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NUTRITION

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GENERAL FEATURES OF NUTRITION 1
NUTRITION

CONTENTS
GENERAL FEATURES OF NUTRITION ............................................................................................................................. 4
ASSESSMENT OF NUTRITIONAL STATUS ....................................................................................................................... 4
FEATURES OF ASSESSMENT OF NUTRITIONAL STATUS ............................................................................................ 4
SHORT STATURE ........................................................................................................................................................ 5
MALNUTRITION ............................................................................................................................................................. 5
GENERAL FEATURES OF MALNUTRITION .................................................................................................................. 5
ACUTE AND CHRONIC MALNUTRITION ..................................................................................................................... 5
KWARSHIORKAR ........................................................................................................................................................ 6
MARASMUS............................................................................................................................................................... 6
MANAGEMENT OF MALNUTRITION.......................................................................................................................... 6
VITAMINS ...................................................................................................................................................................... 7
GENERAL FEATURES OF VITAMINS ........................................................................................................................... 7
GENERAL FEATURES OF VITAMIN A .......................................................................................................................... 7
FEATURES OF VITAMIN A DEFICIENCY ...................................................................................................................... 7
PROPHYLAXIS AND TREATMENT OF VITAMIN A DEFICIENCY ................................................................................... 8
HYPERVITAMINOSIS A ............................................................................................................................................... 9
VITAMIN D................................................................................................................................................................. 9
VITAMIN E ................................................................................................................................................................. 9
VITAMIN K ................................................................................................................................................................. 9
GENERAL FEATURES OF VITAMIN B ........................................................................................................................ 10
THIAMINE ................................................................................................................................................................ 10
RIBOFLAVIN ............................................................................................................................................................. 11
NIACIN ..................................................................................................................................................................... 11
VITAMIN B6 ............................................................................................................................................................. 12
VITAMIN B12 ........................................................................................................................................................... 12
PANTOTHENIC ACID ................................................................................................................................................ 13
BIOTIN ..................................................................................................................................................................... 13
VITAMIN C ............................................................................................................................................................... 13
FOLIC ACID .............................................................................................................................................................. 14
SCURVY ................................................................................................................................................................... 14
MINERALS ................................................................................................................................................................... 15
GENERAL FEATURES OF MINERALS ......................................................................................................................... 15

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GENERAL FEATURES OF NUTRITION 2
NUTRITION

IRON ........................................................................................................................................................................ 16
ZINC ......................................................................................................................................................................... 17
FLUORIDE ................................................................................................................................................................ 17
IODINE ..................................................................................................................................................................... 18
CALCIUM ................................................................................................................................................................. 18
COPPER ................................................................................................................................................................... 18
CHROMIUM............................................................................................................................................................. 19
SELENIUM ............................................................................................................................................................... 19
MILK AND EGG ............................................................................................................................................................ 19
MILK AND PASTEURISATION ................................................................................................................................... 19
EGG ......................................................................................................................................................................... 20
BREAST FEEDING ......................................................................................................................................................... 20
GENERAL FEATURES OF BREAST FEEDING .............................................................................................................. 20
BREAST MILK ........................................................................................................................................................... 20
COLOSTRUM ........................................................................................................................................................... 21
STORAGE OF BREAST MILK ..................................................................................................................................... 22
PROTEINS AND AMINOACIDS ..................................................................................................................................... 22
GENERAL FEATURES OF PROTEINS.......................................................................................................................... 22
PROTEIN INDICATORS ............................................................................................................................................. 23
FATTY ACIDS ................................................................................................................................................................ 23
FOOD FORTIFICATION ................................................................................................................................................. 24
TOXINS IN FOOD ......................................................................................................................................................... 24
FOOD ADULTERATION ................................................................................................................................................ 24
DIET ............................................................................................................................................................................. 24
DIETARY CYCLE AND NUTRITIONAL SURVEILLANCE ................................................................................................ 24
CALORIE REQUIREMENTS........................................................................................................................................ 25
CALORIE REQUIREMENTS OF ADULT ...................................................................................................................... 26
SUPPLEMENTARY NUTRITION IN ICDS .................................................................................................................... 26
RDA ......................................................................................................................................................................... 26
PRUDENT DIET ........................................................................................................................................................ 26
INDIAN REFERENCE MALE AND FEMALE ................................................................................................................. 26
FOOD STANDARDS .................................................................................................................................................. 27
DIETARY FIBRE ......................................................................................................................................................... 27
PROBIOTIC AND PREBIOTIC..................................................................................................................................... 27

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GENERAL FEATURES OF NUTRITION 3
NUTRITION

KEY TO THIS DOCUMENT

Text in normal font Must read point.


Asked in any previous medical entrance
examinations

Text in bold font Point from Harrisons


th
text book of internal medicine 18
edition

Text in italic font Can be read if


you are thorough with above two.

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GENERAL FEATURES OF NUTRITION 4
NUTRITION

GENERAL FEATURES OF NUTRITION

Man weighing 68 kg, consumes 325 gm of Proportion of carbohydrate, protein and fat is correct in
carbohydrate, 65 gram protein and 35 gram fat in diet accordance with balanced diet
Cereals and pulses are considered complementary Cereals are deficient in lysine, pulses are deficient is
because methionine
NOT a dietary change advised by WHO Decrease in complex carbohydrate consumption
NOT a dietary reference intake Food based dietary advice
Good source of vitamin A, C, calcium, Iron Green leafy vegetables
Fenugreek is found to be Anti carcinogenic
When food is taken by an individual at Specific dynamic action
rest, increase in heat production over
basal level

ASSESSMENT OF NUTRITIONAL STATUS

FEATURES OF ASSESSMENT OF NUTRITIONAL STATUS

Anthropometric measurement NOT of much change in Mid arm circumference


1-4 years
Sensitive index of malnutrition in 3-6 years Mid arm circumference
Village health guide measures state of malnutrition in Mid arm circumference
an under 5 child by
During nutritional assessment of a surgical patient, use Mid arm circumference
of muscle protein is indicated by
Shakir tape Measurement of midarm circumference
Mid arm circumference (1-5 years) >13.5 normal, 12.5 13.5 means
malnourished, less than 12.5 means
severely malnourished
Salters scale is a useful method employed in field to Birth weight
measure
Most important anthropometric characteristic of Normal birth weight and subsequent retardation of
nutritional dwarfism growth
Best indicator for nutritional status for a child Rate of increase of height and weight
Best indicator for long term nutritional status Height for age
Kanawati index MAC/HC
NOT a method to assess nutrition in community Hb <11.5 gm% in third trimester pregnancy
NOT true about nutritional surveillance Done in all children < 5 years
NOT an indicator for assessment of nutritional program Prevalence of pregnant mothers having Hb<11.5g% in
3rd trimester
NOT a feature of nutritional surveillance Measurement of height
Primary aim of applied nutrition programme Stimulation of production and consumption of
protective foods by education
Health status of children between 0 and 4 years Malnutrition, infections, birth weight less than 4 kg
affected by
Does NOT indicate poor nutrition in children Low birth weight

