ANC – 1

Section-A
1. a) Define health. Enumerate the different dimensions of health.
Ans
Health is a state of complete physical, mental and social well being and not merely the absence of
disease or infirmity.
According to the definition health is state where an individual is completely well and enjoying that
moment.
The different dimensions of health
Physical health, mental health, social health, spiritual health
b) “Dietary fiber plays an important role in regulation of some body processes”. Comment on
this statement.
Ans-Dietary fibers have many functions in the diet, one of which may be to promote control of
energy intake and reduce the risk of developing obesity. This is linked to the unique physico-
chemical properties of dietary fibers which aid early signalling of satiation and prolonged or
enhanced sensation of satiety. Particularly the ability of some dietary fibers to increase viscosity of
intestinal contents offers numerous opportunities to affect appetite regulation. Dietary fiber used to
be known as ‘roughage’, and refers to a group of substances in plant foods which cannot be
completely broken down by human digestive enzymes. This includes waxes, lignin and
polysaccharides such as cellulose and pectin. Originally it was thought that dietary fiber was
completely indigestible and did not provide any energy. It is now known that some fiber can be
fermented in the large intestine by gut bacteria, producing short chain fatty acids and gases
(methane, hydrogen and carbon dioxide). The fatty acids are absorbed into the blood stream and
provide a small amount of energy. The amount of gas produced depends on the type of fiber eaten
and the gut bacteria present. After a large increase in the amount of fiber in the diet, some people
experience symptoms such as abdominal distension, discomfort and wind. However, the large
intestine and gut bacteria gradually adapt to the increased intake and symptoms usually decrease.

2. Give reason for the following:

(a) Vitamin C helps in rapid wound healing
Ans-Vitamin C plays an important for in synthesis of collagen, special kind of protein, which keeps
the body together. Found in the connective tissues of the body, collagen keeps the tissues together
and therby helps in healing of wounds in case of injury.
b) Milk can help in meeting niacin needs
Ans-There’s a nutrient powerhouse in a variety of flavors that today’s kids love. That beverage is
milk, delivering 9 essential nutrients, including some that are lacking in children’s diets today. Low
fat milk is an excellent source of calcium, vitamin D, riboflavin and phosphorus, and a good source
of protein, potassium, vitamin A, vitamin B-12 and niacin.
c) Absorption of iron from plant food sources is low than animal food sources

1
Ans- Plant based food may contain less iron than animal food, but eating smaller amount throughout
the day is a great way to increase absorption. Probably the best known nutrition fact about iron is
that meats—particularly red meats—are rich in iron. It is also true that a number of plant foods are
also rich in iron. It may come as a surprise that researchers have found that people eating plant-based
diets eat as much or more iron as people who regularly rely on animal foods. And, we'll see that list
of excellent iron sources is largely dominated by plant foods.
d) Iodine content of food is influenced by the iodine content of soil/water.
Much of the iodine in today’s diet comes from nonsalt sources in processed foods, such as iodine-
containing food additives, processing aids, and foods grown in iodine-rich soil. The iodine content of
foods can vary tremendously. The iodine content of water, soil, salt and cereals have been analyzed
using Atomic Absorption Spectroscopy (AAS), titrimetry, Fusion and ion selective electrode
methods at Geological Survey of Ethiopia, Geosciences Laboratory Center, Addis Ababa, Ethiopia

3. Briefly explain how the nutrient needs of adults are influenced by the following factors.
a) Activity level
Ans
Young children are often the most at risk of being malnourished. They have very high energy and
nutrient needs for their body size in comparison to adults. Proper care and feeding is essential for
their normal growth, development and activity.
Children need to maintain their diet of energy-rich and body-building foods throughout their
growing years until they reach adulthood. They should be encouraged to exercise and stay active so
that the high energy intake does not result in obesity.
Children recovering from fevers and sickness should also be given plenty of energy and nutrient-rich
foods to eat.
Eating habits are established early on, so it's important to teach children at an early age how to get
the best from food.

