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The human body utilizes the potential energy contained in foods for maintaining life & doing work. The
energy yielding food factors are:
1.)Y ?arbohydrates.
2.)Y Fats.
3.)Y Proteins.
within the body, these nutrients are oxidized in the cells with the help of catalysis such as enzymes, ?o-
enzymes (containing certain vitamins) & harmones the process is one of continuous utilizaton of O2 &
production of ?O2 water & heat:

carbohydrates & fats oxidation ?O2 + H2O + Heat

Proteins oxidation ?O2 + H2O + Urea




The energy or calorific value of foods depends on the quantity of carbohydrates, fats & proteins present
in them. This can be determine by oxidising a known weight of food an instrument called bomb
calorimeter & measuring the heat produced.

  
The energy value of foods can be expressed in terms of kilocalories (kcal) or megajoules(mj). The unit
union of nutritional sciences has suggested the use of megajoules (mj) as the energy unit in place of
kcal.

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The energy needed to increase the temperature of a gram of water by 1 degree ?elsius depends on the
starting temperature and is difficult to measure precisely.


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The energy metabolism of a subject at complete physical & mental rest & having normal body
temperature and in the past absorptive state i.e. 12 hours after intake of last meal is known as basal
energy metabolism.

&'# %("

Basal metabolic rate (BMR) is the amount of energy expended while at rest in a neutrally temperate
environment, in the post-absorptive state (meaning that the digestive system is inactive, which requires
about twelve hours of fasting in humans). The release of energy in this state is sufficient only for the
functioning of the vital organs, such as the heart, lungs, brain and the rest of the nervous system, liver,
kidneys, sex organs, muscles and skin. BMR decreases with age and with the loss of lean body mass.
Increased muscle mass can increase BMR.

BMR is measured under very restrictive circumstances when a person is awake, but at complete rest. An
accurate BMR measurement requires that the person's sympathetic nervous system not be stimulated.
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It is defined as that percentage of absorbed N which is retained in the body. A protein of high
biological value contains proper amounts of all the essential amino acids and is utilized in a better
way. ?ollagens, gelatins and proteins of cereals and pulses have low biological values. These are
deficient in some essential amino acids. Egg protein, gelatine & maize protein have biological values
of 96, 63 & 60. A mixture of several proteins of low biological values may have better BV as an
essential amino acid is one of them may be compensated by sufficient amounts of the amino acid in
the other proteins. This is known as the supplementary value of proteins. Therefore, eating cereals
with pulses improves the biological values of both of them.

Estimation of biological value.

biological value can be estimated in a number of ways.

c("  
To estimate the biological value of a protein, the animals is first kept on a protein-free diet for a couple
of days and the faecal N & the urinary N are estimated to obtain the amounts of the metabolic faecal N
& endogenous urinary N, respectively. Then the animal is fed with a measured amount of the test
protein & the faecal urinary nitrogens are determined again. The biological value is calculated thus:

#,-../+c0%(""c'0+ c0  c'


c0+"c1%(""c'


"&'2 ""+2 '

It is defined as weight gain per gram protein intake when the protein under test is the sole source of
dietary protein. PER for casein is taken as 2.5. Total protein intake is determined from the total dietary
intake & % composition of protein in the diet (usually, 10%). PER can be calculated from the
equation.

2 ,3,+ (41(4'


25 
65

The common practice to express PER of the test protein as a proportion of the PER obtained with a
standard diet containing 10% casein. The advantage of PER is that it eliminates the cumbersome
measurement of nitrogen excretion. Its main shortcoming is that PER values vary with test animals,
giving higher values when the food appeals to the experimental animals.

&'c2+c2'

NPR was essentially designed to correct the shortcoming of PER. It is determined over a shorter
feeding period of 10 days with an additional control fed on a protein free diet.

c2,3& 74& 6 



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In designing, NPR it is assumed that weight loss by rats on a protein free diet is equivalent to the
amount of protein required for maintenance functions & that above maintenance of N balance
requirements, protein depositon (or retention) efficiency is directly proportional to intake. Hence, the
inclusion of a control on protein-free diet & the shortening of the feeding period of 4 week to 10 days.
Like PER, the NPR value is expressed as a proportion of the NPR of standard diet as 2.5.

The assumption of linearity of N deposition has been found to apply only at points just below & just
above the maintenance level. Therefore, NPR values are ureliable when protein intakes deviate
substantially from maintenance level.

&'c2 8+c2 '

It is concerned with the proportion of dietary protein N intake retained by experimental animal. By
definition:

c2 ,6c,2c0+"c1 c'0+ 1c1 c'


2c5+2c' 2c

Where EFN & EUN stands for endogenous faecal N & endogenous urinary N respectively.
Again, values are expressed as % of the values obtained for a standard protein. The NPU values
obtained with protein concentrations at about maintenance level are often distinguished from those
obtained.


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Recommended ietary Allowances (R As) are the levels of intake of essential nutrients that, on the
basis of scientific knowledge, are judged by the Food and Nutrition Board to be adequate to meet the
known nutrient needs of practically all healthy persons.

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Estimate basal energy expenditure using the Harris-Benedict equations.

    #& & & =
66.5 + (13.75 x kg) + (5.003 x cm) - (6.775 x age)

 4    #& & & =

655.1 + (9.563 x kg) + (1.850 x cm) - (4.676 x age)

Total ?aloric Requirements equal the B.E.E. multiplied by the sum of the stress and activity
factors. Stress plus activity factors range from 1.2 to over 2.

