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ASSIGNMENT 2 (TMA-2)
Course Code: CFN-2
Assignment Code: CFN-2/AST-2/TMA-2/21
Maximum Marks: 100

Assignment-1 consists of two parts and is of 100 marks. The weightage given to each part is indicated in the
brackets.

a) Descriptive type question

b) Practical Exercise

Part B: Descriptive Type Question

All questions are compulsory

1. a) Water is an indispensable nutrient. Why? (3)

Ans:- Water is defined as an essential nutrient because it is required in amounts that exceed the body's ability to
produce it. All biochemical reactions occur in water. It fills the spaces in and between cells and helps form
structures of large molecules such as protein and glycogen. Water is also required for digestion, absorption,
transportation, dissolving nutrients, elimination of waste products and thermoregulation (Kleiner 1999).

Water accounts for 50-80% of body weight, depending on lean body mass. On average, men have a higher lean
body mass than women and higher percentage of body mass as water than in women. The relative mass of
water decreases in both men and women with age. Human requirements for water are related to metabolic
needs and are highly variable. They depend to some extent on individual metabolism.

Solid foods contribute approximately 20% of total water intake or about 700-800 mL (NNS 1995). The remainder
of the dietary intake comes from free water and/or other fluids ( NHMRC 2003). An additional 250 mL or so of
water is also made available to the body from metabolism (water of oxidation). The body must retain a minimal
amount to maintain a tolerable solute load for the kidneys. Excluding perspiration, the normal turnover of water
is approximately 4% of total body weight in adults. In a 70 kg adult, this is equivalent to 2,500-3,000 mL/day.

Water losses from lungs and skin (insensible losses) are responsible for 50% of the total water turnover. They
are sensitive to environmental conditions and can be increased at high temperatures, high altitude and low
humidity. During summer, when heat stress may be high, water depletion can lead to heat exhaustion, loss of
consciousness and heat stroke (Cheung et al 1998, Hubbard & Armstrong 1988). Unfit, overweight, older people

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may be especially at risk, particularly if they are subjected to strenuous exercise. Infants and dependent children
may also be at risk if not offered sufficient fluids. The remainder of the losses are from urine and stools.

Kidney function can decline as part of the normal ageing process with decrease in kidney mass, declines in renal
blood flow and glomerular filtration rate, distal renal tubular diluting capacity, renal concentrating capacity,
sodium conservation and renal response to vasopressin. This decline in kidney function together with hormonal
changes and factors such as decreased thirst perception, medication, cognitive changes, limited mobility and
increased use of diuretics and laxatives make older adults a group of particular concern. Numerous studies have
shown diminished thirst sensations in the elderly. Despite the fact that these changes may be normal
adaptations of the ageing process, the outcomes of dehydration in the elderly are serious and range from
constipation to cognitive impairment, functional decline, falls or stroke.

b) What is protein energy malnutrition? Give its causes and preventive measures. (5)

Ans:- The World Health Organization (WHO) defines malnutrition as "the cellular imbalance between the supply
of nutrients and energy and the body's demand for them to ensure growth, maintenance, and specific
functions." The term protein-energy malnutrition (PEM) applies to a group of related disorders that include
marasmus, kwashiorkor (see the images below), and intermediate states of marasmus-kwashiorkor.

Children with kwashiorkor have nutritional edema and metabolic disturbances, including hypoalbuminemia and
hepatic steatosis, whereas marasmus is characterized by severe wasting. Studies suggest that marasmus
represents an adaptive response to starvation, whereas kwashiorkor represents a maladaptive response to
starvation. Children may also present with a mixed picture of marasmus and kwashiorkor or with milder forms
of malnutrition.

Protein-energry malnutition is a global issue, seen primarily in resource-limited countries. Overall, malnutrition
has decreased worldwide, but the rates vary by region. For example, Asia has seen declines in this condition,
whereas there has been a continued increase in African nations.

Malnutrition can be classified as acute versus chronic. Features of chronic malnutrition include stunted growth,
mental apathy, developmental delay, and poor weight gain. Acute malnutition manifests itself in two major
forms: marasums (the most common form) and kwashiorkor, although some patients' condition may manifest as
a combination of both forms (marasmic kwashiorkor).

Children with marasmus are often low weight-for-height and have a reduced mid-upper arm circumference, as
well as a head that appears large relative to the rest of their body. Other findings include dry skin, thin hair, and
irritability. Kwashiorkor is characterized by peripheral pitting edema, as well as "moon facies," hepatomegaly,
and a pursed mouth.

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2. a) Explain, how the following foods will be digested in the body:

i) Bread

Ans:- Digestion in the Mouth

Once you take a bite of your sandwich, you’ve initiated mechanical digestion. This chewing reduces the size of
the food particles and mixes them with saliva for easier swallowing. Before your food passes from the mouth
and down your esophagus, salivary amylase, an enzyme in saliva, begins to digest the starch in your bread. That
is the start of chemical digestion.

