HUMAN NUTRITION AND DIETETICS

An introduction for students of

Second Edition

LecturerDepartment of Food Technology and Nutritional Science

Santosh, Tangail-1902.First Edition October, 2008Second Edition April, 2009

All rights reserved by the Students of FTNS, MBSTU.

Dedicated to

Newborn LBW baby whose need better care and nutrition. Preface to the second Edition

Nutrition plays an important role in normal growth and development and more so in the prevention and treatment of various communicable and life style diseases. This introduction to the HUMAN NUTRITION AND DIETETICS is intended, in the first place, for the use of students of Food Technology and Nutritional Sciences. It incorporates all the basic needs of normal nutrition including infants, children, adolescent, adults, pregnant, lactation as well as geriatric nutrition. An effective diet plan should be taking into considerations the tastes, eating patterns, cultural patterns and nutritional needs of the individuals. This edition especially introduces the basic human needs and dietary guidelines for nourishment and betterment of health.I am greatly indebted to Dr.K.M.Formuzul Haque for his encouragement and advice and cordially acknowledged to all my colleagues for their help in the writing this book. I am extremely grateful to my family members and all team leaders of study groups especially Rochi, Razon, Shawon, Modumita, Hannan, Setu, Shamoli, Nazmul, Jahangir, Fazlu, Shakat Riaz for their enthusiastic support.

I am thankful to all the students of the FTNS department, MBSTU, for their wholehearted support and cooperation.April, 2009.

A.K.Obidul Huq Chapter-1: Introduction to Human Nutrition and DieteticsHuman Nutrition

Human nutrition is the scientific discipline that deals with nutrition in man. In particular it is concerned with the nutritional requirements, food consumption, food habits, the nutritive value of foods and diets, the relationship between diet and health, and with research in these fields.DieteticsDietetics is the subjects which deals with general diet menu designed for individual (infant, children, adolescence, adult, pregnant, lactation, old age) who require normal diet and who require extensive modified diet (therapeutic diet).

Therapeutic Diet

Therapeutic diet is that component of treatment of an individual with an acute or chronic disease which includes or involves modification food intake. In addition pre-mature birth inherited metabolic disorders (Galactosamia) temporary infection use of some medication needs dietary modification.

Classification of Therapeutic DietAccording to function, Therapeutic diet is classified into 4 groups:1. Primary Therapy: Here diet is the only way to treat the disease. e. g. NIDDM (Non Insulin Dependent Diabetes Mellitus). Carbohydrate modification is used Non-complicated obesity. Inherent metabolic disease Galactosamia, vitamin A deficiency, Iron deficiency anemia, Iodine deficiency problem.2. Integral Therapy: It is used in conjunction with therapeutic agents. i.e. here both diet and medicine is required, e.g. Atherosclerosis, IDDM.3. Adjunct therapy: Here diet helps but not an integral part, e.g. hypertension. Na may be restricted, but medicine is must. Ulcer irritating foods should be avoids but medicine is essential.4. Supportive Therapy: Medical treatment is the only way to treat the disease, but a good diet helps to recovery fast, e.g. bone fracture after surgery diet. Purpose of Diet Therapy:1. To bring about change in body weight, whenever necessary.Obese (( (normal) (( underweight2. To maintain in good nutritional status.

3. To correct nutrient deficiency that may occur.

4. To adjust food intake to bodies ability to metabolize the nutrient. e.g. Carbohydrate in diabetes mellitus.Dietitian: Dietitian is a person who translates the science of nutrition into practice in furnishing the best possible nourishment of the people.Dietitian works in:1. Hospital

2. Education institution (#. Research #. Teaching)3. School going children diet

3. Primary private clinic (RD=Registered Dietitian)

4. Industries lunch

5. Business center

6. Community service agencies

7. Govt. agencies.

Types of Dietitian:

According to activities of works, dietitian are 4 types.

1. Therapeutic Type: He/she is a member of health core team in a hospital. He/she meets a medical stuff and discuss procedures for implementing diet orders. Physician: Disease diagnosis and for this patient( Give medicine and suggest proper diet. Suppose 2000 kcal diet and 30g high quality protein, low fat. Dietitian will be prepare this diet chart and supply it to the kitchen.

2. Clinical Dietitian: He/she works in a private clinic. They provide diet for non hospitalized subjects. The subjects are either refered by physician or they come by themselves (knowledgeable person). The clinical dietitian note their history of food intake, family history of disease, disease record if any, if need ask for blood/stool/urine examination and then prepare diet chart accordingly.3. Research Dietitian: He/she works in medical centre, research centre, university. They perform human metabolic studies to different subject according to problem, provide diet analyze nutrients from blood given and from food stuff and stool and urine collected for 24 hours and finally from the experimental results, dietitian prepare diet chart for specific disease/condition.4. Administrative DietitianThey work in food department (policy making govt.). They supervise/ advice person involved with food formulation policy better nutritional food production or import for a nation. Also helps in food cost accounting. Role of dietitian:1. Dietitian has an important role especially planning the diet of a convalescing patient plan a diet as per the doctors diet prescription.

2. Prepare the patient mentally to accept the modified diet.

3. Plan the diet and make it more appetizing and appealing.

4. Enlightens and motivate the patient as per the needs regarding the technical and scientific aspects governing the diet.

Factors to be considered in planning or preparing a diet chart:1. The subjects/patients ht, wt, BP, body frame, physical activity, complication to be noted.

2. Recent blood/stool/urine analysis report if available should be checked. If needed ask the subjects to analysis blood/stool/urine and bring the report.

3. Family history of disease to be known.4. The diet chart should be nutritionally adequate, but should full with in limits and therapy (i.e. consider disease condition and modify diet accordingly. e.g. diet for atherosclerosis, prepare diet.5. Take food intake history and identity deficiency or excess nutrient excess.

6. For patient history and duration of disease to be known.

7. Subject economic condition o be known.

8. Take care of individuals liking and disliking.

9. Consider a) Religious and cultural preferences. b) Family background and status.

c) Methods of food preparation.

d) Eat all persons at a time or separately.10. Whether patient / subject has basic knowledge on nutrition, nutrient rich food stuff, best cooking process, children / pregnant / lactating mothers should give more food etc.

11. Psychological influence illness usually changes persons behaviors fear, worry ness, insecurity, frustration, change patients behavior which affect food intake.12. Also appearance of food, glass, plate, trays etc. should determine food intake.

13. Also same food preparation everyday and same procedure.

14. Consider age and physical condition children / elderly

15. Suggest food items such a way that can fulfill has / her requirement and at the same time he/ she can digest the food, chew the food, able to metabolize the food.

