NUTRITION.pptx everything about nutrition.

Everything about nutrition.

1. NUTRITION

2. NUTRIENTS Nutrients are organic and inorganic complexes contained in food There are about 50 different nutrients which are normally supplied through the food we eat Macro nutrients Micro nutrients

3. MACRO NUTRIENTS : These are proteins , fats and carbohydrates which are often called proximate principles because they form the main bulk of food in Indian dietary they contribute to total energy intake of Proteins 10-15% Fats 15-30% CHO 50-80% MICRO NUTRIENTS : These are vitamins and minerals They are called micro nutrients as they are required in small amount which may vary from a fraction of a milligram to several grams

4. PROTEINS Proteins are complex organic nitrogenous compounds They are composed of carbon, hydrogen , oxygen, nitrogen and sulfur in varying amounts. Some proteins also contain phosphorus and iron and occasionally other elements. Proteins differ from carbohydrates and fats in that they contain nitrogen, this usually amounts to about 16 per cent. Proteins constitute about 20 per cent of the body weight in an adult.

5. ESSENTIAL AMINO ACIDS leucine isoleucine lysine methionine phenylalanine threonine valine tryptophan and histidine

6. FUNCTIONS OF PROTEINS Proteins are needed by the body for body building, - this component is small compared with the maintenance component, except in the very young child and infant repair and maintenance of body tissues maintenance of osmotic pressure synthesis of certain substances like antibodies, plasma proteins, haemoglobin , enzymes, hormones and coagulation factors.

7. FATS Fats are solid at 20 deg. C they are called "oils" if they are liquid at that temperature. Fats and oils are concentrated sources of energy. They are classified as : Simple lipids e.g triglycerides Compound lipids, e.g phospholipids Derived lipids, e.g cholesterol The human body can synthesize triglycerides and cholesterol endogenously. Most of the body fat (99 per cent) in the adipose tissue is in the form of triglycerides.

8. FATTY ACIDS Fats yield fatty acids and glycerol on hydrolysis. Fatty acids are divided into saturated fatty acids such as lauric, palmitic and stearic acids unsaturated fatty acids which are further divided into 1. monounsaturated (MUFA) (e.g., oleic acid) 2. poly-unsaturated fatty acids (PUFA) (e.g., linoleic acid and a-linolenic acid).

9. The poly-unsaturated fatty acids are mostly found in vegetable oils, and the saturated fatty acids mainly in animal fats. exceptions coconut and palm oils, although vegetable oils, have an extremely high percentage of saturated fatty acids. On the other hand, fish oils, although they are not vegetable oils, contain poly and mono-unsaturated fatty acids.

10. ESSENTIAL FATTY ACIDS Essential fatty acids are those that cannot be synthesized by humans. They can be derived only from food. The most important essential fatty acid (EFA) is linolelc acid, which serves as a basis for the production of other essential fatty acids (e.g., linolenic and arachidonic acids). Not all polyunsaturated fatty acids are essential fatty acids.

11. FATS/OILS SFAs MUFAs LA ALA High SFAs COCONUT PALM KERNEL BUTTER/GHEE 92 83 68 6 15 29 2 2 2 - - 9 HIGH SFA &MUFA PALMOLEIN 39 46 11 <0.5 HIGH MUFA &MODERATE LA GROUND NUT RICE BRAN SESAME 19 17 16 41 43 41 32 38 42 <0.5 1 <0.5 HIGH LA COTTON SEED CORN SAFFLOWER SUNFLOWER 24 12 9 12 29 35 13 22 48 50 75 62 1 1 - -

12. VISIBLE AND INVISIBLE FATS Visible fats are those that are separated from their natural source e.g ghee (butter) from milk, cooking oils from oil- bearing seeds and nuts. It is easy to estimate their intake in the daily diet. "Invisible" fats are those which are not visible to the naked eye. They are present in almost every article of food, e.g., cereals, pulses, nuts, milk, eggs It is difficult to estimate their intake. In fact, the major contribution to total fat intake is from invisible sources rather than visible sources as cereals and pulses constitute the bulk of Indian diet.

13. HYDROGENATION When vegetable oils are hydrogenated under conditions of optimum temperature and pressure in the presence of a catalyst, the liquid oils are converted into semi-solid and solid fat. The resulting hydrogenated fat is known as "vanaspati" or vegetable ghee, which is a popular cooking medium in India. During the process of hydrogenation, unsaturated fatty acids are converted into saturated acids and the EFA content is drastically reduced. The main advantage of vanaspati is its ghee-like consistency and its keeping quality even in hot humid climates. Since vanaspati is lacking in fat-soluble vitamins, it is fortified with vitamins A and D by government regulation to the extent of 2500 IU of vitamin A and 175 IU of vitamin D per 100 grams.

14. TRANS-FATTY ACIDS Trans-fatty acids are geometrical isomers of Cis-unsaturated fatty acids that adapt a saturated fatty acid like configuration. Partial hydrogenation, the process used to increase shelf-life of poly-unsaturated fatty acids (PUFAs) create trans fatty acids and also removes the critical double bonds in essential fatty acids. Metabolic studies have demonstrated that trans-fatty acids render the plasma lipid profile even more atherogenic than saturated fatty acids, by not only elevating LDL cholesterol but also by decreasing HDL cholesterol.

15. Several large cohort studies have found that intake of trans-fatty acids increases the risk of coronary heart disease . It takes years for trans fatty acids to be flushed from the body. Deep fried fast foods, cake mixes, cereals and energy bars, chips and crackers and whipped toppings, packaged cookies and candy, packaged doughnuts, pies and cakes are major sources of trans-fatty acids. It is better to look for "partially hydrogenated oil" on the label of any packed food

16. The WHO/FAO Expert Group on diet, nutrition and prevention of chronic diseases endorse that qualitative composition of fats in the diet has a significant role to play in modifying risk factors of CVD and set the following ranges for population nutrient goals (% of Energy) total fat, 15-30 (at least 20%E (energy) is consistent with good health); Saturated fatty acids less than 10 per cent; PUFAs 6-10 per cent; n-6 about 5-8 per cent; n-3 about 1-2 percent Transfatty acids less than 1 per cent; MUFAs by difference, and cholesterol less than 300 mg a day . It also assessed the risks to adequate growth, development and maintenance of health and provided recommendations for infants, children, adults and for women during pregnancy and lactation.

17. FATS REQUIREMENT Recommendations for dietary fats for Indians have been revised taking into account the recent FAO and WHO recommendations for : 1.total fat, individual fatty acids and health promoting non-glyceride components 2.source of dietary fats in Indians 3.availability of fat. The recommendations are directed towards meeting the requirements of optimal fetal and infant growth and development, maternal health and for combating chronic energy deficiency in children and adults and diet related non-communicable diseases in adults.