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MALNUTRITION 5
NUTRITION

A childs weight for height is more than 2SD of mean, Stunted


and his height for age is less than 2SD of mean. he is
Gomez classification Age dependent
Gomez classification is based on Weight retardation

SHORT STATURE

MC cause of short stature Constitutional


Short stature is seen in Maternal deprivation syndrome, Hypothyroidism, IUGR
Bone age is normal in Genetic short stature

MALNUTRITION

GENERAL FEATURES OF MALNUTRITION

A year old child has weight of 6.4 kg and has vitamin A Third degree
deficiency. grade of malnutrition
th
Reference standard on which classification of PEM 80% of 50 percentile of weight of age of American
based standard
Cell mediated Immunodeficiency is seen in Protein Energy Malnutrition
Transverse ridging of nail and cellophane appearance is Protein deficiency
associated with
Enzymatic reaction depressed in malnutrition Oxidation
Severe malnutrition is indicated by Loss of buccal pad of fat
Severe Acute Malnutrition Weight for height z score less than 3 SD from WHO
standards median
Features of protein energy malnutrition Insulin decreased, GH and cortisol is
increased
Infection in PEM child Gram negative bacteria
NOT altered in PEM Phagocytosis
Finding NOT seen in Protein Energy Malnutrition Nail Changes
Acute complications of PEM Hypothermia, Hypoglycemia, Hypokalemia
Bad prognosis in PEM Hypothermia, Hypoalbuminemia, Hepatomegaly

ACUTE AND CHRONIC MALNUTRITION

Low weight for height Acute malnutrition


Deficit in weight for height in a 3 year old child indicate Acute malnutrition
Best parameter for assessing acute malnutrition Weight for height
Best parameter for assessment of chronic malnutrition Height for age
Common to both acute and chronic malnutrition Weight for age

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MALNUTRITION 6
NUTRITION

KWARSHIORKAR

Kwarshiorkar is also known as Protein calorie malnutrition


Kwarshiorkar in Ghanian ga language means Condition seen in displaced child
Kwarshiorkar is due to Protein and energy deficiency
Kwarshiorkar Develops in weeks, decreased protein
intake during stress state, easy hair
pluckability, high mortality
Essential diagnostic criteria for kwarshiorkar Growth retardation, edema, psychomotor retardation
Flag sign Kwarshiorkar
Death in kwarshiorkar Hypothermia, CCF, Electrolyte imbalance
Flaky paint dermatosis Kwarshiorkar
Crazy pavement dermatosis Kwarshiorkar
Moon face Kwarshiorkar
Poor prognostic factor in Kwarshiorkar Hepatomegaly
NOT a characteristic feature of Kwarshiorkar Muscle wasting
NOT a feature of Kwarshiorkar Alertness, Fatty infiltration of pancreas
NOT a clinical feature of Kwarshiorkar Decrease liver size
NOT a characteristic feature of kwarshiorkar High blood osmolarity

MARASMUS

Marasmus is also known as Cachexia


Appetite in marasmus Good
Marasmus Increased cortisol, Decreased insulin
Simian face Marasmus
Seen in Marasmus NOT in Kwarshiorkar Vocarious appetite
NOT a feature of Marasmus Hepatomegaly
NOT true about marasmus High mortality

MANAGEMENT OF MALNUTRITION

Most important factor to overcome PEM in children less Early supplementation of solids in infants
than 3 years Immunization to child
Child is suffering from severe PEM, calories to be given 200 kcal
per kg body weight to regain weight
Calorie supplementation for severely malnourished 175 cal/kg
child
Hypoglycemia in PEM is corrected by 10 % dextrose
Severely malnourished children should be given Dextrose
Protein requirement in kwarshiorkar child 2-3 g/kg/day
Initial phase treatment F 75
Rehabilitation phase F 100
Iron therapy in PEM Only after a week
Primary failure in treatment of PEM Failure to gain weight by atleast 5 g/kg of
body weight per day by day 10

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VITAMINS 7
NUTRITION

VITAMINS

GENERAL FEATURES OF VITAMINS

Protamines are Carotenes


Vitamin that can act without Lipoamide
phosphorylation
Vitamin required for Epiphyseal growth Vitamin A, D, C
Metabolic bone disease is caused by excess intake of Vitamin A, vitamin D
Hypervitaminosis associated with bony deformities Vitamin A, Vitamin D
Similarity between vitamin C and vitamin K Both help in post translational modification
Vitamin C and Vitamin E are Antioxidants
Homocysteine is elevated in Vitamin B12 and folate deficiency
NOT seen in hypervitaminosis Hyperostosis

GENERAL FEATURES OF VITAMIN A

Vitamin transported in chylomicrons as Vitamin A


ester
Anti infective vitamin Vitamin A
Rich source of Vitamin A Liver and shark oil
Richest source of retinol Halibut liver oil
Papaya fruit rich in Vitamin A
1 RAE is equal to 1 microgram retinol, 12 microgram beta carotene
Normal serum retinol levels in newborn 20 50 microgram/dL
Recommended intake of retinol during 0 350 microgram
1 year
Recommended intake of retinol during 1 400 microgram
6 years
Daily requirement of vitamin A by an adult man is 600 microgram
Recommended intake of retinol during 800 microgram
pregnancy
Recommended intake of retinol during 950 microgram
lactation
Biological active molecule combination that vitamin A Retinol, retinal, retinoic acid
has
Carotenoid is converted to Vitamin A in Intestine
Vitamin A is mainly stored as retinylesters in Liver
Component of visual pigment rhodposin Retinal

FEATURES OF VITAMIN A DEFICIENCY

First sign of vitamin A deficiency Night blindness

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VITAMINS 8
NUTRITION

Vitamin A deficiency causes Night Blindness


Characteristic feature of vitamin A deficiency Bitots spots
First clinical sign of vitamin A deficiency Conjunctival xerosis
X2 in vitamin A deficiency Corneal Xerosis
Corneal necrosis without inflammation is seen in Keratomalacia
Vitamin deficiency leading to keratinisation A
Vitamin deficiency implicated in metaplasia of Vitamin A
respiratory epithelium
Toad skin is seen in deficiency of Vitamin A
Phrynoderma is due to deficiency of Vitamin A
Vitamin A deficiency is considered a public health 1%
problem if prevalence rate of night blindness in children
between 6 months to 6 years is more than
Xerophthalmia is a problem in a community if the 0.5%
prevalence of Bitots spots more than
Criteria for determining xerophthalmia problem in the Bitot spots 0.5%, Corneal ulcer 0.05%, Corneal
community xerosis 0.01%, Serum retinol levels less than 10
microgram/dl 10%
Vitamin deficiency occurring in measles Vitamin A
NOT true regarding vitamin A deficiency Growth retardation is common
Vitamin A deficiency of an individual is assessed by Ratio of retinal binding protein to transthyretin

