a). Short term action : Administration of
vitamin-A orally
: 1st dose with measles vaccine – 100,000 IU
(at...
NUTRITIONAL ANAEMIA
 A condition in which the haemoglobin content of
blood is lower than normal as a result of
deficiency...
IODINE DEFICIENCY DISORDERS
 170 million are estimated to be affected by GOITRE in India.
 In SUB HIMALAYAN GOITRE BELT ...
ENDEMIC FLUOROSIS
 Important health problem in : Andhra Pradesh, Punjab, Haryana,
Karnataka, Kerala & Tamil Nadu.
 TYPES...
LATHYRISM
 Prevalent in : Madhya Pradesh, UP, Bihar, Orissa
 Due to consumption of Lathyrus sativus (khesari dhal)
: ove...
DIABETES
 Impaired metabolism of glucose in the body, which leads to excess of
glucose
in blood and urine.
CAUSES :
 Hig...
OBESITY
 CAUSES :
: Overnutrition
: Prolonged post –prandial hyperlipidaemia
: Relative insulin resistance in peripheral ...
 Dietary Approaches to Stop Hypertension (DASH)
 DASH was one of three eating plans that were
compared in research studi...
 Is low in saturated fat, cholesterol, and total fat
 Focuses on fruits, vegetables, and fat-free or
low-fat dairy produ...
Total fat 27% of calories Sodium 2,300 mg
Saturated fat 6% of calories Potassium 4,700 mg
Protein 18% of calories Calcium ...
Type of food Number of servings for
1600 - 3100 Calorie diets
Servings on a 2000
Calorie diet
Grains and grain products
(i...
Diet and Diabetes
 Eat starchy foods regularly
 More fruit and vegetables
 Reduce animal or saturated fat (Lowers LDL
c...
Diet and Diabetes
 Cut down on sugar
 Use of Sweeteners:
◦ Sugar alcohols (polyols): Sorbitol, mannitol, xylitol
◦ 10-12...
Some Indian remedies : Methi seed
• Contains
• an active ingredient of blood glucose control
• an active ingredient for bl...
NATIONAL NUTRITIONAL
PROGRAMS
 Special nutrition program
 Balwadi nutrition program
 Applied nutrition program
 Tamil ...
 National Nutritional Anemia Prophylaxis
Program
 National Program For Prophylaxis Against
Blindness in Children Caused ...
• National Institute Of Nutrition (NIN), Hyderabad
(Nutrition Society of India)
• National Institute Of Health And Family ...
References
1. National Institute of Nutrition. Low cost Nutritious Supplements.
NIN, Hyderabad, 1975.
2. World Health Orga...
7. Indian Council of Medical Research. Nutrient Requirements and
Recommended DietaryAllowances for Indians, National Insti...
Nutrition, Macronutrients and Micronutrients and their deficiency disorders
Nutrition, Macronutrients and Micronutrients and their deficiency disorders
Nutrition, Macronutrients and Micronutrients and their deficiency disorders
Nutrition, Macronutrients and Micronutrients and their deficiency disorders
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Nutrition, Macronutrients and Micronutrients and their deficiency disorders

All about nutrition, RDA, balanced diet, macro and micro nutrients, proximate principles of food and various deficiency disorders

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Nutrition, Macronutrients and Micronutrients and their deficiency disorders

  1. 1. Dr. Gaurav Kamboj JR Department of Community Medicine PGIMS, Rohtak
  2. 2. Contents  Introduction  Dietary Goals  Classification of food  Proximate principles of food  Micronutrients  Dietary Standards  Consumption Unit, Balanced Diet, Prudent Diet  Food Pyramid  Nutritional Problems  National Nutrition Programmes  References
  3. 3. Introduction  Nutrient (Food Factor): ◦ Organic & inorganic complexes contained in food. ◦ There are about 50 different nutrients which are normally supplied through foods we eat. ◦ Most natural foods contain more than one nutrient.  Dietetics: o is practical application of principles of nutrition; it includes planning of meals for the well and the sick.
  4. 4. DIETARY GOALS Maintenance of a state of positive health & optimal performance in populations at large by maintaining ideal body weight. Ensure adequate nutritional status for pregnant & lactating women. Improvement of birth weights & promotion of growth of infants, children & adolescents to achieve their full genetic potential. Achievement of adequacy in all nutrients & prevention of deficiency diseases. Prevention of chronic diet-related disorders. Maintenance of the health of elderly & increase the life expectancy.
  5. 5. Classification of Foods Chemical Composition • Proteins • Carbohydrat es • Fats • Vitamins • Minerals Function • Energy- giving foods • Body- building foods • Protective foods Source • Animal origin • Vegetable origin Nutritive Value • Cereals and millets • Pulses (Legumes) • Vegetables • Nuts and oilseeds • Fruits • Animal foods • Fats and oils • Sugar and jaggery • Condiments and spices • Misc. foods
  6. 6. NUTRIENTS Micronutrients • Vitamins • Minerals Macronutrients (Proximate Principles) • Carbohydrates (65-80%) • Fats (10-30%) • Proteins (7-15%) *Form the main bulk of food *Required in small amounts
  7. 7. Proximate Principles of food
  8. 8. Proteins (=of first importance)  Complex organic nitrogenous compounds  Primary structural & functional component of every living cell.  20% of body weight  4kcal/gram energy AMINO ACIDS: (20 AA)  Building blocks of proteins. Essential Amino Acids: Cannot be synthesized in body. 9 EAA: Valine, Isoleucine, Leucine, Lysine, Phenylalanine, Methionine, Tryptophan, Threonine, Histidine. (VILLPMTTH)
  9. 9. Sources of Proteins: Animal: Milk and Milk Products, Eggs (reference protein), Meat, Fish Plants: Pulses, Cereals, Beans, Nuts. Digestibility & Bioavailability of proteins in sprouted pulses is better. “Pulses are deficient in Methionine whereas cereals are deficient in lysine and threonine (limiting a.a.), so their combination is complimentary.”