18. Taking into account the unfavourable effect of low fat high carbohydrate diets and the energy requirement set on the basis of age, physiological status and physical activity the minimum intakes of visible fat for Indian adults range between 20-40 g/day. The minimum level of total fat should be 20 per cent of energy. To furnish 20 per cent of total energy, diet of pregnant and lactating mothers should contain at least 30 grams of visible fat

19. CHOICE OF COOKING OIL Use correct combination/blend of 2 or more vegetable oils (1: Oil containing LA Safflower oil Corn oil Sun flower Oil containing high ala Flaxseed oil Canola oil

20. CARBOHYDRATES Carbohydrate is also essential for the oxidation of fats and for the synthesis of certain non-essential amino acids. There are three main sources of carbohydrates, viz., starches, sugar and cellulose. Starch is basic to the human diet. It is found in abundance in cereals, roots and tubers. Sugars comprise monosaccharides (glucose, fructose and galactose) and disaccharides (sucrose, lactose and maltose). These free sugars are highly water soluble and easily assimilated. Free sugars along with starches constitute a key source of energy. Cellulose which is the indigestible component of carbohydrate with scarcely any nutritive value, contributes to dietary fibre .

21. GLYCAEMIC INDEX Glycaemic index of a food is defined by the area under the two-hour blood glucose response curve (AUC) following the ingestion of a fixed portion of test carbohydrate (usually 50 g) as a proportion (%) of the AUC of the standard {either glucose or white bread). Some foods containing different fractions of soluble and insoluble fibres favour slow release of sugar into small intestine and its absorption into blood (reduced peak and prolonged rate). They are therefore termed low glycaemic index foods as compared to high glycaemic foods with readily digestible and absorbable sugar. The concept has practical utility in management of diabetes and control of obesity

22. CLASSIFICATION GI RANGE EXAMPLES LOW GI 55 OR LESS FRUITS; VEGETABLES EXCEPT POTATO,WATER MELON AND SWEET CORN MEDIUM GI 56-69 SUCROSE ,BASMATI RICE, BROWN RICE HIGH GI 70 OR MORE CORN FLAKES, BAKED POTATO

23. DIETARY FIBER "Dietary fibre is the remnants of the edible part of plants and analogous carbohydrates that are resistant to digestion and absorption in the human small intestine with complete or partial fermentation in the human large intestine". It includes polysaccharides, oligosaccharides, lignin and associated plant substances. Dietary fibre exhibits one or more of either laxation REQUIREMENT A daily intake of about 40 grams of dietary fibre per 2000 kcal is desirable. The actual quantity of fibre intake depends upon the nature of cereals, pulses, whole grain, vegetables and millets used

24. VITAMIN A Vitamin A is widely distributed in animal and plant foods - in animal foods as preformed vitamin A (retinol), and in plant foods as provitamins (carotenes). ANIMAL FOODS : Foods rich in retinol are liver, eggs, butter, cheese, whole milk, fish and meat. Fish liver oils are the richest natural sources of retinol , but they are generally used as nutritional supplements rather than as food source PLANT FOODS : The cheapest source of vitamin A is green leafy vegetables such as spinach and amaranth which are found in great abundance in nature throughout the year.

25. The darker the green leaves ,the higher its carotene content Vitamin A also occurs in most green and yellow fruits and vegetables Ex papaya , mango, pumpkin The most important carot enoid is beta carotene It has highest vitamin A activity Carotenes are converted to vitamin A in small intestine

26. Fortified foods Foods fortified with vitamin A ex[ vanaspati,margarine,milk ]

27. The signs of vitamin A deficiency are predominantly ocular. They include nightblindness , conjunctiva! 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 to keratomalacia

28. group Retinol [mcg] Beta carotene [mcg] Infants 0-6 months 6-12 months 350 350 - 2800 Children 1-6 years 7-9 years 400 600 3200 4800 Adolescents 10-17 years 600 4500

29. VITAMIN D Vitamin D is unique because it is derived both from sunlight and foods. Sunlight : Vitamin D is synthesized by the body by the action of UV rays of sunlight on 7- dehydrocholesterol, which is stored in large abundance in the skin. Exposure to UV rays is critical; these can be filtered off by air pollution. Foods : Vitamin D occurs only in foods of animal origin. Liver, egg yolk, butter and cheese, and some species of fish contain useful amounts. Fish liver oils, although not considered to be a food, are the richest source of vitamin D. Human milk has been shown to contain considerable amounts of water-soluble vitamin D sulphate. Other sources of vitamin D are foods artificially fortified with vitamin D, such as milk, margarine, vanaspati and infant foods

30. Rickets : Vitamin D deficiency leads to rickets, which is usually observed in young children between the age of six months and two years. There is reduced calcification of growing bones. The disease is characterized by growth failure, bone deformity, muscular hypotonia, tetany and convulsions due to hypocalcaemia . There is an elevated concentration of alkaline phosphate in the serum. The bony deformities include curved legs, deformed pelvis, pigeon chest, Harrison's sulcus, rickety rosary, kyphoscoliosis, etc. The milestones of development such as walking and teething are delayed.

31. VITAMIN B1[ THIAMINE] Thiamine (vitamin B1) is a water-soluble vitamin. It is essential for the utilization of carbohydrates. Thiamine pyrophosphate (TPP), the coenzyme of co-carboxylase plays a part in activating transketolase, an enzyme involved in the direct oxidative pathway for glucose. In thiamine deficiency, there is accumulation of pyruvic and lactic acids in the tissues and body fluids.

32. whole grain cereals, wheat, gram, yeast, pulses, oilseeds and nuts, especially groundnut. Meat, fish , eggs, vegetables and fruits contain smaller amounts. Milk is an important source of thiamine for infants, provided the thiamine status of their mothers is satisfactory. The main source of thiamine in the diet of Indian people is cereals (rice and wheat) which contribute from 60-85 per cent of the total supply.

33. VITAMIN B12 Vitamin B12 is complex organo-metallic compound with a cobalt atom. The preparation which is therapeutically used is cyanocobalmin , which is relatively cheap. Vitamin B12 cooperates with folate in the synthesis of DNA, so deficiency of either leads to megaloblastosis . Vitamin B12 has a separate biochemical role, unrelated to folate, in synthesis of fatty acids in myelin

34. Sources Good sources are liver, kidney, meat, fish , eggs, milk and cheese. Vitamin B12 is not found in foods of vegetable origin. It is also synthesized by bacteria in colon. Unlike folic acid , vitamin B12 is relatively heat stable. Liver is the main storage site of vitamin B12 About 2 mg are stored in liver, and another 2 mg elsewhere in the body. These stores are sufficient to tide over any deficiency for one to three years.

