Nutrition | Hasnat Hussain (Reus-11)

Nutrition
Q.1) Malnutrition is one of the major nutritional public health problems in
developing countries. It is responsible for the high mortality and morbidity in
children under 5.
(a) What are the commonly used classifications of malnutrition?
(b) How will you assess malnutrition in under 5 children?
ANS:
Commonly used classifications of malnutrition:
1. Gomez
2. Welcome
3. Waterlow
4. Jeliffe
5. WHO
6. CDC
7. McLaren/Read
8. NCHS

Assessment of malnutrition in under 5 children:

By anthropometry.
Parameters used;
(i) Weight
(ii) Height
(iii) Length
(iv) Arm circumference
(v) Skin fold thickness
Reference standards;
(i) Harvard standards
(ii) National centre for health statistics (NCHS)
Indices;
(i) Weight for age
(ii) Height for age
(iii) Weight for height

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 Nutrition | Hasnat Hussain (Reus-11)

(iv) Skin fold thickness

(v) Chest/head circumference ratio
(vi) Arm circumference

Q.2) During a visit to a village, you encountered small children with retarded
growth, muscle wasting, thin hair, loose motion and pot belly.
(a) What factors are responsible for this malnutrition problem?
(b) What preventive measures will you take?
ANS:
Factors responsible of this malnutrition:
1. Inadequate intake of food both qualitatively and quantitatively.
2. Infections e.g. diarrhea, measles
3. Poor environment
4. Overcrowding
5. Poor maternal health
6. Failure of lactation
7. Early weaning
8. Ingestion of dilute cow’s milk

Prevention:
1. Protein rich diet
2. Immunization to prevent infections
3. Promotion of breast feeding
4. Education of mothers about the importance of breast feeding and nutrition of the
child
5. Improvement of environmental conditions
6. Reduction of poverty
7. Provision of low cost weaning foods and supplements
8. Supplement feeding programs
9. Family planning to reduce family size
10.Surveillance
11.Early diagnosis and treatment
12.Rehabilitation

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 Nutrition | Hasnat Hussain (Reus-11)

Q.3) Note on PEM.

ANS:
PEM:
“Malnutrition due to deficiency of protein and calories, and commonly associated with
infections.”
 Occurs in infants and children more frequently.
 Consists of 2 conditions
(i) Marasmus
(ii) Kwashiorkor
 Age groups affected; Marasmus  children below 15 months of age
Kwashiorkor  children more than 15 months of age
 Etiological factors and prevention have already been described.

Q.4) A child of age 2 belonging to a poor family is brought to paeds OPD. The
father is complaining of difficulty to see things at night and occurrence of
repeated chest infections. On examination of the eyes, conjunctival xerosis
was present.
(a) Diagnosis?
(b) Signs and symptoms?
(c) Function of the deficient thing?
ANS:
Dx: Vitamin A deficiency
Signs and symptoms:
1. Night blindness
 Inability to see in dim light.
 Late dark adaptation.
2. Conjunctival xerosis
 Dry conjunctiva.
 Muddy and wrinkled. Not shiny.
3. Corneal xerosis
 Dry cornea.
 Ulceration and scarring may also occur.

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 Nutrition | Hasnat Hussain (Reus-11)

4. Bitot’s spots
 Triangular, white or yellowish foamy spots on the bulbar conjunctiva beside
the cornea.
5. Keratomalacia
 Liquefaction of cornea.
 Cornea may rupture.
 It’s an emergency and urgent intervention is required.
6. Anorexia
7. Growth retardation
8. Recurrent respiratory and intestinal infections

Function of the deficient thing:

1. It is involved in the production of rods in retina, which are required for night vision.
2. Maintains integrity and functioning of glandular and epithelial tissue of respiratory,
intestinal and urinary tract.
3. Skeletal growth.
4. Anti-infective.
5. Protects against some epithelial cancers.

Q.5) Among macronutrients, proteins are of the greatest importance in human

nutrition and constitute about 20% of body weight in an adult.
(a) What is biological complete and incomplete protein?
(b) Describe the complementary action of proteins with examples.
(c) How PEM is classified according to Waterlow’s classification?
ANS:
Biological complete protein:
“Protein that contains all the EAA in sufficient amounts required by human beings.”
E.g. meat, fish, eggs
Biological incomplete protein:
“Protein which lacks one or more EAA.”
E.g. nuts, seeds, legumes

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 Nutrition | Hasnat Hussain (Reus-11)

Complementary (supplementary) action of proteins:

 Human beings derive proteins from multiple sources e.g. animals, vegetables.
 Cereals are deficient in lysine and threonine, while pulses are deficient in methionine.
These are essential amino acids and they are very important for normal growth and
development.
 When two or more foods are eaten together e.g. daal + chawal, they supplement
each other and provide us with a combination of all EAA required.
 Thus, with proper planning, it’s possible for a vegetarian or a poor man to obtain all
EAA from mixed diets of cereals, vegetables and pulses. This is called the
complementary or supplementary action of proteins.
 Examples  (i) daal chawal (ii) tofu + rice (iii) macaroni + cheese (iv) peanut butter +
bread

Waterlow’s classification of PEM:

W/H >m-2 SD <m-2 SD
H/A
>m-2 SD Normal Wasted
<m-2 SD Stunted Wasted and stunted

M = mean
SD = standard deviation

Q.6) Explain pasteurization process to render milk safe for human

consumption and give the definition, causes and common types of
micronutrients deficiency.
ANS:
Pasteurization of milk:
“Heating of milk to a specific temperature for a specific period of time, to destroy all the
pathogens that may be present in the milk while causing minimum changes to milk’s
composition, taste and nutritive value.”
Pasteurization is a very important preventive measure. It makes the milk safe and healthy
to drink. It kills 90% of bacteria present in the milk.

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 Nutrition | Hasnat Hussain (Reus-11)

Methods;
1. Holder method
 Milk is kept at 63-66 deg C for 30 minutes and then quickly cooled to 5 deg C
2. HTST method
 Milk is rapidly heated to 72 deg C for less than 15 seconds and then rapidly
cooled back to 4 deg C
3. UHT method
 Milk is rapidly heated to 125 deg C for a few seconds and then rapidly cooled
and bottled

Micronutrients deficiency:
“Lack of essential vitamins and minerals required in small amounts by the body for proper
growth and development.”
Causes;
1. Poverty
2. Lack of education about nutrition
3. Poor maternal and paternal care
4. Inadequate or no breastfeeding
5. Consumption of formulated or diluted cow milk
6. Parasitic diseases
7. Lack of consumption of fresh vegetables and fruits
8. Lack of consumption of fortified food
9. Consumption of ready-made food or fast food
Types;
1. Vitamin A deficiency
2. Vitamin B deficiency
3. Scurvy
4. Vitamin D deficiency
5. Iodine deficiency
6. Iron deficiency
7. Folate deficiency
8. Calcium deficiency

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 Nutrition | Hasnat Hussain (Reus-11)

Q.7) Name five nutritional disorders of public health importance in the context
of our country. What measures would you take to control PEM?
ANS:
Nutritional disorders of Public Health importance in our country:
1. Low birth weight
2. PEM
3. Xerophthalmia
4. Anemia
5. Goiter
6. Obesity
7. Rickets

Measures to control PEM:

 Described previously.

Prepared By: Hasnat Hussain (Reus-11) 