  10. 10. Functions of proteins Major structural component of cellular membranes. Help in body immunity. Influence & control osmotic pressure of body fluids. Help in movement of muscle fibers. As carrier proteins. As molecular receptors and nucleoproteins. Form enzymes that control chemical reactions throughout body.
  11. 11. Protein contents of some foods Food Protein (g per 100g of food) Animal foods Milk 3.2-4.3 Meat 18.0-26.0 Egg 13.0 Fish 15.0-23.0 Plant foods Cereals 6.0-13.0 Pulses 21.0-28.0 Nuts 4.5-29.0 Soyabean 43.2
  12. 12. PROTEINS PROTEIN QUANTITY Protein energy ratio = Energy from protein × 100 Total energy in diet Recommended protein intake= 15 – 20 % of total daily energy intake. PROTEIN QUALITY Amino acid score = mg of one amino acid per gm protein X 100 mg of same amino acid per gm of egg protein For starches : 50 – 60. For animal foods : 70 – 80 Net protein utilization : (NPU) nitrogen retained by the body ×100 Nitrogen intake 1gm protein is assumed to be equivalent to 6.25gm of nitrogen. If NPU is low, protein requirement is high. NPU for Indian diets : 50 – 80.
  13. 13. Fats Concentrated sources of energy. : Fats liquid at 20°C are called OILS. : 10 – 15% of body weight. : 9kcal /gm energy TYPES – a) simple lipids e.g., triglycerides b) compound lipids e.g., phospholipids c) derived lipids e.g., cholesterol
  14. 14. FATTY ACIDS : • SATURATED: lauric, palmitic, stearic acids • UNSATURATED : • Mono unsaturated Fatty acids(MUFA) : oleic acid • Poly unsaturated Fatty Acids(PUFA) : Linoleic acid (Omega-6) , α-Linolenic acid (Omega-3) ESSENTIAL FATTY ACIDS : • cannot be synthesized by humans. • e.g., linoleic acid(LA) (most important), • α-linolenic acid (ALA) • Found abundantly in vegetable oils
  15. 15. Sources of fat in Indian diets Animal fat (saturated fats): ghee, butter, milk, cheese, eggs, fat of meat and fish Vegetable fats: groundnut, mustard, sesame, coconut Other sources: Rice(3%), Wheat (3%), Jowar (4%), Bajra (6.5%) Small amount of fat which is present as integral component in each & every item of food (invisible fat), the fat in processed and ready to eat foods (hidden fat) and visible fat (vegetable oil, ghee, butter and vanaspati), used as cooking fat, together contribute to total fat intake.
  16. 16. Function in the Body:  MODULATION OF MEMBRANE STRUCTURE AND FUNCTIONS-  Fatty acids affect membrane fluidity and lipid protein interactions which alter activity of membrane-related transport systems, ion channels, membrane bound enzymes and cellular receptors for hormones and neurotransmitters.
  17. 17. ◦ Recent studies have identified that PUFAs of n-6 and n-3 series and their metabolic products regulate the production of lipid cellular mediators namely, lipoxins (from AA*), E series resolvins (from EPA*), and D- series resolvins and neuroprotectins D1 (from DHA*). Lipoxins and resolvins (from both EPA and DHA) have potent anti- inflammatory effects and neuroprotectin D1 has potent anti-inflammatory and neuroprotective effects. Galli C and Calder PC. Effects of fat and fatty acid intake on inflammatory and immune responses: A critical review. Ann Nutr Metab 55:123–139, 2009. *AA=Arachidonic Acid EPA=Eicosapentaenoic acid DHA=Docosahexaenoic Acid
  18. 18. ROLE OF AA AND DHA IN FETAL AND INFANT EARLY GROWTH AND DEVELOPMENT  Rapid accretion of AA and DHA in infant brain, DHA in retina and AA in the whole body for meeting the demands of rapidly growing tissues/organs.  DHA is crucial for the function of rhodopsin for vision and postsynaptic receptors for neurotransmission.  The fetus depends completely on maternal source of LA, ALA, AA and DHA (maternal tissues/stores and dietary intake) & infant obtains these PUFA through breast milk Crawford MA, Bazinet RP and Sinclair AJ. Fat intake and CNS functioning: Ageing and disease. Ann Nutr Metab 55:202-228, 2009.
  19. 19. C) ROLE OF DIETARY FATTY ACIDS IN PREVENTING CHD AND OTHER DIET- RELATED NON-COMMUNICABLE DISEASES (DR-NCD)  Dietary fatty acids modify the concentrations of plasma triglycerides and lipoprotein cholesterol fractions which affect CHD risk significantly .  Recent studies have shown that high intake of specific fatty acids (LA, ALA, EPA and DHA) lower the risk of CHD and CHD events. some studies have shown that the cholesterolemic effect of dietary cholesterol is reduced when diets provide high levels of PUFAs. Skeaff CM and Miller J. Dietary fat and coronary heart disease: Summary of Evidence from prospective cohort and randomised controlled trials. Ann Nutr. Metab. 55:173–201, 2009.
