MeCN UMne caer fe — a | ‘A and endogenous sources are used by the body to maintain rd/ glucose haemostasis. vi th _ Phcaemic index (9) ean Glycaemic index of a food is { a ard (either 50 ; glucose or white bread). e or n Some ae containing different fractions of soluble and insoluble fibres favour se of sugar into (reduced peak an i carl and it rate). as compared to high 3! 3 le and absorbable sugar. The concept has practica management of diabetes and control of obesity. The ording to Gl is as follows : ycaemic fooasVITAMINS Vitamins ae a class of oy tial nutrients, They TMI e req "Pound nihesize them (at least in gyro iS gon ‘ provided by fA el en ame a vitamins, viz. vitamins of theipe’ K: ang ig vitamin has specie fur Sup and vin he th in respec nim been determined, but pect Of many somewhat speculative, ‘"® optim Vitamin 9 Vitamin A" covers convert international units (IU) origin att St™al mos eeinally established fay 7 The bithed for vitamin’ A and_provitamin. were ye! respectively (18). In 1960 the roe, 1954. and 1550 Pe dlcahol (which ena M28 intoduced orm), but most workers prefer the age 20 I crane the international unit The intemai et” Vin A and viiamin A is equivalent te gsrnatnal unit (U) ot {610.55 microgram of retinol palmiatg) ee til Some food composition tables gine se retinol and beta-carotene. To conven, rts values for sale the erm “ete equine eh as We conventionally adopted. The conversion cq) gi, ee? pee can be done inthe 1 meg of retinol = 1 RE 1 meg of B-carotene = 0.167 mcg of RE 1 meg of other carotenoids = 0.084 ney of RE TRE = 3.333 IU of Vitamin A Functions Vitamin A participates in many bodily functions fab is indispensable for Tt contributes to. the yments which are needed for vision it is necessary for maintaining the al, es eves. (c) it wth. (d) it i SSS con an vitamin A deficiency, and (e) it st some epithelial cancers such as bronchial cancers, but the data are not fully consistent (19), However, the role of vitamin A at the molecular level is not yet known. Sources —— jamin Ais widely ibe animal and plant = mania Toods as preformed amin A (eli and plant foods as provitamins (carotenes). (a) ANIMAL FOODS : Foods rich in retinol are ara bute cheese whe lye and meat. xh hur ob ate ; = 705 dency tral aces of retin Tablet he Ib) P ne rd al supplements rather than a PLANT FOODS : The eheapest source of vitamin Ay afy vegetables such as spinach and amaranth which in great abundance in nature throughout the year Vne arker the green leaves, the higher its carotene content Wain A also occurs in most green and Yellow fits and Yeuetables (e.g. papaya, mango. pumpkin) 2nd in some {Rots (e., caros). The most mpatant carotenoid seta Sarolene Which Fas The Maestsutamin.A activity, Carctenes cored i tamin A inthe sal intestine Ths act % Poorly accomplished in malnourished children and those lished in ma suffering from diarrhoea {c\ FORTIFIED FOODS : Foods fortified with vitamin A {€.. vanaspati, margarine, mill ean be an important source tain A content of selected foods isa given in Table 5. ae foun TABLES Retinol equivalents (RE) lies (mcal100 a) = eel Hatibutiver el 900,000 Carrot 1167 Cod'ivero 18,000 Spinach 07 Liver, Ox 16500 Amaranth 515 Butter 525 Greenleaves 300 Margarine 900 Mango.ripe 313 Cheese 350. Papava 18 Fey M0 Orange % | Mik, Cow soso pti Bs Fish 0 Source: (20) The liver has an enormous capacity for storing vitamin A, ‘mostly in the form of retinol palmitate, Under normal conditions, @ well-fed person has sufficient vitamin A reserves to meet his needs for 6 to 9 months or more. Free retinol is highly active but toxic and is therefore transported in the blood stream in combination with retinol-binding Protein, which is produced by the liver. In severe protein Aeficiency, decreased production of retinol-binding protein prevents mobilization of liver retinol reserves Deficiency The signs of vitamin A deficiency are predominantly cular, They include nightblindness, conjunctival xerosis, Bitot’s spots, corneal xerosis and keratomalacia, The term *xerophthalmia” (dry eye) comprises all the ocular manifestations of vitamin A deficiency ranging from nightblindness 10 keratomalacia, Given below is a short description ofthe ocular manifestations, (c) Nightbtindness. Lack of vitamin A. fist causes nightblindness or inability to see in dim light. The mother herselt can detect this condition when her child eannot se in late evenings o ind her ina daskened room. Nightblindness is due to impairment in dark adaptation, Unless vitamin intake is increased, the condition may get worse, expecially when children also sutfer from darthoea and other infections (b] Conjunctival xerosis ‘This is the first clinical sign of vitamin A deficiency. The conjuctiva becomes dry and non-wettable. Instead ofTRITION AND HEALTH muddy and wrinkled: looking smooth and shiny it appe ing smooth and shin. it appe ‘rnd banks at has been well described as “emerging like receding tide” when the child ceases to cry (21), (c) Car Ro acy later, Bot» spt YOUNG See A ete wmin A, decency,” ole serial spas ate fen acve seq o disease, (4) Corneal xerosis This stage is particularly serious, The cornea appears aul in SES nom wetable and eventually opaque. It does ah aes and Me appearance 1 MOTE severe decency FES petorcarutceratn. The uler may heal leaving 2 coreal scar which can affect vision (e) Keratomalacia a Is a grave Keratomalaca or tquefacton of ‘medical emergency. The cornea (a part or the whole) may become soft and may burst open. The process is a rapid one Ifthe eye collapses, vision is lost. EXTRA-OCULAR MANIFESTATIONS These comprise follicular hyperkeratosis, anorexia and srouth retardation which have long been recognized, They ‘are non-specific and difficult to quantify. Recent studies seem to indicate that even mild vitamin A deficiency causes ‘an increase in morbidity and mortality due to respiratory ‘and intestinal infection (22). Deficiency of vitamin A has recentiy been linked to child mortality (23). Treatment Vitamin A deficiency should be treated urgenty. Neasty all ofthe eaty stages of can be by administration of ( yf ‘eal pate) fly on to succes dss 24) A iidren with corneal ulcers should receive vitamin A whether or nat a deficiency is suspected Prevention Prevention andlor control takes two forms — (6) improvement of people's diet so as to ensure a regular ‘and adequate intake of foods rich in vitamin A, and (b) reducing the frequency and severity of contributory factors, eg. PEM, respiratory tract infections, diarrhoea and ‘measles. Both are long term measures involving intensive and community nutrition education of the public participation, Since vitamin A can in the fad bee) evolve tye ican eae lutrtion at Hyderabad (India) for community based. intervention against nutritional blindness, which has subsequently been Adopted by other counties (28), The siategy i 0 ‘administer {retinol palmitate (1 year to 6 years to children between 6 months ar age (24). In this way, the child would be, as it were “immunized” ‘against xerophthalmia. The protection afforded by six-monthly dosing seems very adequate as measured by clinical signs of deficiency (26) Assessment of vitamin A defici The formulation of an effective interver for prevention of vitamin A deficiency (Ung Prog, Characterization of he problem. Ths neti surveys employing both clinical and bien’ pe These surveys (prevalence surveys) are ante cy children (6 months to 6 years) who. anc’, mre The criteria recommended by WHO 19), "Peal Table 6. The presence of any one of arg be considered as evidence of a xerophihag 9 probe the community Proje TABLE 6 c Prevalence criteria for determining xerophthalmia problem : Prevalence at ier at eens i Populaia _atsk 