16. Consider season available of food in particular season especially in case of fruits and vegetables.

17. Consider location availability of food by his /her surroundings e.g. do not advice sea fish who lives far from sea.

18. Diet chart should include varieties of food within same group (e.g. carbohydrate group, protein group, fat group).

19. Consider duration of the diet. If it is for 1-2 weeks and if the diet is deficient in one /two nutrient (e.g. CA, P) than it is ok, but if the diet is for long time than provide the required nutrient even by supplementation.

20. Total diet for 24 hour should be divided into at least 3 times / frequent small meal (5/6) is better.

21. The diet should be acceptable and understandable by the subject.

22. Modified diet according to subject / patient improvement

Balanced Diet: A balanced diet is defined as one which contains a variety of foods in such quantities and proportions that the need for energy, protein and all nutrients are adequately meet, for maintaining health, vitality and general well-being and also makes a small provision of extra nutrients to withstand short duration of weakness.Balanced diet - a diet containing all the nutrients needed by the body to function well. This is attained by eating the right combination of foods in proper quantities. Generally, a nutritious and well balanced diet is composed of a variety of foods selected from the three basic food groups:A balance diet is one which contains all the food constituents in proper proportions toMeet the energy and nutritional requirements of the individual.

The GO or energy -rich foods, the GROW or body-building foods and GLOW or body-regulating foods.Factors to be considered:1. Nutritive values of the food items

2. Age, sex, body weight, height

3. Physiological and pathological conditions , e.g. sickness/ lactation

4. Physiological activities and profession, e.g. sedentary , moderate, mild activity

5. Socioeconomic status

6. Cost and availability of foods

7. Food habits , food choices

8. Religion and customs

9. Climates

10. BMR ( Basal Metabolic Rate )

Importance of balance diet: A balanced diet is an accepted meal to safeguard a population from nutritional deficiencies. It has got the following importance:1. It contains energy yielding, body buildings and protective foods in correct proportions and every individual is assured of obtaining the requirement of all the nutrients.2. It also makes a small provision of extra nutrients to withstand short duration of leanness.

3. It facilitates development of an analytical and chemical approach to food and diet.

4. It is designed to prevent under and over nutrition of the community

5. At present the concept of important of dietary fibre has been incorporated in the formulation of balance diet which protects the population from many diseases like colon cancer, diabetes, CHD etc.

6. As it is designed by taking economic condition, religion, personal likings and disliking, food availability into considerations, it provides total protection from the community for which it is constructive.

********************

Chapter-2: History of Nutrition.Definition and Concept of Nutrition

"To eat is a necessity, but to eat intelligently is an art."La RochefoucauldNutrition means the taking in and use of food and other nourishing material by the body. Nutrition is a three part process. First, food or drink is consumed. Second, the body breaks down the food or drink into nutrients and

Third, the nutrients travel through the bloodstream to different parts of the body where they are used as "fuel" and for many other purposes. To give the body proper nutrition, a person has to eat and drink enough of the foods that contain key nutrients.Nutrition, by definition, is the way our bodies take in and use food. Foods that are great sources of nutrition are called nutrients. Nutrients can be defined as chemical substance present in foods which produce energy. There are six different types of nutrients, such as carbohydrates, fats, proteins, vitamins, minerals and water.Nutrients give us energy, growth, help repair body tissues, and regulate body functions. Therefore each nutrient can be vital to your health.

In a more limited sense, the process by which the living tissues take up, from the blood, matters necessary either for their repair or for the performance of their healthy functions. In the broadest sense, a process or series of processes by which the living organism as a whole (or its component parts or organs) is maintained in its normal condition of life and growth. Finally we can say that Nutrition is the process whereby living organisms utilize food for maintenance of life, growth, the normal functioning of organs and tissues and the production of energy.History of Nutrition The imperative of preserving the historical records of science has long been appreciated by scholars in many fields (e.g. Medicine, chemistry, mathematics, physics, and, more recently, nuclear physics and biochemistry). Medicine and chemistry conspicuously have led the way in building impressive centers of history. The science of nutrition had no center of history until 1975, when Vanderbilt University created "An Accessible Archives of Human Experience in Nutrition", consisting of an extensive collection of monographs on the history of nutrition, 15th century-20th century, and an archive of the personal papers of nutrition scientists. This collection was formalized as a result of the initial major gift by Dr. W. Henry Sebrell, Jr. of his papers and those of Dr. Joseph Goldberger. Vanderbilt's History of Nutrition Collection and Archives has grown significantly since 1975 and has attained national and international recognition. This collection is maintained in the Special Collections of the Eskind Biomedical Library. It represents the efforts and contributions of many individuals during the last three decades plus the encouraging support of the Medical Center's administration and of the major nutrition science society, the American Institute of Nutrition (AIN). Beri-beri: "The first clinical descriptions of beriberi were by Dutch physicians, Bontius (1642) and Nicolaas Tulp (1652). Tulp treated a young Dutchman who was brought back to Holland from the East Indies suffering from what the natives of the Indies called beriberi or "the lameness." Tulp's description of beriberi was a detailed one, but he had no clues that it was a deitary deficiency disease. This discovery came more than two hundred years later. The early history of nutrition may be conveniently following head-lines1. Chemical nature of plant foods and animal tissues2. Respiration and Energy output in human subjects3. Feeding Experiments4. Observations on the treatment of certain diseases in human beings by changing diet.Chapter-3: Composition of Human BodyHealth: Health is a state of complete physical, mental and social wellbeing and not merely absence of disease or infirmity so that each citizen can lead a socially and economically productive life.

New philosophy of health:

Health is fundamental human right

Health is integral part of development

Health involves individual , state or international responsibility

Health is essence of productive life.

Dimensions of Health Four major dimensions of health included in the WHO definition of health-Physical, Mental, Social and Spiritual

Besides these many more may be cited- emotional, vocational, political, philosophical, cultural, socioeconomic, environmental, educational, nutritional, preventive and curativeGuidelines for Good Health

The guidelines for good health are given bellow:

1. Maintain regularity in your routine.

2. Eat as much natural food as you can.

3. Consume seasonal foods as far as possible.

4. Eat well but do not overeat.

5. Avoid excessive salt and spices.

6. Avoid too much sweet, especially sugar.

7. Eat foods which contain carbohydrate, especially starch and fiber.

8. Avoid food that contain large amount of cholesterol and saturated fat.

9. Measure own weight regularly and maintain ideal weight.

10. Avoid eating the same kind of food all the time. Eat a variety of food.

Composition of Human BodyThe human body is divided into three compartments, Body cell mass, 55 percent;

Extra cellular supporting tissue, 30 percent;

Body fat, 15 percent.

The body cell mass is made up of cellular components such as muscle, body organs (viscera, liver, brain, etc.) and blood. It comprises the parts of the body that are involved in body metabolism, body functioning, body work and so on.The extracellular supporting tissue consists of two parts:The skeleton and

Other supporting structures.