Digestion in the Stomach

As the bolus approaches the stomach, a ring-like muscle called the lower esophageal sphincter relaxes, allowing
the chewed food to enter. Peristalsis mixes the bolus with gastric secretions containing hydrochloric acid (HCl),
hormones and digestive enzymes to produce a thick slurry called chyme. Hydrochloric acid is so strong that it
could dissolve metal. It doesn’t eat away at the stomach mucosa (lining) because you have cells that also secrete
mucus to protect your stomach wall. The acid kills much of the microorganisms that piggyback on your food, and
in this way the acid has prevented you from frequently becoming sick. To aid digestion, HCl denatures or unfolds
proteins, making them more available to attack by digestive enzymes.

ii) Butter

Ans:- Digestion of Butter: Butter is a fat product. It gets digested in the small intestine by the action of bile juice.
The bile juice secreted by the liver contains bile salts such as bilirubin and biliverdin which break down large fat
globules into smaller globules so that the pancreatic enzymes can easily act on them. This process is known as
emulsification of fats. Bile juice also activates lipases. Then, the pancreatic lipase present in the pancreatic juice
and the intestinal lipase present in the intestinal juice hydrolyse the fat molecules into triglycerides, diglycerides,
monoglycerides, and finally into the simplest form, glycerol which gets diffused into the blood and from the
blood stream, to each and every cell of the body.

b) Which are the intensive periods of growth? Why are they critical? (4)

Ans:- Prenatal period : During this time when the child is in the mother's womb for about 40 weeks, it develops
from a single cell into a baby weighing about 2.5 kg. Obviously each and every part of the baby's body is gro*ng
at a tremendous pace. Among the different organs, however, the brain grows the fastest and therefore needs a
lot of nutrients for growth; in fact growth in the nine months is unparalleled by growth at any other time of life.
Since the baby derives its nourishment from its mother, you must ensure that she has an adequate diet. She
must increase her intake of cereals, dals as well as vegetables and fruits.

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First year: You already know how rapidly a baby grows in infancy. During this time, its internal organs like the
brain, heart, liver, stomach and kidneys are growing and maturing. For example at birth, the capacity of a baby's
stomach is only 2 tablespoons, at 2 weeks it increases to 4 and by three months the capacity will have increased
to 8 blespoons. Since the infant depends entirely upon its mother for nourishment, ii is important that a nursing
mother has a well-balanced diet. The quantity of milk she produces and the amount of nutrients present in her
milk depends on what she eats and how much. This in turn will affect the baby's growth and health.

Adolescence: During the school years, you know that growth is slow and steady. During the teen years, there is
another spurt in growth when the child grows taller and puts on weight. In fact the child will reach his adult
mature. Final development and maturation of all organs occurs especially with regard to the reproductive
organs.

Growth is a poi factor which influences food needs of children and adolescents. The child's diet also determines
how well a child can grow. The first intensive period of growth is the prenatal period. Therefore, at this time, the
mother's needs are higher than before. For some nutrients the increase in requirements may be a hundred per
cent above her basic needs. She needs to consume more cereals, pulses and protective fruits and vegetables.

During the growth spurt a child needs more food in relation to its body size than it does as an adult. Look at how
much a one year old eats. It is approximately half of what is eaten by an adult man. Since infants are fed
mother's milk, the nursing mother needs to increase her intake of foods from Groups. In the intervening years
between infancy and adolescence, the child's food intake gradually increases as he grows. You may have seen
that a 2 year old child eats one chapati, whereas an eight year old will eat two or two and a half at meal-times.

The next growth spurt, as you know, occurs in adolescence. At this time boys will grow more than girls and so
their requirements are proportionately greater. You need to give them more cereals, dals or meat/fish/egg/milk
as well as vegetables and flits especially the protective ones. Once the growth spurt in adolescence is over, food
needs decrease. In girls who were undernourished, it has been observed that menarche is delayed. Once an
adolescent crosses himlher eighteenth year, his/her requirements will be the same as that of an adult.

3. a) Define the following terms:

i) Toxemia

Ans:- Toxemia: A condition in pregnancy, also known as pre-eclampsia (or preeclampsia) characterized by abrupt
hypertension (a sharp rise in blood pressure), albuminuria (leakage of large amounts of the protein albumin into
the urine) and edema (swelling) of the hands, feet, and face. Pre-eclampsia is the most common complication of
pregnancy. It affects about 5% of pregnancies. It occurs in the third trimester (the last third) of pregnancy.

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Pre-eclampsia occurs most frequently in first pregnancies. It is more common in women who have diabetes or
who are carrying twins. Some women seem to have a strong tendency to develop the disease and suffer from
pre-eclampsia with every pregnancy. Pre-eclampsia is more common in daughters of women who have been
affected; in many cases the disease tends to run in families.

Pre-eclampsia can be a sign of serious problems. It may, for example, indicate that the placenta is detaching
from the uterus. In some cases, untreated pre-eclampsia can progress to eclampsia, a life-threatening situation
for both mother and fetus characterized by coma and seizures.

Treatment is by bed rest and sometimes medication. If that treatment is ineffective, the induction of labor and
delivery or a C-section may have to be considered. Pre-eclampsia usually resolves a short time after the baby is
born.

ii) Measles

Ans:- Measles is a highly contagious illness caused by a virus that replicates in the nose and throat of an infected
child or adult. Then, when someone with measles coughs, sneezes or talks, infected droplets spray into the air,
where other people can inhale them.

The infected droplets may also land on a surface, where they remain active and contagious for several hours.
You can contract the virus by putting your fingers in your mouth or nose or rubbing your eyes after touching the
infected surface.