  20. 20. Hydrogenation  When vegetable oils are hydrogenated under conditions of optimum temp. & pressure in the presence of catalyst, the liquid oils are converted into semisolid & solid fat known as Vanaspati ghee.  During this process, EFA content is drastically reduced.  It is fortified with Vit. A(2500 IU) & Vit. D(175 IU) per 100gm by govt. regulation.
  21. 21. Trans Fatty Acid  Produced by partial hydrogenation of PUFA’s.  Renders the plasma lipid profile even more atherogenic than SFA’s by elevating LDL & decreasing HDL cholesterol.  Takes years for TFA’s to be flushed from body.  Sources : deep fried fast foods, cake, energy bars, chips, cookies & candies.
  22. 22. Recommendations of FAO and WHO on dietary fats  The FAO/WHO Expert Consultation on fats and fatty acids in Human Nutrition held in November 2008 in Geneva, Switzerland, reviewed the scientific evidence on nutrient intake values for total fat and fatty acids . They are as follows:
  23. 23. 1) SFAs  Replacing SFAs with PUFAs decreases LDL cholesterol concentration and the total/HDL cholesterol ratio. A similar but lesser effect is achieved by replacing these SFAs with MUFAs.  Replacing dietary sources of SFA with carbohydrates decreases both LDL and HDL cholesterol concentration but does not change the total/HDL cholesterol ratio.  Replacing SFAs with trans-fatty acids (TFAs) decreases HDL cholesterol and increases the total /HDL cholesterol ratio.  Based on coronary heart disease (CHD) morbidity and mortality data from epidemiological studies and controlled clinical trials (using CHD events and death), it was also agreed that replacing SFAs with PUFAs decreases the risk of CHD.
  24. 24. 2) MUFAs  Replacing carbohydrates with MUFAs increases HDL cholesterol concentrations  Replacing SFA with MUFA reduces LDL cholesterol concentration and total/HDL cholesterol ratio 3) PUFAs  Linoleic acid (LA) and alpha-linolenic acid (ALA) are indispensable since they cannot be synthesized by humans. The minimum intake levels for essential fatty acids to prevent deficiency symptoms are estimated to be 2.5%E LA plus 0.5%E ALA.
  25. 25. 4) TFAs  TFA from commercial partially hydrogenated vegetable oils (PHVO) increase CHD risk factors and CHD events more so than had been thought in the past.  Based on epidemiologic studies and randomized controlled trials of CHD events, the minimum recommended level of total PUFAs consumption for lowering LDL and total cholesterol concentrations, increasing HDL cholesterol concentrations and decreasing the risk of CHD events is 6%E.
  26. 26. When promoting the removal of TFA, which are predominantly a by-product of industrial processing (partial hydrogenation) usually in the form of PHVO, particular attention must be given to what would be their replacement; this is a challenge for the food industry.
  27. 27. Choice of cooking oil 1. Use correct combination / blend of 2 or more vegetable oils (1:1) it is necessary to increase the α-linolenic acid intake and reduce the quantity of linoleic acid obtained from the cooking oil. 2. Re Limit use of butter/ghee 3. Avoid use of PHVO as medium for cooking / frying 4. Replacements for PHVO Frying : oils which have higher thermal stability -- palm oilc / palmoleinc, sesamea, ricebranb, cottonseed -- single / blends ( home /commercial) Food applications which require solid fats : coconut oil/ palm kernel oil/ palm oil / palmolein/ palm stearin and / their solid fractions and / their blends
  28. 28. CARBOHYDRATES : main source of energy. : providing energy= 4kcal/g TYPES - A. Simple carbohydrates 1. Sugars (Simple carb.) :  Monosaccharides : glucose, Fructose  Disaccharides : sucrose, lactose B. Complex Carbohydrates 1. Starch : in cereals, roots, & tubers 2. Fiber : (cellulose & non-cellulose) non-starch polysaccharide. C. Glycogen : carbohydrate reserve (500gm in adult human)
  29. 29. Functions : 55% - 60 % of daily energy requirement As a “ spare protein ” Aid in fat metabolism. Formation of structural elements. ( cartilage, nervous tissue and bone ) Formation of non-essential amino acids.
  30. 30. Glycaemic Index  Area under the 2 hr. blood glucose response curve following the ingestion of 50 gm test carbohydrate.  Utility in Management of diabetes & control of obesity. classification GI range Examples Low GI 55 or less Most fruits and veg.(except watermelon, sweet corn, potatoes), whole grains, pasta foods, beans, lentils Medium GI 56-69 Sucrose, basmati rice, brown rice High GI 70 or more Corn flakes, baked potato, few rice varieties(eg Jasmine), white bread, candy bar, syrupy foods
  31. 31. Dietary Fiber  Fiber is the plant material that doesn’t break down when we digest food.  Examples: Cellulose, Hemicelluloses, Soluble non- cellulosic pectin's, Gums & Mucilage's, Lignin  Many, but not all, complex carbohydrates contain fiber.  DAILY INTAKE: 40g/2000kCal  2Kcal/g energy  Food Sources: ◦ Oatmeal, fruits, vegetables, whole grains and legumes.
  32. 32. Function in the Body: Aids in digestion. May reduce the risk of developing some diseases like heart disease, diabetes and obesity, and certain types of cancer. Helps promote regularity. delays and retards absorption of carbohydrates and fats and increases the satiety value increase the bulk of the stools. protective role of dietary fibre against colon cancer
  33. 33. WATER Electrolytes ◦ Regulates many processes in the body. Homeostasis ◦ Process of maintaining a steady state in the body. Dehydration ◦ Severe reduction in the body’s water content. ◦ Condition that results in the body’s loss of important electrolytes.
