NUTRITION Notes for Allied Health Sciences

NUTRITION Notes for Allied Health Sciences
RGUHS Syllabus
and Assignment Questions.
on
Balanced diet (Definition)
• Caloric value; Definition, Caloric values of carbohydrates, proteins and fats, Total daily caloric requirements of an adult male and female.
• Basal metabolic rate (BMR); Definition, Magnitude of BMR in men and women, Factors affecting BMR
• Thermic effect/ SDA of food (Definition, values for major macronutrients)
• RDA (Definition, standard values for nutrients)
• Carbohydrates; Daily dietary requirement.
• Dietary fibers (Definition, functions, importance and their daily requirements)
• Proteins; Daily requirement, Biological value. a. Definition b. Protein used as a standard for this, Protein sources with high and low biological value, Mutual supplementation of proteins (Definition, examples).
• Fats; Daily requirement, Essential fatty acids (Definition, functions, daily requirement and deficiency manifestations), Saturated and unsaturated fatty acids (Definition, sources, examples).
• Malnutrition; Marasmus and Kwashiorkor

1. Nutrition & Energy Metabolism
P Santosh Kumar

2. Nutrition- Syllabus
•Balanced diet (Definition)
•Caloric value; Definition, Caloric values of
carbohydrates, proteins and fats, Total daily caloric
requirements of an adult male and female.
•Basal metabolic rate(BMR); Definition, Magnitude of
BMR in men and women, Factors affecting BMR
•Thermic effect/ SDA of food (Definition, values for
major macronutrients)
•RDA (Definition, standard values for nutrients)

3. •Carbohydrates; Daily dietary requirement.
•Dietary fibers (Definition, functions, importance and
their daily requirements)
•Proteins; Daily requirement, Biological value.
a. Definition b. Protein used as a standard for this,
Protein sources with high and low biological value,
Mutual supplementation of proteins (Definition,
examples).
•Fats; Daily requirement, Essential fatty acids
(Definition, functions, daily requirement and
deficiency manifestations), Saturated and unsaturated
fatty acids (Definition, sources, examples).
•Malnutrition

4. Nutrition
Introduction:
•The main purpose of food is to provide energy
•Ingested food containing nutrients undergo
metabolism or oxidation in the body to provide
energy which is required to carryout many vital
functions in the body
•Nutrients are essential components of food required
by an organism for growth, reproduction and
maintenance of life.
Nutrients present in the food are of two types
▪Macro nutrients
▪Micro nutrients

5. •Macro nutrients are required in large quantities which
are oxidized in the body to yield energy
▪Ex: Carbohydrates, Proteins and Lipids
•Micro nutrients are required in small amounts and are
not for energy purpose and are involved in several
functions of the body
▪Ex: Minerals, Vitamins and Water
•The energy content of food or nutrients is measured in
calories
•Different food stuffs on burning completely oxidized in
presence of oxygen gives different amount of energy
•The energy obtained by a particular food stuff is
expressed by the term calorific value or simply caloric
value.

6. Calorie/ Caloric value is defined as amount of heat
required to rise the temperature of one gram of water
to through 1
0
C
Since it is a very small unit in medical practice the
energy content of food is usually expressed in kilo
calories (kcal) or Calorie, which is nothing but one
thousand calories
•The calorific value of different food stuffs is measured
by using an instrument called as Bomb calorimeter
The calorific value of different food stuffs are
▪Carbohydrates : 4.0 Kcal/gm
▪Proteins : 4.0 Kcal/gm
▪Lipids : 9.0 Kcal/gm
▪Alcohol : 7.0 Kcal/gm

7. Respiratory Quotient (RQ): Defined as ratio of volume of
carbon dioxide produced to the volume of oxygen
consumed
•It is calculated by using the formula
RQ =
volume of carbon dioxide produced
X
100
volume of oxygen consumed
•Carbohydrates are completely oxidized to CO
2 and H
2O
hence RQ of carbohydrates is 1. So volume of CO
2
produced is the same as the volume of oxygen consumed
•C
6H
12O
6+ 6O
2 =6CO
2 + 6H
2O
•So RQ of carbohydrates
=
volume of carbon dioxide produced
= 6
= 1
volume of oxygen consumed 6

