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Download MBBS Biochemistry PPT 56 Nutrition Lecture Notes

Download MBBS (Bachelor of Medicine, Bachelor of Surgery) 1st year (First Year) Biochemistry ppt lectures Topic 56 Nutrition Notes. - biochemistry notes pdf, biochemistry mbbs 1st year notes pdf, biochemistry mbbs notes pdf, biochemistry lecture notes, paramedical biochemistry notes, medical biochemistry pdf, biochemistry lecture notes 2022 ppt, biochemistry pdf.

This post was last modified on 05 April 2022

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? Composition of Food and its role
in human body.
? Calorific Values/Energy content
of Food constituents.

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? Energy requirement by the

body

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? Basal Metabolic Rate (BMR)

? Respiratory Quotient(RQ)

? Specific Dynamic Action (SDA)

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? Balanced Diet and its Importance

? Nutritional Disorders

? PEM- Kwashiorkor and Marasmus

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? Obesity

INTRODUCTION
What is Nutrition?

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Nutrition is a wide branch of science

which deals with:

vComponents of human food and

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their role in human body

vCalculations of

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vEnergy content of foods
vEnergy requirement by human beings
vNutrition Explores

vHow to choose particular food/

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type of diet?

vPlanning of balanced diet in

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various conditions.

vNutritional Studies Involves


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vRelation of Nutrients in health

and disease.

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vNutritional disorders due to

under and over nutrition.
STUDY OF NUTRITION

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ANSWERS FOLLOWING

QUESTIONS

? WHY TO EAT FOOD ?

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? What are the Dietary Nutrients and their

Role to human body?

? What are Macro and Micronutrients?

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? WHAT FORM AND AMOUNT OF

DIETARY NUTRIENTS TO BE INGESTED?

? What is a Balanced Diet?

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? WHAT HAPPENS IF A FOOD EATEN IN A

BALANCED/IMBALANCED WAY ?


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What Is The Main

Purpose

of Eating Food ?

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?Food/Diet is a prime

requisite for human body

survival and existence.

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? Main purpose of Food is to:

? Provide Energy (Fuel) for cellular activities.

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? Supply basic building blocks, to build

Macrobiomolecules, for structural and

functional role in the body.

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? Enable Accessory growth factors.


? Role Of Human Food

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? Build The Cel and Subcel ular Structures
? Maintains all body functions
? Regulates Metabolism
? Vital for growth and development

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? Therapeutic benefits

?Healing of diseases
?Prevention of diseases

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? What we eat is what we build

? Remember Proper Nutrition

? Maintains normal growth, health

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and reproduction.

? Rewards healthy and happy life

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? Improves life span
How Should Be Our Eating?

One Should Eat

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To Live

A Healthy and Happy Life
?Ingest food Nutrients with

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?Appropriate quantity
?Good quality

?This is very essential for

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normal healthy life.

?Ignorance and wrong

food habits are

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?Responsible for most

il nesses of Human being.
? `Prevention Is Better Than Cure'

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?Good and Proper diet is a

best way to prevent many

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diseases.

? A sound knowledge of nutrition to a

doctor is of paramount importance.

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?To maintain his/her own good

health.

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?Advice for planned diets, to the

patients to maintain their good

health's.

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Composition of Food

and

Their Role in Human Body

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or

Nutritive Value of Nutrients

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What To Eat?

And

What Not To Eat?

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?Nutrients are organic

or inorganic molecules

that are crucial y

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required for human

growth & wel -being.

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? Food items derived from

plant or animal sources

contain nutrients.

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? ~ 40 nutrients identified and present in

food items.
Chief Nutrients

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Of

Food Substances

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Six Classes of Nutrients

? Carbohydrates

? Lipids (Fats)

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? Proteins

? Vitamins

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? Minerals

? Water
Classification Of Nutrients

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? There are four ways to classify the classes

of nutrients:

I. Essential or Nonessential Nutrients

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I . Organic or Inorganic Nutrients

I I. Macronutrient or Micronutrients

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IV. Calorific or Non calorific Nutrients
? Essential Nutrients ?

? Nutrients not biosynthesized in body or

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cannot make enough of to meet the bodies

need.

? These nutrients must be obtained from foods.

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?Examples:

? Vitamins

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? Minerals

? Some of the amino acids and fatty acids.

? Nonessential Nutrients ?

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? Nutrients readily biosynthesized by

body from other ingested nutrients

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Examples:

?Cholesterol

?Non Essential Amino acids

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?Non Essential Fatty acids
? Organic Nutrients - contain carbon

? Carbohydrates

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? Lipids
? Proteins
? Vitamins

? Inorganic Nutrients - do not contain carbon

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? Minerals
? Water

? Macronutrients-

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? Required in large quantities

?Carbohydrates

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?Lipids

?Proteins

?Water

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? Micronutrients

? Required in small quantities.

? Minerals

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? Vitamins

? Energy-yielding nutrients /Calorific

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Nutrients:

?Carbohydrates
?Lipids
?Proteins

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38
? Non energy yielding/Non Calorific

?Vitamins

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?Minerals

Nutritional Goals

? Quality intake of food allows the body

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to function at best and promotes

health.

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?Quality intake should provide

adequate levels of each nutrient.

? Quantity intake of food promotes a

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healthy body weight.

40

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? Nutrition Influences on:

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? Health
?Appearance
?Behavior
?Mood

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41

The Main Food Groups


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Fruit and Vegetables

Fruits and vegetables grow

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on plants: underground, on

Take

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the ground or in trees.

5 a day

Every day we should eat at

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least 5 portions of fruit and

everyday!

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vegetables. (A portion is

about a handful.)
Fruit and vegetables give us

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fibre and vitamins and

minerals.

Grains and Pulses

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This food group includes

wheat, corn, barley, rice,

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lentils, beans etc.

What is..?

These are all from plants

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Rice is the staple food in China

and form a staple part of

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and much of the East. What is

the diet for people all over

it in the West (UK, USA)?

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the world.
Grains and pulses give us

carbohydrates and proteins.

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Nuts are another source of

protein.


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Dairy Products

Dairy foods are made from milk (usually

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cow's milk, but can be from other animals

like goats or sheep). Dairy foods give us

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proteins and fats. They are also a good

source of calcium which is good for bones

and teeth.

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These foods include:

Weird fact

?Cheese (hard, soft, cottage) Ourbrainsare80%

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?Yogurt

fat.

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?Food high in milk or milk products.

Meat, Fish and Eggs

The main nutrients derived from meat are

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proteins, but it also gives us fats and some

minerals.
The meat and fish group includes:Foodie fact

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?Chicken and all poultry

Sushi (raw fish) is now

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?Fish and shellfish

Marks and Spencer's

best-selling lunchtime

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?

snack.

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Beef, pork and lamb

?Eggs are included in this group too.
Athletes eat lots of protein; they help to

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build muscles.




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Body Composition

GROUPS OF NUTRIENTS:

?Carbohydrates

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?Proteins
?Fats
?Vitamins
?Minerals
?Water

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Carbohydrates

?Carbohydrates: are the Sugars

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and Starch present in food.


?They are classified as either

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simple or complex

Carbohydrates.

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?Simple carbohydrates: are

Sugars Examples include:

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vGlucose
vFructose
vLactose

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?Complex Carbohydrates

are Starches-Present in

vWhole grains

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vLegumes


? Simple Carbohydrates

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? pop, candy, sweets, fruit

? individual Glucose or Fructose molecules

? Recent studies reported Refined sugars are Brain

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damaging

? Complex Carbohydrates

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? pasta, rice, breads, potatoes

? Chains of glucose molecules

53

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Dietary Fiber
?Fiber is an

?Indigestible complex

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Carbohydrate

?Non calorific

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Substances As Dietary Fiber

? Cellulose
? Hemicellulose
? Pectins

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? Gum
? Lignin
? Mucilage
? Sources Of Dietary Fibers

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? Richly present in plant food

substances.

? Poorly present in refined and

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commercial food products.

Types Of Dietary Fibers
? Soluble Dietary Fiber ?

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? Decreases Cholesterol levels
? Found in oat bran, fruits and veggies

? Insoluble Dietary Fiber-

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? Reduces risk of colon cancer
? Found in wheat bran and grains

? Recommendation of Dietary Fiber:

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? 25-40 gm per day

Check

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are we getting enough

dietary Fiber through your foods ?


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Ways to Get More Fiber

? Eat more fruits

and vegetables

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? Eat whole grain

foods

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Advantages Of Dietary Fiber

? Act as roughage

? Holds water

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? Forms soft and bulky feces

? Increases bowel movement

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? Easy defecation

? Prevents constipation
?Dietary fiber corrects

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hyperglycemia and

hypercholesterolemia

? Fiber Reduces risk of:

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?Diverticular disease of colon
?Colon cancer
?Varicose veins
?Good satiety and non

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calorific value of dietary

fiber

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?Helps in management of

obesity.

Disadvantage Of Dietary Fiber

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? It binds with trace

elements and reduces its

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absorption.

? Decreases absorption of fat

soluble vitamins.

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A Grain of Wheat

BRAN
- B vitamins

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- minerals

ENDOSPERM

- dietary fiber

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- starch

- protein

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- some iron and

GERM

B vitamins

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- Essential fats

- minerals

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- vitamins

(B's , E and folacin)

? Germinated legumes have

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partial dextrinization of

Starch.

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? Which is good for digestion,

absorption and utilization.
Functions Of Carbohydrates

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v Readily available source & supply

most of the bodies primary energy

needs

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v Antiketogenic
v Build structure of cells
v Store calories as Glycogen
v Excess Carbs convert to Fat

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v Amino acid synthesis
v Cellulose as roughage

Quantity And Quality Of

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Carbohydrates To Be Ingested
? An Adult individual with

his/her routine activities

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should adjust the

Carbohydrates intake.

? RDA for Carbohydrates-

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400-600 gm/day

? Ingestion of Starchy food is

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more preferable.

? Refined sugars have high

glycemic index so the quantity

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should be reduced.

? Dietary fiber in form of

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Cel uloses to be ingested.




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?Dietary Proteins are

nutrients , provide essential

amino acids building blocks

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for tissue proteins.
?Proteins are of structural and

Functional importance

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?Maintain growth, repair and

function of the body cel s and

tissues.

