This document provides an introduction to nutrition and nutritional problems in India. It begins by defining key terms like food, nutrition, malnutrition and discusses the classification and factors affecting food and nutrition. It then examines major nutritional problems in India like protein-energy malnutrition (PEM) which includes kwashiorkor and marasmus. Kwashiorkor is caused by a deficiency in protein quality and causes edema, moon face and liver changes while marasmus is a lack of protein and carbohydrates seen in children under 1 resulting in growth retardation and muscle wasting. The document provides signs, symptoms and classifications of the different types of PEM.

1. UNIT-1
INTRODUCTIO
N
JINCE PRASAD
MS. JINCE MARY PRASAD
TUTOR
SCHOOL OF NURSING
P P SAVANI UNIVERSITY

2. *HIPPOCRATES..(Father of
medicine)JINCE PRASAD

3. *LAVOISIER…
*Father of
NUTRITION
SCIENCE…!!!
JINCE PRASAD

4. *CICELY
WILLIAMS
*Demonstrated that kwashiorkor in
children is caused by protein
deficiency
JINCE PRASAD

5. *WILLIA
M ROSE
*Discovered the Essential
Amino Acid…JINCE PRASAD

6. *IMPORTANT
TERMS*FOOD: It is defined as anything eaten or
drunk that can be absorbed by the body
which is to be used as energy source,
building, regulating or protective material.
Or
*It is the substance taken into the body that
will help meet the body’s need for energy,
maintenance of health, growth and
reproduction.
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7. *Classification of Food
*Based on chemical
composition
*Based on function
*Based on origin
*Based on nutritive value
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8. *Based on chemical
composition
*Macronutrient: Nutrients required in
large amount are called
macronutrient. They are:
carbohydrates, fats, proteins and
water
*Micronutrient: Nutrient required in
small amounts which may vary from
fraction of mg to grams. They are:
Vitamins & Minerals
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9. *Based on function
*Energy Yielding Foods: Foods which gives
energy to the body. These are carbohydrates
& fats. Example: cereals, sugar, cheese.
*Body building Foods: Food that builds our
body, which are rich in proteins are called
body building foods. Example: Milk, meat,
fish, egg.
*Protective food: Food which protects our
body from diseases like food rich in
vitamins & minerals are called protective
food
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10. *Based on origin
*Animal Origin: Food which we are
getting from animals, mainly non
vegetarian food items. Example:
Meat, egg, fish.
*Plant origin: the food that we get
from plants, mainly vegetarian
food. Example: pulses, fruits,
vegetables.
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11. *Based on Nutritive value
*Cereals & Millets: Rice, wheat, ragi,jowar
*Pulses: Black gram, Red gram
*Vegetables: Cabbage, brinjal
*Fruits: Apple, Orange
*Nuts and oil seeds: Cashew nuts,Walnuts, groundnuts
*Animal foods: Meat, milk, fish
*Sugar & Jaggery
*Condiments & spices: Ginger, garlic, asfoetida
*Fats & oils
*Miscellaneous : beverages & fruit juices
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12. *Basal metabolic Rate (BMR)
*The amount of energy
required to carry on
the involuntary work
of the body is called
BMR. It includes the
activities of various
organs such as brain,
heart, kidney, lungs,
maintenance of body
temperature
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13. *NUTRITION: It is defined as the scientific study of food
and its relation to health.
OR
*It is defined as the science which deals with those processes
by which body utilizes food for energy, growth and
maintenance of health.
It is of 2 types:
*Optimum nutrition: it means that the person is receiving &
utilizing the essential nutrients in proper proportions as
required by the body while also providing a ‘ reserve’.
*Good nutrition: satisfactory diet which is capable of
supporting individual consumption (desired nutrient in
required amount)
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14. *NUTRITIONAL STATUS: It is the
condition of the body as it relates to
consumption and utilization of food.
*GOOD NUTRITIONAL STATUS:
It refers to the intake of a well –
balanced diet, which supplies all the
essential nutrients to meet the body’s
requirement.
*POOR NUTRITIONAL STATUS:
It refers to an inadequate or even
excessive intake or poor utilization of
nutrients to meet body’ s
requirement.
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15. *SIGNS OF GOOD &
POOR NUTRITIONAL
STATUS
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16. GOOD NUTRITIONAL
STATUS
*Shiny and smooth hairs
*Smooth skin
*Clear eyes
*Well developed structure
*Normal height & weight
*Normal physical & mental
response
POOR NUTRITIONAL
STATUS
*Poor physique
*Little stamina
*Less hair
*Dull eyes
*Slummed posture.
*Fatigue & depression.
*Over weight/ underweight.
*Irregular diet, sleep &
elimination habits
*SIGNS OF GOOD &
POOR NUTRITIONAL
STATUS
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17. *MALNUTRITION: It refers to the physical effects on human
body of dietary intake, inadequate in quality or quantity.
*UNDERNUTRITION: It is the state of an insufficient supply of
essential nutrients.
*OVERNUTRITION: It refers to excessive intake of one or more
nutrients .
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18. *ROLE OF NUTRITION
IN MAINTAINING
HEALTH
*Growth & Development
*Protects from specific deficiency disorder
*Resistance to infection
*Reduces mortality and morbidity
*Preventive & curative measure for various
disease
*Provides energy & nutrients as needed by
the body
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19. *JINCE PRASAD

