Muffaqam Shah

Roll.No. 68
2009-116 Regular Batch
 Our foods are made up of essential chemical
complexes called nutrients
 There are 7 major classes of nutrients

Classes:
-Carbohydrates
-Fats
-Proteins
-Minerals
-Fiber
-Proteins
-Vitamins

These can also be divided into Macro (Carbs, fats,

and proteins) and Micronutrients (Minerals and
Vitamins)
 These make up most of the Indian diet (50-60 %
of the total energy intake)
 Simple Carbs are: glucose, fructose, sucrose, and
lactose present in fruits, vegetables, honey, and
milk
 Complex Carbs are: oligo and polysaccharides
such as starch in cereals, millets, pulses, and root
vegetables
 A diet with less than 30% of Carbs may cause
ketosis, loss of weight, and breakdown of proteins
 Excess Carbs are converted to Fat
 4 kcal per g are attained from Carbs
Functions
 These are required for growth and synthesis of tissues in the

body; formation of digestive juices, hormones, plasma proteins,

enzymes, and hemoglobin; as buffers to maintain acid-base
equilibrium; and as an alternate source of energy for the body
 They are made up of 20 different amino acids, 8 of which the

body cannot synthesize and hence must be present in the diet

 Histidine and arginine are especially important during infancy

because their rate of synthesis is inadequate for sustaining

growth
 Egg protein has the highest Biological Value as well as the

highest Net Protein Utilisation

 About 8-12 % of the total energy should be provided from

protein sources, they provide 4 kcal per g

 Sources: Eggs, fish, dhals, milk(cow), animal flesh
Funtions
 The major functions of fats are to act as major structural

element of the cell membranes; major source of energy, as well

as carriers of fat soluble vitamins (A,D,E,and K)
 They are present as Fatty acids(Triglycerides), Phospholipids,

and Cholesterol
 Fats are also grouped as Saturated or Polyunsaturated Fatty

Acids
 About 25-30% of the energy intake should be from fats

 In malnourished children upto 45% can be given

 They provide 9 kcal per g

 Essential fatty acids (Linoleic and Linolenic acid) must be

supplied in the diet

Sources
Animal- ghee, butter, milk, cheese, eggs, and fat of meat and fish
Veg- groundnut, mustard, sesame, coconut
Other- cereals, pulses, nuts, and vegetables
First 10 kgs- 100 kcal per kg
10 – 20 kgs – 1000 kcal + 50 kcal per kg for every kg above 10
More than 20 kgs -1500 kcal + 20 kcal per kg for every kg above 10
 Includes polysaccharides such as
-cellulose
-hemicelluloses
-pectin, gums, mucilage, and lignin
Functions
 Are essential for the normal functioning of the

gut, elimination of waste, water holding, bile acid

binding capacity, and for maintaining the growth
of the flora
Sources
-maize, wheat, chickpeas, lentil, apples
 There are three critical periods when the
energy requirements are most important

-around 6 months when complementary

feeding is initiated
-between 1-2 years when physical activity is
increased
-between 10-12 or 15-18 years ( for girls and
boys respectively) when puberty is attained
 A balanced diet is one which contains a variety of foods in
such quantities and proportions that the need for energy,
amino acids, vitamins, minerals, fats, carbohydrates, and
other nutrients is adequately met for maintaining health,
vitality, and general well being. As well as making a small
provision for extra nutrients to withstand short duration of
leanness
Principles
 Proteins – 10-15%

 Fats -25-30%

 Carbs – Remaining (60-70%)

Foods are divided into 5 food groups
-Cereals, millets, pulses*
-Vegetables, and fruits
-Milk and milk products
-Eggs, meat and fish
-Oils and fats

Some non-nutrient substances like dietary-fiber,

antioxidants, and photochemicals which render
positive health benefits should also be included
 The fat soluble vitamins are A, D, E, and K
 These control protein synthesis at the

transcriptional/post-transcriptional level
 They’re converted to active forms by means

