Lecture 1 : Measurement of Fat soluble Vitamins.

Every living creature require some essential food in order to survive, maintain
health, to get energy and reproduce. Human beings also need specific foods that
are different from other living creatures, in order to survive, perform daily tasks,
prevent themselves from diseases and to maintain healthy life. For the best
functioning, human body needs vitamins and minerals in a specific amount.
These nutrients and minerals help the body in the production of muscles,
strengthening of bones , formation of red blood cells and chemical messengers, in
metabolism and boosting the immune system. Human body needs them in tiny
amount therefore, they are known as micronutrients. Vitamins and minerals are
different in that vitamins are made by living things, while minerals are found in
the earth. For example, carrots produce beta carotene, which the body turns into
vitamin A and minerals, such as iron and copper, can be found in soil and rock.
Vitamins are much more delicate than minerals and can break down with heat or
age, and they are organic while minerals are inorganic, making their chemical
form more simple than that of vitamins. Plants get minerals from soil and water.
By this, human body get minerals through plants because chemical structure and
properties of minerals are maintained. These micronutrients also interact in the
process of absorption or functioning of each other e.g vitamin D helps in vitamin
C absorption, vitamin C helps in the absorption of iron. There are 13 essential
vitamins (A, B, C, D, E, and K, with 8 vitamins in the B complex). These
vitamins are divided into two types, fat soluble and water soluble. Fat soluble
vitamins are vitamin A, D, E and K. As its name indicate, these vitamins are
stored in body fats. Vitamin A is also known as retinol and it is measured through
its concentration in serum and plasma. If the concentration is below 10 micro
gram/dl , then there is deficiency and the value is below 20 micro gram/dl, then it
is normal. Vitamin A sources include dairy products, liver, fish, fortified cereals,
carrots, broccoli, cantaloupe, and squash. Vitamin D, also known as sunshine
vitamin, occurs in two forms, ergocalciferol ( D2 ) and cholecalciferol ( D3 ).
These are biologically inactive and are activated in liver in the form of 25
Hydroxyvitamin D. Vitamin D is measured by the by concentration of 25
Hydroxyvitamin D in plasma. If the concentration is above 27.5 nmol/L , then it
is normal.If the concentration lies between 20 to 27.5 nmol/L, then it is
insufficiency and if the concentration is below 20 nmol/L, then it is severe
deficiency of vitamin D and these concentration changes with season. Vitamin D
sources are sunlight, egg, milk , cereal, cheese.Vitamin E has antioxidant
properties and helps in maintaining cell integrity and DNA synthesis.Vitamin E
is also measured by Plasma concentration. When the value lies between 5-20
microgram/ml among adults and children of age 12 or above, and 3-15
microgram/ml in humans, it is considered as normal concentration.Vitamin E
sources are coconut oil, olive oil, avocado, almond, spinach and peanut. Vitamin
K helps the body in wound healing, blood clotting and bone health. Vitamin K is
measured by the plasma and tissue level by high performance liquid
chromatography ( HPLC ). The normal range of vitamin K is 0.2-3.2 ng/mL. Its
sources are egg, fish oil, meat, bean, soybean and spinach.

Lecture 2 : Measurement of Water soluble Vitamins.