  34. 34. WATER REQUIREMENT AGE(in years) WATER(ml per kg body weight) INFANTS Birth-1 120-100 CHILDREN 0-10 60-80 ADOLESCENTS 11-18 41-55 ADULTS 19-51 20-30
  35. 35. MICRONUTRIENTS Vitamins and Minerals
  36. 36. VITAMINS  Human body cannot synthesize it except for vitamin D and K.  Important for proper body functioning.  Unlike carbohydrates, fats, and proteins, vitamins DO NOT provide energy (calories).
  37. 37. 2 TYPES :  FAT SOLUBLE- A,D,E,K  Fatsoluble vitamins can be stored in the body while water- soluble vitamins are not and get easily excreted in urine  WATER SOLUBLE- B and C  Vitamins B-complex and C are heat labile vitamins and are easily destroyed by heat, air or during drying, cooking and food processing.
  38. 38. (A)Fat Soluble VITAMIN SOURCE FUNCTION S DEFICIENC Y DAILY REQUIREME NT TOXICITY VITAMIN -A (retinol, β-carotene) Fish liver oils, Green veg., Green & yellow Fruits. Vision, Epithelium, Immunity. Xerophthalmia , Growth retrd’, Hyperkeratosis . 600 mcg RETINOL Nausea, Vomiting, Anorexia, Papilloedema, Hepatomegaly, Teratogenicity VIT-D Calciferol, cholecalcif- erol (D3) Sunlight (5min/day), Foods of animal origin. Calcium & phosphorous metabolism. Bone mineralisation Rickets, Osteomalacia. Adults: 2.5mcg Infants: 5mcg Preg: 10 mcg -- VIT-E tocoferol Vegetable oils, Egg yolk. -- -- 0. 8 mg / g of essential fatty acids (8- 10mg/d) Cytotoxic effect on lymphocytes VITAMIN -K K1 & K2 Green veg, Milk, Synth. in Blood clotting Increased blood clotting time. 0.03 mg / kg body weight --
  39. 39. (B) Water Soluble VITAMIN SOURCES FUNCTIONS DEFICIENCY DAILY REQUIREMENT VITAMIN- B1 Thiamine Cereals(lost from rice during milling), Groundnut, Pulses-gram dal, Milk Carbohydrate Metabolism. (activates Transketolase) Dry beriberi(peripheral neuritis), Wet beriberi(cardiac), Infantile beriberi(2-4m age), Wernick’s encephalopathy(alcohol ) 0. 5 mg per 1000 KCals of energy intake VITAMIN- B2 Riboflavin Liver, eggs, pulses, milk, leafy veg. Cellular oxidation, Mucocutaneous integrity Angular stomatitis 0. 6 mg per 1000 kcal of energy intake VITAMIN- B3 Niacin Animal products, legumes, groundnuts. Maintain skin, nervous system, intestinal func. Pellagra (Three D’s) Diarrhoea, Dermititis, Dementia 6.6 mg / 1000 kcal of energy intake VITAMIN- B6 Pyridoxine Animal products, cereals, vegetables Amino acid, fat & carbohydrate metabolism Peripheral neuritis 2 mg per day (2.5 in preg & lactation)
  40. 40. Water Soluble Vitamins SOURCE FUNCTIONS DEFICIENCY DAILY REQUIREMENT VITAMIN-B5 Pantothenic acid All foods Adrenal cortical func., Corticosteroids synthesis -- 10 mg VITAMIN-B12 Cyanocobalam ine Animal products, Syn. In colon. Nucleic acid synthesis, Myelin synthesis. Megaloblastic & pernicious anaemia 1 mcg / day (1.5 mcg / day in preg & lactation) VITAMIN-C Ascorbic acid Fresh fruits(amla), Leafy vegs, Germinating pulses. Tissue oxidation, Collagen synthesis. Scurvy 40-60 mg FOLATE folic acid Leafy vegs, Fruits, animal products. Nucleic acid syn., dev. Of blood cells. Megaloblastic anaemia, infertility, GI diturbances 100 mcg, 500 mcg in preg, 150 mcg in lactation
  41. 41. MINERALS Required for : growth, repair, and regulation of vital body functions. Two major groups : Major minerals : calcium, phosphorus, sodium, potassium, magnesium. Trace elements : iron, iodine, flourine, zinc, copper, cobalt, Chromium, Manganese etc. (requirement-- less than few mg/day.)
