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Copyright © 2007, 1982, New Age International (P) Ltd., Publishers Published by New Age International (P) Ltd., Publishers

All rights reserved. No part of this ebook may be reproduced in any form, by photostat, microfilm, xerography, or any other means, or incorporated into any information retrieval system, electronic or mechanical, without the written permission of the publisher. All inquiries should be emailed to [email protected]

ISBN (13) : 978-81-224-2972-5

PUBLISHING FOR ONE WORLD NEW AGE INTERNATIONAL (P) LIMITED, PUBLISHERS 4835/24, Ansari Road, Daryaganj, New Delhi - 110002 Visit us at www.newagepublishers.com Foreword

FOODS AND NUTRITION are essential for maintaining good health and to prevent disease. Although food occupies the first position in the hierarchical needs of man, ignorance of many basic facts relating to foods and nutrition is still widespread. Consequently, various nutritional disorders for which there are simple remedies such as blindness caused by vitamin A deficiency persist. Good nutrition is a function of both economics and education. In our country, the most serious form of nutritional disorder is undernutrition arising from inadequate purchasing power. However, even when purchasing power is adequate to access balanced nutrition, various forms of imbalance in dietary intake occur due to lack of knowledge. The culinary art of which we are justifiably proud, has placed organoleptic considerations as the sole criteria of excellence. The various opportunities for accomplishing balanced nutrition through synergistic interaction within the components of diet have not received the consideration they deserve. I am, therefore, happy that Dr. Sumati R. Mudambi and Dr. M.V. Rajagopal have taken the trouble of revising their excellent book Fundamentals of Foods and Nutrition and added Diet Therapy in the fifth edition of the book. The book covers all the important areas which ought to be taken into consideration while promoting good nutrition in health and disease. The knowledge of foods and nutrition is essential for teachers, health professionals, students of home sciences and health sciences and civil society organizations engaged in fighting endemic and hidden hunger. The revised edition with the addition of diet therapy will be a valuable book for the use of dietetics and nursing students. It will also be a valuable guide and reference book for physicians and other health professionals. The book of Dr. Mudambi and Dr. Rajagopal will make an important contribution to accelerating the pace of achieving good nutrition in health and disease. The publication of the revised version is timely.

Dr. M.S. Swaminathan Unesco Cousteau Chair in Ecotechnology & Chairman, M.S. Swaminathan Research Foundation, Chennai 600113. This page intentionally left blank Preface to the Fifth Edition

WE ARE HAPPY to present the 5th edition of Fundamentals of Foods, Nutrition and Diet Therapy. This book is an introduction to Foods, Nutrition and Diet Therapy. The science courses studied at high school level are sufficient background for this course. This book has consistently been used by students studying the first course in Food Science and Nutrition. In several universities diet therapy topics have been added in the curricula of this course. Therefore diet therapy has been added in this revision. We hope it meets the altered needs of our readers. The revised book is intended to meet the needs of students in a number of faculties in which Foods, Nutrition and Diet Therapy is a major, elective or ancillary subject. These include Home Science, Nursing, Medical and Paramedical, Agriculture, Education, Arts, Social Sciences, Community Health, Pediatrics, Environmental Health and Allied areas. The contents of this edition have been revised in view of the recent developments in the area, logical sequence of subject matter, changes in the syllabi of universities and the feedback from teachers and students. The book covers the following aspects: I. Introduction to the Study of Nutrition (Chapter 1 to 3) II. The Nutrients and Energy (Chapters 4 to 13) III. Meal Planning and Management (Chapters 14 to 17) IV. Foods (Chapters 18 to 22) V. Diet Therapy (Chapters 23 t0 36) As in earlier editions, this book covers the principles of nutrition and food science and discusses the application of this knowledge in practice. In addition, in this edition it covers the principles of diet therapy, the changes in body that occur due to disease, the altered needs of the body due to disease and how to meet these through modification of the normal diet. Figures and tables have been used to help visualise practical information. The contents of the book have been developed out of continuous study and teaching of these subjects and use of the knowledge in consultation with patients and use in practical situations. Each chapter opens with an outline of its contents. Any abbreviations used are explained, and all terms, which need explanation are included in the Glossary at the end of the book. In the Appendices, Food Exchange Lists, Recommended Dietary Allowances for Indians and Food Composition Tables have been included. In addition, Table of Indian names of foods, height and weight of girls and boys from birth to eighteen years and other useful information is given. viiiviiiviii Fundamentals of Foods, Nutrition and Diet Therapy

We hope this edition helps towards making the goal of good nutrition for all, in health and disease, a reality. Any suggestions for improvement of the book in later edition are very welcome, for it indicates a shared interest in the study, development and use of this fascinating subject. We are grateful to the staff of New Age International (Private) Limited for their contribution to the development and completion of the fifth edition.

