Common sources of various nutrients and special nutritional

1. Common sources of various
nutrients and special
nutritional requirements
DR. IQBAL A. FAROOQUI
TUTOR
DEPT OF COMMUNITY MEDICINE
SHEIKH BHIKHARI MEDICAL COLLEGE

2. Food
Food is a substance eaten or drunk to maintain life and
growth.
The foods are generally classified into cereals (wheat, rice,
maize etc.), legumes (pulses and peas), nuts and oilseeds,
vegetables, fruits, milk and milk products and flesh foods
(fish, meat and chicken and egg).
Diet, on the other hand is what a person habitually eats and
drinks.

3. Why do we eat
food
a) Food builds body tissues : The structural materials
of food, proteins, minerals, vitamins and water are
needed for growth and development. The food is also
needed for the maintenance of the cells and tissues.
b) Food regulates body processes : Many a body
processes are regulated by the ‘fuel’ supplied through
food e.g., temperature control of the body (calories),
control of osmotic pressure (proteins and electrolytes),
maintenance of hydrogen ion concentration (pH through
electrolytes), solvent power of fluids (proteins and
water), nerve conduction (minerals), muscle elasticity
(minerals), innumerable metabolic processes (vitamins
and minerals).
c) Food supplies energy : The macronutrients
(carbohydrates, proteins and fats) supply energy. These
provide constant source of fuel to the body. It is
measured in terms of a kilo calorie.
d) Food gives us enjoyment : We want to enjoy food
and entertain our guests with tasty food.

4. Nutrients
Nutrients are organic and inorganic complexes
contained in food.
Nutrient
Macro
Nutrient
Protein
Carbohydrate
Fats
Micro
nutrient
Vitamins
Minerals

5. 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. The estimates of nutrient intakes which
individuals in a population group need to consume to
ensure that the physiological needs of all subjects in that
population are met.

6. Major contributors of energy to our diet - (Some raw foods and their
energy content per 100g)
Table 1 : Major contributors of energy to our diet - (Some raw foods and their energy
content per 100g)
Food stuff
Energy
(Kcal)
Food stuff Energy (Kcal)
Cereals & Millets
Non vegetarian foods
Wheat flour 341 Egg (hen) 173
Rice polished 345 Fish (Hilsa) 273
Bajra 361 Chicken 109
Maize dry 342 Mutton (lean) 118
Ragi 328 Pork (muscle) 114

7. Food stuff
Energy
(Kcal)
Food stuff Energy (Kcal)
Fruits & Vegetables Nuts
Banana 116 Groundnut 567
Apple 59 Cashew nut 596
Grapes, pale green 71 Coconut, fresh 444
Custard apple 104 Miscellaneous
Jack fruit 88 Jaggery 383
Raisins 308 Sugar 398
Potato 97 Veg oils 900
Pulses & Legumes Milk & milk products
Bengal gram 360 Milk, cow 67
Soya bean 432 Milk, buffalo 117
Rajmah 346 Milk, human 65
Redgram (Arhar) 335 Butter 729
Greengram
(Moong)
334 Ghee 900
Lentil (Masoor) 343 Cheese 348
Pea dry 315 Curd 60

8. Table 2 : Energy content of selected Indian food items (per serving)
Food item Kcal Food item Kcal
Samosa (1 no.) 256 Dalia (1 plate) 80
Masala dosa (1 no.) 360 Khichri (1 plate) 160
Kachori (2 nos.) 500 Biscuits (4 nos.) 150
Omlette (1 egg) 236 Poha (1 plate) 120
Puri (4 nos. x
25 g each)
320 Bread (2 slices) 125
Chapati with ghee
(4 nos.)
360
Chapati ( 2 nos.
x 35 g each)
160
Cake (1 small piece) 250 Kheer (1 katori) 120
Butter chicken
(1 katori)
400 Cornflakes (1 bowl) 190
Chicken biryani
(200 g)
400 Veg salad 50

9. Energy content of selected Indian food items (per serving)
Malai paneer
(1 katori)
270 Butter milk (1 glass) 90
Paratha (2 nos.
x 50 g each)
360 Jam (1table spoon) 40
Ice cream (100 ml) 250 Dhokla (2 pcs) 100
Pastry (1 no.) 290
Green leafy veg
(1 katori)
130
Milk cake (1 piece) 300
Idli (2 nos. x
55 g each)
155
Butter (2 table spoon) 180
Dosa (2 nos. x
45 g each)
250
Fried Cashew (50 g) 375
Tinned cheese
(2 tbsp)
105

10. Proteins
Proteins are large molecules made up of nitrogen containing amino acids that are united together
by peptide linkages. In adults approximately 16% of body weight is attributable to proteins.
Sources of proteins : There are two main dietary sources of proteins :
(a) Animal Sources : These include eggs, milk, meat and fish
(b) Vegetable Sources : Pulses, nuts, cereals, beans and oilseed cakes