The extracellular fluid (for example, the blood plasma supporting the blood cells) and the skeleton and other supporting structuresBody fat is nearly all present beneath the skin (subcutaneous fat) and around body organs such as the intestine and heart. It serves in part as an energy reserve. Small quantities are present in the walls of body cells or in nerves.A common determination is to estimate lean body mass (LBM) or the fat-free mass of the body. These measures vary from the very simple to the very difficult. The simpler ones are of course less precise.

Anthropometry using weight, height, skin fold thickness and body circumferences is relatively easy and very cheap to undertake, and does provide some estimate of LBM and body composition.

In contrast, methods using, for example, bioelectrical impedance, computerized axial tomography (CAT scans) and nuclear magnetic resonance require expensive apparatus and highly trained staff.

The fluid in the cells (intracellular fluid) has mainly potassium ions, and the extracellular fluid is mainly a solution of sodium chloride. Both also have other ions. Total body water can be estimated using different methods including dilution techniques to measure, for example, plasma volume. Body fat is estimated using different methods. Because a large portion of adipose tissue is present beneath the skin, it can be estimated by using a skin fold caliper to measure skin fold thickness in different sites .

Another method is to weigh the person both in air and under water using a special apparatus and tank. This method really provides an estimate of body density.

Body composition is much influenced by nutrition. The two extremes are the wasting of nutritional marasmus and starvation and the overweight of obesity.

Body composition differs between the genders and, perhaps only slightly, among races. African Americans have been shown to have heavier skeletons than whites of the same body build in the United States. In females pregnancy and lactation influence body composition. The body composition of children is influenced by their age and growth. Disturbances of growth resulting from nutritional deficiencies influence body composition, including the eventual size of the body and of body organs.******************

Chapter-4: Concept on RDA of the Nutrients for Human Life CycleRecommended Allowances and Requirements: Recommended daily allowances (RDAs) for protein, vitamins and minerals are estimated with an extra safety margin to ensure that the whole populations needs are covered. Allowance for a nutrient is a value estimated to cover the needs of 97% of the population. This value is calculated by estimating a mean + 2 SD) or the observed requirements in a group of Individuals.RDAs may vary from country to country according to levels of intake intended to be achieved.

Requirement for a particular nutrient or energy, on the other hand, is the amount necessary to ensure normal physiological functions, and to prevent occurrence of symptoms of deficiency.

RDA (Recommended dietary allowance)

RDA is the levels of intake of essential nutrients consider being adequate to meet the known the nutritional needs of practically all healthy persons.

RDAs are categorized

For both sexes,

For different age group,

For pregnancy and lactation, and

Sometimes for different kinds of physical work.

RDA as have usually been calculated

On the basis of a certain physique (`reference man or woman`, etc), and

On assumptions concerning the level of activity.

History of RDA: The RDA was developed during World War 2 by Lydia J.ROBERTS, Hazel K. Stiebeling and Helen S. Mitohell under the auspices of the Nation Research Council.The Nation Research Council determined a set of dietary standards were needed, especially given the possibility that rations would be needed during the war. The standards would be used for overseas population who might need food relief. Roberts, Stiedeling, and Mitchell surveyed all available data, created a tentative set of allowances, and submitted them to experts for review. The final set of allowances was accepted in 1941. The allowances were meant to provide superior nutrition for civilians and military personnel, so they included a `margin of safety. ` The RDA was established by the food and Nutrition Board of the (US) National Academy of Sciences. In 1997 at the suggestion of the Institute of Medicine of the National Academy RDA become one part of a broader set of dietary guidelines called the Dietary Reference Intake used by the United States and Canada.

Factors Affecting RDA

The nutrition requirements are affected by several factors such as:

Age- (infant, adolescent, aged). Infants require more per kilo gram of body weight that adolescents, since their metabolic rate is much faster than that of adolescents.

Sex- (male of female) adolescent girls require more iron that adolescent boys in order to replace the iron lost during menstruation every month.

Body size- (height, weight, surface area, stature). A tall heavily built man needs more calories than a small-stature man, since his bob surface area is more than that of the latter.

Physiological state- (pregnancy, lactation). A pregnant woman requires more nutrition food than an ordinary adult woman, since she has to meet the additional nutritional requirements of the growing fetus.

Type of work- (sedentary, moderate, heavy). A sedentary worker requires less calories than a heavy worker, since the former expends less energy than the latter during work.

The RDA may then be considered as The Nutrition Yardstick

Uses of RDA: They are mainly used:

As a basis for all feeding programs such as school-lunch programmers.

To interpret food consumption records.

To evaluate the adequacy of food supplies in relation to nutritional needs.

To establish guidelines for public food assistance programmers

To develop and evaluate new food products developed by the food industry.

To establish guidelines for labeling of food from the nutritional standpoint, and most important.

To develop nutrition education programmers

When studying RDA, it must be remembered that an excess for all nutrients except energy has been given. To be on the save size, some people may consume excess of these, but it must be borne in mind that not all nutrients are well tolerated if taken in excess of RDA e.g. vitamins A and D are stored in the body and may toxic effects unlike water soluble vitamins B and C, which if consumed in excess of the requirements will be excreted by the body. Also an excess of energy intake daily, however small, can result in overweight and lead to obesity in the long run.

With regard to body requirements, the concept of bioavailability has emerged recently. Bioavailability means ho much of the nutrient that is ingested actually gets digested and is absorbed across the intestines. This amount is the amount which is actually made available to the body for further use. When considering the requirement of any nutrient, this important aspect has to be taken into account. Several studies in this regard are being carried out. This idea is being developed and soon we will become familiar with it as more data and knowledge is generated in the coming years.

Reference Daily Intake: (RDI) is the daily dietary intake level of a nutrient considered sufficient to meet requirements of nearly all healthy individuals in each life stage and gender group.

The RDI is used to determine the Recommended Daily Value (RDV) which is printed on food labels in the U.S and Canada. RDI is the current status of RDA.

RDI is based on the Dietary Reference Intake (DRI)

They are intended to serve as nutrition guidance to the general public and health professionals.

USES: i. Food labels. ii. Composition of diets for schools, prisons, hospitals or nursing homes. iii. Industry developing new food stuffs.

iv. Healthcare policy makers and public health officials.

RNI (Recommended Nutrient Intake): is the level of dietary intake thought to be sufficiently high to meet the requirements of almost all individuals in a group with specified characteristics. RNI takes into account individual variability. Of necessary, the RNI exceeds the requirement of almost all individuals (Health and Welfare Canada, 1983)

The presence of experts from the Food and Agriculture Organization/World Health Organization (FAO/WHO) and the United States should provide valuable input of experiences from all over the world and from the country with the most advanced research in nutrient requirements.