About 90% of susceptible people who are exposed to someone with the virus will be infected.

Risk factors

Risk factors for measles include:

Being unvaccinated. If you haven't received the vaccine for measles, you're much more likely to develop the
disease.

Traveling internationally. If you travel to developing countries, where measles is more common, you're at higher
risk of catching the disease.

Having a vitamin A deficiency. If you don't have enough vitamin A in your diet, you're more likely to have more-
severe symptoms and complications.

iii) Colostrum

Ans:- Colostrum is a milky fluid that’s released by mammals that have recently given birth before breast milk
production begins.

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It’s an important source of nutrients that promotes growth and fights disease in infants, but it can also be
consumed during other phases of life — typically in supplement form.

Even though all mammals produce colostrum, supplements are usually made from the colostrum of cows. This
supplement is known as bovine colostrum.

Bovine colostrum is similar to human colostrum — rich in vitamins, minerals, fats, carbohydrates, disease-
fighting proteins, growth hormones, and digestive enzymes.

Bovine colostrum supplements have become popular in recent years, as they may promote immunity, fight
infection, and improve gut health .

For these supplements colostrum from cows is pasteurized and dried into pills or into powders that can be
mixed with liquids. Bovine colostrum typically has a light yellow color and a subtle taste and smell that
resembles buttermilk.

b) How would you justify the food fallacy of deshi and English egg?

Ans:- They are loaded with nutrients, some of which are rare in the modern diet.

Here are 10 health benefits of eggs that have been confirmed in human studies.

1. Incredibly Nutritious

Eggs are among the most nutritious foods on the planet.

A whole egg contains all the nutrients required to turn a single cell into a baby chicken.

A single large boiled egg contains :

 Vitamin A: 6% of the RDA

 Folate: 5% of the RDA
 Vitamin B5: 7% of the RDA
 Vitamin B12: 9% of the RDA
 Vitamin B2: 15% of the RDA
 Phosphorus: 9% of the RDA
 Selenium: 22% of the RDA

Eggs also contain decent amounts of vitamin D, vitamin E, vitamin K, vitamin B6, calcium and zinc

This comes with 77 calories, 6 grams of protein and 5 grams of healthy fats.

Eggs also contain various trace nutrients that are important for health.

In fact, eggs are pretty much the perfect food. They contain a little bit of almost every nutrient you need.

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If you can get your hands on pastured or omega-3 enriched eggs, these are even better. They contain higher
amounts of omega-3 fat and are much higher in vitamin A and E (2, 3).

High in Cholesterol, but Don’t Adversely Affect Blood Cholesterol

It is true that eggs are high in cholesterol.

In fact, a single egg contains 212 mg, which is over half of the recommended daily intake of 300 mg.

However, it’s important to keep in mind that cholesterol in the diet doesn’t necessarily raise cholesterol in the
blood .

The liver actually produces large amounts of cholesterol every single day. When you increase your intake of
dietary cholesterol, your liver simply produces less cholesterol to even it out.

4. a) Comment on the importance of nutrition for nursing mothers. (4)

Ans:- During the first six months after delivery, the baby is fed only on breast milk, and the baby depends on the
mother for all nutrient requirements. Eating a healthy diet while you are breastfeeding is important because
what you eat determines the energy, protein, nutrient and vitamin content of your breast milk. Additionally,
some minerals and vitamins are required for body processes such as healing wounds quickly (e.g. vitamin C and
zinc). Nutritional demands during lactation are high and can have a negative impact on both you and your infant
if they are not met. Your daily diet will be adequate provided that your food selection and preparation is
appropriate.

Energy and nutrient requirements during breastfeeding

Nutritional needs during breastfeeding are increased in response to breast milk production. They must meet the
requirements of both baby and mother.

Energy

An additional 500 kcal for the first six months, and 400 kcal during the next six months, are required for a
lactating mother. This can be met by eating, for example, an extra 6-8 slices of bread per day. Simply eating
more of the usual balanced diet should allow you to meet the higher energy demand while you breastfeed. On
average, 100 ml of human milk gives 70 kcal of energy. During the first six months after delivery, 750 ml of
breast milk is produced daily. If the extra demand for energy is not met from dietary sources, then your reserved
fat stores will be used instead.

Protein

The increase in protein requirements during lactation are minimal compared to that of energy. However, if your
energy intake is low, protein will be used for energy production. The additional protein requirements during
lactation can be met by consuming protein rich foods (e.g. one egg or 25 g of cheese or 175 g of milk). If you do

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not have a high enough protein intake, then the proportion of casein in your milk may be reduced. Casein
protein is an important component of your milk, and helps to provide your baby with calcium and phosphate. It
also forms a clot in the stomach that allows more efficient nutrition. Insulin resistance is modulated by protein
quality, rather than quantity. Proteins derived from fish might have the most desirable effects on insulin
sensitivity.

