This presentation consists of broad classification of food and some important diseases related to particular food item.

1. Nutritional factors in
diseases
Date :- 24/08/2016
Dr Bushra Jabeen
PG 1st year
Dr. B. R. Ambedkar medical college
1

2. Contents
Introduction
Significance
Factors influencing nutrition
Classification
Macronutrients
Micronutrients
Foodborne diseases
Diet plans
. . .
2

3. INTRODUCTION
Nutrition – it is that branch of science, which deals with the
study of dynamic process, in which the consumed food is
utilized for nourishing the body
( A PROCESS OF ASSIMILATION OF FOOD)
3

4. SIGNIFICANCE OF NUTRITION
Growth, Development, Maintenance of normal functions
Chronic degenerative disorders are related to diet and nutritional
status
Obesity - cancer breast, colon, endometrium, gallbladder,
esophagus, pancreas.
Consumption of certain foods reduce risk of certain cancers
4

5.  Physical factors:
- Geographic location, climate, soil, agricultural development
and population density
 Socioeconomic factors:
- Purchasing power . Religious and social customs.
 Biological factors:
- Coexisting communicable and parasitic diseases debilitate
people and produce nutritional deficiency.
Environmental Factors . . .5

6. Host Factors . . .
 Age and sex
 Habits, customs and food fads
 Physiological and pathological stress
 Psychological state
 Heredity and constitution
6

7. Malnutrition
Under-nutrition Over-nutrition
o Protein energy
malnutrition
o Vitamin deficiency
disorders
o Minerals deficiency
disorder
• Obesity
• Hypervitaminosis
• Endemic Fluorosis
• Epidemic dropsis
8

8. Macronutrients:
-Proteins (7-15 %)
-Fats (10-30 %)
-Carbohydrates (65-80 %)
Micronutrients:
-Vitamins
-Minerals
Organic and inorganic complexes contained in food
are called nutrients
Classification of nutrients
9

9. 10

10. PROTEINS
Carbon, hydrogen, oxygen, nitrogen, sulphur
Complex organic nitrogenous compounds.
20 % of body weight.
20+ different amino acids which are found in human body.
8 amino acids are “essential”
First Importance
11

11. Body building
Repair and maintenance of body tissues
Maintenance of osmotic pressure
Synthesis of bioactive substances and other vital
molecules
4 kcal/gram
Functions :12

12. Deficiencies in diet :-
-Actual deficiency or
-Due to lack of knowledge about food and nutrients.
Clinical manifestations and disabilities
Example :
• Protein Energy Malnutrition (PEM),
• Undernutrition (mild, moderate or severe)
13

13. Protein
Energy
Malnutrition
14

14. 15

15. 16

16. 1.Primary prevention
• Health promotion
• Specific protection
2.Secondary prevention
• Early diagnosis and treatment
3.Tertiary prevention
• Rehabilitation
Preventive measures :17

17. FATS
Simple lipids – Triglycerides (body fat)
Compound lipids – Phospholipids
Derived lipids - Cholesterol
Flax seeds/ alsi
18

18. Fatty acid content of different fats ( in %)
19

19. o 9 kcal/gram.
o Vehicles for fat-soluble vitamins
o Support viscera
o Provides insulation against cold.
o Polyunsaturated fatty acids are precursors of prostaglandins.
Functions :20

20. Fats & diseases :
 Obesity
 Phrenoderma
 Coronary heart disease
 Cancer- colon & breast
 Others- kwashiorkor
21

21. Carbohydrate
Provides 4 kcals per gram
Essential for oxidation of fats
Synthesis of some non essential amino acids
3 main sources :
Starch – basic
Sugars – monosaccharide & disaccharide
Cellulose – indigestible
22

22. Glycemic index
Area under 2- hour glucose response curve (AUC) following the injestion
of fixed portion of carbohydrate (50 g) as a proportion (%) of the AUC of
the standard (glucose or whole bread)
23

23. MICRO-NUTRIENTS
24

24. VITAMINS
 Small amounts
 Enables body to use other nutrients
 Provided by food
 Fat soluble or water soluble
25

25. 26

26. Vitamin - A
In vegetables
(Carotene)
50 % absorbed
Vitamin A
(12:1)
Thus a strictly green vegetable diet is not essential to meet vitamin A requirement
27