People with High/Low Activity Levels

Food is the body's fuel. It therefore follows that the more active people are the more fuel they need,
whereas less active people will need less fuel. For most people their work-related activities
determine energy expenditure.
Those who eat more food energy than they use will put on weight. Those who eat less than they use
up in energy will lose weight. When dietary energy intake balances with energy requirements, body
weight remains fairly constant.

b) Age

Ans-The science of nutrition is dedicated to learning about foods that the human body requires at
different stages of life in order to meet the nutritional needs for proper growth, as well as to maintain
health and prevent disease.

2
A baby is born with a very high requirement for energy and nutrient intake per unit of body weight
to provide for rapid growth. The rate of growth is the highest during the first year and declines
slowly after the age of two, with a corresponding decrease in nutrient and energy requirements.
During puberty, however, nutritional requirements increase sharply until this period of fast growth is
completed. Adulthood begins at about the age of fourteen or fifteen for girls, and eighteen or
nineteen for boys.
An adult individual needs to balance energy intake with his or her level of physical activity to avoid
storing excess body fat.
As teenagers reach adulthood, the basal energy needs for maintaining the body's physiological
functions (basal metabolic rate or BMR) stabilize, and so energy requirements also stabilize.
It is very important to reduce one's energy intake at the onset of adulthood, and to make sure that all
of one's nutritional needs are met. This can be accomplished by making sure that an adequate
amount of energy is consumed (this will vary by body weight, degree of physical fitness, and muscle
vs. body fat), and that this amount of energy is adjusted to one's level of physical activity.

4. Explain how nutritional status of the mother influence birth weight of the infant?

Ans- Explanation: “Nutritional status of the mother influence birth weight of the infant”
It has been studied that maternal malnutrition also affects the health and well-being of the foetus, the
infant and the young child. It often results in death of the child. Even if the child survives; it can
condemn the child to a lifetime of poor health.
Children born with weight less than '2.5 kg are considered underweight and are known as low birth
weight babies
The reasons that how Nutritional status of the mother influence birth weight of the infant are entitled
as under:
A. Woman belonging to a low income group living in villages or urban slums, having an average,
weighs height. As a result of short stature the woman can have a difficult delivery and may even
die during such difficult labour. It is also a fact that women with low body weights deliver babies
who are underweight.

B. The prevalence of anemia is very high in pregnant women due to lack of specific nutrients such
as iron and folic acid in the diet of the mother can also cause severe anemia leads to premature
births (birth before 37 weeks of pregnancy) and low birth weights.

C. Poorly nourished women are more susceptible to urinary infection; they also suffer from diarrhea,
malaria and hepatitis. Infection can slow down foetal growth and may lead to still birth or low
birth weight.

D. In remote rural areas women have to participate in agricultural labour in addition to household
activities and walk long distances to collect water or gather fuel wood. The energy needs of such
women are, therefore, higher. Since these women subsist on inadequate diets the weight gain
during pregnancy is low and they have smaller children?

5. List any four dietary considerations that should be kept in mind while planning meals for
each of the following:

3
a) Lactating mother

b) Adolescent girl

6. What are the objectives and components of:

a) Mid-day meal programme

Objective
To boost Universalization of Primary education (class I-V) by improving enrolment, attendance,
retention and learning levels of children especially those belonging to disadvantaged section.
To improve nutritional status of students of Primary stage and to provide nutritional support to
students of Primary Stage of affected areas during summer vacations also.

Components
Supply of food grains, Wheat/rice at 100 grams per child per school.
Cooking cost at Re 1.00 per child per school per day w.e.f.01-09-2004.
Actual cost in transportation @ Rs.100 per quintal.

4
Construction of Kitchen Shed in rural areas for which funds are made available under SGRY and in
urban areas for which funds are available under NSDP and UWEP component of SJSRY. Proposal
to be reflected in the Annual Action Plan.
Creation of drinking water facility for which funds are available under SSA and ARWSP.
Creation of drinking water facility for which funds are available under SSA and ARWSP.

b) ICDS

Integrated Child Development Services (ICDS), Government of India sponsored programme, is