  42. 42. ESSENTIAL MINERALS MINERALS SOURCES FUNCTIONS DEFICIENCY DAILY REQUIREMENT IRON HAEM NON HAEM Liver, meat, poultry, fish Cereals, leafy veg, jaggery Hb formation, brain dev, temperature regulation Anaemia, impaired cell- mediated immunity Males=0.84mg Woman=2.8mg Preg.=3.5mg Lactation:2.4mg CALCIUM Milk & milk products, eggs, fish, leafy veg, cereals, millets Bones & teeth, blood coagulation, muscle contraction Rickets, osteomalacia 600 mg/day PHOSPHOR US vegetables Bones & teeth, Other metabolisms rare Equal to calcium FLOURINE Drinking water, Sea fish, cheese, tea Mineralisation of bones, Dental enamel Dental caries 0.5 to 0.8 mg per litre of water IODINE Sea foods, Cod liver oil, milk, vegetables, cereals Thyroid hormone synthesis Hypothyroidism , Retarded physical & 150 mcg / day Preg: 250 mcg/day
  43. 43. ESSENTIAL MINERALS MINERALS SOURCES FUNCTIONS DEFICIENCY/ EXCESS DAILY REQUIRE MENT SODIUM Processed foods, salt Osmotic skeleton of extracellular fluid >10g intake/d increase B.P. 5g/d POTASSIUM Occurs widely in foodstuffs, little likelihood of deficiency Vasoactive, increases blood flow, sustains metabolic needs of tissue, lowers B.P., intracellular osmolality Little likelihood of deficiency Hyperkalemia –ECG changes (cardiac arrest) 1:1 ratio of sodium: potassium (mmol) MAGNESIU M Metabolism of calcium and potassium Irritability, tetany, hyper-reflexia, hypo- reflexia 340mg/day ZINC Meat, milk, fish Component of >300 enzymes. Metabolism of glucides and proteins, synthesis of insulin, maintain integrity of immune system Growth failure, sexual infantilism in adolescents, loss of taste, delayed wound healing, spontaneous abortions, congenital malformations 12mg/day- Men 10mg/day- women
  44. 44. Other Trace Elements  COPPER: ◦ Widely distributed in nature, deficiency/excess is rare ◦ Hypocupremia (in patients with nephrosis, Wilson’s disease, PEM)- Neutropenia ◦ Hypercupremia: excess intake, leukemia, Hodgkin’s ds, severe anaemia, MI, hyperthyroidism ◦ Daily Req: 2.0mg/day  COBALT: ◦ Part of Vit. B12 molecule ◦ Goitre (role in capture of iodine by gland)  CHROMIUM: ◦ RDA: 35mcg ◦ Role in relation to carbohydrate and insulin function (unusual glucose tolerance curves responsive to chromium)
  45. 45.  SELENIUM: ◦ RDA: 55mcg ◦ Se deficiency: may occur in PEM, reduces antibody production. Endemic cardiomyopathy (Keshan Ds.) ◦ Leads to weight gain when given to children with Kwashiorkor  MOLYBDENUM: ◦ RDA: 45mcg ◦ Excess: bone deformities, Reproductive abnormalities ◦ Deficiency: Neuropathy, Myopathy, Mouth and Oesophageal cancer
  46. 46. NUTRITIVE VALUE OF SOME PLANT FOODS FOOD PRODUCTS Per 100 g Protein Fat Carbohy- drates Energy (Kcal) Vitamins Minerals RAW MILLED RICE 6.8g 0.5g 78.2g 345 Vit –B-1, 2, 3 WHEAT (WHOLE) 11.8g 1.5g 71.2g 346 “ MAIZE ( DRY) 11.1g 3.6g 66.2g 342 “ PULSES : Bengal gram 17.1g 5.3g 360 Vit B-1, 2, 3, C Ca, Fe Red gram 22.3g 1.7g 335 “ Ca, Fe Soya bean 43.2g 19.5g 432 “ Ca, Fe FRUITS : Banana 104 Vit A , C Ca, Fe Mango 74 “ “ Grapes 71 “ “ Guava 51 “ “ DRY FRUITS : Almonds 20.8g 655 “ “ Groundnut 25.3g 567 “ “ Cashew nut 596 “ “
  47. 47. NUTRITIVE VALUE OF SOME ANIMAL FOODS FOOD PRODUCTS PER 100 g Proteins Fats Lactose Energy (Kcal) Vitamins Minerals MILK : Human 1.1g 3.4g 7.4g 65 Vit C=3mg Cal = 28mg Fe = … Cow 3.2g 4.1g 4.4g 67 Vit C=2mg Cal=120mg Fe = 0.2mg Buffalo 4.3g 6.5g 5.1g 117 Vit C=1mg Cal=210mg Fe=0.2mg Goat 3.3g 4.5g 4.6g 72 Vit C=1mg Cal=170mg Fe=0.3mg MEAT , GOAT 21.4g 3.6g .. .. .. 1.1g FISH 19.5g 2.4g .. .. .. 1.5g HEN’S EGG 13.3g 13.3g .. .. .. 1g
  48. 48. Dietary Standards – What are they?  Recommended Dietary Allowance (RDA): the average daily dietary nutrient intake level sufficient to meet the nutrient requirement of nearly all healthy individuals in a particular life stage and gender group. For all nutrients, EXCEPT ENERGY, estimates of allowances are based on defined “minimum requirement” plus a safety margin(+2SD) for individual variation & stresses of everyday life. DOES NOT APPLY TO SICK PEOPLE. The RDA is derived from (i) the individual variability, and (ii) the nutrient bio-availability from the habitual diet.
  49. 49.  The RDA are based on scientific knowledge.  Prepared by the National Nutrition Advisory Committee (ICMR).  The committee revise the RDA every 10 years.  Current RDA of Indians was setup in 2010.
  50. 50. AN INDIAN REFERENCE MAN & WOMAN REFERENCE MAN REFERENCE WOMAN  Age : 18 – 29 years.  Weight : 60 kg, Ht-1.73m  BMI-20.3  Free from disease & fit for active work.  8 hours moderate activity/day.  8 hours in bed.  4-6 hours sitting & moving around.  2 hours in walking & in active recreation or household duties.  Age : 18 - 29 years, Non-pregnant, non-lactating  Weight : 55 kg, Ht-1.61m  BMI-21.2  Free from disease & fit for active work.  8 hours in household work, light industry, or other moderate activity.  8 hours in bed.  4-6 hours sitting & moving around.  2 hours in walking & in active recreation or household duties.