6mendenon /Nighiblindness ot than | peg Biot s spots more than pc Corneal serosi/ Meal more han one I uleeration/keratomalacia Per cen Cornea sear more than 0 | Serum retinol ess More than Sp aa ‘than 10 megidl) 7 { Source (18) Recommended allowances The present committee revised the carctne co rao acount for fase. coment conversion factor of 61 i recommended fo, af Se rep! Persploramhine and eearotene unre seme is recommended. The detailed recommendations area 2 in Table 28 ore Toxicity An. of retinol causes nausea, ants ep dss le ty shin dengue ee infakes of carotene ay eolou pasha an ets tag 7) teen, a ee ne interest (28). viramin 3” The nutritionally important forms of Vitamin D in man are Cakciferol (Vitamin D,) and Cholecaleferol (Vitamin Caleiferl may be derived by irradiation ofthe plant er ergosterol, Cholecalciferol_ is the naturally cura (preformed) vitamin D which is found in animal fats nd sh liver oils, It is also derived from exposure to UV ras ofthe sunlight which conver the cholesterol inthe skin o viain D, Vitamin Dis stored largely in the fat depots Vitamin D : Kidney hormone Major advances have been made in recent yeas of understanding ofthe metabolism of vitamin D in the boy (29). It is now known that vitamin D, by itseh ® metabolically inactive unless it undergoes endosems transformation into several active metaboies (@3, 2 HCC; 1 25 DHCC) frst inthe liver and later inthe He, These metabolites are bound to specific transport Br and are caried tothe target tissues ~ bone and it has been proposed that vitamin D should be €5# aNUTRIMON AnD HALT of man is met by a of in the requirement for man appears to be about for the adult. Newborn infants tend to be vvtamin K due to minimal stores of prothrombin at birth and lack of an established intestinal flora Soon after birth, all infants or those at increased risk should receive a single intramuscular dose of a vitamin K preparation (0.1-0.2 mg of menadione sodium bisulphite or 0.5 mg of ‘vitamin K,) by way of prophylaxis (33). B akan Thiamine (vitamin B,) is 2 water-soluble ‘the utilization of (TPP), the coenzyme apart transketolase. an SSeS a Sources ‘Thiamine occurs in all natural foods, although in small ‘amounts. Important sources are : whole grain cereals, wheat, ‘fish, * seach Sey eens Meat. fish, eggs, contain smaller ‘2mounts. Milk isan important source of thiamine for infants, ‘provided the thiamine status of their mothers is satistactory. The main source of thiamine inthe dist of Indian people i cereals (rice and wheat) which contribute per Cas te feet meet, Tr Stamos conte of selected food stuff is given in Table 9. Thlamine lonses Thiamine is teadity lost trom rice siting. Being 8 srt soluble vi floor dain washing and cocking for advising people t0 eschew highly pry pacolled or under-milled rice (see pane Ne thiamine in Iuits and vegetables ty pete prolonged storage (35). Thier ho aan 's ‘and in cereals cooked with bahing soda foe absence of berber is determined by the (ot, cultural practices concerning the process on™ © tice and other foodstuffs. wand Deficiency The two principal deficiency diseases ar, Wernick’s encephalopathy. Beriberi may oct forms : (a) the dry form characterized by, an (peripheral nes orm character involvement ony ed by turieg seen in infants between baby is usually breast-fed by who commonly shows ‘Jew shor! decades 290, rank cases of ber be frequently seen in the coastal discs ot Aes ie where people eat highly polished rice. Investcess ICMR showed that such cases are now rarely ean, because of improved socio-economic. consisted diversification in the diet consumed now (36) ad by the Prevention Beriberi can be eliminated by educating people to well-balanced (eg., parboiled and undermilled rice) ar a Direct supplementation of high-risk groups te ing mothers) is another approach. Beriberi tends i disappear as economic conditions improve and den become more varied (10). The disease, as has been shown is not completely vanquished but the knowledge and resources needed to bring about its disappearance are available (3). Recommended allowances The body content of thiamine is placed at more than this is given it is Patients on regul supplements of thiamine. Thiamine should aso be aren prophylactically to people with persistent vomiting ot prolonged gastric aspiration and those who go on long fst. For further details see Table 28. RIBOFLAVIN (B,) , Riboflavin (Vitamin B,) is a member of the B-aroup vitamins. It has a fundamental role in cellular oxidation. and if ine (19).Sources ices mata sig lealy vegetables net 3° Feels (whether whoje oe OP Hh ca Hvey Gor sources But Decaysy led ang Nama Bipsumed they contribute eM bulk Gjts. Germination increasec N° Of the Bieareals. The rbot seni Table 10. *aSeS thy isa 244s the igs Content of ag SOK i ie ls Source (34) ot Deficiency The most common te. deficiency i SiO associate malnourished chdren amr hich oeynih tetovn af the state of nutrition of grevalence's used ag erty” dlinial signs su Houpe of SU as an inden oe Br godt not specie) Heck je Other even hen severe, se etc, Hypo-itone ea B-complex vitamins such as pyridoxine; it wennsty go a multiple deficiency syndrome, | Salva part of Requirement There are _no_real_ bod 1 riboflavin. Dail requirement ideas dtd siy For further details see Table spree NIACIN (B,) Niacin or nicotinic acid (B,) is eznarnermein a in Nis he normal functioning of the skin, intestinal and newous systems. This vitamin differs from the other vitamins of the B-complex. n_ essential amino acid, acteristic of niacin is that it is metabo t Sources Pca ci Rae ee ech yponken sch is converted in the body into niacin {about 60 mg of ‘tryptophan is required to result in 1 mg of niacin}, In’ many tbls gue 1 ea acne band” fm Milk is a poor ‘unavailable to the consumer. Deficiency 7 Sey Niacin deficiency: characterized by tht bow > Len dy Niabe tip © The disease Is and ne yn r 709 a da an rmabe and were dicey, dese Prevalent in some parts of Western Asia and Southern Aftica People steal os mae and ite be (38), While Peleg sorely a dese of te malze-ating Audra Pradesh some segments of he population ea another cereal thal is jowar (Sorghum ‘ulate, these Peorle consuming very ie of riko ater fod of animal Origin, Suds by Gopan and ater (39) have shoe that ‘ming acid imbalance caused by an excess of teucine the Cause of playa in both owar and soe eaters. Excess of leucine appears to interfere in the conversion of tryptophan Where Prevention Pellagea is a reventable disease, A good mixed diet meas neal ceeded fention and treatment, Avoidance of 2 on maize of is an important ty, Given knowledge and opportunities for economic. agricultural and social development, there is every reason to hhope that this disease could be eliminated (3). modem Requirement The recommended daily allowance is 12 mg per day of ‘energy intake (11). For further details see Table 28. PYRIDOXINE (B,)_ Pyridoxine (vitamin B,) exists in three forms = pyridoxine, pyridoxal and pyridoxamine. It plays an important role in the metabolism of amino-acids, fats and carbohydrate. It is widely distributed in foods, e.g., milk, liver, meat, eaa yolk, fish, whole grain cereals, legumes and vegetables Pyridoxine deficiency is associated with crab et Riboflavin deficiency impairs the optimal_utilization_of Pyridoxine. INH, an antituberculosis drug ® a recognized Aniagonist, and patients receiving INH are provided with a supplement of pyridoxine (10 ma/day). The requirements of adults vary directly with protein intake, Adults may need 2 mg/day; during pregnancy ané lactation, 2.5 malday. Balanced diets usually contai pyridoxine, therefore deficiency is rare. For further detail see Table 28. PANTOTHENIC ACID (B,) ‘There