of oxidation, hydroxylation, reduction, or

ionization

 Breast milk is deficient in both Vit. D & K

and hence must be supplemented
Sources:
-oil form cod liver, carrots, dark green leafy vegetables, oranges,
tomatoes
RDA:
-Infants 300-400 µg
-Children 400-600 µg
-Adolescents 750 µg
Functions:
-maintenance of vision (night) and maintenance of epithelial
tissues and differentiation of many other tissues, particularly
during reproduction and gestation
Deficiency:
-Xerophtalmia, infertility, metaplastic bones, keratinisation of the
epithelial surfaces (skin, genito-urinary, and lungs)
Toxicity:
-If more than 50,000 IU per day for several months (fatigue,
malaise, anorexia, vomitings, headache, and diplopia)
It is synthesized and secreted from the kidneys under the control
of PTH. It can also be synthesized from 7-dehydrocholesterol in
the skin upon exposure to UV rays. It is necessary for the proper
mineralization of bones
Sources:
-fish, liver, and oils
-human milk (poor source)
-photo-conversion (20 cm² exposed for 15-20 mins)
RDA:
-Infants 5µg
-Children 10µg
Deficiency:
-Rickets (in growing bones) and Osteomalacia (in non-growing
bones)
Toxicity:
-anorexia, vomitings, htn, and renal insufficiency (2000-3000 IU
per day)
Sources:
-vegetable oils(corn, cottonseed, safflower) and their products
(margarine)
-green leafy vegetables and nuts
-breast milk and colostrum*
Functions:
-physiological membrane bound anti-oxidant
-inhibits/terminates radical catalyzed lipid per oxidation
RDA:
-Infants 0.4µg/kg/day
-Premature infants 15-20 mg/day
Deficiency:
-usually born with a state of relative tocopherol deficiency
-Hemolytic anaemia (7-9g/dl) with reticulocytosis and
hyperbilirubinaemia
-Spinocerebellar ataxia with loss of deep tendon reflexes,
ophtalmoplegia, muscle weakness
Sources:
-green leafy vegetables*, animal foods, cereals(low)
-human intestinal flora*
Functions:
-cofactor in the post-transitional carboxylation of glutamic acid to form glutamate
(liver)
-Factors II (Prothrombin), VII, IX, X are procoagulant proenzymes
-Proteins C and S are anticoagulant proenzymes [Coagulation]
RDA:
-normally bacterial flora are depressed by 30% in newborns and even more in pre-
mature infants
-Newborns 3-5µg/day
-At 2 years 10µg/day
-More than 2 years 10-30µg/day
*Prophylactic Vit.K to all newborns (0.5-1.0 mg IM and weekly 1.0mg IM for
parentally fed children and infants
Deficiency:
-due to elimination of bacterial flora, fat malabsorption, short bowel syndrome.
-A syndrome of gastrointestinal bleeding and ecchymoses in the first week of life
[Hemmorhagic disease of newborn]
 Vitamins of the B Complex as well as
Vitamin C constitute the water soluble
vitamins
 They are required by the body in very small

amounts
 They do not yield energy but allow the body

to utilise other nutrients

 It is essential for the utilisation of carbohydrates
Sources:
-occurs in all natural foods
-whole grain, cereals, wheat, gram, yeast, pulses, oilseeds and nuts
(groundnut)
-milk is an important source of thiamine for infants
-for the indian population the main source is from rice and
wheat(cereals)
RDA:
-0.4 mg/ 1000 kcal consumed is the body content and if more than this is
given it is lost in the urine
-Also given prophylactically to those with persistant vomitings
Losses:
-it is readily lost from rice during the process of milling
-parboiled rice can be used
Deficiency:
-Two main diseases are Beri-Beri and Wernick’s
encephalopathy

-Beri-beri occurs in three forms dry, wet, and infantile

-Dry has no oedema, typically includes severe muscle

wasting and cardiomegaly

-Wet is characterized by peripheral oedema, ocular paralysis,

ataxia, and mental impairement

-Infantile is seen in infants between 2-4 months, the affected

child is usually fed by a thiamine-deficient mother (mother
shows signs of peripheral neuropathy). Shows cardiac
involvement (cardiomegaly, cyanosis, dyspnoea, and
aphonia)
 Has a fundamental role in cellular oxidation
 Maintaining the integrity of the mucocutaneous membrane

 Co-factor in a number of enzymes involved in energy metabolism

 Also involved in antioxidant activity

Sources:
-milk, eggs, liver, kidney, and green leafy vegetables
-meat and fish contain small amounts
-germination of pulses and cereals increases the riboflavin content
-human milk contains 40-70 µg/100 kcal
Deficiency: (Ariboflavinosis)
-mainly in places where rice is the staple food
-photophobia, glossitis, angular stomatitis, sebhorreic dermatitis, corneal
vascularisation, and cataracts [anorexia, wt.loss, weakness, dizziness]
-almost always occurs in association with other B complex deficiencies
Requirement:
-Infants 0.4mg/1000 kcal
-Children 0.8-1.2mg/1000 kcal
 Essential for the metabolism of fats, carbs, and proteins, also for the
normal functioning of skin, intestinal, and nervous system
 Incorporated into NAD and NADP, used as co-enzymes for Ox-Red rxns

