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balanced diet

1. Balanced diet

2. DIETARY GOALS : Dietary fat should be limited to approximately 15-30 per cent of total daily intake Saturated fats should contribute no more than 10 per cent of the total energy intake ; unsaturated vegetable oils should be substituted for the remaining fat requirement. Excessive consumption of refined carbohydrate should be avoided ; some amount of carbohydrate rich in natural fibre should be taken

3. 4. Sources rich in energy such as fats and alcohol should be restricted. Salt intake should be reduced to an average of not more than 5 g. per day Protein should account for approximately 10-15 per cent of the daily intake Junk foods such as colas, ketchups and other foods that supply empty calories should be reduced.

4. CONDITIONS UNDER WHICH ABOVE RECOMMENDATIONS NEEDS TO BE MODIFIED: Children Pregnancy Lactation Physical activity Medical disorders Eg. HTN, Diabetes

5. BALANCED DIET IN PREGNANT WOMAN

6. Calculating protein allowance during pregnancy 1: Calculate the RDA for Reference Body weight (Kg) of Adult women RDA for adult women ( Sedentary /moderate / Heavy work ) = 0.83 g/kg/d 55kg X 0.83 = 46 g/d 2. Calculate RDA for 2nd-trimester pregnant women Reference body weight + GWG RDA = 0.83 g/kg/d (additional 9.5g /day ) 46g/d +9.5 g/d = 55.5 g/d 3. Calculate RDA for 3rd-trimester pregnant women Reference body weight + GWG RDA = 0.83 g/kg/d (additional 22g /day ) 46g/d +22 g/d = 68 g/d

7. A balanced and adequate diet is of utmost importance during pregnancy and lactation. On an average, a normal healthy woman gains around 12 kg of weight during pregnancy. The energy requirement of women are increased by pregnancy ( + 350 kcal daily throughout pregnancy), and lactation ( +600 kcal daily during the first 6 months, and +520 kcal daily during next 6 months ) over and above their normal requirements. The protein requirement of a women is increased during pregnancy by about 22 g per day , and during lactation by 17 g per day.

8. Mrs. Fatima, 24 years old, a housewife by occupation weighing 56 kg with a pregnancy of 36 weeks was interviewed for a 24-hour diet recall. Comment on the diet with regard to calories, proteins, iron, calcium and vitamin A. Suggest any modification if required. ITEM QUANTITY Tea 150ml Dosa 2 nos Milk 100ml Rice 1 ½ katori Tomato rasam 1 katori Small fish 1 nos Bread slice 1 nos Tea 150 ml Rice 1 ½ katori Plain dal ½ katori Milk 100 ml

9. ITEM QUANTITY CALORIES PROTEINS IRON CALCIUM VIT A Tea 100ML 50 0.8 0.05 39 11 Dosa 1 Nos 122 3.1 1.1 16 1 Milk 100ml 66.7 3.2 0.2 120 180 Rice 1 katori (125gm) 176 3.4 1.6 5 Tomato rasam 1 katori (150 ml) 28 1 0.4 16 11 Small fish 1 Nos 50 10 2.5 90 ……… Bread slice 1 Nos 112.5 3.2 0.8 7.5 ………. Plain dal 1 katori 258 11.2 2.9 37 17 REFERENCE NUTRITIVE VALUES

10. RECOMMENDED DIETARY ALLOWANCE: Calories : 2480 kcal Proteins : 68 gm Iron : 27 gm Calcium : 1000 mg Vitamin A : 900 mg

11. ITEM QUANTITY CALORIES PROTEINS IRON CALCIUM VIT-A TEA 150 ml 75 1.2 0.075 58.5 16.5 DOSA 2 NOS 244 6.2 2.2 32 2 MILK 100 ml 66.7 3.2 0.2 120 180 RICE 1½ KATORI 264 5.1 2.4 7.5 ------ TOMATO RASAM 1 KATORI 28 1.0 0.4 16 22 SMALL FISH 1 NOS 50 10.0 2.5 90 ------- BREAD SLICE 1 NOS 112.5 3.2 0.8 7.5 2 TEA 150 ml 75 1.2 0.075 58.5 16.5 RICE 1 ½ KATORI 264 5.1 2.4 7.5 ------- PLAIN DAL ½ KATORI 129 5.6 1.45 18.5 8.5 MILK 100 ml 66.7 3.2 0.2 120 180 TOTAL 1374.9 35 12.7 536.5 425.5

12. NUTRIENT RDA WHAT SHE IS GETTING DEFECIT CALORIES 2480 1374.9 1105.1 PROTEINS 68 35 33 IRON 27 12.7 14.3 CALCIUM 1000 536.5 477.8 VITAMIN A 900 425.5 474.5