20. *Malnutrition during
pregnancy leads to still birth,
premature baby.
*Malnutrition during early
childhood delays physical &
mental growth.
*If malnourished, school going
children may become slow
learners.
*Growth & Development
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21. *Protects from
specific
deficiency
disorder
*Lack of protein & calorie
in the diet will produce
kwashiorkor &
marasmus.
*Vitamins & minerals
deficiency in diet may
result in night blindness,
beriberi, goiter, anemia.
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22. *Resistance to
*If individual is having good nutritional status, his immune
system will be strong.
*Malnutrition make us prone to infection like TB
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23. *Reduces mortality and
morbidity
*Malnutrition results in ill
effects in the community
by increasing IMR, MMR
& General death rate.
*Over nutrition is
responsible for obesity &
related diseases
(diabetes, hypertension,
renal diseases, CVD)
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24. *Preventive & curative
measure for variousJINCE PRASAD

25. *Provides energy &
nutrients as needed byJINCE PRASAD

26. *Factors affecting food and
nutrition
*Cultural factors: Every culture has its own customs and belief
regarding nutritional practices. It is deeply involved in affairs of
man. Cultural influences varies from country to country & from
region to region. It includes :
*Lifestyle & food habits: Lifestyle & food habits depends upon the
family status.
Examples: Papaya is avoided during pregnancy in some societies.
In Gujarat, rice and some fruits are avoided during lactation period.
*Food fads: Personal likes and dislikes are called food fads. It plays
an important role in selection of foods.
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27. *Factors affecting food and
nutrition
* Cooking Practices: The method of cooking like draining away the rice
water , peeling and washing of vegetables all affects the nutritive
value.
*Religious factors: Religion has a powerful influence on the food habits
of people. Example: Hindus do not eat beef and Muslim pork, Jains
don’t consume food after sunset.
*Traditional factors: Traditional factors are still influencing the food
habits.
Examples: In some part of India, consumption of milk and fish together,
leads to leprosy.
Some people do not eat unless they have taken a bath.
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28. *Factors affecting food and
nutrition
*Geography: Consumption of foods depends upon the geography of
the area. Rice is the main food in the South India, as South India
receives high rainfall & rice need more water for its growth.
*Superstitions: Food taboos prevent people from consuming
nutritious foods.
*Income: In India, lower income group consume cheaply available
foods like jowar & vegetables. High income people purchase more
foods available in the markets.
*Social values of food: In the families, the male members are fed first,
and left over food is consumed by female members of the family.
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29. *Factors affecting food and
nutrition
*Development & Age
*Gender
*Medication and therapy
*Alcohol and tobacco consumption
*Psychological factors
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30. *NUTRITIONAL
PROBLEMS IN INDIA
*Protein-Energy Malnutrition.( PEM)
*Vitamin A Deficiency Disorder
*Nutritional Anemia
*Iodine Deficiency Disorder.
*Low Birth Weight
*Endemic Fluorosis
*Lathyrism
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31. JINCE PRASAD