11. Table 3 : Major sources including their protein content (g per 100g)
Food Item
(Source)
Protein
content (g)
Food Item
(Source)
Protein
content
(g)
Eggs 13.3 Milk (Cow) 3.2
Meat (goat, lean) 21.4 Fish (Hilsa) 21.8
Pulses (red gram) 22.3 Soya bean 43.2
Groundnuts 25.3 Wheat flour 12.1
Rice (raw, milled) 6.8 French Beans 1.7

12. Supplementary action and limiting amino
acid
The essential amino acid that is in shortest supply in a given food item is known as the limiting
amino acid, for example the limiting amino acid in wheat is lysine and in pulses it is methionine.
The quality of vegetable proteins in a vegetarian diet can be improved by providing a suitable
combination of
vegetable proteins. A relative lack of a particular amino acid in one protein can be compensated by
simultaneous consumption of another protein, which contains that limiting amino acid. This is
known as supplementary action.
Thus a diet combining wheat products such as bread (chapati) with pulses (dal) will
compensate for these deficiencies (of lysine and methionine) and provide all the essential amino
acids. Other similar examples from Indian diet are Idli-Sambhar, Wada-Pav, RiceDal, Khichri etc.

13. Box - 3 : Recommendations on Diet for Proteins
Eat nutritionally balanced diet to get adequate protein
Meat and fish are good sources
Vegetarians must eat proper combination of plant proteins
from both cereal and pulses groups
Include Soyabean in your diet
Two to three servings of protein-rich food must be ensured
every day
One serving may be equivalent to :
- One to two cups of cooked meat, poultry, fish
- Half cup of cooked dry beans/ lentils/ legumes
- One egg
- Handful of fried/roasted- salted groundnuts
- Handful of roasted Bengal grams

14. Recommended Dietary Allowance (RDA) for Proteins
Group Activity
Body
weight
Requirement
g/day
Man Sedentary work
Moderate work 60 60
Heavy work
Woman Sedentary work
Moderate work 50 50
Heavy work
Pregnant woman 50 +15
Lactation
Infants 0-6 months 5.4 2.05/ Kg
6-12 months 8.6 1.65/ Kg

15. Group Activity
Body
weight
Requirement
g/day
Children 1-3 years 12.2 22
4-6 years 19.0 30
7-9 years 26.9 41
Boys 10-12 years 35.4 54
Girls 10-12 years 31.5 57
Boys 13·15 years 47.8 70
Girls 13·15 years 46.7 65
Boys 16-18 years 57.1 78
Girls 16-18 years 49.9 63

16. Fats
Fats are organic compounds, which are insoluble in polar solvents (water) but soluble in organic
solvents such as ether, chloroform and benzene. Fats are only distinguished from oils by their
different melting points; fats are solid and oils liquid at room temperature.
Sources of fats : Dietary fats are derived from two main sources:
(a) Animal Sources : They are milk and milk products (ghee, butter), lard, egg and fish oils.
Animal fats in general are poor sources of essential fatty acids with the exception of certain marine
fish oils such as cod liver oil and sardine oil, but they are good sources of retinol and
cholecalciferol.
(b) Vegetable Sources : They include various edible oils such as groundnut, gingely, mustard,
cottonseed, safflower, rapeseed, palm and coconut oil. Vegetable oils with the exception of
coconut oil are all rich sources of essential fatty acids, but they lack retinol and cholecalciferol
except red palm oil which is rich
in carotenoids.

17. Major sources including their fat content (g/100g)
Food Item (source) Fat content (g/100g)
Eggs (hen) 13.3
Milk, cow 4.1
Meat (Goat lean) 3.6
Fish (Hilsa) 19.4
Ghee 100
Butter 81.0
Groundnut 40.1
Mustard seeds 39.7
Coconut, fresh 41.6
Sunflower seeds 52.1

18. RDA of Fats for Indians
Group Particulars Body wt (Kg) RDA Fat (g/d)
Man
Sedentary work
60 20
Moderate work
Heavy work
Woman
Sedentary work
50 20
Moderate work
Heavy work
Pregnant woman
50 30
Lactation
Children
1-3 years 12.2
25
4-6 years 19.0
7-9 years 26.9
Boys 10-18 years
22
Girls 10-18 years

19. Carbohydrates
Carbohydrates are the basic source of fuel to run life on earth. Chemically carbohydrates are
polyhydroxy aldehydes or ketones, or substances that produce such compounds when
hydrolyzed. They contain carbon, oxygen and hydrogen in proportion approximating that of a
‘hydrate of carbon’ (CH2O), hence the term carbohydrate.
From the nutritional or functional point of view, carbohydrates can be divided into two categories.
(a) Available carbohydrates : These are the carbohydrates which can be digested in the upper
gastrointestinal tract, absorbed and utilized. These are further sub-classified as polysaccharides,
disaccharides, monosaccharides.
(i) Polysaccharides such as starch, dextrin and glycogen
(ii) Disaccharides such as lactose, sucrose and maltose
(iii) Monosaccharides such as glucose, fructose and galactose.
(b) Dietary Fibre : The second category comprises of unavailable carbohydrates or dietary fibre,
which are difficult to digest. These are cellulose, hemicellulose, gums, pectins etc.

