This document discusses a lecture on dietary goals, balanced diets, and protein-energy malnutrition (PEM). The lecture covers nutritional requirements, reference individuals for measuring requirements, dietary goals recommended by WHO including limits on fats, carbohydrates, and salt, and the concept of a balanced diet. It also discusses PEM including causes, signs, prevention through community health promotion and specific protection/management of at-risk groups, and treatment of PEM.

1. Dr. Hitesh Deka
Assistant Professor
Department of Community Medicine
:Dietary goals and balanced diet.
:PEM-Managemt and prevention.

2. Students will be able to describe…..
Concept of Balanced Diet and Dietary Goals.
PEM-causation. Management and Prevention.
Methods Used-
Lecture with ppt.
Q&A/ Quiz
SGD
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3. CM 5.1- Balance Diet and Dietary Goals
Framework of the class-
• Assessing the nutritional requirement in various age
groups.
• Defining the references for estimation.
• Understanding the food balancing.
• Self diet planning
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4. Concept of Nutritional Requirement
• Why?
1. To assess the nutritional adequacy of diets for growth
of infants, children and adolescents.
2. Maintenance of health in adults, during pregnancy, and
lactation.
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5. Measuring Nutritional Requirement
• Recommended daily Allowance(RDA): “amount of
nutrient sufficient for the maintenance of health in
nearly all people”.
• RDA=Minimum requirement + additional for loses.
(Optimum requirement/minimum requirement/safe
level of intake)
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6. Measuring Nutritional Requirement
• Adequate Intake: recommended average daily
intake level based on observed or experimentally
determined approximations or estimates of
nutrients intake by a group of apparently healthy
people.
• Tolerable UL: Highest average daily intake level
that is likely to pose no risk of adverse health
effects for almost all individuals in the general
population.
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7. Measuring Nutritional Requirement
• Individual variability: variability in nutritional
requirement between individuals in a given
population. 12.5% is considered as the extent IV.
• Bio-avilability: it’s the availability of a nutrient
from diet in terms of release of the nutrient from
food, it’s absorption and bio-response in the
body. Imp in measurement of minerals and trace
elements.
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8. 3 Ds of nutrition
3 factors determine the nutritional requirement of
an individual-
• Age
• Gender
• Body Weight.
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9. Food for Energy
• Expressed in terms of Kilo-calorie (kCal) and
Joule (J).
Conversion+
• 1 kCal=4184J 1kJ=0.239kCal.
• 1000kCal=4.18MJ 1MJ=239kCal.
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Proteins 4kCal/g 17 kJ
Fat 9kCal/g 37kJ
Carbohydrate 4 kCal/g 17 kJ

10. Reference Man/Women
Energy intake is measured in comparision to a
reference man/women.
• Reference Man: Between 20-39 years of age and
weighs 60 kg with a height of 1.73 meters and
BMI of 20.3 . He is free from disease and
physically fit for active work. On each working
day he is employed for 8 hrs in occupation that
involves moderate activity. While not at work he
spends 8 hrs in bed, 4-6 hrs sitting and moving
around and 2 hrs in walking and active recreation
or household duties.
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11. Reference Man/Women
• Reference woman: Between 18-29 years of age
and weighs 55 kg and non-pragnant and non-
lactating with a height of 1.51 meter and BMI is
21.2. She is free from disease and physically fit
for active work. On each working day she is
engaged for 8 hrs in occupation that involves
moderate activity. While not at work he spends 8
hrs in bed, 4-6 hrs sitting and moving around and
2 hrs in walking and active recreation or
household duties.
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12. Energy requirement basics
Energy is required for 3 broad areas-
• Required for basal metabolism.(1Kcal/hr/Kg body
weight of adult).
• Required for daily activities.
• Required for occupational work.
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13. Vulnerable Groups
• PW and lactating women- +350 for PW and +600 for
lactating women during first 6 months and+520 for next 6
months.
• children.(> 13 years require energy at per of adult).
• Growing age- after 40 requirement is reduced by 5% till 60
and after the decline is 10% each decade thereafter.
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14. Sources of Energy
• Protein-4Kcal/Kg
• Fat-9Kcal/Kg
• Carbohydrate-4 Kcal/Kg
• Dietary fibre-2 Kcal/Kg.
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Carbohydrates provide about 50-80% of daily energy
intake

