Nutrition, Macronutrients and Micronutrients and their deficiency disorders

Dr. Gaurav Kamboj
JR
Department of Community Medicine
PGIMS, Rohtak

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

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.

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.

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

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

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)

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.”

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.

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

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.

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

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

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.

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.

◦ 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

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.

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.

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.

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.

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:

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.

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.

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.

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.

Nutrition, Macronutrients and Micronutrients and their deficiency disorders

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

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)

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.

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

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.

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

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.

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

MICRONUTRIENTS
Vitamins and Minerals

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).

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.

(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
--

(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)

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

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.)

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

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

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)

 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

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 “ “

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

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.

 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.

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.

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.

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.”

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

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.

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

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

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

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.

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

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

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

IMPORTANCE OF
DIET DURING
DIFFERENT
STAGES OF LIFE

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

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

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”

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)

 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

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

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

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

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

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.

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

 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.

 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.

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

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

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

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

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.

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

 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

• 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

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.

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.

Nutrition, Macronutrients and Micronutrients and their deficiency disorders

More Related Content

What's hot (20)

Similar to Nutrition, Macronutrients and Micronutrients and their deficiency disorders (20)

More from Gaurav Kamboj (7)

Recently uploaded (20)

Nutrition, Macronutrients and Micronutrients and their deficiency disorders