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170 Social and Preventive Medicine

Nutrition and Health

Questions
357. Prudent diet is: (Maharashtra 2005)
a. Diet for dietary goal achievement
b. Diet, which contains variety of foods to safe guard from deficiencies
c. Diet on which a person or group lives
d. Diet, which fulfills recommended daily allowances

358. The Reference protein is: (JIPMER 1986; UPSC 1986)


a. Milk
b. Meat
c. Egg
d. Pulses

359. The guidelines under the CSSM programme recommend that a


low birth baby with good suckling and without any signs of illness
can be managed at home with special care even if the birth weight
of baby is as low as: (UPSC 1997)
a. 2200 grams
b. 2000 grams
c. 1800 grams
d. 1500 grams

360. Positive health indicators of nutritional status include all of the


following EXCEPT: (BHU 1985)
a. Anthropometric measurements of pre-school children
b. Height of school children at school entry
c. Weight of antenatal mothers
d. Prevalence of low birth weight

361. Severe wasting is: (ORISSA 2000)


a. < 60%
b. <70%
c. <80%
d. <90%

170
Nutrition and Health 171
362. BMI (Body Mass Index) is defined as: (JIPMER 2000, AI 2005)
Weight (kg)
a. ————————————————
(Height)2 (meters)

Weight (kg)
b. ——————————————————
(Height)1.6 (cm)

Mid-arm circumference (cm)


c. —————————————————————
Head circumference (cm)

d. Midarm circumference (cm) between ages of 1-5 years

363. ‘Cut-off’ point to define obesity in “Body Mass Index” for females
is: (Delhi 2002)
a. 30 b. 28.6
c. 26 d. 25

364. One of the following is not true about PONDERAL INDEX: (Kerala
2000)
a. It is a measure of obesity
b. It is independent of height and weight
c. It is height and weight dependent
d. Age independent
e. Used for measurement of body weight in adults

365. Which of the following indices is not an index of measurement of


obesity?
a. Body mass index
b. Ponderal index
c. Broca index
d. Sullivan’s index

366. True about NPU (Net protein utilization) is all EXCEPT: (DNB 197)
a. NPU of cow’s milk = 80 %
b. NPU of average Indian diet =50-80 %
c. Low NPU requires increased protein requirement
d. NPU is weight gain per unit protein consumed

367. All are true about NPU EXCEPT: (AI 2000)


a. NPU of milk is 75%
b. NPU of Indian diet is 50-80%
c. NPU is weight gain per unit consumption of proteins
d. If NPU is more, requirement of proteins is more
172 Social and Preventive Medicine
368. Most essential fatty acid which serves as a basis for production
of other fatty acids (EFA) in the body, is known as: (UPSC 2005)
a. Amino acid score
b. Net protein utilization
c. Biological value
d. Protein efficiency ratio

369. According to maternal health programme the daily dose of folic


acid for pregnant women should be: (Bihar 2001)
a. 100 mg
b. 200 mg
c. 300 mg
d. 400 mg

370. RDA of folic acid in adult pregnant woman is: (JIPMER 1995)
a. 50 mcg
b. 150 mcg
c. 300 mcg
d. 500 mcg

371. The dose of iron and folic acid given as supplement during
pregnancy is: (AIIMS 1986)
a. 200 mg and 500 mg
b. 60 mg and 500 mg
c. 200 mg and 500 mg
d. 200 mg and 1 mg

372. The extra energy allowances needed per day during pregnancy
is: (AI 2006)
a. 150 KCals
b. 200 KCals
c. 300 KCals
d. 550 KCals

373. All of the following are nutritional requirements during pregnancy


EXCEPT: (UP 2002)
a. 2 gm Sodium
b. 500 mg Calcium
c. Energy 20% extra
d. Protein 10 gms/day

374. Extra energy required in first trimester of pregnancy: (ORISSA


2004)
a. 350 kcal b. 450 kcal
c. 550 kcal d. 650 kcal
Nutrition and Health 173
375. The recommended daily energy intake of an adult woman with
heavy work is: (AIIMS 2001).
a. 1800
b. 2100
c. 2300
d. 2900

