You are on page 1of 116

ARVIND PATEL

8/14/2018 1
-The study of
how your
body uses the
food that you
eat.

8/14/2018 2
What is a Nutrient
A nutrient is a chemical substance
in food that helps maintain the
body. Some provide energy. All
help build cells and tissues,
regulate bodily processes such as
breathing. No single food supplies
all the nutrients the body needs to
function.

8/14/2018 3
 Protein Sugars
Carbohydrat Starches
es Cellulose
Fats
Vitamins
 Minerals
Water
8/14/2018
4
Nutrients that have
Calories:
 Proteins
 Carbohydrates
 Fats

8/14/2018 5
Definition of a Calorie:

A unit of measure for energy in


food

8/14/2018 6
Protein 1 Gram = 4
K.calories
Carbohydrates 1 Gram = 4
K.calories
Fat 1 Gram = 9 K.calories

8/14/2018 7
Variables which affect nutrient
needs:
1. Age
2. Gender
3. Activity Level
4. Climate
5. Health
6. State of nutrition
8/14/2018 8
 Nature-Complex org.Compound composed
of C,H,O,N & Some Of P,Sulpher.

Protein are formed by combination of amino


acids a simple unit of protein.

8/14/2018 9
 Simple –These are composed of amino acid
only
Albumine in egg white
Serum in blood
Globulins of muscle
Zein of corn
Gladine of Wheat
 Derived-Product of partial break down of
protein
Coagulated protein
Proteoses
Peptides.
8/14/2018 10
 Complete protein- Contain all E.A. Acids.
 Partially incomplete –May not contain one or
more E.A. acids
 Incomplete protein- Content of amino acids
incapable either maintaining of life or
supporting growth e:g Goletine

8/14/2018 11
Animal Sources
Plant sources
Milk & Milk product
Cereals,Pulses,Oilseeds,Beans
Eggs,Meat,Poultry, & Fish

8/14/2018 12
 Essential Amino Acid
 Tryptophane  Non Essential Amino Acid
 Isoleucine  Alanine
 Lysine  Asparagine
 Methionine  Aspartic Acid
 Phenylalanine
 Cystine
 Threonine
 Valine
 Cysteine
 Arginine  Glutamic Acid
 Histidine  Glutamine
 Glycine
 Hydroxy Proline
 Hydroxy Lysine
 Proline
 Serine
 Tryrosine
8/14/2018 13
Protein Source Limiting amino acid
Wheat Lysine
Rice Lysine
Maize Lysine & Tryptophan
Pulses Methionine(or Cysteine)
Phenylalanine(or
Beef
tyrosine)
None;the reference for
Egg,Chiken
absorbable protein
Milk Or Whey, bovine Methionine(or Cysteine)

8/14/2018 14
 Synthesis of new protein
 Body Building
 Protective & Regulative Substance like enzyme,
hormones, Antibodies
 Protein as carrier- Hemoglobin
 Energy Giving- 1 gm 4 Kcal

8/14/2018 15
Group Particular Protein
Man 60
Woman 50
Pregnancy +10
Lactation +20
Infants 0-6 months 2.3-1.8/K.g
7-12months 1.8-1.5/K.g

8/14/2018 16
Children 1 year 17
2 year 18
3 year 20
4-6 years 22
7-9 years 33
10-12 years 41
Adolescents 13-15 years Boy 55

13-15 years Girl 50


16-18 years Boy 60
16-18 years Girls 50

8/14/2018 17
 Two Clinical Forms
Marasmus
Kwashiorkor

8/14/2018 18
 Important cause of child hood morbidity &
Mortality
 Two clinical pictures – Kwashiorkor &
Marasmus. Marasmus is more common
 Causes of PEM-
 Inadequate food intake, Low incom,Education
 Infections- Respiratory infections, measles,intestional
worms,Diahorrea
 Large family, poor maternal health, failure of lactation,
premature termination of breast feeding, poor
distribution of food within family are other causes of
PEM

