Nutrition 4post

Nutrition
1sathishbabum@mgmcri.ac.in

Food classification
Non Vegetarian (Animal origin) (complete)
Vegetarian (Plant origin) (incomplete)
 Protein Body Builders
 Carbohydrates Energy Givers
 Fats
Minerals and Vitamins Protective Food

Mixed diet
Inappropriate proportion

Balanced diet
Definition :
Equal proportion of all food groups 1: 1:4 (P.F.C)
How to select ?
Cheap, easily available, palatable, digestible +
roughage.
+ Essential nutrient
+ Balanced limiting substance
+ 4 major group Milk, Meat, Cereals ,G.L.V. 6sathishbabum@mgmcri.ac.in

 Body weight :
Under nourished or obese
 Protein requirement: 1gm and 2gms /day
 Calorie requirement :
 Socio Culture factors, economic status
 Balanced ?
 Vitamins,Minerals, Essential AA,Roughphage
 Energy expenditure : Physical activity,BMR,
Rq

Energy metabolism
What is calorie ? Mention calorific value of
carbohydrates , protein , lipids .
Calculate energy req for 55kg male medical
student ?
Why during pregnancy and lactation addition
calorie is taken

Calorific value:
Energy content of food is measured in kilocalories
Defn: One calorie is the heat required to raise
the temperature of 1 g of water through 10
C
 Instrument: Bomb calorimeter

Calorie requirement (55 kg)
30 – 35 kcal / kg body wt
 Sedentary workers - 2000 to 2200
 Moderate workers - 2400 to 3000
 Heavy workers - 3000 to 4000
Pregnancy: + 300 kcal/day
Lactation: + 500 kcal/day 10sathishbabum@mgmcri.ac.in

Calorie distribution :
 Carbohydrates: 60 – 65% (4 kcal/g)
 Lipids: 15 – 20% (9 kcal/g)
 Proteins: 10 – 15% (4 kcal/g)

Energy requirement (or) expenditure by an
individual depends on:
 Basal Metabolic Rate (BMR).
 Specific Dynamic Action (SDA).
 Physical activity.

Open book 4
Define BMR ? Factors Affecting It

Basal Metabolic Rate (BMR)
Rate of energy production under basal
conditions per unit time and per square meter
of body surface
Basal conditions
awake / rest
fasting
normal temperature / pressure / humidity

Basal Metabolic Rate (BMR)
 Energy required during physical / emotional /
digestive rest
 Energy required to sustain vital functions

Measurement of BMR
Benedict-Roth apparatus
Indirect calorimetry
Normal Value
Male: 34 – 37 Kcal/m2
/hr
Female: 30 – 35 Kcal/m2
/hr

Factors affecting BMR
 Age
 Sex
 Climate
 Exercise
 Hormones:
BMR : Catecholamines
T3, T4
Growth hormone

Clinical significance
Increased BMR Decreased BMR
fever starvation
hyperthyroidism hypothyroidism
leukemia
cardiac failure

Open book 5
DEFINE RESPIRATORY QUOTIENT?

Respiratory quotient
 RQ = CO2 produced {L/g}
O2 consumed
 RQ for diet
carbohydrate = 1
fat = 0.7
protein = 0.8
[C6H12O6 + 6O2 6CO2 + 6H2O]

Increased RQ Reduced RQ
acidosis alkalosis
fever diabetes

Open book 6
What is Thermogenic effect of food or SDA ?
Significance .

 Person takes 250 gms of carbohydrates
4kcalX250=1000 produced theoretically
 but 10% will be used for digestion and
absorption
i.e. :100 kcal will be lost =1000-100=900

Specific Dynamic Action (SDA):
(Thermogenic effect of food)
(Diet induced thermogenesis)
 Increased heat production (metabolic rate)
following intake of food
 It is due to energy expenditure for
1) digestion and absorption of nutrients
2) synthesis of glycogen, TAG, proteins
(energy reserves)

 Extra energy should be provided to account for the
loss of energy as SDA
 Values of SDA
Protein = 30%
Lipids = 15%
Carbohydrates = 5%
Mixed diet = 10%
(100 gm of protein: energy available is 30% less
then the calculated value)

Open book 7
Mention different classes of workers ?
Doctors and students comes in which type ?