Water-soluble vitamins dissolve in water and are not stored by the body. Since
they are eliminated in urine, we require a continuous daily supply in our diet. The
water-soluble vitamins include the vitamin B-complex group and vitamin C.
Vitamin B-complex group include thiamin (vitamin B1), riboflavin (vitamin B2),
niacin (vitamin B3), vitamin B6 (pyridoxine), folate (folic acid), vitamin B12,
biotin and pantothenic acid. Thiamin or vitamin B1, helps the body to release
energy from foods, promotes normal appetite and plays a role in muscle
contraction and conduction of nerve signals. Vitamin B1 sources are whole grain
products, seeds, oatmeal and fish. To determine the status of Thiamin, red cell
transketolase assay is used and fresh whole blood, not the plasma, is required.
When the transketolase activity is increased due to the addition of coenzyme
thiamine pyrophosphate ( TPP ), it indicates thiamin deficiency. Thiamin
deficiency causes nausea, nerve damage, depression and fatigue. Riboflavin or
vitamin B2, helps to release energy from foods and is also important for the
formation of the red blood cells in the body. Vitamin B2 sources are yogurt,
whole grain breads, green leafy vegetables, milk, cheese, egg and meat.
Riboflavin concentration is assessed by the measurement of erythrocytes
glutathione reductase activity coefficient ( EGRA ) which expresses as a ratio of
results with or without added flavin adenine dinucleotide which act as a co-factor
for EGRA. The deficiency of vitamin B2 is indicated by the ratio of 1.3 and
normal level of vitamin B2 is indicated by the ratio less then 1.3. Niacin or
vitamin B3, is involved in energy production and helps the body in critical
cellular and digestive system. Vitamin B3 sources are eggs, brown rice, baked
potato, fish and milk. Vitamin B3 concentration can be identify by measurement
of its metabolites N-methylnicotinamide (NMN) and N-methyl-2-pyridone-5-
carboxamide. When the NMN ratio is less then 1.5 mmol/mol, deficiency of
Vitamin B3 occurs. Other measures include red cell nicotinamide adenine
dinucleotide ( NAD ) concentration and fasting plasma tryptophan. Vitamin B6,
also known as pyridoxine, aids in protein metabolism, red blood cell formation,
and behaves as an antioxidant molecule. Its sources are raisins, corn, banana and
green leafy vegetables. Plasma concentration of pyridoxal phosphate can be
measured by in order to assess the Vitamin B6 concentration. If the value is
above 30 nmol/l, then the concentration is adequate. Above or below this range
show deficiency or excess of Vitamin B6. Vitamin B12, also known as
cobalamin, aids in the building of genetic material, production of normal red
blood cells, and maintenance of the nervous system. Its sources are poultry,
eggs , milk products, meat and fish. Vitamin B12 concentration is determined by
it’s serum level using radioligand binding or microbiological assay. The
concentration is considered normal when it is more then 150 pmol/l and less then
this would be considered deficiency. Folate, also known as folic acid, aids in
protein metabolism, promoting red blood cell formation, and lowering the risk for
neural tube birth defects. Its sources are leafy and dark green vegetables, beans,
peas, asparagus and liver. Folic acid concentration is determined by serum folate
level. The normal levels are 2-11.0 microgram/l and normal cellular levels are
150-700 micorgram/l. Pantothenic Acid and Biotin are involved in energy
production, aids in the formation of hormones and the metabolism of fats,
proteins, and carbohydrates from food. They are present almost in every food,
plant based as well as animal based. Biotin level is measured by using
microbiological assays in whole blood and the normal range lies between 0.22 to
0.75 microgram/ml. Pantothenic acid is measured in blood and urine and normal
values are less then 100 microgram/dl. Vitamin C aids in wound healing, bone
and tooth formation, strengthening blood vessel walls, improving immune system
function and increasing absorption and utilization of iron. Vitamin C is present
potatoes, fortified juices, kiwi, mangoes, yellow peppers, citrus fruits and melon.
Vitamin C concentration is measured by it’s plasma and leukocytes level. For
plasma level, less then 11mmol/l shows deficiency and more then 17mmol/l is
adequate. For leukocyte levels, less then 2.8pmol/106 are adequate.