35. Vitamin B12 deficiency is associated with megaloblastic anemia (pernicious anemia), demyelinating neurological lesions in the spinal cord and infertility (in animal species); which is rarely seen in India. While clinical deficiency of B12 is not manifested, sub-clinical deficiency is reported to exist in India. Reports indicate that there exist more than 30 per cent deficiency in adults and children in the country.

36. Normal adults 1 mcg Pregnancy 1.2 mcg Lactation 1.5 mcg Infants & children 0.2 mcg

37. FOLIC ACID The recommended name is folate , alternative name is folacin and the usual pharmaceutical preparation is folic acid . Folic acid occurs in food in two forms : free folates and bound folates. The total folates represent both the groups. In man, free folate is rapidly absorbed, primarily from the proximal part of small intestine. The availability of bound folate is uncertain. Folic acid plays a role in the synthesis of the nucleic acids (which constitute the chromosomes). It is also needed for the normal development of blood cells in the marrow

38. The name comes from the la tin folia ( = leaf) but foods such as liver, meat, dairy products, eggs, milk, fruits and cereals are as good dietary sources as leafy vegetables. Overcooking destroys much of folic acid and thus contributes to folate deficiency in man. Folate deficiency has been reported in babies given milk foods subjected to heat sterilization

39. Healthy adults 200mcg Pregnancy 500mcg Lactation 300mcg Children 80-120mcg

40. VITAMIN C [ASCORBIC ACID] It is water soluble vitamin It is most sensitive to all vitamins to heat Man, monkey and guinea pig are perhaps the only species known to require vitamin c in their diet

41. Vitamin C is a potent antioxidant and has an important role to play in tissue oxidation. It is needed for the formation of collagen, which accounts for 25 per cent of total body protein . Collagen provides a supporting matrix for the blood vessels and connective tissue, and for bones and cartilage. That explains why in vitamin C deficiency this support fails, with the result that local haemorrhages occur and the bones fracture easily. Vitamin C, by reducing ferric iron to ferrous iron, facilitates the absorption of iron from vegetable foods. It inhibits nitrosamine formation by the intestinal mucosa.

42. Deficiency of vitamin C results in scurvy, the signs of which are swollen and bleeding gums, subcutaneous bruising or bleeding into the skin or joints, delayed wound healing, anaemia and weakness. Scurvy which was once an important deficiency disease is no longer a disease of world importance

43. Calcium Calcium is a major mineral element of the body. It constitutes 1.5-2 per cent of the body weight of an adult human. An average adult body contains about 1200 g of calcium of which over 98 per cent is found in the bones. The amount of calcium in the blood is usually about 10 mg/dl. The developing fetus requires about 30 g of calcium. There is a dynamic equilibrium between the calcium in the blood and that in the skeleton

44. FUNCTIONS Ionized calcium in the plasma has many vital functions including formation of bones and teeth, coagulation of blood, contraction of muscles, cardiac action. milk production, relay of electrical and chemical messages that arrive at a cell's surface membrane to the biochemical machinery within the cell, keeping the membranes of cells intact and in the metabolism of enzymes and hormones. It also plays a crucial role in the transformation of light to electrical impulses in the retina. In short, the calcium ion controls many life processes ranging from muscle contraction to cell division

45. Source Calcium is readily available from many sources. By far the best natural sources are milk and milk products, (e .g., cheese, curd, skimmed milk and butter milk), eggs and fish. The cheapest dietary sources are green leafy vegetables, cereals and millets. The limiting factor in the complete absorption of calcium from green leafy vegetables (e.g., spinach, amaranth) is the presence of oxalic acid with which calcium forms an insoluble compound, calcium oxalate which interferes with the absorption of calcium. Most cereals are generous providers of calcium, and the millet "ragi" is particularly rich in calcium. Rice is very deficient in calcium . The bioavailability of calcium from cereals is poor because of the presence of phytic acid which forms an insoluble compound with calcium, calcium phytate. An additional source of calcium is drinking water which may provide up to 200 mg/day.

46. No clear-cut disease due to calcium deficiency has ever been observed, even under conditions of low intake . It has been established that if the intake of vitamin D is adequate, the problems of rickets and osteomalacia do not arise even with low calcium intake. On the other hand, no deleterious effects have been observed in man as a result of prolonged intakes of large amounts of dietary calcium, neither have any benefits been demonstrated.

47. IRON Functions Iron is necessary for many functions in the body including formation of hemoglobin, brain development and function, regulation of body temperature, muscle activity, and catecholamine metabolism. Lack of iron directly affects the immune system; it diminishes the number of T-cells and the production of antibodies. Besides hemoglobin , iron is a component of myoglobin, the cytochromes, catalase and certain enzyme systems. Iron is essential for binding oxygen to the blood cells. The central function of iron is oxygen transport

48. Heme-iron is better absorbed than non- haem iron. Foods rich in haem -iron are liver, meat, poultry and fish. Foods containing non-heme iron are those of vegetable origin, e.g., cereals, green leafy vegetables, legumes, nuts, oilseeds, jaggery and dried fruits. They are important sources of iron in the diets of a large majority of Indian people. The bioavailability of non-heme iron is poor owing to the presence of phytates, oxalates, carbonates, phosphates and dietary fibre which interfere with iron absorption. Other foods which inhibit iron absorption are milk, eggs and tea .

49. Other foods which inhibit iron absorption are milk, eggs and tea . The Indian diet which is predominantly vegetarian contains large amounts of these inhibitors, e.g. phytates in bran, phosphates in egg yolk, tannin in tea and oxalates in vegetables. In some areas, significant amounts of iron may be derived from cooking in iron vessel

50. Iron deficiency Three stages of iron deficiency (a) First stage characterized by decreased storage of iron without any other detectable abnormalities. (b) An intermediate stage of "latent iron deficiency", that is, iron stores are exhausted, but anemia has not occurred as yet. Its recognition depends upon measurement of serum ferritin levels. The percentage saturation of transferrin falls from a normal value of 30 per cent to less than 15 per cent. This stage is the most widely prevalent stage in India. (c) The third stage is that of overt iron deficiency when there is a

51. (c) The third stage is that of overt iron deficiency when there is a decrease in the concentration of circulating hemoglobin due to impaired hemoglobin synthesis . The end result of iron deficiency is nutritional anemia which is not a disease entity. It is rather a syndrome caused by malnutrition in its widest sense .

52. IODINE Iodine is an essential micronutrient. It is required for the synthesis of the thyroid hormones, thyroxine (T4) and triiodothyronine (T3) containing respectively 4 and 3 atoms of iodine . Iodine is essential in minute amounts for the normal growth and development and well-being of all humans

53. The best sources of iodine are sea foods (e.g., sea fish , sea salt) and cod liver oil. Smaller amounts occur in other foods, e.g., milk, meat, vegetables, cereals, etc. The iodine content of fresh water is small and very variable, about 1-50 micrograms/L . About 90 per cent of iodine comes from foods eaten; the remainder from drinking water. The iodine content of the soil determines its presence in both water and locally grown foods. The deficiency is geochemical in nature.