Physical activity
Types Energy requirement
Sedentary + 30% of BMR
Moderate + 40% of BMR
Heavy + 50% of BMR

Energy requirement
 Calculation (55 kg, male, moderate worker)
BMR: 24 X 55 kg 1320 kcal
Physical activity: 40% of BMR = 528 kcal
1848 kcal
+ SDA: 10% calories 184 kcal
Total energy required 2032 kcal

Can you calculate for your own
now ?
BMR: …………X ……………….
=…………………….. kcal
Physical activity: ……….% of BMR …
= ……………… kcal
+ SDA : …………% calories
= ……………………
Total energy required = ………………… kcal

Nutritive value of food items
Food (per 100 gm) energy (kcal)
 Cereals / pulses 300
 Vegetables 20
 Potato 100
 Milk 60
 Meat 100
 Egg / fish 170

Calorie content of common food
Chapatti (30 gm) 100 Cal
Masala Dosa 200 Cal
Samosa (1) 150 Cal
Puri (1) bhaji 350 Cal
Upma (one small
bowl)
100 Cal
Rice- dal- papad 280 Cal

Calorie content of common food
Chicken (70 gm) 100 Cal
Ice cream (100 ml) 350- 400 Cal
Payasam (100 ml) 250 Cal
Tea/coffee (200 ml) 80 Cal
Gulab jamun (2) 250 Cal
Rasogolla (2) 150 Cal

Open book 8
Mention the best exercise to lose weight ?

Energy expenditure
Activity kcal/hr
(BMR +)
Writing 30
Walking 150
Cycling (2km/h) 175
Running 490
Swimming (3.5 km/h) 550

Open book 9
Name some artificial sweeteners ?

Importance of carbohydrates
Dietary carbohydrates
available unavailable
( starch, sugar) (fiber)
Starch: cereals, pulses, potato
Sucrose: avoided in diabetes
cause hyperlipidemia

 Artificial sweeteners:
a) Saccharin: Benzoic sulfimide
b) Aspartame: Phenylalanine
Aspartic acid

Nutritive sweeteners – Fructose, polyols
Non nutritive sweeteners – Saccharin,
aspartame, acesulfame-k, sucralose

Open book 9.
What are Dietary fibers ?
Definition :
Sources:
Function:
RDA:
Eg:

Dietary Fiber
Defn: Unavailable or indigestible carbohydrate
in diet
 Sources: vegetables, green leaves, fruits
 Function: Maintenance of normal motility of
GIT
 RDA: 30g/day
 Eg: Cellulose, hemi-cellulose
Lignin, Pectin

Clinical applications
Dietary fibers are used in the treatment of
 Diabetes mellitus (reduces blood glucose)
 Cardiovascular disease (reduces
Cholesterol)
 Colon cancer
 Constipation
 Obesity

Biochemical mechanisms
 Diabetes mellitus
1) dietary fibers slows emptying of stomach
reduces postprandial hyperglycemia
2) reduces insulin secretion
reduces the rebound fall in blood glucose
reduces appetite

 Cardiovascular disease
Fibers reduces cholesterol levels by
1) reducing reabsorption of bile acids
2) binding dietary cholesterol
Prevents absorption

Colon cancer / Constipation
1) helps in water retention
produces softer stools
2) increases bulk of the stool
induces gut peristalsis constipation

Open book 10.
What is glycemic index(GI) of food ?
Clinical condition where it should high GI food
should be restricted

Glycemic index
 Index used to assess the glycemic response
(glucose absorption) to nutrients
 Assessed by the glucose tolerance test after
the particular diet and comparing it with a
reference meal ( 50gm sugar ).

Glycemic index =
Incremental area under GT curve after 50gm test meal
Incremental area under GT curve after 50gm reference meal
1 Hr 2 Hr 3 Hr
50
100
150
175
200
Bl.glu
Reference meal
Test meal
× 100
(mg/dl)

 GI: simple sugars > complex carbohydrates
 GI is low when sugar combined with Protein, Fat
or fiber.
 Eg: Bread: 70 – 79
Rice : 70 – 79
Banana: 60 – 69
Ice cream : 35 – 40

Importance of lipids
 Dietary fat
1) visible fat
fat consumed as such
eg: butter, ghee, oil
2) invisible fat
fat present in other food items
eg: fish, meat

Open book 11.
What is RDA of fat in a diet ?
Clinical condition where high fat should be
avoided
Which oil is good for health ?.

