Social and health education.pdf

1. Social
and
Health education
PREPARED BY
DR. VIPULKUMAR GAJERA
SNLPCP, UMRAKH

2. Food In Relation To Nutrition And Health
Food In Relation To Nutrition And Health:
❑ Nutrition is the field of science that is associated with nutrients, nutrition,
growth, development, regulation, and repair of the body.
❑ Nutrition may be defined as the process by which an animal or plant takes in
and utilizes food substances.
❑Essential nutrients include; protein, carbohydrates, fats, vitamins, minerals, and
electrolytes.

3. • Nutrition: The study of food.
•Food: Substance that contains nutrients.
• Nutrients: Substance that can be digested and used by the body.
• Micronutrients: Micronutrients are usually vitamins and minerals, A sufficient
intake of all micronutrients is required for optimal health.
• Macronutrients: Macronutrients are the nutrients that supply energy and
calories and are essential in large quantities to maintain body tasks and to carry
out the activities of everyday life.

4. Healthy Diet and Nutrition
• Having a healthy food/diet is essential for proper functioning of body.
• Having proper amount of diet is essential and improper diet may cause health
related issues.
• A balanced diet promotes nutritional health.
• A healthy diet and exercise reduce stress.
• A healthy diet can help to boost your immunity and resistance to many diseases.
Include fruits and vegetables in daily diet.
• Don’t skip breakfast.
• Keep yourself hydrated.

5. Healthy Diet and Mental Health
❖ Mental health problems are associated with poor diet.
❑ Ways to protect your mental health
•Take time for yourself.
•Adequate rest and sleep.
•Manage stress diligently.
•Eat healthily.
•Exercise adequately.
•Share concerns and worries with friends and family.
•Think positively.
•Try new things.

6. Healthy Diet and Cancer
•The high amount of Saturated fats in the diet may cause Colon and prostate
cancer.
•High fat intake may cause breast and rectum cancer.
•All types of cancer are related to the dietary component.
Ways to protect your health from cancer
Regular intake of fruits rich in fiber content, vegetables, and substances
containing antioxidants and vitamins like; carotene, vitamin-C, vitamin-E, retinol
which are potential anti-carcinogenic agents.

7. Healthy Diet and Skeletal Disease
• Intake of a diet poor in calcium may cause osteoporosis.
• Intake of excess amount of Alcohol and Smoking habits causes osteoporosis.
• Osteoporosis symptoms are generally observed in elders.
Ways to protect your health from skeletal disease
• Consume Calcium rich diet (for eg. Milk, yogurt, Fish, eggs, etc.).
• Increase uptake of Vitamin D (Salmon, tuna, sardines, Supplements, sunlight,
etc.).

8. Healthy Diet and Chronic Diseases
• Generally, slowly progressing and long-term diseases are called chronic diseases.
• Generally observed in individuals of developed countries.
• Chronic diseases occur with intake of affluent diet Social and Health Education
etc.).
• Examples of chronic diseases: Heart disease, stroke, Cancer, Diabetes, etc.

9. Ways to protect your health from chronic disease
• Maintain a healthy diet and consume an adequate amount of all the nutrients and water.
• Consume nutrient-rich foods
• Maintain body weight
• Don’t skip meals.
• Include fruits and vegetables in your diet.
• Avoid junk food.
• Exercise daily.
• Proper sleep

10. Healthy Diet and Dental Diseases
• Sugar has a causal association with dental caries; the association is particularly strong
during childhood with sugars that are consumed in between meals rather than with
meals.
• Intake of excess amount of sugar diet may cause dental problems.
• One dental disease is gum disease and it is the main reason behind tooth loss.
• The reason behind the development of gum disease is a lack of brushing and flossing.

11. Ways to protect your health from Dental Diseases
•To protect dental diseases and gums, consume healthy vegetables and fruits rich
in calcium, folic acid, vitamins, and minerals.
•Daily brushing and daily flossing can avoid gum diseases and dental diseases.

12. Balanced diet

13. Definition
❑ A diet which contains different types of food possessing the nutrients-
Carbohydrate, protein, fats, vitamins, minerals and water –in a proportion to
meet the requirement of the body.