20. Sources of Carbohydrates
The major source of dietary carbohydrates in an Indian set up is starch from cereal grains, millets,
legumes, roots and tubers.
With increasing prosperity as in industrial societies, sugar has replaced complex carbohydrates as
the main source. The presence of monosaccharides (free glucose or fructose) is limited to fruits
and vegetables, otherwise they are not abundant in natural foods.
Fructose is found in honey, fruits and vegetables. Sucrose and Lactose are the commonest
disaccharides. Sucrose is extracted from sugar cane. Table sugar is 99% sucrose. Sucrose gets
hydrolysed into glucose and fructose. Lactose is found in milk. It is hydrolysed to glucose and
galactose. Maltose is present in malted wheat and barley. Other sources are nuts and seeds.

21. Major sources of carbohydrates (per 100 g)
Food stuff Carbohydrates (g) Food stuff Carbohydrates (g)
Cereals & Millets Pulses & Legumes
Wheat flour 69.4 Bengal gram 60.9
Rice polished 78.2 Soya bean 20.9
Bajra 67.5 Rajmah 60.6
Maize dry 66.2 Redgram (Arhar) 57.6
Ragi 72.0 Pea dry 56.5
Fruits & Vegetables Miscellaneous
Banana 27.2 Milk, cow 4.4
Apple 13.4 Groundnut 26.1
Mango 16.9 Cashew nut 22.3
Raisins 74.6 Coconut, fresh 13
Tapioca 38.1 Jaggery 95
Sweet potato 28.2 Sugar 99.4
Potato 22.6 Honey 79.5

22. Dietary fibres
Dietary fibres are the remnants of the plant cell resistant to hydrolysis by alimentary enzymes and
do not provide significant nourishment. They remain in the ileum but are partially hydrolyzed by the
colonic bacteria. The term ‘dietary fibre’ is a broad term which includes Non Starch Polysaccharide
(NSP) and related material such as resistant starch, resistant oligosaccharides, lignin and complex
assemblies of plant tissue where polysaccharides occur in close association with other molecules.
Fibre can also be classified according to solubility in water, as soluble or insoluble. Insoluble fibre
consists mainly of cellulose, hemicellulose and lignin. Since they remain undigested in the gut they
form bulk and help in movement of the food and peristalsis. Thus they help in elimination of waste
products as well. After absorption of water the fibre swells up and facilitates the gut movement
further. On the other hand the natural gel forming fibres like pectins, gums and mucilages are
soluble.
Recommended Dietary Allowance : The diet should contain 35-40 grams of dietary fibre per day
(15g per 100Kcal)

23. Dietary fibre content of common foods (g/100g)
Foodstuff Fibre content (g per 100g) Foodstuff Fibre content (g per 100g)
Cereals & Legumes
Fruits
Rice, raw, milled 0.2 Guava 5.2
Wheat flour, whole 1.9 Mango, papaya 0.7
Bengal gram, whole 3.9 Pomegranate 5.1
Red gram (Dal arhar) 1.5 Peach, pears, apple 1.0-1.2
Peas dry, Rajmah 4.5 Figs, Sapota 2.2-2.6
Green vegetables
Nuts
Cabbage, cauliflower,
Fenugreek (maithi)
1.0 -1.2 Areca nut 11.2
Amaranth 1 to 6.1 Coconut fresh 3.6
Spinach, radish leaves 0.6 Groundnut 3.1

24. Micronutrients : Vitamins

25. Vitamins
Vitamins are organic compounds required in very small but definite quantities for normal growth
and
maintenance of a healthy life. They are not synthesised in the body and have to be supplied in the
diet. They do not furnish energy and play no part in the constitution of the structure of tissues, but
are essential for the transformation of energy and regulation of tissue metabolism. They are
necessary for the efficient functioning of the organism as a whole, each in a specific manner.

26. Dietary sources
Vitamins are widely distributed in diet. Fresh milk, meat, eggs, fresh vegetables and fruits are rich
sources.
Cereals (esp. whole unrefined cereals) which form the bulk of our diet are also important sources.
No physiological benefit, however, can be expected from a large dose of vitamins under normal
circumstances.
Storage, processing and cooking of food may cause considerable vitamin loss, so that the
maintenance of an adequate intake is more difficult when fresh food is scarce.