Other nutrients

Nutrition during breastfeedingYour intake of some nutrients (e.g. vitamins C, A, thiamine, riboflavin, B6, B12,
iodine and selenium) is reflected in your breast milk composition. Newborn babies have very little amounts of
these particular nutrients, and so they rely on breast milk for an adequate supply. Good sources of iodine are
seafood and iodised salt. On the other hand, nutrients in your breast milk such as zinc, iron, folic acid, vitamin D,
calcium, and copper are not affected by what you eat. The levels of these nutrients in human milk are constant,
despite variations in the mother’s diet or body stores. Dietary and supplemental intake of these nutrients during
lactation will benefit you more than your baby.

b) What is weaning? At what age weaning foods should be started and what precautions should be taken
while weaning an infant?

Ans:- The term,"to wean" means 'to accustom' and it describes the process by which the infant gradually
becomes accustomedto the full adult diet. When would you begin weaning a child? You already know that
breast milk alone is quite sufficient until the baby is four to six months old. Generally the first solid foods are
introduced around thefm to sixth month and this occasion may be celebrated in your home (Annaprasana).

How to Introduce Weaning Foods?:It is importantthat the weaning period be an enjoyableperiod of transition.
When you fust offer an infantfood, you may find that he spits it out. This is because the baby develops the ability
to swallow very slowly. The child should not be forced to eat. You will find that the baby acceptsthe food better
if it is not distracted.

When you start a food give only one teaspoon or two at a time, possibly after the breastfeed. If the infant does
not take it, try again when he is hungry Wait a few days so that the baby is used to one food before you
introduce another Gradually increase the amounts of food offered so that by the end of the year, the infant will
be eating normal family meals

Once the baby accepts a new food, give it quite frequently so that it becomes familiar Klnda ofFoodsGiven:
Normally cereals are the fist foods to be fed. You can give cereals prepared for the family meals such as rice,
chapati or phulka or bread soaked in milk. Rice can be mixed with dal or curds or milk and mashed. By the 7th or
8th month the child should be taking about 4 to 5 teaspoons of the foods. Soft cooked dal or steamed pulse

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preparations can be given by 7 to 8 months of age. You may be preparing dishes like khichadi, pongal, idli,
dhoklas, etc. in your home. These can be fed to the older infant. Fruits like banana, mango, papaya can be
started at 5 months of age. Cooked apple after removing the fibrous parts can be given. By the time the baby is
6 to 8 months of age, you can begin giving him vegetables also. Initially you need to mash the cooked vegetable,
and if necessary, strain it. By the end of the first year, you can change the consistency to coarsely mashed and
then chopped vegetables. Vegetables and fruits supply the baby with minerals and vitamins and also make it get
used to different textures and flavours. Egg yolk can be given between 4 and 6 months of age. Egg white,
however, should be given only by the end of the first year, since some babies are allergic to it. Fish and meat can
be cooked and mashed. Meat may be ground and started in the fifth month. You can feed the baby
altemately'with fiswmeat or egg yolk or dal.

The time of feeding and how frequently you feed the baby can be flexible, depending on when the child feels
hungry. After the first few weeks, the child will regulate itself and develop some sort of a schedule. By the time a
baby is 6 months old, the number of feeds may be reduced to 6 or 7, and at one year of age, the child will take
four or five feeds.

5. a) How is infection and malnutrition related? (4)

Ans:- Malnutrition and risk of illness and death

• Not infectious diseas Responsible for over 50% of child deaths globally

• Some emergencies result in very high levels of severe malnutrition

• „Cut-offs‟ for severe malnutrition is threshold where mortality risk rises sharply

• Risk of death of malnourished associated with infectious disease – malaria, diarrhoea, measles, ARLI, HIV/AIDS.

Nutrition and infectious diseases are related to each other in some aspects. First, nutrition affects the
development of human body immune system. Moreover, nutrition can influence emerge of infectious diseases
(e.g., gastrointestinal infections), food poisoning, intestinal diseases, and systemic infectious diseases. In this
review, the mentioned aspects of the relationship between nutrition and infections are discussed. Furthermore,
the relationship between malnutrition and infectious diseases, nutrition in patients with severe combined
immunodeficiency and relationship between overeating and infection are reviewed. Overall, some factors can
weaken the body's ability to fight infection and cause malnutrition. The factors include anorexia, traditional
behaviors, reduction of intestinal absorption, metabolic damage, disorder metabolism of lipids and
carbohydrates, reduction of vitamins, iron, zinc, and copper. In the case of the relationship between
malnutrition and infection, a large number of studies have illustrated a bidirectional interaction of malnutrition
and infection. In this aspect, to treat serious acute malnutrition and limit the rate of death, some preventive
studies applied antibiotics, probiotic bacteria, and prebiotic foods. In the future, studies may be conducted on
intestinal or systematic immunomodulation.

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b) What are the nutritional requirements of a school age children? How are they related to growth of
children?

Ans:- Eating becomes a social activity in this stage of life. Your kids may spend more time in school than they do
at home, eat meals at friends’ houses, and adopt eating habits from their peers. It can be difficult to ensure they
are getting adequate nutrition when you are not around to monitor their choices, so try to maintain regular
family mealtimes.

Nutrition guidelines for school-age kids

As children develop, they require the same healthy foods adults eat, along with more vitamins and minerals to
support growing bodies. This means whole grains (whole wheat, oats, barley, rice, millet, quinoa); a wide variety
of fresh fruits and vegetables; calcium for growing bones (milk, yogurt, or substitutes if lactose intolerant); and
healthy proteins (fish, eggs, poultry, lean meat, nuts, and seeds). For kids aged 5-12, the key word is variety.
Creative serving ideas will go a long way towards maintaining healthy eating habits.