8. •RQ of proteins is 0.8
•Because of variable nature of proteins or amino acids
they are not completely oxidized and can’t be
measured exactly and it is measured by indirect
method, hence RQ of protein is 0.8
•Where as RQ of fats/lipids is very low because of
low oxygen content in fats hence, RQ of fats is about
0.7
•RQ of mixed diet is about 0.8
•RQ of- Carbohydrates :1.0
•Fats : 0.7
•Protein : 0.8
•Mixed Diet : 0.8

9. Significance of RQ:
•Helps in determining BMR
•Also helpful in the diagnosis of various pathological
conditions
•RQ is increased in Acidosis: during acidosis carbon
dioxide produced is more than oxygen consumed
hence RQ is increased
•Similarly RQ is also increased in febrile conditions
•RQ is decreased in alkalosis because of retention of
carbon dioxide
•Also decreased in Diabetes mellitus and starvation

10. Thermogenic Effect/Specific Dynamic Action
(SDA)
•Defined as extra heat produced over and above the actual
calculated value when a given food is metabolized in the
body
•SDA refers to the increased heat production following
intake of food called as thermogenic effect of food
•SDA is considered as activation energy needed for a
chemical reaction and believed to be due to expenditure of
energy for digestion and absorption. This is trapped from
previously available energy

11. •Suppose a person takes 25gm of proteins the expected
energy produced by proteins is 100 Kcal. However,
when 25gm of proteins are utilized in the body 130
Kcal of heat produced. This extra 30 Kcal of heat is
called as SDA for proteins
▪SDA for proteins is 30%
▪SDA for lipids 15% and
▪SDA for carbohydrates is 5%
▪SDA for mixed diet is 10 % of overall calories
Significance of SDA:
•It is important in calculating energy requirement of
the body
•In constructing balance diet

12. Basal Metabolic Rate (BMR)
•Defined as amount of energy required by an awoken
individual during complete physical, mental and
digestive rest in post-absorptive state to maintain life
or sustain vital functions of the body like working of
heart, circulation, brain function, respiration etc..
•BMR is measured by using an instrument called as
▪Douglass Method (open circuit method)
▪Benedict Roth apparatus (closed circuit method)
•Normal BMR depends upon body surface area.

13. •The body surface area (BSA) is calculated by using the
Du Bois formula
Body surface area (A) = H
0.725
X W
0.425
X 71.84
▪A = Surface area in cm
2
▪H= Height in centimeters
▪W= Weight in Kilograms
To convert the surface are into square meters (m
2
),
divide the above value (cm
2
) by 10,000
Normal body surface area for
Indian males = 1.62 sq.mt
Indian females = 1.4 sq.mt

14. Body surface area (A) cm
2
= H
0.725
X W
0.425
X
71.84
Ex: H = 173 cm , W= 70 kg
•173 cm
0.725
X 70 kg
0.425
X 71.84
•41.9 X 6.08 X 71.84
•18301 cm
2
•BSA in m
2
= 18301 cm
2
/ 10000 = 1.8 m
2
(sq.mt)

15. BMR is expressed in Kcal/Sq.mt/hr
•Normal BMR for adult males – 35 to 38 Kcal/Sq.mt/hr
•Normal BMR for adult females – 32 to 35 Kcal/Sq.mt/hr
Commonly, BMR is expressed as Cal/ day.
•For an adult male, about 24-26 Cal/ kg body weight/day
•for an adult female, about 22-24 Cal/ kg body weight/day
However, it is easy to express BMR as Cal/day for diet
planning
Adult male: around 1,600 Cal/day
Adult female: around 1,400 Cal/day
Note:
cal = calories
Cal = Kilo calories

16. Factors affecting BMR
•Age: more in children than adults
•Sex: more in male than females
•Body surface area: BMR is directly proportional to the
body surface area
•Climate: increased in cold climate
•Exercise: increased during exercise
•Fever: more in fever
•Starvation: decreased

17. •Sleep: decreased BMR
•Drugs: like caffeine, nicotine and epinephrine
increases BMR. Where as anesthetic drugs decreases
BMR
•BMR is increased in Thyrotoxicosis (Hyperthyroidism)
and decreased in Myxedema (Hypothyroidism)
Significance/ Clinical importance of BMR:
•Helpful in calculating energy requirement of the body
•Helpful in the diagnosis of certain disorders like
thyroid diseases, inflammatory conditions and DM etc.
•BMR may increase in leukemias, polycythemia and
hypertension.