376. The highest % of essential fatty acid is found in: (Orissa 1999)
a. Butter fat (Ghee)
b. Sunflower seed oil
c. Corn oil
d. Groundnut oil

377. Which one of the edible oil yields highest quantity of


polyunsaturated fatty acids? (UPSC 2004)
a. Coconut oil
b. Corn oil
c. Groundnut oil
d. Sunflower seed oil

378. According to WHO criteria the adult pregnant female is said to be


anaemic when her hemoglobin level in venous blood is less than:
(Kar 1999, ESIS 2005)
a. 10 gm/dl
b. 11 gm/dl
c. 12 gm/dl
d. 13 gm/dl

379. Which of the following vitamin deficiency diseases occurs in


maize eating population? (MP 2004)
a. Beriberi
b. Megaloblastic anaemia
c. Pellagra
d. Night blindness

380. Maize is deficient in: (MH PGM CET 2000)


a. Methionine
b. Lysine
c. Lucine
d. All

381. Lysine is deficient in: (UP 2004)


a. Cereals
b. Pulses
c. Jowar
d. Soyabean
174 Social and Preventive Medicine
382. Limiting amino acid in Soya bean is: (PGI 1978, AIIMS 1985, DNB
1994, AIIHPH 2001)
a. Threonine
b. Lysine
c. Methionine
d. Tryptophan

383. Net protein utilization of fish is: (UPSC 2004)


a. 57%
b. 67%
c. 74%
d. 87%

384. Practically fish does not have: (ESIS 2005)


a. Carbohydrates
b. Fat
c. Protein
d. Vitamin A

385. Dates are rich source of: (AP 2004)


a. Calcium
b. Iron
c. Vitamin C
d. Carotene

386. Which of the following toxin causes Lathyrism? (MP 2003)


a. Berberine
b. Pyrazolidone
c. Sanguinarine
d. BOAA

387. Which of the toxins causes epidemic dropsy? (UPSC 1986)


a. BOAA
b. Sanguinarine
c. Pyrazolidine
d. None

388. Consumption of which of the following causes epidemic dropsy?


(Delhi 2002)
a. Keshri dal
b. Mustard oil
c. Argemone oil
d. Ergot
Nutrition and Health 175
389. To check the efficiency of pasteurization following tests are done
EXCEPT: (JIPMER 2003)
a. Phosphatase test
b. Standard plate count
c. Coliform count
d. Milk ring test

390. Daily need of calories in pregnancy is (CUPGEE 1999)


a. 1500 kCals
b. 2000 kCals
c. 2500 kCals
d. 3500 kCals

391. Parboiling of paddy helps in retraining: (Kar 1994)


a. Vitamin C
b. Vitamin A
c. Niacin
d. Thiamine

392. Reference protein is: (AIIHPH 2001)


a. Egg
b. Milk
c. Meat
d. Fish

393. Daily requirement of protein is (AI 1988; JIPMER 1986)


a. 1 g/kg body weight
b. 1.2 g/kg body weight
c. 0.9 g/kg body weight
d. 1.5 g/kg body weight

394. Average weight of newborn in India is (in kg): (J and K 2004)


a. 2.5
b. 2.8
c. 3
d. 3.5

395. The best indicator for monitoring the impact of Iodine Deficiency
Disorders Control programme is: (NIMHANS 2004)
a. Prevalence of Goiter among school children
b. Urinary iodine levels among pregnant women
c. Neonatal Hypothyroidism
d. Iodine level in soil
176 Social and Preventive Medicine
396. Dose of vitamin D in children: (UP 2002)
a. 100 IU
b. 200 IU
c. 300 IU
d. 400 IU

397. Which one of the following has highest “Glycemic Index”? (AIIMS
2003)
a. Corn flakes
b. Brown rice
c. Ice cream
d. Whole wheat bread
Nutrition and Health 177

Nutrition and Health

Answers
357. Ans. a (Diet for dietary goal achievement)
(Ref. Park PSM 18th ed. 461)
Prudent diet is diet developed by National nutrition and food policy
for achievement of “dietary goal”.
The Prudent diet recommended by WHO is:
· Dietary fat < 20-30 % of total daily intake
· Saturated fat <10% of total energy intake.
· Avoid excessive consumption of refined carbohydrates.
· Energy rich sources (fat and alcohol) restricted.
· Salt intake should not be more than 5gm per day.
· Proteins should be 15 to 20% of daily intake.
· Junk foods should be reduced.

