Diet and deficiencies B.Pharmacy 8th Semester 2024 (2023-2024) Previous Year's Question Papers/Notes Download - HK Technical PGIMS

Nutrition and health
Kalyani Barve
Nutrition
The science of food & its relationship to
health.
Food
• A substance or a mixture of
substances which when taken into the
body serves to nourish or build up
the tissues or to supply energy to
body.
Food
Functions of food
1.Provides energy for mechanical work
2.Maintains growth, repair & reproduction
3.Maintains the functions of body tissues &
also body temperature
4. Builds resistance against infections &
diseases
5. Satisfies appetite.
Nutrients
• Nutrients are specific dietary constituents
Macronutrients-
- Main bulk
proteins,
fats &
carbohydrates
Micronutrients-
- Minute quantities
vitamins &
minerals
Classification of foods
Based on following criteria
1. Origin
a) Animal origin eg. Eggs
b) plant origin eg. Vegetable
2. Composition/chemical nature
a) Proteins
b) Fats
c) Carbohydrates
d) Vitamins
e) Minerals
3. Function
a) Body-building foods
eg. Meat, pulses
b) Energy giving foods
eg. Cereals, sugar
c) Protective foods
eg. Fruits, vegetables
4. Nutritive value
i) cereals & millets ii) pulses iii) vegetables
iv) nuts & oilseeds v) fruits vi) fats & oils
vii) condiments, spices etc viii) miscellaneous
Carbohydrates
Functions
1. Main constituents of diet
2. Main source of energy ( 4 kcal/g)
3. Essential for oxidation of fats
4. Required for the synthesis of some non –
essential amino acids
Sources
1. Sugars
2. Starch
3. Dietary fibers
4. Glycogen
Sugars – simplest form of
carbohydrates.
1. Glucose
2. Fructose
3. Sucrose
4. Lactose
5. Maltose
6. Starch
7. Cellulose
Starch
• Largest proportion of carbohydrate
in our diet
• Dietary sources are cereals, potato,
unripe fruits.
Dietary fibers
• Non starch polysachharide
• Cellulose
• Non cellulose
– Hemicellulose
– Pectin
– Inulin
– Gums and mucilage
• Degraded by microflora
• Beneficial for patients suffering from
hypertension, diabetes, coronary heart disease
and diseases of the bowel.
Glycogen
• Similar to starch
• Animal origin
Proteins
- Complex nitrogenous compounds
- Essential constituents of all nutrients
- Human body contains 17% proteins
Constituents of proteins
- Contain carbon, hydrogen, oxygen &
nitrogen
- some contains sulphur, phosphorus, iron &
trace element
- Made of smaller units called amino acids.
- Needs 24% amino acids
Essential amino acids
-isoleucine
-leucine
-methionine
-lysine
-phenylalanine
-threonine
-tryptophan
-valine
-histidine
Non essential amino acids
• Glutamic acid
• Proline
• Glycine
Functions
1. Body building, repair & maintenance of
tissues
2. maintenance of osmotic pressure
3. Synthesis of antibodies, plasma proteins &
hemoglobin.
4. Spare amount is used for production of
heat and energy
Sources of proteins
Animal proteins
-milk, egg, meat & fish
Vegetable proteins
-pulses, cereals, beans & nuts
Protein metabolism
1. Stored in body
2. Constantly broken down into individual
amino acids and again reused.
3. Amount & pattern of protein in the body is
maintained constant.
Requirement
Daily requirement 1 g/kg body weight
• Disorders associated with protein
intake
– Amino-acid imbalance
• Pellagra
• Protein energy malnutrition
– Causes
• Poverty
• Infections
Kwashiorkar
Not very thin
Mental changes
Poor appetite
Enlargement of liver
Growth retardation
Miserable & apothetic with
characteristic mewing cry.
Pigmentation, thickening & cracks to
ulceration.