27. Classes of vitamins :
Vitamins have long been classified into two groups; water soluble and fat soluble.
The water soluble group comprises of vitamins B and C; the fat soluble vitamins are A, D, E and K.
Functions :
They do not furnish energy and play no part in the constitution of the structure of tissues directly,
but are essential for control of cell metabolism, transformation of energy, and prevention of specific
nutritional deficiencies.
Many vitamins are now known to have antioxidant properties. The scope of vitamins has now
widened from their earlier role of curing specific deficiencies to preventing cancers and even
aging!

28. Water Soluble Vitamins
Vitamin Function RDA Deficiency Sources
Vitamin C
(Ascorbic acid)
Reductant in hydroxylations
in collagen and carnitine
synthesis Metabolism of
drugs
40mg /day
Scurvy: Spongy,
bleeding
gums, fatigue,
haemearthrosis
Citrus fruits,
guava, amla, green
vegetables , tomatoes,
strawberries
Vitamin B 1
(Thiamine)
Normal growth Coenzyme
for
decarboxylation of 2-keto
acids
and transketolation reactions
0.5mg / 1000Kcal
Beriberi – Cardiac
(wet), Neuritic (dry)
and Infantile
Meat, liver, legumes,
wheat germ
Vitamin B 2
(Riboflavin)
Normal growth Coenzyme
in redox reactions of fatty
acids and TCA cycle
0.6mg / 1000Kcal
Ariboflavinosis:
Magenta tongue,
Cheilosis, angular
stomatitis, corneal
ulcer
Milk, meat, green
vegetables
Niacin
(Nicotinic acid,
Nicotinamide)
Coenzyme for
dehydrogenases
6.6mg / 1000Kcal
Pellagra, characterized
br 3 Ds- dermatitis,
diarrhea, dementia
Meat, groundnus,
legumes, grains
Vitamin B 6
(Pyridoxamine)
Coenzymes in amino
acid metabolism
2mg / day
Anaemia, neuritis,
convulsions
Grains, seeds,
poultry, meat
Folic Acid
Coenzymes in single
carbon metabolism
100μg / day Megaloblastic anaemia
Liver, green vegetables
yeast, fruits
Vitamin B 12
Coenzymes in amino acid,
propionate and single
1μg / day Pernicious anaemia
Liver, lean meat

29. Fat Soluble Vitamins
Vitamin Function RDA Deficiency Sources
Vitamin A (Retinol,
Retinal, Carotenes,
Cryptoxanthines)
Vision, Integrity of
epithelium, Gene
regulation, Antioxidant
600 μg/ day
Xerophthalmia,
Dry skin, impaired
immunity, growth
and reproduction
Retinol (animal foods):
liver, egg, meat, milk
Provitamin A (plant
foods)
yellow, green
vegetables
Vitamin D
(Cholecalciferol,
D3 ; Ergocalciferol, D2)
Calcium homeostasis,
Bone metabolism
100 - 400
IU /day -
(Child)
Rickets in children
Osteomalacia in adults
Synthesised in skin with
exposure to sunlight;
Fish oils, milk
Vitamin E
(Tocopherols)
Cellular membrane
antioxidant
12mg / day
RBC breakdown,
anaemia, nerve
damage, retinopathy
Vegetable oils, green
vegetables, cereal
germ, nuts, seeds
Vitamin K
(Phylloquinones,
Menaquinones,
Menadione)
Clotting of blood,
Calcium metabolism
120 μg /
day (Males)
90 μg / day
(Females)
Bleeding tendencies
Synthesis by intestinal
bacteria, green
vegetables
soya oil, liver, milk

30. Micronutrients : Minerals

31. Minerals
Minerals are required in small quantities and constitute only a small portion of the body weight but
enter into the metabolism to a much greater degree than their mere weight indicates. A large
portion of the ash of the body is composed of calcium, magnesium, sodium, potassium,
phosphorous, sulphur and chlorine

32. Functions
The main functions of the minerals include:
 Providing rigidity and relative permanence to the bones and teeth;
 Providing essential elements for the formation and activities of the muscular, glandular; neural,
and epithelial tissues;
 Forming components of enzyme systems;
 Providing dynamic characteristics to the intra and extra cellular fluids for regulation of pH,
osmotic pressure and electro-neutrality and those of secretion and excretions

33. Classification
The Macrominerals
Calcium, phosphorous, magnesium, sodium, potassium, chloride, sulphur
The Microminerals
Iron, zinc, iodine, Copper, manganese, molybdenum, selenium, chromium and fluorine,
cobalt, nickel, tin, silicon, vanadium, arsenic, cadmium, boron, aluminium
Macrominerals also referred to as major minerals are distinguished from the microminerals by
their occurrence in the body. Taking this as criterion, various definitions of macrominerals
have evolved, such as “those which constitute at least 0.01% of body weight (5g in a 60 Kg
man)” ; or a more quantifiable and unambiguous definition like “mineral whose requirement is
more than 100mg per day”. Calcium, phosphorous, magnesium, sodium, potassium, chloride
and sulphur are the macrominerals