358. Ans. c (Egg)


(Ref. Park PSM 17th ed.-429)
Egg:
· It is a standard protein against which quality of other proteins is
compared (reference protein).
· An egg weighing 60 g contains 6 g of protein, 6 g of fat, 30mg of
calcium and 1.5 mg of iron and supplies about 70 kCal of energy.
· Except for vitamin C and carbohydrates, egg contains all the
nutrients.
· It has all 9 essential amino acids.
· Net protein utilization (NPU) which combines in a single value
the biological value and digestibility, is 100 for egg, 80 for meat
and 75 for milk.
· Cholesterol content of egg is 250mg/egg.
· Biotin deficiency is caused by antibiotic overuse and ingestion of
raw eggs (avidin in egg white AVIDLY binds to biotin).

359. Ans. c (1800)


(Ref. Park PSM 18th ed. 344, OP Ghai 6th ed. 157)
Child Survival and Safe Motherhood Programme (CSSM)
Was started in 1992.
Its components were:
1. Advice on food, nutrition and rest
2. Birth spacing
3. Clean deliveries by trained personnel
177
178 Social and Preventive Medicine
4. Detection of high risk pregnancies and prompt referral
5. Early registration of pregnancy
6. Minimum 3 ANC check-up
7. Promotion of institutional deliveries
8. TT for all pregnant women

LBW babies weighing over 1800 grams constitute 90% of all


neonates and can be managed at home following the same
principles of management of LBW neonates.

RCH Programme (RCH)


RCH Programme has integrated the CSSM services and the major
interventions are essential obstetric care, 24 hour delivery services
at PHCs /CHCs, emergency obstetric care, medical termination
of pregnancy, prevention of reproductive tract infection (RTI) and
sexually transmitted diseases (STD), and district surveys.

The main highlights of the RCH programme are


1. The programme integrates all interventions of fertility regulation,
maternal and child health with reproductive health for both men
and women.
2. The services to be provided will be client oriented, demand driven
high quality and based on needs of community through
decentralized participatory planning and target free approach.
3. The programme envisages up-gradation of the level of facilities
for providing various interventions and quality of care. The First
Referral Units (FRUs) being set-up at sub-district level will provide
comprehensive emergency obstetric and newborn care; similarly
RCH facilities at PHCs will be substantially upgraded.
4. It is proposed to improve facilities of obstetric care, MTP and IUD
insertion in the PHCs. Also for IUD insertion at subcentres.
5. Specialist facilities for STD and RTI will be available in all district
hospitals and in fair number of sub-district level hospitals.
6. The programme aims at improving the out-reach of services
primarily for the vulnerable group of population.

Interventions in All Districts


1. Child Survival interventions, i.e., immunization, vitamin A (to
prevent blindness), oral rehydration therapy and prevention of
deaths due to pneumonia.
2. Safe motherhood intervention, e.g., antenatal check-up,
immunization for tetanus, safe delivery and anaemia control
programme.
3. Implementation of target free approach.
4. High quality training at all levels.
5. Elective activities.
Nutrition and Health 179
6. Specially designed RCH package for urban slums and tribal areas.
7. District sub-projects under local capacity enhancement.
8. RTI/STD clinics at district hospitals (where not available).
9. Facility for safe abortions at PHCs by providing equipment,
contractual doctors, etc.
10. Enhanced community participation through panchayats,
women’s groups and NGOs
11. Adolescent health and reproductive hygiene.

This programme had the following components


1. Early registration of pregnancy
2. To provide minimum three antenatal check-ups
3. Universal coverage of all pregnant women with TT immunization
4. Advice on food, nutrition and rest
5. Detection of high risk pregnancies and prompt referral
6. Clean deliveries by trained personnel
7. Birth spacing, and
8. Promotion of institutional deliveries.

