Nutrition & Health Practical write ups for MBBS per CBME 2019. Dr. Mandar Baviskar, Dr. BVP RMC, Pravara Institute of Medical Sciences(DU), Loni

1. Nutritive Value of Common Foods
Dr. Mandar Baviskar M.D.
Associate Professor-Community Medicine
Dr. Balasaheb Vikhe Patil Rural Medical College
Pravara Institute of Medical Sciences(DU), Loni
Nutrition Practicals Series
CM 5.1 Describe common sources of various nutrients
By theendof thissessionyoushouldbe able to
1. Identify Common Food Groups
2. Enumerate their Important Nutritive Values

2. Cereals
Per 100 gm. Energy
(kcal)
Protein
(gm.)
Fats
(gm.)
Important Micronutrients
Wheat ~345 11.8 1.5 • Rich in Thiamine, Niacin & Riboflavin. Poor in Vitamin
(A,D,C), Iron & Calcium.
• Leucine interferes with tryptophan niacin conversion
• Rice richer in lysine better protein quality
Rice ~345 6.8 1.5
Maize ~340 11 3.6
Jowar ~350 10.5 1.9 Iron(4 mg.), Ca (25 mg.)
Bajra ~360 11.5 5 Iron(8mg.), Ca (42mg.)
Ragi ~330 7.3 1.3 Calcium 344 mg.
Lysine & Threonine are Limiting Amino Acids. High Leucine content in Rice Maize & Jowar can limit Tryptophan conversion
to Niacin leading to Pellagra. Polished rice leads to Beri-Beri. Cereals form the bulk of Indian diet & primary carbohydrate
source. Deficiency may lead to PEM.

3. Pulses
Per 100 gm. Energy
(kcal)
Protein
(gm.)
Fats
(gm.)
Micronutrients
(mg.)
Soya bean 432 43.2 19.5 Ca-240, Fe-10.5
B1-0.7,B2-0.4, B3-3.2
Pigeon Pea/ Red gram
(Tur/Arhar)
335 22.3 1.7 Ca-73, Fe-2.7
B1-0.4,B2-0.2,B3-3
Bengal Gram 360 17.1 5.3 Ca-202, Fe-4.6
B1-0.3,B2-15,B3-3 , Vit. C-3
Black Gram
(Urad)
347 24 1.4 Ca-154, Fe-3.8,
B1-0.4,B2-0.2,B3-2
Green Peas 315 20 1.1 Ca-75, Fe-7
Methionine is the Limiting Amino Acid
Dal paired with rice, Idli –Sambar, Mac & Cheese lead to supplementary action of protein
In raw state pulses have Anti-nutritional factors like phytates & tannins that reduce absorption of other nutrients.
Germination & Fermentation Improves nutritive value (Vitamin B1,2,3)
Oligosaccharides in pulses can lead to Flatulence

4. Animal Products
Hen’s Egg
The average weight of an egg is 60 grams which contains
 6g proteins,
 6g fats,
 30 mg calcium,
 1.5 mg Iron
 Energy of 70 kcal.
Egg contains all the essential amino acids : NPU is 100
It contains all vitamins except Vitamin C
It is also a good source of Ca, Fe, Zn, P
Raw egg is not assimilated due to presence of AVIDIN, an
anti nutritive substance which is destroyed by heat.
Hence, boiled egg is superior to raw egg.

5. Milk
Whole milk
Skimmed milk- Fat free
Toned milk-Water(1),Milk(1), Milk Powder(1/8)

6. Fruits

7. Assessment of Nutritional Status
Dr. Mandar Baviskar M.D.
Associate Professor-Community Medicine
Dr. Balasaheb Vikhe Patil Rural Medical College
Pravara Institute of Medical Sciences(DU), Loni
Nutrition Practicals Series
CM 5.3 Perform nutritional Assessment of Individual, Family
By theendof thissessionyoushouldbe able to
1. Conduct nutritional interview using 24 hour recall method
2. Conduct Anthropometric evaluation
3. Interpret your findings

8. Diet for an Adult
Calories requirement depends on the age, sex, climate
and physical activity.
An average Indian adult man requires per day
2425- Sedentary lifestyle
2875 – Moderate work
3800 – Heavy work
An average Indian adult woman requires per day
1875 – Sedentary lifestyle
2225 – Moderate work
2925 – Heavy work
Additional 350 calories in pregnancy
Additional 600 to 550 calories in lactation (first 6
months)
Proteins: 1 g / kg / day
In woman, + 15 g/ day in pregnancy, + 25g / day
in lactation
Fats: Should be 20 gms/day
Should contribute 30% of total energy intake,
preferably of unsaturated type
Carbohydrates: Main source of energy. Should
contribute 50-70% of total energy intake
Adequate vitamins and minerals through a
balanced diet.