PROPHYLAXIS AND TREATMENT OF VITAMIN A DEFICIENCY

Vitamin A solution contains 1 lakh IU/ml


Vitamin A prophylaxis 2 lakh IU for <5 years every 6 months
Dose of vitamin A prophylaxis in 6 11 months old child 1 lakh IU
is
Vitamin A prophylaxis to be given 6 monthly 66 mg
No of doses of vitamin A to be given to children aged 6 5
months to 6 years for prophylaxis against vitamin A
deficiency
NOT included in vitamin A prophylaxis 50,000 IU at birth
Daily dose of vitamin A in 6-12 months old child 300 microgram
Vitamin A supplementation administered in prevention 1 lakh IU/ml
of nutritional blindness in children program contain
Under national programme for prevention of nutritional 1 lakh IU
blindness, a child in the age group of 6 11 months is
given a mega dose of vitamin A equal to
Under national immunization schedule, total dose of 9 lakh IU
vitamin A given to child is
Vitamin A deficiency in 18 months old child what is the 2 lakh IU
recommended dose
Dosage of Vitamin A in Night blindness 2 lakh IU
Under national programme for prevention of nutritional 1 lakh IU
blindness, a child in the age group of 6-11 months is
given a megadose of vitamin A equal to
Vitamin A supplement administered in Prevention of 1 lakh IU/ml
nutritional blindness in children programme contains
Single massive dose of vitamin A for preventing 2 lakhs IU

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VITAMINS 9
NUTRITION

deficiency in preschool children between age of 1-6


years for every 6 months is

HYPERVITAMINOSIS A

NOT a cause of hypervitaminosis A Excess ingestion of carotenoids


Vitamin associated with increased intracranial tension Hypervitaminosis A
Hypervitaminosis associated with congenital Vitamin A
malformation
Vitamin A over dosage causes injury to Lysosomes
Hypercarotenemia and yellow discolouration is typical Palms and soles
in

VITAMIN D

Vitamin acting as hormone D


Active form of Vitamin D 1,25, (OH)2 Vitamin D
Calcitriol (Most active form) 1,25 dihydroxycholecalciferol
Anti proliferative hormone 1,25 dihydroxy vitamin D
Richest source of vitamin D Fish oil
Vitamin D is least in Milk
Minimum amount of sunlight exposure necessary for 5 min
adequate synthesis of vitamin D in human body for
Daily requirement of vitamin D in children 200 IU (5 microgram)
In absence of sunlight, daily requirement of vitamin D 400-600 IU
Papilledema is caused by Vitamin D intoxication

VITAMIN E

Antioxidant vitamin Vitamin E (Tocopherol)


Vitamin E rich food are Sunflower oil, Wheat germ oil, Soya bean
Germ Oil has high content of Vitamin E
Trace element having vitamin E like action Selenium
Manifestation of Vitamin E deficiency Hemolysis, testicular atrophy, Neurological involvement
Vitamin E deficiency Hemolytic anemia, Posterior column abnormality,
Cerebellar ataxia
Spinocerebellar ataxia is associated with deficiency of Vitamin E
Vitamin E and Tocopherol replenished in eye by Glutathione
NOT a feature of vitamin E deficiency Autonomic dysfunction

VITAMIN K

Intestinal bacteria synthesize Vitamin K


Vitamin essential for protein C Vitamin K
Rich source of vitamin K Goat milk

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VITAMINS 10
NUTRITION

Vitamin K dependent clotting factor 2,7,9,10


Vitamin K is a necessary cofactor for Oxidative phosphorylation
Gamma carboxylation of glutamic acid in clotting Vitamin K
factors II,VII and protein C is dependent on
Vitamin K is needed for which post translational Carboxylation
modification process
Vitamin K is essential for carboxylation of Glutamate
Vitamin K is involved in post translational modification Glutamate
of
Vitamin K is involved in post translational modification Calcium binding proteins
of
NOT a calcium binding protein Tropomyosin
Vitamin K deficiency leads to Normal bleeding time, Increased clotting time
Hemorrhagic disease of newborn is due to deficiency of Vitamin K
Known to prevent interventricular hemorrhage when Vitamin K
given antenatally
Large doses of vitamin K administered to a newborn Prolonged bilirubinemia, Hemolytic jaundice
result in
Large dose of vitamin K in newborn cause Hemolysis
Antagonist of vitamin K known to act as an Uncoupler of oxidative phosphorylation
Most likely to be increased in vitamin K deficiency PT

GENERAL FEATURES OF VITAMIN B

Water Soluble vitamin Vitamin B


Germinating seeds Viatmin B

THIAMINE

RDA of thiamine 0.5 mg/1000 kcal


Richest source of vitamin B1 Ground nut
Thiamine Coenzyme for pyruvate dehydrogenase and alpha
ketoglutarate dehydrogenase
Thiamine is essential for Pyruvate dehydrogenase, Alphaketoglutarate to
succinyl coA, Glucose to pentose, Oxidative
decarboxylation of alpha keto amino acids
Thiamine as cofactor in Pyruvate to acetyl CoA
Thiamine deficiency decreases cellular metabolism Thiamine is a coenzyme for pyruvate dehydrogenase
because and alphaketoglutarate dehydrogenase
Coenzyme for transketolase in pentose phosphate Thiamine
pathway, but this pathway is not directly involved in
energy production
Thiamine acts as cofactor in Oxidative decarboxylation
Thiamine NOT used in Lactate to pyruvate
Thiamine deficiency caused decreased energy It is a coenzyme for pyruvate dehydrogenase and alpha
production because ketoglutarate dehydrogenase in TCA
Thiamine requirement increases in excessive intake of Carbohydrate
Thiamine deficiency is characterized by Pyruvate dehydrogenase

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VITAMINS 11
NUTRITION

lactic acidosis due to defect in action of


Thiamine level is best monitored by Transketolase level in blood
Enzyme activity measured in beri beri Transketolase
Thiamine deficiency estimated by RBC transketolase
Peripheral neuritis is a deficiency sign of Thiamine
Thiamine deficiency known to occur in Food faddist, chronic alcoholic, chronic heart failure
patient on diuretics
Vitamin deficiency leading to lactic acidosis Thiamine
Beri beri heart disease shows Low volume pulse
Pyruvate utilization of tissues is decreased Beri Beri
in
Thiamine deficiency NOT seen in Homocystinemia
Parboiling of rice reduces Beri beri