360. Ans. c (Weight of antenatal mothers)


(Ref. Park PSM 18th ed.24)
Nutritional status indicators
Nutritional status is a positive health indicator.
Three nutritional status indicators are considered important
indicators of health status:
a. Anthropometric measurements of pre-school children
b. Height of school children at school entry
c. Prevalence of low birth weight (< 2.5kg)

361. Ans. b (<70%)


(Ref. Park PSM 18th ed.464)
Nutritional status Stunting Wasting
(% of height/age) (% of weight/age)
Normal >95 >90
Mildly impaired 87.5-95 80-90
Moderately impaired 82 87.5 70-80
Severely impaired < 80 <70

362. (Weight (kg)


Ans. a. —————————————
(Height)2 (meters)

(Ref. Park PSM 18thed.316, 470)


180 Social and Preventive Medicine
Body Mass Index (BMI)
♦ It is most useful index for obesity in young children and adoles-
cents.
♦ Overweight when BMI > 85th percentile of that age sex.
♦ Obesity when BMI > 95th percentile of that age sex.
♦ Obesity is also classified as BMI > 30
♦ Normal BMI value range from 18.5 to 24.99.
♦ It does not distinguish between weight associated with muscle
and weight associated with fat.

(Weight (kg)
BMI (Quetlet’s index) = —————————————
(Height)2 (meters)

Weight (kg)
Dugdale’s Index = ———————————————
(Height)2 (meters)

Weight (kg)
Rao’s index = —————————————
(Height)1.6 (cm)

Mid-arm circumference (cm)


Kanawati’s Index = —————————————————————
Head circumference (cm)

363. Ans. a (30)


(Ref. Park PSM 18thed.316)
Classification of adults based on BMI
Classification BMI Risk of co-morbidities
Underweight <18.50 Low
Normal range 18.50-24.99 Average
Overweight ≥ 25
Pre-obesity 25-29.99 Increased
Obese class I 30-34.99 Moderate
Obese class II 35-39.99 Severe
Obese class I II 30-34.99 Very Severe

364. Ans. b, d, e
(Ref. Park PSM 18th ed.318)
Height in cm
Ponderal Index = ———————————————————
Cube root of body weight in cm
Nutrition and Health 181
365. Ans. d (Sullivan’s index)
(Ref. Park PSM 18th ed. 124, 318)
Body weight, though not an accurate measure of excess fat is a
widely used index.
For adults, various other indicators for measurement of excess fat
are:
♦ BMI
♦ Ponderal index
♦ Broca’s index
♦ Lorentz index
♦ Corpulence index

366. Ans. a (NPU of cow’s milk = 80 %)


(Ref. Park PSM 18th ed.459)
Net protein utilization (NPU)

Nitrogen retained by the body


NPU = x 100
Nitrogen intake
♦ It is a product of digestibility co-efficient and biological value divid-
ed by 100.
♦ NPU of rice is 63%
♦ NPU of meat is 85%
♦ NPU of milk is 75%
♦ NPU of Egg is 100%
♦ NPU of average Indian diet = 50-80 %
♦ Low NPU requires increased protein requirement

Protein - Energy Ratio

Energy from protein


PE percent = ———————————— x 100
Total energy in diet

367. Ans. d (If NPU is more, requirement of proteins is more)


(Ref. Park PSM 18th ed.459)
♦ NPU is a product of digestibility co-efficient and biological value
divided by 100.
♦ NPU of rice is 63%
♦ NPU of meat is 85%
♦ NPU of milk is 75%
♦ NPU of Egg is 100%
♦ NPU of average Indian diet =50-80 %
♦ Low NPU requires increased protein requirement
182 Social and Preventive Medicine
368. Ans. b (Net protein utilization)
(Ref. Park’s Textbook of PSM 18 th Ed. – 459 and above Q for
explanation)
Most essential fatty acid which serves as a basis for production of
other fatty acids (EFA) in the body, is known as Net protein utilization.

369. Ans. d (400 mg)


(Ref. Park PSM 18th ed. 447)
Folic acid supplementation during pregnancy has been found to
increase birth weight of infants and decrease the incidence of low
birth weight babies.