14. Introduction
Balanced diet achieved by eating variety of food.
There is no single food with correct amount of all essential nutrients.
Eating a balanced diet requires a certain amount of knowledge and planning.
The basic composition of balanced diet is highly variable as it differs from country
to country depending on the availability of food.
• Social &cultural habits, economic status, age, sex & physical activity of the
individual largely influence the in take of diet

15. ❑ Nutrient Expert Group from ICMR has recommended the composition of
balanced diet for Indian.
❑ They recommended cereals (rice, wheat, jowar) pulses, vegetables, roots &
tubers, fruits, milk & milk products, fats & oils ,sugar & ground nuts.
❑ Additional intake of Meats, fish & egg for non vegetarian.
❑For vegetarian milk &pulses.

16. Why balanced diet is important
❑ body’s organs and tissues need proper nutrition to work effectively.
❑ Without good nutrition, body is more prone to disease, infection, fatigue, and
poor performance.
❑Children with a poor diet run the risk of growth and developmental problems.
❑Bad eating habits can continue for the rest of their lives.

17. ❑ The USDA reports that four of the top 10 leading causes of death in the
United States are directly influenced by diet.
These are:
Heart disease
Cancer
Stroke
Diabetes

18. Food pyramid
❑ A food pyramid is a pyramid – shaped diagram representing the optimal
number of servings to be eaten each day from each of the basic food groups.

19. 6 Nutrient in balance diet
❑ Carbohydrate
❑ Protein
❑ Fat
❑ Vitamin
❑ Mineral
❑ Water

20. Carbohydrate
RDA (Recommended dietary allowance):400g
Function
1)It is chief source of energy(60-70% total energy).
2) Brain and other parts of CNS are depend glucose for energy.
3) Required for the oxidation of fat.
4) Synthesis of pentose's for DNA,RNA,NAD+,FAD synthesis

21. Sources of carbohydrate
❑ Cereals
❑ Bread
❑ Roots &tubers
❑ Pulses
❑ Sugar

22. Deficiency
Acidosis
Ketosis
Hypoglycemia
Fatigue & decreased energy levels
Unhealthy weight loss
Loss of sodium

23. PROTEIN
RDA:56g
FUNCTION
1.These are the fundamental basis of cell structure & function.
2. Maintains osmotic pressure & have role in clotting of blood, muscle
contraction .
3.All the enzymes, several hormones, immunoglobulins are proteins.
4.Used as energy sources.

24. Source of protein
➢Pulses
➢Leafy vegetables
➢Meat
➢Egg
➢Cereals
➢Milk

25. Deficiency
➢Protein calorie malnutrition
1.Kwashiorker
2.Marasmus
3.Marasmic-kwashiorker
4.Nutrional dwarfing
5.Under weight child

26. Marasmus
Severe protein calorie malnutrition characterized by energy deficiency and
emaciation
Causes stunted growth and wasting of muscles and tissue
Develop between the age of 6 months & 1 years in children who weaned from
breast feeding/who suffer from weakening conditions like chronic diarrhea.

27. Symptoms
Severe growth retardation.
Loss of subcutaneous fat.
Severe muscle wasting.
Child looks thin and limbs
Wrinkled skin.
Bony prominence.
Frequent watery diarrhea & acid stools.
Temperature is abnormal.
Edema absent.

28. Kwashiorker
❑Also called wet-protein energy malnutrition.
❑Form of PEM characterized by protein deficiency.
❑Refers to an insufficient protein consumption but with sufficient calorie intake.
❑Usually appear in the age of 12 months when breast feeding is discontinued.

29. Symptoms
❑Change in skin pigment.
❑Diarrhea.
❑Decreased muscle mass.
❑Swelling(edema).
❑Fatigue.
❑Hair changes
❑Lethargy.
❑Increased & more severe infection due to damaged immune system.
❑Failure to gain weight & grow.

30. Treatment
Treatment strategy divided into 3 stages:
Resolving life threatening conditions. - Hospital management
Resolving nutritional status. -Dietary management
Ensuring nutritional rehabilitation

31. 1. Hospital Management:
➢These conditions should be corrected – hypothermia, hypoglycemia,
infections, dehydration, electrolyte imbalance, anemia & other vitamin &
mineral deficiency.
2. Dietary Management:
➢Diet from staple foods– inexpensive, easily digestible, evenly distributed &
increased number of feedings.
3. Rehabilitation:
➢ Nutritional training for mothers- feeding their children back to health & use
local food.

32. Prevention
Promotion of breast feeding.
Development of low cost weaning.
Nutritional education.
Family planning.
Immunization.
Early diagnosis & treatment.