is along standing evidence for a relation betwee pantothenic acid and adrenal cortical function. Wo Indicates a more specific role for pantothenic acid in biosynthesis of corticosteroids (7). Human blood norma ‘contains 18 to 35 mg of pantothenic acid per 100 ml, mos present in the cells as coenzyme A. The daily requirement set at 5 mg (31). All foods contribute to dietary intal About 3 mg are excreted daily in urineAOE _wsriigg avoneaumy rouate The recommended name is folate, alternative name is folacin and the usual pharmaceutical preparation is folic acid (19), Folic acid occurs in food in two forms fe lates and «he tol flats epresent both the groups In folate is uncertain. [which constitute the chromosomes). It is also needed for the normal development of blood cells in the marrow. Sources contributes to folate deficiency in man. Folate deficiency has been reported in babies given milk foods subjected to heat sterilization. Deficiency Folate deficiency may occur simply from a poor diet. Its ‘commonly found in pregnancy and lactation (40) where requirements are increased. It results in disturbances SucT a: 1¢ administration of joi acid antagonists (e.g., alcohol, pyrimethamine, and cotrimoxazole) in early pregnancy may produce abortions or | congenital malformations. | __ The laboratory diagnosis of folate deficiency is based on measurement of serum and red cal folate concentrations, usually by microbiological assay (41) Requirement Body stores of folate are not large, about 5-10 mg, and | therefore, folate deficiency can develop quickly, Folic acid requirements are greatest in conditions where there is rapid cell multiplication, such as during growth in young childven | and during pregnancy (41). Folic acid supplementation during pregnancy has been found to increase the birth ‘weight of infants and decrease the incidence of low birth weight babies. Intake values recommended by ICMR (2020) are given in Table 28, VITAMIN B,, siological mechanism for its absorption requires intrinsic factor from the stomach, and the complex is absorbed only ata special site in the terminal ileum: Sources Good sources are liver, kidney, meat, fish, eggs, mill-and giese Vin ent outa ods ol we, Iv is also synthesized on, Un an, vitamin Bs relatively heat stable. Live is there Ol a thea vidmin Be, About Pg ween a another 2 mg elsewhere in the body, They (2% and sufficient to tide over any deficiency for one ty yt" are Because of these reserves, deficiency of vitamn prt Yeas to be rare. 2 Pears Deficiency Vitamin B,, deficiency is associated wit ise mesa do ou een B,, is not manifested, sub-clnical deficiency ig oo" of exist in India. Reports indicate that there exist <7 30 per cent deficiency in adults and children int Tne peste at Bond iets cet ny since lage proportion of population cepa food for nutrients (9). lant Requirement Intake values recommended by ICMR (2020) aye below (11). Detailed requirements are as shown in Teh in Tale Per day a} Normal adults Pen b) Presnancy +0.25meg ¢) Lactation +10meg 4) Infants & children 22mea S-vitamin dv Vitamin C (ascorbic acid) is a water-soluble vitamin his the t- Man, monkey and guinea pig are pethaps the only species known to requre Vitamin Cin their diet Functions: Vitamin C is a pote: ae tein (7). Collagen ee: vegetable It inhibits nitrosamine formation by the ets ee er ene Sees pti aa acest = Sources 3 sources of vitamin C are esh fits and bles, Traces of vitamin C occur in fresh meat and fish but scarcely in cereals. Germinating pulse ‘Cotsinasodeemcan, Roots and tubers contain smal amounts. Amla or the Indian gooseberry is one of the richest sources of vitamin C both in the fresh as well as in the rv condition. Guavas are another cheap but rich source of this vitamin. The dietary sources of vitamin C a as given it Table 11 aeTABLE 1, Dietary sources of vit i Amin ¢ Ss <4. "9/1005 a ] rts: Vegetables. ll ee te 600 Cabbage | Guava a 21D) Amaranth hela4 | Lime - 63 Cauliflower eo Orange pres S0 Spinach fii 20 Tomato a 27 Brinjat | ‘Germinated pulses : Potatoes ad Bengal gram Raddish pea | source: (34) tee ae Deficiency Deficiency of vitamin C results i the signs of which and subcutaneous Patising ! to th . delay f Scurvy which Was once an important deficiency disease is no longer a disease of world importance (3). Requirement imated requirement for vitamin C i Obie) Mee The normal body when fully" saturater ee about 5 g of vitamin C. Daily intakes recommended i the ICMR (11) are as given in Table 28. Calcium COnStitutes Uman, An Calcium of w amount of ¢ The develop 1S a dynamic and that in | the interacti Probably calc Functions Tonized cal including fort blood, contr Production, re arrive at a c¢ machinery wit intact and in t also plays a a electrical impul controls _ many contraction to c Sources Calcium is re the best natural cheese, curd, ski A litre of cow’s ra, ed Nia, red ion, york nia or globin IODINE ~ ’ — is an essential micronutrient. It is required for the o esis of the thyroid hormones, thyroxine (T,) and triiodothyronine (T,) containing respectively 4 and 3 atoms of iodine. lodine is essential in minute amounts for the normal growth and development and well-being of all humans. The adult human body contains about 50 mg of iodine, and the blood level is about 8-12 micrograms/dl (31) Sources The best sources of iodine are seafoods te.g.. sea fish, sea salt) and cod liver oil. Smaller amounts occur in other foods, e.g., milk, meat, vegetables, cereals, etc The jodine content of fresh water is small and very variable, about 1-50 micrograms/L (31) About 90 per cent of iodine comes from foods eaten; the remainder from drinking water. The lodine content of the soil determines its presence in both water and locally grown foods. The deficiency is geochemical in nature. Goitrogens “Goitrogens”, are chemical substances leading to the ‘of goitre. They interfere with iodine utilizationeen oe ee eee ‘ = SINAWATS JOVHL YSHLO- (29) any] xd But Z 03 Buryutap uy sepuony Jo Fanay wnudo ‘aay sauujuno> ayeieduay SBpITOTG Fo any papuawsiwooas ay] sjuawasnbay jayo st 2UUOML 1s99xo/oua!4720 ypuseva feruap Jou 4 jo uoneayeiquras yeuuou 2 rt pug} 51 6PO%UTRITION AND HEALTH Source of energy dian diets, whieh are sian erate a ply energy at the The main source of energy in In predominantly plant food based, a protein and dietary fibre. They st? following rates Protein = 4kcala Fat — ocala Carbohydrate = 4 Kea Dietary fibre 2 keal’s compen a at oe a en ule nd revised content of carbohydrates, proteins, fat and dietary fibre (9). Oe ee carecane coa proteins (9). ‘Nutritional individuality In normal individuals at all ages and of both sexes, there is a large variation in energy intake but the reasons for this ‘wide range of nutritional requirements are not known. The concept of nutritional individuality needs to be stressed, and its neglect may result in the over-feeding of some whose needs happen to be less than the “average standard requirement” (78). PROTEIN: Protein requirements vary from individual to individual. Apart from age, sex and other physiological variables, factors like infection, worm infestation, emotional disturbances and stress situations can affect a person's protein requirement. Assessment of protein (a) PROTEIN QUALITY The quality of a protein is assessed by comparison to the “reference protein’ which is usually egg protein. Two methods of assessment of protein quality needs mention {, (i) Amino acid score «Its a measure ofthe concentration alert nips acai ine athe tenet 2 percentage of that amino acid in the reference protein of amino acid per go est protein ‘Amino acid score = SO1SmnO SSE perso nee x 100 ‘mg ofthe same amino aad ‘per g of reference protein a, between 50 and 60 for