UNIT-II

INTRODUCTION

1. Classification of Foods According to their Functions in the Body

 Life cannot be sustained without adequate nourishment. Man needs adequate food for
growth and development and to lead an active and healthy life.

 Nutrition is the science of foods, the nutrients and other substances therein, their
action, interaction and balance in relationship to health and disease.

 Health is defined by The World Health Organisation as the state of complete

physical, mental and social well being and not merely the absence of diseases.
Therefore Food plays an important role in maintaining a person's nutritional and
health status.
CLASSIFICATION OF FOODS: Man must eat to live and what he eats will affect to a
high degree, his ability to keep well, to work and to live long. Food performs many vital
functions in the body.

CLASSIFICATION OF FOOD BY ORIGIN

PLANTS
 Many plant & plant part are eaten as a food.
 Seeds are good source of food for animals including humans because they contain
nutrients.
 All seeds are not healthy. Eg - apple seeds & cherry seeds contains cyanide.
  Fruits are ripened ovaries of plants including seeds within it.
 Vegetables are another most natural way of getting foods.

ANIMALS
 They are used as a food directly or indirectly
 Direct- Meat, fish, chicken etc.
 Indirect- milk, honey, milk products ,eggs etc
Foods are classified according to their functions in the body.

1. Energy Yielding Foods:

 This group includes foods rich in carbohydrate, fat and protein. They may be broadly
divided into two groups.

 Cereals, pulses, roots and tubers: Cereals provide in addition to energy large
amounts of proteins, minerals and vitamins in the diet. Pulses also give protein and B
vitamins besides giving energy to the body.

 Fats, Oils and pure carbohydrates like sugars: Sugars provide only energy and fats
provide concentrated source of energy.

2. Body Building Foods:

 Foods rich in protein are called body building foods. They are classified into two
groups.

 Milk, egg, meat & fish. They are rich in proteins of high biological value. These
proteins have all the essential amino acids in correct proportion for the synthesis of
body tissues.

 Pulses, nuts and oilseeds: They are rich in protein but may not contain all the
essential amino acids required by the human body.
 3. Protective Foods: Foods rich in protein, vitamins and minerals have regulatory
functions in the body like maintaining the heartbeat, water balance, temperature, etc.

Protective foods are broadly classified into two groups.

 Foods rich in vitamins and minerals and proteins of high biological value (eg)
milk, egg, and fish.

 Foods rich in certain vitamins and minerals only (eg) green leafy vegetables and
fruits.

 Food makes your body work, grow and repair it-self. The kind of food you eat can
affect the efficiency of these processes. Body function and the food that sustains it is
infinitely complex. Food is in fact one of the most complicated sets of chemicals
imaginable.

 Getting to know which nutrients are in which foods can help you to understand
something of this complex relationship between your food and your body.

CLASSIFICATION OF FOOD BY NUTRITIVE VALUE

 CEREALS & MILLETS: They provide about 70-80 % of calories, proteins & other
nutrients.
 PULSES: Dried pulses are rich in proteins containing about 19-24%.
 NUTS & OIL SEEDS: They contain proteins 18-40%.

VEGETABLES
 They are categorized as green leafy vegetables, roots & tubers & other vegetables.
 They contain high amount of nutrients & are very healthy.
  FRUITS: They are rich in vitamins.
 MILK & MILK PRODUCTS: 1 litre of cow’s milk provide about 35 g protein, 35g
fat, 1 g calcium, 1.5mg riboflavin,1500 IU of Vit A & small amounts of Vit B &
minerals.
 EGGS: Hen’s egg contains 13% of protein & 13% of fat. Egg white contains of 12%
of protein, some vitamin & traces of fat. Egg yolk contains 15% protein & 3% fat.

MEAT, FISH & ANIMAL PRODUCTS

 Meat- Rich in protein 18-22%.
 Fish-Rich in protein 18-22%.
 Liver- Rich in protein 18-20%.
FOOD is required for two purposes:
 To build up the body and repair tissue waste.
 To supply potential energy, this can be converted into heat and work.
The body uses food to perform one or more of four main functions:
 To supply energy, for growth and repair.
 To supply energy for regulation and for protection.
FUNCTIONS OF FOOD

The functions of food can be broadly classified into three main categories.

1) Physiological functions of food.

2) Psychological functions of food.
3) Social function of food.
1) Physiological functions of food: The physiological functions of food can be further
sub-divided as follow:
a. Energy giving.
b. Body building.
c. Regulatory and protecting functions of food.
a) Energy giving Functions:
 The body needs a constant supply of energy to carry out the involuntary processes of
which we are not even aware, like, respiration, circulation of blood etc. which are
essential for continuance of life.
  Energy is also required to carry out voluntary activities like professional, household
and recreational activities, which every human being indulges in like, either jumping,
walking, playing etc.
 Besides this some amount of energy is also required to convert the ingested food into
usable nutrients in the body and the heat released during this process helps to keep the
body warm.
 Energy is mainly provided to our body through carbohydrates and fats in the food.
Rich sources of carbohydrates are cereals, sugar, jiggery, potatoes, honey etc. Good
Sources of fats include ghee, oil, nuts etc. A major part of our daily diet is constituted
by these energy-rich food materials.

b) Body Building Functions:

 The foods we eat become a part of us. Thus one of the most important functions of
food is that of building the body. A new-born body weighting 2.7-3.2 Kg. Can grow
to its potential adult size of 55-70 Kg., if right kinds and amounts are eaten from birth
to adulthood, In adult life, the food eaten each day helps to maintain the structure of
the adult body, and to replace worn out cells of the body.
 Building of new tissues is very important particularly for the growing children and
pregnant women. There is also a continuous breakdown of old tissues and building up
of new tissues going on in our body at all ages irrespective of the apparent growth,
thus maintaining a need for body building nutrients.
 For the body building purposes, the major nutrients utilized are proteins and minerals.
Proteins are mainly provided through milk and milk products, meat, fish, poultry,
nuts, soybean, and pulses etc.
c) Regulatory and Protective function:
 The third physiological function of food is to regulate the activities of the body. It
includes regulation of such varied activities as beating of the heart, maintenance of
body temperature, muscle contraction, control of water balance, clotting of blood,
removal of waste products from the body etc.
 For any of these processes, one or the other nutrients is responsible. For example
Vitamins of the B groups are an integral part of the enzymes and are responsible for
metabolizing food and thus release energy. Vitamin K is an essential factor in clotting
of blood.
 Apart from regulating our body processes, food also protects us from various
infections, diseases, and injuries. For example, Consumption of Vitamin A and
Vitamin C rich food help in building resistance in the body to fight against invading
organism.
 The main nutrients which perform these functions include proteins, vitamins,
minerals, water and roughage. Although these nutrients are required by the body in
very small amounts, yet it is very important for them to be present in our daily diets.
The major sources of these protective and regulatory nutrients are green leafy
vegetable, milk, fresh fruits and vegetable, fish etc.
2) The Psychological Functions of food
 The second major function of food is the psychological function. Food must also
satisfy certain emotional needs. These include sense of security, love and attention.
Everyone grows in a particular culture with its own unique food habits of that culture
and caste.
 The person begins to associate the food habits and foods commonly consumed by
him, as it gives him a sense of security and satiety. The foods daily eaten by us, give
us more mental satisfaction, even a nutritional balanced meal may not be satisfying to
the individual, if food include is unfamiliar or distasteful to him/her.
 In a friendly gathering, one may try unfamiliar foods and thus enlarge our food
experiences. During the course of time and repeated experience, strange foods
become familiar and new tastes are formed. These new taste are developed should
again be satisfying to the mind.
 For example, a person accustomed to traditional Indian cusine, takes time to adjust to
Chinese or western dishes, but feels mentally satisfied at the site of familiar foods.
3) Social function of Food:
 Food and eating has significant social meaning. Share food with any other person
implies social acceptance. When you share a meal with anyone else, you are
expressing your acceptance of friendship and respect for that person.
 Earlier only persons enjoying equal status in society eat together. A person would
never share a meal with someone inferior to him in social terms. Food is also a
symbol of our social life.
 Food is a medium through which we express our happiness. For example, feasts are
given at specific states of life, such as birth, mundane ceremony, birthday, marriage
etc. Sweets are also distributed and exchanged to mark certain auspicious occasion
like festivals.
 Food is the common link in a meeting, party or get-together that attracts people to
come to such social gatherings. Refreshment served even at officials meeting creates a
relaxed atmosphere, where people can exchange their views. The menu for such get-
to-gather should bring the people together, rather than divide them. Foods help to
strengthen mutual friendship.
 For example, inviting friends and relatives over meals signify acquaintance and
hospitality. Food also has a specific significance and meaning in the religious context.
Certain food items such as fruits, sweets, and coconut are offered to the deity in
temples. Often sweets are prepared at temples and gurudwaras and distributed to
devote as a benediction or prasad.
 Further, people of a given religious community share a common eating pattern. This
is because religious texts and practices strongly recommend some foods while
rejecting others. Food thus becomes an integral part of the social and religious life of
people.
 Thus it can be concluded that food performs various important functions from
satisfying hunger to building mutual understanding and above all helps to maintain
our health and adequate nutritional status.
Classification of Food
1. Nutritional: Foods are complex substances composed of chemical constituents called
nutrients. According to the presence of such nutrient, foods has been classified as proteins,
carbohydrate, fats, vitamins, minerals, water and roughage.
2. Dietary Sources: Food can also be obtained from animal as well as plant kingdom; that is
organic as well as inorganic sources. Organic sources are meat, fish, egg, milk and milk
products. Inorganic sources are cereals, pulses, vegetables etc.
3. Functional: Food can also be classified according to the function it performs:
 Body-building foods- Protein, Minerals
 Energy giving foods- Carbohydrates, Fats
 Protective foods- Vitamins, Minerals.
 Regulatory foods- Water, Roughage.
Proteins, carbohydrates and fats are called “Proximate Principles”. They are oxidised (i.e.
burnt) in the body to provide energy to the body to carry out all activities of life. In addition
to water, which is also a necessary dietary element, proximate principles form the main bulk
of the diet. Vitamins and mineral salts do not supply energy, but they play an important role
in the regulation of several essential metabolic processes in the body.
Functions of food
Food is important for life. To be healthy and active, we should certainly have enough food.
The food we eat should be safe and rich in all the nutrients for our body needs. We should
choose from a wide variety of foods and we should eat them regularly, every day. Do not
forget that we should also enjoy the food that we eat; it should look, smell and taste good.
Without good nutrition, children and young people cannot develop their potential to the full
and adults will have difficulty in doing their best.
Food provides our body with what they need to
 Stay alive, be active, move and work;
 Build new cells and tissues for growth;
 Stay healthy and heal them;
 Prevent and fight infections.
Foods are classified according to their functions in the body. The functions of food can be
broadly classified into three main categories.
Classification of functional foods: Functional foods are classified in to a. Probiotic b.
Prebiotic c. Synbiotic d. Phyto chemicals
Classification of functional foods
Functional foods are classified in to
a. Pro-biotic
b. Pre-biotic
c. Syn-biotic
d. Phyto chemicals
a. Pro-biotic: Pro-biotic is a greek word which means "for life" It was coined by Lilly and
Stilwell in1965. Pro-biotics are living microorganisms which upon ingestion in sufficient
numbers, exert health benefits beyond basic nutrition. Pro-biotics are a viable microbial
dietary supplement which uplifts the health of the host.
b. Pre-biotic: In 1995, Pre-biotics was defined by Gibson and Roberfroid as non-digested
food components that, through the stimulation of growth and/or activity of a single type or a
limited amount of microorganisms residing in the gastrointestinal tract, improve the health
condition of a host. Pre-biotics may be used as an alternative to pro-biotics or as an additional
support for them. Pre-biotics have enormous potential for modifying the gut microbiota, but
these modifications occur at the level of individual strains and species and are not easily
predicted a prior.
c. Syn-biotic: In 1995, Gibson and Roberfroid introduced the term “syn-biotic” to describe a
combination of synergistically acting pro-biotics and pre-biotics. As the word “synbiotic”
implies synergy, the term should be reserved for those products in which a pre-biotic
component selectively favours a pro-biotic microorganism. Syn-biotics have both pro-biotic
and pre-biotic properties and were created in order to overcome some possible difficulties in
the survival of pro-biotics in the gastrointestinal tract.
d. Phyto-chemicals: Phyto-chemicals are plant chemicals that differ from nutrients in some
important ways. Phyto is a greek word for plants. Essential nutrient which include protein,
fats, minerals and vitamins are essential for life. Phyto-chemicals are not necessary for life
but they help to promote optimal health by lowering risk for chronic diseases, such as cancer
and heart disease. They are found only in plant foods. Fruits and vegetables are among the
best sources of these compounds. Phyto-chemicals are believed to have many health benefits
and prevent lifestyle diseases.. Some groups of phyto-chemicals have been linked to
decreased cancer risk also. Following are examples of some phyto-chemicals with nutritional
importance.
i. Flavanoids: Flavanoids are a special class of phyto-chemicals that includes hundreds of
different compounds. They are excellent antioxidants and some have hormonal properties.
Among some of the most studied flavonoids are allicin, which is found in onions and garlic.
Benefits of Flavanoids
 Longer life span.
 Prevents obesity and helps in weight management.
 Prevents cardio vascular disease, diabetes, cancer.
  Prevents neuro generative disease.
 Slows down ageing process.
ii. Carotenoids: Carotenoids are a group of phyto-chemicals that act as pigments, giving
plants their bright green, orange, yellow, red and blue colours.
Benefits of carotenoids
 Beta-carotene, found in carrots, sweet potatoes, green leafy vegetables, red peppers,
and pumpkin. Beta- carotene from foods has been linked to a reduced risk for lung
cancer.
 Lycopene, found in tomatoes and strongly linked to reduced risk for prostate cancer.
 Lutein, found in green leafy vegetables and linked to reduced risk for cancer and
macular degeneration.
iii. Antioxidants: Antioxidants are our first line of defence against free radical damage, and
are critical for maintaining optimum health and wellbeing. Antioxidants are carotenoids,
lycopene, vitamin C, vitamin A, vitamin E etc.
Benefits of Antioxidants
 Slower signs of aging, including of the skin, eyes, tissue, joints, heart and brain.
 Healthier, more youthful, glowing skin.
 Reduced cancer risk.
 Detoxification support.
 Longer life span.
 Protection against heart disease and stroke.
 Less risk for cognitive problems, such as dementia.
 Reduced risk for vision loss or disorders like macular degeneration and cataracts.
 Antioxidants are also added to food or household products to prevent oxidation and
spoilage.
2. Energy Value (Calorific Value) of Food Stuffs