  51. 51. Consumption Unit (C.U.)  The energy requirement of ‘Reference man’ who is aged 18-29 years, healthy, weighing 60 kg doing sedentary work is considered as 1CU. CONSUMPTION UNIT Sedentary Moderate Heavy worker Adult Male 1.0 1.2 1.6 Adult Female 0.8 0.9 1.2 For every 5 Kg weight, 0.1 Co-efficient is to be added.
  52. 52. BALANCED DIET Defined as “ one which contains a variety of foods in such quantities and proportions that the need of energy, amino acids, vitamins, minerals, fats, carbohydrates, and other nutrients is adequately met for maintaining health, vitality, and general well-being and also makes a small provision for extra nutrients to withstand short duration of leaness.”
  53. 53. Composition of Balanced Diet  About 65-80% of energy requirements should come from complex carbohydrates  About 10-15% of energy should come from proteins.  About 10-30% of energy should come from total fat. (Of this, saturated fat should be less than a third). The healthy combination of a balanced diet is one which has low fat, low refined carbohydrates, Optimal amount of Vitamins, Minerals and Fiber
  54. 54. PRUDENT DIET (Dietary Goals) Recommended by Expert Committee of WHO : a) Dietary fat : 15 -30% of total daily intake. b) Saturated fats : <10% of total energy intake. c) Protein should be atleast 10 – 15 % of daily intake. d) Avoid refined carbohydrates; some amount of natural fibre should be taken. e) Energy rich sources like fats & alcohol should be restricted. f) Salt intake <5gm /day.( In India it averages 15gm /day.) g) Junk foods should be reduced.
  55. 55. RDA IN INDIANS
  56. 56. RDA IN INDIANS
  57. 57. Diet recommendations for Children AGE DIET RECOMMENDATIONS 0 – 6 months Only nourishment newborns need is mother’s milk. 6 – 12 months Mother’s milk + Semisolid foods such as fortified infant cereal. 12-23 months 3-4 meals(Family foods, chopped or mashed if necessary) + breastfeed Infant and Young Child Feeding Guidelines: 2010 INDIAN PEDIATRICS VOLUME 47,DEC 17, 2010
  58. 58. Complementary foods for children 1. Kichidi 2. Malted Ragi Porridge 3. Kheer 4. Custard 5. Wheat Payasam Note: 1. All these recipes provide approximately 250 Kcals and 5 g proteins. 2. Non-vegetarian foods such as soft boiled egg, minced meat may be introduced at the age of 6 months
  59. 59. Common Home Measures- Weight & Volume Equivalents  1 Medium size katori: 150-160 ml  1 Table spoon (level): 15g or ml (approx)  1 Table spoon (heaped): 20 g  1 Tea spoon (level): 5g or ml  1 Tea spoon (heaped): 7 g  1 Medium size tea cup: 180-200 ml  Big size glass/Cup: 250 ml
  60. 60. Food Pyramid
  61. 61. FOOD GUIDE PYRAMID 1ST layer – GRAINS- eat most (6 or more servings) Examples: rice, noodles, pasta, whole grain bread, plain biscuits, breakfast cereals, oats. Why should grains make up the main part of our meals? 1. Consist of carbohydrates, protein, vitamins, minerals & dietary fiber. 2. Provide energy & help maintain a constant body temperature 3. Less processed cereals, such as wholemeal bread, brown rice & oatmeal contain more fibers. 4. Help prevent constipation & contain more minerals & vitamins, such as iron & folate & give more long-lasting energy.
  62. 62. 2nd layer – Vegetables & Fruits (eat a lot) Vegetables-3 to 5 servings & 2-4 servings of fruits Examples: Different green & root vegetables & gourds (eg peapods, spinach, tomato, carrot, cucumber) fresh fruits (eg. Apple, orange, banana) & pure fruit or vegetable juice. Why eat a lot of fruits & vegetables every day? Help protect cells & fight against diseases. Rich in fibers, help prevent constipation & help prevent cancer, e.g. colon cancer. Fiber also helps to lower blood cholesterol Contain many phytonutrients or phytochemicals which protect from cancers. E.g. lycopene in tomatoes, allixin in garlic
  63. 63. 3rd layer – Meat, Poultry, Fish, Eggs, Beans, Nuts (eat some – not too much) Milk group-2servings Meat group – 2 servings Examples: Meat (eg. Pork, beef), Poultry (eg. Chicken, duck), fish, Seafood (eg shrimp, crab), egg, beans ,Nuts(eg peanuts) & Milk products (eg milk, cheese, yogurt). Why should we eat some of these foods every day? •Rich in energy, protein & vitamins B & A •Imp. components for cell repair & metabolic energy production needs. •Rich in iron, important for the production of RBCs •Milk products are rich in calcium & important for bone & teeth growth. •Meat & whole milk contain larger amount of animal fat & cholesterol. Eating too much may lead to obesity & high blood cholesterol