Vegetables

3-5 servings per day. A serving might be one cup of raw leafy vegetables, 3/4 cup of vegetable juice, or 1/2 cup
of other vegetables, raw or cooked.

Fruits

2-4 servings per day. A serving may consist of 1/2 cup of sliced fruit, 3/4 cup of fruit juice, or a medium-size
whole fruit, such as an apple, banana or pear.

Whole Grains

6-11 servings per day. Each serving should equal one slice of whole grain bread (beware of breads with only
“wheat” versus “whole wheat/ whole grain”, 1/2 cup of rice or 1 ounce of whole grain cereal (stay away from
the high sugar cereals).

Protein

2-3 servings of 2-3 ounces of cooked lean meat, poultry, or fish per day. A serving in this group may also consist
of 1/2 cup of cooked dry beans, one egg, or 2 tablespoons of peanut butter for each ounce of lean meat.

Dairy products

2-3 servings (cups) per day of low-fat milk or yogurt, or natural cheese (1.5 ounces=one serving).

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Zinc

Studies indicate that zinc may improve memory and school performance, especially in boys. Good sources of
zinc are oysters, beef, pork, liver, dried beans and peas, whole grains, fortified cereals, nuts, milk, cocoa, and
poultry.

Water

6-8 glasses each day.

Healthy fat

Healthy fats are also important to a child’s development. These include monounsaturated fats from plant oils
like canola oil, peanut oil, and olive oil, as well as avocados, nuts (like almonds, hazelnuts, and pecans), and
seeds (such as pumpkin, sesame; and polyunsaturated fats, including Omega-3 and Omega-6 fatty acids, found
in fatty fish, such as salmon, herring, mackerel, anchovies, and sardines, or in unheated sunflower, corn,
soybean, and flaxseed oils, and walnuts. Read more on our Healthy Fats page.

6. a) “Breast milk is the best choice for infants”. Justify the statement. (3)

Ans:-

b) Briefly explain the importance of anthropometric measures in assessing nutritional status. (5)

Ans:- Anthropometric assessment is based on the study of a small number of somatic measurements. Its
advantage is the simplicity of the collection and interpretation of data and the possibility of detecting changes
by means of a follow-up within fixed time intervals. On the other hand, the main shortcomings of
anthropometric assessment are intra- and interobserver variability, which tend to diminish the validity,
accuracy, and precision of the technique. This is why it is essential to select validated, easy to handle, and easy
to calibrate tools and carefully follow the corresponding protocols in order to guarantee the greatest possible
accuracy and precision.

Anthropometric assessments are interpreted by comparison with reference values by age and sex. Ideally,
reference values should represent the range of ‘optimum’ measurements for health and longevity of a
population of the same ethnic origin. Individuals should be considered at nutritional risk when above or below
predetermined reference limits or cutoff points, based on functional impairment, clinical signs of deficiency, or
increased risk of mortality and morbidity.

In practice, reference values are derived from large sets of cross-sectional anthropometric measurements of
representative samples of populations of the same ethnic origin, who are assumed to be well nourished and free

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from infection, parasitic disease, and any other environmental factors which may affect growth and nutritional
status. These data can be supplemented by data derived from direct laboratory studies of body composition.
International reference values are used if local reference data are too difficult, time-consuming, and expensive
to obtain.

Normal, healthy, well-fed people vary in size. Therefore, reference values are usually presented as percentiles,
with values less than the 5th centile or greater than the 95th centile considered outside the normal range. If
international reference values are used, it may be necessary to modify the cutoff points used for identifying
those at risk for particular populations. Since the rate of growth of children is age-dependent, growth charts of
the most commonly used anthropometric measurements and derived indices have been constructed. Children's
growth is best monitored by plotting their sequential measurements on growth charts. A well-nourished healthy
child should progress along a centile between the 5th and 95th centile for each measurement. When a child's
measurements cross centiles of the growth charts, whether owing to growth faltering, failure-to-thrive, or
excessive growth, the cause needs to be investigated. In this way anthropometric measurements can indicate
the adequacy of a child's diet, the timing of the introduction of weaning foods, the impact of illness, and the
response to treatment. To use growth charts such as weight-for-age, height-for-age, and head circumference-
for-age, it is essential to know the age of a child accurately. A child's age cannot be estimated accurately by
examination. A malnourished child is smaller and looks younger and less mature than a well-fed, healthy child.

7. a) What points you must keep in mind while planning a packed lunch? (3)

Ans:- Packed lunches have become a necessity for school going children as schools are either away or the lunch
period is too short for the children to go home and have food. The packed lunch is a lunch that is packed in a
tiffin box to be eaten by the child while away from home. The packed lunches carried by them are usually not
adequate both in quantity and quality.Carrying food from home is less expensive, more convenient, more
hygienic and meets the individual requirements.

Points to be considered in planning a packed lunch.

Some amount of good quality protein like milk or milk product like curd or panner would improve vegetable
protein . It can also be a combination of vegetables protein like cereals and pulses can be given for better
utilisation.addition of egg also improve the quality of protein besides meting many protective nutrient needs.