8/14/2018 19
 First indicator of PEM is Under weight for age
 Marasmus-Low Weight,Dewasting of
Mussules,Wrinkles on skin,Hungry,Infection
 Kwasiorkor-Edema,Liver enlarge, Hair color
change

Grade
ad
III
III
Grade III
II

Grade I
8/14/2018 20
8/14/2018 21
Marasmus-Low
Weight,Dewasting of
Ravenously
Mussules,Wrinkles on
hungry
skin,Hungry,Infection
Gross
weight
loss &
no fat

8/14/2018 22
8/14/2018 23
8/14/2018 24
 Edema on face, Hands & Lags

8/14/2018 25
Infection Sparse
hair
Kwasiorkor-
Edema Swollen
Liver enlarge belly
Hair color change
Dermatitis Decreased
Poor Appetite muscle
mass
Pellagra
Apathy

8/14/2018 26
8/14/2018 27
8/14/2018 28
8/14/2018 29
8/14/2018 30
8/14/2018 31
8/14/2018 32
Health Promotion
 Health education & distribution of supplements
to pregnant & lactating women
 Promotion of breast feeding
 Family planning & spacing of births
 Food & personal hygiene
 Early diagnosis & treatment of all infection
Specific Protection
 Low-cost High protein & energy rich diet to child
 Immunization
 Food fortification
 Improve family diet

8/14/2018 33
 Early Diagnosis & Treatment
 Periodic Surveillance
 EDPT of infections & Diarrhea
 Early diagnosis of lag in growth
 Deworming of infested children
 Rehabilitation
 Nutritional Rehabilitation services
 Hospital services
 Follow – up care

8/14/2018 34
 Nature
 Contain Carbon, Hydrogen & Oxygen.
 Classification
 Mono-Saccharides. e.g. Glucose,Fructose,Gelectose
 Di-Saccharides. e.g. Lactose, Maltose, Sucrose
 Poly-Saccharides. E.g. Starch, Dextrin, cellulose ,
pectin

8/14/2018 35
 Dietary Sources
 Cereals, Pulses, Dry Fruits, Sugar, Jegary, roots &
tubers like potato, sweet potato, fruits-banana, dates

8/14/2018 36
 Function
 Supply energy for body function. 1 gram-4Kcal
 Supply Certain sugar like ribose which constituents
nucleic acid
 Sparing effect on protein
 Fibers plays essential roll in functioning of intestinal
tract
 Adds to the test of diet

8/14/2018 37
 Disorder
 Excess sugar in diet leads to obesity which connected
with Cardiovascular disorder
 Less Sugar utilization of protein, reduce body weight

8/14/2018 38
 Nature
 Technically known as Lipids containing Carbon,
Hydrogen & Oxygen
 Lipids are compound of glycerol & fatty acids

8/14/2018 39
Fatty acids
Saturated Unsaturated
Butyric acid Oleic acid
Caproic acid Linoleic acid
Caprylic acid Linolenic acid
Capric acid Arachidenic acid
Lauric acid
Myristic acid
Palmitic acid
Stearic acid
Arachidic acid
8/14/2018 40
 Dietary sources
Edible vegetable oils,Ghee,oil seeds,millk & Milk
product, Eggs, Fish
Requirement
30 to 50gm per day
(Not more than 15% calorie from fat in the diet)

8/14/2018 41
 Function
 Source of energy- 1gm-9 kcal.
 Source of essential fatty acids-
Linoleic,lenolenic,anachidonic
 Protection of body
 Vehicles of fat soluble vitamins-A,D,E,K.
 Palatability
 Satiety value
 Reserve source of energy

8/14/2018 42
:Deficiency disorder
-Loss of body weight
-Skin disease
:Excessive consumption cause obesity

8/14/2018 43
INTRODUCTION

Micronutrients

In small amounts On a regular basis

Required by
human body

8/14/2018 44
VITAMINS MINERALS

Water Calcium
Fat
soluble Phosphorus
Soluble
Vit-B1(Thaiemine) Iron
Vit-A,D,E,K Iodine
B2(Riboflevin)
Fluorine
B3(Niacine)
Zinc
B6(Pyrodoxin)
Copper
B9(Folic Acid) Cobalt
B12(Cyanocobalmin) Chromium
Vit- C Selenium
8/14/2018 45
 Nature
 Complex higher alcohol with unsaturated structural
bond
 Fat soluble
 Heat stable
 Well stored in body (Liver)