starches, and 797% 0 fous (69) and i ev, digestibility coefficient and biological", "* ® rg 100 (8). The NPU gives a more complet ditt 9 ‘method that requires special laboratory { ih of tig ot ye In calculating protein quality, 1 gra assumed to be equivalent to 6.25 q of Nau The protein requirement varies with protein. If the NPU is low, the protein and vice versa, The NPU ofthe protein between 50 and 80 facilitie, Diol Nitrogen retained by NPU. Nitrogen intake then otal NPY (b) PROTEIN QUANTITY % oe The protein content of many Indian footy, Sl determined and published in food composing," bem way of evaluating foods as Source of poten te Ore what per cent of their energy value is sup yo ‘lemming protein content, This is known as Protein. gat ®Y the, {PE ratio or percentage) 8) Rann PE per cent = fotal energy in diet This concept is useful because in many popu adequate diet is not consumed to meet ene 7 OOM resulting in energy deficits, The ratio o protein wong” Siotestodvousthe: rao of protein calbees tet requirement is as given in Table 24, Ne energy TABLE 24 Protein-eneray ratio for different age groups “Protein Group Energy requirement requirement kyla" kealkad | Pre-school children! ep oer Svea 095 79 re | |Sehool children | 6-10 years 0.91 68 sa | ‘Adolescents | 1-17 years (Boys) 0.88 26 63 AIT years (Gir) 0.86 51 oT | Adults i | Men (Sedentar) 083 2 04 | Women (Sedentars) 083 30 m | | Men (Moderate active) 0.83 39 8s | Wom {Moderate active) 083 a 0 PE Ratio = Protein Energy ratio; these values refer tthe requirement ‘Safe requirement of high-quality protein bb Assuming moderately active children and adolescen's Source: (11) The protein-eneray percentage value of some coment used foods is as shown in Table 25,TABLE 25, ‘Nutents per 100 y t ‘ood eat Prtey RN mig = _ tee Py 200 alc fcow) 4 32 m 8 po ei anos at” of Ree ” 70 net ee rosso Gass 8 fanaa 100 * 6 ; ‘prices 160 ne 4 . 3 Ihe PEs les than 4 percent , jo ea! en0Ugh to sagnty “eM Sbjct wl be unable daily energy intake. gt Its ately Dietary intakes tis customary to ex g of body weigh ress requitem This prin ment in terms of grams groups. althoush absolute additions 9, ES 10 all age proiein per das remade for pregoancy tS Of $m of The ICMR Expert Group (11) sonar 088 gram of protein perk er Ka of body Table 28 gives the protein intakes for nde eny ee Rare eaccae livduals of ciferent Vulnerable groups The poten requirements of women pregnancy. For 10 kg gestational” papacy For ioral "weigt gun, he feqreentinceass by 195 and 2. Dd od vimesier respectively, and dunng acaton by ao 13 g per day (during 010.6 month ver and above tet normal requirements. ‘ Fe increased during Young children (0 to 6 years) require proportionatel mote protein foreach lilogram of body weight han adult They are more vulnerable fomalmsttion The ICMR Expert Group (11) has made recommendations fcx the elderly. It seems reasonable to assume that the requirement of the aged are not less than that for young adults, as shown in Table 31, Al estimates of protein requirement are valid only when the energy requirements are fully met. If the total energy intake is inadequate some dietary protein willbe diverted to provide energy. It is now accepted thal there are no body protein stores which can be filled up by a high protein intake. ‘At present there is no evidence that higher intakes of protein confer greater benefit, although the possibilty cannot be ruled out. Most people, if they ean, apparently choose to feat more protein than the physiological requirement, The {question remains whether high protein intakes, far from being beneficial, may actually be harmful (7). Amino acid requirements ‘The protein intake mus also satisfy the need for essential amino acids, The 2007 WHO Expert Committee Report on Energy and Protein Requirements gives curtent estimates of amino acid requirements (in mglkg per day) for adults. These are reproduced in Table 26, ry TABLE 26 pxonwnonune) 20077 ne aa prten Witting 4 ne 0 a Levcine 0 alee 0 Methionine 10 Cynteine ‘ Methionine + Cyne 5 Threoni 15 Phenylalanine + Tyrosine 28 Tertnton a . Total EAA oy m Teta poten 0.66 gad Safe evel of protein 0.83 ahold (Mean 3050) Source 11) / New tasoes connot be Formed evi! a ths eneat amin adore present inte det. The equrerent of Gecense sharply as one advances in age, The quality f= heer sre eal forthe nant han for he aul FAT Buch oe least 0 per cent of fat intake should consist of Suggested levels of fat intake are as given in Table 27. TABLE 27 ([RgeiGenderi Physical Minimum Fat from Visible fat Piynologeal activity levelot foods other fae Joultet thanvisble SE sid ae [AduitMan Sedenary B otc. =u) ionamin sa Hews 40 Sedetary 2 Moe 210 a | Heavy 30 |adt Pregnant 30 Woman women | Lactating a Be nD a |Infnts 6 months 40.60 Hurnan mi 72Amonts 3 1H dren $6 years 25 79 years 30 Boys 10:12 years 3 Libyan 2 = 10S \ 16.17 years st ‘its 10-12 years x 4 ee 3 ‘Source : (11)it has been said that food is not only a c BIPeadicta picts, oot nutrients open to system of communication, a ¥ but also col f or \d behaviour. ALANCED DIET (© simultaneously customs, situs drate in balanced ( 10 80 per cent of in amounts more ¢ of total energy nbalanced. This ition. , for energy, le 28. ES wutrients for e 29 shows - Table 30 ed diet has become an accepted mean ~ ah Ee population from nutritional deficiencies (79) ee ey: the daily In constructin: g balanced diet, the following pri Table 32 — should be borne in mind : irst and ievariodt bi et. This amounts to 1 example, ergy and t, which shou nts for rgy intake (c fats and should constitute the The requi ) should be met. of micronutrients (Ta TABLE 28 Premwaia 28 do prevent Gromaccep! age (Rowers I JPrten (PE raioy TABLE 30 si % fecormended ake ‘Total Fat Trace Element (oer day) pam 1 Phosph 1000 mg/day Eo save Carbohydrate 2 Sou 2000 maida a O54 > Potass 3500 mg/day "Depends on protein quality orth a Note: For good health, agqjot22 5-10. ee 5 molto Tovah 2 ot Manganese malay Mae 5a imam of 0019 216 Saye) a Source : (11) ‘fats (ood soureosy! 001° = vena 7 shen 0yaiday Source 11) vt ; TABLE 31 h - Fa Womens i | ney Di I eal “Rte PZ VA Thi botann ee p ion Rtotacn Nin Wie eB, Fou We, Vad aloon Magisum Fon nc line Men EAR 1700 ma) toa) oak ti) ol’ tagline) ol (a) Ys v [60% RDA + 2 6 6 16 250 20 CO [Women EAR 1500, 14 200 18 > 19 a 22 oo. Batt. Roa oe M168 8 16 20 ao go ADAG bse 457 o0 14 Ses 191 6s 19 m0 22 ama 1S a } EAR souls the Extated En ‘Source : (11) ils Energy Requirements |EER) TABLE 32 [ige— Cateory Protein Calum Magsesum? ch Zne odne Nac WB, Tale WG UMCA ND Group efwork_(PEratio) (muta). tmgld)” mpd) (mgd) aday) mad) (male) tua) mp) od) Mid) Sedentary 5 * Moderate <40% ©2500» 50 4540.00 oo 2000 0 | Heavy i 35 100 000 | Sedentary | Moderate <40% 2500380 45.) 401100 1000 sm | Heawy |Women resment Sl eRe ol Py bMS 1000 2000300000 Lactation ee er 712 months = ere ettoorninel 92I8% Sar ei Od BA, E00 Infnts sab NR A AS PE ee 5 a i ate OO Severn cog ison | seems AeNa ia (and = 380 600-2500 [oien 1-syeae <18% 1500 gD | Gyees <5! q10 4 12 400 300 800-900-3000 I T-9years <15% 2500 600-800 i S| sooo eis eae Ge Oe 600-800 959 1700 4000 {Boys 10-12 years <15% od | co aoe a = 1 TU Joiis— 10sigyeors isk 9000 22S rss0, za00 4000 |Boy 13-15 years <15% 9000 D2 2 y800° > 2800» 4000 \Gints 13-15 years at a 380 si - EP 49500. 2800 4000. [Boys 16-18 years a ori an __= 2000 2800. 