India's primary social welfare scheme to tackle malnutrition and health problems in children below 6
years of age and their mothers. The main beneficiaries of the programme were aimed to be the girl
child up to her adolescence, all children below 6 years of age, pregnant and lactating mothers. The
gender promotion of the girl child by trying to bring her at par with the male child is a key
component of the scheme.
Objectives
The predefined objectives of ICDS are:
1. To raise the health and nutritional level of poor Indian children below 6 years of age
2. To create a base for proper mental, physical and social development of children in India
3. To reduce instances of mortality, malnutrition and school dropouts among Indian Children
4. To coordinate activities of policy formulation and implementation among all departments of
various ministries involved in the different government programmes and schemes aimed at child
development across India.
5. To provide health and nutritional information and education to mothers of young children to
enhance child rearing capabilities of mothers in country of India

The following services are sponsored under ICDS to help achieve its objectives:
1. Immunization
2. Supplementary nutrition
3. Health checkup
4. Referral services
5. Pre-school non formal education
6. Nutrition and Health information

7. Explain the principle of food preservation involved in the following method:

a) Addition of sodium benzoate to fruit jelly

Ans- Chemical preservatives are frequently used in processed foods to prevent growth of bacteria,
yeast or other microorganisms. Sodium benzoate is a type of preservative commonly used in the fruit
pies, jams, beverages etc. sodium benzoate is the active form of the preservative. Benzoic acid is
found in some fruits such as cranberries, plums and apples.

5
b) Addition of large amount of salt in the pickle
Ans- Increasing the quantity of salt in the food changes its composition. Due to the presence of salt
in the food, osmosis takes place. As a result, water comes out of the food. When there is no or less
water in the food, the microorganisms are not able to grow and the food becomes safe. Salt also
reduces the activity of enzymes, thus preventing the food from getting spoilt. Salt is used as a
preservative in pickle, chutney, sauce and canned food. Salt is rubbed on fish which helps to
preserve it.

c) Addition of citric acid and phosphoric acid to beverages

Ans- Acids: Can you think of any sour food items used as preservatives? These are lemon juice,
vinegar and citric acid. Vinegar is used to preserve onions and tomato ketchup; lemon juice is used
in pickles; citric acid is used in squashes. Acids increase the acidic content of food items, thus
preventing the growth and activity of micro-organisms.

d) Boiling the milk before use

Ans- Micro- and enzymes are destroyed at high temperature, thus food is safe and does not spoil. If
these organisms are not killed, they can spoil food items once the temperature is decreased.
Pasteurization: Pasteurization in milk. We have often heard about pasteurized milk packets. In this
method food is heated to a high temperature and then quickly cooled. The micro-organisms are not
able to withstand the sudden change in temperature and are destroyed. However, some organisms
still survive in this method.

8. Differentiate between the following with suitable examples:

a) Food infections and Food intoxication

Ans- Food infections: When microorganisms are present in the food at the time of consuming food
they cause infections. Getting inside human body they start growing there to cause diseases like
cholera, dysentery, typhoid. All these diseases are caused by eating contaminated fo yd., Sometimes
the food is not processed or handled adequately and causes contamination this is another way of
contracting contamination i.e. through man and causes infectious hepatitis, poliomyelitis and many
other respiratory and intestinal disorders.
Food intoxication: When microorganisms produce toxic substances this contamination is called
intoxication. The toxin present in the food makes the person eating the food sick. There are certain
moulds that produce toxins in the food where they grow in called mycotoxins. A particular mould
attack on peanut, sometimes on maize, wheat, rice, and soybean. They cause liver diseases in them
who consume this infected food. The fungus that produces toxins causing ergotism is associated with
bajra wheat, jowar and rye and is called ergot fungus. This causes gastrointestinal disturbances,
painful cramps in the legs; gangrene in fingers and in toes, depression, weakness and convulsions.
b) Semi-perishable and Non- perishable foods

Ans- -Semi perishable Foods are food like:

Beans in a can, Spaghetti in a can, Instant Noodles, Tinned Fruit, Canned Vegetables
Things like that, I can't really find the words to explain a semi-perishable food but basically it is a
food that is not fresh. Fresh foods are foods like Vegetables, Fruit, Meat, Fish things like that. 
So basically I would say a semi-perishable food is a food that can be kept in the pantry without

6
going off. 
Semi Perishable foods are foods that have low water content and dry foods that contain some amount
of fat.
 Non-perishables are dry and canned foods, sometimes vegetables.
Non-Perishable foods are things such as canned products, Sugar, Spices, All types of pasta. Almost
all dried products are non-perishable as food-spoilage bacteria (like most bacteria) requires moisture
to thrive.

c) List the different method used for assessment of nutritional status.