The Energy-Yielding Food Factors: The energy yielding food factors are

1. Carbohydrates.

2. Fats;

3. Proteins.
Within the body, these units are oxidised in the cells. The process is one of the continuous
utilisation of oxygen and production of CO2, water and heat.

Calorific Value

 Energy value of food stuffs are usually expressed in terms of a term known as
calorific value. The calorific value is defined as the quantity of heat liberated in
calories by the complete combustion of a unit mass of the food stuff in excess air or
oxygen under specified standard conditions.
 The calorific value depends on the nature of the food and relative proportion of
proteins, fats and carbohydrates present in that food. It is usually expressed in kilo
calories and the standard mass taken is 100 g.
 This term is used to grade different food stuffs or fuels. Greater the calorific value
higher the quality of the food stuffs or fuel.
 Different fuels as well as food stuffs are graded on the basis of their calorific values.
Energy Units
The energy value of foods can be expressed in terms of kilo calories (KCal) or mega joules
(MJ). The International Union of Nutritional Sciences had suggested the use of Mega Joule
(MJ) as the energy unit in place of KCal.
Kilo Calorie: One kilo calorie is the quantity of heat required to raise the temperature of 1 kg
of water through 10C. It is one thousand times the small calorie used in physics
measurements.
Mega Joule: One kilo calorie equals 4.186 kilo joules. Hence thousand kilo calorie equals
4.186×103 kilo joules or 4.186 mega joules.
Determination of Calorific Value: Calorific value of foods can be determined by two
methods.
Direct Method: The caloric value of a foodstuff can be determined by measuring the heat
produced when a given amount is completely burnt in oxygen. It is done in a ‘bomb
calorimeter’ where the oxygen is put in under considerable pressure. Since it requires a
calorimeter of robust construction, it has been called a bomb calorimeter. It consists of a
heavy steel bomb, with a cover held tightly.

Procedure

 A weighed amount of food sample is placed inside the calorimeter, in a crucible. It is

filled with oxygen under pressure.
 The calorimeter is immersed in a known quantity of water.
 The sample is ignited by means of electric fuse and heat liberated is measured by the
rise in temperature.
 For example, consider the evaluation of calorific value of 2 g of wheat measured with
a calorimeter containing 3 kilograms of water.
Weight of wheat taken = 2 g
Weight of water in the outside vessel = 3000 g
Water equivalent of calorimeter = 500 g
Initial temperature of water = 240C
Final temperature of water = 260C
Rise in temperature = 20C
Heat gained by water and calorimeter = 3500×2 = 7000 calories
2 g of wheat produces 7 kilo calories
1 g wheat produces 3.5 KCal
Calorific value of 100 g of wheat = 350 KCal.
Indirect Method: The caloric value can also be determined indirectly by burning the food in
oxygen in an oxy-calorimeter. The volume of oxygen required to burn the food sample is
measured and the caloric value is calculated. The energy production is accurately related to
oxygen utilization.
The calculation is based on the principle that when 1 litre of oxygen is utilized in the
oxidation of organic nutrients, approximately 4.8 Kcal of heat is liberated. The measurement
of oxygen consumption which is a relatively simple technique is now universally employed
to estimate the metabolic rate. This is ‘indirect calorimetry’.
The energy obtained as a result of complete combustion is the potential energy but the energy
liberated in the body is not the same, and this is called the physiological energy. Since
carbohydrates and fats contain carbon, hydrogen and oxygen, they can be completely burnt to
CO2 and water and hence the potential energy is the same as the physiological energy.
However, in the case of the proteins, the nitrogen is eliminated as urea etc. so the
physiological energy is less than the potential energy.
Gross Energy Value of Foods: The average gross energy value of pure carbohydrates, fats,
and proteins determined with the bomb calorimeter are given below.
1 g Carbohydrate yields = 4.1 KCal
1 g Fat = 9.45 KCal
1 g Protein = 6.65 Kcal
 3. Digestion and absorption of various nutrients present in foods
Digestion is the chemical breakdown of the ingested food into absorbable molecules.
Absorption refers to the movement of nutrients, water and electrolytes from the lumen of the
small intestine into the cell, then into the blood.
Absorption: Glucose and galactose are absorbed across the apical membrane by secondary
active transport (along with Na+) through the Sodium-Glucose co-transporter (SGLT1). Both
glucose and galactose exit the cell via GLUT2 (Glucose transporter) receptors across the
baso-lateral membrane into the blood. Fructose enters the cell by facilitated diffusion via
GLUT5 and is transported into the blood via GLUT2 receptors.
Digestion and Absorption of various nutrients depends upon the type of food to be digested
and absorbed.

Fig 1 – Sodium moves down its concentration gradient, bringing in glucose to the cell.

.
Figure 1. Digestion and Absorption. Digestion begins in the mouth and continues as food
travels through the small intestine. Most absorption occurs in the small intestine.
 Mechanical Digestion
 Chewing (Mouth): Food is initially broken down in the mouth by the grinding action
of teeth (chewing or mastication). The tongue pushes the food towards the back of the
throat, where it travels down the esophagus as a bolus (Food mixes with Saliva). The
epiglottis (Cartilage located behind Tounge) prevents the bolus from entering the
trachea, while the uvula (Soft flap of tissue) prevents the bolus from entering the nasal
cavity.
 Churning (Stomach): The stomach lining contains muscles which physically squeeze
and mix the food with strong digestive juices ('churning’). Food is digested within the
stomach for several hours and is turned into a creamy paste called chime. Eventually
the chyme enters the small intestine (duodenum) where absorption will occur.
  Movement of Food: (Peristalsis) Peristalsis is the principal mechanism of movement
in the oesophagus, although it also occurs in both the stomach and gut. Continuous
segments of longitudinal smooth muscle rhythmically contract and relax. Food is
moved uni-directionally along the alimentary canal in a caudal direction (mouth to
anus).
 CHEMICAL DIGESTION: Large food molecules (for example, proteins, lipids,
nucleic acids, and starches) must be broken down into subunits that are small enough
to be absorbed by the lining of the alimentary canal. This is accomplished by enzymes
through hydrolysis. Many enzymes involved in chemical digestion are summarized in
Table 8.