It was believed that a situational analysis of the currently available RDAs in the Southeast Asian region could provide useful input for the workshop discussions. This overview attempts to collate and analyze the RDAs in the region for commonalities and differences and to highlight specific and special features. It is hoped that this paper will serve as background information for further deliberations during the workshop and discussion sessions.

For this purpose, RDAs currently in use in the following six Southeast Asian countries were obtained for the review: Indonesia,1 Malaysia,2 Philippines,3 Singapore,4 Thailand,5 and Vietnam.6 In addition, recommendations from WHO/FAO7-9 as well as RDAs used in the United States10 were included for comparison. Brunei Darussalam uses a combination of several RDAs, especially the Malaysian and British RDAs. Recommendations for the most relevant nutrients in the region-namely, energy, protein, calcium, iron, vitamin A, thiamin, riboflavin, folate, vitamin B2, vitamin B12, vitamin C (ascorbic acid), and iodine-are tabulated and compared for the different countries and according to age.

Documentation of the RDAs received were incomplete in most cases, where only the nutrients tabulated were received by the author. The development process or steps and the rationale for the levels of the various recommendations were thus unclear. Some of these aspects, especially with regard to current and future developments in the review of national RDAs, are reported herein by the representatives from various countries.

General Comparisons: The various RDAs have widely differing years of implementation; the oldest is the Malaysian RDA, which was introduced in 1975. Most of the RDAs were introduced in the late 1980s or early 1990s. The Vietnamese RDA was adopted by various sectors in the country and was formally signed by the Minister of Health in September 1996. Indonesia also has high political backing of the RDA, which was officially released as a decree of the Minister of Health in 1994. Several versions of the WHO RDA for specific nutrients are used in this review. The nutrients listed differ widely, but the core group of nutrients is similar; the most common ones are energy, protein, calcium, iron, thiamin, riboflavin, niacin, vitamin A, folate, vitamin B2, vitamin B12, and vitamin C. Thailand and the United States also listed requirements for several other micronutrients.The different RDAs adopted different age groupings, especially from adolescents onward. Indonesia, Malaysia, Philippines, and Thailand refer to adults from 20 years onward; Singapore, Vietnam, the United States, and WHO use 18 years and above. In the RDAs for the United States and Indonesia (female), requirements for adults over 50 years old are separately listed; requirements for adults over 60 years of age are separately listed for Indonesia (male), Singapore, Thailand, and Vietnam. For Malaysia and the Philippines, a cutoff of 70 years is used for older adults. With the exception of Malaysia and Vietnam, the median weight and height for each age group in the RDAs are given.

Comparison of RDAs is complicated by the use of different body weights in different countries. Body weights used in the US RDA are the highest for all age groups in all countries studied. WHO uses a wide range of body weights for each age group. Among the Southeast Asian countries, body weights used also differ considerably for all age groups.

Nutrient Levels: Estimated nutrient levels in the USDA Food Guide at the 2,000-calorie level, as well as the nutrient intake levels recommended by the Institute of Medicine for females 19-30 years of age.NutrientUSDAFood GuideICM Recommendations for Females 19 to 30

Protein, g91RDA: 56

Protein, % kcal18AMDR: 10-35

Carbohydrate, g271RDA: 130

Carbohydrate, % kcal55AMDR: 45-65

Total fat, g65

Total fat, % kcal29AMDR: 20-35

Saturated fat, g17

Saturated fat, % kcal7.8As Low As Possible

Monounsaturated fat, g24

Monounsaturated fat, % kcal11

Polyunsaturated fat, g20

Polyunsaturated fat, % kcal9.0

Linoleic acid, g18AI: 12

Alpha-linolenic acid, g1.7AI: 1.1

Cholesterol, mg230As Low As Possible

Total dietary fiber, g31AI: 28

Potassium, mg4,044AI: 4,700

Sodium, mg1,779AI: 1,500, UL: Anterior Pituitary - Prolactin

Breast > Milk scertion.

Process in milk secretionIt is the process by which the milk is ejected or 'let down' from the alveoli to the duct before the baby can obtain it. The process is caused by a combined neurogenic and hormonal reflex involving the posterior pituitary hormone oxytocin.When the baby suckles the breast or when cries for milk, sensory impulse are transmitted through somatic nerves from the nipples to the spinal cord and then to the hypothalamus, there causing oxytocin secretion at the same time that they cause prolactin secretion. Oxytocin then carried via blood to the breast, where it causes contraction of the myoepithelial cells that surround the outer walls of the/alveoli, and initiates the ejection of milk.

Composition of colostrums and milk (Units are weight per deciliter.)

Component

Human colostrum

m

Human Milk

Cows' Milk

Water, g

-

88

88

Lactose, g

5.3

6.8

5.0

Protein, g

2.7

1.2

3.3

Casein,

Lactalbumin

1.2

3.1

Ratio

Fats

2.9

3.8

3.7

Linoleic acid

8.3%

1.6%

of fat

of fat

Sodium, mg

92

15

58

Potassium, mg

55

55

138

Chlorid, mg

117

43

103

Magnesium, mg

4

4

12

Phosphorus, mg

14

15

100

Iron, mg

0.092

0.152

0.102

Vit. A, ug

89

53

34

Vit. D, ug

0.032

0.062

Thiamine ug

15

16

42

Riboflavin, ng

30

43

157

Nicotinic acid, jig

75

172

85

Ascorbic acid, ug

4.42

4.32

1.62

Nutritional Requirement (RDA) for Lactating Mother:

During lactation mothers requirement of different nutrient is increased. The extra nutrient is mainly required for the production of milk. Lactating woman produce 800-850ml of milk daily, this is equivalent of 600 kcal. With 80% efficiency in converting food energy into milk, a mother needs an additional 750 kcal daily. The RDA table suggests that 500-550 kcal come from added food, assuming the rest will come from the stores of fat her body accumulated during pregnancy for that purpose. Calcium, phosphorus, magnesium and protein needs continue to be high because these nutrients are secreted into the milk for the baby. Folic acid requirement is lower in lactation than in pregnancy because the mothers blood volume declines.

Table: RDA for lactating mother

GroupEnergy (Kcal)Prot

(g)Fat

(g)Iron

(mg)I2(g)VitA

(g)VitB1

(mg)VitB2

(mg)Niacin

(mg)Folate

(g)VitC

(mg)

Lactation27106960762008501.81.718.227030

Diet for lactating mother:

Logically, because the mother is making milk, she needs to consume something that resembles it in composition. The obvious choice is cows milk. Basically, nutritious food should make up the reminder of the needed kcal increases. As the breast milk is a fluid, the mothers fluid intake should be liberal. A mother should need to drink between six and eight glasses of liquids daily.Guidelines for Nutritional ManagementThe diet during lactation is based on the general diet for health by adults and should include choices from the four food groups in the minimum amounts listed in below Table 1 foods may be taken in greater amounts or other food added to supply sufficient, calories to meet individual needs.Many food metabolites are excreted in breast milk and may cause gastrointestinal distress in the baby. Onions, garlic, spicy foods, chocolate, and cola should generally be consumed in moderation. Food metabolites usually appeal' in breast milk within four lo six hours following ingestion. Alcoholic beverages may be permitted in moderate amounts.