Ans- Nutritional screening is the process of identifying characteristics known to be associated with
nutrition problems. Its purpose is to identify populations, sub-groups or individuals who are
malnourished or at nutritional risk. Four different methods are used to collect data used in assessing
nutritional status:
1. Anthropometric
2. Dietary: Nutritional History
Current Intake
3. Biochemical or Laboratory
4. Clinical (physical exam)
PURPOSE OF NUTRITION ASSESSMENT
• To accurately determine nutritional status
• To identify current and potential nutritional and medical problems
• To monitor changes in nutritional status during national policy changes, fortification programs,
nutrition intervention or the course of a chronic or acute illness.

9. How are anthropometric measurements used in assessment of nutritional status?

Ans- Anthropometric Approaches to Nutritional Status Assessment

Anthropometric approaches are, for the most part, relatively noninvasive methods that assess the size
or body composition of an individual. For adults, body weight and height are used to evaluate overall
nutritional status and to classify individuals as at healthy or non-healthy weights. In the United
States of America and other industrialized countries, the emphasis for unhealthy weight is over-
weight and obesity. The standards for these have changed over time. The most recent classification
is to use body mass index (BMI, in kg/m2) (Kuczmarski and Flegal, 2000). BMI, regardless of age or
population, is normal at 18.5 to 25.0 kg/m2, overweight at 25.0 to 29.9 kg/m2, and obese at over 30.0
kg/m2(USDA & USDHHS, 2000). In general BMI greater than 30 is assumed to be due to excessive
adiposity.

In children, growth charts have been developed to allow researchers and clinicians to assess weight-
and height-for-age, as well as weight-for-height. For children, low height-for-age is considered
stunting, while low weight-for-height indicates wasting. In addition to weight and height, measures
of mid-arm circumference and skin fold measured over the triceps muscle at the mid-arm are used to
estimate fat and muscle mass. Anthropometric measures of nutritional status can be compromised by
other health conditions. For example, edema characteristic of some forms of malnutrition and other
disease states can conceal wasting by increasing body weight. Head circumference can be used in

7
children 36 months and younger to monitor brain growth in the presence of malnutrition. Brain
growth is better spared than either height or weight during malnutrition.

To interpret anthropometric data, they must be compared with reference data. The choice of the
appropriate reference has been discussed by Johnston and Ouyang. Because well-nourished children
in all populations follow similar patterns of growth, reference data need not come from the same
population as the children of interest. It is of greater importance that reference data be based on well-
defined, large samples, collected in populations that are healthy and adequately nourished. Reference
growth charts (Kuczmarski et al., 2002) have been compiled from cross-sectional data collected
from population surveys of U.S. children. These have been adopted as international standards by the
World Health Organization’s.

10. Briefly discuss the dietary modifications/ preventive measures for:

a) Diabetes mellitus

Four dietary changes can have a big impact on the risk of diabetes mellitus.
1. Choose whole grains and whole grain products over highly processed carbohydrates.
2. Skip the sugary drinks, and choose water, coffee, or tea instead.
3. Choose good fats instead of bad fats.
4.  Limit red meat and avoid processed meat; choose nuts, whole grains, poultry, or fish instead.
If You Smoke, Try to Quit

Making a few lifestyle changes can dramatically lower the chances of developing diabetes mellitus.
The same changes can also lower the chances of developing heart disease and some cancer.

Control Your Weight

Excess weight is the single most important cause of diabetes mellitus. Being overweight increases
the chances of developing diabetes mellitus seven fold. Being obese makes you 20 to 40 times more
likely to develop diabetes than someone with a healthy weight.

Losing weight can help if your weight is above the healthy-weight range. Losing 7 to 10 percent of
your current weight can cut your chances of developing diabetes mellitus in half.