Hair is thin and sparse and colour is
reddish or grey
Angular stomatitis
Diarrhoea
Management
• Resuscitation
• Treatment
• Rehabilitation
Prevention
• Education of mothers about nutrition
• Supplementation of diet provide nutrition
centers
• Encouraging the use of locally available
diet
Marasmus
- Child is thin & no subcutaneous fat
- Severely wasted
- Head is large
- Ribs are protruding & abdomen
- Diarrhea, dehydration,
Prevention
1. Family planning
2. Immunization
3. Encouraging breast feeding
Fats
- Hydrocarbon consisting of C, H & O
- Fats
- Oils
Classification of fats
1. Simple lipids eg. Triglycerides
2. Comp. lipids eg. Phospholipids
3. Derived lipids eg. cholesterol
Simple lipids
• Neutral fat
• Waxes
– True waxes
– Cholesterol ester
– Vitamin or vitamin D
Compound lipids
• Phospholipids
• Glycolipids
• Sulfolipids
• Aminolipids
• Lipoproteins
Derived lipids
• Obtained by hydrolysis of simple or
compound lipids
Fatty acids
Saturated fatty acids
Eg.Lauric
Steric
Palmitic
Unsaturated fatty acids
Monosaturated
Eg. Oleic acid
Polysaturated
Eg. Linoleic acid
Fats hydrolysis fatty acids + glycerol
Classification
Essential fatty acids (EFA)
- Cannot synthesized in body
- Derived only from food
- Necessary for growth
Functions of fats
1. Provide energy (9 Kcal per gram)
2. Vehicles for fat soluble vitamins (A,D,E & K)
3. Provide support to viscera like heart, kidney
& intestine
4. Insulation against cold
5. Rich sources of EFA
Sources
1. Animal sources
2. Vegetable sources
3. Other sources
Diseases
Excess intake – obesity, CHD, breast & colon
cancer
Deficiency – dry & rough skin, skin lesion
Requirement
Not > 20% of total energy intake
Vitamins
- Organic nutrients required in the diet in
small amounts to perform specific
biological functions for normal
maintenance of optimum growth & health
of organism.
- Do not supply energy
- Body cannot synthesized vitamins
Classification
1. Fat soluble vitamins- vitamins A, D, E & K
2. Water soluble vitamins- Vitamin B
complex & vitamin C.
Fat soluble vitamins
Vitamin A
- An unsaturated alcohol
- Carotene is a precursor & exists in 3
formsalpha, beta and gamma.
Sources
- carrot, spinach, green vegetables,
papaya & mangoes
- Dairy products like milk, butter &
cheese
Functions
- Necessary for retinal pigments. It is
required for vision in dim light.
- Essential for maintaining the
integrity of epithelial cells.
- Supports growth, especially skeletal
growth.
- Anti-infective
- Protects against cancers like lung
cancer.
Deficiency
- Eye manifestations
- Night blindness,
- Corneal xerosis
- Corneal keratosis
Keratomalacia
Bitot’s spot
- Extra ocular manifestations
- Abnormally thickened skin (keratosis)
- Retarded growth
- Lowered resistance to infection
- Atrophy of epithelial cell
Requirement
5000 I.U. daily
Vitamin D
- 2 forms
Vitamin D2 (calciferol)- obtained by
irradiation of ergosterol.
Vitamin D3 (cholecaciferol)- in animal
fats & fish liver oils.
Functions
1. Promotes absorption of calcium &
phosphorus
2. Necessary for bone & teeth
formation
3. Re absorption of phosphate
4. Necessary for normal growth.
Sources
• Sunlight
• Foods : fish liver oils, liver, eggs and
butter
Deficiency
- Rickets in children
- Osteomalacia in adults
Requirements
1000 I.U. daily.
Vitamin E
- Group of compound tocopherols
- Alpha, beta, gamma & delta
tocopherols
- Alpha tocopherol is most active.
Source
soya bean oil, wheat germ oil, rice
germ oil
Functions
- Necessary for reproduction &
deficiency leads to sterility.
- Necessary for muscle metabolism
- Protect vitamin A from destruction
- Prevent hemolysis by protecting
unsaturated fatty acids of
erythrocytes membrane
Deficiency
- Abortion & sterility in animals
- Haemolysis in animals
Requirements
15 IU daily
Vitamin K
Vitamin K1
Vitamin K2
Sources
Vitamin K1- present in liver, spinach, green
leafy vegetables & cows milk
Vitamin K2 – synthesized by intestinal
bacteria.