Provided that individual caloric requirements are met, a general diet with emphasis on dairy products can meet nutrient needs for all essential nutrients except iron. Supplemental iron may be recommended.

Women who strictly exclude animal products from their diets should receive vitamin B12 supplementation. Infants exclusively breast fed by these vegetarian-diet mothers have been shown to exhibit striking dysfunction of the hematopoietic and centra! nervous systems unless the mother and/or child receives vitamin B^ supplementation.table-1: Recommended Minimum Daily Intake from the Four Food Groups for Lactating WomenFood groupsMinimum Daily Amount

Milk and Milk products4 servings or equivalent

Meat and protein equivalent6-8 servings or equivalent

Fruits and vegetables4 servings including a dark green or dark yellow vegetables and citrus fruits or juice

Grains4 servings

Fluids6-8 servings

Food taboos during lactation in Bangladesh:Food items

Reason for restriction Consequences

1. Colostrum Toxic or harmful milk Less immunity and devoid Getting more nutritious milk

2. Vegetables Indigestion and sometimes Sutica. Fewer intakes of vitamins3. Beef Will develop the character of cow Less protein intake

4. Citrus fruits Will delay healing process Less intake of vitamin C and

Delayed healing process

Food taboos/misconception during lactation of the world:

1. India: pumpkin, duck egg and green vegetables are restricted during confinement period. Nutrition requirement but intake decreases.

2. Thailand: restriction about two weeks after delivery regarding beef and certain vegetables.

3. Malaysia:

i). Among Orang asli tribe children fish and fish fliet and salt are restricted.ii). Among Malre women restriction of certain fruits and vegetables for

40 days.

4. Korea: Seaweeds and soup and rice are only eaten.

5.3. Nutrition in Infancy & ChildhoodInfancy is the period which spans from birth to one year of life, is a rapid growth period. The rapid growth and metabolism of the infant, they demand ample supplies of the growth and energy nutrients. Because they are small, babies need smaller total amount of these nutrients than adults do; but as a percentage of the body weight, babies need over twice as much of most nutrients. By the end of the first six months after birth a child nearly doubles his birth weight and by one year he triples it. During this period a child begins to crawl, babble, sit and some may even walk. Girls are generally quicker in these aspects than boys.

An infant grows rapidly in the first year of life. Hence energy requirements are very high. ICMR recommends an intake of 120 cal/kg body weight in the first six months and 100 cal/kg body weights in the next six months. Rapid growth also demands higher intake of protein. Simple easily digestible protein ideally supplied through breast milk is recommended. The ICMR has recommended a protein intake of 2.3- 1.8g/kg body weight in the first months and 1.8-1.5g/kg body weight in the next six months.

Diet for infant:

Breastfeeding should begin as soon after birth as possible. Colostrum, the first milk produced by the breasts after birth, provides important protection against infection as well as nutrients for the growing infant. To insure adequate breast milk production and growth of the infant, Breastfeeding should be "on demand. Breast milk alone is sufficient for an infant from birth through four to six months of age. Breastfeeding should continue as long as possible (2-3 years) to provide continued protection from illness and important nutrients for growth and development.

The mature breast milk has the following properties which fulfill the entire requirement of the infant. They are;

1. Human milk provides all nutrients in right proportion as needed for the rate of growth of the infant and in easily digestible forms.

2. The possibility of contamination in breast feeding is less.

3. The protein present in breast milk is easily digestible.

4. Fat in breast milk comprises of PUFA especially linoleic acid and alpha linoleic acid which is very much needed for child growth.

5. Fat soluble and water soluble vitamin are in good amounts but their concentration depends largely on mothers diet.

6. Among minerals, the sodium concentration is low which supports the new born infants kidney to deal with sodium easily. Iron content though low in breast milk, is well absorbed. Calcium and phosphorus though lower than other milk are fulfilled by the ample intake of the milk.

7. Human milk contain specific immunological factor such as lymphocytes. These help in the production of immunoglobin A (IgA).

8. Breast milk contains anti-body that can protect the infant against infection and has anti-allergic properties too.

It also helps to create a strong emotional bond between the mother and the child and gives the feeling of security and warmthDIET FOR INFANTS ( UP TO ONE YEAR OF AGE)

0-5 months : Exclusive breast- feeding on demand

: No water

: No honey

: No bottle milk

5-6 months : Continue breast feeding

: Cereals- rice = twice a day

: Mashed banana, papaya, mango = once a day

: Cooked mashed potato, carrot, pumpkin = once a day

: Feed = 3-4 times /day

6-9 months : Continue breast feeding, increase all the above mentioned foods = twice a day

: Add khichri (rice + dal) or mashed chappati= twice a day

: Wheat to be introduced after 8 months = twice a day

: Washed dal

=2-3 spoons

: Mashed vegetables = twice a day

: Mashed fruit = once a day

: Feed = 4-5 times /day

9 months -1 year : Continue breast feeding, feed family food rice /chappati/khichri =3 times /day

: washed dal = twice a day

: Mashed cooked vegetables = twice a day

: Mashed fruit = once a day

: Feed = 6-7 times/ day

Breast feeding: Breast feeding is a method of feeding of an infant directly from the human breast. This is the best and most natural way of feeding the infant. Exclusively breastfeeding or giving nothing but breast milk to infants from birth is recommended up to 6 months.Breast Milk - the ideal food for the infant because it is biologically complete , easily digested and assimilated, and can support satisfactory growth and development for the first 6 months of life without the need for other foods. After 6 months, breast milk is not sufficient to sustain growth of the infant. Breast milk, especially colostrums contains antibodies that helps protect the infant from infections.Virtually all children benefit from breastfeeding, regardless of where they live. Breast milk has all the nutrients babies need to stay healthy and grow. It protects them from diarrhea and acute respiratory infections - two leading causes of infant death. It stimulates their immune systems and response to vaccinations. It contains hundreds of health-enhancing antibodies and enzymes. It requires no mixing, sterilization or equipment. And it is always the right temperature.

Children who are breastfed have lower rates of childhood cancers, including leukaemia and lymphoma. They are less susceptible to pneumonia, asthma, allergies, childhood diabetes, gastrointestinal illnesses and infections that can damage their hearing. Studies suggest that breastfeeding is good for neurological development.