4000 | (See ase es — mtake from all sources of nutrient or related substance judged tobe unlikely to lend to adverse health “The TULis the maximum evel of habitual make effects in humans ‘Note: TUL values are only for non-dietary Source: (11) pharmacological dosesTRITION AND HEALTH. a ee oe NU iterent parts of the ES eect re tional education guide “The Food Guide Dante Ap tet a wos en the the ower sections of the Pyramid (Fig. 1). Each of equi Fos foo ous seve poy than DIETARY GOALS Alleountries should develop a national nutrition and food policy setting out “dietary goals” for achievement (72). The dietary goals ?) recommended by the ‘various Expert Committees of WHO (16, 79) areas below (0) dietary fat should be limited to approximately 15-30 per cent of total daily intake (b) saturated fats should contribute no more than J0 per cent ofthe total energy intake; unsaturated vegetable Oi should be substituted for the remaining fat requirement (6) excessive consumption of refined carbohydrate should bbe avoided; some amount of carbohydrate rich in natural fibre should be taken (d) sources rich in energy such as fats and alcohol should be restricted x ° wr P J 10-ge, Fas ols, and sweets Use sparingly / a 505 Milk, yoghurt and) cheese group | 23 servings Vegetable ru 35: 2 edhiow WP ppe8 There are many nuttitonal "Ly (e) salt intake should be , more than 5 4 per gee countries. In India it ay ngd (8) protein should accouns °° Ione cent ofthe daily intae, " (@) junk foods such ar ego? that supply empty aso There may be conditnn Betcha ® Shou Sang recommendations for daily fier ~ ff Stine inhibitiors. Lime is easily available as it is used with betel ipitiors, “ime |s leaves. Sa 9 Ed a ducation / The public must be educated on the U ‘ I nsuming this pulse and the need for removing dl its toxin before consumption. : ( netic approach } Certain strains of lathyrus contain very iow. levels of toxin (0.1%). The selective propagation and cultivation of such strains may be the most effective way to eradicate lathyrism without any drastic change in the food habits of the people. Low toxin varieties can be obtained from the Indian Agricultural Research Institute, New Delhi. __ / (e) Socio-economic changes In the final analysis, it is only socio-economic changes or overall development that can root out lathyrism. Ss NTITRITIONAL FACTORS IN“Bij ul umoys se abeis scadeasip reuoniainu Jo Ax01STH Prt a10y1P unele mamas ‘yoeordde jenyena sadoq “senbiuyoel 1u ayy yo juauissasse UL spoyyour quauissessVy “(avs onunu jo uonebisenut sydes5005 onewsoyul 2s)2214 ureiqo e jo. annoalgo ‘pnisuayaxdo?. uuoy oun stenpiauPul aut 5 ayy sf AyunUIUO? @ Je sryels oishyd aut yy Jo yaTea Te ayer! POOF Aueutsment : tional ass 4 Rac raema met 5 Gad and heath ste: 27 7, Ecological studies se fleet metros uted 1 apprais tus are not cusives tually ex complimentary al of nutritional ‘on the contrary, they aT feature of all SA cinial examination i620 tial po are nce he ist or 0 fis abo the simplest a met ing the nutritional Toerduals, There afe & RUNES! of ia sgn, some specific and To non-specific, known Physics sociated with states of malnur When two of 1 eal signs characteristic of a decter disease are retent simultaneousW, their diegnon'e ‘significance is reatlY presen sa WHO Expert Committe (129) dlassiied signs enhanced al surveys into tc categories 05 Noe mot related to nutrition, 3, alopecia, pyorthoed plerygium: at need further invest. eg, malar pigmentation, corneal vascularization, geographic tongue; and known to be of value, @9. Bitot’s spots, calf tenderness, al ascertaini sfalus of 2 gfOUP angular stomatitis, bsence of knee or ankle jerks (ber-beri), enlargement of the thyroi sland (endemic goitre), etc. ee jowever, clinical signs have the following drawbacks ition cannot be ‘on the basis of clinical 7 ical ost fo minimize subjective and object Sra in cnc eaminatn, dander! forms ot eer been devised covering all areas of the bod pees mien ietementsehedul is gvenaltheend of this chapter (Annexure I). he Permanent damage Nom specie _+) ines signs and | compton yy of disease pte the natural histor is measurements are Tecorded gr” f time, reflect the patterns of eae Pejelopment, ard How ‘ndividuals deviate from the aver ih body size, bulld and nutritional 7a fan be collected bi hs wappomensic dala. © 1y nonmatie ane). given sufficient training, This subject is ines Pemeral in Chapter 11 /aboratory and bio 5 sropomet? they chemical assessment ) Haemoalbinetrn OFant laboratory test that is cared oxtis etaemogtobin level is @ useful index te of its significance in utrition irrespective da haematocrit determinaon are also valuable. (i ine : Stools shouldbe are aed for, Intestinal parasites. Uiisiory of paras examation, chronic dysentery and diarrhoet provides use ‘about the nutritional status of background information ingpould also be examined for albumin an (a It is the most imp nutrition surveys. overall state of m Ganemianem RBC countian persons. Urin sugar With increasing knowled id mn ical signs has get iy be applied body fis ction of abnor! urinary iodié i of the metabolic functions of Sssessment of nutritional status by clini way to mor al tests which ma to measure in (e.g., serum retir amounts of iron) or dete ter a loading dose, ° hich the vitamin is @ known co-@0t) in tiboflavin deficiency) to helP estab malnutrition in its preclinical stages. pense Peete tests are time-consuming and expen ey cannot be applied on a large scale, as {0% example They ae owe ‘asseusment of a whole community tried out on a subsample of the popula, biochemical tests reveal only current nutritional sat ci are useful to quantify z 7 mild. deficiencies ! examination has raised a question, then the viene? — _—a may be invok, = SGA short Ist ot atone oF cable in nutritionsf ee ™"Y adung!Provy e NOMAL STAT. apical Mona survey eteaed ye I suewigy 1 SSMENET OF NUTRITIONAL ST 739 Some biochemical ABLE a3” "ble gg." ats ‘Asesom nt of dietary Intake ‘ a 515 User he value of rurtlonal assessment Is gremly enhanced a. mt wha —_Methoa i Consumption “Dic assessment of fod consumption 2a ? 5 Iwoler day aye when may be Howshol nauis ne 2 ‘Survey methods for t urpose are available (128, 129) (TPP) simone area Adi a ae f the following ytratone* op, || At sey aay be aed ut neo te folowing oe tt | eth th BC attire method widely employed In fda av ts practable and i Sect iy Tapa | Dovey carta tettred ty acura, The adenine ding ee (ratio) ‘Survey team visits the households, and weighs all food that is Urine Nemetr eeotide ‘going to be cooked and eaten as well as that which is wasted amet OF discarded. The duration of the survey may Ya Folate Serum folate {net very reliable) ' ys which is called etary Red cal fla 60. | preferably be analyzed in the state in which they are lWtemin Bz Serum vines eee normally consurred, but this e Sac 1edveai | non seo FeO cc mot. | Ths wuctl a crrmg out det survey ofa a Wacol ac af peop we Ingues are made Monin Protwombinan YSmegoteny | abou He Ratt and gusntly of foods : Poten Serum albumin gt) M-A6seconds | PEEVIO IT properly carried out, oral ae % eet ive lable sul Ade survey uae Fl | may also include collection of data relating to dietary habits (gj "2 Peatbunin d5p and practices. = = | ‘The data that is collected have to be translated into Boe neal (eymeaninike {gras} of food in terns of ceeals, pulses, Pee, WEterbles, fut mit meat, fish and eggs, nd) the ‘unctional indicators mean intake of nutrients per adult man value 2 a eT “ 1th eercco temures the vee indicators) will continue to clon, 8tus (biochemical SY food composition. An excellent guide for to play an Ei : Council of Medical preleestblished a n carrying out this analysis is the Indian Council of Meé ae eed Dracttioners and publi Research (ICNR) publication ; "Nutritive Value of Indian : (of nutritional statu eee emerging as an important class’ is are these are givemin Table da eeSiagtostic tools. Some of _A diet survey provides information Sane It inc tary inadequacies as judged {ot only will such information be Hh 5 TABLE 34 