Intake values of folic acid recommended by ICMR (1989):


Status In mg/Per day
Healthy adults 100
Pregnancy 400
Lactation 150
Children 100

370. Ans. d (500 mcg)


(Ref. Park PSM 18thed. 465)
Supplemental dose of iron and folic acid in pregnancy is 60 mg
elemental iron and 500 mg of folic acid.

371. Ans. b (60 mg and 500 mg)


(Ref. Park PSM 18thed. 465)
♦ Supplemental dose of iron and folic acid in pregnancy is 60 mg
elemental iron and 500 mg of folic acid.
♦ One tablet of iron and folic acid containing 60mg of elemental
iron (180mg ferrous sulphate) and 0.5 mg of folic acid should be
given to mothers.
♦ A total of 100 tablets of iron and folic acid are given to a pregnant
woman by the health worker.

372. Ans. c (300 KCals)


(Ref. Park PSM 18thed. 458)
——————————————————————————————
Group Type of work Energy allowances
(kcals/day)
——————————————————————————————
Adults Males Light work 2425
Moderate work 2875
Heavy work 3800
Adults Females Light work 1875
Moderate work 2225
Nutrition and Health 183
Heavy work 2925
Pregnancy +300
Lactation 1st 6 months +550
6-12 months +400
——————————————————————————————
Recommended daily nutrients for female of 50 kg weight
——————————————————————————————
Nutrient’s Non-pregnant Pregnancy Lactation
——————————————————————————————
Kcals 2200 2500 2900
Proteins (gm) 50 60 70
Calcium (gm) 500 1000 1500
Iron (mg) 18 40 30
Vitamin A (IU) 5000 6000 8000
Vitamin D (IU) 400 400 400
Vitamin B12(mcg) 2 2 2
——————————————————————————————
Female Basic Kcals Pregnancy+300 Kcals

Sedentary work 1875 2175


Moderate work 2175 2474
Heavy work 2925 3225

373. Ans. d (Protein 10 gms/day)


(Ref. Park PSM 18thed. 465)
Female Basic Kcals Pregnancy+300 Kcals
Sedentary work 1875 2175
Moderate work 2175 2474
Heavy work 2925 3225

Requirements in Pregnant women (50 kg)


♦ Net energy  + 300 Kcal/d
♦ Protein  + 15 g/d
♦ Fat  30 g/d
♦ Calcium  1000 mg/d
♦ Iron  38 mg/d
♦ Retinol  600 microgm/d
♦ Beta carotene  2400 microgm/d
♦ Thiamin  +0.2 mg/d
♦ Riboflavin  +0.2 mg/d
♦ Nicotinic acid  +2 mg/d
♦ Pyridoxine  2.5 mg/d
♦ Ascorbic acid  40 mg/d
184 Social and Preventive Medicine
♦ Folic acid  400 microgm /d
♦ Vitamin B12  1 microgm/d

374. Ans. a (350 kcal)


(Ref. Park PSM 18thed. 458)
——————————————————————————————
Group Type of work Energy allowances per day
(kcals)
——————————————————————————————

Adults Males Light work


2425
Moderate work
2875
Heavy work
3800
Adults Females Light work
1875
Moderate work
2225
Heavy work
2925
Pregnancy +300
Lactation 1st 6 months +550
6-12 months +400
——————————————————————————————

375. Ans. c (2300)


Recommended daily nutrients for female of 50 kg weight
——————————————————————————————
Nutrient’s Non-pregnant Pregnancy Lactation
——————————————————————————————
Kcals 2200 2500 2900
Proteins (gm) 50 60 70
Calcium (gm) 500 1000 1500
Iron (mg) 18 40 30
Vitamin A (IU) 5000 6000 8000
Vitamin D (IU) 400 400 400
Vitamin B12(mcg) 2 2 2
——————————————————————————————