Functions
- Necessary for synthesis of clotting
factors especially prothrombin
Deficiency
- Increased bleeding
Requirements
0.03 mg/kg daily
Water soluble vitamins
Vitamin B complex are
Thiamine (Vitamin B1)
Riboflavine (Vitamin B2)
Nicotinic acid (Vitamin B3)
Pyrodoxine (Vitamin B6)
Pantothenic acid
Biotin
Folic acid
Cynocobalamine (Vitamin B12)
Thiamine (Vitamin B1,
Aneurine)
Sources: peas, beans, oatmeal, peas nut,
vegetable & fruits
Deficiency
Beriberi: dry, wet,
infantile, cerebral ( Wernickes
encephalopathy)
Metabolism of carbohydrates
Brain metabolism
Requirements
2 mg daily
Riboflavin (Vitamin B2)
Sources: milk, eggs, liver, kidney, green
leafy vegetables, meat & fish
Deficiency :
Delay wound healing
Increase susceptibility to cataract
Impaired neuromotor function
Orogenital syndrome
Coenzyme in tissue oxidation
and respiration
Angular stomatitis
Corneal vascularization
Glossitis
Requirements
2 to 3 mg daily
Niacin (Nicotinic acid/
nicotinamide)
Sources: liver, kidney, meat, poultry, fish,
legumes & ground nut.
Requirements:
50 mg daily
Deficiency:
Pellagra
Three D’s – diarrhea
- dermatitis
- dementia
In addition
- glossitis
- stomatitis Coenzyme in metabolism
Pyridoxine (Vitamin B6)
Sources: milk, liver, meat, egg yolk, fish, whole
grains, cereals, legumes & vegetables.
Function: co-enzyme for amino-transferase and
for the synthesis of GABA
Deficiency:
In infants-Convulsions due to decreased GABA production
In children- irritability, abdominal distension, loss of body
weight & anemia.
In adults- lesion of skin & mouth, peripheral neuritis & mental
changes.
- Peripheral neuritis
Requirements
2 mg per day
During pregnancy & lactation 2.5 mg per day
Pantothenic acid (Vit B5)
• Sources: liver, egg, meat, milk, yeast, peas,
sweet potatoes and molasses
• Function: carbohydrate metabolism,
biosynthesis of corticosteroids
• Deficiency:
– Burning feet syndrome
• Requirement:
– 10 mg for adult
Folic acid ( Pteroyl
Glutamic Acid)
• Sources: liver, egg, yeast, green leafy vegetables,
milk, dairy products, fruits and cereals
• Function: Production of purines and pyrimidines
• Deficiency:
– Megaloblastic anaemia
– Glossitis /cheilosis
– GIT disturbances
– Infertility/ sterility
Cyanocobalamin (Vitamin B12)
Sources:
Meat, beaf, liver, kidney, oysters, eggs & milk.
Function: metabolism of folate, synthesis of
fatty acids in myelin
Deficiency
- Megaloblastic anemia
- Addisons or pernicious anaemia
- Subacute combined degeneration
- Abnormalities of epithelial cells
Requirements
1 to 1.5 micrograms per day
Biotin ( Vitamin B7)
• Source: eggs
• Deficiency:
– Dermatitis
– Pain in muscles
– Tiredness
– Nausea
– Loss of appetite
Vitamin C (ascorbic acid)
Sources
Citrus fruit, tomatoes, green vegetables, amla,
guava fruits.
Function: antioxidant
Facilitates transport of Ferric iron
Deficiency :
Defective formation of connective tissues,
intercellular cement, dentine, osteoid tissue
- Scurvy-
- Cutaneous bleeding
- Ecchymoses
- Delayed wound healing
- Anaemia
Requirements
40-60 mg daily
Minerals
> 50 chemical elements
Mineral make up 1/20th of body weight
Function of minerals
1. Constituents of bone & teeth & required
for their growth.
2. Constituents of various body tissues
3. Maintain electrolyte balance in body
fluids
4. Maintain tone & functions of muscles
5. Stimulate digestive secretion
6. Necessary of growth.
Classification of minerals
1. Major minerals- calcium,
phosphorus, sodium, potassium &
magnesium
2. Trace elements with known
functions- iron, iodine, fluorine, zinc
& copper
3. Trace elements with no known
functionslead, mercury, barium, aluminium.