33. FIBER
• The complex carbohydrate are not digested by the human enzymes are
collectively refers to as dietary fibers
• Soluble fiber-mostly found in fruits & legumes insoluble fiber- vegetables
&grains

34. Function
Prevent constipation
• Eliminate bacterial toxin
• Decrease G.I.T cancers
• Improve glucose tolerence
• Reduce plasma cholestrol

35. Adverse effect of fiber
Digestion &absorption of protein
Intestinal absorption of minerals(Ca,P,Mg)
Flatulence and discomfort Drinking plenty of water reduces the adverse effects

36. Sources of fiber
➢Fruits
➢Leafy vegitables
➢Wheat & legmes Rice bran

37. Deficiency
• Constipation
• High blood pressure
• Diabetes
• Cardiovascular diseases
• Obesity
• Cancer

38. FAT
RDA:70g
❑FUNCTION
• It provide 15-50% total energy.
• Concentrated fuel source of body.
• Constituents of membrane structure& regulate membrane permeability.
• Source of fat soluble vitamins.
• As cellular metabolic regulators.
• As insulating material protect internal organs.

39. Sources of fat
➢Butter
➢Egg
➢Red meat
➢Cream
➢Cheese

40. VITAMINS
❑ Chemical compounds required in very small quantities which are essential for
normal and health metabolism.
According to the solubility
1. Water soluble
2. Fat soluble

42. Vitamin A
➢Vitamins are a class of organic compounds categorized as essential nutrients.
➢They are micronutrients.
➢They DO NOT yield energy, but enable the body to use other nutrients.
➢The body generally CANNOT SYNTHESIZE THEM, so they must be provided by
food.

43. ➢A consists of Retinol (pre-formed vitamin), Retinal, Retinoic acid and ẞ-carotene
(pro-vitamin)
➢Some of the ẞ-carotene is converted to retinol in the intestinal mucosa.

44. FUNCTIONS
➢For NORMAL VISION in dim light.
➢Maintaining the INTEGRITYAND NORMAL FUNCTIONING of glandular and epithelial
tissues which lines intestinal, respiratory and urinary tracts as well as skin and eyes.
➢Supports GROWTH (skeletal growth)
➢Retinol and retinoic acid function as STEROID HORMONES.

45. ➢They regulate the protein synthesis thus involved in cell growth and differentiation.
➢SYNTHESIS of certain glycoproteins.
➢Essential for the MAINTENANCE of proper immune system
➢CAROTENOIDS function as antioxidants and reduce the risk of cancers.
➢MAY protect against some epithelial cancers.

46. SOURCES ANIMAL FOODS
➢Animal Foods : Liver, eggs, butter, cheese, whole milk, fish and meat Fish liver oil- richest
natural source of retinol
➢PLANT FOODS: green leafy vegetables , most green and yellow fruits and vegetables ,
roots(carrot)
➢FORTIFIED FOODS: food fortified with Vit. A such as vanaspati, margarine, milk.

48. STORAGE
➢Liver has an enormous capacity for storing Vit.A in the form of retinol palmitate
➢Under normal conditions, a well fed person has sufficient Vit. A reserves to meet his needs for
6- 9months or more
➢Free retinol is HIGHLY ACTIVE BUT TOXIC, so it is transported in the blood stream by
combining with retinol binding protein (produced in the liver)
➢So, in severe protein deficiency, sed production of retinol binding protein prevents
mobilization of liver retinol reserves.

49. DEFICIENCY
EXTRA- OCULAR
Follicular hyperkeratosis,
anorexia
growth retardation
OCULAR

50. A) NIGHT BLINDNESS
➢Lack of Vit. A FIRST causes Night blindness.
➢It is the inability to see in DIM LIGHT.
➢It occurs due to impairment in dark adaptation.
➢The condition may get worse if Vit. A is not taken, especially if they suffer from diarrhoea
and other infections.

51. B) CONJUNCTIVAL XEROSIS
➢It is the FIRST SIGN of Vit.A deficiency.
➢The conjuctiva becomes dry and non-wettable
➢It appears muddy and wrinkled (instead of smooth and shiny)
❑ Conjunctival xerosis is described as “emerging like sand banks at receding tide”

52. BITOT’S SPOTS
➢ They are triangular, pearly white or yellowish, foamy spots on the BULBAR CONJUCTIVA
on either side of the CORNEA.
➢Usually bilateral
➢In YOUNG children, it indicates Vit. A deficiency
➢In OLDER individuals, it is often an inactive sequelae of earlier disease.