Lecture 3 : Measurement of Minerals

Minerals are inorganic substances required by the body in small amounts for a
variety of different functions. Minerals are divided into two categories, major and
trace minerals. The major minerals are calcium, chloride, magnesium,
phosphorus, potassium, sodium, and sulfur. Trace minerals include iron,
manganese, copper, iodine, zinc, cobalt, fluoride, arsenic, nickel, silicon, boron,
chromium, selenium and cobalt. Major minerals are used and stored in large
quantities in the body, some might absorb quickly ( like potassium ) while some
require a carrier for absorption and transportation ( like calcium ). These major
minerals help the body in maintaining fluid balance, makin teeth and bones
healthy and stabilizing protein structures. Sodium balances fluids in the body,
helps send nerve impulses, and helps make muscles contract. Sodium
concentration is measured in plasma and the normal range of sodium lies
between 135-150mmol/l. Calcium builds bones and teeth, activates enzymes
throughout the body, helps regulate blood pressure and nerves to send messages.
Calcium is 99% percent stored in bones. The daily requirement of calcium for
males and females under the age of 19 to 50 is 1000 mg/day. The normal value of
plasma for calcium is 2.15-2.55mmol/l and about 50% of the plasma calcium is
bounded to protein, specifically albumin. Potassium balances fluids in the body,
helps to maintain a steady heartbeat and to make muscles contract, involved in
acid base regulation, and may benefit bones and blood pressure. Potassium is also
measured in plasma and it’s normal range is 3.5-5.0mmol/l. Out of the total body
calcium, 95% of calcium is found in cells. Phosphorous, in the form of
phosphate, is present in every cell of the body and 80-85% is founded is founded
with calcium in hydroxyapatite. Phosphorus plays key roles in regulation of gene
transcription,constituent of nucleic acid, activation of enzymes, maintenance of
normal pH in extracellular fluid, and intracellular energy storage. Phosphate
concentration is measured in serum by colorimetric methods. The normal range
of phosphorous in adult is 0.7-1.5mmol/l. Magnesium builds bones and teeth. It
also helps to regulate blood pressure and blood sugar and enables muscles to
contract, nerves to send messages, blood to clot, and enzymes to work.
Magnesium status is also measured in serum and the normal range lies between
0.7-1.0mmol/l. Trace minerals are present in the body in small amounts. Trace
minerals function primarily as catalysts in enzyme systems, strengthens bones,
some metallic ions participate in oxidation-reduction reactions in energy
metabolism. There deficiency and excess can lead to problematic conditions such
as Mn overload leads to iron deficiency and low intake of iodine can lead to
weight gain. Iron helps make hemoglobin (the oxygen-carrying chemical in the
body's red blood cells) and myoglobin (a protein in muscle cells). Iron is essential
for activating certain enzymes and for making amino acids, collagen,
neurotransmitters, and hormones. Iron deficiency is the most widespread mineral
deficiency in the world. The sources of iron are milk, cereals, meat, liver, poultry
etc. Iron deficiency develop in 3 stages. Fe depletion, in which serum ferritin
levels will fall below 12 microgram/l. Fe deficient erythropoiesis, in which serum
Fe concentration is low and transferrin saturation is less then 16%. Fe deficiency
anaemia, in which hemoglobin level is less then 11.5mg/l in women and less then
13mg/l in men. Copper assists with metabolizing fuel, making red blood cells,
regulating neurotransmitters, and mopping up free radicals. An adult body has 80
mg of Cu in their body. Copper is measured in serum and normal levels are 12-26
microgram/l. Iodine is involved in maintaining normal synthesis and operation of
thyroid hormone, by catalyzing the conversion of thyroid stimulating hormone
(TSH) into triiodothyronine (T3) and thyroxine (T4), preventing the incidence of
hypothyroidism, ensuring optimal neural development in the growing fetus in
pregnancy, lowering the risk of goitre and promoting memory, concentration and
intelligence. Iodine status is indicated by the levels of thyroid stimulating
hormone (TSH). In severe deficiency, serum level of T3 and T4 decline.
Selenium play critical roles in reproduction, thyroid hormone metabolism, DNA
synthesis, and protection from oxidative damage and infection. Selenium level is
measured in whole blood and the normal concentration lies between 70-
150ng/ml.

Lecture 4 : Water (1)

Water makes up 50-75% of human body weight. A loss of just 4% of total body
water leads to dehydration, and a loss of 15% can be fatal. Likewise, a person
could survive a month without food but wouldn’t survive more then 10-14 days
without water. Water is also a main component of body cells and almost all the
reactions of a cell occur in the presence of water. Men have more percentage of
water in the body cells than woman because of more muscle tissues. The
newborns have highest water content and it decreases with age. The fluids of the
human body are divided into two fluid compartments, intracellular and
extracellular. Intracellular fluid is the fluid found inside cells. It is separated into
compartments by membranes that encircle the various organelles of the cell and it
accounts for about 65% of total body fluid. Extracellular fluid (ECF) usually
denotes all the body fluid that is outside of the cells and it accounts for about
35% of the total body fluid. Water is important because water lubricate and
cushion joints, spinal cord, and tissues, helps in excretion of waste through
perspiration, urination, and defecation, helps maximize physical performance,
helps in preventing constipation, aids in digestion, helps with nutrient absorption,
improves blood oxygen circulation, helps keep skin bright, prevents overall
dehydration, helps to maintain body temperature/pH and aids in cognitive
function.