The Digestive Enzymes (Table 8)

Enzyme Category Enzyme Name Source Substrate Product

Salivary Enzymes Lingual lipase Lingual glands Triglycerides Free fatty acids, and
mono- and diglycerides
Salivary Enzymes Salivary amylase Salivary glands Polysaccharides Disaccharides and
trisaccharides
Gastric enzymes Gastric lipase Chief cells Triglycerides Fatty acids and
monoacylglycerides
Gastric enzymes Pepsin* Chief cells Proteins Peptides
Brushborder α-Dextrinase Small intestine α-Dextrins Glucose
enzymes
Brushborder Enteropeptidase Small intestine Trypsinogen Trypsin
enzymes
Brushborder Lactase Small intestine Lactose Glucose and galactose
enzymes
Brushborder Maltase Small intestine Maltose Glucose
enzymes
Brushborder Nucleosidases Small intestine Nucleotides Phosphates, nitrogenous
enzymes and phosphatases bases, and pentoses
 Carbohydrates Digestion:
 There are three carbohydrate products which are absorbed by the small
intestine; glucose, galactose and fructose.
 Digestion of starch is initiated in the mouth, facilitated by salivary amylase.
The majority of carbohydrate digestion occurs in the small intestine.
 The main enzyme is pancreatic amylase, which yields disaccharides from
starch by digesting the alpha 1-4 glycosidic bonds. The disaccharides
produced (maltose, maltotriose, and a -dextrins) are all converted to glucose
by brush border enzymes.
 Disaccharides occurring naturally in food do not require amylase to break
them down. Brush border enzymes (lactase, sucrase, trehalase) hydrolyse these
compounds into molecules of glucose, galactose and fructose.

 Carbohydrate Absorption:

 By the end of this process of enzymatic digestion, we're left with three
monosaccharides: glucose, fructose, and galactose. These can now be absorbed
across the enterocytes (Intestinal absorptive cells) of the small intestine and into
the bloodstream to be transported to the liver.
 Digestion and absorption of carbohydrates in the small intestine are depicted in a
very simplified schematic below. (Remember that the inner wall of the small
intestine is actually composed of large circular folds, lined with many villi, the
surfaces of which are made up of microvilli. All of this gives the small intestine a
huge surface area for absorption.)
 Fig. 4.5. Digestion and absorption of carbohydrates in the small intestine.

 Protein Digestion: Protein digestion begins in the stomach with the action of pepsin,
which breaks protein into amino acids and oligopeptides. The process of digestion is
completed in the small intestine with brush border and pancreatic enzymes. They split
the oligopeptides into amino acids, dipeptides and tripeptides.
 Protein Absorption: Amino acids are absorbed via Sodium co-transporter, in a
similar mechanism to the monosaccharide. They are then transported across the baso-
lateral membrane via facilitated diffusion. Di and tri-peptides are absorbed via
separate H+ dependent co-transporters and once inside the cell are hydrolysed to
amino acids.

Fig 2 – The sodium-amino acid transporter, which is nearly identical to the sodium-
glucose transporter.

 Lipids Digestion: Lipids are hydrophobic, and thus are poorly soluble in the aqueous
environment of the digestive tract.
 Lipids digestion is started by lingual and gastric lipases, but this only digests 10% of
ingested lipids.
 The remainder of the lipids are digested in the small intestine. Here, bile aids
digestion by emulsifying the fat goblets into smaller chunks, called micelles, which
have a much larger surface area.
 Pancreatic lipase, phospholipase A2 and cholesterol ester hydrolase (3 major enzymes
involved in lipid digestion) hydrolyse the micelles, breaking them down into fatty
acids, monoglycerides, cholesterol and lysolecithin.
  Lipids Absorption:
 The products from digestion are released at the apical membrane and diffuse into the
enterocyte.
 Inside the cell, the products are re-esterified to form the original lipids, triglycerides,
cholesterol and phospholipids.
 The lipids are then packaged inside apo-proteins to form a chylomicron (Droplet of
fat left after absorption). The chylomicrons are too large to enter circulation, so they
enter lymphatic system via lacteals.

Fig 3 – The action of bile acids. By enveloping the lipid, the bile enhances absorption.

 Vitamins Digestion and Absorption: Vitamins are organic molecules necessary for
normal metabolism in animals, but either is not synthesized in the body or is
synthesized in inadequate quantities and must be obtained from the diet. Essentially
all vitamin absorption occurs in the small intestine. Digestion of vitamins and
minerals begins in your mouth, when you chew your food. When food enters the
stomach, hydrochloric acid and other stomach enzymes help release its nutrients.
Your pancreas helps by releasing bile that aids with digestion. From this point, the
vitamins and minerals travel to the small intestine, where they are absorbed into the
bloodstream. Your blood carries the nutrients to your liver, where they are used up
immediately, stored for later use or sent to the kidneys for excretion through urine.
Absorption of vitamins in the intestine is critical in avoiding deficiency states, and
impairment of intestinal vitamin absorption can results from a number of factors,
including intestinal disease, genetic disorders in transport molecules, excessive
alcohol consumption and interactions with drugs.
Water Soluble Vitamins

 Water-soluble vitamins are packed into the watery portions of the foods you eat. They
are absorbed directly into the bloodstream as food is broken down during digestion or
as a supplement dissolves.
 Because much of our body consists of water, many of the water-soluble vitamins
circulate easily in your body. Our kidneys continuously regulate levels of water-
soluble vitamins, shunting excesses out of the body in your urine.
 Although water-soluble vitamins have many tasks in the body, one of the most
important is helping to free the energy found in the food you eat. Others help keep
tissues healthy.
 Contrary to popular belief, some water-soluble vitamins can stay in the body for long
periods of time. You probably have several years’ supply of vitamin B12 in your
liver. And even folic acid and vitamin C stores can last more than a couple of days.
Generally, though, water-soluble vitamins should be replenished every few days.
 Most water soluble vitamins are available for intestinal absorption from two sources:
1) the diet, and 2) synthesis by microbes in the large intestine or, in the case of
ruminants, the rumen. These dual-origin vitamins include biotin, folic acid,
pantothenic acid, riboflavin and thiamin.
 Ascorbic acid can be synthesized by many animals, but not by pigs, in which it is a
true vitamin and must be obtained from dietary sources.
 Niacin is also a bit different - it can be synthesized within the body from tryptophan
but is also absorbed in the intestine from dietary sources.
 Water soluble vitamins of dietary origin are absorbed predominantly in the small
intestine, whereas they are synthesized by microbes and absorbed in the large
intestine. For most of these vitamins, specific carrier-mediated transport systems have
been identified that allow uptake from the intestinal lumen into the enterocyte and for
export from the basolateral surface of the enterocyte. Some of these transporters are
sodium-dependent, while others are not.