Get Moving—and Turn Off the Television

Inactivity promotes diabetes mellitus. Working your muscles more often and making them work
harder improves their ability to use insulin and absorb glucose. This puts less stress on your insulin-
making cells.

b) Iron Deficiency Anaemia

Food-based approaches represent the most desirable and sustainable method of preventing
micronutrient malnutrition. Such approaches are designed to increase micronutrient intake through
the diet. Food-based approaches should therefore include strategies to:

8
 Improve the year-round availability of micronutrient-rich foods;

Ensure the access of households, especially those at risk, to these foods; and

Change feeding practices with respect to these foods.

One of the greatest strengths of these food-based strategies lies in their potential to result in multiple
nutritional benefits. These benefits can, in turn, achieve both short-term impact and long-term
sustainability.

To prevent iron deficiency anemia in infants, feed your baby breast milk or iron-fortified formula for
the first year. Cow's milk isn't a good source of iron for babies and isn't recommended for infants
under 1 year. Between the ages of 4 and 6 months, start feeding your baby iron-fortified cereals or
pureed meats at least twice a day to boost iron intake

Section-B

Q.1. What is balance diet? List the steps involved in preparing a balance diet. Using these steps
plan a balance diet for a pregnant women in the 2nd trimester of pregnancy belonging to low
socio-economic group.

Ans- "A Balanced diet can be defined as one which contains different types of foods in such
quantities and proportions that the need for calories minerals, vitamins and others nutrients is
adequately met and small provision is made for extra nutrients to withstand short duration of
leanness."

Every person needs (i) Energy giving food (ii) Body Building food (iii) Protective food from his
daily diet. A balanced diet means a diet, which contains all the above constilveats in needed
quantity, in accordance with the requirements of age, sex, constitution of the body, the type of work
and climatic conditions.
Steps involved in preparing a balance diet.
1. Identify the individual and his/her specific characteristics.
2. Consult RDIs for energy and proteins.
3. Decide on total amounts of specific groups.
4. Decide on number of meals to be consumed.
5. Distribute total amount decided between meals.
6. Decide on items and their amounts within each groups for each meal.
7. Check day’s diet for inclusion of specific food groups in the amounts decided.

Balance diet for a pregnant woman in the 2nd trimester of pregnancy belonging to low socio-
economic group.

9
Distribution of foods over day meal for pregnant lady in the 2nd trimester.

Q.2. Plan a snack in iron, energy and protein suitable for a 10-12 year old girl. Your answer
must specify.

10
●Name of the snacks – Bread rolls

●List of ingredients –
The ingredients of bread rolls as:
 Bread pieces
 Potatoes (2-3)
 Tomatoes (1)
 Spinach (25g)
 Chana Dal
 Onion (1)
 Salt, Pepper, Oil
 Sauce (prepared separately/ readymade)

● Method of preparation –

The steps for preparation

 Boil chana dal, and spinach.

 Peel potatoes and mash them. Also mash spinach and mix all these ingredients.

 Cut onion, tomatoes. Make a mix of all these ingredients. Now add salt, pepper etc.

 Take bread pieces and cut the corner of the pieces. Soak bread pieces into water.

 Take some oil in a pan. In every bread pieces, add and fill it with mixture. Put each bread roll on
pan and prepare it till it turns brown.

 Serve it hot with sauce or chutney.

● Sources of iron, energy and protein included.

Iron – It is provided by potatoes, tomatoes and spinach.

Protein- Chana dal and spinach

Fiber – fiber is provided by chana dal and tomatoes in same quantity.

Bread provides carbohydrates.

Q.3. Look up Table 5.3, section 5 of Practical Manual -1 giving a food plan for pushpa, a
sedentary woman. How would you explain this table to pushpa in simple language?

Explain in detail.

11
(You need to explain the concept of use of different food groups, food exchanges, use of food
exchanges in meal planning and conversion of exchanges to the nutrient requirement for a
balanced diet planning as per the RDA to Pushpa.)

Ans- Pushpa is 28 year old women who is a primary school teacher with sedentary life style she will
need 1875 calories energy and 50 gram of protein. I will describe the pushpa the table in easy
manner in following way.

(i) Firstly food groups will be described as ‘Food’ providing energy which includes grains, roots and
tubers as (onions, potatoes etc) sugar and jaggery and oil/fats this group includes fats, carbohydrates
etc providing high calories.