Functional indices of n valuable fo out it ill oon Natients ‘also allow an assessment to be made of the extent and a natue of changes need in the agriculture end food Esto ais Gre production industries Glace ae | 6. Vital statistics 2. Host defence | and. morbid Leucocyte chemotaxis PIE, 2a | LLeucocste phagocstic capacity PIE Fe Leucocyte bactericidal capacity PIE,Fe,se | Tell bastogenesis, PE Zn developing countries, it may be as much as Delayed cutaneous hypersensity —PIE,Zn counites sich a8 Australia, Denmark or France. The ot 3. Haemostasis rates commonly used for this purpose are Prothrombin tne vik | en Sperm count oy nutritional status and may thus be indices of nutritio 5. Nerve functi status, Mortal wide a satisfac erection. Previa, 8, | Satds-Mortality data, however, do not provide a satsiact. Pe edi VitA, Zn picture of the nutritional status of a population (130). a PIE, Data cn morbidity (e.g., hospital data or data ft Work capacity community health and. morbidity surveys) particularl Heart rate Pie: i relation to protein energy malnutrition, anaer vi ‘Vasopressor response xerophthalmia and other vitamin deficiencies, ende goitre, diarthoea, measles and parasitic infestations car Source :(127)4 The importance of surveilanceof foodborne diseases he then underined inthe WHO Sth General Pra Werk forthe pend 1978-1988. The mot important international progamme earying out wet nthe fe of food hygiene a the Jom PAOWHO Food Standord Programme 14) Fe Food is « pois! source of infection contamination by mioorganim at an) et mney om the producer fo the consume een deat conse, implies Hygiene in the and NUTRITION AND HEALTH ‘(00D HYGIENE Is lable to ‘and o Pegrouped under the following headings. MILK HYGIENE wgiene can Source of Infection Milk isan efficient vehicle for a great variety of disease ‘agents. The sources of infection or contamination of milk may be (1) the dairy animal (2) human handler or (3) the environment, e.9., contaminated vessels, polluted water, fies, dust, ete (143). Milkborne diseases ‘A doint FAQWHO Expert Committee (1970) on Mik Hygiene classified milkbome diseases as under (144). (1) Infections of animals that can be transmitted to man: Primary importance : Tuberculosis Brucellosis Streptococcal infections Staphylococcal enterotoxin poisoning Salmonellosis Qtever. Lesser importance : Cou-pox Foot and mouth disease Anthrax Leptospirosis Tick-borne encephalitis. (2) Infections primary to man that can be transmitted through milk : ‘Typhoid and paratyphoid fevers Shigellosis Cholera Enteropathogenic Escherichiacoli (EEC) 'Non-diarthoeal diseases {a} Streptococcal infections {b) Staphylococcal food poisoning ‘() Diphtheria (a) Tuberculosis {e) Enteroviruses (1) Viral hepatitis Clean and safe milk The safety and beeping quality of mil ae relaey microbial content. The as esenial he Seana therefore. sa healthy ned lik from @ healthy udder contains only a few o” and these are relatively unimportant. Secondly. 40" there the amas roused ond ied ae The mil Ane rs and equipment in which milk wei ii et mlecoranans in ik Tee ton ig ae leap dernie quar nl he hich ee the basis ofthe time required to reduce a definite quent methylene blue has been worked out. The txt teases fai Bieter tie canna a US Serves as Pasteurization of milk Pasteurization may be defined as the of ly. the prema ld be sani Sanitary, carried of be present while pasteurization. Three are widely used Vat In this process, milk is kept ai and then larger cities, it is going out of use ‘Also known as Mik is rapidly heate is held at that temperature for not less nd then apy caked 04 dea Ths is now the most widely used method. Very large quantities of milk can be pasteurized by this method. Also known as iy. then rally eooed a le. Pasteurization is a preventive measure of public health Imporance and coretponds mall respects (athe det Therefore, despite pasteurization, with subsequent # temperature, the bacteria are bound to multiply. In order check the growth of microorganisms, pasteurized milk & tapidly cooled to 4 degC. Itshould be kept cold untlitreache® the consumer. Hygienically produced pasteurized milk ba? keeping quality of not mcre than 8 to 12 hours at 18 des ——Vee Fish deteriorates or loses 4 autolysis which sets in after d a which \8 bacteria with which they become 7 S be condemned. The signs of fres! , Roast of stiffness or rigor mortis, (2) ed. Consequently, the test is used to 8) the eyes ate clear and promi e pasteurization ot the addition of raw milk, : The bacteriological quality of Dibothriocephalus latus. This fikis determined by the stan man, but is very rarely encow zed nthe West enforce a limit of viruses (e.g., the virus of ae milk, ( concentrated in shellfish such Vibrio parahaemolyticus, § M pasteurized —_ botulinum type E, and other of certain fish may sometime sik : td in most TINNED FISH : When ea ) ears ‘bsent in L ml of mit, (or meat or any food), the fc Fish is the intermediatef tly upon the state 0 a aaaeonies working in the food handlers at e time of ter éq)) e day to day ie th of the food handlers is also equally important, those who are ill should be excluded from food banaloge is also important that any el ina Geeneaaianily should at once 6 Education _of food handlers in matters of personal hygiene, food handling, utensils, dish washing, and insect and rodent control is the best means of promoting food hygiene. Many of the food handlers have little educational background. Certain aspects of personal hygiene are therefore required to be continually impressed upon them: is : The hands should be clean at all times. Hands should be scrubbed and washed with soap immediately after visiting a lavatory and as often as necessary at other times. Finger nails should be kept trimmed and free from dirt. 0) Ha Hes should be provided, particularly in e case of females to prevent loose hair entering the food-stuffs. : Clean white overalls should be worn by all food handlers. (auptabits 4 Coughing and sneezing in the vicinity of food, licking the fingers before picking up an article of food, smoking on food i to be avoided. 7 eae bale emma ree fh Fe G (Gh) 3s (2) \ (3) | ala Ls pro eat ae fur foca Asvest* ei Pesticide Te Ah Food-borne inf Group (1) Bacterial diseases ee er Be gee ha | nal sect (2) Viral diseases (3) Parasites ft sidues ( ‘ections DDI ou Examples of illness in each group Typhoid fever. Paratyphoid fever, Salmonellosis, Staphylococcal intoxication, Cl.perfringens illness, Botulism, B.cereus Food Poisoning, E.coli diarrhoea, Non-cholera vibrio illness, V.parahaemolyticus infection, Streptococcal infection, Shigellosis Brucellosis. hepatitis A and E, Norovirus Gastroenteritis. Taeniasis Hydatidosis, Trichi i ae , Trichinos! Ascariasis, Amoebiasis, Out etna -— 2 on oe we ow 8... su rer als up) be repo2ase, gents h the mass srease y be (148) ; QaEOOD TON ee 1, Neurolathyrism The cause of neurolathyrism is a toxin, Beta oxalyl amino alanine (BOAA) which is found in the seeds of the pulse, L.sativus |). Neurolathyrism is a public health problem i parts of the country where this pulse is eaten (see page 734). 