34. Mineral Function Sources
Sodium Needed for proper fluid balance, nerve
transmission, and muscle contraction
Table salt, soy sauce; large amounts in
processed foods; small amounts in milk,
breads, vegetables, and unprocessed meats
Chloride Needed for proper fluid balance, stomach acid Table salt, soy sauce; large amounts in
processed foods; small amounts in milk,
meats, breads, and vegetables
Potassium Needed for proper fluid balance, nerve
transmission, and muscle contraction
Meats, milk, fresh fruits and vegetables, whole
grains, legumes
Calcium Important for healthy bones and teeth; helps
muscles relax and contract; important in nerve
functioning, blood clotting, blood pressure
regulation, immune system health
Milk and milk products; canned fish with
bones (salmon, sardines); fortified tofu and
fortified soy milk; greens (broccoli, mustard
greens); legumes
Phosphorus Important for healthy bones and teeth; found
in every cell; part of the system that maintains
acid-base balance
Meat, fish, poultry, eggs, milk, processed
foods (including soda pop)
Magnesium Found in bones; needed for making protein,
muscle contraction, nerve transmission,
immune system health
Nuts and seeds; legumes; leafy, green
vegetables; seafood; chocolate; artichokes;
"hard" drinking water
Sulfur Found in protein molecules Occurs in foods as part of protein: meats,
poultry, fish, eggs, milk, legumes, nuts

35. Mineral Function Sources
Iron Part of a molecule (hemoglobin) found in red blood
cells that carries oxygen in the body; needed for
energy metabolism
Organ meats; red meats; fish; poultry; shellfish
(especially clams); egg yolks; legumes; dried fruits; dark,
leafy greens; iron-enriched breads and cereals; and
fortified cereals
Zinc Part of many enzymes; needed for
making protein and genetic material; has a function
in taste perception, wound healing, normal fetal
development, production of sperm, normal growth
and sexual maturation, immune system health
Meats, fish, poultry, leavened whole grains, vegetables
Iodine Found in thyroid hormone, which helps regulate
growth, development, and metabolism
Seafood, foods grown in iodine-rich soil, iodized salt,
bread, dairy products
Selenium Antioxidant Meats, seafood, grains
Copper Part of many enzymes; needed for iron metabolism Legumes, nuts and seeds, whole grains, organ meats,
drinking water
Manganese Part of many enzymes Widespread in foods, especially plant foods
Fluoride Involved in formation of bones and teeth; helps
prevent tooth decay
Drinking water (either fluoridated or naturally containing
fluoride), fish, and most teas
Chromium Works closely with insulin to regulate blood sugar
(glucose) levels
Unrefined foods, especially liver, brewer's yeast, whole
grains, nuts, cheeses
Molybdenum Part of some enzymes Legumes; breads and grains; leafy greens; leafy, green
vegetables; milk; liver

36. Special nutrients requirements

37. Pregnancy and Lactation
Appetite changes; cravings and aversions set in for certain foods. This is augmented by certain
endocrine changes. Changed peristalsis state leads to constipation. Besides these the
requirement for energy and various other nutrients go up steeply to cater for the developing fetus
(1). The physiological changes continue during lactation. There are hormonal changes followed by
physiological changes in the mammary system, involution of uterus continues. Psychological and
emotional changes too play a part.
The process of lactation requires energy. The additional energy required is based on the volume of
milk secreted, its energy content and the efficiency of conversion of food energy into milk energy.
Women secrete up to 850 ml milk per day at 80% efficiency of conversion of food energy into milk
energy.

38. Pregnancy and Lactation
Energy requirements : The energy equivalent of the raised resting oxygen consumption is of the
order of about 27,000 Kcal, over the entire duration of pregnancy. The diet also has to provide
energy for the fat and proteins laid out in the foetus and maternal tissues. The maternal fat
deposited is about 4 kg. The total energy cost of pregnancy could be put at about 73,000 Kcal.
Most of this extra energy is needed in the latter two trimesters. An additional requirement of
300Kcal per day is to be met, throughout the pregnancy. The additional energy requirement during
lactation has been worked out to 550 Kcal in the first 6 months and 400 Kcal thereafter.

39. Protein requirements : The rapid growth of foetus, development of placenta and other maternal
tissues, the expanding fluids (blood volume, amniotic fluid) and other storage reserves demand
extra proteins. It has been recommended that an additional 15 g of proteins per day must be
catered for during pregnancy. During lactation, extra protein demand is incurred for the production
of milk. Therefore an additional intake of 25 g proteins/day in the first six months and 18 g in the
next 6 months (6 - 12 months) is recommended.

40. Fats & Essential Fatty Acids (EFA) : The linoleic acid requirement during pregnancy is put at
4.5% of total energy. This can be met by the normal intake of invisible fats along with an intake of
12.5% of total energy equivalent of visible fats. The EFA requirement goes up further during
lactation to 6% of total energy. This can be met by the normal intake of invisible fats along with an
intake of 17.5% of total energy equivalent of visible fats. This would correspond to a total of about
45g of visible fats.