Inclusion of one serving of green leafy vegetables would take care of one third requirements of mainly vitamins
and minerals

Preferably the packed lunch should consist of all five food groups, through the number of dishes may be less

The school lunch should meet one third daily requirement in calories, protein and other nutrients of the child, to
boost concentration and energy for the rest of the school day

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To make the food appetizing, foods like whole fruit or butter milk in a bottle or chips in a polythene bag can be
taken

Monotony should be avoided in packed lunch.There should be variety

It is sensible to have a different food in packed lunch than what one had for breakfast

The food should have a different food in packed lunch than what one had for breakfast

Containers should be clean and dried before packing the food.

b) What are the various factors influencing the adolescent’s food intake? (3)

Ans:- Food choices established during childhood and adolescence tend to persist into adulthood with
consequences for long-term health. Yet, to date, relatively little research has examined factors that influence
the food choices of children and adolescents from their perspectives. In this article, previous research is
extended by examining developmental differences between children's and adolescents' perceptions of factors
influencing their food choices. Focus group discussions were conducted with 29 young people from three age
groups (9–10, 13–14 and 16–18 years). An inductive thematic analysis identified three key factors as influencing
food choices. These factors included intra-individual factors: the link between food preferences and awareness
of healthy eating; intra-familial factors: the role of the home food environment; and extra-familial factors: eating
away from the home. Findings indicate that there were developmental differences between children's and
adolescents' perceptions of factors influencing food choice. Among adolescents, parental control began to
diminish and adolescents exercised increased autonomy over their food choices compared with children. To
develop effective nutrition interventions, it is important to gather child and adolescent input regarding factors
perceived as influencing their food choices.

8. a) List the physiological changes that occur in later years of life (old age). (3)

Ans:- 1. Heart

Heart pumps all day and night, whether you are awake or asleep. It will pump more than 2.5 billion beats during
your lifetime! As you age, blood vessels lose their elasticity, fatty deposits build up against artery walls and the
heart has to work harder to circulated the blood through your body. This can lead to high blood pressure
(hypertension) and atherosclerosis (hardening of the arteries).

Taking care of your body with the right types of fuel will help you keep your heart healthy and strong. You can
take care of your heart by exercising and eating heart-healthy foods.

2. Bones, Muscles & Joints

As we age, our bones shrink in size and density. Some people actually become shorter! Others are more prone
to fractures because of bone loss. Muscles, tendons, and joints may lose strength and flexibility.

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Exercise is a great way to slow or prevent the problems with bones, muscles and joints. Maintaining strength
and flexibility will help keep you strong. In addition, a healthy diet including calcium can help your bones strong.
Be sure to talk to your doctor about what types of diet and exercise are right for you.

3. Digestive System

Swallowing and digestive reflexes slow down as we age. Swallowing may become harder as the esophagus
contracts less forcefully. The flow of secretions that help digest food in the stomach, liver, pancreas and small
intestine may also be reduced. The reduced flow may result in digestive issues that weren’t present when you
were younger.

4. Kidneys and Urinary Tract

Kidneys may become less efficient in removing waste from the bloodstream because your kidneys get smaller as
they lose cells as you age. Chronic diseases such as diabetes or high blood pressure can cause even more
damage to kidneys.

b) What is the basis of formation of food habits? (3)

Ans:- Food refers to anything that is eaten to provide energy and keep the body healthy. It forms an important
part of many Ghanaian customs and traditions. Whilst some foods are not regarded as food at all by some
groups, the same foods are delicacies for others. As a caterer you need to learn about the role food plays in the
life of the different people you have to cater for. People need food especially because it keeps them healthy and
offer enjoyment. If the food you offer for sale does not do any of the above people may not patronize your
services. This is why it is important for you to learn how to make wise food choices and provide the kinds of food
your varied customers want.

Have you ever traveled away from home for many days? While you were away, did you long for some of the
foods you are used to eating back home? If you do, your longing for the home food is the results of the habit you
have cultivated around those foods.

When you travel from the East Coast of Ghana to the West, you would notice the various ways in which food
commodities are used. maize, for example, is used to make ‘akpele’ by Ewes, Gas would use it for ‘komi’, Efutus
would use it for ‘etsew’, Fantes would make ‘ntew’ from it and Ahantas would use it for ‘fomfom’. These corn
dishes are eaten with different kinds of sauces and soups depending on who is eating it.

Again, have you observed how people eat their food? Some people use their fingers, others use cutlery and still
others use chop sticks. All of these describe the food habits of people. Food Habits is therefore the way in which
people select, cook, serve and eat foods that are available to them. Food habits differ from one ethnic group to
another and from one country to another. These differences come about because of many influences on people.

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PART B (Practical Exercises) (40 Marks)

There are four exercises in this part. You have to attend all the questions.

1. Plan a day’s diet for a lactating woman (0-6 months of lactation) . Also mention different points you
would keep in mind while planning the diet for her. (10)

Ans:- Eating well when you’re nursing means getting a variety of nutritious foods. And since a varied diet
changes the taste and smell of your milk, it will expose your baby to many different flavors (so the carrots, Thai
or salsa you’re eating today may have your baby reaching for those foods in the future).