RIBOFLAVIN

Recommended dietary allowance of 0.6 mg/1000 Kcal


riboflavin
Richest source of riboflavin Liver
Seborrhoic dermatitis produced by deficiency of Vitamin B2
Riboflavin deficiency cause Angular stomatitis
Riboflavin deficiency is associated with Magenta tongue, cheilitis, stomatitis
Vitamin deficiency which is not associated with any Vitamin B2 (Riboflavin)
neurological abnormality

NIACIN

Natures valium Niacin


Recommended dietary allowance of niacin 6.6 mg/1000 Kcal
1 cup of coffee provides 1 mg of niacin
Pellagra is prevalent in Andhra
Vitamin deficiency occurring in maize eating population Pellagra
Niacin deficiency in maize eating population is due to High leucine
Casals paint necklase caused by Pellagra
Cassals necklace is seen in deficiency of Vitamin B3
Niacin deficiency occurs in Isoniazid use
Niacin deficiency can result in Pellagra
Pellagra presents with Dementia, Diarrhoea, Dermatitis
Niacin deficiency is associated with Bright red tongue
Gauntlet Pellagra
Vitamin deficiency associated with Pellagra Niacin, Pyridoxine, Tryptophan
Diarrhea, dermatitis, dementia, fourth D Death
NOT seen in niacin deficiency Deafness
Niacin toxicity cause Hepatitis, diabetes, macular edema
Niacin toxicity does NOT cause Hypertriglyceridemia

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VITAMINS 12
NUTRITION

VITAMIN B6

Daily requirement of pyridoxine 2 mg


Patient presenting with pellagra, parkinsonism, Pyridoxol phosphate
convulsion, anemia and kidney stones has deficiency of
Vitamin required for heme synthesis Pyridoxine
Coenzyme used in transamination Pyridoxal phosphate
Pyridoxine dependent Homocystinuria, Oxaluria, Xanthinuria
Pyridoxine dependent disorder Homocystinuria, Cystathionuria, Xanthurenic aciduria
Pyridoxol phosphate is needed in Glycogenolysis
NOT pyridoxine dependent Maple syrup urine disease
INH leads to deficiency of Pyridoxine
Significant drug interaction between pyridoxine and Isoniazid, levodopa, hydralazine
Vitamin B6 deficiency associated with Penicillamine, INH, CYCLOSERINE
Decreased level of serum vitamin B6 is seen in INH therapy
Vitamin deficiency leading to neonatal seizure Pyridoxine
Large dose of pyridoxine is of some value in Homocystinuria
Large doses of pyridoxine is useful in Pre menstrual syndrome

VITAMIN B12

Daily requirement of vitamin B12 1 microgram


Red vitamin B12
Salivary glycoprotein binding with cobalamine Haptocorrin
Vitamin B12 acts as coenzyme to which of the following Homocysteine methyl transferse
enzyme
Cobalt forms component of Vitamin B12
Vegetarians derive Vitamin B12 from Curd
Vitamin B12 Glycopeptide factor needed for absorption
Vitamin B12 and folic acid supplementation in Increased DNA synthesis in bone marrow
megaloblastic anemia leads to improvement of anemia
due to
NOT a dietary source of vitamin B12 Soyabean
Anemia and posterior column dysfunction in 65 year old Vitamin B12 deficiency
man
Vitamin B12 deficiency give rise to Myelopathy, Optic atrophy, peripheral neuropathy
Posterior column sensations in lower limb are lost in Vitamin B12 deficiency
Deficiency causing glossitis and cheilitis Vitamin B12
Vitamin B12 deficiency Folate trap, Methyl malonylaciduria, SACD,
Megaloblastic anemia
Methlymalonyl coA is increased in Vitamin B12 deficiency
Malonylaciduria is due to deficiency of Vitamin B12
Methylmalonic aciduria in B12 deficiency Methyl malonyl CoA mutase
is due to B12 dependent enzyme
Vitamin B12 deficiency is likely to cause Centrocaecal scotoma
Strict vegetarian diet results in deficiency of Vitamin B12
Vitamin B12 absorbed in Ileum
Vitamin B12 deficiency can cause Myelopathy, Optic atrophy, Peripheral neuropathy

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VITAMINS 13
NUTRITION

NOT seen in vitamin B12 deficiency Myopathy


Increased B12 level Cirrhosis, primary hepatocellular carcinoma, hepatitis
Serum vitamin B12 is increased in Hepatitis, Cirrhosis, Hepatocellular carcinoma
Conditions associated with abnormal schilling test Pernicious anemia, Chronic pancreatitis, Achlorhydria,
Bacterial overgrowth syndrome, Ileal dysfuction

PANTOTHENIC ACID

Daily requirement of pantothenic acid 10 mg


Active moiety of CoA is Thiole of pantotheine
Act as cofactor after its modification Pantothenic acid
Vitamin necessary for coenzyme synthesis Pantothenic acid
Pantothenic acid is a coenzyme for Acetylation
Synthesis of Acetyl CoA requires Pantothenate
Burning sole syndrome is seen in deficiency of Pantothenic acid

BIOTIN

Coenzyme required for carboxylation reactions Biotin


Biotin mediated Carboxylation involves Acetyl co A to Malonyl co A, Propionyl co A to Methyl
malonyl co A, Pyruvate to Oxaloacetate
Biotin dependent enzymes Carbomyl phosphate synthase, Acetyl CoA acrboxylase,
Pyruvate Carboxylase
Biotin deficiency Dermatitis, Glossitis, Alopecia
Enzyme affected by biotin deficiency Carboxylase
Increased urinary excretion after leucine challenge test is Biotin deficiency
seen in
Anti biotin Avidin

VITAMIN C

Vitamin that can lead to toxicity on Vitamin C


overdose
Highest amount of vitamin C Indian goose berry
Vitamin C is present in large amounts on Amla
Animal Synthesizing Vitamin C Red Headed Bul Bul
Vitamin C content of which of the following is >5 mg per Sitaphal
100 gram
Vitamin C content is enhanced by Germination
Vitamin excreted in urine Vitamin C
Vitamin cannot be synthesized by body Vitamin C
Humans cannot synthesize vitamin C due L gluconactone oxidase
to lack of
Vitamin not linked with generation of free radicals Vitamin C
Vitamin involved in cross linking of collagen Vitamin C
Required for hydroxylation of proline in collagen O2, Vitamin C, Dioxygenase

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VITAMINS 14
NUTRITION

synthesis
Aminoacyl tRNA NOT required for Hydroxyproline
Vitamin C deficiency leads to Defective osteoid formation
Pseudoparalysis is associated with Vitamin C deficiency
Vitamin C deficiency is associated with Corkscrew hair, coiled hair
In vitamin C deficiency, post translational modification Lysine
of which aminoacid is defective
Bleeding manifestation with normal PT and CT Vitamin C deficiency
Vitamin deficiency diagnosed by Rump Vitamin C
Leed test