Lecture 5 : Water (2)

Being attentive to the amount of water we drink each day is important for optimal
health. Most people drink when they’re thirsty, which helps regulate daily water
intake. People get about 20 percent of their daily water intake from food. The rest
is dependent on drinking water and water-based beverages. The amount of water
intake depends on age, gender, environmental temperature and physical
conditions. For adults, the average water requirement is 1ml for every calorie
consumed. Certain medical conditions increases the water requirement such as
diarrhea, hyperthyroidism and fever. Every life stage has it’s specific water
requirement. Among infants ( of age 0-6 and 6-12 months), the water
requirement is 0.7 and 0.8 litre/day. In children ( of age 1-3 and 4-18 years), the
water requirement is 1.3 and 1.7 litre/day. Males (from age 9-13 and 14-18
years), the adequate intake of water is 2.4 and 3.3 L/day and from 19 years
onward, the adequate intake of water is 3.7 L/day. Females (from age 9-13 and
14-18 years), the adequate intake of water is 2.1 and 2.3 L/day and from 19 years
onward, the water requirement is 2.7 L/day. As deficiency and excess of anything
is dangerous. Therefore, for optimum health, the body must be in the state of
homeostasis. For maintaining homeostasis, the body must in the state of fluid and
electrolyte balance. Almost 500 ml of water per day is lost through the skin,
lungs, and feces and for maintaining balance, this loss must be replaced in terms
of both volume and electrolyte content. Electrolytes are measured in
milliequivalents (mEq/L). Noticeable water loss is water loss through urine and
unnoticeable water loss is water loss in feces, perspiration and respiration. Water
moves through cell wall by osmosis, which is a process in which molecules of a
solvent tend to pass through a semipermeable membrane from a less concentrated
solution into a more concentrated one. Sodium is the major solute in extracellular
fluids, so it effectively determines the osmolarity of extracellular fluids.
Potassium is the most abundant cation in the intracellular fluid and it plays a vital
role in the maintenance of normal cell functions. There are variety of factors that
lead to fluid imbalances such as environmental factors, personal behaviors,
psychological influences and consequences of diseases. Environmental factors
include exposure to sun or high atmospheric temperatures. Personal behaviors
include fad diets, excessive water intake etc. Psychological influences are fatigue,
depression, excess of alcohol and low protein intake. Consequences of diseases
include fever, diarrhea, valvular diseases and fatigue.

Lecture 6 : Water (3)

Dehydration occurs when loss of fluid is more than take in, and the body doesn't
have enough water and other fluids to carry out its normal functions. If one don't
replace lost fluids, he will get dehydrated. The most common causes of
dehydration in is severe diarrhea, infections affecting the lungs or bladder,
excessive perspiration and excessive urination. Signs of dehydration are rapid
heartbeat, sunken eyes, sleepiness, lack of energy, confusion or irritability, not
peeing or having very dark yellow pee, very dry skin, muscle cramps, dry oral
mucous membranes, weight loss and headache. Dehydration is especially
dangerous for young children and older adults. It is because when water is lost,
electrolytes are lost as well. Water loss of average 10% can cause serious
problems and 20% loss can cause circulatory failure and lead to death. As it is
necessary to maintain fluid and electrolyte balance, the body must also maintain
acid base balance. An acid is a substance which releases hydrogen ions (H+) on
dissociation in solution. A base is a substance which in solution accepts hydrogen
ions. pH is a scale of 0-14 of acidity and alkalinity. Pure water has a pH of 7 and
is neutral (neither acidic nor alkaline). pH above 7 is alkaline and below 7 acidic.
Hydrochloric acid is secreted by stomach and ammonia is a base produced in the
kidneys. The pH of blood is 7.35-7.45. The kidneys and lungs maintain the
balance (proper pH level) of acids and bases in the body. Alkalosis occurs when
our body has too many bases. It can occur due to decreased blood levels of
carbon dioxide, which is an acid. It can also occur due to increased blood levels
of bicarbonate, which is a base. Acidosis is caused by an overproduction of acid
that builds up in the blood or an excessive loss of bicarbonate from the blood. A
person can maintain his health if he consciously concern about the balance of
fluid and electrolytes as well as acid base balance.