376. Ans. c (Corn oil)


(Ref. Park PSM 18th ed. 440)
——————————————————————————————
Type of oil % of Essential fatty acid (PUFA)
——————————————————————————————
Coconut oil 2%
Palm oil 9%
Mustard oil 15%
Sunflower seed oil 56%
Corn oil 57%
Groundnut oil 39%
Nutrition and Health 185
Safflower oil 73%
Soyabean oil 7%
Meat, eggs 0.5-0.3%
Milk (fat) 0.4-0.6
Leafy greens varied
Fish oil 10%
——————————————————————————————

377. Ans. b (Corn oil)


(Ref. Park PSM 18th ed. 440)
——————————————————————————————
Type of oil % of Polyunsaturated fatty acid (PUFA)
——————————————————————————————
Coconut oil 2%
Butter 3%
Margarine 50%
Palm oil 10%
Cottonseed oil 50%
Groundnut oil 31%
Sunflower seed oil 65%
Corn oil 65%
Safflower oil 75%
Soyabean oil 62%
——————————————————————————————

378. Ans. b (11 gm/dl)


(Ref. Park PSM 18th Ed. 450)
Cut-off points for the diagnosis of anaemia:
Category Venous blood (g/dl) MCHC (%)
Adult male 13 34
Adult non-pregnant female 12 34
Adult pregnant female 11 34
Children, 6 months to 6 years 11 34
Children, 6 years to 14 years 12 34

379. Ans. c (Pellagra)


(Ref: Park, PSM, 17th ed., 427)
Cereal and pulse proteins complement each other and provide a
more balance and “complete” protein.
Germinating pulses, however, contain higher concentration of
vitamins, especially vitamin C and B; pulses are called “poor man’s
meat”.
186 Social and Preventive Medicine
——————————————————————————————
Food material Rich in Deficient in
——————————————————————————————
Cereals

Maize Fat, excess leucine (Pellagra) Lysine and tryptophan.

Rice Lysine and Vitamin B Vitamins A, D and C, Ca++,


Iron

Wheat Protein, Vitamin B Lysine and threonine

Milled rice - Thiamine, riboflavin,


(Polished rice) niacin, proteins

Millets

Jowar Excess Leucine (Pellagra) Lysine and threonine.

Ragi Calcium -

Bajra Calcium, iron, vitamin B Lysine and threonine

Pulses (Legumes)

Pulses 20–25% of proteins, Lysine, Methionine and cystein.


Mineral, vitamin B

Soya bean: 40% of protein, 20% of fat, Methionine


and 4% of minerals.

Vegetables : “protective foods” High vitamin and mineral content,


leaf proteins (2 to 4%) are good sources of lysine, Leafy vegetables
are high in water content and dietary fibre, Low caloric value. The
recommended daily intake of green leafy vegetables 40g for an
adult.
Milk: Milk is a good source of all vitamins except vitamin C.

380. Ans. a (Methionine)


(Ref. Park PSM 17th ed.-427)
Wheat: The limiting amino acids are lysine and threonine.
Maize: Proteins of maize are deficient in tryptophan and methionine.
Jowar (sorghum and bajra): The protein content varies from 9 to
14% and the proteins are limiting in lysine and threonine. It is
pellagrogenic due to excess Leucine content.
Ragi: is rich in calcium.
Pulses (Legumes)
♦ Pulses contain 20–25% of proteins.
Nutrition and Health 187
♦ Pulse proteins are poor in methionine and to a lesser extent in
cystein.
♦ Germinating pulses, however, contain higher concentration of
vitamins, especially vitamin C and B.
♦ Pulses are called “poor man’s meat”.

381. Ans.a (Cereals)


(Ref. Park PSM 17th ed.-426)
Cereals
♦ Cereal proteins are poor in nutritive quality, being deficient in the
essential amino acid, lysine.
♦ Proteins of maize are still poorer, being deficient in lysine and
tryptophan.
♦ Cereal and pulse proteins complement each other and provide a
more balance and “complete” protein (AI-2002).
♦ Rice proteins are richer in lysine than others and devoid of vitamins
A, D and C.

382. Ans. c (Methionine)


(Ref. Park PSM 18thed.554)
Soyabean:
40% of protein, 20% of fat, and 4% of minerals.
♦ Limiting amino acid is methionine.
♦ Highest amount of protein is found in it (40%).