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? Sources of dietary Protein

? Animal (complete)

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? meats, dairy

? Vegetable (incomplete)

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? beans, nuts, legumes,

grains

? Types of Amino Acids

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Amino acids linked together

? Nonessential (10) ? can be made by body

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? Essential (8) ? must be made by body

? Semiessential (2)- Made in body to less amount

need also from diet

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Nutritional Classification Of Proteins
? Dietary Proteins nutritional y

classified into two groups:

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?Complete Proteins
?Incomplete Proteins

? Complete Proteins/ First Class

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Proteins/High Biological y Valued

? Complete Protein contains adequate

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amounts of al essential amino acids.



SOURCES INCLUDE:

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Animal Origin Proteins

?Fish

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?Meat

?Poultry Meat and Eggs,

?Milk, Cheese and yogurt

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?Soya Bean products
? Incomplete Proteins

? Incomplete Proteins lack one or more

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essential amino acids (limiting amino acid).
SOURCES INCLUDE:
? Beans

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? Pulses ( Limit in Met)

? Nuts

? Whole grains (Limit in Lys and Thr)

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Dietary Protein Requirements

? RDA average = 0.8-1.0 g/kg body weight/Day

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? RDA Athlete = 1.2-1.6 g/kg/day
?High levels of Dietary

Protein intake

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above 2 g/kg/day

can be harmful

to the body

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Biological Value Of Proteins

?Dietary Proteins differ in

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their quality i.e

?Efficiency of digestibility

and absorption capacity.

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? An effectiveness of dietary

Protein is in

? Providing amount of

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essential amino acids for

tissue Protein biosynthesis.

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Evaluating Protein Quality



? Biologic Value (BV) of Protein:

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?Amount of ingested Nitrogen

retained in the body

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compared with Nitrogen

absorbed.
Biological Value = Nitrogen Retained x 100
Nitrogen Absorbed

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Biological Value of Protein is

Percentage of Nitrogen absorbed

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and retained in the body.

? Thus BV of Protein

indicates effectiveness

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of utilization of dietary
Proteins
? Proteins with high biological

value(B.V) are also termed as:

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? Superior Proteins
?Complete proteins
?First class Proteins

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?All animal origin

Proteins rich in all

essential amino acids are

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of high B.V.
? Dietary Proteins with high

biological value support

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good tissue biosynthesis

and retain the Proteins in

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body for their functional use.

?Complete Proteins with

high biological value

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maintain

Positive/Nitrogen

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equilibrium
? Plant proteins are of low

B.V since deficient in one

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or two essential amino

acids.

? Net Protein Utilization (NPU):

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?Percentage of Nitrogen

consumed that is retained by
the body.

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Mutual Supplementation

Of

Dietary Proteins

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Improves Biological Value

Of Proteins

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? Eating Pulses and Grains gives all

essential Amino acids required for

the tissue Protein biosynthesis.

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? Dal and Roti
?Rice and Dal
? Idli and Sambhar
?Rajma Chanwal

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?Chhole Chanwal
Source Of

B.V

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Limiting Amino

Protein

acid

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Egg

94

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Nil

Milk

84

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Sulfur containing

amino acids

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Fish

85

Tryptophan

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Meat

75

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Sulfur containing

amino acids

Soya Beans

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65

Sulfur containing

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amino acids

Source Of

B.V

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Limiting Amino

Protein

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acid

Rice

68

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Lysine and

Threonine

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Wheat

58

Lysine and

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Threonine

Pulses

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58

Sulfur containing

amino acids

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? Biological value of protein affects

nitrogen balance.

?Low B.V proteins leads to negative

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nitrogen balance.

?Increased loss of NPN substance

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Urea in urine.

Functions Of Dietary

Proteins

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? Supply amino acids for growth &

repair of body tissues

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? Biosynthesize all tissue Proteins

?Hemoglobin

?Nucleoproteins

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?Glycoprotein

?Lipoproteins
?Enzymes

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?Hormones

?Antibodies

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?ETC Components

?Collagen (bones)

?Keratin (nails & hair)

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? Protein serve as a source of

energy :

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?When there is shortage of

Lipids & Carbohydrates in the

body.

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? Proteins has role in

osmoregulation ,transport and

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acid-base balance


? Dietary lipids predominantly

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contains Triacylglycerol (TAG).

? TAG to human body serves as a

secondary source of energy on

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long term basis.
?TAG stored as reserve food

in adiposecytes

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?Provides energy in

between meals , fasting

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and starvation condition.

? The other forms of dietary

lipids viz Phospholipids and

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Cholesterol has structural

and functional role in the

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body.
?Fats/Oils are type of

neutral lipids,

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insoluble in water.

?Fatty acids are the

building blocks of

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various tissue Lipids .

Types of Fatty Acids

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? Saturated Fatty Acids

? Animal sources

? Solid at room temperature

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? High intake is associated with an increased risk of heart disease

? Unsaturated Fatty Acids (MUFAS and PUFAS)

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? Vegetable sources

? Liquid at room temperature

? Associated with a reduced risk of heart disease

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? Trans Fatty Acids

? Hydrogenation to alter "state" of fat example Vanaspati Dalda

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? Increase shelf-life & market availability

? Repeated heating of Oils
Composition of Oils (%)

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Type

Sat

Poly Mono

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safflower



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09

75


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16

sunflower

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10

66

24

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corn

13

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59



28

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soybean

14

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58



28

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sesame

14

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42



44

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peanut 17

32

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51

palm

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49

09

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42

olive

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14

08

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78

canola

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07

35

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58

? Those Fatty acids are

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considered as good

? Who on entry in body get

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easily metabolized and

give good effect to body.
? Those Fatty acids are considered as

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bad

? Which are more stable and get less

metabolized and remain for long

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time in the body.

? As the fatty acids remain for long

--- Content provided by​ FirstRanker.com ---

time it increases the risk of

Atherosclerosis.

Quality and Quantity Of Dietary Lipids

--- Content provided by⁠ FirstRanker.com ---


? Quantity of Dietary Lipids 60 gm/day

? Quality of Dietary Lipids:

--- Content provided by⁠ FirstRanker.com ---

? TAG with mixture of Fatty acids linked

? Fatty acids in ratio of MUFA:PUFA:SFA 1:1:1

? Zero Trans Fatty acids

--- Content provided by‍ FirstRanker.com ---


? Equal proportion of Antioxidants To protect In

vivo PUFA's

--- Content provided by‌ FirstRanker.com ---

? Adequate Carbohydrate Diet-No too much

excess of Glucose to transform into Fatty acids

and Cholesterol

--- Content provided by‌ FirstRanker.com ---

? Fatty food is associated

?With fat soluble vitamins A,

D, E, and K

--- Content provided by⁠ FirstRanker.com ---


?Sources of Linoleic acid-

essential fatty acid that is

--- Content provided by FirstRanker.com ---

needed for growth and

healthy skin.

Recommendations for

--- Content provided by​ FirstRanker.com ---


Fat Consumption

? Dietary Fat Recommendations

--- Content provided by​ FirstRanker.com ---

? Less than 30% of calories in diet

from dietary Lipids.

? Less than 1/3 of dietary fat

--- Content provided by‌ FirstRanker.com ---


should be saturated.
? Ways to Decrease Intake of Fat

?Minimize "fast" foods and Snacks

--- Content provided by FirstRanker.com ---


?Minimize processed foods

?Use better cuts of Red meat

--- Content provided by​ FirstRanker.com ---

?Use low fat alternatives

?Pork Fat

?Choose foods with "Natural Lipids"

--- Content provided by FirstRanker.com ---


Food s Should be rich In

Essential Fatty Acids (EFAs)

--- Content provided by‌ FirstRanker.com ---

? Linoleic acid (LA)

? Linolenic (LNA) or Alpha

Linolenic acid or (ALA)

--- Content provided by⁠ FirstRanker.com ---


? Arachidonic Acid
Omega-3 and Omega-6 Fatty acids

?Linolenic Acid (18:3n

--- Content provided by​ FirstRanker.com ---


-3) belongs to the

omega-3 family of

--- Content provided by FirstRanker.com ---

fatty acids

?Linoleic Acid

(18:2n-6) belongs

--- Content provided by​ FirstRanker.com ---


to the omega-6

family
Role Of Essential Fatty Acids

--- Content provided by‍ FirstRanker.com ---


(EFAs)

? LA can be converted to both Arachidonic and Linolenic

--- Content provided by⁠ FirstRanker.com ---

acids

?Essential FA are necessary for growth, skin &

hair integrity.

--- Content provided by⁠ FirstRanker.com ---


?Regulation of Cholesterol metabolism.
?Lipotropic activity
?Decreased platelet adhesiveness and

--- Content provided by‍ FirstRanker.com ---

reproduction.

? Rich Dietary Sources of

Linoleic Acid :

--- Content provided by‍ FirstRanker.com ---


?Soya oil

?Sunflower oil

--- Content provided by‌ FirstRanker.com ---

?Safflower oil

?Sesame seeds

?Corn oil

--- Content provided by‌ FirstRanker.com ---


?Most nuts
? Dietary Sources Of Linolenic

Acid :

--- Content provided by​ FirstRanker.com ---


? Flax seeds(abundantly )
?Walnuts(Small quantities)
?Cold pressed Canola oil
?Wheat germ

--- Content provided by FirstRanker.com ---

?Dark green leafy vegetables

? Diets with <1-2% EFAs

will affect growth rate,

--- Content provided by​ FirstRanker.com ---

cause dry scaly rash
and poor wound
healing
? The right ratio of LA to ALA in the

--- Content provided by⁠ FirstRanker.com ---

diet

? About 3:1 or 2:1, is important
? An imbalance in the ratio
? May lead to a variety of mental

--- Content provided by FirstRanker.com ---


disorders,

? including hyperactivity,

--- Content provided by FirstRanker.com ---

depression, brain allergies, and
schizophrenia

? Docosa Hexenoic Acid (DHA-C22)

--- Content provided by FirstRanker.com ---

? Is high in the phospholipids of brain gray matter .

? DHA is rich in Algae and Fishes

? It is the main component of CNS importance for its

--- Content provided by⁠ FirstRanker.com ---


function

? Depletion of DHA in the brain can result in learning

--- Content provided by‌ FirstRanker.com ---

deficits/Cognitive Function.
?DHA appears to

be important for

--- Content provided by‍ FirstRanker.com ---

visual and

neurological

development

--- Content provided by‌ FirstRanker.com ---


? EPA and DHA

supplementation during

--- Content provided by‌ FirstRanker.com ---

pregnancy

? Has evidenced beneficial

effects on long-term

--- Content provided by FirstRanker.com ---


cognitive development in

children
Functions Of Lipids

--- Content provided by​ FirstRanker.com ---


v A concentrated & reserve secondary source of

energy

--- Content provided by​ FirstRanker.com ---

v Physical protection for vessels, nerves, organs
v Insulate against changes in temperature
v Structure of body tissues, cell membranes &

nuclei

--- Content provided by‌ FirstRanker.com ---


v Carry the fat-soluble vitamins (A, D, E, K)
v Give appetite appeal
v Aid satiety (delay emptying time of the

--- Content provided by‌ FirstRanker.com ---

stomach)

v Spare Protein
v Supply Linoleic acid, the other essential fatty

--- Content provided by‌ FirstRanker.com ---

acids.

