Contents : General features of nutrition Assessment of nutritional status Features of assessment of nutritional status Short stature Malnutrition General features of malnutrition Acute and chronic malnutrition Kwarshiorkar Marasmus Management of malnutrition Vitamins General features of vitamins General features of vitamin A Features of vitamin A deficiency Prophylaxis and treatment of vitamin A deficiency Hypervitaminosis A Vitamin D Vitamin E Vitamin K General features of vitamin B Thiamine Riboflavin Niacin Vitamin B6 Vitamin B12 Pantothenic acid Biotin Vitamin C Folic acid Scurvy Minerals General features of minerals Iron Zinc Fluoride Iodine Calcium Copper Chromium Selenium Milk and egg Milk and pasteurisation Egg Breast feeding General features of breast feeding Breast milk Colostrum Storage of breast milk Proteins and amino acids General features of proteins Protein indicators Fatty acids Food fortification Toxins in food Food adulteration Diet Dietary cycle and nutritional surveillance Calorie requirements Calorie requirements of adult Supplementary nutrition in icds RDA Prudent diet Indian reference male and female Food standards Dietary fibre Probiotic and prebiotic For more details, visit www.medpgnotes.com You can send your queries to medpgnotes@gmail.com

1. NUTRITION
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2. NUTRITION
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1GENERAL FEATURES OF NUTRITION
CONTENTS
GENERAL FEATURES OF NUTRITION ............................................................................................................................. 4
ASSESSMENT OF NUTRITIONAL STATUS ....................................................................................................................... 4
FEATURES OF ASSESSMENT OF NUTRITIONAL STATUS ............................................................................................ 4
SHORT STATURE........................................................................................................................................................ 5
MALNUTRITION............................................................................................................................................................. 5
GENERAL FEATURES OF MALNUTRITION.................................................................................................................. 5
ACUTE AND CHRONIC MALNUTRITION..................................................................................................................... 5
KWARSHIORKAR........................................................................................................................................................ 6
MARASMUS............................................................................................................................................................... 6
MANAGEMENT OF MALNUTRITION.......................................................................................................................... 6
VITAMINS...................................................................................................................................................................... 7
GENERAL FEATURES OF VITAMINS ........................................................................................................................... 7
GENERAL FEATURES OF VITAMIN A.......................................................................................................................... 7
FEATURES OF VITAMIN A DEFICIENCY ...................................................................................................................... 7
PROPHYLAXIS AND TREATMENT OF VITAMIN A DEFICIENCY ................................................................................... 8
HYPERVITAMINOSIS A............................................................................................................................................... 9
VITAMIN D................................................................................................................................................................. 9
VITAMIN E................................................................................................................................................................. 9
VITAMIN K................................................................................................................................................................. 9
GENERAL FEATURES OF VITAMIN B ........................................................................................................................ 10
THIAMINE................................................................................................................................................................ 10
RIBOFLAVIN............................................................................................................................................................. 11
NIACIN..................................................................................................................................................................... 11
VITAMIN B6............................................................................................................................................................. 12
VITAMIN B12........................................................................................................................................................... 12
PANTOTHENIC ACID................................................................................................................................................ 13
BIOTIN..................................................................................................................................................................... 13
VITAMIN C............................................................................................................................................................... 13
FOLIC ACID .............................................................................................................................................................. 14
SCURVY ................................................................................................................................................................... 14
MINERALS ................................................................................................................................................................... 15
GENERAL FEATURES OF MINERALS......................................................................................................................... 15

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2GENERAL FEATURES OF NUTRITION
IRON........................................................................................................................................................................ 16
ZINC......................................................................................................................................................................... 17
FLUORIDE ................................................................................................................................................................ 17
IODINE..................................................................................................................................................................... 18
CALCIUM ................................................................................................................................................................. 18
COPPER ................................................................................................................................................................... 18
CHROMIUM............................................................................................................................................................. 19
SELENIUM ............................................................................................................................................................... 19
MILK AND EGG ............................................................................................................................................................ 19
MILK AND PASTEURISATION ................................................................................................................................... 19
EGG ......................................................................................................................................................................... 20
BREAST FEEDING......................................................................................................................................................... 20
GENERAL FEATURES OF BREAST FEEDING .............................................................................................................. 20
BREAST MILK........................................................................................................................................................... 20
COLOSTRUM ........................................................................................................................................................... 21
STORAGE OF BREAST MILK ..................................................................................................................................... 22
PROTEINS AND AMINOACIDS ..................................................................................................................................... 22
GENERAL FEATURES OF PROTEINS.......................................................................................................................... 22
PROTEIN INDICATORS ............................................................................................................................................. 23
FATTY ACIDS................................................................................................................................................................ 23
FOOD FORTIFICATION................................................................................................................................................. 24
TOXINS IN FOOD ......................................................................................................................................................... 24
FOOD ADULTERATION ................................................................................................................................................ 24
DIET............................................................................................................................................................................. 24
DIETARY CYCLE AND NUTRITIONAL SURVEILLANCE................................................................................................ 24
CALORIE REQUIREMENTS........................................................................................................................................ 25
CALORIE REQUIREMENTS OF ADULT ...................................................................................................................... 26
SUPPLEMENTARY NUTRITION IN ICDS .................................................................................................................... 26
RDA ......................................................................................................................................................................... 26
PRUDENT DIET ........................................................................................................................................................ 26
INDIAN REFERENCE MALE AND FEMALE................................................................................................................. 26
FOOD STANDARDS .................................................................................................................................................. 27
DIETARY FIBRE......................................................................................................................................................... 27
PROBIOTIC AND PREBIOTIC..................................................................................................................................... 27

