Community Medicine - Nutrition

Copyright – mohammadamir.blogspot.com


PROBLEMS ON NUTRITION

1) Give your comments on the group of food articles consumed by the following :

i) a) 80 gms of fats and oil by a sedentary adult

Ans : In a balanced diet the daily requirement of fats and oils is as follows.

Male : 40g/day

Female : 20g/day

Therefore 80gm of fats and oil is in excess of the daily normal requirement.

Excess consumption of fats result in obesity, fats is a risk factor for CVD, breast cancer, colon cancer.

b) 100gms of sugar and jaggery by a sedentary adult.

Ans : in a balanced diet the daily requirement of sugar and jaggery is as follows :

Men : 30.8 /day

Women : 20g/day

Hence 100gms is excess consumption

ii) 300gm cereals and 100gms of pulses by adult during heavy work

Ans : In balanced diet ;

Normal requirement of cereals required by a sedentary

Male : 460 gm

Female : 410gm

Hence 300gm of cereals – inadequate

Normal requirement of pulses for a sedentary

Male and female : 40gm each

Hence 100gm of pulses is more than adequate

iii) 800gm cereals and 100gm of oil and fat by an adult sedentary adult.

Ans : In balanced diet;

Normal requirement of cereals by a sedentary adult

Male : 460gm

Female : 410gm hence 800gm cereals adequate

Normal requirement of fat by a sedentary

Male : 40gm

Female : 20gm

Therefore 100gms  excess

iv. 250gms of cereals and 50 gms of milk by a pregnant women in 2nd trimester of pregnancy

Ans : Normal requirement of cereals

Adult pregnant woman (2nd trimester) : 410 + 300 kcal extra

710 kcal provided by 49 = 710/4 = 710 kcal

= 180gms

Normal requirement of milk during preg. 100g

Cereals = inadequate

Milk = adequate

v. 30gm pulses, 25gm vegetables by a lactating woman having a 2m old infant.

Ans : Normal requirement of pulses in a lactating woman : 30gm

Vegetables 190 gm/day (100-leafy vegs, 40-other vegs, 50 – roots and jubers)

Hence vegetables is inadequate.

II. Mention whether the following statements are true or false and give your comments :

1. a) Cereals are poor source of energy :

Ans : False – cereals are the main sources of energy (carbohydrates). They provide about 350 kcal per 100 gms. They contribute 70-80 percent of the total energy intake of our diet.

b) Vegetables and fruits and rich sources of proteins :

Ans : False – They are protective foods. They are good sources of vitamins and minerals.

2. a) Raw egg is superior to boiled egg

Ans : False – Raw egg white is not assimilated by the intestinal mcuosa, therefore it must be cooked before consumption. Boiling destroys ‘avidin’ a substance which prevents the body from obtaining biotin, a B-complex vitamin. Boiled egg is nutritionally superior to raw egg.

b) Whole egg can be consumed by an obese person

Ans : False – The cholesterol content of one egg (250mg); Hence a reduction in intake of eggs is advised for those at risk of CHD.

c) Egg is good source of carbohydrate

Ans : False – Egg contains all the nutrients except carbohydrate and vitamin C.

3. a) Butter and ghee should be given in large quantity to children.

Ans : True – fats and oils intake for children to be 25gms/day; so needed in large quantity for growth. Because of their rapid growth rate, young children need more energy per kg body wt than adults.

b) Ghee is of better nutritive value than groundnut oil to the elderly people.

Ans : False – ghee contains fats and provides a kcal per gm of fat. It contains vitamins A, D and contains more of saturated fatty acids which is not good for elderly people.

Groundnut oil contains 40 percent fat and 26.7% protein. They are good sources of vitamins of the B-group. They contain calcium, phosphorus, iron, and are rich in essential fatty acids. EFA reduce CHD mortality.

4) Dietic factors have no role in cancer.

Ans : False – Diets high in fat increase the risk of colon and breast cancer. Dietary fibre is protective against colon cancer; smoked fish courses – stomach cancer.

5. a) Iodised salt should be made available for the whole community.

Ans : True – iodization of salt is now the most widely used prophylactic public health measure against endemic goiter. It is most economical, convenient and effective means of mass prophylaxis.

b) Low concentration of iodide in water results in dental caries

Ans : False - Low concentration of fluoride in water results in dental cancer.

6.a) Only breast milk should be given to the children under 1 yr of age

Ans : False – Exclusive breast feeding is to be done upto 6 months of age and continued breast feeding with complementary feeds upto 1 year of age.

b) Nutrition rehabilitation means feeding the disabled

Ans : False – nutrition rehabilitation services are for protection of malnourished children.

7) There is difference between food

a) Adulteration and food fortification

True – adulteration consists of a large number of particles eg. mixing, substitution, concealing the quality, putting up decomposed foods for sale, misbranding or giving false labels and addition of toxicants eg. addition of midgrits to cereals like rice.