Recommended daily intake
 15-20% of total calories
 PUFA: 25-30%
 SFA: < 10%
 Cholesterol < 250 mg
Cholesterol rich: egg yolk, liver, brain
Cholesterol free: vegetables, cereals, pulses

W 3
fatty
acid,
Essential fatty
acid
Trans fatty acid
What do mean by ?
Sources?
Beneficial effect :
-
Give some examples
Harm full effect if taken in
excess

What are essential fatty acid .

Essential fatty acids :
Poly unsaturated fatty acids
Sources: vegetable oil, fish oil
Uses: Reduces cholesterol level
Anti atherogenic
Deficiency: fatty liver, dermatitis

Omega -3 fatty acids
Source: fish
Uses: reduces LDL / VLDL
Trans fatty acids
Source: dairy products, hydrogenated oil
Adverse effects: atherogenic ( HDL, LDL)
insulin resistance
endothelial dysfunction

What are precautions to be
taken while prescribing diet
CVD
 Hypolipidemic diet
 To decrease LDL and increase HDL and
cholesterol excretion
 Decrease TFA
 MUFA 1/3rd
,PUFA 1/3rd
and 1/3rd
saturated fat
Plant origin & fish


Open book 13.
 Daily Req of protein ?
 Limiting amino acid ?
 Complete Protein

Nutritional importance of Proteins
 RDA: 1g / kg body weight /day
 Complete / first class / reference protein
eg: egg protein
milk protein (lactalbumin)
 Incomplete protein
eg: cereals, vegetables
 Mutual supplementation
pulses: cereals – 1:5

Nitrogen balance
 Nitrogen intake = Nitrogen excretion
 Positive nitrogen balance
Intake > excretion
Conditions : growth
pregnancy
Hormones : growth hormone
insulin

Negative nitrogen balance:
Intake < excretion
Conditions: malignancy
malnutrition
diabetes
burns / trauma
hormones: corticosteroids

Assessment of quality or nutritional value of
protein?

Quality (nutritional value) of proteins
Can be assessed by Nutritional indices
1) Biological value
2) Net protein utilization
3) Protein efficiency ratio
4) Chemical score

Biological value of protein (BV):
BV = Retained nitrogen X 100
Absorbed nitrogen
Eg: egg – 90
milk – 84
wheat - 58
meat - 80

Net protein utilization (NPU):
Retained nitrogen x100
Intake nitrogen
denotes quality and availability of protein
Eg: egg – 91
milk – 75
wheat - 47
meat - 76

Net dietary protein value
(NDPV):
Used in assessment of both quantity and quality of
the proteins in the diet
NDPV = Intake of N x 6.25 x NPU

Protein efficiency ratio (PER):
Weight gain per gram of protein taken
Eg: egg – 4.5
milk – 3.0
wheat – 1.7
meat – 2.8
soyabean – 2.0

 Chemical score ( Amino acid score) :
used to express essential amino acid content
Amino acid score =
content of limiting amino acid in test protein x 100
content of limiting amino acid in reference protein
eg: egg – 100
milk – 65

Balanced diet
A diet which supplies proportionate quantities
of all essential nutrients to meet the body
requirement
Balanced diet should be based on
 Locally available foods
 Easily digestible and palatable
 Should contain enough roughage materials
 Fit with local food habits / economic means of the
people

Basic food groups
 Milk group: dairy products
 Meat group: meat, fish, egg, pulses/beans
 Green leafy vegetables / fruits group
 Cereal groups

Diet for 60 kg sedentary men
veg non veg
 Cereals 350 g 350 g
 Pulses 75 g 60 g
 Oil 40 ml 25 ml
 Milk 250 ml 150 ml
 Vegetables 200 gm 200 gm
 Fish / meat 60 gm

Open Book Exam 14
Calculate your BMI and categorize your class
of BMI?