? High intake of animal origin

food is linked to increased

--- Content provided by‌ FirstRanker.com ---


blood Cholesterol .

? Excess Cholesterol can lead to

--- Content provided by⁠ FirstRanker.com ---

an increased risk of

Atherosclerosis and heart

disease.

--- Content provided by FirstRanker.com ---






--- Content provided by‌ FirstRanker.com ---


Vitamins

? Organic substances that are

--- Content provided by⁠ FirstRanker.com ---

vital for human body.

? Vitamins are accessory

growth factors to human

--- Content provided by‌ FirstRanker.com ---


body.



--- Content provided by‌ FirstRanker.com ---






--- Content provided by⁠ FirstRanker.com ---



? Vitamins are classified into two groups:

? Water-soluble Vitamins:

--- Content provided by‍ FirstRanker.com ---


? Vitamins dissolve in water and pass easily into

the blood during digestion.

--- Content provided by FirstRanker.com ---

? The body does not store these so they need to

be replenished regularly.

? Includes vitamins C, and Vitamin B Complex

--- Content provided by FirstRanker.com ---


members B1 ,B2, B3,B5, B6, Folic acid, and B12.

? Excesses of water soluble

--- Content provided by‍ FirstRanker.com ---

vitamins will be excreted in the

urine.

? However, B-6 and Niacin can be

--- Content provided by FirstRanker.com ---


toxic when ingested in

unusually large amounts.

--- Content provided by⁠ FirstRanker.com ---






--- Content provided by‍ FirstRanker.com ---






--- Content provided by FirstRanker.com ---


? Fat-soluble vitamins

? These include vitamins A, D, E, and

--- Content provided by FirstRanker.com ---

K.

? These Vitamins are absorbed,

stored, and transported through

--- Content provided by​ FirstRanker.com ---

dietary fat.

? Body stores these vitamins in fatty

tissue, liver, and kidneys.

--- Content provided by FirstRanker.com ---


? Excess buildup in tissues can be

toxic.Fat Soluble Vitamins

--- Content provided by⁠ FirstRanker.com ---

? Consist of Vitamins A, D, E, and K
? Absorbed at the small intestine in the

presence of bile (and fatty

--- Content provided by⁠ FirstRanker.com ---

substances).

? Overdoses can be toxic (A and D)
Vitamin Supplementation?

--- Content provided by​ FirstRanker.com ---

? Not necessary if diet is healthy
? Multivitamins are safe (100% RDA)
? Not all vitamins are "pure"
? Can be toxic at high doses

--- Content provided by⁠ FirstRanker.com ---

Vitamin A Role in vision, growth and Fish Liver

differentiation of germinal

Sweet

--- Content provided by​ FirstRanker.com ---


epithelial cells,

potatoes,

--- Content provided by​ FirstRanker.com ---

anticancer

Carrots

Vitamin B

--- Content provided by⁠ FirstRanker.com ---


Form Coenzymes, help

Green leafy

--- Content provided by​ FirstRanker.com ---

enzymes in metabolic

vegetables,

reactions

--- Content provided by FirstRanker.com ---


Fruits, yeast

Vitamin C

--- Content provided by‌ FirstRanker.com ---

Collagen synthesis,

Citrus fruit,

Steroidogenesis, Iron

--- Content provided by⁠ FirstRanker.com ---


tomatoes

metabolism, Healing skin,

--- Content provided by‍ FirstRanker.com ---

preventing colds

Vitamin D

Calcium metabolism,

--- Content provided by​ FirstRanker.com ---


Milk

Strengthen bones

--- Content provided by⁠ FirstRanker.com ---

Sunlight

Vitamin E

Potent Antioxidant,

--- Content provided by​ FirstRanker.com ---


Vegetable

Helps strengthen cells

--- Content provided by FirstRanker.com ---

Oils, nuts




--- Content provided by‌ FirstRanker.com ---






--- Content provided by‍ FirstRanker.com ---






--- Content provided by FirstRanker.com ---






--- Content provided by‌ FirstRanker.com ---






--- Content provided by‌ FirstRanker.com ---





? Most of the vitamins except very few are

--- Content provided by‍ FirstRanker.com ---


not biosynthesized in human body.

? Vitamins are associated with various plant

--- Content provided by‌ FirstRanker.com ---

and animal origin foods of nature.

? Ingestion of foods rich in vitamins is

mandatory for a good health.

--- Content provided by‍ FirstRanker.com ---


? Vitamins helps to maintain growth ,health

and reproduction.

--- Content provided by‌ FirstRanker.com ---

? They do not generate calories/Non calorific

? Most Vitamin B complex members serve as

Coenzymes for Enzyme action.

--- Content provided by‌ FirstRanker.com ---


? Vitamins help to regulate many vital

body processes that include:

--- Content provided by‍ FirstRanker.com ---

? Digestion
? Absorption
? Metabolism
? Bone Ossification
? Vision

--- Content provided by‌ FirstRanker.com ---

? Antioxidant role

?


--- Content provided by​ FirstRanker.com ---



Minerals

Minerals

--- Content provided by⁠ FirstRanker.com ---


? Inorganic elements found in

food that are essential for life

--- Content provided by‍ FirstRanker.com ---

processes

? About 25 are essential Minerals
?Minerals are classified

--- Content provided by⁠ FirstRanker.com ---

as:

?Macro minerals

?Trace minerals

--- Content provided by FirstRanker.com ---


? Macro Minerals: Sodium,

Potassium, Chloride, Calcium,

--- Content provided by‌ FirstRanker.com ---

Phosphorus, Magnesium, Sulfur

? Trace Elements: Iron, Zinc,

Selenium, Molybdenum, Iodine,

--- Content provided by‌ FirstRanker.com ---


Copper, Manganese, Fluoride,

Chromium
Macro Minerals

--- Content provided by​ FirstRanker.com ---


?Calcium

?Is needed for bone

--- Content provided by FirstRanker.com ---

and teeth rigidity

?Helps in blood

clotting,

--- Content provided by‍ FirstRanker.com ---


?Muscle contraction &

normal nerve

--- Content provided by‍ FirstRanker.com ---

functions.
?Phosphorous

?Helps build strong

--- Content provided by‍ FirstRanker.com ---

bones & teeth

?Forms various

Phosphorylated

--- Content provided by FirstRanker.com ---


compounds.

? Sodium, Chloride,

--- Content provided by‍ FirstRanker.com ---

Potassium

? Serve as body Electrolytes

? Work together to regulate

--- Content provided by‌ FirstRanker.com ---


the fluids in the body

? Help regulate the nervous

--- Content provided by FirstRanker.com ---

system, muscle functions

& nutrient absorption in

the cells

--- Content provided by⁠ FirstRanker.com ---

? Magnesium

? Helps regulate body

temperature,

--- Content provided by​ FirstRanker.com ---


? Muscle contractions & the

nervous system

--- Content provided by⁠ FirstRanker.com ---

? Helps cells metabolize

Carbohydrates, Fats, and

Proteins

--- Content provided by‍ FirstRanker.com ---


? Sulfur

? Helps in detoxification

--- Content provided by FirstRanker.com ---

reactions (PAPS)

? Is present in the amino acids

in proteins

--- Content provided by⁠ FirstRanker.com ---


? A component of constituents

of mucopolysaccharides &
essential compounds

--- Content provided by​ FirstRanker.com ---

Microminerals

? Iron combines with Protein

to form Hemoglobin

--- Content provided by‍ FirstRanker.com ---


? Iodine is needed by Thyroid

gland to produce Thyroxine

--- Content provided by‍ FirstRanker.com ---

? Copper is necessary in the

formation of Hemoglobin

? Fluorine helps reduce

--- Content provided by‌ FirstRanker.com ---


incidence of tooth decay

? Zinc plays an important role

--- Content provided by‍ FirstRanker.com ---

in the formation of protein,

? Thus, assists in wound

healing, blood formation and

--- Content provided by‍ FirstRanker.com ---


general growth &

maintenance of all tissues
? Cobalt is a component of

--- Content provided by​ FirstRanker.com ---


vitamin B12

? Manganese is necessary for

--- Content provided by​ FirstRanker.com ---

normal development of bones

and connective tissues

? Chromium maintains normal

--- Content provided by‌ FirstRanker.com ---


glucose uptake into cells &

helps insulin bind to cells

--- Content provided by FirstRanker.com ---

? Selenium along with vitamin

E protects cells from

destruction.

--- Content provided by⁠ FirstRanker.com ---


? Glutathione Peroxidase

contains Selenium.

--- Content provided by‍ FirstRanker.com ---

? Molybdenum is a component

of Xanthine oxidase and

Aldehyde oxidase

--- Content provided by‌ FirstRanker.com ---






--- Content provided by‍ FirstRanker.com ---


? Functions Of Minerals

? Body cannot manufacture Minerals

--- Content provided by​ FirstRanker.com ---

but are needed for forming healthy

bones and teeth .

? Regulate many vital body processes.

--- Content provided by​ FirstRanker.com ---

? Aids in muscle function
? Help transmit messages in nervous

system

--- Content provided by​ FirstRanker.com ---

Mineral Guidelines

? Dietary supplementation of

Calcium is beneficial for post-

--- Content provided by‍ FirstRanker.com ---


menopausal women

? Salt should be limited in the

--- Content provided by‍ FirstRanker.com ---

diet of hypertensives.
Calcium

? Important for preventing osteoporosis
? RDA = 800-1000 mg/day

--- Content provided by​ FirstRanker.com ---

? Found in dairy products and vegetables

High protein diets leach calcium from

bones and promote osteoporosis

--- Content provided by⁠ FirstRanker.com ---


Iron

? Important component of

--- Content provided by FirstRanker.com ---

hemoglobin

? Iron deficiency is known as

anemia

--- Content provided by​ FirstRanker.com ---


(Symptoms: shortness of breath, fatigue)
Antioxidants

? Antioxidants are chemical substances

--- Content provided by‍ FirstRanker.com ---


which fight with free radicals.