383. Ans. c (74%)


(Ref. A.P. Kulkarni Community Medicine 2nd Ed. – 609)
NPU of various eatables:
Milk – 85
Egg – 96
Meat – 76
Rice – 77
Wheat – 61
Bengal gram – 61
Fish NPU – 74%

384. Ans. a (Carbohydrates)


(Ref. Park PSM 18th ed. 456)
Fish is rich in unsaturated fatty acids, vitamin D and vitamin A, and
proteins. It practically does not contain carbohydrates.

385. Ans. a (Calcium)


(Park PSM 18thed. 448)
Sources of calcium
♦ Milk and its products
♦ Green leafy vegetables
188 Social and Preventive Medicine
♦ Cereals and millets
♦ Ragi
♦ Sitaphal
♦ Drinking water
♦ Dates

386. Ans.: d (BOAA)


(Park’s textbook of PSM – 18th ed. 564)
Lathyrism
♦ Neurolathyrism is a crippling disease of the nervous system
characterized by gradually developing spastic paralysis of lower
limbs, occurring mostly in adults consuming the pulse, Lathyrus
sativus, is commonly known as “Khesari Dhal”.
♦ The toxin present in Lathyrus is beta oxalyl amino alanine (BOAA).
♦ It is common in Madhya Pradesh (MP).
♦ The disease affects mainly young men in the age group of 15–45
years and manifests itself in stages:
a) Latent stage
b) No-stick stage
c) One-stick stage
d) Two stick stage
e) Crawler stage.
Interventions
a) Vitamin C prophylaxis
b) Banning the crop
c) Removal of toxin
i) Steeping method
ii) Parboiling
iii) Education
iv) Genetic approach
v) Socio-economic changes

387. Ans. b (Sanguinarine)


(Ref: Park, PSM, 18thed., 479)
Epidemic Dropsy
· Caused by a toxic alkaloid sanguinarine from argemone oil.
· This toxic substance interferes with the oxidation of pyruvic acid
which accumulates in the blood of sudden, non-inflammatory,
bilateral swelling of legs, diarrhea.
· Dyspnoea, cardiac failure and death may follow glaucoma.
· Following tests may be applied for the detection of argemone oil:
(1) Nitric acid test
(2) Paper chromatography test - the most sensitive test as yet

388. Ans. c (Argemone oil)


(Ref: Park, PSM, 18thed.479; Refer above Q. for explanation)
Nutrition and Health 189
Ergot is not a storage fungus, but a field fungus, e.g., Claviceps
fusiformis. Symptoms are acute but rarely fatal and include nausea,
repeated vomiting, giddiness and drowsiness extending peripheral
gangrene due to vasoconstriction of capillaries have Ergot-infested
grains can be easily removed by floating them in 20% salt water.

389. Ans. d (Milk ring test)


(Ref. Park’s textbook of PSM – 18th ed. 477)
Pasteurization
♦ It may be defined as the heating of milk to such temperatures
and for such periods of time as are required to destroy any
pathogens that may be present while causing minimal changes
in the composition, flavour and nutritive value.
♦ Pasteurization kills nearly 90% of the bacteria in milk including
the more heat resistant tubercle bacillus and the Q fever
organisms.
♦ Neither themoduric bacteria nor the bacterial spores are killed.
♦ To check the growth of microorganisms, pasteurized milk is rapidly
cooled to 40C.
Methods of Pasteurization:
1. Methylene Blue Reduction Test: It is an indirect method for
detection of micro-organisms in milk. The milk that remains blue
the longest is considered to be of the best quality.
2. Holder (Vat) Method: In this process, milk is kept at 63–660C for
at least 30 minutes, and then quickly cooled to 50C.
3. HTST Method: “High temperature and short time method”. Milk is
rapidly heated to a temperature of nearly 720C, is held at that
temperature for not less than 25 sec, is then rapidly cooled to
40C. This is now the most widely used method.
4. UHT Method: “Ultra-high temperature method”. Milk is rapidly
heated usually in 2 stages to 1250C for few seconds only.
To check the efficiency of pasteurization:
1. Phosphatase test: to check the efficiency of pasteurization. The
test is used to detect inadequate pasteurization.
2. Standard plate count: Bacteriological quality of pasteurized milk
is determined by the standard plate count
3. Coliform count: Their presence in pasteurized milk is an indication
either of improper pasteurization or post-pasteurization contami-
nation.