15. Standard requirement
Protein 10-15% of daily energy
intake should be from
protein.
Fat 15-30% of daily energy
intake should be from fat.
Carbohydrate 50-80% of daily energy
intake should be from
carbohydrate
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16. Dietary Goals
WHO recommendations for dietary goals are-
• Fat should be limited to 15-30% of daily intake.
• Saturated fat should constitute <10% of energy
intake.
• Refined carbohydrate should be limited.
• Restriction in energy reach food (fat, alcohol).
• Salt intake limited to 5gm/day/adult.
• Protein intake should be 10-15% of daily intake.
• Foods supplying empty calories should be
reduced.
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17. Balanced Diet
• A diet which contains a variety of foods in
such a quantities and proportions that need
for energy, amino acids, vitamins, minerals,
fats, carbohydrates and other nutrients is
adequately met for maintaining health, vitality
and general well being and also makes a small
provision for extra nutrients to withstand
short duration of leanness.
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18. Role of balancing
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19. Food Pyramid
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21. Balanced Plate-Vegetarian
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22. Balanced Plate-Non-Vegetarian
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23. Question/Assignment:
• Make an assessment of the diet of you friend
using 24HR method and identify any dietary
gap.
• How will you formulate the balanced daily
platter based on the assessment for Him/Her?
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24. Nutrition Related Health Disorders
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25. Nutritional Problems
• Low Birth Weight.
• Under Nutrition.
• Xerophthalmia.
• Nutritional Anaemia.
• IDD
• Endemic Flurosis.
• Lathyrism.
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27. Mal -Nutrition
Under-Nutrition OR Over-nutrition impact
• High childhood morbidity
• High childhood mortality
• Delayed physical growth
• Poor mental growth
• NCDs.
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28. Malnutrition Spectrum
Under-nutrition Over nutrition
PEM
Micro-nutrient
deficiencies
Stunting
Wasting
Under-weight
Obesity
Diabetes
Cancer
CVD
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29. Measuring Malnutrition
• “ANTHROPOMETRY”
Anthropometric Indices in children-
• Weight for Age (underweight)
• Height for Age (Stunting)
• Weight for Height.(Wasting)
• MUAC.(Wasting).
Anthropometric Indices in Adult-
• Weight
• BMI
• Waist hip ratio
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30. PEM
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42. Protein Energy Malnutrition (PEM)
Cause-
• Inadequate intake of food (Food Gap).
• Recurrent infection.
• Poor environmental conditions.
• Large family size
• Maternal health, lactation failure.
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44. Early detection of PEM-
Under weight for age-first indicator.
• Tool to measure- “Growth Chart”.
MUAC-
• Indicates reduction in body muscle mass
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13.5 CM 12.5-13.5 CM <12.5 CM
Normal Moderate
malnutrition
Severe malnutrition

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49. PEM prevention in Community
1. Health Promotion-
 Empowering women, PW and lactating women.
 BF promotion/ FP.
 Low cost weaning food.
 Improved family diet.
 Nutrition education/ home economics.
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50. PEM prevention in Community
2. Specific Protection-
 The child's diet must contain protein and
energy dense food, milk, eggs, fruits etc.
 Immunization.
 Food fortification.
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51. Specific Management
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52. PEM prevention in Community
3. Early Diagnosis and Treatment
 Periodic surveillance.
 Early diagnosis of growth lag.
 Early diagnosis of infection and management.
 Programmes for diarrhoea management.
 Supplementary feeding programmes.
 De-worming programmes.
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53. PEM prevention in Community
4. Rehabilitation
 Nutritional rehabilitation services.
 Hospital treatment.
 Follow up care.
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55. Thank you
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