27. 1. Discarding colostrum (the first source of vitamin A for the newborn)
2. Measles infection
3. Malabsorption and diarrhea
4. Delayed weaning (i.e. starting complementary feeding after 1 year)
5. Pregnancy (increases vitamin A demand and as much as 7.8%)
Causes of Deficiency :
1 IU of vitamin A = 0.3 mcg retinol = 0.55 mcg retinol palmate
28

28. WHO Classification
Clinical condition of
Xerophthalmia
Prevalence among
Preschool Children
XN Night blindness >1%
X1A Conjunctival xerosis -
X1B Bitot’s spots >0.5%
X2 Corneal xerosis -
X3A
Corneal ulceration/keratomalacia
(involving <1/3 of cornea)
>0.01%
X3B
Corneal ulceration/keratomalacia
(involving >1/3 of cornea)
>0.01%
XS Corneal scar >0.05%
XF Xerophthalmic fundus -
Biochemical Plasma retinol <0.35 μmol/l >5%
29

29. TOXICITY :
• Nausea
• Vomiting
• Anorexia
• Sleep disorders
• Skin desquamation
• Enlarged liver
• Papillary edema
• Teratogenicity
30

30.  Dietary modifications
 Nutrition education
 Fortification of ghee/oil/butter, sugar, bread and milk.
 Periodic massive dosage : Vitamin A administration is now integrated
with immunization program.
 Long term action : Constant nutritional education, importance of
immunization, environmental sanitation, breast feeding, early treatment
of infections and good maternal and child health care.
Prevention & control31

31. National Prophylaxis Program for Prevention
of Blindness due to Vitamin A deficiency
Launched in 1970.
India was the first country to launch a national program of vitamin A
distribution for prevention of blindness in children.
A massive dose of vitamin A given once in six months to preschool children.
Nutrition education to mothers to promote consumption of vitamin A rich
foods by the children
Implemented through primary health centers
Distribution is done by paramedical workers.
32

32. Vitamin - D
Calciferol (D2) & cholecalciferol (D3)
Kidney hormone
Functions :
 Intestinal absorption of calcium & phosphorus
 Mineralization of bone
 Tubular absorption of phosphate
 Normal growth
33

33. Deficiency :
Rickets –
curved legs, deformed pelvis, pigeon chest, rickety
rosary, kyphoscoliosis
Osteomalacia
ICMR – 400 IU (10 mcg) daily supplement + exposure to sunlight
34

34. Toxicity :
o Anorexia
o Nausea
o Vomiting
o Thirst
o Drowsiness
o Coma
o Cardiac arrhythmias
o Renal failure
35

35. 36

36. 37

37. MINERALS
Major minerals :-
Calcium
Phosphorus
Sodium
Potassium
magnesium
Trace elements :-
Iron
Iodine
Fluorine
Zinc
Copper
Trace contaminants :-
Lead
Mercury
Barium
Boron
Aluminium
38

38. 39

39. 40

40. IRON
• 3-4 grams in body
• 60-70 % in blood
• 1g Hb = 3.34 mg iron Functions :
 Hemoglobin formation
 Brain development
 Temperature regulation
 Muscle activity
 Catecholamine metabolism
41

41. Iron losses :
1 mg daily (12.5 mg/ 28 days)
Iron deficiency :
o Decreased storage
o Latent iron deficiency
o Overt iron deficiency
• Nutritional anemia
• Impaired immunity
• Diminished work performance
42

42. General
• Weakness, easy fatigability,
lethargy
• Immunocompromised
• Diminished physical and mental
capacity
• Reduced work capacity, reduced
endurance
Pregnant and Lactating
Women
• Weakness, diminished physical
and mental capacity,
• Increased morbidity
• Increased risk of low birth baby,
abortion, premature delivery,
intra-uterine growth retardation,
• Congenial fetal malformations,
PPH, maternal mortality
Children
• Low birth weight, Perinatal
mortality,
• Impaired cognitive performance,
motor development and
scholastic achievement,
• Psychological and behavioral
effects
• Inattention, fatigue and
insecurity
Consequences of Anaemia . . .
43