8/14/2018 46
 Dietary sources
 Animal sources- As Retinol-Milk & Milk
Product,Eggs,Liver,Pork,Fish liver oil
 Vegetable sources-As Carotene-Yellow & orange
color fruits & vegetabls,Red palm oil, vegetable ghee

8/14/2018 47
 FUNCTION
 Essential for good vision
 Necessary for reproductive system
 Protecting mucosmembranes
 Helping in immune function
 Necessary for bone formation
 Prevent dry skin
 Anti oxidents

8/14/2018 48
 Daily requirement
 Adult Men & women-600mcg-Retinol
 Pregnant mother,Adolecent(10-12 yrs)-600mcg
 Lactating mother-950 mcg
 Infant-350 mcg
 Children(1-9 yrs)-400mcg

8/14/2018 49
 Deficiency
 Night blindness
 Bitot spot
 Xerophthelmia
 Keretomalacia
 Dermatosis on skin

8/14/2018 50
 Primary signs:- X1A Conjunctiva Xerosis
X1B Bitot”s spot with Conjunctiva Xerosis
X2 Corneal Xerosis
X3A Corneal Ulceration with Xerosis
X3B Keratomalacia
 Secondary signs:- XN Night blindness only
XB Bitot”s spot only
XF Typical fundus only
XS Corneal scars attributable to
Xerophhalmia
Most common in aged 1-3 years
 Associated risk factors- ignorance, faulty feeding
practices, infections,Meassles,

8/14/2018 51
BITOT SPOT KERATOMALACIA

V
A
D

BILATERAL
BLINDNESS

8/14/2018 52
8/14/2018 53
 Short Term Action: Large doses of Vita. A
orally
 Medium Term Action: Fortification of
certain foods with Vita. A
 Long Term Action: - Consume green leafy
vegetables, Yellow &
Orange color fruits
& vegetables daily
- promotion of Breast feeding
- Immunization
- improved MCH services

8/14/2018 54
 Nature
 Activated sterols closely related to cholesterol
 Fat soluble
 Relatively heat stable
 Well stored in body
 Dietary sources
 Fish liver oil, Egg
yolk,sardines,butter,Cream,Vegetable ghee
 Ultraviloet Rays of sun

8/14/2018 55
 FUNCTION
 Essential for calcium & phosphorous absorption for
formation of teeth & bones
 Essential for growth
 Daily Requirement
 Infant & Children-10mcg(400IU)
 Pregnant & Lactating Mother-10mcg(400IU)
 Adult Man & Woman-2.5mcg(100IU)

8/14/2018 56
 Deficiency-RICKETS in children
 Causes disturbances in metabolism of Ca.& P.
 In adults osteomalacia
 Excess vit-d –Toxic-calcification & damage to
kidney muscular weakness, nausea.

8/14/2018 57
Rickets
& osteomalasia

8/14/2018 58
 Nature
 A pyrimidine thiozol compound Having Sulphur
 Water soluble
 Heat labile, poor stored in body
 Dietary sources
 Lean pork,Peanuts,dried peas & beans,
liver, chicken, green beans, Whole cereals &
pulses

8/14/2018 59
 Daily Requirement
 0.5mg per 100K.cal.(1-2mg per day)
 Deficiency diseases
 Infantile beriberi
 Wet beriberi
 Dry beriberi

8/14/2018 60
 Cardiac beriberi (wet beriberi)
edema & cardiovascular symptoms
Dry beriberi
numbness, burning sensation, muscles
tenderness, loss of wt.,loss of
appetite,dizziness,indigetion
Infantile beriberi
cardiac failure & ultimate death.

8/14/2018 61
8/14/2018 62
8/14/2018 63
 Nature
 Flavin compound, Yellowish green fluorescence
 Water soluble, Heat stable
 Detoration when exposed to light
 Dietary sources
 Liver, lean meat, egg yolk,
peanuts,spinach,lttuce,carrots,culiflower,beats,milk,
buttermilk,whole grain.

