Nutrition Reference man He is between 18-29 years of age and weighs 60 kg with a height of 1.73m with a BMI of 20.3 and is free from disease and physically fit for active work; on each working day, he is engaged in 8 hours of occupation which usually involves moderate activity, while when not at work he spends 8 hours in bed, 4-6 hours in sitting and moving about, 2 hours in walking and in active recreation or household duties. Reference Woman She is between 18-29 years of age, non-pregnant non- lactating (NPNL) and weighs 55 kg with a height of 1.61m and a BMI of 21.2, is free from disease and physically fit for active work; on each working day she is engaged in 8 hours of occupation which usually involves moderate activity, while when not at work she spends 8 hours in bed, 4-6 hours in sitting and moving about, 2 hours in walking and in active recreation or household duties. Age group/ Category Caloric Protein Sex Requirement requirement (Kcal/day) Man Sedentary 2320 1 gm/kg/day Moderate 2730 Heavy 3490 Woman Sedentary 1900 1gm/kg/day Moderate 2230 Heavy 2850 Pregnancy +350 +0.5 gm (1st trimester) +7 gm (2nd trimester) + 23 gm (3rd trimester) Lactation +600 +19 gm (0-6 months) Lactation +520 +13 gm (7-12 months) Recommended metabolizable energy Protein 4 Kcal/gm Fat 9 Kcal/gm Carbohydrates 4 Kcal/gm Dietary Fiber 2 Kcal/gm Alcohol 7 Kcal/gm Healthy Diet • Fruits, vegetables, legumes (e.g. lentils, beans), nuts and whole grains (e.g. unprocessed maize, millet, oats, wheat, brown rice). • At least 400 g (5 portions) of fruits and vegetables a day. • Less than 10% of total energy intake from free sugars, but ideally less than 5% of total energy intake for additional health benefits. • Less than 30% of total energy intake from fats. Unsaturated fats are preferable to saturated fats. Industrial trans fats are not part of a healthy diet. • Less than 5 g of salt per day and use iodized salt. Assessment of protein quality Amino acid score = No. of mg. of one amino acid per gram of protein X 100 No. of mg. of same amino acid per gram of egg protein Digestibility coefficient= nitrogen absorbed X 100 Nitrogen intake Assessment of protein quality Biological value = nitrogen retained X100 Nitrogen absorbed Net protein utilization = nitrogen retained X 100 Nitrogen intake Assessment of protein quantity Protein efficiency ratio = weight gain in gm Protein intake in gm MCQ The highest percentage of monounsaturated fatty acids is present in- a) Sunflower Oil b) Mustard Oil c) Rice bran Oil d) Olive Oil The net protein utilization is defined as- a) The gain in weight of young animals per unit weight of protein consumed b) The product of digestibility coefficient and biological value c) The percentage of protein absorbed into the blood d) The percentage of nitrogen absorbed from the protein absorbed from the diet A teacher will be classified as a a) Sedentary worker b) Moderate worker c) Heavy worker d) Average worker A ‘safety margin’ of + 2 SD is not incorporated for the RDA of a) Energy b) Fats c) Water soluble vitamins d) Fat soluble vitamins For a 60 kg Indian male, the minimum daily protein requirement has been calculated to be 40 g (mean) & standard deviation is 10. The recommended daily allowance of protein would be: a) 60 g/day b) 70 g/day c) 40 g/day d) 50 g/day The assessment of protein quality is done by all except- a) Protein efficiency ratio b) Biological value c) Digestibility coefficient d) Net protein utilization Egg is deficient in a) Carbohydrates b) Vitamin C c) Both of the above d) None of the above The extra energy allowance needed per day during pregnancy is- a) 150 Kcals b) 200 Kcals c) 350 Kcals d) 550 Kcals An average sized egg would provide (UPSC CMS 2012) a) 50 kcal b) 70 kcal c) 90 kcal d) 110 kcal Vitamins Vitamin A Functions: 1) It is vital for the formation of retinal pigment rhodopsin in rods of the retina 2) integrity of cellular structure 3) immune defense mechanism of the body 4) antioxidant property RDA: • 2000 IU / 600 µg RE • Pregnant & Lactating mothers- 950 RE Vitamin A Sources: • Richest source is Halibut liver oil followed by Cod liver oil. • Top sources of vitamin A include: • Beef liver • Egg yolk • Cheddar cheese • Fortified milk Xerophthalmia Night blindness Conjunctival xerosis Bitot’s spots Corneal xerosis Corneal ulceration Corneal scar Xerophthalmic fundus Treatment <6 months 50,000 IU 6m- 1 year 1 lac IU >1 year but weight less than 8 kg > 1 year 2 lac IU The above dose should be given on Day 0,1 and 14 Vitamin A Supplementation The first dose of 100,000 IU is given at 9 months of age along with measles vaccines. Thereafter, the second and subsequent doses of 200,000 IU are given at 6 monthly intervals till 5 years of age. Thiamine (B1) Functions: • Acts as a coenzyme in many