41. Iron : Additional iron is required to meet the augmented demand for foetal growth, expansion of
maternal tissue including RBC mass, iron content in placenta and blood loss during parturition.
Owing to these additional needs the iron requirements go up in the second and third trimester to
3.3 mg and 5 mg respectively (taken as RDA of 38mg during pregnancy). Breast milk contains
iron, so this iron need is to be catered for during lactation. There is no menstrual loss and the total
daily iron requirement remains the same as that of a normal woman i.e. 1mg/day (or the RDA of
30mg).

42. Effect of Micronutrient Deficiency
During Pregnancy
The micronutrient demands of the rapidly growing fetus are mandatory and inevitable. It is
extremely sensitive to the deficiency of micronutrients during the organogenesis and growth.
Whenever there is micronutrient deficiency in the mother’s diet, the high demand of the foetus is
initially met
by the maternal resources. But when these resources are exhausted, the maternal reserves are
tapped and besides foetus, the mother’s health is also compromised.

43. Box - 1 : Adverse effects of micronutrient deficiency on foetus and
mother
Nutrient Adverse effect on mother Adverse effect on foetus/infant
Thiamin - Infantile Beriberi
Folic Acid Anaemia
Iugr, Neural Tube Defects, Low
Birth Weight, Abortion
Vitamin A Anaemia Low Birth Weight, Premature Birth
Vitamin D Increased risk of osteomalacia
Impaired Bone Development,
Hypocalcemia, Rickets
Vitamin E - Birth Defect, Spontaneous Abortion
Calcium
Higher risk of hypertension,
eclampsia, osteoporosis
Impaired Bone Development,
Hypocalcemia, Rickets
Magnesium
Higher risk of hypertension,
eclampsia
Premature Birth
Iron Anaemia
Low Birth Weight, Premature Birth,
Higher Infant Mortality
Iodine Hypothyroidism
Still Birth, Cretinism, Neonatal
Hypothyroidism, Deaf Mutism
Zinc -
Birth Defect, Premature Birth, Low
Birth Weight, Hypogonadism

44. Diet During Pregnancy
The diet is mainly a cereal based diet supplemented with little pulses and vegetables. Many a
times only a chilly - salt mixture or onion is eaten with rice or chapati, with no pulses, vegetables,
fat or fruits. Milk is used only to prepare tea. Usually only two main meals are taken. The nutrient
value of such a diet is grossly limited even for a non pregnant woman. This inadequate diet is not
only limited in calories, but is poor in proteins, fats and micronutrients as well. The pregnant
woman becomes malnourished. She is more prone to post-partum haemorrhage and death. This
anaemic and malnourished woman delivers a physically and/or mentally retarded neonate. There
may be bone deformities, mental deficiencies and due to low immunity and nutritional reserves
such a child would be more prone to infections and malnutrition. In case it was a girl child, she
grows into a nutritionally deficient teenaged girl and mother. The cycle continues and so
perpetuates the malnutrition cycle. It is therefore important to offer and consume a balanced diet.
The diet should be so modified that more of the protective foods (vitamins and minerals) and body
building foods (proteins) are included rather than only excess of energy.

45. Table - 2 : Balanced diet for a pregnant woman* (3)
Food Group Food stuff Amount per day
Cereals Rice, wheat, millets 300 g
Fats Oil, ghee, butter 30 g
Sugars Sugar, Jaggery 20 g
Milk Milk, curds, etc 500 ml
Pulses & Nuts Pulses, legumes, dry beans, nuts 60 g
Fruits & vegetables Fruits 200 g
Vegetable 350 g
Green Leafy Vegetables 150 g
Other vegetables 120 g
Roots and tubers 100 g
*The diet shown in the table is a vegetarian diet for a pregnant sedentary woman, for non vegetarians additional 30 g of flesh
foods (meat, fish, chicken) or one egg is suggested in lieu of 30 g pulses.

46. Summary
Many physiological changes take place during pregnancy and lactation. The nutritional
requirement increases substantially during this time. The daily energy requirement increases by
300 Kcal, protein and fat requirement by 15 g and 10 g respectively. The iron requirement also
goes by about 8 mg. The demand during lactation is still higher. The energy requirement goes up
by 550 Kcal and protein and fat requirement by 25 g each. Suitable modification in diet should to
be made through addition of another meal, mid meal snacks and nutrient dense foods. Protein,
iron and vitamin rich foods should be included in diet. It is wise to include fruits, vegetables, whole
grains, milk products, meat, egg, legumes, nuts, etc. Also include vitamin C rich foods to improve
iron absorption. Minimise coffee/tea during mealtime. It is advisable to take iron - folate
supplement. Don’t take any medicines without prescription and abstain from smoking and alcohol.

