Nutrition and vitamin deficiency

1. NUTRITION AND
HEALTH

2. NUTRITION AND HEALTH
1. Primary concern in growth and development
2. Nutrient used for specific dietary constituents i.e. Protein, vitamins and minerals
3. Dietic is a practical application of the principles of nutrition
4. It includes planning of meal for the well as well as sick
5. Concern about community nutrition which includes
Nutritional requirement , assessment of nutritional status , nutrition problems in
public health and nutritional programmes in india

3. NUTRITION AND HEALTH
Changing concept
Specific nutritional diseases were identified and technologies developed to control
them
• Protein energy malnutrition
• Endemic goiter
• Nutritional anemia
• Nutritional blindness
• Diarrheal diseases , etc.

4. CHANGING CONCEPT
• The association of nutrition with
• Infection
• Immunity
• Fertility
• Maternal and child health
• Role of dietary factors in pathogenesis of non communicable diseases like
Coronary heart diseases , diabetes and cancer

5. CHANGING CONCEPT
Nutritional epidemiology
Disease etiology and identification of risk factors
Also planning and evaluation of nutritional programmes
Nutrition is corner stone of socioeconomic development
Improvement in health and nutritional status by attack on poverty and injustice
and integrated approach

7. NUTRIENTS
• Nutrients are organic and inorganic complex contained in food
• There are around 50 different nutrients which are normally supplied through
foods
• Each nutrient has specific functions in the body
• Most natural food contains more than one nutrient
• Macronutrient :proximate principles
• Micronutrient : requires in smaller amount

8. PROTEINS
• Proteins are complex organic nitrogenous compounds
• Composed of carbon , hydrogen , oxygen , nitrogen and Sulphur in varying
amounts
• Some protein also contains phosphorus and iron in varying amounts
• Protein differ from carbohydrate and fats as they contain nitrogen in 16 percent
• Protein constitute around 20 percent of body weight

9. ESSENTIAL AMINO ACIDS
• Proteins are made up of smaller units called aminoacid
• Some 20 amino acids are needed by human body
• Of which 9 are essential amino acids
1. Leucine , Isoleucine , Lysine , methionine , phenylalanine, threonine,
valine, tryptophan, histidine .
2. Non essential aminoacid – arginine , asparagine acid, serine,
glutamic acid , proline and glycine
3. Both are needed for synthesis of protein.
4. Biological complete and biological incomplete protein

10. FUNCTIONS OF PROTEIN
• Body building
• Repair and maintenance of body tissue
• Maintenance of osmotic pressure
• Antibodies
• Plasma proteins
• Hemoglobin
• Enzymes , hormones

11. SOURCES OF PROTIEN
1. Animal sources
Milk , eggs chesse , meat, fish, fowl
Egg protein is considered best protein because of their high biological value and
digestibility
They are used in nutrition studies as reference protein
1. Vegetable sources
2. Legumes, pulses, cereals, beans nuts oil seed cakes
3. Are main dietary sources , they are cheap easily available and consumed in
bulk

12. PROTIEN CONTENTS OF SOME FOOD
Animal food Protien gram /100 gm of
food
Milk 3.2-4.3
Meat 18-26
Eggs 13
Fish 15-23

13. PROTIEN CONTAIN OF SOME FOODS
Plant food Protien gm / 100 gm of foods
Cereals 6 -13
Pulses 21-28
Vegetables 1-4
Fruits 1-3
Nuts 4.5- 29
Soyabeans 43, 2
Other
Oils and fats Nil
Sugar and jaggery Nil

14. SUPPLEMENTARY ACTION OF PROTIEN
• Cereal proteins are deficient in lysine and threonine and pulses in methionine
• These are know as limiting amino acids
• When two or more vegetable foods are cater together
• There protein supplements one another and provide protein comparable to
animal protein in respect of all EAA
• It is possible for vegetarian to obtain high grade protein diet
• This know as supplementary action of protein

15. PROTIEN METABOLISM
• Not stored in adipose tissue so consumed every day
• Body protein are constantly broken sown to their constitute amino acid and
rrsued for protein synthesis
• The overall turnover is carry out tissue to tissue
• The reutilization of amino acid is major contributory factor to the economy of
protein metabolism
• Overall turn over is 2 -3 of total body protein in a day