32. *Protein-Energy Malnutrition
(PEM)
* PEM is a term given to a group of clinical conditions which
occur due to inadequate protein and calorie intake ,
especially in children.
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33. *Causes of PEM
*Failure of breast- feeding
*Late introduction of supplementary food.
*Inappropriate choice of supplementary
food.
*Poverty & Inability to buy food due to high
cost.
*Neglect of small children in a large family.
*Illiteracy
*Less income, unemployment
*Food fads, customs, superstition.
*Twins/ triplets/ multiple babies.
*Improper spacing between the babies.
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34. *Signs of PEM
*Edema
*Poor wound healing
*Depigmentation of hair
*Irritability
*Dull and thin hair
*Muscle wasting
*Electrolyte imbalance
*Moon face
*Depigmentation of skin
*Scaly skin (flaky paint)
*Hepatomegaly( enlargement of liver)
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35. *Classification of PEM
*Kwashiorkor
*Marasmus
*Marasmic kwashiorkor.
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36. *Kwashiorkor
*A severe malnutrition of infants & young
children, caused by the deficiency in the
quality and quantity of protein in diet.
*It is common in children between 1 to 5
years.
*It occurs after child is discontinued of breast
milk and child is given food low in protein.
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37. *Signs of
*Growth failure
*Mental changes
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38. *Signs of Kwashiorkor
*Edema
*Muscle wasting
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39. *Signs of Kwashiorkor
*Moon face: The full well round face
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40. *Signs of Kwashiorkor
*Liver changes: liver is slightly enlarged
*GI Tract: loss of appetite & Vomiting is common.
*Skin & Hair Changes: Also known as “ Crazy pavement”
dermatosis. Most marked on buttocks, back of thighs &
axilla.
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41. *Marasmus
*Marasmus is second clinical
form of severe PEM caused
by inadequate protein as
well as carbohydrates.
*Seen in children below 1
year of age.
*Seen in children who are
bottle fed with diluted milk
or not provided with the
supplementary food.
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42. *Signs & symptoms of
*Growth retardation: loss of weight &
height.
*Muscle wasting & loss of subcutaneous
fat: Muscles are wasted. The arms are thin
& the skin gets loose. Subcutaneous fat is
absent.
*Vitamin A deficiency
*Anaemia
*Skin changes.
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43. *Clinical features
Clinical features Kwashiorkor Marasmus
Weight Below normal, may be marked
by edema
Very much below than
normal
Muscles Thin upper arm , marked by
edema
Very thin upper arm
Edema Yes , in lower legs , face, lower
arm
No
Skin Stretched & pale patches Wrinkled , no
pigmentation
Anaemia Sometimes Sometimes
Vitamin deficiency Usually found Sometimes found
Stools Loose motions Loose motions/
constipation.
Hepatomegaly Yes No
Appetite Poor Good
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44. *Marasmic
*It includes the symptoms of both
marasmus & kwashiorkor, it
represents the gravest form of
PEM.
*It leads to extreme weight loss,
weakness, edema & other features
of kwashiorkor.
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45. *Prevention of PEM
*Educate the pregnant & the lactating mother
*Promotion of breast feeding
*Family planning & spacing of birth
*Family environment
*Promotion of low cost weaning food.
*Improve family diet
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46. *Management
*Child diet must contain protein
& energy rich food. Milk, egg,
fresh fruits
*Early diagnosis and Rx of
infection, diarrhea.
*Hospital treatment
*Nutritional rehabilitation
*Follow up care.
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47. JINCE PRASAD

48. *Vitamin A Deficiency
*It is a major nutritional problem resulting from the
deficiency of vitamin A, leading to blindness.
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49. *Causes of Vit. A
*Lack of dairy products in diet.
*Limited amount of fresh fruits and vegetables in
diet.
*Artificially fed infants
*Mothers diet is low in vitamin A.
*Diarrhea
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50. *Signs of Vit. A
*Dry skin
*Dry eyes
*Softening of cornea
*Blindness
*Abnormal growth of epithelial cell
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51. *Night BlindnessJINCE PRASAD

52. *Night Blindness
*Earliest symptom of vitamin A deficiency
in pre school children.
*Affected child cant see properly after
sunset.
*When vitamin A is deficient, formation of
rhodopsin is impaired giving rise to night
blindness.
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53. *Conjunctival
*Characterized by dryness of the conjunctiva.
*Conjunctiva becomes thick & wrinkled.
*Appears rough.
*Dryness becomes more obvious , when
exposed to air for 10-15 seconds by keeping
eye lids drawn back.
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54. JINCE PRASAD

55. *BITOT’S SPOT
*Dirty, white foamy and raised spots on
the surface of conjunctiva.
*Generally seen on outer side of cornea.
*Formed due to accumulation of
epithelial cells.
*Appear as single spot or several spot ,
which later unite to form triangular
patch with base towards cornea.
*May appear in one or both eye.
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56. *BITOT’S SPOTJINCE PRASAD