July 2006 Sumati R. Mudambi M.V. Rajagopal Preface to the First Edition

THERE HAS been a long felt need for a book on the fundamentals of foods and nutrition for the students preparing for the Higher Secondary School of Certificate Examinations of both the Central and State Boards of Education. Neither do the students of nutrition in the first year of Home Science colleges have any compact Indian book on this subject. Most of the colleges usually recommend American textbooks because of the absence of any suitable Indian book in this area. The American books, however, discuss the subject with reference to the needs of an economy different from ours with the result that students do not learn anything about the applications of nutrition to Indian conditions. This book covers the subjects of applications of the findings of the food science and nutrition to Indian conditions and at the same time discusses in simple language all the basic principles of foods and nutrition. Figures and tables have been used profusely to bring home to the beginner all aspects of foods and nutrition. For the more inquisitive and interested student references to advanced books are given in the bibliography. Through painstaking research, knowledge has been acquired about the nutrition needs of people. It is the aim of this book to motivate teachers and students to make use of this knowledge and bring about a change in the health and welfare of our people. (i) Basic Nutrition (Chapters 1 and 2). (ii) Food Selection and Preparation (Chapters 3, 4 and 5) (iii) Meal Planning (Chapters 6, 7 and 8) (iv) Disorders of Malnutrition (Chapter 9) (v) Food Preservation (Chapters 10 and 11) (vi) Safeguarding the Food Supply (Chapters 12, 13 and 14) It is hoped that this book will help our readers to understand: 1. Functions of foods, which supply our nutritional needs. 2. How to meet human need of nutrients in terms of available foods. 3. Prices are guides of supply and demand and not of their nutritive value. 4. Techniques of preparation which help us meet our needs in an enjoyable manner. 5. Meal planning as a tool in meeting nutritional needs of the family through acceptable enjoyable meals. 6. Preservation as an aid to improved food availability. 7. Safeguarding the supply through proper selection, careful storage and preparation. 8. One’s responsibilities as a consumer. The difficulties encountered by foods and nutrition teachers, due to lack of an appropriate Indian text, were brought to our notice by the teachers, who attended the NCERT Summer Workshops conducted by one of us (SRM) at the Lady Irwin College in 1978. It prompted us to complete this book, which we had started writing, on a priority basis. xxx Fundamentals of Foods, Nutrition and Diet Therapy

Great care has been taken to ensure that no mistakes have crept into the book. However, if there are any which have escaped our scrutiny, we would welcome corrections from our readers. We are grateful to the Director, National Institute of Nutrition for supplying the figurs 9.2, 9.3, 9.4, 9.5, 9.6, and 9.7, to Messrs Voltas Limited for figures 3.1, 10.2, 10.3, 10.4, 12.4 and 14.1 and to Messrs Balsara & Company for figure 12.2. We are grateful to late Dr. Leela Phadnis, Professor of Foods & Nutrition, Vanasthali Vidyapeeth, Vanasthali, Rajasthan, Dr. S.S. Ajagaonkar, former President, All-India Institute of Diabetes, Bombay and to late Dr. V. Nagarajan, Assistant Director-General, Indian Council of Agricultural Research, New Delhi, for their careful appraisal of the manuscript and valuable suggestions. We sincerely appreciate the assistance of our sons Anand and Shyam, who corrected typescripts and prepared the glossary for us.

Bombay SRM September, 1982 MVR Contents

Foreword v Preface to the Fifth Edition vii Preface to the First Edition ix

Part I: Introduction to the Study of Nutrition Chapter 1 Foods, Nutrition and Health ...... 3 Chapter 2 Digestion, Absorption and Utilisation of Nutrients ...... 11 Chapter 3 The Recommended Dietary Allowances for Nutrients ...... 26