8/14/2018 64
 Function
 Production of co-enzyme for proper utilization of
carbohydrates
 Help in oxidative process of living cell
 To form enzyme flavo protein

 Daily Requirement
 0.6mg/1000K.cal(About 1-2-3mg/day)

8/14/2018 65
 Inflammation of lips
 Angular stomasis
 Dermatitis of nasolabial folds
 Phtophobia,burning,itching,irritation of the
eyes

8/14/2018 66
8/14/2018 67
8/14/2018 68
 Nature
 Organic compound related to nicotine
 Heat stable, Water soluble
 Dietary Sources
 Liver,meat,leanbeef,milk,egg
yolk,spinach,lettuce,green cabbage, green
peas,soyabeans,groundnutt,Whol cereals & pulses,
Niger seeds.

8/14/2018 69
 Function
 A constituent of co-enzyme
 Necessary for health of epithelium & nervous system
 Requirement
 6.6mg/1000K.cal.

8/14/2018 70
 Dermatitis,stmatitis,diarrhoea,Sunbur
n,
 Mild redness,sorness & smoothness of
toung & mouth, ulceration
 Nausea & vomiting
 Mentally not concentrated

8/14/2018 71
 Water soluble, Heat labile.
 Dietary sources
 Liver,green,spinach,GLV,Soyabeans
 Function
 Necessary for red blood cell formation & assist vit-
B12 function in this process
 Essential component in DNA Synthesis
 Essential for growth

8/14/2018 72
 Deficiency
 Pernicious anemia
 Poor growth in children
 Depression, Mental confusion
 Excessive intake associated with
gastrointestinal problem

8/14/2018 73
 Nature
 Sparingly soluble in water
 Stable to heat
 Red-pink color with cobalt element
 Dietary sources
 Liver, egg, meat, fish,& milk
 Requirement
 1.0mcg/day for adults
 Lactating mother-1.5mcg/day

8/14/2018 74
 Function
 Development of D.N.A
 Co-enzyme in amino acid(metionine) metabolism
 Building in epithelial tissue
 Promotes maluratin of red blood cell
 Utilized in formation of white blood cells &
blood platelets.
 Deficiency
 Megaloblastic anemia

8/14/2018 75
 Nature
 Alaetone haxuronic acid
 Water soluble, Heat labile, Poorly stored in the body
 Dietary sources
 All citrus fruit,spinach,cabbage,cucumber,
guava,drumstic, coriander leaves amla,& germinated
cereals & pulses
 Requirement
 Adult-40mg/day
 Lactating mother-80mg/day

8/14/2018 76
 Function
 Important for healthy immune system
 Essential for collagen formation 7 healthy
bones,teet,gums,
 Facilitates iron absorption
 Helps in wound healing
 Acts as antioxidants

8/14/2018 77
 Deficiency
 Leads to scurvy Excessive bleeding, loose gums &
teeth.
 Inflammation of joints & edema
 Reduce risk of heart attack, cancer.

8/14/2018 78
 Weakness,Anamia,swelling of gums &
multiple hemorrages,joint effusion

8/14/2018 79
 Dietary sources
 Milk & Milk
product,GLV,Soya,Almonds,Custard
Apple,Bajra,Jowar,Pulses,Sesame seeds etc.
 Function
 Bone & teeth formation,
 Cell transport
 Require for nerve cell transport
 Essential for muscle contraction
 Important for blood clotting

8/14/2018 80
 Requirement
 Adult-400mg /day
 P/L mother-1000mg/day
 Children-400-600mg/day
 Deficiency
 Osteoporosis(Thining of bones)
 Rickets in children
 Tiredness & muscular dysfunction
 Excess calcium causes kidney disease &
development of kidney stones.

8/14/2018 81
IRON – A MICRONUTRIENT

Iron is an essential micronutrient in human nutrition.