18. Calorie requirement/ energy requirement of a
person:
Following factors should be considered for calculating
energy requirement of an individual.
a)BMR: which is required to maintain fundamental
body activities
b)SDA: Energy required for maintenance of SDA
should be consider 10% (mixed diet)
c)Muscular activities: energy required for various
activities is not constant and it depends upon the
type of activity and duration of time.

19. d)Depending upon the nature of work done energy
requirement for muscular activities can be divided
into 3 groups
Type of
work.
ex: Energy Required in
kcal/hour
Light
work
office workers,
teachers, doctors,
accountant etc.
2700 to 3200 Kcal or
additional 30-40 % of
BMR
Moderate
work
Students, house
wives, industry
workers etc.
3200 to 4000 Kcal or
additional 40-60 % of
BMR
Heavy
work
Agriculture workers,
miners, factory
workers etc.
4000 to 45000 Kcal or
additional 60-100 % of
BMR

20. Calorie requirement during Special period of life:
During growing period addition of nutrients are
required to provide extra calories
‣Ex: energy requirement of infants up to 2 months is
120 Kcal/day, whereas calorie requirement of child
6 months to 1 year 100 Kcal/day
‣During pregnancy calorie requirement is increased by
about additional 300-400 Kcal /day above the normal
requirement
‣Lactation increases the calorie requirement by about
500-700 Kcal /day above the normal requirement

21. S.N. Activity Energy Required in
kcal/hour
1.Eating 28
2.Writing 30
3.Driving a car 63
4.Typing at high speed 100
5.Walking 140
6.Cycling (speed 2 km/h) 175
7.Running 490
8.Swimming 550

22. Calculate total daily caloric requirements of a 50
kg adult male moderate worker
Step1: energy requirement for BMR (24 to 26
Kcal/Kg body weight)
= 50 x 26 Kcal (Maximum calorie requirement
of man) = 1300 Kcal
Step2: energy requirement for physical activity
(additional 40-60 % of BMR)
= 1300 X 60% = 780 Kcal
Step 3: subtotal = (Step1 + Step 2)
1300 Kcal + 780 Kcal = 2080 Kcal (energy
requirement)

23. Step 4: energy requirement for SDA (additional 10
% of energy requirement)
= 2080 Kcal x 10% = 208 Kcal
Step 5: Total energy requirement= 2080 Kcal + 208
Kcal = 2288 Kcal
Rounded to nearest multiple of 25 = 2300 Kcal /day
So, the energy requirement of a 50 kg man,
engaged in moderate work is calculated to be
around 2300 Kcal /day.

24. Calculate total daily caloric requirements of a 60 kg
adult male Light worker
•Step1: energy requirement for BMR (24 to 26
Kcal/Kg body weight)
• = 60 x 26 Kcal (Maximum calorie requirement of
man) = 1560 Kcal
•Step2: energy requirement for physical activity
(additional 30- 40% of BMR; light work)
• = 1560 X 40% = 624 Kcal
•Step 3: subtotal = (Step1 + Step 2)
• 1560 Kcal + 624 Kcal = 2184 Kcal
(energy requirement)

25. •Step 4: energy requirement for SDA (additional 10
% of energy requirement)
• = 2184 Kcal x 10% = 218 Kcal
•Step 5: Total energy requirement= 2184 Kcal + 218
Kcal = 2402 Kcal
•Rounded to nearest multiple of 25 = 2425 Kcal/day
•So, the energy requirement of a student of 60 kg
man, engaged in light work is calculated to be
around 2425 Kcal /day.
•Now you calculate total daily caloric requirements
of a 50 kg adult woman engaged in light work.