9. Item Calories
Poha 270
Shira 300
Upma/Rawa 220
Lapshi/Daliya 220
Idlli(2) 150
Dosa 125
Vada(2) 140
Sambar 110
Chutney 120
Corn Flakes 230
Pakoda(8) 280
Samosa 200
Veg. Puff 170
Veg. Sandwich 200
Omlette 160
Non veg. Cutlet 200
Item Calories
Tea 75
Coffee 110
Milk 180-320
Biscuits 50-100
Bread slice(2) 170
Cold drink(200 ml.) 150
Fruit Cake 270
Custard 160
Halwa 320
Ice Cream 200
Lassi 110
Banana 110
Salad 10-30
Calorie values of Foods
Item Calories
Roti 100-150
Rice (1 wati) 170
Dal (1 wati) 200
Vegetables 150-200
Chicken (3/4 wati) 240
Mutton (3/4 wati) 260
Fish (3/4 wati) 240
Kheema 240
Item Calories
Liquor (60 ml.) 140
Liquor (180 ml.) 426
Beer (500 ml.) 220
Fried Nuts (1/2
serving)
170

10. Sample Dietary History
The patient consumes mixed diet (Non veg at least 1 time/wk.)
Calorie req.: 2300, Consumption: 2100, Deficit: ~±200
Protein req.: 75 grams, Consumption: 66 grams, Deficit: 9 grams
Time Item Calories Proteins
Breakfast Rice (1 wati)
Dal(1 wati)
Chapati 2
Vegetable (1 wati)
Tea 1 cup
300
300
200
150-400
50
10
16
5
5
-
Lunch Sabzi/ Dal tadka
Roti 2
300
300
10
5
Evening Snacks Tea 1 cup
Biscuits/Chips
50
150
-
Dinner Dal Khichadi (1 plate) 300 15
Total 2100-2450 66

11. Role Play
1. Farmer
2. Farm Laborer (Woman)
3. Medical Student

12. Anthropometry
Weight (Thumb rule): Height in cm.-100
BMI (Body Mass Index):
Weight (kg.)/(Height in meters)2

13. Anthropometry as Risk Assessment tool
Waist Circumference: Better indicator in
India
Hip Circumference: Broadest part of Hip
Waist: Hip Ratio:
According to the World Health Organization (WHO),
a moderate WHR is:
0.9 or less in men
0.85 or less for women
In both men and women, a WHR of 1.0 or higher
increases the risk of heart disease and other
conditions that are linked to having overweight.

14. Assignment
1. Mr. AK a 36 year old Businessman complains of frequent breathlessness & sweating on
exertion. His height is 160 cm and weight is 90 kg. His waist circumference is 110 cm.
Calculate Anthropometric indicators for Mr.AK ?
Is he at a higher risk of Non communicable Diseases?
What medium to long term target should he set for himself based on given data?
2. Take 24 hour recall dietary history of your roommate. Comment on calorie
deficit/excess.
3. Measure & Note your own Height, Weight, BMI, Waist circumference and Waist : Hip
ratio.