47. Nutrient Requirements for Infants
and Children
Weight for weight, the infants and children require more food as compared to adults. This is
because the children not only need food for maintaining the BMR, thermogenesis, repairing wear
and tear, but also for the important function of continuous growth. Child therefore needs all kinds
of extra nutrients, namely, proteins, fats carbohydrates, minerals and vitamins.

48. Daily Energy Requirements of Infants
Age Kcal/kg
Average during
1st year
0 - 3 months 116
103 Kcal/kg
3 - 6 months 99
6 - 9 months 95
9 - 12 months 101
Daily Energy Requirements for Children
Age (years) Boys (Kcal/kg) Girls (Kcal/kg)
1-3 1287 1193
4-6 1752 1630
7-9 2075 1833
10-12 2194 1965
13 - 15 2447 2056
16 - 18 2642 2064

49. Daily Protein* Requirement for Infants
Age (months) Proteins (g/kg body weight)
0 - 3 2.3
3-6 1.85
6-9 1.65
9-12 1.5
*In terms of milk proteins
Table - 7 : Daily Protein* Requirements of Children
Age (years)
Boys (g/kg
body weight)
Girls (g/kg
body weight)
1 - 2 1.81 1.81
2 - 3 1.67 1.67
3 - 4 1.61 1.61
4 - 6 1.52 1.52
7 - 9 1.48 1.48
10-12 1.46 1.45
13 - 15 1.4 1.33
16 - 18 1.31 1.21
*In terms of proteins present in routine Indian diets (cereals and pulses)

50. Diet for the infants up to 6 months
of age
There is no variation in the opinion of the scientists that breast milk is the best for the baby. It contains
all the nutrients required by the baby in the correct proportion for at least the first 4 - 6 months. It is well
balanced nutritionally and immunologically and is easily digestible. Composition of Breast Milk :
Breast milk is an astonishing emulsion that contains more than 200 known substances, including more
than 30 types of sugars, 10 types of fats and many proteins and minerals. Its primary constituents are :
Nutrients : Milk contains almost all known nutrients : fats, proteins, sugars, minerals, vitamins, etc.
Enzymes : These are present to digest and absorb the nutrients.
Immune factors : Many antibodies, lysozymes, etc are present to protect the baby from infections.
Growth factors and hormones : These are present for adequate growth of child.
Breast feeding : The mother must begin breast feeding at the earliest. The milk that is secreted by the
woman in the first week after birth is a thick yellowish mixture, called as colostrum. It is highly
recommended that the colostrum must be fed to the child as it is not only rich in fats, proteins, minerals
and vitamins but also has anti - infective properties (antibodies, immunoglobulins, etc). The carotene
content of colostrum is 10 times higher than milk. Vitamin A and E along with other antioxidants play an
important role in the growth
and immunological defence of the neonate. The practice of pre - lacteal feeding with honey, glucose
water or formula feeds must be discouraged. It is advisable to exclusively breast feed the child till about
4 to 6 months. Following this some liquid feeds/supplements may be started (e.g. orange / tomato
juice).

51. Diet for the infants from 6 months
to 1 year
Breast milk is good enough to meet the nutritional requirements of infant till about 4 to 6 months of
age, thereafter the requirements of the infant goes up and the milk yield also starts declining. As a
result it is advisable to supplement feeding at six months of age to maintain good growth rate.
Weaning is the introduction of supplementary foods to augment the energy and nutrient intake of
the infant. During this phase breast feeding is continued and maintained till about 1 year of age.
Supplementary foods are gradually introduced and increased in quantity whilst breast feeding is
slowly withdrawn. The process starts with omitting one breast feed and supplementing it with a
chosen food in suitable quantity.
Gradually the baby is given higher quantities of top – feeds and more frequently. This allows the
mother to withdraw and eventually cease breast feeding smoothly. It is ideal to wean the child
completely by 18 months of age.

52. Supplementary Feeding for infants
aged 6 months to 1 year
a) Liquid supplements : Breast milk must be continued in this period of the 1st year of life. However
supplementation and substitution with certain liquids is recommended. Foods that can be used could
be fruit juices like orange, mousambi and grapes. These would cater for mineral and vitamin
requirement of the growing infant. Green leafy vegetable soups can be used as alternatives.
Cow/buffalo milk is also introduced in a graded manner.
b) Mashed solid supplements :
(i) Mashed solids like boiled and mashed potatoes with salt and ghee, cereal gruels like sweet dalia,
porridge, etc. must be introduced in the 7th month. These foods contribute to the energy required for
the rapidly growing baby. Well boiled and if
required mashed dals can also be added. These will add to the variety and protein content of diet.
(ii) Vegetables : Green leafy vegetables can be used as semisolid soups suitably garnished with salt
and ghee.