16. EVALUATION OF PROTIEN
• Knowledge of amino acid content of food is not sufficient for evaluation of
protein quality
• Digestibility and biological value
• Net protein utilzation
• It is the product of biological value and digestible coefficient
• The proportion of ingested protien retain in body under specific condition for
maintenance and growth of tissue

17. ASSESSMENT OF PROTIEN SYNTHESIS
• A battery of test suggested for assessment protein synthesis
• Arm muscle circumference
• Serum albumin
• Transferrin
• Total body nitrogen
• At present time the best measure of the state of protein nutrition is serum albumin
• It should be more than 3.5 g/dl
• 3.5 gm/dl is consider as mild degree of malnutrition and level 3gm/dl severe
malnutrition

18. PROTIEN REQUIRMENT
• In term of body weight
• Indian council of medical research
• 1gm/kg is recommended For an Indian adult
• Assuming that NPU is 65 for dietary protein
• It also depends of age sex type of physical activity

19. FATS
• Fats are called solid at 20 degree C, they are called oils if they are in liquid state
at same temperature
• Classified as
• Simple lipids; triglyceride
• Compound lipids: phospholipids
• Derived lipids; cholesterol

20. FATS
• The human body can synthesis the triglyceride and cholesterol endogenously
• Most of the body fat are store in adipose tissue are triglyceride
• Adipose tissue constitute around 10 to 15 percent of body weight
• One kg of fat can yield around 7700 kcal..

21. FATTY ACIDS
• Fat yields fatty acid and glycerol on hydrolysis
• Fatty acid are derived into saturated fatty acid such as lauric and stearic acid
• And unsaturated fatty acid which are further divided in to MUFA AND PUFA
• MUFA e.g. oleic acid
• PUFA e.g. linoleic and a linolenic acid
• The PUFA mainly found in vegetable oil
• And saturated fat mainly found in animal protein
• But there is an exception for example coconut oil and fish oils

22. ESSENTIAL FATTY ACID
• PUFA i.e. linolic acid is essential fatty acid since it not produce in human body
• It requires for the synthesis of linolenic and arachidonic acid
• Not all Polyunsaturated fatty acid are essential fatty acid

25. VISIBLE FAT AND INVISIBLE FATS
• Visible oils are those that are separated from their natural sources
• e.g. ghee from milk , cooking oil from oil bearing seeds and nuts
• It is easy to estimate their daily intake
• Invisible fats – not visible through naked eye.
• They are present in in almost every article of food
• Cereal pulses nuts milk eggs is major fat intake than visible fat

26. VISIBLE AND INVISIBLE FATS
• Edible plant foods have low content of fat and saturated fatty acids
• They are good source of mono and poly unsaturated fatty acids
• It contains 1.5 to 3 percent.
• Cereals contains mostly linoleic acid while pulses , green leafy vegetables
• And some oil seeds like soyabean, mustard, flaxseed and fenugreek seeds contains both linoleic and
alpha linoleic acid
• Animal source contains more of cholesterol and saturated fatty acid
• While fish poultry and lean meats contains less fat and high in PUFA
• While animal foods like ghee whole milk fatty cheese and fatty meats contains cholesterol and
saturated fatty acids

27. HYDROGENATION
• Vegetable oils are hydrogenated under condition of optimal temperature and
pressure in the presence of catalyst, the liquud are converted to semi solids and
solid fat
• The resulting hydrogenated fats is known as vanadpati ghee
• This process causes unsaturated fats in to saturated fats with reduced in EFA
• The main afvantage is it givrs ghee like consistency andbkerp quality in hot humid
temperature.
• Since it is lacking fat soluble vitamins ..it is fortified with vitamin A and Vitamin D

28. TRANSFATTY ACIDS
• Partial hydrogenation
• Reduced PUFA
• More atherogenic
• Increases LDL and decreases HLD
• FOODS – deep fried foods, chips , crackers, whipped
Doughnuts, pies cakes are major sources.