? Antioxidants prevents Peroxidation of

--- Content provided by⁠ FirstRanker.com ---

biomolecules.

? Antioxidants protect the biomolecules of

human body.

--- Content provided by‌ FirstRanker.com ---


? Promote healthy status to human body.

Dietary Sources Of Antioxidants

--- Content provided by‍ FirstRanker.com ---

? Pigmented Fruits and Vegetables

? Broccoli

? Cantaloupe

--- Content provided by⁠ FirstRanker.com ---


? Carrot

? Bananas

--- Content provided by‍ FirstRanker.com ---

? Mango

? Pumpkin

? Red Pepper

--- Content provided by FirstRanker.com ---


? Spinach

? Strawberries

--- Content provided by FirstRanker.com ---

? Sweet potato




--- Content provided by FirstRanker.com ---

Fresh Fruit and Vegetables

? These contain Fibre ,Minerals, Vitamins

and Antioxidants.

--- Content provided by​ FirstRanker.com ---





?Water makes up

--- Content provided by FirstRanker.com ---


around 65% of

the body weight.

--- Content provided by⁠ FirstRanker.com ---

Remember

?It's important to

drink at least 8 cups

--- Content provided by‌ FirstRanker.com ---


of water a day to

maintain health.

--- Content provided by FirstRanker.com ---


Role Of Body Water

? Water is essential to keep the body

--- Content provided by‍ FirstRanker.com ---

healthy.

? It helps to cook , swal ow and digest

food.

--- Content provided by⁠ FirstRanker.com ---


? It keeps the body hydrated.

? Water Helps to Maintain

--- Content provided by​ FirstRanker.com ---

Many bodily functions.

? Chief component of blood plasma

which serves as a transport media.

--- Content provided by FirstRanker.com ---


? Bodies solvent helps in metabolic

reactions(Hydrolase and Hydratase).

--- Content provided by FirstRanker.com ---

? Lubricates joints and mucous

membranes.


--- Content provided by‍ FirstRanker.com ---

? Serve as Shock absorber in eyes,

spinal cord, and amniotic sac

(during pregnancy).

--- Content provided by⁠ FirstRanker.com ---


? Absorb , transport and eliminate

nutrients and metabolic wastes.

--- Content provided by‌ FirstRanker.com ---

? Perspiration/sweating helps to

maintain normal body

temperature.

--- Content provided by​ FirstRanker.com ---


Remember

?Man can live for many

--- Content provided by‍ FirstRanker.com ---

days without food,


?But cannot live few

--- Content provided by​ FirstRanker.com ---

days without water.
Calorific Values Of Food

OR

--- Content provided by‌ FirstRanker.com ---

Energy Content Of Food

Calorimetry
?Calorimetry is a term

--- Content provided by‌ FirstRanker.com ---

used to measure energy

content of food and its

nutrients.

--- Content provided by‌ FirstRanker.com ---


? Calorific value of food is defined

as :

--- Content provided by​ FirstRanker.com ---

? An amount of energy released

by the combustion of 1 gram of

nutrient.

--- Content provided by FirstRanker.com ---


(Carbohydrate/Lipid/Protein)
Determination

Of

--- Content provided by FirstRanker.com ---


Calorific Values of Food

?Bomb Calorimeter is used

--- Content provided by FirstRanker.com ---

to determine Calorific

values of food nutrients.
Bomb Calorimeter

--- Content provided by⁠ FirstRanker.com ---

? It is a closed metal ic Oxygen

chamber with electrical y heated

platinum wires.

--- Content provided by⁠ FirstRanker.com ---


? When food is placed inside it and

operated

--- Content provided by​ FirstRanker.com ---

? It combust the Nutrients and

determines the calorific value of

foods.

--- Content provided by‍ FirstRanker.com ---


? Nowadays there are highly

automated efficient

--- Content provided by​ FirstRanker.com ---

combustion Calorimetric

systems available

? To compute the energy

--- Content provided by⁠ FirstRanker.com ---


contents of food and body.
Kilocalories

? Kilocalorie/Calorie is a Unit

--- Content provided by​ FirstRanker.com ---


for measuring heat energy, of

food and energy requirement

--- Content provided by​ FirstRanker.com ---

for the body.

? When you hear "Calorie," it is

real y a kilocalorie

--- Content provided by‌ FirstRanker.com ---


173

Definition of Kilocalorie

--- Content provided by‍ FirstRanker.com ---

? 1 kilocalorie is amount of

heat required to raise the

temperature of 1 gram of

--- Content provided by‍ FirstRanker.com ---


water with 1 degree Celsius.
Calorific Contents of Nutrients

? Macronutrients ( Calorific)

--- Content provided by‌ FirstRanker.com ---


?Carbohydrates = 4 Cal/g

?Proteins = 4 Cal/g

--- Content provided by FirstRanker.com ---

( 5.3 Cal/g in Bomb Calorimeter)

?Fats = 9 Cal/g
?Carbohydrates and

--- Content provided by‌ FirstRanker.com ---

Fats are completely

oxidized in the body

to CO2 and H2O.

--- Content provided by⁠ FirstRanker.com ---


? Proteins are not completely

oxidized in the body.

--- Content provided by‍ FirstRanker.com ---

? Nitrogenous excretory product

Urea stil contain oxidizable

carbon and hydrogen in it.

--- Content provided by⁠ FirstRanker.com ---

? Micronutrients (Non Calorific)

?Vitamins = 0 Cal/g

?Minerals = 0 Cal/g

--- Content provided by​ FirstRanker.com ---


?Water = 0 Cal/g

Calorific value of Foods

--- Content provided by FirstRanker.com ---

? Food contain mixture of nutrients.

? Calorific value of foods depends

upon the amount of nutrients

--- Content provided by FirstRanker.com ---


present in it.
Calculation of Calorific Value

of

--- Content provided by FirstRanker.com ---


Food Stuffs

? Food energy is the amount of

--- Content provided by⁠ FirstRanker.com ---

energy liberated by food

nutrients.

? Through digestion absorption

--- Content provided by FirstRanker.com ---


and assimilation of food

nutrients.
Energy is provided by the following

--- Content provided by FirstRanker.com ---


Carbohydrates:

60% (45-65%) of the diet
1gm provides 4 kcal

--- Content provided by​ FirstRanker.com ---


Fats:

35% (25-45%) of the diet
1gm short-chain provides 5.3 kcal

--- Content provided by‌ FirstRanker.com ---

1gm medium-chain provides 8.3 kcal
1gm long-chain provides 9 kcal

Proteins:

--- Content provided by‍ FirstRanker.com ---

11% (9-15%) of the diet
1gm provides 4 kcal

Calculation Of Energy Content

--- Content provided by​ FirstRanker.com ---

Of Foods
100 gram of Wheat flour contains

? 69.6 gm Carbohydrates
? 12.0 gm Proteins

--- Content provided by FirstRanker.com ---

? 1.5 gm Fat

? Calories of 100 gm Wheat flour=
(69.6x4)+(12x4)+(9x1.5)=340 Calories

--- Content provided by​ FirstRanker.com ---

? Energy Content of foods is computed

as:

? Multiplying the amounts of calorific

--- Content provided by‌ FirstRanker.com ---


nutrients in 100 gm of food with their

physiological calorific values.

--- Content provided by⁠ FirstRanker.com ---

? Final y adding up the values.
Energy Requirements by

Human body

--- Content provided by⁠ FirstRanker.com ---

? Human body daily requires sufficient

amount of energy to expend on

various body activities.

--- Content provided by‍ FirstRanker.com ---


? This energy need is provided by

combustion/oxidation of food

--- Content provided by​ FirstRanker.com ---

nutrients of calorific values.

?Usual y Carbohydrates and Fats
?In emergencies Proteins.
Energy Requirement By

--- Content provided by‌ FirstRanker.com ---


Human Body Differs

In Different

--- Content provided by‍ FirstRanker.com ---

Phases Of Life

?Approximately 80-120

kcal/kg body weight for

--- Content provided by​ FirstRanker.com ---


the 1st year of life.

?Approximate 2500

--- Content provided by‍ FirstRanker.com ---

Kcal/day for an Adult

individual


--- Content provided by​ FirstRanker.com ---

An Amount of Energy Needed by a body is

Based on:

1. Basal Metabolism (BMR)

--- Content provided by FirstRanker.com ---


2. Physical Activities

3. Specific Dynamic Action of foods(SDA)/

--- Content provided by​ FirstRanker.com ---

Thermic effect



RQ for mixed diet is .82

--- Content provided by​ FirstRanker.com ---


from 40% CHO & 60%

fat.

--- Content provided by FirstRanker.com ---

? Non-protein RQ is

between 0.7 and 1.0.

? Thermal equivalents

--- Content provided by​ FirstRanker.com ---


of oxygen for different

non-protein mixtures.
BMR > Activity > Dietary Thermogenesis

--- Content provided by‌ FirstRanker.com ---


Basal Metabolic Rate

(BMR)
What Is

--- Content provided by‌ FirstRanker.com ---


? Basal Metabolic Rate (BMR) ?

?BMR is the minimum

--- Content provided by FirstRanker.com ---

amount of energy required

by the body to maintain life

in basal condition.

--- Content provided by​ FirstRanker.com ---


? Basal condition of body is :

1) Post absorptive phase

--- Content provided by‍ FirstRanker.com ---

2) Awake condition

3) Thermo neutral

environment

--- Content provided by​ FirstRanker.com ---


4) Complete physical and

mental rest
?BMR is the minimum

--- Content provided by‌ FirstRanker.com ---


resting energy

expenditures by an

--- Content provided by⁠ FirstRanker.com ---

awake alert person.

? The energy required in basal condition is

consumed for the involuntary actions of

--- Content provided by⁠ FirstRanker.com ---


body viz

?Pumping of Heart
?Blood Circulation

--- Content provided by⁠ FirstRanker.com ---

?Respiration process by Lungs
?Muscular Twitching and reflexes
?Intestinal Peristalsis
?Metabolic Reactions
?Renal Functions

--- Content provided by FirstRanker.com ---

Determination Of BMR

Preparation Of Patient

For BMR Estimation

--- Content provided by‌ FirstRanker.com ---



? In early morning subject should be

in:

--- Content provided by‍ FirstRanker.com ---


?Post absorptive phase (12 hr Fast)

?Physical y and mental y relaxed

--- Content provided by FirstRanker.com ---

?Lying position, awake condition

?Room Temperature should be

around 21-25 degree centigrade

--- Content provided by⁠ FirstRanker.com ---


?Normal humidity

? Direct Method For BMR

--- Content provided by FirstRanker.com ---

Determination Using :

?Benedict Roth Apparatus
?Dubois Apparatus
? Benedict-Roth Apparatus

--- Content provided by‍ FirstRanker.com ---


? Calculates the amount of

Oxygen consumed under the

--- Content provided by⁠ FirstRanker.com ---

specific basal conditions.