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3GENERAL FEATURES OF NUTRITION
KEY TO THIS DOCUMENT
Text in normal font – Must read point.
Asked in any previous medical entrance
examinations
Text in bold font – Point from Harrison’s
text book of internal medicine 18th
edition
Text in italic font – Can be read if
you are thorough with above two.

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4GENERAL FEATURES OF NUTRITION
GENERAL FEATURES OF NUTRITION
Man weighing 68 kg, consumes 325 gm of
carbohydrate, 65 gram protein and 35 gram fat in diet
Proportion of carbohydrate, protein and fat is correct in
accordance with balanced diet
Cereals and pulses are considered complementary
because
Cereals are deficient in lysine, pulses are deficient is
methionine
NOT a dietary change advised by WHO Decrease in complex carbohydrate consumption
NOT a dietary reference intake Food based dietary advice
Good source of vitamin A, C, calcium, Iron Green leafy vegetables
Fenugreek is found to be Anti carcinogenic
When food is taken by an individual at
rest, increase in heat production over
basal level
Specific dynamic action
ASSESSMENT OF NUTRITIONAL STATUS
FEATURES OF ASSESSMENT OF NUTRITIONAL STATUS
Anthropometric measurement NOT of much change in
1-4 years
Mid arm circumference
Sensitive index of malnutrition in 3-6 years Mid arm circumference
Village health guide measures state of malnutrition in
an under 5 child by
Mid arm circumference
During nutritional assessment of a surgical patient, use
of muscle protein is indicated by
Mid arm circumference
Shakir tape Measurement of midarm circumference
Mid arm circumference (1-5 years) >13.5 – normal, 12.5 – 13.5 means
malnourished, less than 12.5 means
severely malnourished
Salter’s scale is a useful method employed in field to
measure
Birth weight
Most important anthropometric characteristic of
nutritional dwarfism
Normal birth weight and subsequent retardation of
growth
Best indicator for nutritional status for a child Rate of increase of height and weight
Best indicator for long term nutritional status Height for age
Kanawati index MAC/HC
NOT a method to assess nutrition in community Hb <11.5 gm% in third trimester pregnancy
NOT true about nutritional surveillance Done in all children < 5 years
NOT an indicator for assessment of nutritional program Prevalence of pregnant mothers having Hb<11.5g% in
3rd trimester
NOT a feature of nutritional surveillance Measurement of height
Primary aim of applied nutrition programme Stimulation of production and consumption of
protective foods by education
Health status of children between 0 and 4 years
affected by
Malnutrition, infections, birth weight less than 4 kg
Does NOT indicate poor nutrition in children Low birth weight

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5MALNUTRITION
A child’s weight for height is more than 2SD of mean,
and his height for age is less than 2SD of mean. he is
Stunted
Gomez classification Age dependent
Gomez classification is based on Weight retardation
SHORT STATURE
MC cause of short stature Constitutional
Short stature is seen in Maternal deprivation syndrome, Hypothyroidism, IUGR
Bone age is normal in Genetic short stature
MALNUTRITION
GENERAL FEATURES OF MALNUTRITION
A year old child has weight of 6.4 kg and has vitamin A
deficiency. grade of malnutrition
Third degree
Reference standard on which classification of PEM
based
80% of 50
th
percentile of weight of age of American
standard
Cell mediated Immunodeficiency is seen in Protein Energy Malnutrition
Transverse ridging of nail and cellophane appearance is
associated with
Protein deficiency
Enzymatic reaction depressed in malnutrition Oxidation
Severe malnutrition is indicated by Loss of buccal pad of fat
Severe Acute Malnutrition Weight for height z score less than – 3 SD from WHO
standards median
Features of protein energy malnutrition Insulin decreased, GH and cortisol is
increased
Infection in PEM child Gram negative bacteria
NOT altered in PEM Phagocytosis
Finding NOT seen in Protein Energy Malnutrition Nail Changes
Acute complications of PEM Hypothermia, Hypoglycemia, Hypokalemia
Bad prognosis in PEM Hypothermia, Hypoalbuminemia, Hepatomegaly
ACUTE AND CHRONIC MALNUTRITION
Low weight for height Acute malnutrition
Deficit in weight for height in a 3 year old child indicate Acute malnutrition
Best parameter for assessing acute malnutrition Weight for height
Best parameter for assessment of chronic malnutrition Height for age
Common to both acute and chronic malnutrition Weight for age