  64. 64. 4th Layer – Fat, Sugar & Salt (eat least ,use sparingly) Examples: Cooking oils (eg peanut oil, corn oil, sunflower oil), deep fried foods (eg potato chips & french fries), cream, salad cream, butter & margarine, candies, sweet drinks, salted preserved fish or vegetables Why to eat these in small amounts? Oil & sugar are high in energy but low in other nutrients. Sweet food eaten too often can cause dental caries. Other problems include blocked arteries & appearance of heart disease . Salt helps retain body water- high intake of salty food -a burden for the kidneys
  65. 65. IMPORTANCE OF DIET DURING DIFFERENT STAGES OF LIFE
  66. 66. NUTRITIONAL PROBLEMS
  67. 67. PROTEIN ENERGY MALNUTRITION FEATURES MARASMUS KWASHIORKOR CLINICAL ALWAYS PRESENT Muscle wasting Obvious Hidden by oedema & fat Fat wasting Severe loss Fat retained , but not firm Oedema None Lower legs, face, lower arms Weight for height Very low Low but masked by oedema Mental changes Quiet & pathetic Irritable, moaning, apathetic CLINICAL SOMETIMES PRESENT Appetite Usually good Poor Diarrhoea Often Often Skin changes Usually none Flaky paint dermatosis Hair changes Seldom Sparse, silky, easily pulled out Hepatic enlargement None Sometimes, due to fat accumulation
  68. 68. MALNUTRITION / INFECTION CYCLE (PEM) INADEQUATE DIETARY INTAKE • APPETITE LOSS • NUTRITION LOSS • MALABSORPTION • ALTERED METABOLISM • WEIGHT LOSS • GROWTH FALTERING • IMMUNITY LOWERED • MUCOSAL DAMAGE DISEASE : incidence, duration, severity
  69. 69. CLASSIFICATION OF PEM  GOMEZ CLASSIFICATION : : based on weight retardation : normal reference child is in 50th centile of Boston standards.  WATERLOW’S CLASSIFICATION : defines two groups : a) drop in height age ratio – chronic malnutrition “STUNTING” b) low weight for a normal height – acute malnutrition “WASTING”
  70. 70. XEROPHTHALMIA VITAMIN-A DEFICIENCY IN INDIA  5.7% children in India suffer from eye signs of VAD  Most common in children aged 1-3 years and is often related to weaning.  Ocular Manifestations: Prevalance Criteria(6m-6yrs) a. Nightblindness >1% b. Conjunctival Xerosis First clinical sign c. Bitot’s spots >0.5% d. Corneal Xerosis >0.01% e. Keratomalacia >0.01% Corneal Ulcer >0.05% Serum Retinol >5% (less than 10 mcg/dl)
  71. 71.  PREVENTION : a). Short term action : Administration of vitamin-A orally : 1st dose with measles vaccine – 100,000 IU (at 9 month) : doses every 6 monthly upto 5yrs age – 200,000 IU. b). Medium term action : Food fortification c). Long term action : health education
  72. 72. NUTRITIONAL ANAEMIA  A condition in which the haemoglobin content of blood is lower than normal as a result of deficiency of one or more essential nutrients, regardless of cause of such deficiency.  PREVALENCE : : children upto 3yrs age – 72.7% in urban & 81.2% in rural : in pregnant women – 50-80% : in adolescent girls – 50-80% INTERVENTIONS : a) Iron & folic acid supplementation : Mothers :100mg elemental iron & 0.5 mg folic acid Children :20mg elemental iron & 0.1mg folic acid b) Iron fortification : fortify salt c) Other strategies : changing dietary habits : control of parasites : nutrition education
  73. 73. IODINE DEFICIENCY DISORDERS  170 million are estimated to be affected by GOITRE in India.  In SUB HIMALAYAN GOITRE BELT alone, nearly 71 million are estimated to be suffering from Endemic Goitre.  GOITRE CONTROL : a). Iodized salt : Level of iodination : 30ppm at production point : 15ppm at consumer level b). Iodized oil : intramuscular injection and oral c). Iodine monitoring : Neonatal hypothyroidism is sensitive pointer to environmental iodine deficiency. d). Manpower training e). Mass communication
  74. 74. ENDEMIC FLUOROSIS  Important health problem in : Andhra Pradesh, Punjab, Haryana, Karnataka, Kerala & Tamil Nadu.  TYPES : i). Dental fluorosis : ingestion of fluoride >1.5mg/L in first 7yrs of life. ii). Skeletal fluorosis : lifetime daily intake of 3-6mg/L. if conc.>10mg/L– CRIPPLING FLUOROSIS iii).Genu valgum : among people whose staple diet is sorghum  INTERVENTION : a). Changing water source : fluoride content 0.5-0.8mg/L b). Chemical treatment : NALGONDA TECHNIQUE c). Other measures : avoid fluoride supplements (toothpastes) in endemic areas
  75. 75. LATHYRISM  Prevalent in : Madhya Pradesh, UP, Bihar, Orissa  Due to consumption of Lathyrus sativus (khesari dhal) : over 30% dhal taken over period of 2-6 months.  Due to toxin : Beta oxalyl amino alanine (BOAA)  Results in spastic paralysis  INTERVENTIONS : a). Vitamin-C prophylaxis b). Banning the crop c). Removal of toxin : steeping method parboiling d). Education e). Genetic approach f). Socio-economic changes
  76. 76. DIABETES  Impaired metabolism of glucose in the body, which leads to excess of glucose in blood and urine. CAUSES :  High calorie intake  Obesity related: Non-manual occupations.  Hormone imbalance  Genetic  Deficiency of trace elements– zinc, copper, chromium.  Malnutrition --related diabetes.  Protein deficiency.  Excessive alcohol consumption.