? Oxygen consumption for 2-6

minutes and measure the value

--- Content provided by​ FirstRanker.com ---


from graph.

? Indirect Method of BMR

--- Content provided by⁠ FirstRanker.com ---

Determination:

?Analysis of expired air
?Determining of O2 consumption and

--- Content provided by​ FirstRanker.com ---

CO2 output.

? The total heat production is

determined and is then

--- Content provided by​ FirstRanker.com ---


? Calculated per sq.m of body surface per

hour
BMR= Total heat production in Cal/hr

--- Content provided by‌ FirstRanker.com ---


Body surface area in Sq.m

Normal Values Of BMR

--- Content provided by‍ FirstRanker.com ---

? Males= 35-40 kcal/ sq.m /hr

? Females= 30-35 kcal/ sq.m /hr
? Indirect Calorimetry:

--- Content provided by​ FirstRanker.com ---

? Calculates Respiratory Quotient

? Oxygen Consumption

? Carbon Dioxide Production

--- Content provided by‍ FirstRanker.com ---


? Spirometer or Respirometer

apparatus is used to measure

--- Content provided by FirstRanker.com ---

the amount of Oxygen

consumed and Carbon dioxide

produced.

--- Content provided by FirstRanker.com ---


? This helps in calculating the

energy expended.
Respiratory Quotient

--- Content provided by​ FirstRanker.com ---


? Respiratory Quotient (RQ) is ratio

of volume of carbon dioxide

--- Content provided by⁠ FirstRanker.com ---

produced to volume of Oxygen

consumed by an individual in a

given interval of time.

--- Content provided by⁠ FirstRanker.com ---


Respiratory Quotient (RQ)

Volume of CO2 Produced

--- Content provided by‌ FirstRanker.com ---

RQ = Volume of O2 Consumed

At the CELL

Each substrate has its own RQ value.

--- Content provided by​ FirstRanker.com ---


(Carbohydrates (1.0) vs Fatty acids (0.7))
? Respiratory Quotient (RQ)

?Amt CO2 produced/O2 consumed

--- Content provided by‌ FirstRanker.com ---


?Varies for different Calorific Nutrients

? Amount of CO2 formed does not always

--- Content provided by⁠ FirstRanker.com ---

equal amount of O2 consumed

RQ for CHO and FAT

Carbohydrate (Glucose):

--- Content provided by‌ FirstRanker.com ---


C6H12O6 + 6O2 6CO2 + 6H2O + Energy

RQ = 6CO2 / 6O2 = 1.00

--- Content provided by‌ FirstRanker.com ---

Fat (Palmitic Acid):

C16H32O2 + 23O2 16CO2 + 16H2O + Energy

RQ = 16CO2 / 23O2 = 0.70

--- Content provided by​ FirstRanker.com ---

?R.Q of Protein is 0.8
?R.Q of Mixed diet is 0.85

? R.Q in Heavy work exceeds more than 1.

--- Content provided by‌ FirstRanker.com ---

?During heavy exercise the tissue

metabolism is increased.

?CO2 out put is increased by

--- Content provided by FirstRanker.com ---


enhanced pulmonary

ventilation

--- Content provided by‍ FirstRanker.com ---

?Oxygen consumption is not

proportionately increased.
? Thus R.Q is an indicator of metabolic

--- Content provided by⁠ FirstRanker.com ---

status.

? R.Q of food stuffs depend upon:

? Type of food Nutrients

--- Content provided by FirstRanker.com ---

?Their varying proportions

?RQ value can be used to

find the amount energy

--- Content provided by‍ FirstRanker.com ---


produced per litre of

Oxygen consumed
? Conditions increasing R.Q

--- Content provided by‌ FirstRanker.com ---


? Violent Exercise
? Fever
? Acidosis

--- Content provided by FirstRanker.com ---

? Conditions Decreasing R.Q

? Starvation
? Diabetes mellitus
? Alkalosis

--- Content provided by​ FirstRanker.com ---

Significance Of R.Q

? R.Q value helps in:

?Estimation of Basal Metabolic Rate

--- Content provided by FirstRanker.com ---

?Type of food oxidized
?Diagnosis of various pathological

conditions such as Acidosis ,

--- Content provided by‍ FirstRanker.com ---

Diabetes mel itus ,fever etc.

? To estimate the Calories needed

for basal metabolism/hour:

--- Content provided by FirstRanker.com ---


?For Men: Multiply body weight

(lbs) by 11

--- Content provided by​ FirstRanker.com ---

?For Women: Multiply body

weight (lbs) by 10
Average Calories Required for Basal Metabolism is

--- Content provided by⁠ FirstRanker.com ---

70 C/hr or 1680 C/day

Factors Affecting BMR
BMR is Influenced By Many Factors.

--- Content provided by‌ FirstRanker.com ---

? Age
? Sex
? Body Surface Area
? Climate/Environmental Temperature
? Nutritional Status

--- Content provided by‌ FirstRanker.com ---

? Hormones
? Pregnancy

? Physical Activity- Exercises
? Circadian Rhythms

--- Content provided by‌ FirstRanker.com ---


? Emotional State

? Smoking and Caffeine

--- Content provided by‍ FirstRanker.com ---

? Body temperature

? Diseases

? Digestive Processing

--- Content provided by​ FirstRanker.com ---


(Specific Dynamic Action)

? Aquatic Salinity (Osmoregulation)

--- Content provided by​ FirstRanker.com ---



Age

? Infants and children have much

--- Content provided by‍ FirstRanker.com ---


higher BMR than adults.

? Growth increases BMR.
? Highest BMR is noted at age of 5-6 yrs

--- Content provided by FirstRanker.com ---


(58kcal/sq.m/hr)

? BMR is gradually decreased as age

--- Content provided by⁠ FirstRanker.com ---

proceeds
Gender/Sex

? BMR of men is always higher

--- Content provided by‌ FirstRanker.com ---

than women.

? Men possess

? increased lean muscle mass.

--- Content provided by‌ FirstRanker.com ---

? increased physical activities.

Body Surface Area

? Body surface area is related to

--- Content provided by‍ FirstRanker.com ---


height and weight of an

individual.

--- Content provided by‌ FirstRanker.com ---

? BMR is directly proportional to the

body surface area.
?Increased Body Surface

--- Content provided by‍ FirstRanker.com ---

(lean muscle) area has

greater BMR.

?Lean muscle mass is

--- Content provided by‍ FirstRanker.com ---


more metabolical y

demanding than Fatty

--- Content provided by⁠ FirstRanker.com ---

tissue.
? Lean tal persons with greater

muscle mass has higher BMR.

--- Content provided by⁠ FirstRanker.com ---

? Obese short persons with

lower lean muscle mass has

lower BMR.

--- Content provided by‌ FirstRanker.com ---


? Lower body Fat percentage

higher is the BMR.

--- Content provided by FirstRanker.com ---

? Higher the body Fat percentage

lower is the BMR.
Climate/Environment Temperature

--- Content provided by​ FirstRanker.com ---

? BMR is decreased in summer
? BMR is increased in winters

Nutrition

--- Content provided by​ FirstRanker.com ---

?BMR is lower in

persons with

malnutrition and

--- Content provided by‍ FirstRanker.com ---


starvation.
Endocrine Secretion/Hormones

? Thyroid hormone influences

--- Content provided by⁠ FirstRanker.com ---


directly on BMR

?BMR is increased in

--- Content provided by‌ FirstRanker.com ---

hyperthyroidism

?BMR is decreased in

hypothyroidism.

--- Content provided by FirstRanker.com ---


?High levels of Growth

hormone and Epinephrine

--- Content provided by​ FirstRanker.com ---

also increases BMR.
Pregnancy

?BMR is raised by 5%

--- Content provided by⁠ FirstRanker.com ---

in pregnancy.

BMR For Physical Activity
ACTIVITY LEVEL

--- Content provided by⁠ FirstRanker.com ---

PERCENTAGE OF BASAL

METABOLISM CALORIES

Inactive: sitting most of the

--- Content provided by‌ FirstRanker.com ---


30%

day; <2 hours moving about

--- Content provided by FirstRanker.com ---

slowly or standing

Moderate: sitting most of

50%

--- Content provided by‍ FirstRanker.com ---


the day; walking or standing

2-4 hours, no strenuous

--- Content provided by FirstRanker.com ---

activity

Active: physically active for

75%

--- Content provided by FirstRanker.com ---


>4 hours a day; little sitting

or standing; some strenuous

--- Content provided by​ FirstRanker.com ---

activity

Thus BMR Increases With

Rate Of Physical Activity

--- Content provided by​ FirstRanker.com ---

Circadian Rhythms

? BMR is lower in sleep
? BMR is higher in awake

--- Content provided by‌ FirstRanker.com ---


Emotional State

? Stress increases BMR
Smoking and Caffeine

--- Content provided by‍ FirstRanker.com ---


?Smoking and ingestion

of Caffeine increases

--- Content provided by‌ FirstRanker.com ---

BMR.

Body Temperature

? BMR increases with increasing

--- Content provided by FirstRanker.com ---


body temperature .

? An elevation of body temperature

--- Content provided by⁠ FirstRanker.com ---

above 370C will increase BMR by

13% per 0C.

? Thus in Fever BMR is raised.

--- Content provided by FirstRanker.com ---

BMR In Diseased Conditions

? BMR is increased in

? Fevers

--- Content provided by‍ FirstRanker.com ---

? Leukemia
? Cardiac Failure
? Hypertension
? Metabolic disorders
? Surgery

--- Content provided by‌ FirstRanker.com ---

? Infections
? Anorexia

Significance Of BMR Calculation

--- Content provided by​ FirstRanker.com ---

? BMR values help in calculating

energy requirement of an

individual body which help in

--- Content provided by⁠ FirstRanker.com ---


planning of diets.

? To know the effect of food and

--- Content provided by‌ FirstRanker.com ---

drugs on BMR.
? BMR value checks the basal

metabolism and disease

--- Content provided by⁠ FirstRanker.com ---

conditions.

? BMR values help in assessing

Thyroid function.