54. DEFICIENCIES The most obvious consequence of iodine deficiency is goiter but recent studies have indicated that there is a much wider spectrum of disorders, some of them so severe as to be disabling. They include : (a) hypothyroidism (b) retarded physical development and impaired mental function (c) increased rate of spontaneous abortion and stillbirth (d) neurological cretinism, including deaf-mutism; and (e) myxoedematous cretinism, including dwarfism and severe mental retardation.

55. FLUORINE Fluorine is the most abundant element in nature. Being so highly reactive, it is never found in its elemental gaseous form, but only in combined form. About 96 per cent of the fluoride in the body is found in bones and teeth. Fluorine is essential for the normal mineralization of bones and formation of dental enamel

56. The principal sources of fluorine available to man are : (a) Drinking water : The major source of fluorine to man is drinking water. In most parts of India, the fluoride content of drinking water is about 0.5 mg/L, but in fluorosis-endemic areas, it may be as high as 3 to 12 mg/L . (b) Foods : Fluorides occur in traces in many foods, but some foods such as sea fish, cheese and tea are reported to be rich in fluorides

57. Fluorine is often called a two-edged sword. Prolonged ingestion of fluorides through drinking water in excess of the daily requirement is associated with dental and skeletal fluorosis; and inadequate intake with dental caries. The use of fluoride is recognized as the most effective means available for the prevention of dental caries.

58. FLUOROSIS Endemic fluorosis In many parts of the world where drinking water contains excessive amounts of fluorine (3- 5 mg/L) endemic fluorosis has been observed. Endemic fluorosis has been reported to be an important health problem in certain parts of the country e.g. , Andhra Pradesh (Nellore, Nalgonda and Prakasam districts), Punjab, Haryana, Karnataka, Kerala and Tamil Nadu

59. The toxic manifestation of fluorosis comprise the following : (a) Dental fluorosis : Fluorosis of dental enamel occurs when excess fluoride is ingested during the years of tooth calcification - essentially during the first 7 years of life . It is characterized by "mottling" of dental enamel, which has been reported at levels above 1.5 mg/L intake . The teeth lose their shiny appearance and chalk white patches develop on them. This is the early sign of dental fluorosis. Later the white patches become yellow and sometimes brown or black. In severe cases, loss of enamel gives the teeth a corroded appearance. Mottling is best seen on the incisors of the upper jaw. It is almost entirely confined to the teeth and develops only during the period of formation

60. (b) Skeletal fluorosis : This is associated with lifetime daily intake of 3.0 to 6.0 mg/L or more. There is heavy fluoride deposition in the skeleton. When a concentration of 10 mg/Lis exceeded, crippling fluorosis can ensue . It leads to permanent disability. (c) Genu valgum : A new form of fluorosis characterized by genu valgum and osteoporosis of the lower limbs has been reported in some districts of Andhra Pradesh and Tamil Nadu . The syndrome was observed among people whose staple was sorghum (jowar). Further studies showed that diets based on sorghum promoted a higher retention of ingested fluoride than do diets based on rice

61. Lathyrism is a paralyzing disease of humans and animals. In the humans it is referred to as neurolathyrism because it affects the nervous system, and in animals as osteolathyrism ( odoratism ) because the pathological changes occur in the bones resulting in skeletal deformities . Neurolathyrism is a crippling disease of the nervous system characterized by gradually developing spastic paralysis of lower limbs, occurring mostly in adults consuming the pulse, Lathyrus sativus in large quantities.

62. LATHYRISM Lathyrus sativus is commonly known as " Khesari dhal". It is known by local names such as Tora dhal, Lak dhal, Batra, Gharas , Matra etc The seeds of lathyrus have a characteristic triangular shape and grey colour . When dehusked the pulse looks similar to red gram dhal or bengal gram dhal. Like other pulses, lathyrus is a good source of protein, but for its toxin which affects the nerves. It is eaten mostly by the poor agricultural labourer because it is relatively cheap.

63. Studies have shown that diets containing over 30% of this dhal if taken over a period of 2- 6 months will result in neurolathyrism . The toxin The toxin present in lathyrus seeds has been identified as Beta oxalyl amino alanine (BOAA). It has been isolated in crystalline form and is water soluble; this property has been made use of in removing the toxin from the pulse by soaking it in hot water and rejecting the soak water. Studies indicate that there is a blood-brain barrier to this toxin. In order to overcome this barrier, the pulse must be eaten in large amounts over a period of time for 2 months or more. Besides BOAA several other toxins have also been reported

64. The toxin The toxin present in lathyrus seeds has been identified as Beta oxalyl amino alanine (BOAA). It has been isolated in crystalline form and is water soluble; this property has been made use of in removing the toxin from the pulse by soaking it in hot water and rejecting the soak water. Studies indicate that there is a blood-brain barrier to this toxin. In order to overcome this barrier, the pulse must be eaten in large amounts over a period of time for 2 months or more. Besides BOAA several other toxins have also been reported

65. ALFATOXIN Aflatoxins are a group of mycotoxins produced by certain fungi, Aspergilusflaus 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 1 and G1 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 temperatures ranging from 11 to 37°C favour toxin formation.

66. Aflatoxicosis is quite a public health problem in India. The latest report (1975) of 400 cases of aflatoxin poisoning including 100 deaths from Banswada and Panchmahal districts of Rajasthan and Gujarat respectively highlight the problem in India. Aflatoxin B1 has also been detected in samples of breast milk and urine collected from children suffering from infantile cirrhosis, Attempts are also being made to relate aflatoxin with human liver cirrhosis. Control and preventive measures : A crucial factor in the prevention of fungal contamination of foodgrains is to ensure their proper storage after drying Moisture content should be kept below 10 per cent. If the food is contaminated, it must not be consumed. It is also essential to educate the local population on the health hazards of consuming contaminated foodgrains.