Part II: The Nutrients and Energy Chapter 4 Carbohydrates ...... 37 Chapter 5 Fats and Other Lipids...... 46 Chapter 6 Proteins and Amino Acids ...... 58 Chapter 7 Energy Metabolism ...... 70 Chapter 8 Fat-soluble Vitamins ...... 87 Chapter 9 Water-Soluble Vitamins ...... 99 Chapter 10 Major and Trace Minerals ...... 115 Chapter 11 Water, Fluids, Electrolytes and Acid-base Balance...... 128 Chapter 12 Nutrition for Fitness, Athletics and Sports ...... 136 Chapter 13 Disorders of Nutrition ...... 141

Part III: Meal Planning and Management Chapter 14 Food Guides for Selecting an Adequate Diet...... 159 Chapter 15 Meal Planning for the Family ...... 175 Chapter 16 Meal Planning for Various Age Groups ...... 185 Chapter 17 Indian Meal Patterns—Vegetarian & Non-Vegetarian ...... 205 xiixiixii Fundamentals of Foods, Nutrition and Diet Therapy

Part IV: Foods Chapter 18 Food Selection, Purchase and Storage ...... 213 Chapter 19 Food Preparation...... 226 Chapter 20 Effect of Preparation on Food Components ...... 235 Chapter 21 Factors Affecting Food Acceptance ...... 241 Chapter 22 Food Sanitation and Hygiene ...... 246

Part V: Diet Therapy Chapter 23 Adaptation of Normal Diet for Changing Needs ...... 257 Chapter 24 Principles of Diet Therapy and Therapeutic Nutrition ...... 261 Chapter 25 Nutrition in Infections, Fever and Lung Diseases ...... 275 Chapter 26 Nutrition in Diseases of the Gastrointestinal Tract ...... 281 Chapter 27 Nutrition in Diseases of Liver, Gallbladder and Pancreas ...... 287 Chapter 28 Nutrition in Diabetes Mellitus ...... 293 Chapter 29 Nutrition in Cardiovascular Diseases ...... 301 Chapter 30 Diet and Nutrition in Kidney Diseases ...... 314 Chapter 31 Nutrition in Cancer ...... 325 Chapter 32 Nutrition in Immune System Dysfunction, AIDS and Allergy ...... 329 Chapter 33 Nutrition Support in Metabolic Disorders ...... 336 Chapter 34 Nutrition in Stress, Burns and Surgery ...... 343 Chapter 35 Nutrition: Addictive Behaviours in Anorexia Nervosa, Bulimia and Alcoholism .... 350 Chapter 36 Nutrient Drug Interaction ...... 355 Appendices ...... 363 Index ...... 399 PART - I Introduction to the Study of Nutrition This page intentionally left blank CCCHAPTERHAPTERHAPTER 1

Foods, Nutrition and Health

Definitions Food Nutrition Adequate Nutrition Nutritional Status Malnutrition Nutritional Care Health Functions of Food Physiological, Social and Psychological Functions Functions of Nutrients Carbohydrates, Fats, Proteins, Vitamins, Minerals and Water Food Composition Food Exchange Lists Nutrient Density How Will you be a Responsible Nutrition Student? Study Questions

FOOD HAS been a basic part of our existence. Through the centuries we have acquired a wealth of information about the use of food to ensure growth of children and youth, to maintain good health through life, and to meet special needs of pregnancy and lactation and to use it to recover from illness. When you study food composition you will know the nutritional contribution of foods. You may have been told that certain foods are very important for maintaining good health, while others are harmful. As you study the science of Foods and Nutrition, you will need to examine the ideas you have about foods very carefully and accept or reject these in the light of the knowledge you will acquire. Whatever you learn in this area should be used and applied in your personal life. A large part of our food heritage is scientifically beneficial and needs to be retained; some aspects may need to be modified in the view of the changes in our lifestyle. Food is an important topic of conversations, articles in newspapers and magazines, as also of advertisements. Some of this information may be correct, but a large part of it may not be. As you learn 444 Fundamentals of Foods, Nutrition and Diet Therapy this subject, you will be able to spread the knowledge gained to those around you, so that they discard false ideas about food, which interfere with their food selection and affect their health. Food, nutrition and health are intimately connected aspects of our life. Let us start our study by defining these and related terms.