FOLIC ACID

Low folate Goat milk


Gene for folic acid absorption is present in Chromosome 21
Water soluble vitamin Folic acid
Folic acid consists of Pteridine, PABA, Glutamine
Daily requirement of folic acid 100 microgram
RDA of folic acid in pregnant woman 400 microgram
Folic acid supplementation during lactation 300 microgram/day
CH2 transfer reaction mediated by Folic acid
Tetrahydrobiopterin is a cofactor for Tyrosine hydroxylase, Phenylalanine hydroxylase,
Tryptophan hydroxylase
Aminoacid involved in 1 carbon metabolism Folic acid
Vitamin related to a cofactor in glycine metabolism Folic acid
Conversion of glycine to serine require Folic acid
Incorporation of carbon units except methane during Tetrahydrofolic acid
oxidation involves
Tetrahydrofolate reductase (THFR) Incorporates C2, C8
Methotrexate inhibits THFR
Folic acid deficiency caused by Methotrexate
Folate deficiency precipitated by Alcohol, sufasalazine, phenytoin
Vitamin deficiency common on woman on phenytoin Folic acid
therapy
Folate deficiency is associated with Biotin deficiency

SCURVY

MC age group for scurvy 6 months 2 years


Burtons disease Scurvy with rickets
Exclusive milk ingestion manifest as Scurvy
In scurvy, there is a defect in Collagen
Scurvy affects bone by Less formation of osteoid matrix
Petechiae in scurvy is due to Endothelial disintegeration
Scurvy bleeds on Gums
Reducing substrate for the enzyme Prolyl hydroxylase
catalyzed reaction is deficient in scurvy

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MINERALS 15
NUTRITION

Enzyme defect in Scurvy Lysyl hydroxylase


Scurvy Bowing of legs
Scurvy Subperiosteal hematoma with tenderness, Separation
of epiphysis, Gingival bleeding, Bony thickening,
Metaphyseal calcification
6months old infant fed totally on cows milk, bleeding Scurvy
spots, anemia, fever, generalized tenderness. Swelling
in both extremities. blood count normal
Female with excess consumption of junk food, presents Hydroxylation of proline and lysine
with gum bleed, ecchymosis, hemarthrosis,
perifollicular bleed
A young patient with enlargement of costochondral Scurvy
junction and with white line of Frenkel at metaphysis
Pseudoparalysis Vitamin C deficiency
NOT true about scurvy Defective proximal calcification is the central cause for
bone change
Level of vitamin C in body is best estimated by Buffy coat
Woody leg appearance Scurvy
Definitive sign of Scurvy in X-ray White line in epiphysis
Wimberger sign Scurvy
Pelkan spur Scurvy
Ring sign Scurvy
Corner sign of peak Scurvy
X ray finding of infantile scurvy A dense line between metaphysis and epiphyseal
cartilage, A clear band of rarefaction on diaphyseal side
Metaphyseal fracture is commonly seen in Scurvy
Scurvy Pelcan spur, Zone of demarcation near epiphysis,
Frenkel line
Pencil thin cortex Scurvy
Scurvy White line of Frenkel, Wimberger line, Osteoporosis of
bone, Pelcan spur, Zone of demarcation near epiphysis,
Metaphyseal porosis, Metaphyseal infarction
NOT a radiological feature of scurvy Widening of epiphysis
Not a radiological feature of scurvy Growth arrest lines

MINERALS

GENERAL FEATURES OF MINERALS

Non essential micronutrient Lead


NOT an essential trace mineral Cesium
Tomatoes are rich in Citric acid, oxalic acid
Double edged Sword Iron
Molybdenum is associated with Esophageal varices, dental caries,
hyperuricemia
Vanadium is associated with Regulation of sodium and potassium
exchange

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MINERALS 16
NUTRITION

IRON

Molecular iron Stored in combination with ferritin


Dates are rich source of Iron
Poor mans iron source Jaggery
Poor source of iron Butter
Pulse having highest iron content Soya bean
Best source of non heme iron Spinach
Lowest iron content in Milk
Fish is deficient in Iron
Trace element that cannot be completely Iron
supplemented by diet during pregnancy
RDA of iron for infants 5 mg
Daily iron requirement in adult Indian woman 15 30 mg
Daily dose of iron for adult man 18 mg/dl
Recommended iron intake during pregnancy 60 mg/day
Elemental iron given to pregnant woman 60 mg
RDA of iron during menstruation and 21 mg
lactation
Elemental iron per 1000 Kcal 6 mg
Iron in blood is carried by Transferrin
Iron absorption from habitual Indian diet <5%
Iron absorption from intestine regulated by Mucosal block in intestinal cell is according to iron
requirement
Total loss of iron from body 1 mg
Daily excretion of iron in urine NIL
An adult pregnant female is termed anemic if her Less than 11 g/dl
hemoglobin in venous blood
Oral iron pills or iron injection must be taken along with High doses of vitamin C
In iron deficiency anemia, after hemoglobin level has 0-3 months
returned to normal so that iron stores are replenished.
iron tablets should be recommended for
Elemental iron and folic acid content of pediatric iron 20 mg iron and 100 microgram folic acid
folic acid tablet supplied by RCH programme
Amount of iron required for each 1 mg 250 mg
hemoglobin below normal
Maximum tolerated iron at term 2500 mg
Improvement of hemoglobin with oral iron 1 gm per week
Iron intake during antenatal period Increased birth weight of baby
Oral iron therapy response is achieved after 8 weeks
Earliest response after starting iron in 6 year old girl Increased reticulocyte count
With oral iron treatment, hemoglobin increases One gram per week
Iron poisoning in 4 year child treated with Desferrioxamine 100 mg IV
Antidote for acute iron poisoning Desferioxamine
Vin rose urine is due to Administration of desferioxamine in iron toxicity
Clinical features of Atransferrinemia Microcytic hypochromic anemia, hemosiderosis in heart
and liver, heart failure

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MINERALS 17
NUTRITION

ZINC

Trace element next to iron Zinc


Dietary requirement of zinc in male 9.4 mg/day
Perioral rash and pigmentation of skin creases, neuritis Zinc deficiency
Alopecia, hyperpigmentation, psoriatic dermatitis in Zinc
genitals and mouth, hypogonadism, deficiency
Metal deficiency associated with hyposmia Zn
Growth retardation, taste alteration, Zinc
hepatosplenomegaly, hypochromic microcytic anemia,
loss of hair, hypogonadism
Impaired cell mediated immunity, alopecia, psoriatic
dermatitis in genitals and mouth
Zinc deficiency is associated with Hypoguesia, hyposmia
Micronutrient deficiency associated with rash and Zinc
diarrhea
Zinc acts as cofactor for Alcohol dehydrogenase, Lactate dehydrogenase,
Carbonic anhydrase, Alkaline phosphatase, Superoxide
dismutase
Zinc is required for Carboxypeptidase
Acrodermatitis enteropathica is seen in deficiency of Zinc
Inheritance of Acrodermatitis enteropathica Autosomal recessive
NOT true about acrodermatitis enteropathica Triad of dermatitis, dementia, diarrhea
NOT a feature of acrodermitis enteropathica Thymic hyperplasia