67. CEREALS Cereals constitute the bulk of daily diet It is the main source of energy [carbohydrate] Examples : Rice Wheat Maize Cereals are deficient in several essential amino acids such as lysine, threonine, tryptophan

68. RICE

69. PROTEIN g 6.8 FAT g 0.5 CHO g 78.2 THIAMINE mg 0.06 NIACIN mg 1.9 RIBOFLAVIN mg 0.06 MINERALS g 0.6 ENERGY kcal 345 PROTEIN g 6.8 FAT g 0.5 CHO g 78.2 THIAMINE mg 0.06 NIACIN mg 1.9 RIBOFLAVIN mg 0.06 MINERALS g 0.6 ENERGY kcal 345

70. RICE Rice is good source of vitamin B, especially thiamine Para boiling is a ancient Indian technique of preserving nutrient value of rice Para boiling leads to retention of vitamins, increases shelf life

71. GLYCAEMIC INDEX It is defined by area under the 2 hour blood glucose response curve following the ingestion of a fixed portion of test carbohydrate [usually 50g]as a proportion [%] of the AUC of the standard [either glucose or white bread] Low GI 55 or less watermelon , whole grains, beans Medium GI 56-69 sucrose,basmati rice, brown rice High GI 70 or more corn flakes, baked potato,white rice,bread

72. PUFFED RICE

73. PUFFED RICE Puffed rice and popped rice are types of puffed grains made from rice by heating under high pressure It is gluten free ,low in fat It is heavily processed food poha is the much healthier alternative to rice or puffed rice

74. WHEAT

75. WHOLE WHEAT PROTEIN 11.81 FAT 1.5 CHO 71.2 THIAMINE 0.45 NIACIN 5 RIBOFLAVIN 0.17 MINERALS 1.5 ENERGY 346

76. WHEAT The protein content of wheat varies from 9 to 16 The limiting amino acids are lysine and threonine The whiter the flour greater the loss of vitamins and minerals Thus whole grain wheat flour is richer source of vitamin B than refined wheat flour Gluten is the protein naturally found in wheat Some people are allergic to wheat but that is not same as gluten allergy

77. MAIZE

78. CORN DRY MAIZE PROTEIN g 11.1 FAT g 3.6 CHO g 66.2 THIAMINE mg 0.42 NIACIN mg 1.8 RIBOFLAVIN mg 0.1 MINERALS g 1.5 ENERGY kcal 342

79. MAIZE[CORN] Maize runs next to rice and wheat in world consumption The yellow variety of maize contains carotenoid pigment It is rich in fat It is deficient of tryptophan and lysine , some strains contains excess of leucine Excess of leucine interferes in conversion of tryptohan into niacin and thus aggravates pellagragenic action of maize Uses in manifecture of breakfast foods such as corn flakes

80. MILLETS Term millets is used for small grains which are ground and eaten without having outer layer removed Examples of millets Jowar Bajra Ragi

81. JOWAR

82. PROTEIN 10.4g FAT 1.9g CARBOHYDRATE 72.6g MINERALS 1.6g CALCIUM 25mg IRON 4.1mg THIAMINE 0.3mg RIBOFLAVIN 1.3mg NIACIN 3.1mg ENERGY 349kcal

83. JOWAR Jowar is also called as kaffir corn or milo It is a major crop grown in India next only to white and rice It’s a staple diet Certain varieties have high leucine content and consumption of these varieties is associated with pellagra This disorder is often seen in Telangana and Marathwada region

84. BAJRA

85. PROTEIN 11.6g FAT 5.0g CHO 67.5g MINERALS 2.3g CALCIUM 42mg IRON 8mg THIAMINE 0.3mg RIBOFLAVIN 0.25mg NIACIN 2.3mg ENERGY 361kcal

86. BAJRA Bajra is grown extensively in the dry belts of northern and peninsular india Protein content varies from 10 to 14 per cent Proteins are deficient in lysine and threonine Bajra contains significant amount of B group vitamins and minerals such as calcium and iron

87. RAGI

88. PROTEIN 7.3g FAT 1.3g CARBOHYDRATE 72g MINERALS 2.7g CALCIUM 344mg IRON 3.9mg THIAMINE 0.2mg RIBOFLAVIN 0.18mg NIACIN 2.3mg ENERGY 328 kcal

89. RAGI Ragi is rich in minerals like calcium, iodine Small cereals like ragi are called millets Ragi is rich in amylase Amylase rich food powder can be added to other recipes towards the end of cooking to reduce the bulk on cooking and to increase digestibility

90. MILLETS jowar PROTEIN g 10.4 FAT g 1.9 CHO g 72.6 MINERALS g 1.6 CALCIUM mg 25 IRON mg 4.1 THIAMINE mg 0.3 RIBOFLAVIN mg 1.3 NIACIN mg 3.1 ENERGY kcal 349

91. PULSES Pulses are rich source of protein They meet the protein requirement of vegetarians Pulses lack vitamin A and C But germinated legumes contain vit C They are deficient in methionine and cysteine Oligosaccharides in pulses causes flatulence

92. CHICKPEA /BENGAL GRAM

93. energy 360kcal proteins 17.1g fat 5.3g calcium 202mg iron 4.6mg Thiamine 0.30mg Riboflavin 0.15mg niacin 2.9mg Vitamin c 3mg

94. BENGAL GRAM It contains sterol which interferes with cholesterol absorption in blood and helps in reducing blood cholesterol level It is good source of fiber which gives sense of fullness helps in lower food intake It helps in weight gain Balances hormonal levels in women Treats anemia and improves bone health

95. SOYA BEANS

96. ENERGY 432Kcal PROTEINS 43.2g FAT 19.5g CALCIUM 240mg IRON 10.4mg THIAMINE 0.73mg RIBOFLAVIN 0.39mg NIACIN 3.2mg VIT C

97. SOYABEANS Richest among pulses The proteins of soyabeans are of relatively high nutritive value Limiting amino acid is methionine It prevents osteoporosis Prevents neural tube defects Reduces the risk of insomnia and sleep disordes

98. RED GRAM

99. energy 335KCAL Proteins 22.3g fats 1.7g Calcium 73mg Iron 2.7mg thiamine 0.45mg riboflavin 0.19mg Niacin 2.9mg Vit C

100. RED GRAM Tur dal It increases and maintains red blood cell production benefits from high content of folate Improves digestive health Aids weight loss Boosts blood circulation

101. GREEN GRAM

102. ENERGY 348KCAL PROTEINS 24.5g FAT 1.2g CALCIUM 75mg IRON 3.9mg THIAMINE 0.47mg RIBOFLAVIN 0.21mg NIACIN 2.4mg VIT C

103. GREEN GRAM It helps improve nerve functioning and brain health It lacks amino acid methionine and cysteine The limiting amino acid tryptophan is present in green gram It is a good source of riboflavin and vit C Useful in weight reduction calories in green gram are on lower side and it is high in fiber

104. BLACK GRAM

105. ENERGY 350kcal PROTEINS 24g FAT 1.4g CALCIUM IRON THIAMINE RIBOFLAVIN NIACIN VIT C

106. PROTEIN [g] FAT [g] FIBER[g] CHO[g] ENERGY[kcal] IRON [mg] BENGAL GRAM 17 5.3 3.9 60 360 4.6 BLACK GRAM 24 1.4 0.9 60 350 3.8 GREEN GRAM 24 1.3 4.1 57 340 4.4 RED GRAM 22 1.7 1.5 58 340 2.7 SOYA BEANS 43 19.5 3.7 20 430 10.4