57. *Corneal Xerosis
*In this, cornea loses its normal smooth & lack luster
appearance.
*Becomes dry & rough.
*Due to photophobia, child tends to keep the eyes closed,
particularly in bright light.
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58. JINCE PRASAD

59. *Corneal ulcer
*Corneal xerosis, if not treated , leads to the
ulceration of the cornea.
*Initially, the ulcer may be shallow.
*If it becomes deep, it may lead to perforation.
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60. *Corneal scar
*The ulcer on cornea, on healing leaves a white
scar which varies on the size of the ulcer.
*When the scar is positioned centrally, normal
vision is affected.
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61. *Xerophthalmia Fundus
*In school children or adults with prolonged vitamin
A deficiency, ophthalmoscope examination may
show lesions appearing as spots, either white or
yellow scattered along the sides of blood vessel.
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62. *Keratomalacia
*Condition of rapid necrosis and liquefaction of full
thickness of cornea leading to prolapse of iris,
resulting in permanent blindness.
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63. *Treatment
*Corneal xerosis, keratomalacia, xerophthalmia on
diagnosis- 1,00,000 IU of vitamin A I/M.
*Night blindness, conjunctiva xerosis, bitot’s spot
on diagnosis- Palamite 2,00,000 IU - Orally
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64. *Prevention Of Vit. A
* Should encourage the use of green leafy
vegetables in diet such as spinach(palak),
drum stick & its leaves, fenugreek leaves.
* Red palm oil can be used.
* Intake of yellow fruits & vegetables like
papaya, mango, pumpkin, carrot.
*Consumption of animal food such as cheese,
milk, curd, butter & egg should be promoted.
*Nutritional and health education
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65. JINCE PRASAD

66. *NUTRITIONAL ANAEMIA
*It may be defined as the condition that
results from the inability of the RBC to
maintain a normal Hb concentration
leading to reduction in total circulating Hb.
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67. *Types of Nutritional
Anaemia
*Hypochromic/ Microcytic Anaemia
*Megaloblastic Anaemia
*Dimorphic Anaemia
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68. *Hypochromic/ Microcytic
Anaemia
*Caused due to insufficiency of iron for
the formation of Hb.
*Here the RBC is pale & small
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69. *Megaloblastic Anaemia
*If the maturation of RBC in the bone
marrow is impaired by the lack of
folate/ Vitamin B12, the cells that
enters the blood stream are irregular in
size.
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70. *Dimorphic Anaemia
*If both iron and either folate or vitamin
B12 are deficient, it give rise to
dimorphic anaemia.
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71. *Effects of Nutritional
*Maternal and fetal morbidity &
mortality. (premature birth, abortion,
low birth weight)
*Infection
*Impaired work capacity
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72. *Intervention
*Estimation of Hb to assess the degree of anaemia. Anaemia is
severe- less than 10g/dl.
*If severe, requires blood transfusion & high doses of iron.
*If between 10-12g/dl then:
Referred to national Nutritional anaemia prophylaxis
programme sponsored by Govt. Of India
 Iron and folic acid supplementation: For mothers- 1 tablet of
iron & folic acid containing 100mg of elemental iron & 0.5 of
folic acid daily, until 2- 3 months.
For children- 1 tablet of iron & folic acid containing 20mg of
elemental iron & 0.1 of folic acid daily, until 100 days.
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73. JINCE PRASAD

74. *GOITRE
*Enlargement of the thyroid gland on the
front and sides of the neck.
*Normal weight of thyroid gland in a adult
is about 25mg, may weigh about 200-
500gm or more.
*Caused due to abnormal thyroid
secretion, due to lack of iodine in the diet.
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75. *Grading of Goiter
*Depending upon the size of thyroid, goiter is graded
into following stages:
*Grade 1A- Palpable goiter(can be felt but not seen)
*Grade 1B- Goiter is visible when neck is fully
extended
*Grade 2- Goiter is visible when neck is in normal
position.
*Grade 3- goiter is visible from a considerable distance
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76. *GOITRE
*Iodization of salt
*Iodized oil (1 ml provide
protection for 4 year)
*Iodine monitoring: amount of
iodine in water, soil, food, iodine in
salt.
*Mass communication.
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77. JINCE PRASAD