Iron is necessary for :

1. Formation of Haemoglobin

2. Development & function of brain

3. Regulation of body temperature

4. Muscle activity

5. Acts as cofactor for many enzymes

Lack of Iron directly affects the immune system. It


diminishes the number of T- cells and production of
antibodies.
8/14/2018 82
IRON – A MICRONUTRIENT

Iron is essential for binding of oxygen to the blood

cells i. e. RBCs.

The main function of Iron is :

Oxygen Transport

&

Cell respiration.

8/14/2018 83
Sources of IRON

Animal Plant
Source Source

Haem Iron Non - Hem Iron

Better absorbed Less absorbed

Meat , liver , Cereals , GLV, Legumes , Nuts,


poultry, fish Oil seeds , Jagerry & dried fruits.

Hem iron also promotes absorption


of non hem Iron
8/14/2018 84
•Iron absorption is more when there is increased
demand for Iron; e.g. pregnancy.

•Only a small fraction (5 to 10 % ) of the total


iron in the diet is absorbed.

8/14/2018 85
Regulation of Iron

The body has no mechanisms specifically designed to


excrete iron.

Normal losses that occur through the gut or skin are very
small.

•Regulation of total body iron therefore occurs through


regulation of the absorption of Iron.

8/14/2018 86
Total dietary Iron intake ( 28 mg/day)

Haem Iron Non Haem Iron

10% of Dietary Enhancers


Iron is absorbed
Inhibitors
Iron absorbed from gut
( 2.8 mg/day )

Total body Iron (3 - 4 g )


Haemoglobin Iron stores (5 % )
75%
Circulatory iron Myoglobin (20% )

8/14/2018 87
WHAT IS ANAEMIA ?

It is a condition in which haemoglobin

level in the blood falls below a standard

value which is age - sex specific .

Normal Anaemic
Reduced Oxygen
blood blood
carrying capacity

8/14/2018 88
CAUSES OF ANAEMIA

Diet
Dietdeficient
deficient Poor absorption of Iron Blood Loss /
ininIron
Iron available in the diet Increased
demand of Iron

Absence of Iron
absorption Enhancers Hookworm infestation
 Cereals based diet
 Less consumption Presence of Iron Malaria,Typhoid
of Iron rich diet absorption Inhibitors Juondic,
Poor bioavailability of Start of menstruation
Iron in Diet During Childhood &
Adolescent
Deficiency of Vit.C,B12,&
folic acid Frequent Pregnancy

8/14/2018 89
 Hemoglobin content of blood is lower than
normal
 Most frequent cause- Iron deficiency
 Less frequent cause – Follate or Vita. B12
deficiency
 Increase risk of maternal & foetal mortality
& morbidity due to Anaemia

8/14/2018 90
PREVALENCE OF ANAEMIA

Nearly 50 % population of India is suffering from anaemia

6 out of 10 adolescent girls


( 60% adolescent girls )

7 out of 10 children below


5 yrs
( 70% Children )

8 out of 10 pregnant women


( 80% pregnant women )
8/14/2018 91
DIAGNOSIS OF ANAEMIA

Lab Diagnosis :
By estimation of haemoglobin in blood

Cut off figures of haemoglobin levels below which Anaemia is


indicated :

Group Age Hb ( gm/dl of blood )


Children 6 months to 6 years 11
6 years to 14 years 12
Adult Males 13
Females 12
Pregnant Women 11

8/14/2018 92
Clinical Diagnosis :

Anaemia can not always be diagnosed through lab

diagnosis because of non - availability of facilities,

particularly in rural areas.

Therefore, some of the following symptoms and signs may

help to suspect anaemia.

8/14/2018 93
SYMPTOMS OF ANAEMIA

1. Excessive tiredness

2. Breathlessness on slight exertion

8/14/2018 94
SIGNS OF ANAEMIA

Pale and lusterless eyes Spoon shaped nails

Oedema of feet Pallor tongue


8/14/2018 95
CONSEQUENCES OF ANAEMIA

A. In Children

1. Deterioration in school performance.

2. School absenteeism.

3. Impaired brain development .

4. Mental irritability.

5. Retarded growth.

8/14/2018 96
B. In Adolescent Girls

1. Fatigue and tiredness

2. Lack of interest in regular activities

3. Lack of concentration, which leads to poor

performance in school

4. Poor appetite

8/14/2018 97
5. Poor overall growth

6. Delayed menstruation

7. Less ability to prevent infections

8. When anaemic adolescent girls get married and

become pregnant, they run the risk of being more

anaemic , which can have adverse effects on both,

the mother and the child .