107. GREEN LEAFY VEGETABLES The darker the green leaves the greater the nutrient value With exception of vit B12 green leaves are rich source of carotene , calcium, iron, riboflavin, folic acid and vit C Good source of lysine although deficient in sulphur containg amino acid It is high in water content and dietary fiber Because of low calorific value and large bulk they have important place in dietaries of obese people

108. SPINACH

109. SPINACH It is regarded as super food It improves blood glucose control in people with diabetes It lowers the risk of cancer and improves bone health It helps in iron absorbtion Prevents cancer as it is high of zeaxanthin and carotenoids that can flush out free radicles from body Anti acid lutein and zeaxanthin contribute to good eyesight

110. CABBAGE

111. CABBAGE Cabbage contains indole 3 carbinol which is an anti oxidant that helps liver to remove toxins Cabbage can be cooked as vegetable or eaten raw in salad It contains powerful antioxidants that may help reduce inflammation It contains insoluble fiber which keeps the digestive system healthy Increasing intake of potassium rich foods like cabbage helps lower high blood pressure levels

112. MINT Mint is a popular herb that may possess potential health benefits This include helping with digestive health Reducing allergic symptoms Soothing common cold symptoms Using fresh mint and other herbs adds flavor while reducing their sodium and sugar intake

113. SPRING ONIONS Prevents cold and flu Aids in digestion Reduces risk of cancer Boosts immunity Rich in vitamin c

114. FRUITS Fruits are protective foods They are invaluable in human nutrition because they are good source of vitamins and minerals They can be eaten raw and fresh The orange , guava and Indian gooseberry [amla] are rich in ascorbic acid

115. CALORIES CALCIUM[mg] IRON [mg] CAROTENE [ug] VITAMIN C[mg] BANANA 104 10 0.5 124 7 GRAPES 71 20 1.5 1 GUAVA 51 10 0.27 212 MANGO 74 14 1.3 2,210 16 ORANGE 48 26 0.32 2,240 68 PAPAYA 32 17 0.5 2,740 57 SITAPHAL 104 17 4.31 37 AMLA 58 50 1.2 9 600

116. CALORIES CALCIUM IRON CAROTENE VITAMIN C

117. APPLE Apples are rich in vitamins,minerals and fibers It helps control of hunger and regulate blood sugars They are good source of vitamin C and fiber Apples are particularly filling due to their high fiber and water content Their polyphenols may also have anti obesity effect The type of fiber found in apples improve gut friendly bacteria which helps protect against chronic disease

118. MANGO

119. CALORIES 74 CALCIUM 14mg IRON 1.3mg CAROTENE 2240ug VITAMIN C 68mg

120. MANGO It is rich in beta carotene a pigment responsible for yellow orange color of fruit Ripe mango can either be consumed raw or in the form of salad, juice , jams and milk shake It contains vit C,A and B6 Green mangoes has more vitamin C than ripe mangoes

121. GRAPES

122. CALORIES 71 CALCIUM 20mg IRON 1.5mg CAROTENE VITAMIN C 1mg

123. GRAPES Grapes protect against heart disease by lowering blood pressure and cholesterol level It is high in antioxidents Through grapes are high in sugars their low to moderate GI makes them fairly safe to eat in diabetes It boosts memory and brain health

124. BANANA

125. CALORIES 104 CALCIUM 10 IRON 0.5 CAROTENE 124ug VITAMIN C 7mg

126. The fiber in banana can aid in digestion and helps prevent constipation It has high potassium content that helps lower blood sugar Bananas are natural remedy for heart burn and acid reflux It contains no fat It has vit B6 ,A,C , folate , potassium

127. ORANGE

128. CALORIES 48 CALCIUM 26mg IRON 0.32mg CAROTENE 224 VITAMIN C

129. It is rich in vit C It has antioxidant property and also helps build immune system Oranges whose flavour may vary from sweet to sour are commonly peeled and eaten fresh raw or squeezed for juice Oranges help fight cancer , helps regulate high blood pressure Helps body make collagen a protein that heals wound and give you smoother skin

130. PAPAYA

131. CALORIES 32 CALCIUM 17mg IRON 0.5mg CAROTENE 2740ug VITAMIN C 57mg

132. PAPAYA Papaya fruit and its latex are rich in papain , it is used for tenderizing meat Papaya also contains healthy antioxidants known as carotenoids particularly called lycopene It is a tropical fruit , high in vitamin A and C Powerful antioxidant so reduce oxidative stress and lower diseases like alzheimers

133. ROOTS AND TUBERS Good source of carbohydrate Poor source of protein , minerals, vitamins Example : carrots, onion , potato, sweet potato, radish

134. CARROT

135. CARROT Carrots are particularly good source of beta carotene , fiber,vitamin K1, potassium , antioxidants Carrots are about 10% carbs cousisting of starch,fiber,simple sugars Vitamin A : carrots are rich in beta carotene , which converts in to vit A ,it promotes good vision and is important for growth , development and immune function Each 100g of carrot contains 48kcal and 0.9gm protein

136. BEET ROOT

137. BEET ROOT Good source of fiber , folate, potassium , iron High content of inorganic nitrats It contains vitamin C BATANIN most common pigment in beet root

138. POTATO

139. POTATO Potato is a starchy root vegetable Potato starch is used in the food industry as a thicker and binder for soups and sauces Potatos are fat , sodium and cholesterol free

140. RADISH Each 100g of radish contain 17kcal and 0.7 g protein It is rich in calcium and vit C It contains antioxidants like catechin ,vanillic acid It lowers the risk of diabetes , heart disease and diabetes

141. Milk Milk is the best and most complete of all foods. It is secreted by the animals to serve as the sole and wholesome food for their suckling young ones. It is a fine blend of all the nutrients necessary for growth and development of the young ones. Thus milk is a good source of proteins, fats, sugars, vitamins and minerals.

142. ( i ) Proteins : The chief protein of milk is casein; it occurs in combination with calcium as calcium caseinogenate . The other proteins are lactalbumin and lactoglobulin. Animal milks contain nearly three times as much protein as human milk. Milk proteins contain all the essential amino acids. Human milk proteins contain greater amounts of tryptophan and sulphur -containing amino-acids (especially cystein ) than the animal milk proteins.

143. (ii) Fat : The fat content of milk varies from 3.4 per cent in human milk to 8.8 per cent in buffalo milk. Human milk contains a higher percentage of linoleic acid and oleic acid than animal milks. Milk fat is a good source of retinol and vitamin D (iii) Sugar : The carbohydrate in all milks is lactose or milk sugar. It is found nowhere else in nature. It is less sweet than cane sugar and is readily fermented by lactic acid bacilli. Human milk contains more sugar than animal milks.