53. D) CORNEAL XEROSIS
•The cornea appears dull, dry and non-wettable and eventually opaque.
•This stage is VERY SERIOUS.
• In more SEVERE DEFICIENCY, there maybe corneal ulceration
• The ulcer may heal leaving a corneal scar which may affect vision.
•Corneal xerosis with corneal ulcer Corneal Scar

54. E) KERATOMALACIA
•• It is the liquefaction of the cornea.
•This is an MEDICAL EMERGENCY.
•The cornea(a part or the whole) may become soft and may burst open.
•This process is rapid and if the eye collapses, vision is lost.

55. XEROPTHALMIA (dry eye)
•It refers to ALL the ocular manifestations of Vit.A deficiency.
• It is a serious nutritional disorder leading to blindness particularly in South-East Asia.
• It is MOST COMMON in children aged 1-3yrs, and often related to weaning
• It is associated with PEM

56. • Associated risk factors include ignorance, faulty feeding practises and infections (diarrhoea
and measles)
• Andra Pradesh, Tamil Nadu, Karnataka, Bihar and West Bengal are BADLY AFFECTED.
• The rest of the North Indian states have LESSER cases of xeropthalmia.

57. EXTRA-OCULAR MANIFESTATIONS
➢Consists of follicular hyperkeratosis, anorexia and growth retardation.
➢Even a MILD Vit.A deficiency causes an increase in morbidity and mortality due to
RESPIRATORY & INTESTINAL INFECTIONS?

58. TREATMENT
• Vit. A deficiency should be treated urgently
• Nearly ALL the early stages of Xeropthalmia can be REVERSED by:
Administration of MASSIVE DOSE of 200,000 IU (or 110mg) of retinol
palmitate ORALLY on 2 successive days.
• ALL children with corneal ulcers are given Vit. A whether or not a deficiency is
suspected,

59. PREVENTION & CONTROL
❑SHORT TERM : • Administration of large doses of Vit.A
❑MEDIUM TERM: Fortification of food
❑LONG TERM: Reduction or elimination of factors contributing to ocular disease

60. SHORT TERM ACTIONS
➢ A simple technology was developed by the National Institute of Nutrition (Hyderabad) .
➢The strategy is to administer SINGLE MASSIVE DOSE of Vit. A in oil(retinol palmitate)
ORALLY.
Age group Dose Duration
Children <12months 1,00,000 IU Once every 4- 6months
Children >12months 2,00,000 IU Once every 4- 6months
Child bearing age 3,00,000IU Within 1month of
delivery

61. MEDIUM TERM ACTIONS
➢FORTIFICATION of certain food [such as dalda (vanaspati), margarine & dried
skimmed milk] with Vit. A
➢• Fortification is successful only if the chosen food is consumed in sufficient
quantities by groups at risk

62. LONG TERM
ACTIONS REDUCING or ELIMINATING the frequency and severity of contributory factors to ocular
disease (PEM, respiratory tract infections, diarrhoea, measles)-
i. To consume green leafy vegetables or other Vit.A rich food
ii. Promotion of breast feeding
iii. Improvements in environmental health (such as ensuring safe and adequate WATER SUPPLY,
maintenance of SANITARY LATRINES to safeguard against diarrhoea)
iv. Immunization against infectious diseases (measles), prompt treatment of diarrhoea and other
infections
v. Better feeding of infants and young children vi. Improved health services for mothers and children
vii. Social and health education.

63. Vitamin B12 deficiency
➢Vitamin B12 (cobalamin) is a water-soluble vitamin obtained through the ingestion of fish,
meat, and dairy products, as well as fortified cereals and supplements.
➢It is coabsorbed with intrinsic factor, a product of the stomach's parietal cells, in the terminal
ileum after being extracted by gastric acid.
➢Vitamin B12 is crucial for neurologic function, red blood cell production, and DNA synthesis,
and is a cofactor for three major reactions:
❖the conversion of methylmalonic acid to succinyl coenzyme A
❖the conversion of homocysteine to methionine
❖the conversion of 5-methyltetrahydrofolate to tetrahydrofolate.