  77. 77. OBESITY  CAUSES : : Overnutrition : Prolonged post –prandial hyperlipidaemia : Relative insulin resistance in peripheral tissues CANCER POSSIBLE DIETARY FACTORS : • Dietary fat: Colon cancer & Breast cancer • Dietary fibre: Protective for Colon cancer. • Micronutrients: Protective Vit-A : lung cancer Vit-C : stomach cancer • Food additives & contaminants: saccharin & cyclamate : bladder carcinogens coffee : bladder & prostate cancer • Alcohol: Contributes to 3% of all cancer deaths Associated with liver cancer Beer : may be related to cancer rectum
  78. 78.  Dietary Approaches to Stop Hypertension (DASH)  DASH was one of three eating plans that were compared in research studies sponsored by the National Heart, Lung, and Blood Institute (NHLBI), USA.  The DASH research showed that an eating plan containing 2,300 milligrams (mg) of sodium per day lowered blood pressure.  An eating plan containing only 1,500 mg of sodium per day even further lowered blood pressure.
  79. 79.  Is low in saturated fat, cholesterol, and total fat  Focuses on fruits, vegetables, and fat-free or low-fat dairy products  Is rich in whole grains, fish, poultry, beans, seeds, and nuts  Contains fewer sweets, added sugars and sugary beverages, and red meats.
  80. 80. Total fat 27% of calories Sodium 2,300 mg Saturated fat 6% of calories Potassium 4,700 mg Protein 18% of calories Calcium 1,250 mg Carbohydrate 55% of calories Magnesium 500 mg Cholesterol 150 mg Fiber 30 g
  81. 81. Type of food Number of servings for 1600 - 3100 Calorie diets Servings on a 2000 Calorie diet Grains and grain products (include at least 3 whole grain foods each day) 6 - 12 7 - 8 Fruits 4 - 6 4 - 5 Vegetables 4 - 6 4 - 5 DASH diet plan includes Low fat or non fat dairy foods 2 - 4 2 - 3 Lean meats, fish, poultry 1.5 - 2.5 2 or less Nuts, seeds, and legumes 3 - 6 per week 4 - 5 per week Fats and sweets 2 - 4 limited
  82. 82. Diet and Diabetes  Eat starchy foods regularly  More fruit and vegetables  Reduce animal or saturated fat (Lowers LDL cholesterol).  Choose monounsaturated fat in place of saturated (eg. olive oil, canola oil, peanut oil)  Reduce salt  Fiber intake is encouraged: 40gm/day or 25gm/1000 calories
  83. 83. Diet and Diabetes  Cut down on sugar  Use of Sweeteners: ◦ Sugar alcohols (polyols): Sorbitol, mannitol, xylitol ◦ 10-12 tablets/day  A small amount of weight loss can: ◦ improve insulin resistance ◦ lower blood glucose ◦ improve blood cholesterol ◦ reduce blood pressure
  84. 84. Some Indian remedies : Methi seed • Contains • an active ingredient of blood glucose control • an active ingredient for blood cholesterol control • The typical range of intake for diabetes or cholesterol-lowering is 5–30 grams with each meal or 15–90 grams all at once with one meal.
  85. 85. NATIONAL NUTRITIONAL PROGRAMS  Special nutrition program  Balwadi nutrition program  Applied nutrition program  Tamil Nadu integrated nutrition program  Wheat based supplementary nutrition program  Integrated child development services scheme (ICDS SCHEME) 89
  86. 86.  National Nutritional Anemia Prophylaxis Program  National Program For Prophylaxis Against Blindness in Children Caused Due To Vitamin-A Deficiency  Pilot project against micronutrient malnutrition  ANTYODAYAANNA YOJANA SCHEME  World food program
  87. 87. • National Institute Of Nutrition (NIN), Hyderabad (Nutrition Society of India) • National Institute Of Health And Family Welfare (NIHFW), New Delhi • Indian Council of Medical research(ICMR), New Delhi • Central Health Education Bureau • NGOs • Nutrition Foundation Of India, New Delhi
  88. 88. References 1. National Institute of Nutrition. Low cost Nutritious Supplements. NIN, Hyderabad, 1975. 2. World Health Organization. Diet, Nutrition and the Prevention of Chronic Diseases. Report of a WHO Study Group, WHO Technical Report Series No. 797, WHO, Geneva, 1990. 3. National Nutrition Policy, Government of India, Department of Women and Child Development, Ministry of Human Resources Development, New Delhi, 1993. 4. Reddy V, Pralhad Rao N, Sastry JG and Kasinath K. Nutrition Trends in India. National Institute of Nutrition, Hyderabad, 1993. 5. Raghuram TC, Pasricha S. and Sharma RD. Diet and Diabetes. National Institute of Nutrition, Hyderabad, 1993. 6. K. Park. Park’s Textbook of Preventive & Social Medicine; 22nd edition. Nutrition and Health.
  89. 89. 7. Indian Council of Medical Research. Nutrient Requirements and Recommended DietaryAllowances for Indians, National Institute of Nutrition, Hyderabad, 2010. 8. Ghafoorunissa and Kamala Krishnaswamy. Diet and Heart Disease. National Institute of Nutrition, Hyderabad, 1995 9. Gopalan C, Rama Sastri BV. and Balasubramanian SC. Nutritive Value of Indian Foods. Revised and updated by Narasinga Rao BS, Deosthale YG and Pant KC., National Institute of Nutrition, Hyderabad, 1996. 10. Bamji MS, Kamala Krishnaswamy and Brahmam GNV. Text Book of Human Nutrition, Oxford&IBH Publishing Co. Pvt. Ltd., New Delhi, Third Ed. 2009. 11. National Institute of Nutrition. 25 Years of National Nutrition Monitoring Bureau. NIN, Hyderabad, 1997. 12. Gopalan C and Krishnaswamy K (Eds.). Nutrition in Major Metabolic Diseases, Oxford University Press, New Delhi, 1997.

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