--- Content provided by‍ FirstRanker.com ---


Energy Required For

Physical Activities
? Energy requirement for an

--- Content provided by‍ FirstRanker.com ---


individual per day varies from:

? Person to person
? Action to action

--- Content provided by FirstRanker.com ---

?Mode of life style
?Type of occupation

Energy Requiring Factors For Physical

--- Content provided by​ FirstRanker.com ---

Activities

? Age
? Sex
? Body Surface Area ?

--- Content provided by​ FirstRanker.com ---

Body weight ,size and height
? Nature of work
? Duration and intensity of work.
Workers

--- Content provided by⁠ FirstRanker.com ---

Calories/Day

B.M.R %

Light Workers

--- Content provided by‍ FirstRanker.com ---


2200-2500

30-40%

--- Content provided by⁠ FirstRanker.com ---

Teachers, Doctors, Office

Workers

Moderate Workers

--- Content provided by⁠ FirstRanker.com ---


2500-3000

40-50%

--- Content provided by‍ FirstRanker.com ---

Students, House wives

Heavy Workers

3000-3500

--- Content provided by​ FirstRanker.com ---


50-60%

Farmers ,Miners, Athlete

--- Content provided by⁠ FirstRanker.com ---

Very Heavy Workers

3500-4000

60-100%

--- Content provided by‍ FirstRanker.com ---


Rickshaw Pullers,

Construction Workers

--- Content provided by‌ FirstRanker.com ---

Activity

Energy Expenditure in

Calories/ hour

--- Content provided by‍ FirstRanker.com ---


Sitting

25 Calories/hour

--- Content provided by⁠ FirstRanker.com ---

Standing

30 Calories/hour

Writing

--- Content provided by‌ FirstRanker.com ---


30 Calories/hour

Car Driving

--- Content provided by⁠ FirstRanker.com ---

60 Calories/hour

Typing

75 Calories/hour

--- Content provided by‌ FirstRanker.com ---


Walking Upstairs

800 Calories/hour
Every physical activity needs energy above BMR

--- Content provided by⁠ FirstRanker.com ---


Energy Cost of Physical Activities

Activity

--- Content provided by​ FirstRanker.com ---

Cal/KgBW/Hour

Bicycling (fast)

7,6

--- Content provided by‍ FirstRanker.com ---


Bicycling (slow)

2,5

--- Content provided by‍ FirstRanker.com ---

Dancing (foxtrot)

3,8

Dancing (waltz)

--- Content provided by⁠ FirstRanker.com ---


3,0

Dish washing

--- Content provided by‌ FirstRanker.com ---

1,0

Driving

0,9

--- Content provided by‍ FirstRanker.com ---


Table tennis

4,4

--- Content provided by FirstRanker.com ---

Marathon run

7,0

Sawying

--- Content provided by⁠ FirstRanker.com ---


5,7

Walking 5 km/h

--- Content provided by⁠ FirstRanker.com ---

2,0

Writing

0,4

--- Content provided by FirstRanker.com ---


Playing piano

2,0

--- Content provided by‍ FirstRanker.com ---

Sewing

0,6

Specific Dynamic Action

--- Content provided by FirstRanker.com ---


(SDA)

Thermogenic Effect Of

--- Content provided by FirstRanker.com ---

Food (TEF)
SDA also termed as

Calorigenic Action Of Food.

--- Content provided by‌ FirstRanker.com ---

? SDA is the extra heat

produced when food is

consumed by the body,

--- Content provided by‍ FirstRanker.com ---


over and above the

calculated calorific value.
? 25 gm of dietary proteins when

--- Content provided by⁠ FirstRanker.com ---


consumed in the body should

produce 100 Calories of energy.

--- Content provided by‌ FirstRanker.com ---

? 25 x 4= 100 Calories
? But actual heat produced is 130

Calories

--- Content provided by​ FirstRanker.com ---

? Thus 30 Calories of energy is extra.

? SDA is referred to an increased

heat production following an

--- Content provided by​ FirstRanker.com ---


intake of food.

? SDA heat is expended for

--- Content provided by FirstRanker.com ---

digestion and absorption of

food.
SDA or TEF

--- Content provided by​ FirstRanker.com ---

?SDA of Protein diet 30%

?SDA of Carbohydrate diet 5%

?SDA of Lipid diet 13%

--- Content provided by⁠ FirstRanker.com ---


Dietary Proteins

Has Highest SDA Values
? Protein rich meal eaten in hot

--- Content provided by FirstRanker.com ---


weather feels the body hot

and sweaty.

--- Content provided by‍ FirstRanker.com ---

? Protein rich meal in cold

weather provide cozy and

comfortable feeling.

--- Content provided by​ FirstRanker.com ---


? SDA accounts for

approximately 10% of the

--- Content provided by​ FirstRanker.com ---

body's total energy need

(basal needs and energy

needs)

--- Content provided by‌ FirstRanker.com ---

SDA of food is the amount of

energy required to digest mixed food

(Carbohydrate, protein, lipid, fruit &

--- Content provided by​ FirstRanker.com ---


vegetable).
Approximately 10% of BMR is

required as the SDA of food

--- Content provided by‍ FirstRanker.com ---


Adult 60 Kg, requires BMR =24 Cal/kg

BMR

--- Content provided by FirstRanker.com ---

= 1440 Cal

SDA

= 144 Cal

--- Content provided by FirstRanker.com ---


Total = 1584 Cal (BMR+SDA)

Significance Of SDA

--- Content provided by​ FirstRanker.com ---

? Heat of SDA can be utilized

for maintaining body

temperature but not for

--- Content provided by‍ FirstRanker.com ---


muscular activity.

Conditions with Decreased SDA

--- Content provided by⁠ FirstRanker.com ---

? Conditions where amino acid catabolism

decreased

? SDA is decreased

--- Content provided by FirstRanker.com ---


?Starvation
?Growth
?Pregnancy
?Convalescence period (Recovery )

--- Content provided by FirstRanker.com ---

Balanced Diet

OR

Prudent Diet

--- Content provided by⁠ FirstRanker.com ---


(Thoughtful And Careful Way Of Eating)

? Nutrition is a first need of human

--- Content provided by​ FirstRanker.com ---

beings.

? General health and wel being of a

body depends on

--- Content provided by FirstRanker.com ---


? Nutritional status of an individual
?If human body is considered as a

Machine

--- Content provided by‌ FirstRanker.com ---


?Food is our fuel

Composition of Food Nutrients

--- Content provided by FirstRanker.com ---

Determines:

?Bodies composition and built
?Bodies strength to cope up with

--- Content provided by FirstRanker.com ---

interacting environmental

pol utants
?Bodies capacity to grow, repair and

--- Content provided by​ FirstRanker.com ---

reproduce.




--- Content provided by FirstRanker.com ---

What Is a Balanced Diet?

Balanced Diet

IS A Planned Diet At Various

--- Content provided by​ FirstRanker.com ---


Physiological States

Balanced Diet A Healthy Diet
? Nutritionists planned the diet considering :

--- Content provided by‌ FirstRanker.com ---


? Various physiological phases of human life

? Human Nutritional requirement of the body

--- Content provided by FirstRanker.com ---

?Calculates the energy requirement per day

related to

?BMR and various physical activities.

--- Content provided by‌ FirstRanker.com ---


?Its necessary to maintain balanced diet

since:
?What we eat today, will affect our health

--- Content provided by FirstRanker.com ---


in the future.


Maintain Balanced Diet By

--- Content provided by​ FirstRanker.com ---


?Eating items from al food groups

?With appropriate quantity and good quality to

--- Content provided by FirstRanker.com ---

provide all nutritionally essential nutrients.

?Eating properly and regularly (Timely) without

skipping the whole meals.

--- Content provided by​ FirstRanker.com ---


? It is especial y important to

take care of eating during

--- Content provided by⁠ FirstRanker.com ---

? Growth, Pregnancy and

lactation

?Remember a young plant, not

--- Content provided by​ FirstRanker.com ---


given proper nutrients grows up

to a poor specimen with less/no

--- Content provided by‍ FirstRanker.com ---

fruits and flowers.
Features of Balanced Diet

? Balanced diet provides the

--- Content provided by FirstRanker.com ---

mixture of al dietary nutrients

in:

?Adequate quantity

--- Content provided by‌ FirstRanker.com ---


(Restrict to RDA values)

?Good quality

--- Content provided by‌ FirstRanker.com ---

? Balanced Diet Provides

?Calorific needs
?Building blocks
?Accessory Growth factors

--- Content provided by FirstRanker.com ---

?Balanced diet does not

al ow an individual

?To ingest any one

--- Content provided by​ FirstRanker.com ---


dietary nutrient in

excess or less amount.

--- Content provided by FirstRanker.com ---

?Thus Balanced diet

prevents a body


--- Content provided by‍ FirstRanker.com ---

?To suffer from over or

under nutritional

disorders.

--- Content provided by‍ FirstRanker.com ---

Points To Consider

While Planning For Balanced Diet

1. Physiological States

--- Content provided by‌ FirstRanker.com ---

2. BMR (Considering al factors)
3. Physical activities of an individual
4. SDA

? The food included during planning of

--- Content provided by‌ FirstRanker.com ---


balanced diet should be local y

available

--- Content provided by⁠ FirstRanker.com ---

? The food should be within economic

means of people.
? It should fit with local food habits.

--- Content provided by FirstRanker.com ---

? Balanced diet food items should be

easily digestible and palatable.

? The food eaten should contain al

--- Content provided by​ FirstRanker.com ---


the chief constituents which

suffice bodies health, growth and

--- Content provided by⁠ FirstRanker.com ---

reproduction.

? An individual should eat fol owing food

groups in recommended quantity and

--- Content provided by​ FirstRanker.com ---


quality and maintain balanced diet.

?Cereals and Pulses
?Milk

--- Content provided by‌ FirstRanker.com ---

?Meat and Fish
?Vegetables and Fruits
? RDA values differ during

different physiological states

--- Content provided by‍ FirstRanker.com ---


of human body

? viz growth, pregnancy,

--- Content provided by FirstRanker.com ---

lactation and convalescence.

Points To Remember

? During growth, pregnancy and

--- Content provided by‌ FirstRanker.com ---


Lactation the dietary intake

should be increased

--- Content provided by‍ FirstRanker.com ---

? To build the body and maintain

reproduction respectively.
Indian Balanced Diet

--- Content provided by‌ FirstRanker.com ---

? The Nutrition Expert Group

constituted by ICMR

? Taking into account of Indian

--- Content provided by‌ FirstRanker.com ---


available foods

? Has recommended the composition

--- Content provided by⁠ FirstRanker.com ---

of Balanced diets for Indians.