26. Recommended dietary allowance (RDA):
Definition: it is defined as average daily dietary intake
of nutrients that is sufficient to meet the nutritional
requirement of nearly all the healthy individuals in a
particular life stage or gender group.
In India, Indian council of medical research (ICMR) is
responsible for setting up reviewing and revision of
RDA.
To ensure meet the nutritional requirement of all the
healthy individuals, the safety factor 2 SD is added to
the average minimum requirement of nutrients of the
subjects measured.
RDA values = Average minimum requirement + 2 SD

27. Factors influencing RDA
Sex, age, physical activity pregnancy and lactation etc.
Significance of RDA
•It is essential to know the RDA of various essential
nutrients for the formulation of balance diet for
different categories of people
•To meet the daily physical needs and maintains
optimal health of individuals and to prevent deficiency
diseases.

31. Nutritional value of food stuffs
•The proximate principles in the diet are
carbohydrates, proteins, lipids, minerals, vitamins and
water
•Based on the biological value of these proximate
principles in the diet classified into
▪Energy yielding nutrients: required in large
quantities, undergo oxidation in the body to supply
energy.
Ex: Carbohydrates and lipids
▪Protective nutrients: required in small quantities,
they are not for energy but place an important role
in growth, development, and cellular regulation.
Ex: Proteins, minerals, vitamins, and water

32. Nutritional value of carbohydrates
•The major dietary carbohydrates are starch, glycogen,
cellulose, sucrose, lactose, glucose and fructose
•They are the major sources of energy to the body.
About 65 to 70 % of energy required by the body is
supplied by carbohydrates
•Other major functions of carbohydrates includes
supply of energy to the brain, RBCs and kidneys.
Pentoses present in small quantities are having limited
nutritional value but they are required or synthesis of
nucleic acids
•Protein sparing action of carbohydrates, detoxification
of xenobiotics, synthesis of glycoprotein, GAGs,
Glycolipids and also carbohydrates acts as dietary
fibers

33. •Calorific value of carbohydrates is 4.0 Kcal/gm
•RDA of carbohydrates depends upon the nature of
work
▪Sedentary man requires about 300 gm/day
▪Moderate working man requires a 400-500gm/day
▪Heavy working man requires a 600-700gm/day
•Dietary Carbohydrates are mainly classified into
▪Digestible carbohydrates/ Available
carbohydrates: These are easily digestible in the
body and are the major sources of energy
▪Undigestible carbohydrates : These are not
digested in the body and are not for energy
purpose. Undigestible carbohydrates in the diet are
called as dietary fibers. Dietary fibers are cell
wall polysaccharide components.

34. •Dietary fibers are classified into soluble and insoluble
dietary fibers
•The insoluble dietary fibers includes cellulose and hemi-
cellulose present in whole wheat and vegetables
•Where as soluble dietary fibers are lignin, pectin and
mucilages. These are present in fruits, vegetables and
legumes
•RDA: 30-50 g/day
Functions of dietary fibers:
▪Retains water, increases the peristalsis and there by
prevents constipation
▪Prevents colon cancer and Diverticulosis
▪Acts as hypoglycemic agents
▪Acts as hypocholesterolemic agents
▪Gives satiety value to the food and there by helps in
decreasing body weight

35. Glycemic index (GI):
•Assessed by glucose tolerance test
•Glycemic response is assessed after giving a particular diet
and comparing it with a Reference meal. The reference
meal is always 50 gm of glucose
•It is defined as the ratio of area covered under the blood
glucose curve after 50g of test meal (carbohydrate rich
food), to the area covered under blood glucose curve after
50 g of reference meal.
•Glycemic index
=
area covered glucose tolerance curve
after 50 g test meal
area covered glucose tolerance curve
after 50 g reference meal (50g of glucose)
?????? 100

36. Importance of glycemic index:
•Glycemic index of Simple and refined carbohydrates (glucose,
sugar) is more than Complex carbohydrates (starch) because of
slow digestion and absorption of complex carbohydrates and
will not increase the blood glucose to the same extent.
•Glycemic index of carbohydrates is lowered by combining
with protein/ fat /fibers.
•So ice-cream has low glycemic index even though it
containing sugar, it because it contains a lot of fats which
prevents absorption.