FLUORIDE

Primary mechanism of action on topical Conversion of hydroxyappetite to


application fluoracetate by replacing OH- ions
Role of fluorine in dental health To protect against cariogenic process
Drinking water fluoride levels should be less than 1 mg/L
Level of fluoride in drinking water highly associated 2 mg/L
with dental fluorosis
Safe limit of fluorine in drinking water 0.5 to 0.8 mg/L
Acceptable fluoride concentration in drinking water 1 ppm
Maximum permittable level of fluoride in drinking 1 meq/L
water is
Increased density in skull vault is seen in Fluorosis
Manifestations of fluorosis Stiffness of back ligaments, Dental changes, Stiffness of
bones and tendons
Diagnostic radiological finding in skeletal fluorosis Interosseous membrane ossification, Intervertebral
ligament calcification
Maldon teeth is due to Fluoride
Dental caries is due to deficiency of Fluorine
st
Dental fluorosis is best seen in Central incisor and 1 molar
Dental fluorosis, if fluoride level is above 1.5 mg/L
Skeletal fluorosis, if fluoride level is 3 6 mg/L
Osteofluorosis is best characterized by Calcification of ligaments and tendons

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MINERALS 18
NUTRITION

NOT true about fluorosis Fluorosis is most common cause of dental caries in
children
Defluoridation of water is done by Nalgonda technique
Nalgonda technique used in Endemic fluorosis
Sequence of Nalgonda technique Lime + alum

IODINE

Trace element Iodine


NOT present in fish Iodine
Daily requirement of iodine in children 90 120 microgram
Daily requirement of iodine in adult 150 microgram
Iodine requirement in pregnant women 220 microgram per day
As per WHO, iodine deficiency disorders are endemic in 10%
a community if the prevalence of goiter in school age
children is more than
Endemic cretinism is seen when iodine uptake is less 20 microgram/day
than
Spectrum of IDD cretin does NOT include Hyperactivity
Twin fortified salt contains Iodine + iron
1 gram of twin fortified salt provides 40 microgram iodine + 1 mg iron
PFA act 1954 has laid down standard for level of 30 ppm at production level and 15 ppm at consumer
iodinisation of salt level
Iodised oil (1 ml im) gives protection for 3-4 years
Treatment of iodism Lavage with 1% starch and 5% sodium
thiosulphate

CALCIUM

Maximum calcium Ragi


Highest calcium concentration Dates
Ragi rich in Calcium
Calcium content is least in Human milk
Calcium requirement of growing school child 1 gram per day
Adequate calcium requirement per day for 20 50 years old 1000 mg
Adequate calcium requirement per day for > 50 years 1200 mg
NOT a type II nutrient element Ca

COPPER

Copper is required in collagen synthesis for Lysyl oxidase


Copper containing enzymes Cytochrome oxidase, Catalase, Tyrosinase, Superoxide
dismutase, Monoamine oxidase, Ascorbic acid oxidase,
ALA synthase, Phenol peroxidase, Uricase
Copper containing enzymes are Superoxide dismutase, Cytochrome
oxidase, Tyrosinase, Amine oxidase
Copper deficiency characterized by Myelopathy, Neutropenia, microcytic hypochromic

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MILK AND EGG 19
NUTRITION

anemia
Copper deficiency cause Myelopathy similar to subacute combined
degeneration
Menkes disease Defect in copper binding ATPase,
associated with poor growth, lax joints
and thin skin, reduced levels of
ceruloplasmin, NOT associated with
hepatitis and cirrhosis

CHROMIUM

Role of chromium in body Facilitates action of insulin


Chromium is associated with Lung cancer
Glucose tolerance factor Chromium

SELENIUM

Antioxidant Mineral Selenium


Known to influence bodys ability to handle oxidative Selenium
stress
Reactivation of Glutathione reductase Selenium
Selenium is a cofactor in Glutathione peroxidase
Glutathione peroxidase contains Selenium
Selenium decreases daily requirement of Tocopherol
Selenium deficiency cause Cardiomyopathy

MILK AND EGG

MILK AND PASTEURISATION

Biologically content Milk


Butyrometer or Gerbers apparatus is used Fat in milk
to check
Pasteurization method for small and rural Holder/VAT method
community
Pasteurization of milk Does NOT kill thermoduric bacteria, Does NOT kill
spores, Kills tubercle bacillus
Pasteurization by Holder method is heating milk at 65* for 30 minutes
Pasteurization does NOT kill Staphylococcal exotoxin
Pasteurized milk most commonly tested by Phosphatase test
Phosphatase test Quality of pasteurization
NOT a test for pasteurized milk Methylene blue reduction test
Methylene blue test is used to detect Microorganisms
Milk borne diseases Brucellosis, Tuberculosis, Q fever, Leptospirosis

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BREAST FEEDING 20
NUTRITION

Milk does NOT transmit Endemic typhus

EGG

Egg are reference protein because of Increased biological value and NPU
Egg is ideal protein because it has Best quality of protein
NPU value for egg 96
In egg, egg white contribute 58%
Energy in one egg 70 Kcal of energy
Source of invisible fat Egg
Vitamin NOT present in egg Vitamin C
Egg is poor in Carbohydrate and vitamin C

BREAST FEEDING

GENERAL FEATURES OF BREAST FEEDING

World breast feeding week August


Water given with breast milk Predominant breast feeding
In an infant feeding exclusively on breast milk Hemolysis due to vitamin K deficiency, GI bleeding due
to vitamin K deficiency, Relative prolongation of
physiological jaundice, Golden colour stools
A child exclusively feed on cows milk, deficiency is Iron
1 year old baby exclusively breast fed 1 cm Serum iron estimation
hepatomegaly, severe pallor and no spleen. most
important investigation
Average stool sodium content of newborn who fed on 26 mEq/L
breast milk alone
Baby friendly hospital initiative Breast feeding started immediately after birth. For 24
hours, baby is kept with mother
Breast feeding in acute diarrhea Continued
Breast feeding should be begun Immediately after delivery
Breast feeding is contraindicated if mother is taking Phenytoin
Breast feeding is contraindicated when mother is on Theophylline, Cimetidine, Metronidazole
NOT contraindicated in breast feeding Methotrexate
Maximum breast milk secretion at Maximum breast milk secretion at
Milk secretion CANNOT be suppressed by Fluid restriction
Witchs milk Discharge from nipple of a newborn