Fat-Soluble Vitamins

 Fat-soluble vitamins gain entry to the blood via lymph channels in the intestinal wall
(see illustration). Many fat-soluble vitamins travel through the body only under escort
by proteins that act as carriers.
 Food containing fat-soluble vitamins is ingested. The food is digested by stomach
acid and then travels to the small intestine, where it is digested further. Bile is needed
for the absorption of fat-soluble vitamins. This substance, which is produced in the
liver, flows into the small intestine, where it breaks down fats.

 Nutrients are then absorbed through the wall of the small intestine. Upon absorption,
the fat-soluble vitamins enter the lymph vessels before making their way into the
bloodstream. In most cases, fat-soluble vitamins must be coupled with a protein in
order to travel through the body.

 These vitamins are used throughout the body, but excesses are stored in the liver and
fat tissues. As additional amounts of these vitamins are needed, your body taps into
the reserves, releasing them into the bloodstream from the liver.

 The fat soluble vitamins A, D, E and K are absorbed from the intestinal lumen using
the same mechanisms used for absorption of other lipids. In short, they are
incorporated into mixed micelles (lipid molecules) with other lipids and bile acids in
the lumen of the small intestine and enter the enterocyte largely by diffusion. Within
the enterocyte, they are incorporated into chylomicrons (lipoproteins) and exported
via exocytosis into lymph.
Minerals Digestion and Absorption:

 Digestion of minerals begins in your mouth, when you chew your food. When food
enters the stomach, hydrochloric acid and other stomach enzymes help to release its
nutrients.

 Your pancreas helps by releasing bile that aids with digestion. From this point, the
minerals travel to the small intestine, where they are absorbed into the bloodstream.
Your blood carries the nutrients to your liver, where they are used up immediately,
stored for later use or sent to the kidneys for excretion through urine.

 The food is digested by stomach acid and then travels to the small intestine, where it
is digested further. Nutrients are then absorbed through the wall of the small intestine.
Upon absorption, the fat-soluble vitamins enter the lymph vessels before making their
way into the bloodstream.
 During the process of absorption, nutrients that come from the food (including
carbohydrates, proteins, fats, vitamins, and minerals) pass through channels in the
small intestine into the bloodstream. The blood works to distribute these nutrients to
the rest of the body.

 The vast bulk of mineral absorption occurs in the small intestine. The best-studied
mechanisms of absorption are clearly for calcium and iron, deficiencies of which are
significant health problems throughout the world.

 The small intestine absorbs most of the nutrients in your food, and your circulatory
system passes them on to other parts of your body to store or use. Special cells
help absorbed nutrients to cross the intestinal lining into your bloodstream.

Energy and nutrient needs of human body: Human energy requirements are estimated
from measures of energy expenditure plus the additional energy needs for growth, pregnancy
and lactation.

 Recommendations for dietary energy intake from food must satisfy these
requirements for the attainment and maintenance of optimal health, physiological
function and well-being.
  The latter (i.e. well-being) depends not only on health, but also on the ability to satisfy
the demands imposed by society and the environment, as well as all the other energy-
demanding activities that fulfil individual needs.

 Energy balance is achieved when input (i.e. dietary energy intake) is equal to output
(i.e. total energy expenditure), plus the energy cost of growth in childhood and
pregnancy, or the energy cost to produce milk during lactation.

 When energy balance is maintained over a prolonged period, an individual is

considered to be in a steady state. This can include short periods during which the
day-to-day balance between intake and expenditure does not occur.

 An optimal steady state is achieved when energy intake compensates for total energy
expenditure and allows for adequate growth in children, and pregnancy and lactation
in women, without imposing metabolic, physiological or behavioural restrictions that
limit the full expression of a person’s biological, social and economic potential.

 Within certain limits, humans can adapt to transient or enduring changes in energy
intake through possible physiological and behavioural responses related to energy
expenditure and/or changes in growth.

 Energy balance is maintained, and a new steady state is then achieved. However,
adjustments to low or high energy intakes may sometimes entail biological and
behavioural penalties, such as reduced growth velocity, loss of lean body mass,
excessive accumulation of body fat, increased risk of disease, forced rest periods, and
physical or social limitations in performing certain activities and tasks.

 Some of these adjustments are important and may even increase the chances of
survival in times of food scarcity.

Concept of Healthy Diet: An adequate, healthy diet must satisfy human needs for energy
and all essential nutrients. Furthermore, dietary energy needs and recommendations cannot be
considered in isolation of other nutrients in the diet, as the lack of one will influence the
others. Thus, the following concept is based on the assumption that requirements for energy
will be fulfilled through the consumption of a diet that satisfies all nutrient needs.
Energy requirement: is the amount of food energy needed to balance energy expenditure in
order to maintain body size, body composition and a level of necessary and desirable physical
activity consistent with long-term good health. This includes the energy needed for the
optimal growth and development of children, for the deposition of tissues during pregnancy,
and for the secretion of milk during lactation consistent with the good health of mother and
child.

The recommended level of dietary energy intake: For a population group, it is the mean
energy requirement of the healthy and well-nourished individuals who constitute that group.

 Based on above definitions, a main objective for the assessment of energy

requirements is the prescription of dietary energy intakes that are compatible with
long-term good health. Therefore, the levels of energy intake recommended by the
expert consultation are based on estimates of the requirements of healthy and well-
nourished individuals.
 It is recognized that some populations have particular public health characteristics that
are part of their usual, "normal" life. Foremost among these are population groups in
many developing countries where there are numerous infants and children who suffer
from mild to moderate degrees of malnutrition and who experience frequent episodes
of infectious diseases, mostly diarrhoeal and respiratory infections.

Daily energy requirements and daily energy intakes: Energy requirements and
recommended levels of intake are often referred to as daily requirements or recommended
daily intakes.

 These terms are used as a matter of convention and convenience, indicating that the
requirement represents an average energy needs over a certain number of days and
that the recommended energy intake is the amount of energy that should be ingested
as a daily average over a certain period of time.
 There is no implication that exactly this amount of energy must be consumed every
day or that the requirement and recommended intake are constant, day after day.
 Neither is there any biological basis for defining the number of days over which the
requirement or intake must be averaged.
  As a matter of convenience, taking into account that physical activity and eating
habits may vary on some days of the week, periods of seven days are often used when
estimating the average daily energy expenditure and recommended daily intake.