37. Importance of Glycemic index:
•Food with low in glycemic index and high fiber content
(ex: whole grain, fruits, vegetables etc.) is considered
good for health, especially for diabetic patients.
Glycemic index of some of the food stuffs are:
•Potato: 80-90, bread: 70-79,
•Rice: 70-79, banana: 60-90,
•Beans and peas 40-49,
•Milk: 35-40 and ice creams 35-40

38. Nutritional value of fats/lipids
•Lipids are macro nutrients and they provide about
20 -30 % of total energy required by the body
•Ketone bodies supplies energy during starvation
•Triglycerides are storage form of energy in adipose
tissues supplies energy during fasting
•Other functions of lipids includes
▪Structural components of cell wall
▪Protects internal organs
▪Gives palatability to foods
▪Acts as insulators
▪Important role in blood coagulation
▪Necessary for synthesis of prostaglandins

39. ▪Plays an important role in vision
▪Necessary for growth and reproduction
Dietary sources of lipids are of two types
•Visible fats: means fats consumed as such
▪ex: butter, ghee, oils etc..
•Invisible fats: means fats present in foods
▪Ex: egg, fish, meat, cereals, nuts and oil seeds
Recommended dietary allowance/ Daily
requirement of fat:
▪Adult = 20gm /day
▪Pregnancy = 30gm/day
▪Lactation = 45gm/day

40. •Lipids are the only sources of essential fatty acids.
•Essential fatty acids (EFA) are the fatty acids not
synthesized in the body should be supplied through the
diet. Ex:
▪Linoleic acid is 18 C fatty acid having two double
bond.
▪Linolenic acid is also 18C fatty acid having 3
double bonds
▪Arachidonic acid 20C fatty acid having 4 double
bonds is often considered as essential fatty acid but
it is synthesized from linolenic acid
Sources of fatty acids:
•Rich sources of fatty acids: sunflower oil, sun flower
oil, cotton seed oil, ground nut oil and peanut oil,
Where as coconut oil is a poor source of EFA.

41. RDA essential fatty acids: is about 5-10 gm/day
Functions of essential fatty acids:
•Structural components of cell wall
•Acts as precursor for synthesis of Eicosanoids
(Prostaglandins, Prostacyclins, Thrombaxanes &
leucotrienes) which act as local hormones.
•Required for growth and reproduction
•Decreases plasma cholesterol level
•Prevents fatty liver by acting as lipotropic agents
•DHA (Docosohexaenoic acid) formed from linolenic acid
present high concentration in retina and it is required for
normal retinal function. It is rich in fish oils belongs to
omega 3 fatty acids necessary for development of brain
and retina

42. Deficiency of Essential fatty acids leads to:
•Phrynoderma (Toad skin) - Skin lesions (rough and dry
skin) condition; horny popular eruptions on posterior and
lateral parts of thigh and back and buttocks.
•Cessation of growth.
•Dermatitis
•Poor wound healing & Loss of hair.
•Fatty liver.
•Deficiency of DHA (Docosohexaenoic acid formed from
linolenic acid) causes Retinitis pigmentosa

43. Nutritional value of Proteins
•Proteins are building block required for growth and
reproduction.
•Supplying energy (About 10-15 % of total energy
required by the body).
•When sufficient carbohydrates are present in the diet
proteins are not used for energy purpose – called as
proteins sparing effect of carbohydrates. During
starvation amino acids are used for energy.
•Provision of nitrogen, phosphorus, and sulfur.
•Other functions of proteins are plays an important role
in muscle contraction, transport of various substances,
defense function, respiratory function, structural role,
acid base balance etc..

44. •Proteins present in the diet are two types
▪Animal proteins: meat, fish, egg and milk. These
animal proteins are first class proteins with high
biological value
▪Vegetable proteins: soya bean, cereals and pulses
are the major vegetable proteins, belongs to second
class proteins with low biological value
•Recommended daily intake proteins
▪Adult males: 55 gm/day
▪Adult females: 45 gm/day
▪During pregnancy and lactation : 60gm/day
▪Children requires about 2 gm/kg body weight/day

45. Amino acid composition of proteins: proteins are
made-up of 20 standard amino acids.
•Depending upon the nutritional requirement they are
classified into essential, semi essential and non
essential amino acids.
•Among 20 standard amino acids; 8 are essential, 2 are
semi essential, and remaining 10 amino acids are non
essential amino acids
•Limiting amino acids: certain proteins are deficient
in one or more essential amino acids. If this proteins
are supplied to an animal or a person there will be a
failure of growth and weight gain. The essential amino
acid that are deficient in a particular dietary protein
are called as limiting amino acids.