43.  Breastfeeding and appropriate weaning
 Dietary modification
 Deworming
 Nutrition education
 Iron Supplementation & Iron Fortification
Prevention & control44

44. National Nutritional Anemia Prophylaxis Program
(NNAPP)
- Initiated in 1970.
- Prophylactic doses of iron and folic acid tablets distributed to
high risk groups by the local health workers.
- Food fortification and dietary diversification.
- Infants between 6 and 12 months, school children 6 to 10 year
old and adolescents 11 to 18 years old included in this program.
For children 6 to 60 months ferrous sulphate and folic acid are to be provided in a liquid
formulation containing 20 mg elemental iron and 100 mcg folic acid per ml of liquid
formulation.
45

45. Iodine deficiency disorder
46

46. Pregnancy
Spontaneous Abortion,
Still births
Fetus
Abortions
Still births
Congenital anomalies
Increased perinatal mortality
Increased infant mortality
Infant
Neurological Cretinism
Mental deficiency
Deaf mutism
Spastic diplegia
Squint
Myxedematous Cretinism
Dwarfism
Psychomotor defects
Neonate
Neonatal goitre
Neonatal hypothyroidism
SPECTRUM OF IODINE DEFICIENCY DISORDERS
Child and
adolescent
Goiter,
Juvenile hypothyroidism
Impaired mental function
Subnormal intelligence (loss
of 10 to 15 IQ points)
Retarded physical development
Delayed motor milestones
Hearing and speech defects
Stunting and muscle disorder
Adult
Goitre and its complications
Hypothyroidism
Lack of energy
Impaired mental function
Lowered productivity
Animal
Reproductive failure
Decreased yield of milk, egg,
etc.
47

47. Under the National IDD Control Programme
four main components are :
1.Use of Iodized salt or oil
2. Iodine monitoring
3. Manpower training
4. Mass communication
Prevention & control48

48. Fluoride consumption
Water Food Toothpaste Air pollution etc.
Higher concentration in ground waters than surface waters
The optimum concentration for drinking purpose is 0.5 to 0.8 mg/L
(ppm) but the permissible upper limit is 1.5 mg/L (1.5 ppm).
‘A double edged sword’.
fluorine
49

49. fluoride
Excess Deficiency
Fluorosis Caries
(< 0.5 ppm )
- Dental fluorosis
(> 1.5 ppm, 0-7 yrs of life)
- Skeletal fluorosis
(> 10 ppm)
Health problem in rural districts of Andhra Pradesh (esp. Nellore, Nalgonda and Prakasham districts), Haryana, Karnataka, Kerala, Punjab, Rajasthan
and Tamil Nadu.
50

50. Prevention & control
 Change in water source
 Defluoridation—The Nalgonda Technique (lime and
alum precipitation)
 Prohibit fluoride fortified water (0.5–0.8
ppm)/toothpaste in endemic areas
51

51. Foodborne diseases :
Due to naturally occurring
toxins in some food
• Lathyrism
• Endemic ascites
Due to toxins produced by
some bacteria
• Botulism
• Staphylococcus poisons
Due to toxins produced by
some fungi
• Alfatoxin
• Ergot
• Fusarium toxin
Foodborne chemical
poisoning
• Lathyrism
• Endemic ascites
• Heavy metals
• Oils, petroleum
derivatives and
solvents
• Migrant chemicals
from package
materials
• Asbestos
• Pesticide residues
Foodborne intoxicants
52

52. Foodborne infections
• Typhoid fever, paratyphoid fever, salmonellosis, staphylococcal
intoxication, cl. perfringes illness, botulism, B. cereus food
poisoning, E. coli diarrhea … etc…
Bacterial diseases
• Viral hepatitis, gastroenteritis
Viral diseases
• Taeniasis hydatidosis, trichinosis, ascariasis,
amoebiasis, oxyuriasis
Parasites
53