BREAST MILK

Cows milk Less carbohydrate than mothers milk, Has more K+


and Na+ than infant formula feeds, Has more protein
than breast milk
One ounce of fresh cows milk yield 67 kcal

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BREAST FEEDING 21
NUTRITION

As compared to cows milk, breast milk has More iron, More lactose
Breast milk Coefficient of uptake of breast milk is 70%, Calcium
absorption of human milk is better than that of cows
milk, Provides 70 kcal per 100 ml
Human milk Contains more vitamin D, Higher percentage of linoleic
acid and oleic acid, Better iron bioavailability
Mothers milk Best even in preterm baby, Lactoferrin promotes
lactobacilli in babys gut, Prevents allergy and asthma
Carbohydrate in human milk than cow Higher
Protein in breast milk 1.1
Sodium content in human milk Less
Anti infective property in milk by Lactoferin, lysozyme
Substance having anti infective property in milk Lactalbumin, Lactoferrin, Lysozyme
Protective effects of breast milk associated with IgA antibodies
Paraaminobenzoic acid in breast milk prevent infection Plasmodium vivax
of
Bifidus factor and lactobacilli in breast E.coli
milk prevent infection of
Glycosaminoglycans in breast milk protect Malaria
infection against
Lipase in breast milk protects infection Amoeba and giardia
against
Peroxisomes in breast milk protect Bacterial infection
Amount of calcium in human milk in 100 ml 28 mg
Whey casein ratio in breast milk 7:3
Ratio of casein to albumin ratio in breast 1:2
milk
Casein is a Phosphoprotein
Percentage of lactose in human milk 7.2 gram
Lactose in human milk High
Iron content in 100 gm breast milk 100 microgram
Level of protein in human milk 1.1 gm
Preterm milk is rich in Proteins
Less concentration in preterm milk Lactose, Ca, P
Hind milk is richer in Fat
Least amount of protein in 100 gm of milk Human milk
Breast milk deficient in Vitamin K
NOT present in milk Vitamin C, iron
Breast milk is known to transmit Tuberculosis
90% of milk is obtained by breast feeding infant in 4 minutes
Maximum output of breast milk 5-6 months
NOT true about breast milk Maximum output 12 weeks

COLOSTRUM

Colostrums Rich in immunoglobin, Contains more protein and less


fat
Colostrum contains more Protein, vitamins and minerals

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PROTEINS AND AMINOACIDS 22
NUTRITION

Colostrum contain Less fat

STORAGE OF BREAST MILK

Breast milk stored in refrigerator up to 24 hours


Breast milk at room temperature is stored for 8 hours

PROTEINS AND AMINOACIDS

GENERAL FEATURES OF PROTEINS

Highest content of protein found in Soya bean


Percentage of protein in soya bean 80%
Maximum protein content per 100 gm Soya bean
Poor mans meat Pulses
Reference protein Egg, milk
RDA of protein 0.6 gm/kg body weight (10- 14%)
Protein requirement of an adult 0.7 gm/kg in terms of egg protein and 1 gm/kg in terms
of mixed vegetable protein
For an adult Indian male, the daily requirement of 1 gm/kg body weight (0.83)
protein is expressed as
For 60 kg Indian male, minimum daily protein 60 g/day
requirement has been calculated to be 40 g. Standard
deviation is 10. recommended daily allowance of
protein
Conditionally essential amino acids Tyrosine, cysteine
Cereals and proteins are considered complementary Cereals are deficient in lysine and pulses are deficient in
since methionine
Limiting aminoacid in wheat Lysine, threonine
Limiting aminoacid in pulses Methionine
Bengal gram is deficient in Methionine
Amino acid lesser in rice Lysine
Lysine is deficient in Cereals
Maize is deficient in Lysine
Maize is deficient in Tryptophan
Aminoacid found in excess in some strains of maize Leucine
Sorghum is pellagrogenic due to excess of Leucine
Maize is pellagrogenic due to excess of Leucine
Normal nitrogen content of 200 gm protein 32 mg
100 gm of protein contain 16 gm of Nitrogen
Optimum calories to be provided by proteins should be 15-20%
Protein in cereals 6 12%
Protein requirement per day for 1-3 year child 22 g
In 13-15 year female child, Recommended Daily Protein 1.33
Intake is
Exclusive intake of protein meal causes Hypoglycemia

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FATTY ACIDS 23
NUTRITION

PROTEIN INDICATORS

Best indicator of protein quality for recommending Net protein utilization


dietary protein requirement
Net protein utilization Ratio of total nitrogen retained by total nitrogen intake
multiplied by 100
Method of assessment of quality of NPU
proteins give complete assessment of
protein quality
NPU Defined as nitrogen retained by nitrogen consumed *
100, Good for estimating protein quality, Egg has
highest NPU value
Net protein utilization Average NPU of Indian foods 50 80%, NPU of cows
milk 81%, If NPU is low, more protein is required
NPU is maximum in Egg
Protein quality indicator adopted by ICMR in NPU
recommending dietary protein requirement
Protein efficiency ratio is defined as Gain in weight of young animals per unit weight of
protein consumed
Protein efficiency ratio Weight gain per unit of protein consumed
Biological value is maximum of Egg
Biological value of rice protein 67
Protein energy ratio highest in Fish
Protein energy of fish 80%
Definition of nitrogen balance Nitrogen intake nitrogen loss
Minimum amount of protein needed for positive 60 gm/day
nitrogen balance
In seriously ill patient, addition of amino acid in diet Increased secretion of insulin
results in positive nitrogen balance. this is because of

FATTY ACIDS

Highest fat content in Bajra


Richest source of cholesterol Egg
ASHA has recommended consumption of Two portions of fish per week
Suggested intake of dietary fat per day in pregnancy is 30 gm
Percentage of calorie from fat and essential fatty acid 10-30%
Percentage of total fat Less than 30%
Percentage of saturated fat Less than 10%
Milky fats Increases gastric lipase activity, Given during
steatorrhea, Easily digestible
Highest content of saturated fatty acid Coconut oil
Highest percentage of PUFA in Soya bean oil
Richest source of PUFA Safflower oil
PUFA is found mostly in Vegetable oil except coconut oil and palm
oil
Fatty acid necessary during 0-6 months Linoleic acid

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FOOD FORTIFICATION 24
NUTRITION

Cardioprotective fatty acid Omega 3 fatty acid


Omega 3 fatty acids, eicosapentanoic acid and Fatty fish
docosapentanoic acid are particularly rich in
Omega 3 fatty acid Alpha linoleic acid
Most important essential fatty acid Linoleic acid
Linoleic acid is maximum in Safflower oil
Important fatty acid present in milk Docosahexanoic acid