And breastfeeding offers a benefit that cannot be measured: a natural opportunity to communicate love at the very beginning of a childs life. Breastfeeding provides hours of closeness and nurturing every day, laying the foundation for a caring and trusting relationship between mother and child.

Advantage of breast feeding

B = Best for baby

R = Reduces allergy

E = Economical

A = Antibodies

S = Stool inoffensive

T = Temperature in correct stage

F = Fresh

E = Emotional bonding between mother and child

E = easy

D = Digest easily

I = immediately available

N = Nutritional balance

G = Gastrointesterities greatly reduces

Breast feeding is successful when:

The baby suckles frequently

The mother wants to breast feed and is confident in her ability to do so.

COMPLEMENTARY FEEDING (WEANING) is the process of expanding the diet to include food and drinks other than breast milk (Complementary feeding (weaning) and the Complementary feeding (weaning) Diet, DoH, 1994).

Complementary feeding (weaning) is a time of nutritional vulnerability. It represents a period of dietary transition just when nutritional requirements for growth and brain development are high. A nutritionally adequate complementary feeding (weaning) diet is essential for achieving optimum growth in the first year. Growth in the first year influences both the wellbeing of the child and the long term health of the adult.

There are important nutritional and developmental reasons for introducing solid foods.

Nutritional

After about six months of age, breast milk alone cannot meet an infants energy requirements.

Both stores of iron and zinc are likely to be depleted by six months, these minerals must then be supplied in the diet.

Developmental

Introduction of different tastes and textures promotes biting and chewing skills.

Chewing improves the mouth and tongue co-ordination which is important for speech development.

Failure to introduce different textures and tastes by 6-7 months can results in their rejection later.

Proper Age of Complementary feeding (weaning): Complementary feeding (weaning) is a gradual process which does not start at a given age or weight. Current guideline states:

The majority of infants should not be given solid foods before the age of four months and a mixed diet should be offered by the age of six months

Practical Points about Complementary feeding (weaning)

A mothers attitude is important because a relaxed approach; a peaceful atmosphere is required and television and family noise are rarely helpful.

Safety should be emphasized from the start because of the risk of choking; infants must never be left alone.

If choking occurs:

1. Place the infant face down along forearm or lap

2. The head should be supported, but tipped below chest

3. Tap firmly between shoulders

Complementary feeding (weaning) is messy and mothers need to be prepared for this.

Utensils should be appropriate.

Food should not be forced on a baby.

The process of reducing milk feeds should be gradual.

Initially drop one milk feed during the day.

By eight month a second milk feed may be dropped.

Suitable first complementary feeding (weaning) foods include vegetables and fruit purees, non-wheat cereals, unsweetened yoghurt. The quantity, consistency, flavour, potential allerginicity and preparation of first foods all need to be considered.

First complementary feeding (weaning) foods should be bland and smooth, but once food is accepted from a spoon, introduction to a variety of different taste should be encouraged.

Allergenicity: Infants are most vulnerable to the initiation of food allergy in the first months of life and the risk of allergy is greatly increased by family history of atopic disease such as eczema and asthma. For these at risk infants, potential food allergens should be avoided until at least six month of age.

Common food allergens include:

Cows milk, Eggs, Citrus fruits, Nuts, Wheat, Fish etc.A vegetarian complementary feeding (weaning) diet is little different from any other in the first weeks and suitable first foods are the same, i.e. pureed fruits and vegetables, baby rice and gluten free cereals. As complementary feeding (weaning) progresses, nutrients at potential risks of insufficiency include energy, iron, good quality protein and vitamin D.

General advice can be given as follows:

Energy:

Maintain breast-milk throughout the first year.

Include energy dense foods, e.g. nut butter, ground nut and cheese, regularly

Use less bulky and low fiber vegetables.

Iron:

Give iron rich foods daily and give vitamin C rich fruits, vegetables.

Avoid giving tea or excessive quantities of whole cereals which may inhibits iron absorption.

Protein:

Include a variety of cereals, pulses and dairy products to achieve a good protein intake

Vitamins:

Vegetarians mother who are breast feeding should receive vitamin D supplements

Checklist for an adequate complementary feeding (weaning) foods or diets

1. Foods from each groups daily

2. 600 ml breast milk or infant formula milk daily

3. Vitamins drops if exclusively breast-fed after six months, or any dietary restriction

4. Iron rich foods

5. Vitamin C rich foods at meal time

6. Limited use of high fibre foods

7. Restricted use of low fat foods

8. Three meals and two snacks from around nine months.

plementary feediGuidelines for comng (weaning): 1 Breastfeeding alone is normally sufficient until an infant is 4-6 months of age.

2 From 4-6 months, soft foods should be added gradually to the diet.

3 When foods are first introduced they should be mashed smoothly; by about nine months, foods can be finely chopped; by two years, most children can manage adult foods.

4 From six months to two years, a child should be fed four to six small meals each day in addition to breastfeeding.

5 After six months, an infant should be eating body-building, energy and protective foods plus breast milk every day.

6 Food for young children, once prepared, should never be stored without refrigeration for more than two hours.

7 The hands of both mother and child should be washed before handling food.

8. Use a clean cup and spoon for feeding young children never use feeding bottles.

Recommended complementary feeding (weaning) food:

The complementary feeding (weaning) process should be gradual. It should start with some soft foods like mashed banana, mashed potatoes or other tubers.

Suggested introductory food includes;

1. Low-sugar rusks or unsweetened ground rice in milk.

2. Mashed cooked vegetables, such as carrots and potatoes.

3. Mashed cooked meat and fish with unsalted gravy

4. Mashed fruits like banana and fresh orange juice

5. Cooked egg-yolk

Gradually more carbohydrate foods (e.g. starchy vegetables, cereal products, rice, bread and fruits) and less fatty foods should be offered as the child approaches 2 years of age. A variety of protein food should be offered including plant proteins such as beans, pulses and Soya products. And animal protein also be included (e.g. meat, fish, dairy products and egg).

Nutrition of ChildrenAlthough the nutritional needs of children are similar to those of the adults; i.e. energy, protein, mineral elements and vitamins, yet they differ from those of the adults in three respects;

1. Their energy requirement per unit of weight is higher than that of the adults

2. Their food should contain a higher proportion of tissue-building materials, namely proteins and mineral elements as well as vitamins than that of adults.

3. Their diet should be made up of foods which are suitable to the digestive abilities of any given age.

Nutritional requirement of children:

In the second year and the through the years of child hood the muscle development is more and boons begin to lengthen although the skeletal growth is slower. During this period the child needs less calories but more proteins and minerals for growth. Teething continues from infancy to early childhood. The specific nutrients on which we have to give more emphasis are protein, calcium and iron. Vitamins especially C and A are required for growth and development of tissues.