46. •So the limiting amino acid is that amino acid which
limit the weight gain and development when such a
protein is supplied to a person is called as limiting
amino acid
•Mutual supplementation of proteins: by taking a
mixture of proteins in the diet and cancel each other
deficiencies and becomes first class proteins called as
mutual supplementation of proteins
•For ex: pulses are deficient in methionine but rich in
lysine. Cereals are deficient in lysine but rich in
methionine. Similarly fish oil is deficient in
tryptophan, millets and meats are deficient in
methionine, rice is deficient in lysine and methionine.
•Combination of pulses and cereals like chapatti and
dhal.

47. Nutritive value or quality of proteins assessed by
several methods like:
▪Biological value of proteins (BV)
▪Net protein utilization (NPU)
▪Protein efficiency ratio (PER)
▪Chemical score (CS) or amino acid score

48. Biological value of proteins (BV): defined as ratio
between amount of nitrogen retained and nitrogen
absorbed during a special interval
▪Calculated by using the formula
Retained Nitrogen
Absorbed Nitrogen
B V = x 100
•A pure protein give to an experimental animal as the
only source of nitrogen and nitrogen excretion in
urine and feces are measured.
•Suppose 127mg of protein is given to an animal in a
day, 4 mg is recovered in feces and 24 mg is seen in
urine.

49. •Amount of nitrogen ingested is = 127 mg
•Amount excreted in faeces = 127-4 =123 mg
•Amount excreted in urine = 24 mg
So amount retained equals = 123-24 =99mg
99
123
B V = x 100 = 81 %
•Importance of BV: It is an index of quality of
proteins, higher the BV higher is the quality of
proteins.
•It reflects the essential amino acid content of the
proteins.

50. ProteinBV NPU PER CS Limiting
A.A
Egg 96 91 4.5100Nil
Fish 85 92 3.0 60Tryptophan
Meat 80 76 3.8 70Methionine
Milk 84 75 3.0 65Methionine
Rice 64 57 2.0 60Lys & Thr
Wheat 58 47 1.7 47Lys & Thr

51. Disorders associated with dietary proteins
•Protein energy malnutrition (PEM) is one of the most
common nutritional disorder associated with proteins
in developing countries like India specially in early
childhood.
•There are two extremes of PEM
▪Marasmus,
▪kwashiorkor and also
▪Marasmus-kwashiorkor

52. •Marasmus (Greek work “to waste”) is most common than
Kwashiorkor and is primarily due to deficiency of calories
and secondarily to deficiency of proteins
•Kwashiorkor: is primarily due to deficiency of proteins
along with adequate calories
(Kwashiorkor means “sickness the older child gets, when the
next child is born”, a term from the local language of Ga tribe
of Ghana.)
•Where as Marasmus-Kwashiorkor refers to the combined
form of PEM and is characterized by muscle wasting -which
is characteristic feature of Marasmus and edema -
characteristic feature of Kwashiorkor
Differences between Marasmus and Kwashiorkor

54. A child with Marasmus
This Photo by Unknown Author is licensed under CC BY-SA-NC

55. The children with Kwashiorkor:

56. Marasmus Kwashiorkor
Age of onset< 1 yr 1 – 5 yrs
DeficiencyCalorie Protein
Cause Early weaning and repeated
infections, use of dilute &
inadequate dietary formula
which leads to repeated
infections and gastro enteritis
Starchy diet after
weaning; precipitated
by acute infection
Growth
retardation
Marked Present
Attitude Irritable and fretful Lethargic & apathetic
AppearanceLoss of subcutaneous fat,
wasting of muscles leading to
emaciation; dehydrated
Looks plump due to
edema on face; lower
limbs also show
edema
Comparison Between Marasmus and Kwashiorkor

57. Marasmus Kwashiorkor
AppetiteNormal Anorexia
Skin Dry and atrophic“Crazy pavement
dermatitis” due to
pealing, cracking and
denudation
Hair No characteristic
change
Sparse, soft and thin
hair; curls may be lost
Associated
features
Other nutritional
deficiencies; watery
diarrhea. Muscles are
weak and atrophic
Angular stomatitis and
cheilosis are common,
watery diarrhea.
Muscles undergo
wasting. Crawling and
walking are delayed.