Nutritional disorders
 Protein – Energy Malnutrition
Kwashiorkor
Marasmus
 Obesity

Obesity
Causes
 Genetic influences (leptin mutation)
 Physiological : pregnancy
post menopausal women
 Endocrine disorders: hypothyroidism
Cushing's syndrome
PCOS
 Metabolic disorders: type II diabetes

Leptin
 Secreted by adipocytes
 Function: regulate energy intake /expenditure
 Mechanism: adequate fat deposit
leptin secretion
inhibit Neuropeptide – Y
reduce appetite

Assessment of obesity
 Body mass index (BMI)
BMI: weight (kg)
height (m2
)
 Waist circumference
 Waist – Hip ratio

Biochemical alterations
 Hyperglycemia
 Dyslipidemia
Cholesterol: increased
TAG: increased
 Hyperinsulinemia

Metabolic syndrome (syndrome X)
Components
 Obesity
 Diabetes mellitus
 Hypertension
 Dyslipidemia
 Insulin resistance

Protein – Energy Malnutrition
 Causes:
1) poor intake (neglect child)
2) maternal malnutrition
3) infections
4) diarrhea
5) early weaning

Types of PEM
Kwashiorkor
 deficiency of protein with adequate intake of
calorie
 Age: 1 – 5 years
Marasmus
 deficiency of both calorie and protein
 Age: < 1year

Biochemical alterations
 Plasma albumin: reduced (< 2 g/dl)
glucose: reduced
potassium: reduced
magnesium: reduced
 Fatty liver
reduced lipoprotein synthesis
 IgG: increased

Solve this
4 yrs child come with retarded growth and
pedal edema,skin and hair discoloration.on
enquiry by doctor child was on breast milk up to
1.5 years of age and for 2and half years she
was on rice and dal . Lab data showed low
albumin
1.Probable diagnosis
2.Cause for the oedema
3.Prevention ?

 Treatment
calories: 150 – 200 kcal / kg body weight
protein: 3 – 4 gm / kg body weight
vegetable protein: milk protein = 3:1
(pea nut / Bengal gram)

Food faddist ?

Total Parenteral nutrition (TPN)
 Feeding a person intravenously, bypassing the
usual process of eating and digestion
 Indications
GIT disorders: malabsorption
prolonged diarrhea
intestinal obstruction
malnutrition
coma
burns

 Nutrient solution is infused through large vein.
 Contains glucose, amino acids, electrolytes,
minerals (except iron), lipids & vitamins
Complications
 Infection
 Pulmonary embolism
 Fatty liver

Assessment of Nutritional status
 Clinical assessment
Useful in severe forms of PEM
P/E: skin, hair, eyes
 Anthropometric assessment
height, weight, BMI, Waist / Hip
skin fold thickness
 Dietary assessment
assess calorie / protein content

Laboratory assessment
 Biochemical parameters
Serum proteins, Creatinine, hydroxyproline
potassium / magnesium
 Hematological parameters
Hb, iron, vitamin levels
 Microbiology
Parasites

Diet prescription: principles
 Ideal body weight (for height = 153 cm)
male: 48 kg
female: 45 kg
 Calculate calorie requirement
 Calculate protein requirement
 Diet should contain adequate proximate
principles
[carb: prot: fat = 60: 20 : 20]

 Calories: 2000 kcal
 Carbohydrate: 350 g
 Protein: 60 g
 Fat: 35 g
 Calcium: 400 mg
 Iron: 25 mg

Diet in diabetes
 Calorie distribution
breakfast: 15%
mid morning snack: 5%
lunch: 30%
tea: 10%
dinner: 35%
bed time snack: 5%

 Carbohydrates: 55 – 65%
Sweet / refined carbohydrates are avoided
Leafy vegetables are increased
 Fiber: 25 – 35 gm / day
 Protein: 12 – 16% (soy protein: 20 gm/day)
 Fat: < 30%
SFA: < 10%
MUFA: 12 – 15%
PUFA: < 10%
Cholesterol: < 200g/day

Diet in cardiovascular disease
 Cholesterol lowering diet
similar to diabetes diet
SFA < 7% (avoid palm oil, coconut oil)
Milk with low fat preferred
 Hypertension
low sodium diet (<6 gm/day)
increase intake of vegetables / fruits

Diet in Renal failure
 Maintain fluid and electrolyte balance
1) Acute renal failure
2) Chronic renal failure
3) Dialysis

Acute renal failure
 Water intake = urine out put + 500 ml
 Protein: 0.4 – 0.5 g / kg body wt
 Sodium and potassium are restricted

Chronic renal failure
 Total calories: > 35 kcal/day
 Protein: 0.6 – 0.7 g/kg body wt
 Sodium: 1 – 3 g/day
 Potassium: 40 – 70 mmol /L
 Magnesium: 200 – 300 mg/day
 Fiber: 20 – 25 g/day