Sources:
-liver, kidney, meat, poultry, fish, legumes, and groundnut
-human milk
Deficiency:
-Pellegra
-Chracterised by 3 d’s – diarrhoea, dermatitis, and dementia, as well as
glossitis and stomatitis
-red discolouration of the tongue, along with neurological manif.
-due to the excess leucine consumption. Interferes with the conversion of
tryptophan to niacin
RDA:
-6.4-8 NE/1000 cal *1 NE = 1mg of Niacin/ 60 mg of tryptophan
 Important role in the metabolism of amino acids, fats (EFA),
and carbs, as well as Ab prod, may help with learning
difficulties
 Req. for the prod. Of Neurotransmitters like Serotonin,

Dopamine, N-Adr, Adr

Sources;
-milk, liver, meat, egg, yolk, fish, whole grain cereals, legumes,
an vegetables
Deficiency
-anaemia,nerve damage, seizures, skin problems, sores in
mouth
-INH (anti-TB) drugs is a recognised antagonist, hence
supplement of 10-50 mg/day is given
 Free folates absorbed from the proximal part of sm.int
 Plays a role in the syn. of nucleic acids(constitute chromosomes), also

needed for the normal development of blood cells in bone marrow

Sources:
-liver, meat, dairy products, eggs, milk, fruits and cereals, leafy
vegetables.
-Overcooking destroys much of folic acid
Deficiency:
-affects normal cell division and protein syn impairing growth of all
tissues in the body
-causes megaloblastic anaemia, memory problems, neural tube
defects(pregn. women)
Requirement:
5-10 mg is body stored, deficiency can develop quickly
-required more in times of rapid cellular multipication such as growth in
young children and pregnancy
 Folic acid supplementation during
pregnancy has been found to increase the
birth weight of the child.
-Pregnancy = 500 mcg (a month before and
at least 3 months after delivery)
-Lactation = 300 mcg
-Children (mcg/day)
Infants=70
1-3y=100
4-6y=150
7-9y=200
10-12y=250
13-15y=300
 Cyanocobalamine is the preperation which is therapeutically used
 Vit B12 cooperates with folate in the syn of DNA

 Mainly acts in the syn of fatty acids of myelin

 Absorption requires intrinsic factor from stomach

Sources:
-liver, kidney, meat, fish, eggs, milk, and cheese, (not found in
vegetables)
-stored in liver (2mg) and 2mg elsewhere
- One to three years

- -deficiency is rare in young infants

Deficiency:
-assoc. with megaloblastic anaemia & demyelinating disorders in the
spinal cord
-may arise in strict vegetarians
Requirement:
-Infants 0.3 µg/day
-Children 0.5-1.5 µg/day
-Adolescents 2.0 µg/day
 Most sensitive of all vitamins to heat
Functions:
-is a potent anti-oxidant and has an important role in tissue oxidation
-needed for formation of collagen
-collagen provides a supporting matrix for the blood vessels, connective
tissue, bones, and cartilage
-by reducing Ferric ions to Ferrous it facilitates the absorption of Iron
from vegetable foods
Sources:
-fresh fruits and green leafy vegetables,germinating pulses
-amla (indian gooseberry) is one of the richest sources,guavas, lime,
orange
Deficiency:
-results in scurvy (anorexia, diarrhoea, pallor, irritability, succeptibility to
infections) [Barlows Disease]
-signs: swollen and bleeding gums, subcutaneous bruising or bleeding
into the skin or joints, delayed wound healing, anaemia, and weakness
Requirements:
-Infants 30-40 mg/day for & -Children 70 mg/day
Calcium- coagulation, nerve conduction, muscle stimulation
Milk, and dairy products
1-10 y 500-800mg/day; Puberty 1000-1200mg/day
Def. may cause tetany, rickets and osteperosis(chronic)
Magnesium-membrane transport, signal transmission, multiple enzyme
rely
on it
Legumes, bananas, whole grains
-Upto 6m 40-50mg/day; 6-12m 60mg/day; More than 12m 200mg/fday
Def. may cause irritability, tetany, hypo/hyperreflexia
Zinc-causes poor physical growth,hypogonadism, and anaemia (3.5
5.0mg/day)
Copper-microcytic hypochromic anaemia*, neutropenia, osteoperosis
Selenium-Keshan Disease (cardiomyopathy), macrocytosis, and lossof hair
pigment
Chromium
Iodine-IDD(Cretinism, mental retardation, retardation of physical growth)
Iodine-IDD(Cretinism, mental retardation, retardation of physical
growth)
90µg for preschool children
120µg for school children
Iron-impaired physical coordination and capacity, mental dev.,
cognitive abilities, social and emotional dev.
 Essential Pediatrics; OP Ghai, 7th edition
[Nutrition, Micronutrients in Health and
Disease]
 Preventive and Social Medicine; K.Park, 21 st

edition [Nutrition and Health]