Food fortification as defined by WHO is ‘the process whereby nutrients are added to foods in relatively small quantities to maintain or improve the quality of the diet of a group, a community or a population.

Eg. fortification of vanaspati with vitamins A, D.

b) Nutrition assessment and diet survey are not the same

Ans : True – Assessment of nutritional status involves various techniques and one of the technique of assessment of dietary intake is diet survey.

8. There is no difference between nutritional surveillance and growth monitoring

Ans : False – growth monitoring is to the individual child and is a dynamic measures of its health from month to month. It focuses on normal nutrition and the means to promote continued growth and good health.

Nutritional surveillance can be carried out on a representative sample of children in the community. It gives a reliable idea of the overall nutritional condition of the village or area, and to compare with other area and to detect any improvement or deterioration with time.

2) Prescribe a balanced diet for – adult male a) sedentary worker b) moderate worker c) heavy worker. Mention importance of each group of food article.

Ans :

Male worker (60kg) Net energy kcal/d G/d prot G/d fat Mg/d Ca Mg/d iron Mg/d vit A retinal Mg/d  carotene Mg/d thiamine Mg/d riboflavin

Sedentary 2425 60 20 400 28 600 2400 1.2 1.4

Moderate 2875 60 20 400 28 600 2400 1.4 1.6

Heavy 3800 60 20 400 28 600 2400 1.6 1.9





Particulars Nicotinic acid mg/d Pyridoxine mg/d Ascorbic acid mg/d Folic acid mg/d Vit B12 g/d

Male worker

Sedentary 16 2.0 40 100 1

Moderate 18 2.0 40 100 1

Heavy 21 2.0 40 100 1



1) Carbohydrates : Constitute main source of energy requirement (50-70%) rich in dietary fibre. Provide 4 Kcal/gm.

2) Proteins : Constitute 15-20% of daily energy requirement, provides the required essential aminoacids necessary for growth – body building; repair and maintenane of body tissues, maintenance of osmotic pressure: provide 4 kcal / gram of protein.

3) Fats : Contribute to > 50% of the energy requirement during infancy and 20% of the adult energy requirement of which at least 50% of the fat intake should consist of essential fatty acids. The requirement of EFA ranges from 3-5.7% of energy intake in young children. It also provides fat soluble vitamins A, D.

4) Iron : For formation of hemoglobin, muscle activity, catecholamine metabolism, oxygen transport and cellular respiration.

5) Vitamin A : 1) Production of retinal pigments for vision.

2) Maintaining the integrity of the glandular, epithelial tissue.

3) Protects against bronchial cancer

4) Supports skeletal growth

6) Thiamine (Vit. B1) Essential for utilization of carbohydrates

7) Riboflavin (Vit.B2) Fundamental role in cellular oxidation.

8) Nicotinic acid / Niacin : Essential for metabolism of carbohydrate, fat, protein. Essential for normal functioning of skin, intestinal and nervous system.

9) Pyridoxine (Vit.B6): Role in metabolism of amino acids, fats, carbohydrates.

10) Ascorbic acid (Vit. C) Required for formation of collagen, facilitates absorbtion of iron from vegetables, protects against infection.

11) Folic acid : Required for growth in young children, pregnancy to increase the birth weight, reduce the incidence of low birth weight.

12) Vitamin B12: - Synthesis of fatty acids in myelin

- Synthesis of DNA

13) Calcium : Formation of bones, teeth, coagulation of blood, cardiac activity, milk production, metabolism of enzymes and hormones.













3) Prescribe a balanced diet for adult female.

i)

Particulars Net energy kcal/d Protein g/d Fat g/d Cal mg/d Iron mg/d Vit. B1 Mg/d Vit.A Mg/d

Retinol  Ca

Worker

Sedentary

Moderate

Heavy

1875

2225

2925



50



20



400



30

0.9

1.1

1.2



600



240



Particulars Vit.B2 mg/d Niacin mg/d Vit B6 mg/d Ascorbic acid mg/d Folic acid mg/d Vit. B12 Mg/d



Worker

Sedentary

Moderate

Heavy

1.1

1.3

1.5

12

14

16



2.0



4.0



100



1





ii)

Lactating woman (50kg) with (3month old infant) Pregnancy woman (50 kg) in 2nd Trimester

1) Net energy kcal/d 1875 (+550) 1875 (+300)

2) Protein g/d 50 (+25) 50 (+15)

3) Fats (g/d) 45 30

4) Calcium (mg/d) 1000 1000

5) Iron (mg/d) 30 38

6) Vit. A (mg/d)

Retinol

 carotene

950

3800

600

2400

7) Thiamine (mg/d) + 0.3 + 0.2

8) Riboflavin (mg/d) + 4 + 0.2

9) Niacin (mg/d) + 3 + 2

10) Vit. B6 (mg/d) 2.5 2.5

11) Vit. C (mg/d) 80 40

12) Folic acid (mg/d) 150 400

13) Vit. B12 (mg/d) 1.5 1