Average requirement and inter-individual variation

 Estimates of energy requirements are derived from measurements of individuals.

 Measurements for collection of individuals of the same gender and similar age, body
size and physical activity are grouped together to give the average energy requirement
- or recommended level of dietary intake - for a class of people or a population group.
 These requirements are then used to predict the requirements and recommended levels
of energy intake for other individuals with similar characteristics, but on whom
measurements have not been made.
 Although individuals in a given class have been matched for characteristics that may
affect requirements, such as gender, age, body size, body composition and lifestyle,
there remain unknown factors that produce variations among individuals.
 Consequently, there is a distribution of requirements within the class or population
group (WHO) (Figure 2.1).

FIGURE 2.1: Distribution of energy requirements of a population group or class of

individuals*
* It is assumed that individual requirements are randomly distributed about the mean
requirement for the class of individuals and that the distribution is Gaussian (Normal
distribution, also known as the Gaussian distribution, is a probability distribution that is
symmetric about the mean, showing that data near the mean are more frequent in occurrence
than data far from the mean. In graph form, normal distribution will appear as a bell curve).

 For most specific nutrients, a certain excess of intake will not be harmful. Thus, when
dietary recommendations are calculated for these nutrients, the variation among
individuals in a class or population group is taken into account, and the recommended
level of intake is an amount that will meet or exceed the requirements of practically
all individuals in the group.
 For example, the recommended safe level of intake for proteins is the average
requirement of the population group. This approach cannot be applied to dietary
energy recommendations, because intakes that exceed requirements will produce a
positive balance, which may lead to overweight and obesity in the long term.
 A high level of energy intake that assures a low probability of energy deficiency for
most people also implies a high probability of obesity for most people owing to a
dietary energy excess (Figure 2.2).
 Therefore, in agreement with above theory, it is concluded that the descriptor of the
dietary energy intake that could be safely recommended for a population group is the
estimated average energy requirement of that group.

FIGURE 2.2: Probability that a particular energy intake is inadequate or excessive for an
individual*
* Individuals are randomly selected among a class of people or a population group. The two
probability curves overlap, so the level of energy intake that assures a low probability of
dietary energy deficiency. It is the same level that implies a high probability of obesity owing
to dietary energy excess.

Sources of Dietary Energy: Energy for the metabolic and physiological functions of humans
is derived from the chemical energy bound in food and its macronutrient constituents, i.e.
carbohydrates, fats, proteins and ethanol, which act as substrates or fuels. After food is
ingested, its chemical energy is released and converted into thermal, mechanical and other
forms of energy.

 Energy requirements that must be satisfied with an adequately balanced diet and does
not make specific recommendations for carbohydrates, fats or proteins.
 Nevertheless, it should be noted that fats and carbohydrates are the main sources of
dietary energy, although proteins also provide important amounts of energy,
especially when total dietary energy intake is limited.
 Ethanol is not considered part of a food system, but its contribution to total energy
intake cannot be overlooked, particularly among populations that regularly consume
alcoholic beverages.
 Allowing for the mean intestinal absorption, and for the nitrogenous portion of
proteins that cannot be completely oxidized, the average values of metabolizable
energy provided by substrates in a mixed diet are 16.7 kJ (4 kcal) per gram of
carbohydrate or protein, and 37.7 kJ (9 kcal) per gram of fat. Ethanol provides 29.3 kJ
(7 kcal) per gram.
 The energy value of a food or diet is calculated by applying these factors to the
amount of substrates determined by chemical analysis, or estimated from appropriate
food composition tables.

Components of Energy Requirements: Human beings need energy for the following:

1. Basal metabolism.

 This comprises a series of functions that are essential for life, such as cell function
and replacement; the synthesis, secretion and metabolism of enzymes and
hormones to transport proteins and other substances and molecules; the
 maintenance of body temperature; uninterrupted work of cardiac and respiratory
muscles; and brain function.
 The amount of energy used for basal metabolism in a period of time is called
the basal metabolic rate (BMR), and is measured under standard conditions that
include being awake in the supine position (means lying horizontally with the
face) after ten to 12 hours of fasting and eight hours of physical rest and being in a
state of mental relaxation in an ambient environmental temperature that does not
elicit heat-generating or heat-dissipating processes.
 Depending on age and lifestyle, BMR represents 45 to 70 percent of daily total
energy expenditure, and it is determined mainly by the individual’s age, gender
and body size and body composition.

2. Metabolic response to food.

 Eating requires energy for the ingestion and digestion of food, for the absorption,
transport, inter-conversion, oxidation and deposition of nutrients.
 These metabolic processes increase heat production and oxygen consumption, and
are known by terms such as dietary-induced thermogenesis, specific dynamic
action of food and thermic effect of feeding.
 The metabolic response to food increases total energy expenditure by about 10
percent of the BMR over a 24-hour period in individuals eating a mixed diet.

3. Physical activity.

 This is the most variable component after BMR, the second largest component of
daily energy expenditure.
 Humans perform obligatory and discretionary physical activities. Obligatory
activities can seldom be avoided within a given setting, and they are imposed on
the individual by economic, cultural or societal demands.
 The term "obligatory" is more comprehensive than the term "occupational",
because, in addition to occupational work, obligatory activities include daily
activities such as going to school, tending to the home and family and other
demands made on children and adults by their economic, social and cultural
environment.
 4. Discretionary activities.

 Although not socially or economically essential, are important for health, well-being
and a good quality of life in general. They include the regular practice of physical
activity for fitness and health; the performance of optional household tasks that may
contribute to family comfort and well-being; and the engagement in individually and
socially desirable activities for personal enjoyment, social interaction and community
development.

5. Growth.
 The energy cost of growth has two components:
1) The energy needed to synthesize growing tissues;
2) The energy deposited in those tissues.
 The energy cost of growth is about 35 percent of total energy requirement during the
first three months of age, falls rapidly to about 5 percent at 12 months and about 3
percent in the second year, remains at 1 to 2 percent until mid-adolescence, and is
negligible in the late teens.
6. Pregnancy.
 During pregnancy, extra energy is needed for the growth of the foetus, placenta and
various maternal tissues, such as in the uterus, breasts and fat stores, as well as for
changes in maternal metabolism and the increase in maternal effort at rest and during
physical activity.
7. Lactation.
 The energy cost of lactation has two components:
1) The energy content of the milk secreted; and
2) The energy required producing that milk.
 Well-nourished lactating women can derive part of this additional requirement from
body fat stores accumulated during pregnancy.