64. Risk Factors for Vitamin B12 Deficiency
❑Decreased ileal absorption
➢Crohn disease
➢Ileal resection
➢Tapeworm infection
❑Decreased intrinsic factor
➢Atrophic gastritis
➢Pernicious anemia
➢Postgastrectomy syndrome (includes Roux-en-Y gastric bypass)
➢Genetic

65. ❑Inadequate intake
• Alcohol abuse
• Patients older than 75 years
• Vegans or strict vegetarians (including exclusively breastfed infants of vegetarian/vegan
mothers)
❑Prolonged medication use
• Histamine H2 blocker use for more than 12 months
• Metformin use for more than four months
• Proton pump inhibitor use for more than 12 months Risk Factors for Vitamin B12 Deficiency

66. Clinical Manifestations of Vitamin B12 Deficiency
❑Cutaneous
• Hyperpigmentation
• Jaundice
• Vitiligo
❑Gastrointestinal
• Glossitis

67. Hematologic
• Anemia (macrocytic, megaloblastic)
• Leukopenia
• Pancytopenia
• Thrombocytopenia
• Thrombocytosis

68. ❑Neuropsychiatric
• Areflexia
• Cognitive impairment (including dementia-like symptoms and acute psychosis)
• Gait abnormalities
• Irritability
• Loss of proprioception and vibratory sense
• Olfactory impairment
• Peripheral neuropathy

69. ❑Maternal vitamin B12 deficiency during pregnancy or while breastfeeding may lead to:
➢Neural tube defects,
➢Developmental delay,
➢Failure to thrive,
➢Hypotonia,
➢Ataxia,
➢ Anemia.

70. Pernicious anemia
• refers to one of the hematologic manifestations of chronic auto-immune gastritis, in which
the immune system targets the parietal cells of the stomach or intrinsic factor itself, leading to
decreased absorption of vitamin B12.
• Asymptomatic autoimmune gastritis likely precedes gastric atrophy by 10 to 20 years,
followed by the onset of iron-deficiency anemia that occurs as early as 20 years before
vitamin B12 deficiency pernicious anemia.

71. Treatment
➢Vitamin B12 deficiency can be treated with intramuscular injections of cyanocobalamin or
oral vitamin B12 therapy.
➢Guidelines from the British Society for Haematology recommend injections three times per
week for two weeks in patients without neurologic deficits.
➢If neurologic deficits are present, injections should be given every other day for up to three
weeks or until no further improvement is noted
➢In general, patients with an irreversible cause should be treated indefinitely, whereas those
with a reversible cause should be treated until the deficiency is corrected and symptoms resolve.
➢If vitamin B12 deficiency coexists with folate deficiency, vitamin B12 should be replaced first
to prevent subacute combined degeneration of the spinal cord.
➢The British Society for Haematology does not recommend retesting vitamin B12 levels after
treatment has been initiated
➢No guidelines address the optimal interval for screening high-risk patients.

72. Vitamin D deficiency
❑INTRODUCTION
➢Vitamin D is an Fat-soluble vitamin.
➢It is present in animals, plants and yeast & has several important functions in the body.
➢Technically it should be considerd as Hormone ( Secosteroid ) because –
-It is synthesized by the body(skin) from sunlight (UV-B ray, wave band-290-315 nm),
-It is transported by blood, activated & then acts on specific receptors in the target tissue.
-Feedback regulation of Vit D activation occure by plasma Ca level & by active form of Vit D

73. WHAT IS VITAMIN D ????
Chemistry: There are two chemical forms of vitamin D,
-Vitamin D2 (Ergocalciferol) and
-Vitamin D3 (Cholecalciferol).
The natural form of vitamin D for animals and man is vitamin D3; it can be produced in their
bodies from cholesterol and 7-dehydrocholesterol.
An alternative vitamin D2 is commercially prepared from ergosterol that is present in yeast.
Cholesterol in animals and man is a precursor substance for all steroid hormones as well as
vitamin D3.
The molecular structure of vitamin D is closely allied to that of the classical steroid
hormones.

74. SOURCES OF VITAMIN D
2 sources
- 90% synthesised in skin via UVB light exposure Cholecalciferol (vitD3 = inactive)
- 10% from food – Ergocalciferol (vit D2= inactive)

75. DIETARY SOURCES
Fatty fish, like tuna, mackerel, and salmon.
Cod liver oil
Foods fortified with vitamin D, like some dairy products, orange juice, soy milk, and cereals.
Beef liver.
Cheese.
Egg yolks
RICHEST SOURCE - FISH LIVER OIL
CHEAPEST SOURCE - SUNLIGHT

76. Vitamin D Synthesis Pathways

77. RISK FACTORS FOR VITAMIN D DEFICIENCY
➢Elderly Individuals older than 65 years
➢Dark skin
➢No sun exposure
➢Strict vegan diet
➢Obesity
➢Nursing home residents
➢Patients on medications that induce P-450 enzyme
activity.
➢Individuals with kidney disease (CRF)
➢Individuals with low bone mass or osteoporosis
➢Individuals with nonvertebral or hip fractures
➢Individuals with a history of falls

78. CAUSES OF VITAMIN D DEFICIENCY
❑The main reasons for low levels of vitamin D are:
➢Lack of vitamin D in the diet, often in conjunction with inadequate sun exposure.
➢Inability to absorb vitamin D from the intestines.
➢Inability to process vitamin D due to kidney or liver disease.