●Food helpful is saving from the disease etc are called glow foods. It is provided by green
vegetables, yellow fruits, citrus as spinach, tomatoes, palak, brinjal and fruits etc. It is helpful in
providing especially vitamins to our body.

(ii) Food exchange evaluate the need of amount of every food item as we need most energy so we
should at least include to exchange of grains which provide 200 grams of energy. In the same way 2
exchanges of milk has to include which can be attained easily from 500mg of glass of milk. 200
grams per day of grains provide 700 kcal and 500 mg, provides 340k calories of energy.

●In the same way pushpa can get 100 grams from one exchange of green vegetables. We can say
that a food exchange is a method of dividing our meals so that required amount of calories, vitamin,
and proteins are attained and included in the food.

●Roots and tubers are sufficient for one exchange but she must take two exchanges of milk which
she can take in it’s by product form also as butter, cheese etc.

●Sugar must include 5 exchanges where every exchange provides 5g is 5 * 5 = 25 gram per day.

●Oil and fat meal include 7 exchanges providing 5 g from one exchange as 7*5=35 grams.

●Pulses of 2

0exchanges means 2 * 30 = 60 grams per day.

●Only the exchange of green vegetables is needed as it provides 100 grams and energy as minimal.

●Total calories are 1885 and proteins are 56 grams as required by her.

Q.4. Look up Annexure 4, “Proforma on regional patterns”. Fill up the Proforma as per the
directions given and submit along with this assignment for assessment.

Ans- DETAILS ABOUT YOUR REGION

12
State- Himachal

District- Hamirpur

Name of village/town/city- Sujanpur

INFORMATION ON MEALS PATTERNS OF YOUR REGION

1) a) How many meals are taken in a day?

Ans- Six

b) List the meals with their names and timing.

Ans- The usual meal patterns resemble this:

Early Morning – Tea

Later in the Morning (around 9 a.m.) – Milk

Lunch (1 p.m.) - ● Rice and/or chapatti (maize or wheat flour)

● Dal preparation or seasonal vegetable

● Salad made of onion/ginger

Evening Tea (4 p.m.)- ●Tea

Dinner (9 p.m.) - ● Chapati and/or rice

● Dal/Vegetable Preparation

OR

● Bedi with chach (bedi is a colocasia/arbi/kachalu and maize flour

Preparation and chach is buttermilk)

Bed Time (10 p.m.) - ● Milk

2) a) Is there a fixed time for eating snacks with tea/coffee/milk? Yes. No.

Ans- No there is no fixed time for eating snacks with tea/coffee/milk.

13
 b) If yes, when are such meals taken?

Ans- There is no fixed time for eating snacks.

c) If no, when are snacks generally eaten? Please specify.

Ans- Snacks are generally eaten with morning and evening tea like Babroo, Badana, and Prak

3) Give a day’s typical menu using this chart.

Ans-

Meal Menu (List of items) Ingredients used Description of dish

and cooking method*
(i) Babroo Wheat flour, sugar, Mixing wheat flour
Breakfast water, Flat frying pan with sugar or shakkar
and water and then fried
on pan in small rounds.

(ii) Chholang Citrus fruits, covered Citrus fruits warmed

bowl, smoking coals for a short time in a
covered bowl over
smoking coals.

Lunch Rice and/or chapatti Rice, maize or wheat Boil rice in water and
flour) making chapatti from
wheat or maize flour.
Adrak ki subji Ginger, spices such as Dry preparation of
turmeric, coriander ginger cut into small
powder, garam masal, pieces and fried with
cumin,fenugreek seeds, spices.
asafoetida and salt

Dal Urad dal, rongi, Urad and rongi dal

turmeric, ginger, hing, boiled with turmeric,
coriander seed or ginger,asafoetida(hing).
powder, cumin and Fried all spices in oil
garam masala, oil and this mixture is

14
 poured over the dal.

Evening Tea Water, milk, sugar, tea Boil water and add
leaves. sugar and tea leaves,
after that add milk.
Poori Atta, oil, salt Deep fried small rounds
Dinner made of atta.