2. Aflatoxins (153, 154) Aflatoxins are a group of mycotoxins produced by certain fungi, Aspergillus flavus and A parasiticus. These fungi infest foodgrains such as groundnut, maize, parboiled rice, sorghum, wheat, rice, cotton. seed and tapioca under conditions of improper storage, and produce aflatoxins of which B, and G, are the most_potent hepatotoxins, in addition to being carcinogenic. The most important factors affecting the formation of the toxin are moisture and temperature. Moisture levels above 16_per cent and femperatures ranging from 11 to 37°C_favour_toxin formation. Aflatoxicosis is quité-a public health problem in India. The latest report (1975) of 400 cases of aflatoxin poxpning including 10Q deaths from Bagsvade and chmahal districts of Rajasthan and Guj ivel Rane ujarat respectively ighlight the problem in India. Aflatoxin B, has also been eae in si mi les of breast milk and urine collected fro" ren suffering from infantile cirrhosis, Attempts are also being mi ade 7. a . to relate aflatoxin with human liver cirrhosis- in liver ¢FN te ae a ee Gontral ond preserve meas preenton oat eae saan ‘rca factor in the of foodgrains is t0 soe Ste cae Wd pent eae eave th nated sao gen © on the heal cdg el 3. Ergot (155, 156) Unlike Aspe Ee field nn Poet ola tase ang) bt 9 wheat ave a tendency ro ner oat, er sorghum, 2nd se by the ergot ete during the flowering Wee a a lakh naar ard ihe eds Beene bask 90d Consumption of eraotinlested gato este Spode cues oe pao ral ps ve been epertd fom tine to aim human population fatal and inchaie oD, The symptoms are acute but rasly Fe are elude nase, repented vomiting, adanes a°4 Tahoe eeS somtimes Tor pets, ute 0 ingeson of ergy gran. n chronic ase afl ramps in links ad pegheal aanarene due (2 vasocondcuor of caplis hve bee ported. Rowe'e RENEE Heda convring sol anoin ofthe ee res susceptible o infestation, Exgotintsted grains can be easly emoved.y lating then in 20 percent wate, The <2 also be removedby_hand-picking or_air Moatatian. The upper safe limit forthe ergot allaloids has been estimated t0 'b2(0.05 mg per 100 grams ofthe food material sangiironet mic dopey" are fopsy was not 4, Epidemic dropsy (157, 142) From time to time, outbreaks of “epider reported in India, The cause of epidemic Known until 1926, when Sarkar ascribed_it to the contamination of fqustard oil with argemone.ojl)Lal ond Roy (1937) and Chopra et.al, (1939) gave experimental proof of the cause of epidemic dropsy. Mukhesi eto (1941) isolated a toxic alkaloid, sanguinarine _from argemone oil and found! out is chemical formula. This toxit substance interferes withthe oxidation ich accumulates inthe blood The symptoms ie doe co of sudden, noninflammatory lateral sweling of legs often assaciaed Dyspnea, cardiac failure and death may with diarthoe follow” Some patients may develop laucoma. The dsease may occur at all ages except breastfed infants. The mortality vatis from 5-50 per cent The contamination of mustard or other oils with argemone oil may be accidental or doliberate. Seeds of ‘Argemone mexicana (prickly poppy), closely resemble rusfaaseeds, The plant grows wild in India. It has picly leaves and bright yellow flowers. Crops_of mustard_ate ($atered during Motch, and during his pio, the seeds of date likely to be harvested along ‘argemane also mature an ‘wit mustard seeds, Sometimes unscrupulous dealers mix ‘argemone oil with mustard or other ols smone oil is or 1rwith an acrid odout The following oe ‘be applied for the detection of argemone oil = r A simple test is to nie oe sal of i ae be, The te Shaken and the development of a Town to oran: —_ ws the P thie 8 colo Sete oth ft aryemone est is DOSE 158) BE sen ods can Oe Bi Et i et i losses Fo a « (159, 160) A re ratte Ten Mae opi en ga oat ie ots i gunng 1973 and age 4 Fast of Nutt a Ins ubsist of The Nations ton subst ots a showed th so ea spare se cantly Se or ral Fated with wee a orarinated wih we ae Sania to contain Fepototorns Shunjhunia plans sun fhe mile a sir ahununia which those of the mile which om eehold Levelt TMeNS = hae ably sale ha 6. Fusarium toxins (161) ‘ofGield fang) are is also know! believed fo be 07 the increase Flee i abo tant Phe fate, and identify the ymatum. e problem ol ‘Nutrition to isol National Institute of duced by fusarium Incar toxie metabolites ro% Food additives concept of adding “non-foo ee ane eng on angen culnas prclse rod serving food articles such as mango. lime: &1° fies ay long periods by the addition of salt and spices, to ay rag af food technology has revolutionized food Mocessing with the introduction of chemical additives '9 eroteee ihe shellfe of food, improve its taste, and to racer texture or colour. Majority of the processed foods sien hs bread, biscuits, cakes, sweets, confectionary, jams, Folie, soft dint, ice creams, Ketchup and refined oils contain food adkltives. Food additives are defined as non-nutritious substances which are added intentionally to food, generally in small quantity, to imorove its appearance, flavour, texture or storage properties (162). This definition also includes animal food adjuncts which may result in residues in human food and components of packing materials which may find their way into food (163). Food additives may be classified into two categories Additives of the first category include colouring agents {e4,, saffron, turmeric), flavouring agents (e.g., vanilla .4” substances to food d.# essence), sweetzners (e.., saccharin), preservatives (e.g.Enrichment :- T ao BP won ttettttn yeaa Seine oecond category are eric spenking,cOnaTINET (165). Uncontrolled or indiscriminate ue of ee pallve yp eh ha eso re et he wn nd wo egos Pacts Ot od tha cont food ade hat Fo gma herent Slimate effects of food additives on man is an important Boe and te health aministators Van fortification @L Noisa SSpaitaton ar Ton a public health measure aimed ig the usual dietary intake of nutrients with utrtional 5 as “the ely sorbic acid, sodium benzoate). a (eg, citric acid, acetic acid). etc ( generally considered safe for human ct at reinfocin ‘dditional supplies to preveni/control some nk WHO (1 jin Programmes of demonstrated effectiveness of fortification as a preventive of bating th (e., vanaspati, milk) Technology has also been Jn order to qualify as suitable for fortification, the vehicle ‘and the nutrient must full certain criteria (25) {e) the Sip esi (b) the amount of it just provide an a < Sonera ° (6) the addition ofthe mavent should indergo any. noticeable cl it to ‘smh 0 an (A) the cost of fortification must not raise the price ofthe fed beyond the reach of he populi is \g-ter fc ry mis 2 long-term mensre for miging speci _ problems of malnutrition in the community. eee £8 abe Pane ‘Aduleraiion of foods is an age-old problem. It consis. a large number of practices, .g.,. mixing, substi eoncenting the quality, putting up decomposed foods ®: Sale, misbranding of giving false labels and addition fonicants. Adulteration results in two disadvantages for 4 ‘bout the current practices of food adulteration is by S® means complete. Table 37 shows the types of adulterayre seen in India (166). ation anid? Adulteration of foods | Food material ‘Common adulterants Coral such 35 Mad gis, onpnone bits wheat ce | Dals Coal: dyes, hes dal | Hata Turmeric) powder Lead chromate powder Dhania powder Starch, cow un orhorse dung ower Black pepper Dried see of papaya Chil powder Saw dust, brick powder Teaduleaves Blaciaram hk, tamarind seeds | poder so dt ed tadust Cofee powder Date his, amaring his, Chico, ‘Asafoetida (Hing) ‘Sand, grit, resins, gums | Masses Seeds of prickly porn-Argemone Eubleo Mineral ol, rgemone of Buter Stare, animal fat | leecteam Cele sch, eon permits Suectneats Non-permited colours Fresh ven peasin packing Green dve Mik Extraction of fat, ation otc and water Ghee Vanospat Source (166) Prevention of Food Adulteration Act, 1954 Enacted by the Indian Parliament in 1954, with the objective of ensuring pure and wholesome food to the consumers and to protect them from fraudulent and deceptive trade practices, the Prevention of Food Adulteration (PFA) Act was amended in 1964, 1976 and lately in 1986 to make the Act more stringent. A minimum iprisonment of 6 months with a minimum fine of Rs.1,000 is envisaged under the Act for cases of proven adulteration whereas for the cases of adulteration which may render the food injurious to cause death or such harm which may amount {0 grievous hurt (within the meaning of section 320 of LPC.) the punishment may go upto life imprisonment land a fine which shall not be less than Rs.5,000. With the amendment in 1986, the consumer and the voluntary ‘organizations have been empowered under the Act to ‘ake samples of food, eePRITION AND HEALTH Anaemia Mukt Bharat Strategy (175) The Anaemia Mukt Bharat Strategy is a universal strateay, and will focus on the following six interventions 1. Prophylactic iron and folic acid supplementation 2. Deworming. 