Lecture 7 : Dietary guidelines (1)

The word "diet" immediately make people think of an unpleasant weight-loss
regimen but there is another meaning of this word. Diet refers to the food and
drink a person consumes daily and the mental and physical circumstances
connected to eating. According to WHO, health is a state of complete physical,
mental and social well being and not merely the absence of disease or infirmity.
Therefore, if a person has some psychological or physical or social problems,
then he is not a healthy person. As over consumption of any thing is dangerous,
dietary components should also be taken in balance. Over consumption of dietary
components leads to non communicable diseases such as diabetes, hypertension,
obesity and oral diseases due to the disproportionate consumption of fats, sugar
and other minerals. Therefore , dietary guidelines formed by nutrition and health
authorities and scientifically proven by epidemiological studies should be
followed in order to achieve and maintain good health. Poor eating habits include
under or over eating, not having enough of the healthy foods we need each day,
or consuming too many types of food and drink, which are low in fibre or high in
fat, salt and/or sugar. Poor nutrition can contribute to the risk of developing some
illnesses and other health problems such as being overweight or obese, tooth
decay, high blood pressure, high cholesterol, heart disease and stroke, type-2
diabetes, osteoporosis, some cancers and depression. Diverticular disease consists
of three conditions that involve the development of small sacs or pockets in the
wall of the colon, including diverticulosis, diverticular bleeding, and
diverticulitis. Osteoporosis is a bone disease that develops when bone mineral
density and bone mass decreases, or when the quality or structure of bone
changes. This can lead to a decrease in bone strength that can increase the risk of
fractures.

Lecture 8 : dietary guideline 2

As dietary guidelines are formed by health authorities, they provide advice on
what to eat and drink to meet nutrient needs, promote health, and prevent
diseases. The Dietary Guidelines are utilized by experts to structure the premise
of Federal nourishment strategy and projects, backing nourishment schooling
endeavors, guide neighborhood,state, and public wellbeing, advancement and
illness anticipation activities and advise different associations and enterprises.
Every country in the world has its specific guidelines depending on the prevailing
diseases and socioeconomic patterns of the population. If a country's population
has more cardiovascular diseases, the dietary guidelines would include those
foods that include less fat level. For example, in US, obesity and diabetes are
major problems. In South Asia, problems of malnutrition exist. In Pakistan, India
and Bangladesh, the ratio of stunting is very high. All of these countries form
their own guidelines while specifically focusing on these issues. The dietary
guidelines of Asia pacific region include variety of foods that helps in
appropriate growth, avoiding obesity and increasing physical activity such as
meat, poultry, fish, fruits, whole grain cereals in a specific quantity. Negative
factors that are involved in the dietary guidelines of Asia pacific region include
the use of salt, refined sugar, alcohol and fats. Pakistan dietary guidelines for
better nutrition are a set of dietary recommendations based on scientific and
epidemiological evidence to meet the nutrients requirement of population through
improved dietary practices and healthy lifestyles. These guidelines include
exclusive breastfeeding the baby in the first six months and continue
breastfeeding along with complementary feeding at least for two years, limiting
the consumption of edible oil and fat in cooking, consumption of fortified flour,
grains and their products, limiting the use of salt in cooking and always using
iodized salt and consumption of meat and meat products, fish and eggs in
moderation.

Lecture 9 : RDA 1
Dietary reference values (DRVs) are the values that indicate the amount of a
nutrient which must be consumed on a regular basis to maintain health in an
otherwise healthy individual or population. They include recommended dietary
allowance (RDA), reference nutrient intake (RNI), low reference nutrient intake
(LRNI) and estimated average requirement (EAR). Recommended dietary
allowances (RDAs) refer to the average daily intake level of a particular nutrient
that is likely to meet the nutrient requirements of healthy individuals in a
particular life stage or gender group. Knowledge of nutrients requirement by
different age groups is essential for transforming nutrients into portions of foods
required by each age group. They are formed from epidemiological studies,
which depend on deciding mean supplements admission of the reference
population. The period of infancy (0-6 months) is characterized rapid body
growth and development. Infants gain about 4-5 kg weight and 15-16 cm length
during this period and breastfeeding is recommended due to its unique nutrients
composition best suited for the baby. Nutrients supplied by mother's milk are
considered adequate for the optimal growth and development of infants. The
energy requirement during this period is 113kcal/kg/day at birth to 81kcal/kg/day
at 6 months for boys and 107 kcal/kg/day at birth to 57 82 kcal/kg/day at 6
months for girls.