53. (iii) Other vegetables can also be used. The skin and seeds of these boiled vegetables can be
removed and only the pulp used for the baby. The mother should start feeding with small quantity
and increase gradually.
(iv) Boiled egg : It is a very useful, nutritious and easy to cook foodstuff. One may start with egg
yolk. Egg white can be introduced later. Initially a partially boiled egg can be given later on a boiled
or poached egg is fed.
(v) Meat : Well cooked, finely minced or ground meat or mashed fish can also be introduced at this
time.
(vi) Fruits : Mashed ripe banana, mango, chickoo, apple, etc can be given depending on the
availability and taste.
c) Unmashed solid supplements : When the baby starts cutting his teeth it is time to introduce
chopped and solid foods. Chopped vegetables and minced meat of a coarser consistency can be
used. Bit of potato, well cooked rice or dalia can also be given. A piece of toast, biscuits, banana,
carrots can also be given for healthy teeth and gums. Fruit slices should be preferred to fruit juices
now.

54. Supplementary Feeds for children
aged 1 to 2 years
Cereals : Cereals (wheat or rice) based preparations which the child could easily masticate and
digest must be encouraged. Potato, sweet potato, tapioca and other starchy vegetables must be
continued. These can be given at least three times a day.
Pulses : A pulse or legume preparation must be given at least once a day, to cater for the protein
requirement.
Milk : While the breast milk quantity is being tapered off, the dairy milk must be supplemented,
starting from about 200ml to 500 ml a day.
Vegetables and Fruits : Well cooked green leafy vegetables and other vegetables must be given
twice a day to the child. Fruits must also be given at least once a day.
Eggs : One egg a day, prepared in any form is advisable to be given. As discussed earlier, it could
be half boiled, boiled, poached or in any other acceptable form.
Meat : Meat, fish, chicken and their products can also be given as per dietary practices. Easily
digestible forms are preferable. Minced meat, keema, mashed, shredded or meat soups can be
used.

55. Summary
Weight for weight the infant and children require more food than adults. It is advisable to
exclusively
breast feed infants till about 6 months. Thereafter they should be gradually weaned through
introduction of fruit juice, cow’s milk, semisolid foods, boiled vegetables, potatoes, eggs and fat.
As the children grow, so do their nutrient requirements. It is wise to keep an eye on the age -
weight chart while the child is growing up.

56. Nutritional Requirements for the
Elderly
Many physiological, social, economic, medical and psychological alterations take place in the old
age, which directly or indirectly affect the food intake, digestion and nutritional status. The BMR
goes down with age and so does the physical activity. These factors dictate the reduction of diet.
Just like every other system the efficiency of gastrointestinal system goes down, resulting in a
lower appetite. The elderly may be lonely and socially aloof, so the zest to cook and enjoy food is
lost, thereby compromising with availability of good food intake. The old man may be affected by
many chronic illnesses that restrict his food intake, for example salt has to be restricted in
hypertension, sugar in diabetes, fat in CVD and proteins in renal disease. The ‘taste’ of food is
thus lost and so is the interest. Certain psycho - social factors like loneliness, lack of family
support, feeling of worthlessness, stresses of daily living and possible economic constraints
further limit the intake.

57. Nutritional Requirements
Energy : There has not been any conclusive word regarding energy requirement and
recommendation for the elderly. Results of various studies have at best been highly variable.
Therefore the expert groups have not come out with any special requirements for the elderly. But
since it is known that BMR and physical activity go down in the elderly the energy requirement
might have to be curtailed. Some authorities recommended energy requirement to be reduced by
11% in elderly men and 10% in women, as compared to young adults.
Proteins : Lean body mass protein, turnover and protein synthesis fall with age. WHO/FAO/UNU
expert group has recommended a safe protein intake of 1 to 1.25g/kg per day.
Fats and Oils : Fats and oils are recommended at the same level as for the young. In case the
person suffers from any chronic lifestyle disease e.g. CVD, hypertension, stroke, etc he might be
advised to restrict fat.

58. Principles of Diet for the Elderly Foods to be preferred
• Simple but nutritious food
• Include green leafy vegetables
• Eat plenty of fruits
• Include whole cereals
• Insist on frequent, small meals
• Drink plenty of fluids
• Avoid fasting
• Avoid fried foods
• Consume low salt and sugar
• Food should be easy to cook
Dalia
Khichdi
Upma
Kheer
Pohe
Canned foods
Fruit juices
Vegetable soups
Meat stew

59. Summary
It is a challenge to meet the nutritional requirements of the elderly people for more than one
reason. There is not enough research to base our recommendations for various nutrient
requirements. Unlike adults where only the physical requirements govern the nutritional demand,
in elderly the social, psychological, economic, emotional and physical needs are all important
when it comes to eating food. Moreover the biological process of ageing differs in each individual.
The challenges increase with increasing longevity. Illness, psychological voids, bereavements all
pose varied impact. It is understood that the nutritional requirements for elderly are almost the
same as that for adults. The food must be simple,
easy to cook and more palatable.

60. Any questions??