Diet for children

During the year 1 to 3 the emphasis need to give more on proteins, minerals and vitamins. If supplementation of the diet has been done carefully then the child is consuming 3-meal pattern diet but without heavy spices, oils and fats. So also all bran and coarse cereals must be avoided. It is necessary in case of some toddlers who dislike milk to fed them with curds o milk solids in mashed potatoes, soups, custards or puddings. On the other hand some toddlers who may drink more milk than required may exclude some solid food in the diet. For such children food and mealtimes may be made more attractive so that acceptance of food is readily accomplished.

It must be emphasized here that refined sweets and fried foods must be totally avoided. A variety of foods must be offered in smaller amounts to provide key nutrients.

The mother may encourage some degree of food choice and self-feeding so that eating can be pleasant and positive mans of development. The preschool children (3 to 6 years) demand a lot of variety in foods. Sometimes he may gorge himself, at other times appear disinterested in food. He generally refers single foods with simple flavors rather than complicated foods and dishes such as heavily spiced curries. The child appears to be interested in the texture, color and form of the food. His need is so identify each food on the basis of its characteristics and name it. Finger foods such as raw fruit and vegetables cut in finger size are much acceptable in this age group. Milk is less preferred by the pre-schoolers. The emphasis of the diet should be on the quantity and quality. If a child is given smaller servings, a great number of them may be consumed. As they prefer to do things by themselves, they should be given opportunity to do so.

*****************************Chapter- 6: Nutrition in AdolescentsThe adolescent period is characterized by the onset of puberty which is the final growth spurt of childhood. Malnutrition of children varies widely. Boys tend to mature later than girls. This fluctuation in the development accounts for the wide differences in metabolic rates, in requirement of food in scholastic capacity. The body changes in girl and boys are the result of the hormonal changes that regulate the development of sex characteristics. This different in growth pattern also emerges as a difference in other aspects such as in the case of girls there is an increase in the accumulation of subcutaneous fat, especially around the pelvic region. Boys although slow in growth, beat the girls in height and weight science they put on more muscle mass and there is growth of the long bones.

Nutritional Requirement of Adolescents

olescent: The adolescent period is characterized by heavy demands of calories and proteins. The appetite of the child increases and he tends to consume more carbohydrate foods and fewer protein foods. The need for calcium and iron support bone and muscle growth continues. In case of girls menstrual iron losses may predispose her to simple iron deficiency anemia. Her needs for iron are more than those of boys of similar age. Since rate of metabolism is high the need for iodine is also increased. This nutrient must be taken care of in the areas lacking adequate iodine in soil and therefore in foods. It can easily be supplied through use of iodized salt. The B vitamins are required in the greater amount by boys than girls to meet the extra demands of energy and muscle tissue development. Intakes of vitamin C and A be low due to improper habits of eating snacks. It is necessary to take more care of girls than the boys, who may be vulnerable to malnourishment. If the physical activity of the girl does not match her intake may result in excessive fat deposit. Secondly, if she is figure-conscious she may follow some crash diets which will predispose her to malnutrition. The hazard of such diets can be gauged from the fact that her body is preparing for motherhood which in conditions of undernourishment or malnutrition can spell danger for the future mother.

Table 3: Simple food exchange list for adolescent boy and girl(16-18 years old)

Energy Requirement: 2820 kcal;Protein:

53 g

Food group

No. ofexchanges

Protein (g) Energy (kcal)

___________________________________________________________________

1. Milk

4

20.2

400

2. Legumes and pulse 2

12.0

200

3. Flesh food

1

10.0

100

4. Vegetable A

2

-

-

5. Vegetable B

2

-

100

6. Fruit

4

-

200

7. Cereal

12

24

1200

8. Fat

4

-

400

9. Sugar

50 g

-

200

________________________________________________________________

Total

66.0

2800

Chapter- 7: Geriatric Nutrition

Nutrition of Elderly People:The people whose age 65 years or above are considering as old people. Changes in organ function that often occur with aging. Some of the most significant changes occur in digestive system, once such change is painful deterioration of the gums and subsequent loss of teeth. The sense of taste and smell may also be altered, reducing the pleasure of eating. The stomachs secretion of hydrochloride acid and enzymes decreases, as do the secretion of digestive juices by the pancreas and small intestine. Muscles of the GI tract weaken with reduced use. Food moves slowly through GI tract and constipation may become a problem.

The heart and blood vessels also age, become weaker, and the arteries become less flexible. The decreases in blood flow through the kidneys makes them gradually less efficient at removing wastes and maintaining the bloods normal composition. Visual impairment that occurs with aging can make it difficult for the older person to shop foods and prepare them. Hearing loss is also common. As the metabolic rate slows with age, the older person may not have the same strength and energy he had when he was younger. Furthermore because the elderly are more likely to have chronic diseases, they are also likely to be taking prescription drug over long periods of time. And this increase the risk of drug related malnutrition.

During aging the bones show osteoporosis changes because of deficiency of calcium, protein, vitamins, minerals and hormones. Osteomalacia is also common, particularly in women confined in doors with deficient intake of vitamin D. The process of aging can be retarded by maintaining a strong cardiovascular and respiratory system. Exercise, regular and active enough to increase heart beat and respiration rate is one of the keys to good health in later year.

Nutritional Requirement of Elderly People:

Calorie:

The lower metabolic rate in the elderly reduces calorie requirement. A retired life, arthritis and angina reduce physical activities to minimum. Calories should therefore restrict to ombat any tendency to obesity. On the other hand, if there is loss of weight, adequate calories should be supplied to regain normal weight. Average figures for people 75 and older are 2050kcal/day for the man and 1600kcal/day for the woman.

Carbohydrate:

Science the caloric requirement of adults is lowered, it is necessary to control the intake of carbohydrate especially the simple sugar. Consumption of complex carbohydrate can be encouraged to include food such as whole grain, cereals, potatoes and dried legumes in the diet. These foods should supply about 40 to 45% of the total caloric requirement. About 5 to 10% of the total energy requirement may come from simple sugar.

Protein:

The rate of protein synthesis decreases every year as age advances. No new tissue is formed except that there is maintenance of worn out tissues. The requirement for dietary protein decreases by about 30%. It is necessary to supply protein at about 15-20% of the caloric requirement. This applies to people who have good health and do not suffer from any problems. Older person suffering from gastro-intestinal problems, infection or changed metabolic efficiency as a result of disease or medication should increase their protein intake appropriately. The daily protein intake should be at least 1.0 to 1.4 g/kg body weight.