29. REFINED OILS
• Treatment with steam alkali
• To remove any odour, free fatty acids and rancid material
• Does not bring any change in unsaturated fatty acid content
• It improves the quality and taste of oil
• These oils are costly

30. FUNCTIONS
• Vehicle for fat soluble vitamins
• Supports to visceral organs
• Provides insulation against cold,
• Without fat food have limited in palatability
• Non caloric role – body growth and structural integrity of cell membrane
• EFA – reduces cholesterol and low density lipo protein
• PUFA is precursor of prostaglandin- physiological role in vascular haemostasias
• GIT motility, lung physiology and reproduction.
• Cholesterol is component of membranes and nervous tissue
• And precursor of steroid hormones and bile acid.

31. FATS AND DISEASES
• Obesity
• Phrenoderma _ rough and dry skin
• Coronary heart diseases
• Cancer – colon and breast cancer
• Choice of cooking oil
• Fat requiements- 20 to 40 gm /day

32. CARBOHYDRATES
• Starch
• Sugar
• Cellulose – indigestible component
• Gylcogen reserve in body
• Fasting
• Glucose haemostasis
• Glycemic index

33. GLYCEMIC INDEX
Classification GI range Examples
Low GI 55 or less Fruits vegetables whole
grains
Medium GI 56-69 Basmati rice , brown rice
High HI 70 or more Corn flakes, baked potato,
white rice (jasmine ) white
bread candy bar syrupy foods

34. DIETARY FIBRE
• Complex carbohydrates cellulose hemicellulose pectin and cariety of gums ,
mucilages form the fiber
• Reduced coronary heart disease
• It binds to bile salts and prevents its reabsorption
• And thus reduced cholesterol level in blood
• Gum and pectin reduced post prandial glucose level
• Fenugreek seed – 40% gum reduces blood glucose levels

35. VITAMINS
• Vitamins are organic compounds categorizes as essential nutrient
• Required in small quantity
• Vitamins does not any enegry but help the body to other nutrients
• Vitamins are divided into fat soluble and water soluble
• Each vitamin have specific function
• Specificif deficiency diseases
• Vitamin E specific – no deficiency yet known

36. VITAMIN A
• Preformed vitamin retinol provitamin beta carotene
• International unit - .3 microgram of retinol
• Retinol equivalents to 3.33 IU of vitamin A
• Functions
• Vision
• Retinal pigments
• Integrity of grandular and epithelial tissue of GIT , RESPIRATORY, URINARY TRACT, SKIN AND EYES
• Support skeletal growth
• Anti infective property
• Increae suseptobilty and lower immune response in vitamin A dificiency

37. SOURCES OF VITAMIN A
• Milk
• Eggs
• Fish
• Carrots
• Green leafy vegetables
• Papaya oranges
• Mango pummkin

38. VITAMIN A
• Retinol palmitate
• Stores in liver – 6 to 9 months
• Retinol highly active – bind with binding protein produce by liver
• PEM – Prevents mobilization of liver retinol reserve

39. DEFICIENCY OF VITAMIN A
• Night blindness
• Conjunctival Xerosis- dry wrinkled not smooth or shiny
• Bitot spots – pearly white or yellowish foamy spots on bulbar conjunctiva
• Corneal xerosis- dull dry not wettable eventually opaque
• Severe deficiency – corneal ulceration
• May heal leaving corneal scar which can affect vision

40. BITOT SPOTS

41. CORNEAL OPACITY DUE TO VITAMIN A DEFICIENCY

42. EXTRAOCULAR MANIFESTATION OF VITAMIN A
• Follicular keratosis
• Anorexia
• Growth retardation
• Prone for respiratory and intestinal infection
• Linked to child mortality

43. PREVENTION
• Improvement in diet with adequate intake of food rich in Vitamin A
• Reducing the frequency and severity of contributing factors eg PEM, respiratory
inf, diarrhoea, measles
• Long term measures- nutritional education of the public and community partition
• Administration of massive dose of vitamin A
• Immunized against xerophthalmia
• Six monthly dosing.

44. ASSESSMENT OF VITAMIN A DEFICIENCY
• Population survey
• Employing both clinical and biochemical criteria
• Criteria
• Night blindness more than 1 percent
• Bitot spots more than 0.5 percent
• Corneal xerosis, ulceration, keratomalacia. More than 0.01 percent
• Corneal ulcer more than 0.05 percent
• Serum retinol- (less than 10 microgram/dl) more than 5 percent