79. CAUSES OF VITAMIN D DEFICIENCY. CONT….
Inadequate sun exposure
➢Sunscreen with SPF 15+ blocks 99% vitamin D synthesis
➢Pigmented skin
➢Aging (older than 65 years)
➢Winter season
➢Physical agents blocking UVR exposure, clothing, season, air pollution, cloud cover, latitude
& altitude.

80. Decreased absorption
➢Bowel bypass surgery
➢Crohn’s disease
➢Celiac disease
➢Fat and cholesterol absorption inhibitors.

81. Inability to process vitamin D
Impaired production of 25hydroxy vitamin D3
➢- Liver disease
Impaired production of 1,25 dihydroxy vitamin D3
➢Kidney disease,
➢Hypoparathyroidism,
➢Oncogenic osteomalacia,
➢X-linked hypophosphatemic rickets.

82. CAUSES OF VITAMIN D DEFICIENCY. CONT….
Other Causes
Breastfeeding
Medications;
- Steroids decrease half life of vitamin D.
- Barbiturates, Phenytoin, and Rifampin can induce hepatic p450 enzymes to accelerate the
catabolism of vitamin, - Ketoconazole impaired 25-hydroxylation.
- Increased degradation of 25 (OH) D
-Drugs such as, Rifampicin, Isoniazid, Phenytoin, Glucocorticoids.
Target organ resistance
- Vitamin D receptor mutation.

83. VITAMIN D RELATED DISORDER
➢RICKETS in Children
➢OSTEOMALACIA in Adults
➢Increase the risk of Osteoporosis .

84. Rickets and osteomalacia
Rickets and osteomalacia are disorders of the mineralization of newly synthesized bone
matrix(osteoid).
In children, defects occur in the growth plate and in the mineralization of cartilage, leading to
characteristic deformities; ie. Rickets.
In adults, it occurs after epiphyseal closure, & involves only bone; ie. Osteomalasia.

85. Rickets
Age incidence- 4m-2y
Clinical Feature:
Symptom-
• Irritability & restlessness
• Rocking of head in pillow & sweating of forehead
• Delayed dentation & Delayed milestones
Sign-
• Craniotabes - Pot belly
• Frontal bossing - Harrison’s sulcus
• Rickety rosary -Pegion chest
• Bowed legs or Knocked knee
• Delayed closure of ant. frontanelle

86. Radiological changes:
➢Cupping widening & fraying of lower end of radius & ulna.
➢Widening of wrist (soft tissue shadow)
❑ Biochemical changes
➢Increased alkaline phosphatase
➢Hypophosphataemia
➢Hypocalcimia

87. Osteomalacia
Osteomalacia is the softening of the bones caused by defective bone mineralization
secondary to hypocalcemia , hypophosphatemia & vitamin D deficiency.
The causes of adult osteomalacia are varied, but ultimately result in a vitamin D deficiency:
Even in the presence of normal calcium and phosphate levels, chronic acidosis and drugs
such as bisphosphonates (etidronate ) & phosphate-binding antacids can lead to osteomalacia.
Demineralization occurs mainly in spine, pelvis & lower extremities.

88. It manifest with bone pain, severe malaise, proximal muscle weakness & waddling gait.
Radiological feature
-Pseudo fracture- or Looser’s Zones of decalcification along the course of major arteries.
Biochemical changes
➢Decreased serum calcium or phosphorus.
➢Decreased serum 25-hydroxyvitamin D .
➢Increased Serum ALP & PTH.

89. PREVENTION OF VITAMIN D DEFICIENCY
➢Sensible sun exposure- 5-30 minutes of exposure of arms and legs between 10 am and 3 pm
twice a week is often adequate.
➢To prevent vitamin D deficiency, the American Academy of Pediatrics (AAP) recommends
that infants and children receive at least 400 IU per day from diet and supplements.
➢All pregnant & lactating mother should take 400IU vitamin D supplements daily
➢Evidence shows that vitamin D supplementation of at least 700 to 800 IU per day reduces
fracture and fall rates in adults.
➢Fortification of food with Vitamin D such as milk, butter chapatiflour, maida, cereals etc.