Lecture 10 : RDA 2
During the period of second half of infancy and young children (6-24 months),
growth speed becomes relatively slow. The average weight and height gain
during this period is 4kg body weight and 20 cm height. The energy requirement
for this age group is 80-82kcal/kg/day for boys and girls. Protein requirements
during the first and second years of life are 1.69 g and 1.25 g / kg /day. The
energy requirements are 200Kcal/day for 6-8 month-old infants, 300kcal/day for
9-11month old infants and 550 kcal/day for 12-23 month-old children. Children
at the age group of 24-36 months grow, learn and acquire skills, enjoy greater
mental and motor skills and are actively engaged in eating and playing. The
energy requirement for this age group is 80kcal/kg/day and the protein
requirement is 1.1g/kg/day. The total energy requirements of children in this age
group range between 1000-1400 kcal/day depending on age, size, sex and
physical activity. Children during the period of 3-10 years gain about 2-2.5 kg
body weight/year and 5-6cm height/year. Energy requirements for boys and girls
are estimated at 80 kcal/kg/day and 77 kcal/kg/day at age 3 but decreased to 67
kcal/kg/day and 61 kcal/kg/day at age 10 for boys and girls. Protein requirement
for this age group children is 1.2 g/kg/day. During the period of adolescents (10-
19 years), the average weight and height gain is about 3-5 kg/year and 6-7
cm/year. Energy requirements for adolescent boys and girls are 55-65
kcal/kg/day and 45-60 kcal/kg/day. Protein requirement for adolescents is 1.1-1.2
g/kg/day. During the period of adults (19-60 years), bone mass increases till the
age of 30-35 years. For adults with 60 kg body weight, energy requirements are
2318, 2727 and 3485 kcal/day and for women with 55 kg body weight, energy
requirements are 1899, 2234 and 2854 kcal/day. Protein requirement for adults is
1g/kg/day. During the period of elderly ( greater then 60 years), nutritional
requirement depends upon the health status. During this age period, adequate
dietary and nutritional supplements should be provided in order to improve their
nutritional well being.

Lecture 11 : RDA 3
Human body has increased nutritional needs during pregnancy because of
feeding a whole new person. Nutrients requirement vary in three trimesters,
based on the growth and development of fetus. The total cost of energy during
pregnancy is estimated at around 80,000 kcal, which comes to 300 kcal per day.
Energy requirement for the second and third trimesters are 300 kcal per day and
the protein requirement for the second and third trimesters are 7g/day and
23g/day.. For overweight and obese women, weight gain should be less then 12
kg. For normal- moderate women, weight gain should be 12 kg and for
underweight women, weight gain should be between 12-14 kg. Nutrient needs
during lactation depend primarily on the volume and composition of milk
produced and on the mother's initial nutrient needs and nutritional status. Energy
requirement for lactating women is 500 kcal/day and the protein requirement are
19g and 13g during the first and second six months of lactation. The daily intake
requirement of selected nutrients ( vitamins, minerals, proteins, fats ) for
Pakistani population varies depending upon age and gender. The AI is a
recommended average daily nutrient intake level, based on experimentally
derived intake levels or approximations of observed mean nutrient intake by a
group (or groups) of apparently healthy people that are assumed to be adequate.
An AI is established when there is insufficient scientific evidence to determine an
RDA. The tolerable upper intake level (UL) refers to the maximum daily intake
levels at which no risk of adverse health effects is expected for almost all
individuals in the general population. In other words, the UL is the highest usual
intake level of a nutrient that poses no risk of adverse effects.