3. Intensified year-round behaviour change communication campaign (slid bods, smart mind) focussing on four key behaviours = (a) improving compliance to ron folic ac Supplementation and dewormina: (b) appropriate infant ‘and young child feeding practices; (c) increase in intake @f ironich food through diet diversity/quantity frequency and/or fortified foods with focus on harnessing Iocally available resources; and (d) ensuring delayed cord clamping after delivery (by 3 minutes) in health facilities. 4. Testing and treatment of anaemia, using digital methods and point of care treatment, with special focus on pregnant women and school-going adolescents. 5. Mandatory provision of iron and folic acid fortified foods in government-funded public health programmes. 6. Intensifying awareness, screening and treatment of non- nutritional causes of anaemia in endemic pockets, with special focus on malaria, haemoglobinopathies and fluorosis, The Anaemia Mukt Bharat Strategy will be implemented in all villages, blocks, and districts of all the states/UTs of India through existing delivery platforms as envisaged in the (ational Iron Plus Initiative (NIPI) and Weekly Iron Folie or Supplementation WIS) programe 15) \ UES ITRITION PROGRAMMES The Government of India have initiated several large- scale supplementary feeding programmes, and programmes aimed at overcoming specific deficiency diseases through various Ministries to combat malnutrition. They are as shown in Table 38, TABLE 38 Nutrition programmes in India Vitamin A prophylaxis inisry of Health and programme Family Welfare 2. Prophylaxis against inistry of Health and nutritional anaemia smily Welfare 3. Iodine deficiency disorders inistty of Health and control programme Family Wellare 4. Special nutrition jstty of Social Welfare programme: Pa 5. Balwadi nutrition programme inistry of Social Welfare 6. ICDS programme Ministry of Social Welfare 7. Mid-day meal programme Ministry of Education 8. Mid:day meal scheme Ministry of Human, ment __ 1 fiitamin A prophylaxis programme “One of the components of the 5. Balwadi nuts Welfare in 1970 on th ’ Health and. Family ee technology developed at the National Insitute of Nees o at Hyderabad. of the “programme io® revealed a signific ee page J Prophylaxis against nutritional anaemia In view of its public health importance, programme for the prevention of nutritional ance launched by the The progra folifa proaranmes the tsstcey for he are ten through It has also developed at the National Insitute of ‘Nutmne® Hyderabad (see page 732 for more details) for details Natio na Mia. wag ‘Control of iodine deficiency disorders The National Gore Conta Programme was launch the Government of India in 1962 in the conventional ao mn with the objective aj identification of t! goitre control measures over a period of time Surveys, however, indicated that the problem of goite and iodine deficiency disorders was more widespread thar was thought earlier, with nearly 145 million people estimate, to be living in known goitre endemic areas of fe @ result, @ major national programme — Programme ~ was mounted in 1986 with the objecive ta replace the entire edible salt by iodide salt, in a phased manner by 1992 (see page 494, 733 for more details) A. Special nutrition programme This prostamme was stated in 1970 forthe nso of children bel pepeinotiecs ond in and protein, This supplement is provided to them for about a yaramme was originally launched as a ie and was transferred to the State sector in the fifth Five Year Plan as Part of the Minimum Needs Programme (168). The main aim of the Special Nutrition Programme is to improve the ulna sts of he tral groups. This rogram 8 gradually being merged into the {CDS program ition programme Balwadis are being phased out because of universalization of ICDS,S1cbS programme start ics) for Children. "There of the inet wo aniee y Stne, ene opulent apear gh Aug Siiiral pattern to cover mere beset WThe workers at the village are called Anganwad!_ wo Rnetwo Project are noe th sation aS ranma aan, done ty he. Ci 7 Jfid-day meal programme rime (MDMP) is ako Known 35 his programme has been in throughout the country. The major so attract more children for ‘admission to schools andre aus taetiess improvementof child foes roweMENTOT children could t Jn formulating mid-day meals for school children, the following broad principles should be kept in mind (169) the meal should be a supplement and not a substitute t0 the home diet the meal should supply atleast one-thig of the otal ree eectorerendiet teecaiicee the coe of he meal should baseasanan the teal should be such het it ean be prepared Sain schools, ho ompleated cooking prowess Be eetnostoae as far as possible, locally availabe foods should be sed, this wil reduce the cost-ofthemesl and the mena should be frequently changed to avoid monotony. MODEL MENU © e 2 ‘A model menu for a mid-day schoo! meal is given in Table 39, TABLE 29 A mid-day school meat “Foodstutfs 7 ana Cereals and millets 75, Pulses 30 Oils and fats 5 Lealy vegetables 30 Nor-leafy vegetables 30, The National Institute of Nutrition, Hyderabad has prepared model recipes for the preparation of school meals Suitable for North and South Indians. Copies of these publications can be had gratis on request. The National Institute of Nutrition is of the view that the minimum. number of feeding days in a year should be 250 to have the desired impact on the children (170). ‘8. Mid rien ie 0 ugauenninen Jes Oe ‘I lass rmirum, 300-CAlGHES (ot te chitaien 1m ‘Some suggestions economical mid-day ™ Tae whole counts chile yve and innovative Eaucer ee iuensunPtownee of Me Seni Oumar Sha peat ae ecucayonal Fer enions: ye Rube Oe pact ot, Ses rg became, Pan ent progr Tritt (ae ee 2 5,6 Ena : Bo Nationa Mi al ache ogra a jarantee we 'Education Gu lying Centres als bs mid-day meal wi Pidctive, n cooked TN Of protein Tov. mun 300_Ci ror preparation of nut esis ave as under Sia place auay from Foodgrains must be store Satie ins te avd Foodgrains mesh ught containers/oim tolesiatior neat ot trnken wheat (alia) Se preparing mid-day meals ; Pere rod preferably banaroiled or unpolished: Se Dia Meal using broken wheat oF ee, ‘Single Dish Mee amount of a pulse or sovabeans. incorporating -Ohieigreen leafy vegetable, and som seasonal vesctle ell will save both time ond fu Pout ag nutritious. Broken wheat pulao; lea Thicker, upma, dal-vegetable bhaat examples of single dish meals, _ Corea pulse combination is necessary to Vaxs_39 quality protein. "The cereal pulse ratio could rat from Gil to 5:1 Sprrated pulses have more nutrients and shoul Thigrporaied in single dish meals ~ eaty"wenctales when aia to any. prepar Soa EE thoroughly washed before cutting Should not be subjected to washing after cutting Soaking of rice, dal, bengal-aram etc. reduces co time Wash the grains thoroughly and soak sufficient amount of water required for cooking, Rice water if leit after cooking should be mixe dal if these are cooked separately and should n¢ thrown away, = Fermentation improves nutritive value. Preparz idli, dasa, dhokla etc. may be encouraged.