144. (iv) Minerals : Milk contains almost all known minerals needed by the body such as calcium, phosphorus, sodium, potassium, magnesium, cobalt, copper, iodine, etc. Milk is particularly rich in calcium; it is however a poor source of iron. (v) Vitamins : Milk is a good source of all vitamins except vitamin c

145. HUMAN MILK BANK If mothers own milk is insufficient – best option is pasturized donor human milk Location of HMB – with in the boundaries of NICU Post natal wards Well baby clinic Recipients – absent/insufficient lactation babies of non lactating mothers abandoned neonate/sick neonate

146. EGG

147. EGG It contains all nutrients except except CHO and vit c Minerals like calcium , phosphorus, iron, zinc are present Raw egg white is not assimilated by the intestinal mucosa therefore cooked before consumption Boiling destroys avidin which prevents body from obtaining biotin 1 bolied egg contains 86 calories and 6gram protein

148. FISH

149. FISH Fish proteins easily digested Rich in proteins with good biological value and satisfactory amino acids The fat in fish rich in unsaturated fatty acids ,vit A, vit D There is no carbohydrate in fish

150. MEAT Chicken 100g contains 110 calories , 25 gram protein Mutton 100g contains 200 calories, 20grams protein Beef 100g contains 400 calories , 20 grams protein

151. FATS[OIL] Fats are solids at 20 deg C, They are called oils if they are liquids at room temperature Dietary source of fats may be classified as Animal fats : the major sources of animal fats are ghee, butter, milk,cheese Vegetable fats: groundnut oil , mustard oil, sesame oil , coconut oil, Other sources : small quantity of fat are found in cereals , pulses Eg : 3 % of fat in rice and 4% in jowar

152. Fats are high energy foods , providing as much as 9 kcal for every gram Besides providing energy fats serve as vehicles for fat soluble vitamins Fat in the body supports viscera such as heart, kidney, intestine Fat beneath the skin provides insulation against cold Disease : obesity, phrenoderma , coronary artery disease

153. Fats / oils SFA MUFA LA ALA Coconut 92 6 2 - Butter /ghee 68 29 2 1 Sunflower 12 22 62 - SFA- saturated fatty acid MUFA – mono unsaturated FA LA – linoleic acid , ALA- alpha amino LA

154. BUTTER

155. Butter is a natural product made by churning cream until it becomes semi solid It has 2.5% salt ,16.3% moisture, 80.2% fat Protects against tooth decay Used as anti inflammatory substance and for wound healing It is a source of vit E and K Ghee is a type of clarified butter that’s made from heating butter

156. COCONUT OIL

157. COCONUT OIL It comes from meat of matured coconuts harvated from coconut palm It contains antioxidants such as vit E pro vitamin A Medium chain fatty acids are absorbed and transported directly to liver where they are burned for energy It is useful in malabsorption conditions It has anti bacterial and antiviral properties

158. COD LIVER OIL

159. COD LIVER OIL It is a dietary supplement derived from liver and cord fish Prepared from fresh liver of cord fish It is pale yellow thin liquid , slightly fishy taste It contains vitamin A and D OMEGA 3 fatty acids in cod liver oil reduces inflammation of cells It is used for heart health , depression, arthritis, helps relieve joint stiffness , repair damaged teeth , nails , hair and skin It contains eicosapentaenoic acid and decosahexaenoic acid

160. SUNFLOWER OIL

161. SUNFLOWER OIL Sunflower oil is rich in linoleic acid 55-70% It is considered premium oil because of its light color It lacks trans fats It is bland in flavor It has high oxidative stability Has high smoke point

162. MALNUTRITION Malnutrition refers to undernutrition and is defined as an imbalance between nutrient requirement and intake or delivery that results in deficits of energy, protein , micronutrients that may negatively affect growth and development

163. WHO classification WEIGHT FOR HEIGHT BETWEEN -2 TO -3 Z SCORE[WASTING] BELOW -3 Z SCORE [SEVERE WASTING] HEIGHT FOR AGE BETWEEN -2 TO -3 Z SCORE [STUNTING ] BELOW -3 Z SCORE [SEVERE STUNTING ] SYMMETRICAL EDEMA NO YES

164. IAP Classification GRADE NORMAL >80% 1 71-80% 2 61-70% 3 51-60% 4 <=50%

165. GOMEZ Classification GRADE/DEGREE WEIGHT FOR AGE NORMAL >90% 1 76-90% 2 60-75% 3 <60%

166. WELLCOME –TRUST INTERNATIONAL CLASSIFICATION TYPE OF MALNUTRITION WEIGHT FOR AGE EDEMA Kwashiorkor 60-80% + Undernutrition 60-80% - Marasmus <60% - Marasmic kwashiorkor <60% +

167. JELLIFFE’S CLASSIFICATION GRADE/DEGREE WEIGHT FOR AGE Normal >90% I 80-90% II 70-80% III 60-70% IV <60%

168. Based upon MUAC i . Arnold classification MUAC INTERPRETATION >13.5 cm Normal 12.5-13.5 Mild under nutrition 11.5-12.5 Moderate Under nutrition <11.5 cm Severe Under Nutrition

169. Pathological changes in PEM CNS Microcephaly and reduced brain growth Cerebral atrophy Abnormalities in auditory potentials and VEPs (Visual Evoked Potentials) Dendritic arborization abnormalities --> Relative low IQ in later life

170. GIT Smooth tongue with flattened/ atrophic papillae Shiny, atrophic intestinal mucosa (jejunum and ileum) ↓ Abs -> Vicious cycle Reduced brush border enzyme -> Disaccharidases / lactase Rectal prolapse

171. Liver and pancreas It leads to fatty liver , especially in patients with kwashiorkor Pancreatic exocrine insufficiency is observed which is earlier and more severe compared to endocrine insufficiency

172. Endocrine system Thyrotoxin levels are normal to high in kwashiorkor and normal in marasmus Also there can be raised levels of growth hormone and cortisol that increases in case of stress or catabolic conditions Low serum insulin levels in kwashiorkor but not in marasmus , and this is due to Reduced pancreatic beta cell function Hypokalemia Reduced insulinotropic factors

173. Increased glucagon levels and reduced somatomedins In kwashiorkor when there is catsabolic activity serum cortisol and growth hormone raises as a part of stress response of the body

174. CVS In patients with PEM there can be cardiac muscle atrophy Reduced cardiac out put , bradycardia and congestive cardiac failure

175. Renal system Tubular disfunction , leading to aminoaciduria and phosphaturia Production of acidic urine as hypokalemia is there the body tends to retain potassium Increasing the exchange of urinary potassium hydrogen ATPase and thus the secretion of hydrogen ions in urine increases thus acidic nature of urine