Definitions Food is that which nourishes the body. Food may also be defined as anything eaten or drunk, which meets the needs for energy, building, regulation and protection of the body. In short, food is the raw material from which our bodies are made. Intake of the right kinds and amounts of food can ensure good nutrition and health, which may be evident in our appearance, efficiency and emotional well-being (Figure 1.1). Nutrition has been defined as food at work in the body. Nutrition includes everything that happens to food from the time it is eaten until it is used for various functions in the body. Nutrients are components of food that are needed by the body in adequate amounts in order to grow, reproduce and lead a normal, healthy life. Nutrients include water, proteins, fats, carbohydrates, minerals and vitamins. There are several nutrients in each of the groups: proteins, fats, carbohydrates, minerals and vitamins; hence the plural form of these words has been used. Thus there are over 40 essential nutrients supplied by food, which are used to produce literally thousands of substances necessary for life and physical fitness. The study of the science of nutrition deals with what nutrients we need, how much we need, why we need these and where we can get them. Nutrition is the result of the kinds of foods supplied to the body and how the body uses the food supplied. Adequate, optimum and good nutrition are expressions used to indicate that the supply of the essential nutrients is correct in amount and proportion. It also implies that the utilisation of such nutrients in the body is such that the highest level of physical and mental health is maintained throughout the life-cycle.

Figure 1.1: A well-nourished child engrossed in play. Foods, Nutrition and Health 555

Nutritional status is the state of our body as a result of the foods consumed and their use by the body. Nutritional status can be good, fair or poor. The characteristics of good nutritional status are an alert, good natured personality, a well developed body, with normal weight for height, well developed and firm muscles, healthy skin, reddish pink colour of eyelids and membranes of mouth, good layer of subcutaneous fat, clear eyes, smooth and glossy hair, good appetite and excellent general health. General good health is evident by stamina for work, regular meal times, sound regular sleep, normal elimination and resistance to disease. Poor nutritional status is evidenced by a listless, apathetic or irritable personality, undersized poorly developed body, abnormal body weight (too thin or fat and flabby body), muscles small and flabby, pale or sallow skin, too little or too much subcutaneous fat, dull or reddened eyes, lustreless and rough hair, poor appetite, lack of vigour and endurance for work and susceptibility to infections. Poor nutritional status may be the result of poor food selection, irregularity in schedule of meals, work, sleep and elimination. The WHO (World Health Organization) has defined health as the ‘state of complete physical, mental and social well-being and not merely the absence of disease or infirmity’. Malnutrition means an undesirable kind of nutrition leading to ill-health. It results from a lack, excess or imbalance of nutrients in the diet. It includes undernutrition and overnutrition. Undernutrition is a state of an insufficient supply of essential nutrients. Malnutrition can be primarily be due to insufficient supply of one or more essential nutrients; or it can be secondary, which means it results from an error in metabolism, interaction between nutrients or nutrients and drugs used in treatment. Overnutrition refers to an excessive intake of one or more nutrients, which creates a stress in the bodily function. Diet refers to whatever you eat and drink each day. Thus it includes the normal diet you consume and the diet people consume in groups (hostel diet). Diet may also be modified and used for ill persons as part of their therapy (therapeutic diets). Nutritional care is the use of nutritional knowledge in planning meals and the preparation of these meals in an acceptable and attractive manner to feed people. It involves assessment of the exiting meal patterns and improving these in an acceptable manner. While the nutritional plan may be general for a group of people, the actual execution is individualized to suit the person’s needs and background. Thus one has to use a lot of ingenuity to succeed in making nutritional care effective in practical terms. Health the word health refers to the condition of the body, good health not only implies freedom from disease, but physical, mental and emotional fitness as well.

Functions of Food Physiological functions of food. The first function of the body is to provide energy. The body needs energy to sustain the involuntary processes essential for continuance of life, to carry out professional, household and recreational activities, to convert food ingested into usable nutrients in the body, to grow and to keep warm. The energy needed is supplied by the oxidation of the foods consumed. The foods we eat become a part of us. Thus one of the most important functions of food is building the body. A newborn baby weighing 2.7-3.2 kg can grow to its potential adult size of 50–60 kg if the right kinds and amounts of food are eaten from birth to adulthood. The food eaten each day helps to maintain the structure of the adult body, and to replace worn out cells of the body. 666 Fundamentals of Foods, Nutrition and Diet Therapy

The third function of food is to regulate activities of the body. It includes regulation of such varied activities as: • Beating of the heart • Maintenance of the body temperature • Muscle contraction • Control of water balance • Clotting of blood • Removal of waste products from the body The fourth function of food is to improve our body’s resistance to disease. The Social Functions of Food. Food has always been a central part of our social existence. It has been a part of our community, social, cultural and religious life. Special foods are distributed as a benediction or prasad in the religious functions in homes, temples