53. 54
Lathyrism

54. Since 1833 nearly 40 outbreaks have been described in India.
In India, lathyrism is mainly reported from Satna and Rewa districts of Madhya Pradesh and to a lesser extent from Uttar Pradesh, Bihar and West Bengal. It is
often reported from Gujarat, Maharashtra, Karnataka and Andhra Pradesh.
Lathyrus sativus
BOAA
Neurodegenerative
disorder
Neurolathyrism
Neurotoxin/
Excitotoxin
overstimulating the nerve cells of upper motor
neurons followed by their destruction
Pulse/dhal Kesari-Dal’
(Theora dal, Lak dal)
(b-Oxalyl Amino Alanine)
upper motor neuron disease
(spastic paralysis)
(‘poor man’s crop)
55

55. Removal of
toxin
• Steeping
method
• Parboiling
method
Health
education
• The hazards
• Removal of
toxin
Genetic
approach
• Other
pulses
• Other
strains
Vitamin C prophylaxis
• Daily administration for
about one week
• 500 to 1000 mg of ascorbic
acid
Legislation
• PFA-Act
• Cultivation and adultration
with is banned
Prevention
&
control
56

56. Accumulation of
Pyruvic acid & Lactic
acid
Toxic
vasculites
Edema
Epidemic dropsy
Gut Circulation Carbohydrate
metabolism
‘Sanguinarine’ and ‘Dihydrosanguinarine’
Cooking oil
Oil of argemona mexicana seeds
(prickly-poppy seeds)
Mustard oil
57

57. Prevention & control
 Supply of pure mustard oil (Prevention of Food Adulteration Act)
 Public awareness programs (health education about argemone seeds and oil)
 Testing of blood and urine for sanguinarine in suspected cases of dropsy.
 All packed cooking oils should have a label ‘ARGEMONE FREE’.
 All patients of epidemic dropsy should be monitored by various investigations (IOP
recording) Separation of seeds: Mustard seeds sink in salt solution.
Another method is by air elutriation/air floatation.
Separation of toxin: Steam is passed through the oil for 30 minutes.
58

58. Cancer
Nutritional Causes :
- Dietary fat
- Dietary fibre
- Micronutrients
- Food additives and contaminants
- Alcohol
“Group of heterogeneous disorders characterized by Clonality (arise
from a single stem cell that clones into carcinomatous cells), Autonomy
(the cell division and growth is uncontrolled), Anaplasia (lack of cell
differentiation) and Metastasis (distant spread)”.
59

59. 60

60. Food Cancer
Ascorbate deficiency Leukoplakia
↑ saturated fat Breast, colon
Vitamin A deficiency
Betel, areca, Beef , Iron deficiency
Oral, esophageal, colorectal
Tobacco (either in cigarettes or in its various
chewable forms)
Lung, oral
Alcohol Liver
Smoked fish (a popular dish in Japan),
nitrosamines (food additive)
Stomach
Dietary fiber deficiency colorectal
61

61. Primary prevention :
1. Control of tobacco and alcohol
2. Maintenance of personal hygiene (monogamous relationship)
3. Lessen radiation exposure
4. Lessen occupational exposure
5. Immunisation—Hepatitis B vaccine; HPV vaccine.
6. Legislation and surveillance of food additives, drugs and cosmetics.
7. Control of air pollution.
8. Treatment of precancerous lesions.
9. Cancer education- Early detection
Prevention & control62

62. Secondary prevention
 Cancer registration :
 Hospital based registry
 Population based registry
 Early detection by screening :
 Mass screening
 Selective screening of risk groups.
Tertiary prevention
• Analgesia—Considered the right of the moribund patient.
• Rehabilitation (after amputation/laryngectomy/colostomy/facial surgery).
63

63. National Cancer Control Program, 1975–76 and
Modified Cancer Control Program, 2005.
1. Primary prevention—Health education on cancer.
2. Secondary prevention—Screening, teaching self examination of breasts,
strengthen existing treatment facilities.
3. Tertiary prevention—Comprehensive cancer rehabilitation and palliative
care.
Objectives :
64

64. 1. Strengthening of existing Regional Cancer Centers.
2. Develop oncology wings medical colleges and hospitals.
3. District cancer control scheme implemented by a nodal agency at district
levels.
4. Financial assistance to NGOs (health education & screening activities).
5. Nationwide education and antitobacco campaign from the central level.
6. Research—Training programs
Schemes :65