176. SEVERE ACUTE MALNUTRITION [SAM] Another term for SAM is severe childhood undernutrition CRITERIA for SAM Weight for height <70% of expected or <-3 z score Bilateral pitting pedal edema MUAC <11.5 cm ,in 6-60 months old MUAC <11 cm

177. COMPLICATIONS OF SAM Hypothermia Hypoglycemia Dehydration Electrolyte imbalance Infections Micronutrients deficiencies Initial re feeding

178. INVESTIGATIONS OF SAM HEMOGRAM RENAL FUNCTION TEST SERUM ELECTROLYTES SCREENING FOR INFECTIONS CUE URINE CULTURE X RAY CHEST

179. DIABETES Permit nutritious age appropriate foods with minimum permissible sugar, if required Encourage balanced diet – 1/3 rd high quality high fiber rich carbohydrate , 1/3 rd of fruits and vegetables 1/3 rd protein Promote intake of complex carbohydrate with low glycemic index food Encourage frequent small meals with home based fluids during acute illness to avoid ketoacidosis Adjust insulin as per meal plan

180. HEPATIC DISEASE The goal is to provide adequate calories and electrolytes to prevent hypoglycemia , hypoalbuminemia , hypokalaemia Liberal CHO, fruits , adequate proteins and fats according to tolerance are given in mild disease High fat decreases gastric emptying and may aggravate nausea Phospholipids extract from soyabeans is found to help in liver regeneration L-Ornithine-L-aspartate orally or IV is beneficial in liver disorder Ursodeoxycholic acid effective in cholestatic jaundice

181. LACTOSE INTOLERANCE Lactose is a disaccharide of beta D GALACTOSE and beta D GLUCOSE in beta 1,4 linkage It is digested by the enzyme lactose to form glucose and galactose in the brush border of the intestine Lactose intolerance is the inability to digest and metabolize lactose a sugar found in milk Symptoms abdominal bloating and cramps , flatulence, diarrhoea , nousea , vomiting

182. Lactose containing food Fresh , skimmed and condensed milk Cream Yogurt Cheese Processed foods diagnosis : stool acidity test , hydrogen breath test Treatment : can be managed with dietary changes

183. FOOD ITEM QUANTITY CALORIE PROTEIN IDLI 1 50 1 DOSA 1 70 2 CHAPATTI 1 70 2 PURI 1 80 2 BREAD 1 50 1.7 RICE 1 CUP 175 4 DAL 1 BIG SPOON 10 1 BISCUIT 1 15 0.25 CURD 100G 60 3.1

184. OBESITY IN CHILDERN Adults BMI ≥ 25: Overweight ≥ 30: obesity Children BMI between 85 th to 95 th percentile: overweight BMI ≥95 th percentile: obesity

185. Management of Childhood Obesity Appropriate calorie intake Lifestyle modification: Pharmacotherapy I. Phentermine + Topiramate II. Amylin+ leptin

186. COMPLICATIONS OF OBESITY Dyslipidemia Hypertention Non alcoholic fatty liver disease PCOD Pseudotumor cerebri Migraine Obstructive sleep apnea Asthma

187. FORTIFICATION OF NUTRIENTS Fortification of food minimizes risk of hidden hunger Improves nutritional status and dietary intake Enables correction of nutritional deficiency

188. DIET IN PHENYLKETONURIA Low protein diet Controlled intake of many foods such as potatos and cereals Fats like olive oil ,butter , coconut oil , ghee Non dairy milk or yogurt

189. NATIONAL NUTRITIONAL PROGRAMME Integrated child development service scheme Mid day meal program Special nutrition program Wheat based nutrition programs National program for prevention of blindness due to vitamin A deficiency National nutritional anemia prophylaxis program National goiter control programme Applied nutritional programme Balwadi nutrition programme

190. INTEGRATED CHILD DEVELOPMENT SCHEME This is an excellent ongoing programme aimed at total development of the child. It is now renamed as ‘Integrated Mother and Child Development (IMCD) Services’. The ICDS programme was started in 1975 with specific objectives. The main objectives of the programme are to improve the nutritional status of children (0-6 years) to reduce morbidity and mortality rates, to reduce school dropout rates through early stimulation programme for children (3-6 years old) to provide the environmental conditions necessary for mental, physical and social development of the child, to enhance mother's capacity to look after the health and nutritional needs of the child through nutrition and health education and to achieve effective coordination at the policy making and implementation level among Government departments to promote child development. The services are delivered through a network of Anganwadis .

191. SPECIAL NUTRITIONAL PROGRAMME This special feeding programme for the pre-school children (6 months to 6 years) and pregnant and nursing mothers was started in 1970 for the weaker sections of the population. The supplementary feeding supplies 300 kcal and 10 to 12 g protein per child per day. The mothers receive daily 500 kcal and 25 g protein. This feeding is for 300 days in a year. The Urban Special Nutrition Programme (USNP) and ICDS are examples. The Ministry of Social Welfare is in charge of this programme . In places where Balawadis are there to give preprimary education, similar feeding is given by the Development Department

192. MID DAY MEAL PROGRAMME This was initiated in 1992 with preset goals by integrating all the available services and resources into a new package. It has child survival and safe motherhood components. The child survival components of CSSM include neonatal care, immunization, vitamin A deficiency control and prophylaxis, diarrhoea control and oral rehydration therapy, acute respiratory infection control and therapy, iron and folic acid supplementation, deworming

193. ANEMIA MUKT BHARAT Intensified iron plus initiative aims to strengthen the existing mechanisms and foster newer strategies for tackling anemia Objectives To reduce anemia is one of the important objectives of poshan abhiyaan launched in march 2018 It is designed to reduce prevalence of anemia by 3% between the year 2018 and 2022

194. Strategy Deworming Prophylactic iron and folic acid supplements Ensuring delayed cord clamp Appropriate infant and child feeding practices Increased intake of iron rich food Testing and treatment of anemia Mandatory provision of iron and folic acid fortified food

195. SPECIFIC NUTRIENT SUPPLEMENTATION This includes iodine deficiency disorder control program, vitamin a profile access program & anemia control program. The supply of iodine salt in endemic areas, supply of 5 mega doses of Vitamin-A to children at an interval of six months & supply of Iron Folic Acid tablets to expectant and nursing mothers as well as children are being implemented weekly.

196. Vitamin A Prophylaxis Programme To Decrease prevalence of Vitamin A deficiency Objectives: Promoting consumption of Vitamin A rich food. Creating awareness about prevention of Vitamin A deficiency Prophylactic Vitamin A One lakh units- 9 Months with Measles Two Lakh units- 16 to 18 Months with DPT booster Two lakh units- Every six months for 5 Years.

197. THANK YOU