15. Dietary Planning for Special Groups
Dr. Mandar Baviskar M.D.
Associate Professor-Community Medicine
Dr. Balasaheb Vikhe Patil Rural Medical College
Pravara Institute of Medical Sciences(DU), Loni
Nutrition Practicals Series
CM 5.4 Prescribe dietary plan for various special groups
By theendof thissessionyoushouldbe able to
1. Identify Nutritional Requirements of various special groups.
2. Prescribe appropriate diet plan as per requirements

16. SPECIAL GROUPS
Pregnancy Lactation Children Elderly
Chronic
Diseases

17. LACTATION
Energy: Usual Req.+350 kcal/day
Proteins (for 10 kg gestational weight
gain)
◦ 1st trimester- +1 gm./day
◦ 2nd trimester- +7 gm./day
◦ 3rd trimester- +23 gm./day
Energy:
0-6 months +600 kcal/day
Next 6 months +520kcal/day
Proteins:
0-6 months +13 gm./day
PREGNANCY

18. Infancy
Breast feeding is the best for the child.
Exclusive breast feeding is advocated till the
child is 6 months of age.
Early breast feeding within ½ hour of birth in
normal deliveries & within 4 hours of birth in
cases of cesarean sections.
Colostrum is important and should not be
discarded.
The child should receive both : foremilk and
hind milk
Complementary feeding should start from 6 months
onwards as breast feeding alone is not enough to
meet the requirements of the baby after 6 months..
Home made semi-solid foods followed by solid
foods are to be given.
Rice Kanji, dal water, soups, fruit juices are the early
weaning foods followed by bananas, mashed
potatoes, khichadi (cereal-pulse comb.). Full diet
by age of 1 year.
Breastfeeding should be continued till 2 years of
age.
Complementary feeding

19. Diet in Childhood
A child should be able to eat all that is normally
cooked in the house
The following points should be kept in mind
Higher Calories are required to meet needs of
higher BMR, greater physical activity & growth
Adequate carbohydrates should be taken.
Excessive ingestion of sweets to be avoided.
A high protein diet is necessary to meet the
growth requirements. Use of milk, milk products,
cereals, pulses, nuts, meat, fish and egg are
advocated.
Adequate fat, mineral, vitamin and fluid intake
are advocated.
Age
(M-Male, F-Female)
Calorie
requirement
kcal/day
Protein req.
g/kg/day
(T- total)
Infants
0-3 months
3-6 months
6-9 months
9-12 months
120 kcal/kg/day
115 kcal/kg/day
110 kcal/kg/day
108kcal/kg/day
2.3
1.8
1.8
1.5
Children
1-3 years
4-6 years
6-9 years
1240
1690
1950
1.8 (T- 21)
1.5 (T- 29)
1.4 (T- 40)
Adolescents
10-12 M
10-12 F
13-15 M
13-15 F
16-18 M
16-18 F
2190
1970
2450
2060
2640
2060
1.4 (T- 54)
1.4 (T-57)
1.4 (T- 70)
1.3 (T- 65)
1.3 (T- 78)
1.2 (T- 63)

20. Diet in Old Age
Principles
Calories should be restricted to prevent obesity.
Adequate carbohydrates are to be supplied
Proteins around 70 g/day. This high protein diet is required for counteracting hypo-
proteinaemia, correction of anemia & for increasing body resistance.
Fats around 15-30% of total energy intake, preferably of unsaturated nature
Multivitamin supplements are necessary especially in under-nutrition and osteoporosis.
Adequate fluids and minerals are necessary. It may be necessary to supplement potassium and
calcium.

21. Diet in PEM
The problem: Deficiency of proteins and calories often associated with deficiency of various vitamins and
minerals.
Calories: 150-100 cal/kg/day. Almost twice the (N) requirement.
Proteins: 20% of the total calories should be supplied by proteins. 3-4 g/kg/day are required. This is
obtained from foods like milk, Bengal gram, egg yolk, rice-moong dal khichadi etc.
Fats: Required to give calories & make diet tastier. Ghee or oil should be added extra in the diet
Carbohydrates: Are the main source of the calories required. They should give 50-70% of the required
calories.
Vitamins: Multivitamin preparations are helpful as vitamin deficiencies are also associated.
Minerals: i) Potassium supplements may be required
ii) Iron and calcium are supplemented.

22. Diet in Liver Diseases
The problem:
A person suffering from a liver disease has a limited capacity to metabolism. However,
adequate nutrients are required to meet the needs of the body.
Principles:-
Calories : A minimum of 1,000 calories / day in a comatose patient others require 1,500 – 2,500
calories
Carbohydrates: High carbohydrate diet is necessary. It provides calories, prevents endogenous
protein breakdown & protects liver cells from damage by filling them up with glycogen. It also
prevents hypoglycemic episodes to which these patients are prone.

