1
Q
Human Nutrition - goals
A
- defining nutritional requirement for health:
- promoting
- protecting
- maintaining
IN ALL GROUPS OF POPULATION
2
Q
Purpose of assessing nutritional requirement
A
what is the right amt of diet for any particular group for them to grow proper and (in case of adults) be capable of proper maintenance
3
Q
Terms defining the nutrition needs
A
- recommended dietary allowances or intake
- optimum requirement
- minimum requirement
4
Q
RDA of a particular group (of any gender/ age group)
A
- average
- daily
- dietary nutrient intake
- meet nutrient requirement of 97-98% healthy individual
5
Q
Adequate intake
A
- used when RDA cannot be determined
- it’s estimated or approximated recommended average daily intake
- observed or experimentally determined in apparently healthy individual
6
Q
Tolerable upper intake level
A
- highest average daily intake
2, no adverse health risk to almost all the individual in general population
7
Q
Estimated average requirement
A
- average daily nutrient intake level
2. estimated to fulfill needs of half the individuals of a particular gender and age
8
Q
Deriving of RDA - (factors)
A
- individual variability
2. bioavailability
9
Q
bioavailability depends on
A
- release of nutrient from food
- it’s absorption in intestine
- it’s bioresponse
10
Q
bioavailability - is
A
level of nutrient in the diet that’ll help meet the requirement
11
Q
low bioavailability
A
of iron
12
Q
iron - amt in diet
A
20-30 more than what is required daily
13
Q
foods in which bioavailability factor plays an important role
A
- protein
- zinc
- iron
- calcium
14
Q
Validity of RDA of a nutrient
A
only if all the other dietary nutrients intakes are satisfactory
15
Q
individual variability of requirements
A
RDA takes into account
- variability of requirement among individuals of the population
16
Q
distribution of nutritional requirement of the population (nutritional requirement of infants, nutritional requriement of pregnant women etc) is normal if -
A
RDA (covering 97% of population) corresponds to the said requirement
i.e if RDA covers requirements of all the age groups and genders.
if say one age group requires A lot larger or lesser amt of nutrients than RDA, then the population requirement is’t normal but rather an anomaly.
17
Q
nutritional requirement of individual depends on
A
- age
- gender
- body weight
18
Q
body weight and height of children reflects
A
- state of health
- nutrition
- growth rate
19
Q
body weight and height of adult reflects
A
- what can be attained by an individual with a norm la growth
20
Q
Reference value of anthropometric measurement
A
infants and children of well to do families having good health care and no nutritional constraints
21
Q
purpose of RDA
A
attaining reference antrhopometric standards
22
Q
multicentre growth reference standard for 0-60 month boys and girls
A
given by WHO
23
Q
WHO reference standards - formation
A
- exclusively breast fed babies of
- USA
- brazil
- ghana
- norway
- oman
- india
24
Q
reference values for Indian children
A
median weights of infants and preschool children
25
Reference man
1. 18-29 years
2. 60 kg
3. 1.73 m
4. BMI is 20.3
5. free from diseases
6. physically fit for active work
7. 8 hours of moderate occupational work
8. 8 hours of sleep
9. 4-6 hours sitting and moving about
10. 2 hours in walking and in active recreation or household duties
26
Reference woman
1. 18-29 years
2. non pregnant, non lactating
3. 55 kg
4. 1,61 m
5. BMI - 21,2
6. free from disease
7. fit for active work
8. 8 hours of moderate occupational work
9. 8 hours of sleep
10. 4-6 hours sitting and moving about
11. 2 hours in walking and in active recreation or household duties
27
Reference infant - 0- 6 months
average of
| birth weight and body weight at 6 month
28
Reference infant - 6-12 months
average of
| body weight at 6 months and at 12 months
29
Reference body weight- children 1-3 years of age
average of WHO median body weight at
18 month, 30 month, and 42 months
i.e what WHO multicentre growth reference standard takes as an median weight of 18 mo, 30 mo and 42 mo child needs to added and then divided by 3 to get the reference child's weight
30
Reference body weight - child from 4-6 years
average of body weights at
| 4, 5 and 6 years of
31
Reference body weight - child of older age groups
average of 95th percentile body weights of rural india
32
Reference body weight- for adult
1. 18-19
2. 20-24
3. 25-29
average of body weights for each groups
33
Energy - role
1. body function
2. growth
3. resist infection
4. ability to work
5. strong will
34
measurement of energy - unit
kilocalorie
C
Joule
35
1 Joule
energy required to:
move 1 kg mass
by 1 metre distance
by 1 newton force
36
one newton force
force required to:
accelerate 1 kg mass
by 1 m per second square
37
kilocalorie
heat required to:
1. raise the temperature of 1 kg water
2. at 14.5 degrees C
3. to 15. 5 degree C
38
1 kcal =
4.184 Kilojoules
39
1 Kilojoules
0.239 kcal
40
1000 kcal
4184 KJ
| 4.18 MJ
41
1 MJ
239 kcal
42
values for the reference man and woman
1. for whom the energy intake values are calculated
2. adjustments are made for the people who deviate from the standard values
this procedure is devised by FAO comittee on calorie requirement
43
Energy requirement
1. level of energy intake from food that balances energy expenditure:
of an individual who has:
- body size
- body composition
- level of activity consistent with long time health
of an individual who can:
- maintain economically essential activities
- socially desirable activities
(deposition of tissues, secretion of milk in amts a healthy person should)
44
Why are standard deviation values not added in the energy intake
1. energy intake and expenditure is finely balanced
2. excess is stored as fats
3. continuous excess can cause obesity
45
process of Upper limit of adaptation
1. intake increased to suit the expenditure
| 2. output increased to suit the intake
46
components of energy requirement - adult
1. BMR- 1 kcal/ kg/ hour
2. daily activities
3. occupational work energy expenditure - light, moderate, heavy
47
procedure for calculating total energy expenditure are given i n
WHO expert committee on energy and protein requirements
48
Energy requirements
1. vary from person to person depending on:
- inter related variables like
i. age
ii. sex
iii. working condition
iv. body composition
v. physical activity
vi. physiological state
49
energy requirements are laid down by
```
FAO and WHO expert groups
Indian council of medical research
various standards are
Bristish standards
american standards
canadian standards
```
50
vulnerable groups
pregnant and lactating mothers
children
adults
51
pregnant mothers -energy requirement
+350 kcal through out pregnancy
| for deposition of tissue
52
lactating mothers -energy requirement
first six months - +600 kcal
next six months - +520 kcal
(for deposition of tissues and secretion of milk in amt that a healthy person should be able to)
53
energy requirement of children is more per kg of weight
1. because of rapid growth rate
54
for catch up growth in malnourished children children
RDA based on age and not weight (ICMR standards)
55
children above 13 years - energy requirements equal to those in adults
1. increased activities
2. increased BMR
3. increased growth
56
Fall of energy requirements with age
1. 2 percent decline with each decade
57
cause of fall of energy requirement in old age
1. decreasing BMR
| 2. decreased physical activity
58
FAO/ WHO recommended decline in energy requirement
1. above 40 - 5 % decrease of intake every decade
| 2. above 60 - 10 % decrease in intake each decade
59
source of energy
1. fats
2. carbohydrates
3. proteins
4. dietary fibers
60
energy supply - fats
9 kcal / g
61
energy supply - carbohydrates
4 kcal / g
62
energy supply - proteins
4 kcal / g
63
dietary fibers
2 kcal / g
64
dietary fibers - energy extraction
1. fibers
2. ferments in colon
3. yeilds short chain fatty acids - butyric, acetic and propionic acids
4. fats used as energy by colon cells, liver
65
fermentable dietary fiber %
70
66
carbohydrates - energy source
1. cereals - 80 % of our diet
| 2. provides 50-80% of daily requirement
67
fats as energy source
1. poor - 5 % of diet
2. very rich - 30% of diet
3. average person - 10-12 % of diet
68
nutritional individuality - a concept
to avoid excess intake of energy by those who need less than average/ standard requirements
69
variation in protein requirement depends on
1. age
2. sex
3. physiological variables
4. infection
5. infestation
6. emotional disturbances and stress
70
assessment of protein
1. protein quality
| 2. protein quantity
71
protein quality testing - methods
1. amino acid score
| 2. NPU
72
reference protein
egg protein
73
amino acid score method
measure of concentration of each essential amino acid in test protein/ measure of concentration of the same essential amino acid in the egg protein x 100
(expressed as percentage of EAA in the reference protein)
74
amino acid score for starches
50 to 60
75
amino acid score for animal foods
70- 80
76
Net protein utilisation
biological value x digestibility / 100
77
what protein quality assessment is better
NPU
78
NPU is
nitrogen retained in the body / nitrogen intake x 100
79
1 gram nitrogen
6.25 gram of protein
80
protein requirement
varies with NPU of the said protein
| - is inversely proportional
81
NPU of proteins of indian diets
50-80
82
evaluating foods as a source of protein
calculate PE - i.e. what percentage of their total energy is provided by proteins
83
PE per cent =
energy provided by protein content / total energy provided x 100
84
why is PE a better scale for calculating protein requirement ?