Lecture 12 : Nutritional assessment 1

Nutritional assessment can be defined as the interpretation from dietary,
laboratory, anthropometric, and clinical studies. It is used to determine the
nutritional status of individual or population groups as influenced by the intake
and utilization of nutrients. Nutritional status represents meeting of human body
needs for nutritive and protective substances and the reflection of these in
physical, physiological, and biochemical characteristics, functional capability,
and health status. Generally there are 4 nutritional assessment methods,
anthropometry, biochemical, clinical and dietary methods. While using the
anthropometry method, there are four different measurements for the assessment
of growth in children including length, height, weight and head circumference.
By using the length measurement, a wooden measuring board (also called sliding
board) is used for measuring the length of children under two years old to the
nearest millimetre. Procedure of the length measurement is ; both assistant and
measurer are on their knees, the assistant holds the child’s head with both hands
and makes sure that the head touches the base of the board, the assistant’s arms
should be comfortably straight, the line of sight of the child should be
perpendicular to the base of the board (looking straight upwards), the child
should lie flat on the board , the measurer should place their hands on the child’s
knees or shins , the child’s foot should be flat against the footpiece , read the
length from the tape attached to the board, record the measurement on the
questionnaire.

Lecture 13 : Nutritional assessment 2

When using height measurement, the child or adult should be in a standing
position. The head should be in the Frankfurt position during measurement and
the shoulders, buttocks and the heels should touch the vertical stand.
Measurements are recorded to the nearest millimetre. Procedure for the height
measurement is ; Both the assistant and measurer should be on their knees, the
right hand of the assistant should be on the shins of the child against the base of
the board , the left hand of the assistant should be on the knees of the child to
keep them close to the board, the heel, the calf, buttocks, shoulder and occipital
prominence (prominent area on the back of the head) should be flat against the
board, the child should be looking straight ahead, the hands of the child should be
by their side, the measurer’s left hand should be on the child’s chin, the child’s
shoulders should be levelled, the head piece should be placed firmly on the
child’s head , the measurement should be recorded on the questionnaire. When
using the weight measurement, a weighing sling, also called the ‘Salter Scale’ is
used for measuring the weight of children under two years old, to the nearest 0.1
kg. A beam balance is used and the measurement is also to the nearest 0.1 kg. If
available, a digital electronic scale can be used. Readjusting the scale to zero
before each weighing is important. Instructions for using the weight measurement
are ; Adjust the pointer of the scale to zero level, take off the child’s heavy
clothes and shoes, hold the child’s legs through the leg holes , hold the child’s
feet, hang the child on the Salter Scale , read the scale at eye level to the nearest
0.1 kg, remove the child slowly and safely.

Lecture 14 : Nutritional assessment 3

While assessing nutritional status, variety of experiences happen in field setup.
For instance in the field set up, it is hard to gauge extremely little youngsters who
can't sit without help from anyone else and a few kids become panic during the
estimation and pee. Therefore, moms or guardians may not be happy or allow
their kids to be measured in such a way. One must need to guarantee the bowl is
as near the ground as conceivable due to the chance that if the child drops out,
there must have a sense of safety during gauging. In the event that the bowl is
filthy, at that point one need to clean it with a disinfectant. While measuring
weight using secca weight machine, first we get the weight of the mother and
then we press the reset button in order to make the reading zero. After resetting,
child is given to mother and the machine/ scale will show the reading of child
weight only. An index is a combination of two measurements or one
measurement plus the person’s age. A few indices that one may find useful are:
Weight-for-age is an index used in growth monitoring for assessing children
who may be underweight. It helps in assessing weight-for-age of all children
under two years old when carrying out your community-based nutrition (CBN)
activities every month. Height-for age is an index used for assessing stunting
(chronic malnutrition in children). Stunted children have poor physical and
intellectual performance and lower work output leading to lower productivity at
individual level and poor socioeconomic development at the community level.
Stunting of children in a given population indicates the fact that the children have
suffered from chronic malnutrition so much so that it has affected their linear
growth. Weight-for-height is used for assessing wasting (acute malnutrition).
Body mass index is the weight of a child or adult in kg divided by their height in
metres squared: Weight (kg)/(Height in metres) 2. If the weight of the child at
birth is more then more than 2500 grams, then it is considered as normal birth
weight. If the child weight is in between 1500–2499 grams, then it is considered
as low birth weight and if child weight at birth is less then 1500 grams, then it is
considered as very low birth weight. An indicator is an index (for example, a
scale showing weight for age, or weight for height) combined with specific cut-
off values that help in determine whether a child is underweight or malnourished.
These indicators helps by providing a scale with specific cut off values that
indicate whether the child is malnourished or underweight.