90. MINERAL
➢ The mineral (inorganic) elements constitute only a small proportion of the body weight.
➢ There is a wide variation in their body content.
➢For instance, calcium constitutes about 2% of body weight while cobalt about 0.00004%.

91. General Functions
• Minerals perform several vital functions which are absolutely essential for the very existence
of the organism.
• These include:
➢Calcification of bone, Blood coagulation,
➢Neuromuscular irritability, Acid-base equilibrium,
➢Fluid balance and Osmotic regulation.

92. General Functions
➢Certain minerals are integral components of biologically important compounds such as
hemoglobin (Fe), Thyroxine (I), Insulin (Zn), and Vitamin B12 (Co).
➢Sulfur is present in thiamine, biotin, lipoic acid and coenzyme A.
➢ Several minerals participate as cofactors for enzymes in metabolism (e.g. Mg, Mn, Cu, Zn,
K).
➢Some elements are essential constituents of certain enzymes (e.g. Co, Mo, Se).

93. Minerals - Classification
➢The minerals are classified as principal elements and trace elements.
➢The seven principal elements (macroelements) constitute 60-80% of the body’s inorganic
material.
➢These are calcium, potassium, chloride and sulfur.
➢The principal elements are required in amounts greater than 100 mg/day.

94. Minerals - Classification
➢The trace elements (microelements) are required in amounts less than 100 mg/day.
➢They are subdivided into three categories.
➢Essential trace elements: Iron, copper, iodine, manganese, Zinc, molybdenum, cobalt,
fluorine, selenium and chromium.
➢Possibly essential trace elements: Nickel, Vanadium, cadmium and barium.
➢Non-essential trace elements: Aluminium, lead, mercury, boron, silver, bismuth.

95. Calcium
❑Introduction
➢Calcium is the most abundant among the minerals in the body.
➢The total content of calcium in an adult man is about 1 to 1.5kg.
➢As much as 99% of it is present in the bones and teeth.
➢A small fraction (1%) of the calcium bound outside the skeletal tissue, performs a wide
variety of functions.

96. Calcium –Biochemical Functions
(i) Development of bones and teeth: Calcium, along with phosphate, is required for the
formation (of Hydroxyapatite) and physical strength of skeletal tissue I.e. bones and teeth.
(ii) Muscle contraction: Ca2+ promotes muscle contraction.
(iii) Blood coagulation: Several reactions in the cascade of blood clotting process are
dependent on Ca2+ (factor IV).
(iv) Nerve transmission: Ca2+ is necessary for the transmission of nerve impulse.
(V) Membrane integrity and permeability: Ca2+ influences the membrane structure and
transport of water and several ions across it.
(vi) Activation of enzymes: Ca2+ is needed for the direct activation of enzymes such as lipase
(pancreatic), ATPase and succinate dehydrogenase.

97. Daily Requirements
• Adult men and women - 800 mg/day
• Women during pregnancy, lactation and post- menopause- 1.5 g / day.

98. Sources
• Best sources - Milk and milk products
• Good sources- Beans, leafy vegetables, fish, cabbage, egg yolk.

99. Calcium – Deficiency Diseases
➢The blood Ca level is maintained within a narrow range by the homeostatic control, most
predominantly by Parathyroid hormone.
➢Hence abnormalities in Ca metabolism are mainly associated with alterations in Parathyroid
Hormone.

100. Calcium – Deficiency Diseases
➢Hypercalcemia
➢The serum Ca level (normal 9-11 mg/dl) is elevated in hypercalcemia.
➢Hypercalcemia is associated with Hyperparathyroidism caused by increased activity of
parathyroid glands.
➢Decrease in serum phosphate (due to increased renal losses) and increase in alkaline
phosphatase activity are also found in hyperparathyroidism.
➢Elevation in the urinary excretion of Ca and P, often resulting in the formation of urinary
calculi, is also observed in these patients.

101. Calcium – Deficiency Diseases
• The symptoms of hypercalcemia include:
➢Lethary,
➢Muscle weakness,
➢Loss of appetite,
➢Constipation,
➢Nausea,
➢Increased myocardial contractility and
➢Susceptility to fractures.