Aloo ki sbji Potato, tomato, hing, Boiling after that fried

zeera, turmeric, red potato with masala.
chilli/coriander powder

Section-c
1. Comment on the interrelationship of the following in 2-3 sentences:
a) Protein quality and Cereal-Pulse combination
The nutritional value of high protein foods are based on both protein quantity and quality. A recent
study assessed the protein quality of cooked pulses using the Protein Digestibility Corrected Amino
Acid Score (PDCAAS) method. Products containing a combination of plant protein sources can have
improved protein quality due to their complementary amino acid profiles. For example, the protein
in pulses is higher in lysine and lower in sulphur amino acids, while cereal grains such as wheat or
rice are lower in lysine and higher in sulphur amino acids. The improved protein quality of
combined pulses and cereals can have nutritional advantages when using these blends for
formulating food products.

b) Food fortification and Salt

Comment: Crude edible salt purchased locally was crushed to a coarse powder. The powdered salt
was mixed thoroughly with ferrous sulphate, potassium iodide or iodide, and other chemicals in the
proportions. This process is called Fortification of Salt with Iron and Iodine
Example: Iron-deficiency - anemia & iodine-deficiency disorder - Goiter is prevalent worldwide and
severely affecting women, pregnant women in particular and preschool children. Providing salt
containing Iodine and Iron played a great role in eradication of these deficiency diseases.

c) ORS and Diarrhoea

Diarrhoeal diseases are a leading cause of mortality in children aged <5 years, accounting for 1.7
million deaths annually.1 Because the immediate cause of death in most cases is dehydration, these
deaths are almost entirely preventable if dehydration is prevented or treated. In 1960s and 1970s,
physicians working in South Asia developed a simple oral rehydration solution (ORS) containing
glucose and electrolytes that could be used to prevent and treat dehydration due to diarrhoea of any
aetiology and in patients of all ages.

15
In 1970s, the World Health Organization (WHO) recommended that an ORS formulation with total
osmolarity 311 mmol/l be used for prevention and treatment of diarrhoeal dehydration.

d) Amylase rich food (ARF) and Digestibility

Amylase is a digestive enzyme that acts on starch in food, breaking it down into smaller
carbohydrate molecules. The enzyme is made in two places. First, salivary glands in your mouth
make salivary amylase, which begins the digestive process by breaking down starch when you chew
your food, converting it into maltose, a smaller carbohydrate. When starchy foods like rice or
potatoes begin to break down in your mouth, you might detect a slightly sweet taste as maltose is
released. Cells in your pancreas make another type of amylase, called pancreatic amylase, which
passes through a duct to reach your small intestine. Pancreatic amylase completes digestion of
carbohydrate, producing glucose, a small molecule that is absorbed into your blood and carried
throughout your body.

e) Adolescence and catch-up growth

Various chronic diseases and malnutrition cause growth failure in childhood and adolescence;
following recovery, catch-up growth may occur. The extent to which growth failure can be
compensated for depends on the timing, severity and duration of the growth failure, as well as on the
aetiology and pathogenesis of the disease restricting growth and development. There are three types
of catch-up growth. In type 1, when growth restriction ceases, growth occurs to such an extent that
the height deficit is rapidly eliminated. Once the original growth curve is attained, growth proceeds
normally. In type 2, when growth restriction ceases, there is a delay in growth and somatic
development. However, growth continues for longer than usual, compensating for the growth arrest.
Type 3 is a mixture of types 1 and 2, and all three types may be complete or incomplete. Two factors
make it difficult to record catch-up growth during adolescence: the large variability in timing,
expression and duration of pubertal growth and somatic development, and the relationship between
the measurement error and the increase in growth observed within a defined time period. To avoid
data collection and analysis problems, prospective and long-term study design should be considered.
Ideally, data collection should be started in the prepubertal period and continue until final adult
height is reached

f) Blanching and Food preservation

Blanching is a unit operation prior to freezing, canning, or drying in which fruits or vegetables are
heated for the purpose of inactivating enzymes; modifying texture; preserving color, flavor, and
nutritional value; and removing trapped air. Hot water and steam are the most commonly used
heating media for blanching in industry, but microwave and hot gas blanching have also been
studied. The design of blanching systems depends on the product, the process following it, and the
final use of the product. Blanching is carried out as a pretreatment for freezing, canning, and drying.