Dialysis
 Water intake: 750 – 1000 ml/day
 Protein: 1 – 1.2 g/day
 Sodium: < 1 g/day

Food fortification (enrichment)
 It is the process of adding micronutrients to
food
 Criteria
1) to replace nutrients lost during production
2) to act as public health intervention
Eg: a) salt fortified with iodine
b) Vanaspathi fortified with vitamin A / D

Food additives
 non-nutritive substance added deliberately to
any food product to improve its color, texture,
flavor or shelf life
 Eg: a) vinegar
b) antioxidants
c) coloring agents
d) flavor enhancers

Food adulteration
 The presence of harmful, unpalatable, or otherwise
objectionable foreign substances in food
 Eg:
Common Salt White powdered stone
Honey Water
Ice Cream Washing Powder
Sugar Chalk
Milk Water

Food toxins
 Agents which are present naturally / produced
by living organisms that contaminates food
 Causes food poisoning
 Classification
Natural toxins: endogenous
exogenous
Synthetic toxins

Natural toxins
 Endogenous source
toxin source effects
1. glucosinolates cabbage goitre
2. cyanogens sweet potato neuropathy
3. solanine potato headache
 Exogenous source
Aflatoxins: contaminate grains / peanut
causes hepatic disease /
encephalopathy

Synthetic toxins
 acquired during food processing and storage
Eg: nitrosamines
ethylene dioxide
trichloroethylene

Food additives
Non food substance to food intentionally
Ancient lime
mango
Salt, spices preserving
Newer Chemicals to increase taste , color, shell life
classification
Category I Category II
Safe
Color, preservation,
flavour, acidity
Health hazardous
Incidental
During packing,
processing, farming,
environment 108sathishbabum@mgmcri.ac.in

Safety in food additives
Additives Use Safety
olestra Fat replacement G I
saccharine sweetener Ca Urinary bladder
sulphite Dough container Asthma
Sorbital/hexital Gum sweetener diarrhea
aspartame Artificial sweetener
Monosodium glutamate taste hypertension
Sodium nitrate antimicrobial methemoglobenemia

Food adulteration
Neurolathyrism
Beta oxalyl aminoalanine
1. Vitamin – c
2. Soaking pulse in boiling
water 2hrs
1. Parboiling
2. Baning the crop

Aflatoxin
 Mycotoxin (mycotoxin aspergillus
flavus,A.parasiticus)
 Improper storage nuts and grains
 Hepatocellular ca, infantile cirrhosis
Moisture should be <10%

Ergot
 Bajra, rye, wheat, sorgum
 During harvesting
infection by ergot fungus
nausea, vomiting
,giddiness.
 gangrene

Epidemic dropsy
 Mustard oil with argemone oil
 Toxic alkaloid-sanguinarine
 Interfere with oxidation pyruvate
Nitric acid test for argemone oil
Paper chromotography

Common adulterants
Cereals (rice,wheat) Mud, grits, soap stones
Dal Coal tar dye, khesari dal
Turmeric powder Lead chromate
Dhania powder Cow dung
Pepper Papaya seed
Chillipowder Brick powder
Tea dust Tamarid husk, date husk
Ghee vanaspathi
Edible oil Mineral oil
asafoetida Sand, resin, gum

Prevention of food adulteration
act,1954
 Minimum imprisonment 6 months
 Grevious hurt (320) life imprisonment
Central food lab:
Kolcutta, mysore, ghaziabad and pune

• Must be able write what are SDA with its significance?
• Must be able to calculate energy requirement of man with different physical
activity?
• Must be able write about glycemic index with examples and its relevance in
clinical
• Must be able write about Dietary fibres & its beneficial in health and diseases
• Must be able to define balance diet and mention the basic principle in
prescribing a diet
• Must be able to list Nutritional functions of lipids?
• Must be able to list essential fatty acids
• Must be able to list Nutritional functions of protein?
• Must be able to say what is of complete proteins?
• Must be able to say what is Nitrogen balance?
• Must be able to list the condition for negative and positive balance?
• Must be able to say what is Protein energy malnutrition? Types? Differences?
• Must be able to say what is TPN? When it is indicated and the complications

Nutrition 4post

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