8/14/2018 98
C. In Pregnant Women

1. Birth of low birth weight babies.

2. High infant mortality.

3. High maternal mortality.

4. Impaired cognitive development in newborn

Pregnant women, thus, form the highest

risk group calling for urgent interventions.

8/14/2018 99
Control of Anaemia

Long Term Medium Term Short Term


measures measures measures

Dietary Food Iron


Modifications Fortification Supplementation

8/14/2018 100
DIETARY MODIFICATIONS

1. Regular dietary intake of iron and folic

acid rich foods such as :

Green leafy vegetables,

Cereals like wheat, jowar, bajra, pulses ( especially

sprouted ones ),

Jaggery,

Roasted bengal gram, etc.

8/14/2018 101
3. Iron absorption enhancers -

Intake of vitamin C rich foods like lemon, amla, guava,

orange, germinated foods etc in diet enhances the

absorption of iron.

8/14/2018 102
4. Iron absorption inhibitors – ‘ Tannins ’ present in

tea and coffee are the most potent inhibitors of iron

absorption. Taking tea or coffee along with meals

greatly reduces the absorption of iron.

8/14/2018 103
 Interventions
1. Iron and folic acid supplementation :
Dosage : Mothers – one tab. Daily
60 mg elemental iron +
0.5mg folic acid
Children- one tab daily
60 mg elemental iron +
0.5mg folic acid
2.Iron fortification
3.Other strategities – Control of parasites,
Nutritional education
4.Iron Rich Food
5.Public health measure-Control of Malaria
-Control of Hook worm
-Safe drinking water
-Personal hygiene & Sanitation.
8/14/2018 104
Iron
Loss, Phytate, Oxalate, Carbonate, Phosphate, Dietary Fibres, Milk, Tea, Eggs,
Or Interfere with iron Absorption.
Absorption Ascorbic acid increases absorption.
Total Daily Iron loss through haemorrhage & Basal loss through urine, sweat,
bile, surface cells.
Adult Male – 1 mg.
Mens. Female – 2 mg.

Absorption Duodenum & Small intestine in ferrous state.


& Absorbed Iron is transported as plasma ferritin and stored in liver, spleen,
Transport kidney and bone marrow.

Daily
Age & Gender Absorption Intake
Requirement
Healthy Adult Male – 0.9 mg. 28 mg/day
Female (Mens.) – 2.8 mg 30 mg/day
Pregnant Women First Half – 0.8 mg. 38 mg/day
Second Half – 3.5 mg
Lactating Mother 2.4 mg. 38 mg/day
Children 1.0 mg. 26 mg/day

8/14/2018 105
8/14/2018 106
 Iodine deficiency causes Goiter & cretinism
 The IQ Score of children less 13 points
 Implication of loss of IQ
poor scholastic performance, frequent
failure/Grad repititions/Abseteeism,Dropouts
 Daily Requirement – 150 microgram
 Iodization of salt is best prophylactic measure

8/14/2018 107
8/14/2018 108
Enlarged Thyroid Gland

8/14/2018 109
Thyroid Gland

Goiter

8/14/2018 110
• Endemic Cretinism
• Note normal man and three adult
women with cretinism:
• Short stature
• Protuberant abdomen
• Swollen features

8/14/2018 111
8/14/2018 112
 Excessive amounts of fluorine(3-5mg/L) in
drinking water causes fluorosis
 Toxic manifestation –
 Dental Fluorosis
 Skeletal Fluorosis
 Interventions –
 Changing the water source
 Chemical treatment
 Avoid fluoride tooth paste

8/14/2018 113
8/14/2018 114
8/14/2018 115
8/14/2018 116

You might also like