g) Lathyrus sativus and Crippling Paralysis

Excessive consumption of Lathyrus sativus leads to crippling, irreversible paralysis of both lower
limbs, mainly in males. This is attributed to the presence of a non-protein amino acid, β-N-oxalyl-l-
2, 3-diaminopropionic acid or β-N-oxalylamino-l-alanineLathyrus sativus contains β-N-oxalyl-L-
α,β-diaminopropionic acid (β-ODAP), which is thought to cause neuronal damage through excitation
of the AMPA-activated receptors although some researchers believe the mechanism, is more

16
complex.  Beta-amino-propionitrile (BAPN) found in lathyrus odoratus (our more common garden
sweet pea plant) is thought to be responsible for osteolathyrism, which in humans is quite poorly
documented. Patients develop bone pain and disfigurement of bones, including vertebrae and pelvis.
This is to be distinguished from Kashin-Beck's disease which is related to selenium deficiency. 

h) Prophylaxis – nutrition programmes

Comment: Poor people cannot afford to consume diet rich in vitamins and minerals as they are too
expensive. It is not possible for the Government to make these foods available to poor and needy on
regular basis.
As an alternative method, Government of India runs organized special programmes, under which the
commercially prepared vitamins and minerals are supplied to vulnerable sections of the population
through organized programmes. These programmes are known as Nutrient Deficiency Control
Programmes or Prophylaxis Programmes.
Examples:
1. National Prophylaxis Programmes for Prevention of Nutritional Blindness.
2. National Nutritional Anaemia Control Programme.
3. Iodine Prophylaxis Programme.

i) Dietary fat intake and Coronary Heart Disease

Beginning of the deposition of fatty later in Coronary Arteries – Increase in fatty deposits and
beginning of the obstruction in the smooth flow of the blood – Formation of Blood clots in the
coronary arteries – Blood clots leads to complete blockage of arteries. – Due to blocked arteries, the
supply of blood is completely stopped to the heart muscle, resulting in the death of the part of the
tissue of the myocardium (heart muscle).

j) Mid day meal Programme and School enrolment

We find that midday meals result in substantial increases in primary school enrollment, driven by
early primary school responses to the program. School lunches are one such policy. They are thought
to increase enrollment through two main channels. First, they lower the cost of schooling, thereby
providing an implicit subsidy to parents. Second, by improving child nutrition school lunches are
thought to foster learning, thereby increasing the returns to education. School feeding programs are
popular in the developing world and beyond, not only because of their educational but also for their
nutritional benefits. We find that midday meals lead to large and statistically significant increases in
primary school enrollment. This indicates that the positive enrollment we observe in our quasi-
experimental setting may be driven by the implicit subsidy channel rather than nutrition-induced
improvements in learning.

2. List the deficiency disorder(s) and rich food sources of the following nutrients/substances:

a) Iodine
Goiter, Hypothyroidism, Cretinism, Subnormal intelligence, Mental deficiency, Hearing problem,
Squint in eyes, Spasticity, Muscle weakness, Spontaneous abortions and Miscarriages.
Sources are Iodized salt, tablets of sodium or potassium iodide, iodized oil.

b) Folic acid

17
Anemia, tiredness, having little energy (lethargy), feeling faint, and becoming easily breathless. Less
common symptoms include headaches, heartbeats suddenly becoming noticeable (palpitations),
altered taste and ringing in the ears (tinnitus)
Good sources of folic acid are Green leafy vegetables, fruits, milk and animal food.

c) Niacin
Severe deficiency, called pellagra, can cause symptoms related to the skin, digestive, and nervous
system. They include:
Thick, scaly pigmented rash on skin exposed to sunlight, swollen mouth and bright red tongue,
vomiting and diarrhea, headache, apathy, fatigue, depression, disorientation, memory loss
If not treated, pellagra can lead to death.
Good sources of niacin include red meat, fish, poultry, fortified breads and cereals, and enriched
pasta and peanuts.

d) Riboflavin
Acne, Muscle cramps,. Boosting the immune system, Aging, Maintaining healthy skin and hair,
Canker sores, Memory loss including Alzheimer's disease.

e) Vitamin A
Xerophthalmia, Night blindness, conjuctival xerosis, Bitot spots, corneal xerosis, koratomalacia
Green leafy vegetables, yellow fruits.

18