Calcium
- Forms 1.5 to 2 percent of body weight
- Avg. adult body contains 1200 gm of calcium
- 98 % in bones
Functions
1. Necessary for growth of bones & teeth
2. Required for clotting of blood
3. Regulates the contraction of muscles.
4. Required for cardiac action & milk
production
5. Transforms light into electrical impulses in
the retina
6. Forms component of several enzymes
Sources
1. Milk & milk products like cheese, curd,
butter milk
2. Green vegetable like spinach
3. Milletes like ragi
Deficiency
In children - rickets
In adult- osteomalacia
- Delay blood clotting
Requirements
400-500 mg per day
Iron
- Very important nutrient
- Body contain 3-4 g of irons
- 50-70 % present in hemoglobin of blood
Sources- liver, meat, kidney, fish, cereals, green
leafy vegetables, legumes, jaggery
Functions
1. Necessary for synthesis of hemoglobin
2. Required for brain development & muscle
activity
3. Regulates body temperature
4. Central function in oxygen transport & cell
respiration.
Deficiency
- Leads to anemia
- Impaired immunity & decrease
resistance to infection.
Requirements
15-30 mg per day
Iodine
-Essential micronutrient
-Total body content of iodine about 50 mg
Functions
- Required for synthesis of thyroid
harmones
- Minute amounts requires for growth,
development & well being.
Sources
- Sea foods
- Cod liver oil
- Small amounts are present in milk, meat,
cereals & vegetables.
Deficiency
1. Hypothyroidism
2. Retarded physical growth & mental
development
3. Spontaneous abortion & still birth
4. Neurological cretinism
5. Myxoedematous cretinism
Requirements
150 micrograms per day
Fluorine
- Most abundant element in nature
- Highly reactive
- Combined form as fluoride
- Fluoride is present in bones & teeth.
Functions
1. Require for normal mineralization of
bone
2. Formation of dental enamel.
Sources
Drinking water, sea fish,
cheese & tea
Deficiency
Dental caries
Excess
Dental & skeletal fluorosis
Requirement
0.5 to 0.8 mg per liter.
Zinc
• Sources: Ordinary diet
• Deficiency
– Growth retardation
– Sexual dysfunction
– Multiple infections
– Disorder in taste
– Alopecia
– Skin lesions
• Requirements:
– 12 mg
Copper
- Synthesis of hemoglobin & also some
enzymes
Sources
Common salt, banana, tomatoes & green
leafy vegetables
Disturbance
- Wilson’s disease: liver damage and
neurological disturbances
Balance diet
Is defined as a food which contains
adequate amounts of carbohydrates,
proteins, fats, vitamins & minerals
which provide enough energy &
maintain good health.
- Prevent diseases caused due to
malnutrition.
Composition of balance
diet
For an average Indian male
Cereals – 400g
Pulses - 55-70 g
Leafy vegetables – 100 g
Other vegetables – 75 g
Roots & tubers - 75 g
Milk – 200 g
Fats & oils – 35 g
Meat & fish - 30 g
Egg – 30 g
Fruits – 30 g
Sugar & jaggery – 30 g
Nutrition programmes in
India
1. Vitamin A prophylaxis programme
2. prophylaxis against nutritional
anemia
3. Special nutrition programme
4. Balwadi nutrition programme
5. ICDS programme
6. Mid-day meal programme.
Dietary goals
• Dietary fat
• Refined carbohydrates
• Restriction of fats and alcohol
• Salt intake
• Protein intake
• Avoidance of junk foods
Malnutrition
• Protein energy malnutrition:
– Kwashirokar
– Marasmus
• The incidence in pre-school children
is 1-2%
• PEM is due to
– Inadequate food intake
– Occurrence of diseases
• Other factors include:
– Poor environmental conditions
– Poor maternal health
– Large family size
– Failure of lactation
– Premature termination of breast
feeding
– Adverse cultural practices
• Malnutrition is self perpetuating
• Early detection of PEM
– Underweight child
• Classification of PEM
– Gomez
– Waterlow’s classification
• Malnutrition with retarded growth
• Malnutrition with a low weight
• Arm circumference
– Reliable estimation of muscle mass.
• Preventive measures
– Health promotion
– Specific protection
– Early diagnosis and treatment
– Rehabilitation