Here’s what to aim to consume each day to ensure you’re getting the nutrients you need and offering your baby
a taste for the healthy stuff early on:

Protein: 3 servings

Calcium: 5 servings (or between 1,000 and 1,500 mg — especially important since breastfeeding draws from
your calcium reserves)

Iron-rich foods: 1 or more servings

Vitamin C: 2 servings

Leafy green and yellow vegetables/fruits: 3 to 4 servings

Other fruits and veggies: 1 or more servings

Whole grains and complex carbohydrates: 3 or more servings

High-fat foods: Small amounts (you don't need as much as you did during pregnancy)

Omega 3s: 2 to 3 servings a week to promote baby's brain growth (that’s at least 8 ounces a week of low-
mercury fish like wild salmon and sardines; you can also get omega 3s in DHA-enriched eggs)

Prenatal vitamin: Daily

Aim to drink more water than usual a day, so at least 8 cups along with fluids from fruits, vegetables and other
sources — especially in the weeks after birth, since it will help your body recover. To ensure you’re getting
enough, a good rule of thumb is to drink a cup of water at every nursing session. In all, you'll need about 128
ounces of fluids a day from all sources (so don't worry, you don't have to down 16 glasses of water daily while
you're breastfeeding).

Keep in mind that your milk supply won’t be affected unless you’re seriously dehydrated, but your urine will
become darker and scanter. Not drinking enough can also set you up for health issues including urinary tract
infections (UTIs), constipation and fatigue. So just be sure to drink whenever you're thirsty, which will likely be
often when you're breastfeeding!

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Foods to avoid while breastfeeding

When you're breastfeeding, there's a lot more that’s on the menu than off — with a few caveats. Here are the
drinks and foods to avoid while you're breastfeeding:

Excessive caffeine: One or two cups of coffee or tea a day, amounting to 300 milligrams or less, are safe while
you're breastfeeding (and during those early, sleep-deprived months, that might be just what you need to keep
going). More than that, however, may lead to you and your baby feeling jittery, irritable and sleepless. Other
sources of caffeine include tea, soda and chocolate.

High-mercury fish: The same EPA guidelines on fish safety that apply to pregnant women also apply to
breastfeeding women: Avoid high-mercury fish including shark, orange roughy, swordfish, marlin, big eye tuna,
tilefish (Gulf of Mexico) and King mackerel. Limit tuna to 8 to 12 ounces a week of canned light tuna or no more
than 4 ounces a week of white albacore tuna.

Some herbal supplements. Few studies have been done on the safety of herbal supplements, so little is known
about how they affect a nursing baby — plus these supplements aren’t regulated by the Food and Drug
Administration (FDA). To stay safe, ask your doctor before taking any herbal remedy, and think twice before
drinking herbal tea or breastfeeding brews. For now, stick to reliable brands in varieties that are considered safe
during lactation (orange spice, peppermint, raspberry, red bush, chamomile and rosehip). Read labels carefully
to make sure other herbs haven't been added.

2. Plan two dishes that are high in protein and fibre suitable for pregnant women. Give the ingredients
to be used and method of preparation. (10)

Ans:- High-fiber snacks

fruit (apples, raspberries, pears)

vegetables (broccoli, peas, artichokes)

whole grains (brown rice, cooked barley)

legumes (black beans, chickpeas, lentils)

Two types of fibres:

Insoluble Fibres: This type of fibre acts as a natural laxative, and it helps in faster and easier waste movement
through the digestive tract. It softens the stool, and prevents constipation. It can be found in whole grains,
fruits, vegetables, beans, and dried peas.

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Soluble Fibres: This type of fibre helps to regulate blood sugar and cholesterol levels. Soluble fibres can be found
in dried peas and beans, fruits, vegetables, barley, and oats.

A hormone called progesterone, which is produced by the ovaries during pregnancy, relaxes the stomach
muscles, and slows digestion. Adding fibre to your diet can make all the difference here, as it helps to curb
irregular digestion and bowel movements. Here are some other ways that fibre is good for you during your
pregnancy:

Helps keep pregnancy weight under control: As high-fibre foods keep you fuller for longer and do not contain
too many calories, they are a great way to help you manage your pregnancy weight.

Helps to prevent constipation: Having the recommended amount of fibre in your diet will prevent you from
becoming constipated, which is a problem faced by most pregnant women.

High Protein Foods

1. Eggs

Whole eggs are among the healthiest and most nutritious foods available.

They’re an excellent source of vitamins, minerals, healthy fats, eye-protecting antioxidants, and brain nutrients
that you need.

Whole eggs are high in protein, but egg whites are almost pure protein.

Egg and foods containing egg are not suitable for people with an egg allergy.

2. Almonds

Almonds are a popular type of tree nut.

They are rich in essential nutrients, including fiber, vitamin E, manganese, and magnesium.

Almonds are not suitable for people who have a nut allergy.

Protein content: 15% of calories. 6 grams and 164 calories per ounce (28 grams)

4. Oats

Oats are among the healthiest grains available.

They provide healthy fibers, magnesium, manganese, thiamine (vitamin B1), and several other nutrients.

Protein content: 14% of calories. One cup of oats has 11 grams and 307 calories .

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3. Record the weight and height of ten 5 year old children in your locality.