390. Ans.: c (2500 kCals)


(Park’s textbook of PSM – 17th edition – 435; A.P.Kulkarni 2nd
ed.627,628)
For moderately working woman it is 2225 kCals / day + 300 kCals
/ day for pregnancy)
190 Social and Preventive Medicine

Female Basic Kcals Pregnancy+300 Kcals


Sedentary work 1875 2175
Moderate work 2175 2474
Heavy work 2925 3225

391. Ans. d (Thiamine)


(Ref. Park PSM 18th ed. 453)
♦ Parboiling (partial cooking in steam) is ancient Indian technique
of preserving the nutritive quality of rice.
♦ Technique of parboiling recommended by Central food
technological research institute, Mysore is known as the ‘hot
soaking process’.
♦ The process starts with soaking the paddy (unhusked rice) in hot
water at 65-70oC for 3-4 hours, which swells the grain, which is
followed by draining of water and steaming the soaked paddy in
the same container for 5-10 minutes. The paddy is then dried,
and later home-pounded or milled.

392. Ans. a (Egg)


Egg:
· It is a standard protein against which quality of other proteins is
compared (reference protein).
· An egg weighing 60 g contains 6 g of protein, 6 g of fat, 30mg of
calcium and 1.5 mg of iron and supplies about 70 kCal of energy.
· Except for vitamin C and carbohydrates, egg contains all the
nutrients.
· It has all 9 essential amino acids.
· Net protein utilization (NPU) which combines in a single value
the biological value and digestibility, is 100 for egg, 80 for meat
and 75 for milk.
· Cholesterol content of egg is 250mg/egg.
· Biotin deficiency is caused by antibiotic overuse and ingestion of
raw eggs (avidin in egg white AVIDLY binds to biotin).

393. Ans. a (1 g/kg body weight)


(Ref: Park, PSM, 17th ed., 413, 432)
——————————————————————————————
Criteria Indian Indian
Reference man Reference woman
——————————————————————————————
Weight 60 kg 50kg
Age 20-39 years 20-39 years
Occupation Moderate Moderate
Working hours 8 8
BMR kCal/hr/m2 35.5 31.6
Nutrition and Health 191
2
Surface area m
1.62 1.40
Energy needed (kCal)
1380 1062
Protein requirement
60gm/day 50gm/day
(1 gm/kg/day) (1 gm/kg/day)
——————————————————————————————

394. Ans. b (2.8)


(Park PSM 17th ed.377)
Average weight of newborn in India is 2.8 kg.
——————————————————————————————
Age (months) 0 5 12 24 36 60 120
Weight (kg) 2.8 x2 x3 x4 x5 x6 x10
Height (cm) 50 - 73 90 - 105 130
HC (cm) 35 - 45 438 - - 52
——————————————————————————————
395. Ans: c (Neonatal Hypothyroidism)
Epidemiological assessment of iodine deficiency
Indicators are useful in this regard
a)Prevalence of goiter.
b)Prevalence of cretinism.
c) Urinary iodine excretion.
d)Measurement of thyroid function by determination of serum levels
of thyroxine (t) and pituitary thyrotropic hormone (TSH) and
prevalence of neonatal hypothyroidism.

396. Ans. b (200 IU)


Dose of vitamin D in different age group:
Infants and children  200 IU (5.5 mcg)
Adults  100 IU (2.5 mcg)
Pregnancy and lactation  400 IU (10 mcg)

397. Ans. a (Corn flakes)


Glycemic index
♦ It measures how fast food is likely to raise the blood sugar and
helps in managing the blood sugar in diabetic patients.
♦ It indirectly measures effect of foods on blood sugar.
♦ It indicates area under blood glucose curve.
♦ Corn has highest “Glycemic Index”
————————————————————
Food Glycemic Index
————————————————————
Corn 83
Wheat 66
Bran 51
————————————————————

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