The recommended dietary allowance for males & females of different age groups are tabulated as
below:
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The following table provides you with energy, protein, ?arbohydrate and Fat content of most of the
Indian foods, classified under different food groups such as:

Y ?ereal grains .
Y Pulses (dals).
Y Leafy vegetables.
Y Roots and tubers .
Y Other vegetables .
Y Fruits.
Y Milk and milk products .
Y Meat and poultry.
Y Fishes and sea food.
Y Fats and oils .
Y Sugars.
Y Nuts and oil seeds .

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1.)Y The nutritional status of an individual is often the result of many inter-related factors.
2.)Y It is influenced by food intake, quantity & quality & physical health.
3.)Y The spectrum of nutritional status spread from obesity to severe malnutrition.

cc  
The purpose of Nutritional Assessment is to:
1.) Identify individuals or population groups at risk of becoming malnourished.
2.)Y Identify individuals or population groups who are malnourished.
3.) To develop health care programs that meet the community needs which are defined by the
assessment.
4.) To measure the effectiveness of the nutritional programs & intervention once initiated.

%   

1.) Nutrition is assessed by two types of methods; direct & indirect.
2.)Y The direct methods deal with the individual & measure objective criteria, while indirect
methods use community health indices that reflects nutritional influences.

"    
These are summarized as AB?.
1.)Y Anthropometric methods.
2.)Y Biochemical, laboratory methods.
3.)Y ?linical methods.
4.)Y .ietary evaluation methods.

"    
These include three categories:
1.)Y Ecological variables including crop production.
2.)Y Economic factors e.g. per capita income, population density & social habits.
3.)Y Vital health statistics particularly infant & under % mortality & fertility index.

"  
1.)Y It is an essential features of all nutritional surveys.
2.)Y It is the simplest & most practical method of ascertaining the nutritional status of a group
of individuals.
3.)Y It utilizes a number of physical signs, (specific & non specific), that are known to be
associated with malnutrition & deficiency of vitamins & micronutrients.
4.)Y Good nutritional history should be obtained.
5.)Y General clinical examination, with special attention to organs like hair, angles of the
mouth, gums, nails, skin, eyes, tongue, muscles,bones & thyroid gland.
6.)Y .etection of relevant signs helps in establishing the nutritional diagnosis.

"  

 
1.) Fast & easy to perform.
2.) Inexpensive.
3.) Non-invasive.
  
1.) not detect early cases.
 $ $2  c
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% is the condition that develops when the body does not get the right amount of the
vitamins, minerals, and other nutrients it needs to maintain healthy tissues and organ function.

Malnutrition occurs in people who are either under-nourished or over-nourished. Undernutrition is a

consequence of consuming too few essential nutrients or using or excreting them more rapidly than
they can be replaced.

Infants, young children, and teenagers need additional nutrients. So do women who are pregnant or
breast-feeding. Nutrient loss can be accelerated by diarrhea, excessive sweating, heavy bleeding
(hemorrhage), or kidney failure. Nutrient intake can be restricted by age-related illnesses and
conditions, excessive dieting, severe injury, serious illness, a lengthy hospitalization, or substance
abuse.

The leading cause of death in children in developing countries is protein-energy malnutrition. This
type of malnutrition is the result of inadequate intake of calories from proteins, vitamins, and
minerals. ?hildren who are already undernourished can suffer from protein-energy malnutrition
when rapid growth, infection, or disease increases the need for protein and essential minerals.

  $ 6 

Poverty and lack of food are the primary reasons why malnutrition occurs in the United States. Ten
percent of all members of low income households do not always have enough healthful food to eat,
and malnutrition affects one in four elderly Americans. Protein-energy malnutrition occurs in 50% of
surgical patients and in 48% of all other hospital patients.

There is an increased risk of malnutrition associated with chronic diseases, especially disease of the
intestinal tract, kidneys, and liver. Patients with chronic diseases like cancer, AI.S, and intestinal
disorders may O
  rapidly and become susceptible to undernourishment because they
cannot absorb valuable vitamins, calories, and iron.

People with drug or alcohol dependencies are also at increased risk of malnutrition. These people
tend to maintain inadequate 
for long periods of time and their ability to absorb nutrients is
impaired by the alcohol or drug's affect on body tissues, particularly the liver, pancreas, and brain.

Unintentionally losing 10 lb (4.5 kg) or more may be a sign of malnutrition. People who are
malnourished may be skinny or bloated. Their skin is pale, thick, dry, and bruises easily. Rashes and
changes in pigmentation are common.

Hair is thin, tightly curled, and pulls out easily. Joints ache and bones are soft and tender. The gums
bleed. The tongue may be swollen or shriveled and cracked. Visual disturbances include night
blindness and increased sensitivity to light and glare.

Other

 
of malnutrition include:
—Y Anemia.
—Y .iarrhea.
—Y .isorientation.
—Y   (enlarged thyroid gland).
—Y loss of reflexes and lack of coordination.
—Y muscle twitches.
 —Y scaling and cracking of the lips and  .

Malnourished children may be short for their age, thin, listless, and have weakened immune systems.

2

1.) Breast-feeding a baby for at least six months is considered the best way to prevent early-
childhood malnutrition. The United States .epartment of Agriculture and Health and
Human Services recommend that all Americans over the age of two. ?onsume plenty of
fruits, grains, and vegetables.

2.) Eat a variety of foods that are low in fats and  O
 O
and contain only moderate
amounts of salt, sugars, and sodium.

3.) Engage in moderate physical activity for at least 30 minutes, at least several times a week.

4.) Achieve or maintain their  O.

5.) Use alcohol sparingly or avoid it altogether.

6.) Every patient admitted to a hospital should be screened for the presence of illnesses and
conditions that could lead to protein-energy malnutrition. Patients with higher-than-average
risk for malnutrition should be more closely assessed and reevaluated often during long-term
hospitalization or nursing-home care.

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