Calculation of Energy Requirements

 The total energy expenditure of free-living persons can be measured using the doubly
labelled water technique (DLW) or other methods that give comparable results.
 Among these, individually calibrated heart rate monitoring has been successfully
validated. Using these methods, measurements of total energy expenditure over a 24-
 hour period include the metabolic response to food and the energy cost of tissue
synthesis.
 For adults, this is equivalent to daily energy requirements. Additional energy for
deposition in growing tissues is needed to determine energy requirements in infancy,
childhood, adolescence and during pregnancy, and for the production and secretion of
milk during lactation.
 It can be estimated from calculations of growth (or weight gain) velocity and the
composition of weight gain and from the average volume and composition of breast
milk.

Estimates of total energy expenditure: Energy spent while sleeping, resting, and working,
doing social or discretionary household activities and in leisure may in turn be calculated by
knowing the time allocated to each activity, and its corresponding energy cost. Special
considerations and additional calculations assist the formulation of recommendations for
children and adolescents with diverse lifestyles.

 Total energy expenditure has also been measured in groups of adults, but this has
been primarily in industrialized countries. Variations in body size, body composition
and habitual physical activity among populations of different geographical, cultural
and economic backgrounds make it difficult to apply the published results on a
worldwide basis.
 Thus, in order to account for differences in body size and composition, energy
requirements were initially calculated as multiples of BMR. They were then converted
into energy units using a known BMR value for the population, or the mean BMR
calculated from the population’s mean body weight.
 The extra needs for pregnancy and lactation were also calculated using factorial
estimates for the growth of maternal and foetal tissues, the metabolic changes
associated with pregnancy and the synthesis and secretion of milk during lactation.

Expression of requirements and recommendations: Measurements of energy expenditure

and energy requirement recommendations are expressed in units of energy (joules, J), in
accordance with the international system of units. Because many people are still used to the
customary usage of thermo-chemical energy units (kilocalories, kcal), both are used.
Gender, age and body weight are the main determinants of total energy expenditure. Thus,
energy requirements are presented separately for each gender and various age groups, and are
expressed both as energy units per day and energy per kilogram of body weight. As body size
and composition also influence energy expenditure, and are closely related to basal
metabolism, requirements are also expressed as multiples of BMR.

RECOMMENDED DIETARY ALLOWANCES: BASIC CONCEPT Humans need a

wide range of nutrients to lead a healthy and active life. The amount of each nutrient needed
for an individual depends on age, body weight, physical activity, physiological state
(pregnancy, lactation) etc. So basically the requirement for nutrients varies from individual to
individual.

 For example in case of infants and children, the requirement may be equated with the
amount that will maintain a satisfactory rate of growth and development.
 Similarly for an adult the nutrient requirement is the amount that will maintain body
weight and prevent the depletion of the nutrient from the body which otherwise may
lead to deficiency.
 In physiological condition like pregnancy and lactation, adult women may need
additional nutrients to meet the demand of fatal growth along with their own nutrient
needs.
 Now within each group (say infants or an adults etc) there may be individual
variations in the nutrient requirements. For instance, there may be a period of low
intake or the quality of the diet may vary, similarly the effect of cooking and
processing may be different and bioavailability of the nutrient from the diet may also
vary.
 A safety factor is added over and above the nutrient requirement for each group to
arrive at the Recommended Dietary Allowances.

The Recommended Dietary Allowances (RDA) are the levels of intake of the essential
nutrients that are judged to be adequate or sufficient to meet the nutrient requirement
of nearly all (97 to 98 percent) healthy individuals in a particular life stage and gender
group.
The various applications of RDA include:
 Comparison of individual intakes to the RDA allows an estimate to be made about the
probable risk of deficiency among individuals.
 Modifying nutrient requirements in clinical management of diseases.
 To help public health nutritionists to compose diets for schools, hospitals, prisons etc.
 For health care policy makers and public health nutritionists to design, develop
nutrition intervention programmes and policies.
 For planning and procuring food supplies for population groups.
 For evaluating the adequacy of food supplies in meeting national nutritional needs.
 For interpreting food consumption records of individuals and populations.
 For establishing Standards for the national feeding programmes implemented by the
Governments for its vulnerable population.
 For designing nutrition education programmes for the masses.
 For developing new food products and dietary supplements by the industry.
 Establishing guidelines for the national labelling of packaged foods (by Food
Standards Safety Authority of India (FSSAI).
Recommended Dietary Allowances (RDA) for Indian Population: For the Indian
population, the dietary standards have been computed by the Indian Council of Medical
Research (ICMR). These recommendations have been published as "Nutrient Requirements
and Recommended Dietary Allowances for Indians" (ICMR 2010).
The recommendations are constantly revised whenever new data is available. Based on the
new guidelines of the International Joint FAO/WHO/UNU Consultative Group and based on
the data on Indians that had accumulated after 1989 recommendations. Table 1(a) and Table
1(b) present these recommendations.
 Note, the RDA for Indians are presented for the different age categories: 0-6 months,
7 to 12 months, 1 – 3 years, 4 – 6 years, 7 – 9 years, 10 – 12 years, 13 – 15 years,16 –
18 years, adult man and women.
 Recommended dietary allowances for adults are based on sex (male or female) body
weight and physical activity level (i.e. Sedentary, Moderate and Heavy work).
 RDA for energy is expressed in kilocalories (Kcal), for proteins, fats in grams (g) for
calcium, iron, vitamins and minerals in milligram (mg) or microgram.
 RDA for protein is based on body weight. The relationship can be expressed as 1g
protein per kg body weight in the case of adults. It varies for other age categories.
 RDA for energy and protein are given as additional intakes in pregnancy and
lactation, indicated by a (“+ “sign). This requirement is over and above the normal
requirement of adult women. RDA for other nutrients is given as total intake figures.
 In infancy RDA's for energy, protein, iron, thiamin, riboflavin and niacin are
expressed as per kg body weight (expected for a healthy, normal growing infant of a
particular age).
 RDA for Vitamin A have been given in terms of retinol or alternatively in terms of
Beta Carotene.
 The knowledge of nutrients and the rich food sources of these nutrients will form the
basis for diet planning. The amount of different foods to be consumed would depend
on the RDA.
  Higher the RDA for a particular nutrient, the more should be the consumption of food
rich in that nutrient. For example, we learnt that the RDA for energy for a heavy
worker (adult male) is more as compared to a sedentary male adult.
 To meet these increased high needs of energy we must ensure that we include more of
carbohydrates and fat rich foods in the diet of the heavy adult worker. Carbohydrate
rich foods such as cereals, sugars, roots and tubers and fat from oils, butter, ghee etc.
will help meet the increased energy requirement.
 Similarly in case of infants (6-12 months of age) when the protein needs are high
(1.69 g/kg body weight/d) as compared to adults (1g/kg body wt) it would be
recommended that high protein rich foods such as milk and milk products, pulses,
meat and meat products may be included in the diet of the infants. A detailed review
on planning balanced diet is covered in another unit.
NUTRITIONAL PROBLEMS: Malnutrition is the underlying cause of at least 50 per cent
of deaths of children under five years of age. The statistics for nutrition-related problems in
our country reveal an alarming situation:
 Almost one-third of the infants born in India are low birth weight babies i.e., they
weigh less than 2500g or 2.5kg. Low birth weight may have adverse effects
throughout their growing years and may have adverse implications even in adult life.
Low birth weight may even lead to child mortality.
 There is widespread prevalence of growth retardation among preschoolers (from
socio-economically disadvantaged families) and almost half the children suffer from
mild and moderate under nutrition.
 A large proportion of children (and adults) suffers from micronutrient deficiencies in
varying degrees of severity. The micronutrients of most concern are iron, zinc,
vitamin A, iodine, folic acid and vitamin B12.
India mostly faces the problem of under nutrition; however, the problem of over nutrition is
also on the rise.
Causes of Nutritional Problems
Gradually, over the years, large numbers of persons have altered their dietary patterns and
lifestyles.
 With respect to lifestyle, people have become more inactive, relying on faster means
of transportation, walking less and doing less amount of outdoor or physical activity.
 In large cities, even children do not play enough outdoor games. Simultaneously
dietary patterns have become less ‘healthful’. Food choices have become less
 ‘healthy’ because processed foods, fast foods, snacks, western type foods, e.g.,
burgers, pizzas, biscuits, chocolates, cakes and pastries, soft drinks, even Indian
mithais, samosas, etc. (that are high in energy, sugar, fat, salt and low in other
nutrients and fibre) are increasingly becoming part of the daily diet.
 At the same time, intake of whole grains, pulses, vegetables and fruits has reduced.
All these lead to undesirable/inappropriate weight gain, overweight and obesity and
ultimately lead to diseases such as hypertension, heart disease, diabetes, cancer,
arthritis and others. These diseases are non-communicable and take their toll not only
on the physical health but also on quality of life, adding to the financial burden.
 Thus India is said to face “the double burden of malnutrition” i.e., coexistence of both
under nutrition and over nutrition. Although communicable diseases like smallpox
have been controlled, newer ones like HIV/AIDS and old ones like tuberculosis,
hepatitis, malaria are increasing in frequently.
 The ultimate consequences of these communicable diseases are far worse for those
who are not optimally nourished i.e., those who are undernourished and those who
have lower immunity due to obesity, diabetes, HIV/AIDS, etc. This poses challenges
for doctors, nutritionists and the government in terms of treatment, control and
prevention.
MAJOR NUTRITION PROBLEMS IN INDIA
WHO IS AT RISK
PREGNANT WOMEN
LACTATING WOMEN
INFANTS
PRESCHOOL CHILDREN
ADOLESCENT GIRLS
ELDERLY PEOPLE
1. Protein- Energy Malnutrition (PEM): It is caused by inadequate food intake vis–a–
vis the requirements, i.e., insufficient intake of the macronutrients (energy and
protein).
 Children are at greatest risk although PEM can occur in adults especially the elderly,
as well as in some diseases e.g. T.B., AIDS. It is assessed by evaluating the
anthropometric measurements (weight, height, head-chest circumference, etc.). EN
PEM