FOOD FORTIFICATION

NOT food fortification Saffron color in milk

TOXINS IN FOOD

BOAA is the toxin responsible for Neruolathyrism


BOAA Betaoxalyl aminoalanine
Aminoacid in BOAA Alanine
Lathyrism is due to consumption of Khesari dhal
Lathyrism Banning the crop, Vitamin C prophylaxis, Flaccid
paralysis, BOAA is causative toxin
Poisoning resulting in spastic paraplegia Lathyrus
Lathyrism from khesari dal can be prevented by Parboiling
Epidemic dropsy is caused by Sanguinarine
Dropsy is due to Sanguarine
Sanginarine is derived from Argemone oil
Test to detect contamination of mustard oil with Nitric acid test
argemone oil
Manifestation of epidemic dropsy Glaucoma, CHF, GI bleed, Gut telangiectasia, Dyspnoea
Food contaminant associated with occurrence of Jhunjhunia
endemic ascites
Endemic ascites is caused by Pyrrolizidine
Ingestion of which of the following results in ergotism Bajra
Ergotism is caused by Claviceps purpura
St. Antony fire Ergotism
Primary aflatoxin producing fungi Aspergillus flavus, Aspergillus parasiticus

FOOD ADULTERATION

Food adulteration does NOT include Fortification

DIET

DIETARY CYCLE AND NUTRITIONAL SURVEILLANCE

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DIET 25
NUTRITION

One dietary cycle 7 days


Components of nutrition surveillance Nutritional survey, Policy maker

CALORIE REQUIREMENTS

Calorie requirement per day for newborn 90 kcal/day


Calorie required for 0-6 month infant is 92 kcal/kg /day
Calorie required for children 6 12 months 80 Kcal/kg/day
Energy requirement of infant 110-120 kcal/kg
Calorie requirement of one year old child 1000 kcal
Normal calorie requirement of 5 year old child 1500 calories
Daily extra calorie requirement in first trimester of 150
pregnancy
Extra energy per day during pregnancy 350 kcal
Additional calorie requirement in 350 Kcal, 23 g protein
pregnancy
Additional calorie requirement in 600 Kcal, 19 g protein
lactation (0 6 months)
Additional calorie requirement in 520 Kcal, 13 g protein
lactation (6 12 months)
Daily need of calories in pregnancy 2500 kcal
Recommended daily dietary intake of an adult pregnant 3200 kcal
women with heavy work
Over and above metabolic requirements, a pregnancy in 60000 kcal
total duration consumes about
Consumption unit, the coefficient of dietary intake for 1
an adolescent is of value
According to ICMR, cereals and pulses requirement for 460 and 40 gm
a sedentary vegetarian male is
Energy requirement of sedentary female <2000 kcal
Recommended daily energy intake of an adult woman 2900
with heavy work
Calorie intake for people below poverty line Rural 2400, Urban 2100
To reduce half of body weight over a period of one 225 Kcal
week, required calorie reduction per day
Highest calorie content is found in Banana
Highest calorie content is found in Animal meat
Maximum calories per 100 gram are seen in Jaggery
Maximum calorie per 100 gram in Bengal gram
Highest glycemic index Cornflakes
Human milk 25 calorie per ounce
One gram of carbohydrate 4.1 Kcal
Amount of energy in alcohol 7 Kcal/g
Energy yielded by one ml of alcohol 7 cal
One cup of cooker rice 170 kcal
Atkins diet Severely reduced carbohydrate content
Tea and coffee contain Tannin
Semisolid food should be started to a baby at an age of 6 months

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DIET 26
NUTRITION

CALORIE REQUIREMENTS OF ADULT

TYPE ADULT REFERENCE MALE ADULT REFERENCE FEMALE


Sedentary 2320 (1) 1900 (0.8)
Moderate 2730 (1.2) 2230 (0.9)
Heavy 3490 (1.8) 2850 (1.2)

SUPPLEMENTARY NUTRITION IN ICDS

BENIFICIARY CALORIES PROTEIN


0 1 year 200 Kcal 68g
1 6 years 300 Kcal 8 10 g
Malnourished 600 Kcal 16 20 g
Pregnancy, lactation and 500 Kcal 20 25 g
adolescent

RDA

RDA Statistically defined as two standard deviations above


estimated average requirement
RDA RDA is decided by a panel of experts and is based on
scientific research, RDA is often higher than
recommended minimum requirement, RDA is based on
estimated average requirement
In calculating RDA for a particular nutrient, 2 SD not Energy
added for
RDA is above EAR (estimated average requirement)

PRUDENT DIET

Man of 68 kg, consumes 325 gm carbohydrate, 65 mg Proportion of proteins, fats, carbohydrates is correct
protein, 35 gm fat in his diet. most applicable statement and in accordance with a balanced diet
Dietary change for prevention of heart disease Reduction of cholesterol to below 100 mg per 1000 kcal
per day
Prudent diet Diet for dietary goal achievement
Dietary fat in prudent diet 15-20%
TRUE statement about Prudent diet Protein Should Be 10-15% Of Diet
Protein in prudent diet 10-15%

INDIAN REFERENCE MALE AND FEMALE

Age of Indian reference male and female 20 39 years


Indian reference man weights 60 kg
Indian reference male 60 kg, 8 hours in blood, 18-29 age, 1.73 meter

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DIET 27
NUTRITION

True about Indian Reference Male is Work is mainly sedentary


Weight of Indian reference woman 55 Kg
NOT true about Indian reference female Age 20-39 females

FOOD STANDARDS

Standardization of food by the directorate of marketing AGMARK standards


and inspection of government of India
Purely voluntary AGMARK
International food standards Codex Alimentarius
National food standards PFA
Food standard in India have to achieve a minimum level PFA standards
of quality under

DIETARY FIBRE

Dietary fibre Pectin, cellulose, hemicelluloses


Dietary fibre Soluble fibres increase metabolism of sugar in GIT,
Increased bulk of stool
Dietary fibre is Non starch polysaccharide
Dietary fibre reduces atherosclerosis by Binding to cholesterol
High roughage in diet Decreases stool transit time
NOT fermented by gastrointestinal organisms Lignin
Colonic bacteria on digestion of dietary fibre give Butyrate

PROBIOTIC AND PREBIOTIC

Daily requirement of dietary fibre by an adult is 40 gm


approximately
Fructosan Prebiotic, non digestible food ingredient that
beneficially affect the host by selectively stimulating the
growth of bacteria or yeast
Inulin like fructans are used as prebiotics as they are Beta configuration of anomeric C2
non digestible. resistance to digestion in the upper GI
tract results from
Inulin is a Fructosan
Inulin is made from Fructose
NOT a polymer of Glucose Inulin
Probiotics are used for Necrotizing enterocolitis

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