Determine their growth status using the growth charts (You can refer to CFN-2, Block-5, and Unit-15).
Comment on their health status. Record your observation in tabulated form. (10)

Ans:- Growth denotes increase in physical size of the body and development denotes improvement in skills and
function of an individual. Together they denote physical, intellectual, emotional and social well being of a
person.

Normal growth and development is observed only if there is proper nutrition, without any recurrent episodes of
infections and if there is freedom from adverse and environmental influences.

 Determinants of growth and development

 Genetic inheritance - especially height, weight, mental, social development and personality.
 Nutrition before and after birth - Retardation in an infant indicates malnutrition.
 Age - Growth rate is maximum during fetal life, first two years of life and during puberty.
 Sex - Men usually are larger in size than women. During puberty girls grow fast and earlier than boys,
but boys grow more.
 Infections and infestations - Infection with TORCH during intrauterine life retards growth of fetus.
Recurrent infections like diarrhea and measles especially in a malnourished child will adversely affect
the growth.
 Physical surroundings - Sun shine, good housing, lighting ventilation have their effect on growth and
development.
 Psychological factors - Love, tender care and proper child parent relationship are all found to influence
growth in a child.
 Economic factors - Higher the family income better is the nutritional status of an infant.
 Other factors - Birth order, Birth spacing, Education of parents (higher the educational level better the
growth).

Normal growth

In children, parameters used to measure growth are weight in kilograms, height in meters and head and chest
circumferences. Assessment can be longitudinal where serial measurement of the same child is recorded over
different periods of time or cross-sectional where recorded measurement is compared to that of his peers.

In India, we are using the new WHO child Growth Standards (2006) for children. However values differ
substantially among adults of different ethnic groups. We have ICMR values as Indian standard.

Weight

Most widely used and simplest, reproducible anthropometric measurements for the evaluation of nutritional
status.

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 It indicates body mass

 It is sensitive to even small changes in nutritional status due to childhood morbidity like diarrhea.
 Rapid loss of weight indicates a potential malnutrition
 Serial weight recording is more valuable for progressive growth of a child when age of a child is not
known.
 Technique for measurement

To measure weight beam or lever accentuated scales with an accuracy of 50-100 g are preferred. Portable Salter
scale (CMS Weighing Equipment, Ltd. England): the child is suspended from the scale which is hung from a
branch or a tripod. Special "pants" are used to weigh babies. Robust, cheap, and easy to carry, these scales
should be replaced after one year because of stretching of the spring and inaccurate readings. The model with
readings up to 25 kg (x 100 g) is recommended.

Bathroom scales are not recommended as errors up to 1.5 kgs can occur with this.

Precautions to be taken while weighing

 Zero error has to be adjusted.

 Minimal clothing should be worn and be without shoes.
 While recording the value do not lean against or hold anything.
 Preferably record under basal conditions in early morning.
 Most types of scales (especially beam scales) are sensitive to dust and mud.

Standards

 On an average, a baby weighs double the birth weight by five months, trebles its birth weight by one
year and quadruples its birth weight by two years.
 A baby should gain at least 500g per month in the first three months of life. If the growth is less than this
it points to malnutrition. In different parts of India, the aver.

4. Make an inventory of your 3 days minute to minute activity. Then classify yourself as sedentary,
moderate or heavy worker according to the average activity performed. (Refer to CFN-2, Block-1, Unit-2)
(10)

Ans:- Sedentary

If you’re sedentary, your daily activities include:

Activities of daily living only, such as shopping, cleaning, watering plants, taking out the trash, walking the dog,
mowing the lawn and gardening.

No moderate of vigorous activities.

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Unless you do at least 30 minutes per day of intentional exercise, you are considered sedentary.

Spending most of the day sitting (e.g. bank teller, desk job)

The majority of people will be considered sedentary.

Lightly Active

If you’re lightly active, your daily activities include:

Activities of daily living only, such as shopping, cleaning, watering plants, taking out the trash, walking the dog,
mowing the lawn and gardening.

Daily exercise that is equal to walking for 30 minutes at 4mph. For an adult of average weight, this amount of
exercise will burn about 130-160 additional calories.

More intense exercise can be performed for less time to achieve the same goal. For example, 15-20 minutes of
vigorous activity, such as aerobics, skiing or jogging on a daily basis would put you in this category.

Spending a good part of the day on your feet (e.g. teacher, salesman)

Active

If you’re active, your daily activities include:

Activities of daily living only, such as shopping, cleaning, watering plants, taking out the trash, walking the dog,
mowing the lawn and gardening.

Daily exercise that is equal to walking for 1 hour and 45 minutes at 4mph. For an adult of average weight, this
amount of exercise will burn about 470-580 additional calories.

More intense exercise can be performed for less time. For example, jogging for 50 minutes per day.

Spending a good part of the day doing some physical activity (e.g. waitress, mailman)

Very Active

If you’re very active, your daily activities include:

Activities of daily living only, such as shopping, cleaning, watering plants, taking out the trash, walking the dog,
mowing the lawn and gardening.

Daily exercise that is equal to walking for 4 hours and 15 minutes at 4mph. For an adult of average weight, this
amount of exercise will burn about 1,150-1400 additional calories.

More intense exercise can be performed for less time. For example, jogging for 2 hours minutes per day.

Spending most of the day doing heavy physical activity (e.g. bike messenger, carpenter)

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