metabolic reactions • health of the nerve tissue and for normal cardiac and gastro-intestinal functions RDA: • 0.5mg per 1000 Kcal Sources: Yeast, egg yolk, liver, wheat-germ, nuts, red meat and cereals Deficiency: Beriberi and Wernicke- Korsakoff psychosis Wet beriberi is the acute form - CVS Dry beriberi is the chronic form of disease - PNS Infantile beriberi occurs in the first few months of life Wernicke-Korsakoff psychosis (wet brain, alcoholic encephalopathy)is seen in • chronic alcoholics with poor diet • in patients undergoing prolonged intravenous therapy without B1, • gastric stapling • hunger strikes. Treatment Beriberi - Thiamine 500 mg in 10 divided doses Wernicke-Korsakoff psychosis – Thiamine 1000 mg in 10 divided doses Riboflavin (B2) Sources: Dairy products, liver, vegetables, eggs, cereals, fruit, yeast Functions: (a) Promotion of normal growth (b) Assisting synthesis of steroids, RBC and glycogen (c) Maintenance of mucous membranes, eyes and the nervous system (d) Aiding iron absorption Riboflavin (B2) RDA: • 0.6 mg per 1000 Kcal Deficiency: • Cheilosis, angular stomatitis, glossitis, magenta tongue, nasolabial seborrhea and genital (scrotal or vulval) dermatosis Niacin (B3) Sources: • Meat (especially the organs), fish, chicken, eggs, milk, whole meal cereals, groundnuts and pulses are good sources. • 60 mg of tryptophan is needed to form 1mg niacin RDA: • 6.6mg niacin equivalents per 1000 Kcal Functions: As coenzymes in metabolism Deficiency: Pellagra (a) Dermatitis: The neck is frequently involved and the distinctive distribution of skin lesions is known as Casal’s Collar. (b) Diarrhea: This is often accompanied by inflamed scarlet tongue. (c) Dementia: It may present as mild confusion and disorientation to mania and psychosis. Pyridoxine (B6) Functions: Metabolism of amino acids, fats and carbohydrates RDA: 2mg; Pregnancy and lactation- 2.5 mg Sources: Milk, liver, meat, egg yolk, fish, cereals, legumes and vegetables. Deficiency: Peripheral neuritis Cyanocobalamin (B12) Functions: (a) Vitamin B12 plays important role in the synthesis of DNA (b) It helps in maintenance of myelin in the nervous system (c) It has an important role in the treatment of pernicious anemia RDA: 1 μg Sources: • not present in any vegetable foods. • present in animal products - milk, milk products, meat and fish. • also synthesized by the microorganisms in the gut Deficiency: • Megaloblastic anemia • Peripheral neuropathy Folic Acid Functions: (a) synthesis of DNA. (b) anti anemia factor RDA: • 100 µg • Pregnancy 400 µg • Lactation 150 µg Sources: It occurs in green leaves, pulse, cereals, liver, kidney, mushroom and yeast Deficiency: • Megaloblastic anemia • Neural tube defects • Hyperhomocystenemia Vitamin C Functions: • formation of collagen • enhances the absorption of iron • anti-oxidant property RDA: • 40 mg • 80 mg for lactating women Sources: • Gooseberry (Amla) is the richest source. • Citrus fruits • Liver, whale skin, oysters, brain are good animal sources Deficiency: • Scurvy Vitamin D Functions: absorption and excretion of calcium; bone mineralization RDA: 100 IU Sources: Cod liver oil, other oily fish, milk, margarine, eggs, liver. Deficiency: • Rickets in Children • Osteomalacia in adults Stoss therapy for treatment of Rickets • Give 600,000 IU of Vitamin D2 orally • White line of mineral deposition at the growing ends of bones • If it fails, then repeat • If no improvement still, then it’s Vitamin-D resistant rickets. • calcium 1000 mg/day • After 3-months, maintenance dose - 400 IU of Vitamin D2 Vitamin K Functions: Synthesis of Prothrombin and blood coagulation factors. RDA: 0.03 mg/kg/day Sources: Exogenous: Green leafy vegetables, vegetable oils esp. soya bean oil, eggs, meat and dairy products Endogenous: Gut bacteria Deficiency • Vitamin K Deficiency Bleeding (VKDB) • All newborns with birth weight of 1000gm or more should be administered 1mg of Vitamin K IM while those weighing less than 1000 gm should receive 0.5 mg dose. Daily requirement of Thiamine is determined by metabolism of which of the following (AIIMS 2009) a) Proteins b) Fats c) Carbohydrates d) Cholesterol Prolonged treatment with Isoniazid leads to deficiency of- (AIPGME 2011) a) Pyridoxine b) Thiamine c) Pantothenic acid d) Niacin All of the following are true except (AIIMS 2009) a) Vitamin K is given in Keratomalacia b) Hypervitaminosis A causes Pseudotumor cerebri c) Zinc excess causes pulmonary fibrosis d) Iodine deficiency causes Goiter When a patient is cut off the sources of vitamin A its deficiency is manifested after (AIIMS 2008) a) 1 year b) Immediately c) Within weeks d) Within few days Which of the following vitamins given as a supplement during the peri-conceptional period to a woman can help prevent the neural tube