The Indian balanced diet composed of

? Cereals : Rice, Wheat,Jawar

--- Content provided by​ FirstRanker.com ---


? Pulses

? Vegetables- Roots,Tubers

--- Content provided by FirstRanker.com ---

? Fruits

? Milk and Milk products

? Oil

--- Content provided by⁠ FirstRanker.com ---


? Sugar

? Fish

--- Content provided by​ FirstRanker.com ---

? Meat

? Eggs
Recommended Daily Al owance(RDA)

--- Content provided by‌ FirstRanker.com ---

? RDA of Chief Nutrients for an Adult Individual
? Prescribed by WHO
? Modified by ICMR as per Indian conditions

Nutrient

--- Content provided by FirstRanker.com ---


RDA in Grams

Carbohydrates

--- Content provided by​ FirstRanker.com ---

400 gm

Fats

70 gm

--- Content provided by‍ FirstRanker.com ---


Proteins

60 gm

--- Content provided by FirstRanker.com ---

Fiber

40 gm

? Carbohydrate content of

--- Content provided by FirstRanker.com ---


Some common foods

Food Item

--- Content provided by‌ FirstRanker.com ---

Carbohydrate Content

Cane Sugar

100 %

--- Content provided by⁠ FirstRanker.com ---


Rice

80%

--- Content provided by⁠ FirstRanker.com ---

Wheat

70-80%

Bread

--- Content provided by FirstRanker.com ---


50-60%

Potatoes

--- Content provided by⁠ FirstRanker.com ---

25%
Vitamins

RDA

--- Content provided by​ FirstRanker.com ---

Vitamin A



3000- 4000 IU

--- Content provided by‍ FirstRanker.com ---


Vitamin D

200-400 IU

--- Content provided by FirstRanker.com ---

Vitamin E



9 mg

--- Content provided by‍ FirstRanker.com ---


Vitamin K

70 ug

--- Content provided by‍ FirstRanker.com ---

Vitamin C

60 mg

Folate

--- Content provided by​ FirstRanker.com ---


400 ug

Thiamine (B1)

--- Content provided by FirstRanker.com ---



1.2 mg

Vitamins

--- Content provided by FirstRanker.com ---


RDA

Biotin

--- Content provided by‌ FirstRanker.com ---

30 mcg

Riboflavin (B2)

1.2 mg

--- Content provided by⁠ FirstRanker.com ---


Niacin (B3)

15mg

--- Content provided by‍ FirstRanker.com ---

Pantothenic (B5)

5 mg

Pyridoxine (B6)

--- Content provided by‌ FirstRanker.com ---


1.6 mg

Cyanocobalamin (B12)

--- Content provided by‍ FirstRanker.com ---

2.4 ug
Minerals

RDA

--- Content provided by‍ FirstRanker.com ---

Calcium (Ca)

1200 mg

Phosphorus (P)

--- Content provided by‌ FirstRanker.com ---


700 mg

Magnesium (Mg)

--- Content provided by‌ FirstRanker.com ---

370 mg

Sodium (Na)

500 mg

--- Content provided by⁠ FirstRanker.com ---


Chloride (Cl)

750 mg

--- Content provided by FirstRanker.com ---

Potassium (K)

2000 mg

Minerals

--- Content provided by‌ FirstRanker.com ---


RDA

150 ug

--- Content provided by⁠ FirstRanker.com ---

Iodine (I)
Iron (Fe)

10 mg

--- Content provided by‌ FirstRanker.com ---

Copper (Cu)

1.5 mg

Zinc (Zn)

--- Content provided by⁠ FirstRanker.com ---


14 mg

Selenium (Se)

--- Content provided by‌ FirstRanker.com ---

60 ug


Minerals

--- Content provided by​ FirstRanker.com ---

RDA

Molybdenum (Mo)

75 ug

--- Content provided by‍ FirstRanker.com ---




Manganese (Mn)

--- Content provided by​ FirstRanker.com ---

2 mg

Fluoride (F)

4 mg

--- Content provided by‍ FirstRanker.com ---


Chromium (Cr)

50 ug

--- Content provided by FirstRanker.com ---

q Eat different forms of foods to

keep healthy

qOR

--- Content provided by‌ FirstRanker.com ---


qEat varied type of diet in a day



--- Content provided by⁠ FirstRanker.com ---


Eat A Balanced Diet

Guidelines for

--- Content provided by‌ FirstRanker.com ---

Healthy Eating

Fol ow principles in the Food Guide Pyramid


--- Content provided by‍ FirstRanker.com ---

? 75% of a day's

food

? Should come

--- Content provided by FirstRanker.com ---


from grains,

vegetables and

--- Content provided by⁠ FirstRanker.com ---

fruits

? Extra servings of green

and yellow vegetables

--- Content provided by‍ FirstRanker.com ---


may be beneficial

? Extra consumption of

--- Content provided by⁠ FirstRanker.com ---

citrus and other fruits

may be beneficial
Tips For Eating Wel

--- Content provided by‌ FirstRanker.com ---

? Eat regular meals
? Do not skip breakfast
? Eat foods from al food

groups /According to the

--- Content provided by‌ FirstRanker.com ---


food pyramid

? Limit processed /Junk food
?Prefer meals on starchy

--- Content provided by⁠ FirstRanker.com ---


foods

?Eat Egg and Fish

--- Content provided by‌ FirstRanker.com ---

?Eat adequate amounts of

vitamins and minerals

?Eat lots of fruit and

--- Content provided by FirstRanker.com ---


vegetables

? Eat fresh and natural foods
? Cut down saturated fats , trans fats and

--- Content provided by‍ FirstRanker.com ---


refined sugars.

? Try to eat less salt (no more than 5g/day)
? Restrict Alcohol

--- Content provided by‍ FirstRanker.com ---

? Limit Tea and coffee
? Drink plenty of water
? Remain active and try to maintain a

healthy weight.

--- Content provided by​ FirstRanker.com ---






--- Content provided by‌ FirstRanker.com ---




Regularly Recal the 8 tips

--- Content provided by⁠ FirstRanker.com ---

Significance Of Balanced Diet


Balanced Diet

--- Content provided by​ FirstRanker.com ---

Makes Life

Healthy And Happy

? Eating balanced diet right from the

--- Content provided by‍ FirstRanker.com ---


beginning of life builds:

? The organ system of human body

--- Content provided by‌ FirstRanker.com ---

with ful of strength and vital

capacity

? This prepares the body to face any

--- Content provided by​ FirstRanker.com ---


critical conditions.

?Metabolic stress
?Infections etc

--- Content provided by‍ FirstRanker.com ---

?Balanced diet Significantly

? Maintains bodies normal growth , health

and reproduction.

--- Content provided by‍ FirstRanker.com ---


? Prevents from the suffering of nutritional

disorders.

--- Content provided by‌ FirstRanker.com ---

? Increases span of healthy and happy life.

Energy Balance and Imbalance
?Body weight is stable

--- Content provided by​ FirstRanker.com ---

when energy consumed

is equal to energy

expended.

--- Content provided by‍ FirstRanker.com ---


?This is termed as

Nitrogen balance.

--- Content provided by​ FirstRanker.com ---

Energy Balance:

Input vs Output
One pound of body weight is equal to

--- Content provided by‌ FirstRanker.com ---

3,500 kilocalories

?Body weight increases,

when energy consumed

--- Content provided by​ FirstRanker.com ---


is greater than energy

expended.
?Body weight decreases

--- Content provided by‌ FirstRanker.com ---


when energy consumed is

less than it expenditure.

--- Content provided by​ FirstRanker.com ---

? Balanced Energy Intake: not losing or

gaining weight

? Negative Energy Balance

--- Content provided by‍ FirstRanker.com ---


?Weight loss: Energy intake < Energy

expended

--- Content provided by FirstRanker.com ---

? Positive Energy Balance

? Weight gain: Energy intake > Energy

expended

--- Content provided by⁠ FirstRanker.com ---

Nutritional Disorders

MALNUTRITION

A pathological state resulting

--- Content provided by‍ FirstRanker.com ---

from a relative or absolute
deficiency or excess of one or
more essential nutrients.
Forms of Malnutrition

--- Content provided by⁠ FirstRanker.com ---

v

Undernutrition:

Kwashiorkor, Marasmus

--- Content provided by​ FirstRanker.com ---


v

Overnutrition:

--- Content provided by‌ FirstRanker.com ---

Obesity, Hypervitaminosis

v

Specific Deficiency:

--- Content provided by⁠ FirstRanker.com ---


Kwashiorkor, Hypovitaminoses, Mineral

Deficiencies

--- Content provided by FirstRanker.com ---

v

Imbalance: Electrolyte Imbalance

? Human beings suffer from Nutritional

--- Content provided by‍ FirstRanker.com ---


disorders due to:

?Lack of general awareness
?Il iteracy

--- Content provided by‍ FirstRanker.com ---

?Poverty
?Wrong food habits
?Disorders
? The availability of food is not uniform

--- Content provided by‌ FirstRanker.com ---

due to:

?Unequal distribution of food items
?Unequal economical status of

--- Content provided by​ FirstRanker.com ---

human population

ETIOLOGY OF MALNUTRITION
Types Of Nutritional Disorders

--- Content provided by‍ FirstRanker.com ---

? Under Nutritional Disorders
? Over Nutritional Disorders
Under Nutritional Disorders

Under Nutritional Disorders

--- Content provided by‍ FirstRanker.com ---


? It is a type of Malnutrition.
? Less intake of food nutrients.
? Insufficient building blocks and

--- Content provided by‌ FirstRanker.com ---

vital growth factors.

? Insufficient energy sources.
Protein Energy Malnutrition(PEM)/

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Protein Calorie Malnutrition (PCM)

? Protein Energy Malnutrition (PEM)

? Protein and Energy deficiency go

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hand in hand.

? This combination leads to protein-

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energy malnutrition
?PEM is the worlds most

widespread malnutrition

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problem in developing

countries.

PEM PRECIPITATING FACTORS

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? LACK OF FOOD (Famine, Poverty)
? INADEQUATE BREAST FEEDING
? WRONG CONCEPTS ABOUT NUTRITION
? DIARRHOEA & MALABSORPTION

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? INFECTIONS (Worms, Measles, T.B)
EPIDEMIOLOGY & ETIOLOGY

? Seen most commonly in the first year of

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life due to lack of breast feeding and the

use of dilute animal milk.