102. Calcium – Deficiency Diseases
➢Hypocalcemia
➢Hypocalcemia is a more serious and life threatening condition.
➢It is characterized by a fall in the serum Ca to below 7 mg/dl, causing tetany.
➢The symptoms of tetany include neuromuscular irritability, spasms and convulsions.
➢Hypoparathyroidism is associated with a decrease in serum Ca and an increase in serum
phosphate, besides the reduced urinary excretion of both Ca and P.

103. Calcium – Deficiency Diseases
➢Rickets
➢Rickets is a disorder of defective calcification of bones.
➢This may be due to a dietary deficiency of Ca and P or both.
➢The concentration of serum Ca and P may be low or normal.
➢An increase in the activity of Alkaline Phosphatase is a chacteristic feature of rickets.

104. Calcium – Deficiency Diseases
➢Osteoporosis
➢Osteoporosis is characterized by demineralization of bone resulting in the progressive loss of
bone mass.
➢Occurrence: The elderly people (over 60 yr) of both sexes are at risk for osteoporosis.
However, it more predominantly occurs in the postmenopausal women.
➢Osteoporosis results in frequent bone fractures which are a major cause of disability among
the elderly.

105. Calcium – Deficiency Diseases
• Etiology:
➢The etiology of osteoporosis is largely unknown, but it is believed that several causative
factors may contribute to it.
➢The ability to produce calcitriol from Vitamin D is decreased with age, particularly in the
postmenopausal women.

106. Calcium – Deficiency Diseases
➢Immobilized or sedendary individuals tend to decrease bone mass while those on regular
exercise tend to increase bone mass.
➢Deficiency of sex hormones ( in women) has been implicated in the development of
osteoporosis.

107. Calcium – Deficiency Diseases
➢Treatment: Estrogen administration along with calcium supplementation ( in combination
with Vitamin D) to postmenopausal women reduces the risk of fractures.
➢Higher dietary intake of Ca (about 1.5 g/day) is recommended for elderly people.

108. Sodium
Function
Acid-base balance
Osmotic pressure
Nerve & muscle function Deficiency
Hyponatremia
RDA (5-10g/d)
Source: Table salt

109. Potassium
❑ FUNCTION
Acid-base balance
Osmotic pressure
Muscle function Deficiency
Muscular weakness
Mental confusion
RDA(3-4g/d)
sources: fruits, nuts, vegetables

110. IRON
Function
• Constituent of heme.
• Involved in O2 transport & biological oxidation
Deficiency
Hypochromic &micro cystic anemia
RDA(10-15mg/d)
Sources
Organ meats(liver, heart)
Leafy vegetables

111. IODINE
❑ Function Constituent of thyroxine & tri iodo thyronine
❑ Deficiency:
➢ Critinisum Goiter Myxedema
➢RDA(150-200µg)
➢Sources Iodised salt Sea food

112. COPPER
➢Function. Constituent of enzyme eg: cytochrome C oxidase, catalase, tyrosinase
in iron transport.
➢Deficiency. Anemia. Menkas disease.
➢RDA(2-3mg/d).
➢Sources: organ meat, cereals, leafy vegetables.

113. Malnutrition and its prevention.

114. Introduction
➢Malnutrition is defined as imbalance between the body’s need and the intake of
nutrients, which can lead to nutritional disorders.
➢So intake of nutrients in proper amount is needed

115. Types of Malnutrition
Malnutrition is divided into two main types
1. Under-nutrition
2. 2. Over-nutrition
In under-nutrition nutrients are undersupplied, and
In over-nutrition nutrients are over supplied both causes nutritional disorders.

118. Disorders due to Malnutrition
❑Protein-energy malnutrition
➢Kwashiorkor
➢Marasmus
❑Under nutrition of vitamins and minerals
➢Obesity

119. Under nutrition of vitamins and minerals
❑ Under nutrition of minerals
• Calcium – Rickets
• Iodine deficiency – Goiter
• Iron deficiency – Anemia
• Zinc – Growth retardation

120. ❑Under nutrition of vitamins
• Thiamine (Vitamin B1) – Beriberi
• Niacin (Vitamin B3) – Pellagra
• Vitamin C – Scurvy
• Vitamin D – Rickets

121. Prevention of malnutrition
➢Use of modern agricultural techniques to increase the agricultural production
➢Proper education to peoples regarding importance of food
➢Enrichment of food
➢Fortification of food
➢Genetic engineering for the development of new varieties eg- golden rice

122. ➢Government projects to provide healthy food to infants and pregnant woman
➢Staple food should available at very cheap rate
➢Common people should adopt rotation in food
➢Use of probiotic microorganism in food
➢Global public health and disease control measures.

123. Thank you