65. Obesity
Excess of dietary energy intake as compared to energy expenditure
Critical Periods for Weight Gain :
● Age range of 12 to 18 months
● Age range of 12 to 16 years
● Gain of 60% (or more) of his ideal weight
by an adult
● Weight gain during pregnancy
Causes :
• Increased energy intake
• Passive overeating
• Binge eating
• Decreased energy expenditure
• Metabolic factors
• Genetic factors (Obesogenic
genes –Leptins, etc.)
66

66. 67

67. 68

68. Diabetes mellitus
Greek
Siphon
(passing water)
Latin
Honey
(sweet)
Metabolic Syndrome  Polyuria, Polyphagia, Polydypsia, Hyperglycemia & Glycosuria
Deficiency of the hormone insulin
(either by action or by secretion or both)
Controls the metabolism
carbohydrate,
protein, fat & electrolytes
70

69. 72

70. Complications :
Nephropathy Retinopathy Neuropathy
1. Heart disease and stroke. 50% of people with diabetes die of cardiovascular
disease (primarily heart disease and stroke).
2. Foot ulcers  limb amputation.
3. Diabetic retinopathy - blindness. After 15 years of diabetes, approximately
2% of people become blind, and about 10% develop severe visual impairment.
4. Kidney failure. 10–20% of people with diabetes die of kidney failure.
73

71. Hypertension
Nonmodifiable Risk Factors
• Age: > 40 years of age.
• Sex: middle age- male, later- women
• Genetic factors
• Ethnicity
75

72. Modifiable Risk Factors
• Occupation
• Socioeconomic status
• Physical activity
• Obesity.
• Diet:
– Salt intake
– Fats and sweets – obesity- HTN.
– Dietary fibers (reduced risk-reduces LDL)
• Diseases: diabetes mellitus
• Lifestyle (Habits): High alcohol
• Other factors: OCPs, noise, vibration, humidity, etc.
(require further investigations.)
76

73. Hypertensive patients are grouped into
three groups:
1. Those who do not have any symptoms, but are
detected during the routine check-up
2. Those who come with specific complaints as
explained above
3. Those who come with complications.
77

74. Prevention & control
Primary Prevention
Population strategy :
On nutrition- DASH diet
On weight
On behavioral changes
Health education
Self care
Recreation
High-risk strategy :
Screening by recording BP
Secondary Prevention
• Early diagnosis
• Non pharmocological management
• Appropriate drugs
• Regular follow up
Tertiary Prevention
• Disability limitation
• Rehabilitation
78

75. Diet plans
79

76. 80

77. 81

78. 82

79. 83

80. Recommended Dietary Allowances
or Intakes (RDA or RDI)
The RDA of a nutrient is the amount (of that nutrient) sufficient for the
maintenance of health in nearly all people.
Corresponds to mean intake of the given nutrient + 2 Standard Deviation
It covers the requirement of 97.5%.
Excess of energy intake is as undesirable as inadequate intake.
Not used for defining the energy requirement.
84

81. Prevention of Nutritional Disease and Upkeep of Nutrition in the
Community
Individual level :
Food selection, activity, sleep, mental peace.
Family level :
Locally available foods must be prefered to ‘imported’ foods.
Community level :
Make national programmes beneficial.
Government level :
Various nutritional programmes.
85

82. 1. 20 –30% energy from fat
2. Saturated fatty acids <10% of energy consumption
3. Increase in fiber intake and reduction of refined carbohydrates (flour,
bread, suji, sugar)
4. Restriction of energy rich food like alcohol
5. Salt <5g/day
6. 15–20% of energy intake from proteins
7. To avoid junk food
8. Cholesterol < 100 mg/1000 kcal.
Dietary Goals/Prudent diet [WHO]
87

83. REFERENCES
Textbook of public health & community medicine 1st edition
– AFMC Pune (2009)
Community medicine- students manual 2015
- Parikshit Sanyal
Community medicine with recent advances 4th edition
- Suryakantha (2016)
Textbook of preventive and social medicine 4th edition
- Mahajan & Gupta (2013)
Textbook of preventive and social medicine 23rd edition
- K Park (2015)
Internet
88

84. 89
. . . For patience hearing