? Poverty or famine and diarrhoea are the

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usual precipitating factors

? Ignorance & poor maternal nutrition are

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also contributory factor

Development Of PEM

? The majority of world's children

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live in developing countries

? Lack of food & clean water, poor

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sanitation, infection & social

unrest lead to LBW & PEM
? PEM leads to

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? Increased Rates of Infant Mortality

? PEM disorders caused due to lack of

adequate Proteins and Energy in the

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diet.

? According to W.H.O PEM is the most

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important public health problem

prevailing in developing countries.


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? PEM most common in Africa, Central

America, South America, Middle

East, SE/E Asia

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? Also see in US

?Homeless
?Inner-city

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?Rural poverty

? PEM most often affects

children:

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?500 mil ion children are

malnourished

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?>50% of deaths of <5

children (5 mil ion/year)
? Adults may also be affected with PEM

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?Men at greatest risk are:

?Those living in poverty

?Elderly living alone

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?Addicts

?Those with eating-disorders

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?Those with long-term illness

Forms Of PEM
? Protein Energy Malnutrition (PEM)

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includes



? Kwashiorkor

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? Marasmus

? Marasmic Kwashiorkar

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(Noted during Starvation or Wasting

extreme energy deprivation)

?Kwashiorkor

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?Marasmus

? Two Facets of PEM
Kwashiorkor

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?Kwashiorkor means sickness

of displaced/deposed child.
?Kwashiorkar describe the

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sickness of weaning,

?That affects the first born

child, when the second

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child is born.

KWASHIORKOR Historical Aspects

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? The word Kwashiorkor was

introduced to the medical literature
in 1933 ,by Cecil y Wil iams, a British
Nurse.

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? Kwashiorkor is the Ghanaian name

for the Evil Spirit
Biochemical Cause

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? Kwashiorkar is an extreme

condition of Protein Energy

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Malnutrition

? Caused due to ingestion of

Protein deficient diet.

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Cause

? Age of onset- 1 to 5 years
? Child gets displaced by mothers

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attention.

? Ingestion of low dietary Proteins
? No milk fed instead low protein diet

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like gruel prepared from grains and

potatoes is fed.
Biochemical Alterations

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? Amino acid deficiency for tissue

protein biosynthesis.

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? Serum Albumin levels markedly

decreased < 2gm%

? Digestive Enzymes lowered

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? Overal body Proteins are lowered
? Serum Cortisol levels decreased

Clinical Signs And Symptoms

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? Enlarged abdomen
? Pitting edema of trunk, limbs and

eyelids (Low serum Albumin)

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? Moon Face
? Anemia
? Growth retardation
? Loss of weight, lethargic
? PSYCHOMOTOR CHANGES

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? SKIN DEPIGMENTATION

? Failure of digestion and absorption due to

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lack of digestive enzymes.

? Due to indigestion of food

vLoss of appetite and anorexia

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vDiarrhea
vWater and Electrolyte imbalance
? Subnormal Immunocompetence
(Low Immunity)
? Mental Changes observed-Low

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Neurotransmitters

? Fatty Liver-Low/No mobilization of

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Lipids

? Sparse ,soft, thin and curly hairs
? Glossitis
? Conjunctivitis

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? One theory says Kwashiorkar is

a result of Liver insult with

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hypoproteinemia and oedema.


? Food toxins like Aflatoxin have

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been suggested as precipitating

factors for Kwashiorkar.


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Kwashiorkor

(Edematous Malnutrition)

? Underweight with Edema

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? Stunted growth
? Irritable, difficult to feed
? Highest mortality ?
50 to 60%
Treatment Of Kwashiorkar

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? Gradual feeding with good

quality food proteins

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?Milk
?Egg
?Legumes /Pulses

Marasmus

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? Marasmus means neglected child
? Marasmus is a disorder of PEM

where an infant is virtual y

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starving

? Due to lack of both dietary

calories and proteins.

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? The term Marasmus is derived from

the Greek word, which means

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wasting.

? Marasmus involves inadequate

intake of Protein and Calories and is

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characterized by emaciation.

? Marasmus represents the end result

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of starvation where both proteins

and calories are deficient.
Causes Of Marasmus

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? Age of onset- Below 1 year
? Deficiency of both Calories and

Proteins.

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? Marasmus occurs in areas where

there is severe starvation and

famine/draught conditions.

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Biochemical Alterations In Marasmus

?Serum Albumin levels 2-3

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gm%

?Serum Cortisol levels

increased

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Clinical Signs And Symptoms

? Marked growth retardation
? Severe Muscle wasting
? Loss of sub cutaneous fat

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? Extreme loss of body weight
? No Edema

? No mental changes
? No characteristic change in hair

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? Appetite is normal
? Skin becomes dry and atrophic
? Child looks older than his age


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?Feels Hungry
?Diarrhoea &

Dehydration

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?Alert but miserable
Differentiation Between

Kwashiorkar

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And

Marasmus

Features

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Kwashiorkor

Marasmus

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Displaced Child

Neglected Child

Age Of Onset

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1-5 years

Below 1 year

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Cause

Deficiency of dietary

Deficiency Of dietary

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Protein

Proteins and Calories

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Serum Albumin

< 2gm%

2-3 gm%

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Edema

Significantly Present

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Absent

Muscle Wasting

Not severe

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Markedly sever

Growth Retardation

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Present

Markedly noted
Features

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Kwashiorkor

Marasmus

Attitude and

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Lethargic ,apathetic

Irritable and fretful

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Appearance

Face looks plump

Shrunken with skin and

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bones

Appetite

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Anorexia

Normal

Skin Changes

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Crazy pavement

Dry and atrophic

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Dermatitis

Hair Changes

Sparse, soft thin and

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No characteristic

curly

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change

Serum Cortisol

Decreased

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Increased

Investigations for PEM

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? Ful Blood Counts
? Blood Glucose
? Serum Electrolytes, Ca, P
? Serum Proteins and Albumin
? Septic screening

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? Stool & urine for parasites & Microbes
? Mantoux test
NON-ROUTINE TESTS

? Hair analysis

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? Skin biopsy
? Urinary Creatinine
? Measurement of trace elements

levels, iron, zinc & Iodine

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Complications of P.E.M

? Hypoglycemia
? Hypothermia

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? Hypokalemia
? Hyponatremia
? Heart failure
? Dehydration & shock
? Infections (bacterial, viral & thrush)

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Treatment

? Slow refeeding

?Small frequent feeding round the

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clock

?Patient encouragement of food

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? Nutritional rehabilitation

?Play and teaching
?Control infections

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In Acute/ life threatening Cases:

?Fluid and Electrolytes

?K and Mg shifts

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?Oral rehydration, slowly

70-100 ml/kg
?Infections: Main cause of death

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? Aggressive treatment

?Other deficiencies

? Anemia and Heart failure,

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? Care with transfusions and no diuretics
? Vitamin A: immediate treatment

? Dietary support:
? 3-4 g protein & 200 Cal /kg body

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wt/day + Vitamins & Minerals

? Prevention of hypothermia
? Counsel parents & plan future care

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including immunization & diet

supplements.
KEY POINT FEEDING

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? Continue breast feeding
? Add frequent smal feeds
? Use liquid diet
? Give vitamin A & Folic acid

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? With diarrhea use lactose-free or soya

bean formula

PROGNOSIS

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? Kwashiorkor have greater risk of

morbidity & mortality compared to

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Marasmus and under weight

? Early detection & adequate treatment

are associated with good outcome

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? Late il -effects on IQ, behavior &

cognitive functions are doubtful and not

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proven


Over Nutrition Disorders

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Obesity
Obesity

?

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Generalized, excessive
accumulation of fat in
subcutaneous & other tissues

? Classification according to

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"desirable" weight standard:

? Overweight ~ >10%
? Obese ~ >20%

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Obesity Is Identified By

Measurement Of Body Mass Index

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(BMI)



What Causes Obesity

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? 3 major factors contribute to

the development of obesity:

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?Genetic background
?High Dietary intake
?Low Physical activity
q Psychic disturbances

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q Endocrine & metabolic

disturbances are rare

Biochemical Alterations

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? Increased stores of TAG in adiposecytes
? Increased biosynthesis of Endogenous

Lipids

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? Derangements in Insulin activity
? Increased risk of Diabetes mel itus
? Biochemical Derangements in Lipid Profile
? Increased Risk of Atherosclerosis , CAD ,

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Stroke
Clinical Manifestations:

v Fine facial features on a heavy-

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looking stout child

v Larger upper arms & thighs
v Genu valgum common

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v Relatively small hands & fingers

tapering

v Adiposity in mammary regions

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v Pendulous abdomen with Striate
v In boys, external genitalia appear

small though actually average in

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size

v In girls, external genitalia normal

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& menarche not delayed

v Psychologic disturbances

common

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v Bone age advanced
Treatment of Obesity

1st principle: Decrease

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energy intake

Initial medical exam to

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diagnose pathological

causes

Plan the right diet

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a.Avoid all sweets, fried foods

& fats

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b.Limit milk- intake not >2

glasses/day

c.For 10-14 yrs, limit to 1100-

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1300 cal diet for several

months
2nd principle: Increase energy

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output

I. Obtain an activity history
II. Increase physical

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activity

III. Involve in hobbies to

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prevent boredom

Complication of

Obesity

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Pickwickian Syndrome/

Obesity Hypoventilation Syndrome

? Pickwickian syndrome is a

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condition in which severely

overweight people

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? Fail to breathe rapidly enough or

deeply enough,

? Resulting in low blood oxygen

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levels and high blood carbon

dioxide (CO2) levels
?Rare complication

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of extreme
exogenous obesity

Signs And Symptoms

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?Severe cardio respiratory

distress & alveolar
hypoventilation

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?Includes polycythemia,

hypoxemia, Cyanosis, CHF

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?Low Metabolic rate
?Lethargic and Fatigue


? Obesity Hypoventilation

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Syndrome have:

? Concurrent obstructive sleep

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apnea, a condition

characterized by snoring.

? Interrupted sleep

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? Excessive Daytime Sleepiness

Lets Fight For Malnutrition
Questions

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? Short Notes

? Food Groups ,their constituents and

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their role

? Basal Metabolic Rate (B.M.R.) & its

importance.

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? Calorific value of food and its

calculations.

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? Respiratory Quotient.(R.Q)

? Specific Dynamic Action (S.D.A.)

? Balanced diet

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? Factors affecting BMR



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? Biological value of Proteins.
? Nitrogen Balance & types.

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? Role of Fiber in diet/Significance of

dietary fibers.

? Protein Energy Malnutrition (PEM) /

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? Differentiate between Kwashiorkor

and Marasmus.

Eat Natural Foods

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