78. *Low birth weight
*It is defined as the percentage of live born infants
with birth weight less than 2,500g, regardless of
gestational age.
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79. JINCE PRASAD

80. *Endemic fluorosis
*An abnormal condition caused by the excessive
intake of fluorine, as from fluoridated drinking
water, characterized by mottling of teeth, if severe,
calcification of ligaments.
*It is of two types: dental and skeletal fluorosis.
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81. *Dental fluorosis
*Characterized by the “ mottling” of dental
enamel, which has been reported at levels
above 1.5mg/l intake.
*Teeth loses its shiny appearance . Develop
white patches, which later become yellow,
brown or black.
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82. *Skeletal fluorosis
*There is heavy fluoride deposition in
the skeleton.
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83. *Genu ValgumJINCE PRASAD

84. *Management
*Change the water source
*Chemical treatment of water for the
removal of fluorine.
*Deflouridation of water is carried out by
“Nalgonda technique”. Involves addition
of 2 chemicals alum and lime.
*Flouride supplements to be stopped.
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85. JINCE PRASAD

86. *It is a paralyzing disease of the
humans, caused due to certain
legumes (kesari daal).
*Caused due to toxin present in
lathyrus seed identified as
Beta Oxalyl Amino
Alanine.(BOAA)
*Affects at the age of 15-45
years.
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87. *Stages of Lathyrism
*Latent stage: Individual is apparently healthy , but when subjected to
stress, may exhibit uneven gait. Disease can be prevented during this
stage, if the pulse is withdrawn from diet.
*No-stick stage: Individual walks with small jerky steps without the
help of the stick.
*One- stick stage: Individual walks with crossed gait with tendency to
walk on toes and needs stick to maintain balance.
*Two – stick stage: Due to excessive bending of knees and crossed legs,
patient need two stick to walk. Severe stage as patient gets tired
easily.
*Crawler Stage: Individual cannot stand straight ,as knees cannot
balance the body weight.
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88. *Intervention
*Vitamin C injection: 500-1000mg for a week
*Banning the crop / Taking the daal in low proportion.
*Removal of toxins by soaking it in warm water/ lime and drying
under sunlight.
*Education
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89. *Food standards
*A set of criteria that a food must meet if it is to be
suitable for human consumption, such as source,
composition, appearance, freshness, permissible
additives, and maximum bacterial content.
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90. *CODEX
*FAO or WHO formulates food standards for international
market.
*CODEX ALIMENTARIUS (Latin word for "Food Code") is a
collection of internationally recognized standards, codes of
practice, guidelines, and other recommendations relating
to foods, food production, and food safety.
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91. *AGMARK standards
*It indicates that the product meets certain standard of purity
and quality.
*Labels of different color are used to indicate the grade of the
products.
*Quality check and test are done to maintain the standards. With
the help of such grades, products produced can be sold through
right channel and right prices.
*Consumers can buy the products without any fear.
*Products covered are: cereals, spices, oilseeds, legumes,
vegetable oil, milk products
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92. JINCE PRASAD

93. *PFA standards
*Standards has been established under the
prevention of “ Food Adulteration Act”
(1954).
*The purpose of PFA standards are to obtain a
minimum quality of food stuff attainable
under Indian standards.
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94. *Bureau of Indian
Standards(BIS)
*It came into effect on 23 December 1986.
*It is a government body, prescribes quality
standards for agricultural products and
processed foods such as wheat, maize, barley,
pulse products, corn flakes, biscuits, bread.
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95. *Indian Standards
Institution (ISI)
*Various committees including representatives from
government consumers & industry formulated ISI.
*It includes vegetables , fruit products, spices,
condiments, animal products, processed food.
*Manufacturers whose products conform to these
standards are allowed to use an ISI label on each unit
of their product.
*It has various testing laboratories at Delhi, Bombay,
Calcutta.
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96. JINCE PRASAD

97. *fssai
*Stands for Food Safety and Standards Authority of India
(FSSAI).
* It is an autonomous body established under the Ministry of Health
& Family Welfare, Government of India.
*The FSSAI has been established under the Food Safety and
Standards Act, 2006.
*FSSAI is responsible for protecting and promoting public
health through the regulation and supervision of food safety.
*It covers dairy products, Fats, oils and fat emulsions, fruits and
vegetable products, Cereal and cereal products, Meat and meat
products, fish and fish products, salt, spices, beverages etc.
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98. JINCE PRASAD