CAUSES AND RISK FACTORS CONTRIBUTORY

FACTORS
Inadequate intake of food Poor environment Hygiene
Diarrhea Large family size
Measles Poor maternal health
Intestinal worms Failure of lactation
Infants and pre schoolers e “food gap”.. Premature termination of breast feeding
Respiratory infections Delayed supplementary feeding
Use of over diluted cow’s milk
 Kwashiorkor is the most common and widespread nutritional disorder in developing
countries. It is a form of malnutrition caused by not getting enough protein in the diet.
 Marasmus is a severe form of malnutrition that consists of the chronic wasting away
of fat, muscle, and other tissues in the body. Malnutrition occurs when the body does
not get enough protein and calories. This lack of nutrition can range from a shortage
of certain vitamins to complete starvation. Marasmus is one of the most serious forms
of protein-energy malnutrition (PEM) in the world.
Comparative Chart
KWASHIORKOR MARASMUS
Acute illness/infections, measles, AGE, Severe prolonged starvation, chronic/recurring
trauma, sepsis are some causes infections

Protein is principal nutrient Calories and protein are principal nutrients

18 months to 3 years 6 months to 2 years
Rapid, acute onset Chronic, slow onset
Some weight loss Severe weight loss
High mortality Low mortality unless related to underlying
disease condition
Low Birth Weight: An LBW newborn is any newborn with a birth weight of less than 2.5kg
(including 2.499kg) regardless of gestational age.e.
RISK FACTORS
 Maternal malnutrition
 Anaemia
CAUSES
 Illness/infections
 Short maternal stature
 Very young age
 High parity
 Close birth intervals
 IUGR
 Hard physical labour during pregnancy
 Smoking

Prevention

 Identification of mothers at risk – malnutrition, heavy work

 load, infections, disease and high BP
 Increasing food intake of mother, supplementary feeding,
 Distribution of iron and folic acid tablets
 Avoidance if smoking
 Improved sanitation methods
 Improving health and nutrition of young girls
 Early detection and treatment of medical disorders – DMHTN
 Controlling infections – UTI, rubella, syphillis, malaria

2. Micronutrient deficiencies: If the diet is deficient in energy and protein content it is

also likely to contain inadequate amounts of other nutrients especially micronutrients
viz. minerals and vitamins. The term “hidden hunger” is used to refer to micronutrient
deficiency. The deficiencies of iron, vitamin A, iodine, zinc are of major public health
concern. In addition, there is growing concern about deficiency of vitamin B12, folic
acid, calcium, vitamin D and riboflavin. Some micronutrient deficiencies of public
health concern are described below:
 Iron-deficiency anemia (IDA): It is the most common nutritional disorder in the
world and is prevalent in both developed and developing countries.
 The vulnerable groups are women in child–bearing age, adolescent girls, pregnant
women and school age children.
 IDA occurs when haemoglobin production is considerably reduced and it results in
low levels of haemoglobin in blood.
 Symptoms depend on the rate of fall in haemoglobin. Since haemoglobin is required
for carrying oxygen in the body, any physical exertion leads to shortness of breath
(breathlessness on slight exertion) and the person complains of fatigue and may feel
lethargic.
 Manifestations of IDA include general pallor, paleness of conjunctiva of eyes, tongue
and nail beds and soft palate. In children, cognitive functions (attention span,
memory, concentration) are adversely affected.
Prevention
 Estimation of Hb to assess degree of anaemia.
 Blood transfusion in severe cases of anaemia (<8g/dL).
 Iron and folic acid supplements.
 Food fortification with iron.
 Changing dietary habits.
 Control of parasites.
 Nutritional education and awareness.