13. ITEM QUANTITY CALORIES PROTEINS IRON CALCIUM VIT A TEA 150 ml 75 1.2 0.075 58.5 16.5 DOSA 2 NOS 244 6.2 2.2 32 2 SAMBAR ½ KATORI 68 2.25 1.0 17 8.5 MILK 250 ml 166.6 8 0.5 300 450 BANANA 2 NOS 92 0.96 0.188 13.6 62.4 RICE 2 K 352 6.8 3.2 10 -------- CABBAGE + MIXED VEG 1 K 144 3.6 10.8 216 25.3 S.FISH 2 NOS 100 20 5 180 --------- DOSA 2 NOS 244 6.2 2.2 32 2 SAMBAR ½ KATORI 68 2.25 1.0 17 8.5 TEA 150 ml 75 1.2 0.075 58.5 16.5 MILK 200 ml 133.3 6.4 0.4 240 360 RICE 2 K 352 6.8 3.2 10 --------- POTATO CURRY 1K 250 2.6 1.4 22 10 BOILED EGG 1 NOS 78 6.0 0.9 27 230 TOTAL 2441.9 78.5 32.038 1233.6 831.7

14. BALANCED DIET IN UNDER-FIVES

15. Children between 1-4 years of age are generally called Pre school age children or Toddlers . This age group has become a focus for organized medical-social welfare activities. Under five death rate is considered as significant indicator of the social situation in country. Need special attention and care.

16. Pre-school age children has following important characteristics: 1)LARGE NUMBERS Represent 12 % of general population. Large majority live in rural and tribal areas & in urban slums. Should receive large share of health and social services. 2) MORTALITY: 11.2 % of all deaths. Malnutrition and infection are the commonest causes in the underprivileged sections. 3) MORBIDITY: The main cause of morbidity is PEM. Usually associated with Anemia , Xerophthalmia , Diarrhea, parasitic infestation. Accidents are also becoming frequent especially burns and trauma from home accidents and traffic accidents.

17. 4) GROWTH AND DEVELOPMENT: 1-4 years is most vulnerable period in child's life. Any adverse influences operating on children like infection or malnutrition results in severe limitations in their development. This vulnerability calls for special preventive care and special actions to meet the biological and psychological needs of this age group. 5) ACCESSIBILITY: Very difficult to reach the toddlers as compared to the infants. Special inputs are needed to reach the toddler and to bring him into the orbit of health care. (day care centres, play group centres ,children’s clubs etc)

18. 6) PREVENTION IN CHILDHOOD OF HEALTH PROBLEMS IN ADULT LIFE: Obesity, HTN, DM, cardio-vascular diseases, mental disorders—Foundations for these diseases are laid in early life. Events like child’s diet, infection etc affects its health when it becomes adults. So, they deserve special attention by the administration, general population and the family.

19. Low birth weight Malnutrition Infections and Parasitosis Accidents and poisoning Behavioral problems Common child health problems

20. Rajesh, 3-year-old male weighing 10 kg gets the following diet as per 24 hour diet recall. ITEM QUANTITY Milk 100 ml Banana 1 nos Dosa 1 nos Rice 1 katori Dal + Veg ½ katori Comment on the diet with regard to calories, proteins, iron, calcium and vitamin A. Suggest any modification if required.

21. ITEM QUANTITY CALORIES PROTEINS CALCIUM IRON VIT A MILK 100 ml 66.5 3.2 120 0.2 180 Banana 1 Nos 46 0.48 6.8 0.144 31.2 Dosa 1 Nos 122 3.2 16 1.1 1 Rice 1 katori 176 3.4 10 3.2 --------- Dal +Veg 1 katori 20 1 14 0.35 7 Reference nutritive values

22. ITEM QUANTITY CALORIES PROTEINS CALCIUM IRON VIT A MILK 100 ml 66.5 3.2 120 0.2 180 Banana 1 Nos 46 0.48 6.8 0.144 31.2 Dosa 1 Nos 122 3.2 16 1.1 1 Rice 1 katori 176 3.4 10 3.2 --------- Dal +Veg ½ katori 40 2 28 0.7 14 450.5 12.28 180.8 5.34 226.2

23. RECOMMENDED DAILY ALLOWANCE Calories: 1350 kcal Proteins: 16 gm Calcium: 550mg Iron: 11mg Vitamin-A: 510 micro gm

24. Total calories: kcal Proteins: 18.48gm Calcium: 316.8mg Iron: 6.644mg Vitamin-A : 407.2mcg