Fat:

It is necessary to consume fat comprising about 10-15% of the total calorie intake. This is because many adults are prone to heart disease for which this preventive measure needs to b paid attention to. Serum cholesterol levels increase after the age of 50 years. Therefore one should completely avoid foods containing high levels of cholesterol such as egg yolk, whole milk, organ meats etc. Adequate use of PUFA, less or no fried foods and trimmings of all visible fats from meats would minimize the intake of saturated fats. Vegetable oil is recommended to take which helps fulfill essential fatty acid requirements and to reduce cholesterol level.

Vitamins:

The requirements for these are similar to adults. However, due to the normal aging process the ability to store fat soluble vitamins decreases. The problem of vitamin deficiency in the old may stem from inadequate intake rather than from increased need. The need for the fat soluble vitamins especially A and D may be met easily through the diet but their absorption and storage may be hampered due to lack of dietary fat, inadequate bile secretion, use of laxatives and antibiotics and/or pancreatic insufficiency. Special attention need to be given to vitamin D science bone decalcification is very common in the later years. If its requirement is not met through the diet, supplements may have to be given. Other fat soluble vitamins may be supplied through diet. Older people may require supplementation of B vitamins especially thiamine, pyridoxine, cyano-cobalamine and folic acid because their daily food intake is decreased, hence the decrease intake of dietary vitamins has to be compensated by external supplementation with vitamins. The increased needs for these vitamins may be due to less efficient absorption or altered metabolism and excretion resulting not only from physiological change but also from certain medications on drug interaction. Adequate vitamins intakes can be ensured by including foods from each of the food groups. And special emphasis should bee given to fruits and vegetables groups. If the diet consumed does not provide adequate amount of vitamins, a multivitamin tablet providing daily requirement of different vitamins should be given.

Minerals:

Special attention needs to b given to two main minerals, iron and calcium, since these may be lacking in poor diets and may need to be supplemented. The requirement of iron for women may be higher than that of men until they attain menopause. But after completion of menopause their requirement for iron is similar to that of men. Absorption of calcium decreases with age resulting in osteoporosis and fragile bones with fracture easily. Calcium is also important for maintaining health of the oral tissues.

Fluid:

The importance of adequate fluid intake so as to maintain the volume of urine excreted at minimum of 1.5 liters. They should drink about 6 to 8 glass of fluid like water, juice etc. a day.

Fiber:

Fiber recommendation for the general population should be stressed to the older citizens as well: increase the use of fruits, vegetables, legumes and whole grain cereals. The fiber consumption helps to avoid constipation and reduce cholesterol level of the body.

Guidelines for meal planning:

1. Consider the food likes and dislikes of the individual. Learn essential food dishes acceptable to the person. For example, milk may be disliked as beverage but well accepted in curd, custards, and puddings and so on.

2. Use fried foods, rich desserts, highly seasoned foods, and strongly flavored vegetables with discretion and according to the patients tolerance.

3. If chewing is difficult, adjust the meals to include finely minced or chopped meats, soft breads, fruits and vegetables.

4. Serve four or five small meals when the appetite is poor.5. Breakfast is the meal most enjoyed by many older persons, and every effort should be made to provide pleasing variety.

6. Dinner at noon rather than in the evening is preferred by some.

7. If coffee and tea produce insomnia, they should be restricted to meals early in the day.

8. Encourage a liberal fluid intake daily. Adjust the fiber content of the diet if composition is a problem.

Table 4: Simple food exchange list for an Old Man (60-80 Years)

Age: 65 yearsRequirementsEnergy-1757 kcal

Protein 55 g

Food group

No. of exchanges Protein (g) Energy (kcal)

1. Milk

4

20.

400

2. Legumes and pulses 2

12.0

200

3. Flesh food

5.0

50

4. Vegetable A

2

-

-

5. Vegetable B

2

-

100

6. Fruit

2

-

100

7. Cereal

6

12.0

600

8. Fat

2

-

200

9. Sugar

25 g

-

100

Total

49

1750

NUTRITIONAL REQUIREMENTS IN NORMAL SITUATION FOR ALL GROUPS

Average individual energy requirements and safe levels of intake for various nutrients

Sex & age groupEnergy (Kcal)Prot

(g)Fat

(g)Iron

(mg)Iodi

(g)VitA

(g)VitB1

(mg)VitB2

(mg)Niacin

(mg)Folate

(g)VitC

(mg)

Children

6-12m9501421503500.60.55.43220

1-3 y1350223013704000.90.89.05020

3-5 y1600263514904001.11.010.55020

5-7 y1820304019904001.21.112.17620

7-10 y19003442231204001.41.314.510220

Boys

10-12 y21204847231505001.71.617.210220

12-14 y22505950361506001.81.719.117030

14-16 y26507059361506001.91.819.717030

16-18 y27708159231506001.91.820.320030

Girls

10-12 y19054942231505001.51.415.510220

12-14 y19555943401506001.61.516.417030

14-16 y20306445401505501.61.515.817030

16-18 y20606346481505001.41.415.217030

Men-active

18-60 y28955564231506001.91.819.820030

> 60 y20205545231506001.91.819.820030

Women-active (non pregnant or non lactating)

18-60 y22104949481505001.41.314.517030

> 60 y18354941191505001.41.314.517030

Pregnant24105654761756001.61.516.842030

Lactating27106960762008501.81.718.227030

Safe levels of intake are the levels that maintain health and nutrient stores in almost all healthey individuals within a group.Chapter-8 Primary Nutritional Diseases

Primary Nutritional Diseases

Major nutritional deficiency diseases are--> Protein-Energy Malnutrition (PEM)

Vitamin A Deficiency Disorders (VADD)

Nutritional anemia (esp. Iron)

Iodine Deficiency Disorders (IDD)Vitamin A Deficiency Disorders (VADD)

VADD : VADD is a comprehensive term that covers all the effects of the deficiency state, including those on health, survival and vision. VAD is the underlying cause of xeropthalmia.Vitamin A requirements

Retinol Equivalents (RE) per day

( 1 RE = 1 g retinol)

Child

1-6 years

400 RE

Adult

Women

500 RE

Men

600 RE

Pregnancy

600 RE

(FAO/WHO, 1983)

Major food sources

Dark green leafy vegetables

Yellow fruits

Carrots

Palm oils

Liver and liver oilsFunctions

Vision (night, day, colour)

Epithelial cell integrity against infections

Immune response

Haemopoiesis

Skeletal growth

Fertility (male and female) and Embryogenesis

Stages of deficiency

Subclinical

Clinical

reducing stores

xerophthalmia

lowering serum level

- non-blinding

metaplasia

- blinding

Xerophthalmia classification by ocular signs

Night blindness (XN)

Conjunctival xerosis (X1A)

Bitots spot (X1B)

Corneal xerosis (X2)

Corneal ulceration/keratomalacia (X3A)