because if the energy requirement is not sufficient, the protein will be sued up for providing energy instead of doing it's usual growth and repair maintenance function
85
if the PE ratio of the diet is less than 4
subject won't be able to eat enough to satisfy the protein requirement
86
normal % of protein intake
10-12
87
unit of protein requirement
gm / kg/ day
88
protein requirement - ICMR expert group
1 g / kg/ day (of 65 NPU proteins)
89
vulnerable groups - protein requirement increased
1. pregnant women
2. lactating women
3. 0-6 years old children
90
pregnant women with 10 kg GWG - protein requirement
1st trimester - +1 g/ day
2nd trimester - + 7 g/ day
3rd trimester - +23 g/ day
91
lactating women -protein requirement
13 g per day for 0-6 months
92
protein requirement - of young children aged 0-6 years
increased protein per kg per day intake
93
protein requirement - elderly
not less than adult because protein utilisation decreases in old age
94
WHO expert committee report on energy and protein requirement (2007)
gives amino acid requirement in mg/kg/ day
95
role of all the essential amino acids
new tissues cannot be formed unless all the essential amino acids are present in diet
EAA requirement decreases with age
96
fat intake in infants
50% of total energy intake
97
fat intake in adults
20 % of total energy intake (of which half should be vegetable oils rich in essential fatty acids)
98
requirement of essential amino acids in infants
3 to 5. 7%
99
RDA carbohydrate
50-80%
100
carbohydrates in indian diet -
upto 90%
101
vitamin A RDA
600 mcg
102
Beta carotene RDA
4800 mcg
103
vitamin E RDA- males
10 mg Alpha tocoferol
104
vitamin E RDA- - females
8 mg alpha tocoferol
105
thiamine RDA
0.5 mg/ 1000 kcal
106
riboflavin RDA
0.6 mg / 1000 kcal
107
niacin RDA
6 mg/ 1000 kcal
108
calcium RDA man
60 mg
109
iron RDA man
17 mg
110
zinc RDA man
12 mg
111
magnesium RDA in man
340 mg
112
RDA net energy in a man
2320 kcal
113
RDA protein in a man
60 g
114
RDA visible fats in a man
25- 40 g
115
nutritional requirements are interrelated
1. protein and energy
2. Ca, P and vitamin D
3. carbohydrates and vitamins
4. fats and vitamins
116
food - role
```
collection of nutrients
system of communication
protocol for customs
protocol for situations
protocol for behaviour
```
117
Diet
1. kinds of
2. food
3. people
4. live on
118
balanced diet
1. has a variety of foood
2. in such quantities and proportions
3. that it provides all the nutrients
4. adequately to maintain health, vitality and general well being
5. the amt of nutrient it has should also make small provision for extra nutrients to withstand short duration of leanness
119
role of balanced diet
it safeguards the person from nutritional deficiencies
120
principles of constructing a balance diet
1. RDA of protein should be met (10-15 % of total E)
2. fat intake limited to 15-30%
3. carbohydrate + nautral fibers - remaining 50-80%
4. micronutrient demands should be met
121
type of food in a country depends on its
1. economic status
2. climatic conditions
3. region
4. customs
5. taboos
6. tastes
7. habits
122
balanced diet is formulated by
ICMR
123
The food guide pyramid - five major food groups (irreplaceable)
from top to bottom
each group provide some but not all nutrients
1. fats and oils and sweets - use sparingly
2. milk and milk product, meat, poultry, fish , dry beans eggs and nuts (2-3 servings)
3. vegetable group (3-5 servings), fruits group ( 2-4 servings)
4. bread, cereals, rice, and pasta (6-11 servings
124
dietary goals
prudent diet
125
national nutrition and food policy
sets dietary goals
126
WHO's expert committee - dietary goals
1. fats - 15-30%
2. SFA - <10 %
3. unsaturated fats - rest
4. refined carbohydrates - avoided; natural fiber carbs preferred
5. sources rich in energy like fats and alcohol avoided
6. salt intake reduced from 15 g in tropical countries to less than 5 g
7. protein 10-15 %
8. junk foods reduced
9. diet should be adapted for special needs like growth, pregnancy, lactation, physical activity and mental disorders
Preventive and social medicine
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