58. Marasmus Kwashiorkor
Serum albumin2 – 3 gm/dl < 2 gm/dl
Serum cortisolIncreased Decreased
BMR Decreased Decreased
Lipid profileNormal Total serum
cholesterol, TGs &
Lipoproteins are
decreased
Fatty liverFatty liver is not
present
Fatty liver is most
common
HypoglycemiaMay be seen Not seen
S. ElectrolytesThere may be
hypokalemia and
hypomagnesemia
There may be
hypokalemia and
hypomagnesemia

59. Balanced Diet
Balanced diet is defined as which contains variety of
foods containing essential nutrients in such quantities
and proportions, that the need for energy. minerals
vitamins and other nutrients is adequately met for
maintaining normal Health, vitality and general well
being and also makes small provision for extra
nutrients to withstand short duration of illness or
leanness

60. While constructing balanced diet following
principles should be kept in mind
•Ideal body weight should be preserved
•Ideal requirement of protein with adequate essential
amino acids should be met with which amounts to 15-
20 %
•Fat requirement is about 20-30% of total requirements
•Carbohydrates rich in natural fiber
•SDA should be taken into account
•The requirement of micronutrients like vitamins and
minerals
•The balanced diet should contain calories from
carbohydrates, proteins and lipids in the ratio of
60:20:20

61. Balanced diet should be based on
•Locally available food
•It should be within economical range
•Should fit for local habits
•It should be easily digestible and palatable
•It should contain enough roughage

62. The dietary pattern varies widely in different parts of
the country; it depends upon the type of food produced
and imported, climate condition, economical capacity,
religion, customs and habit of people
•Indian diet is composed of cereals, pulses, vegetables,
roots and tubers, milk and milk products, oil, sugars,
and ground nuts
•Meat, fish, eggs are present in non-vegetarian foods
•Incase of vegetarians additional intake of milk and
pulses are advised

63. Balanced diet for an Adult Man

64. FOOD GUIDE PYRAMID
•The food guide pyramid is a diagrammatic
representation of a balanced diet.
•It is intended for the general population, as a guide
for the types as quantities of foods to be taken in
daily.
•The pyramid is prepared to give an Idea of the
variety and the right proportions of different types
of food.
•The food guide pyramid can be modified for
different age groups, physiological states and for
different parts of the world.
9
1

65. FOOD GUIDE PYRAMID TO A BALANCED DIET

66. Short Essays
1.What is protein energy malnutrition (PEM)? Differences between
Kwashiorkor and Marasmus
2.What is Balanced diet? What are factors to be considered while
prescribing a balanced diet?
3.Define (BMR) Basal Metabolic Rate, Factors affecting BMR and
its clinical importance.
4.Nutritional importance of proteins
5.Thermic effect/Specific dynamic action and its importance.
Mention SDA value of major macro nutrients.
6.Nutritional importance of Carbohydrates
7.What are the sources of dietary fibers? Discuss the importance of it
in nutrition.
8.What are essential fatty acids? Write their functions, RDA and
deficiency manifestations.
9. Glycemic index
Nutrition- Assignment Questions

67. Short answers
10.Define calorific value? Give calorific value of
carbohydrates, protein and lipids.
11.Biological value of proteins
12. Recommended daily allowance (RDA)
13.Dietary fibers
14.Calculate total daily caloric requirements of a 50 kg
adult male moderate worker
15.Calculate total daily caloric requirements of a 60 kg
adult male Heavy worker
16.Calculate total daily caloric requirements of a 50 kg
adult female light worker
Nutrition

68. Thank you
References:
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medical students. JP Medical Ltd; 2013.
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