23. Proteins
◦ In a comatose patient, these are totally restricted as products of protein metabolism can cause
deterioration of neurological status.
◦ 40 g/day are allowed in conscious patient with jaundice and unconscious patient without jaundice.
◦ High protein diet is recommended for conscious patient without jaundice for regeneration of liver cells.
Fats: Totally restricted in comatose patients. In others 20-30 g/day.
Vitamins: esp. B complex and Vit. C are supplemented
Minerals: It may be necessary to restrict / supplement in a severely ill patients.
Alcohol is strictly prohibited even in mild cases

24. Diet in Diabetes Mellitus
1) To achieve normal blood sugar levels (glycemic control)
2) To avoid wide fluctuations in blood sugar levels
Principles:
To provide nutritive diet
To prevent undue starvation
To prevent ketosis
To maintain weight at 5% less than the calculated weight, since some obese diabetics may
become euglycemic on weight reduction.
Underweight person needs to be fed to prevent hypoglycemia. A person with normal
weight should take appropriate diet.

25. Requirements:-
Adequate calories
Refined carbohydrates are minimized to reduce blood sugar
Fats are to be given in moderate amounts
Proteins 1g/kg/day is allowed
Adequate vitamins and minerals through a balanced diet.
Food articles to be excluded are:
Sweet beverages , fruit juices and carbonated drinks
Cakes, pastries, cream, beer, wines
Sweet pickles, jaggery, sweetmeats.

26. Diet in Cardiovascular Diseases
Calories: Adequate calories as per age, sex, height norms. Obese people should decrease caloric
intake.
Carbohydrates: These are required for energy. However, they are not to be taken in excess.
Proteins : Normal intake of 1g./kg./day
Fats: should be less than 30% of total energy intake. PUFA type fats of vegetable origin eg.
Safflower oil, corn oil, sunflower oil. Milk, fish can be taken in adequate amounts
Animal fats like beef, meat, port fat, egg yolk, Hydrogenated vegetable oils, coconut oil, palm oil
are to be avoided
Vitamins and minerals : In (N) amounts
Sodium restriction in hypertension or heart failure. Papads, chutneys, pickles, pastries, salted
biscuits, red meat, egg yolk and tinned foods – to be avoided.
Others : Smoking is strictly prohibited

27. BALANCED DIET
A balanced diet is one which contains variety of foods in such quantities
and proportion that the need of all nutrients is adequately met for
maintaining health, vitality and general wellbeing and makes a small
provision for extra nutrients to withstand short duration of leanness.
ALLOCATION OF NUTRIENTS
◦ Protein ~ 15-25%
◦ Fat ~ 20-30% (MUFA, PUFA)
◦ Carbohydrate~ 55-65%
◦ Salt

28. Various Other Diets
Prudent Diet Avoid excess intake of energy, increase dietary fibre intake, reduce total fat
intake to approximately 30 per cent of energy intake, take a high proportion
of fat as the polyunsaturated form.
Mediterranean Diet The Mediterranean diet is a diet inspired by the eating habits of people who
live near the Mediterranean Sea. The diet includes proportionally high
consumption of olive oil, legumes, unrefined cereals, fruits and vegetables,
moderate to high consumption of fish, moderate consumption of dairy
products (mostly as cheese and yogurt), moderate wine consumption, and
low consumption of non-fish meat products. The Mediterranean diet is
associated with a reduction in all-cause mortality.
DASH Diet DASH diet (Dietary Approaches to Stop Hypertension) is a dietary pattern
promoted by the NIH, to prevent and control hypertension. The DASH diet
is low Salt, rich in fruits, vegetables, whole grains, and low-fat dairy foods. It
includes meat, fish, poultry, nuts, and beans, and is limited in sugar-
sweetened foods and beverages, red meat, and added fats. In addition to
its effect on blood pressure, it is designed to be a well-balanced approach
to eating for the general US public.

29. Atkins Diet The Atkins diet is a low carb diet, usually recommended for weight loss. Proponents of this diet
claim that you can lose weight while eating as much protein and fat as you want if you avoid foods
high in carbs. Because the Atkins diet can increase saturated fat intake, it’s important to speak
with your doctor before starting it and monitor yourself throughout.
Dixit Diet Two meals a day, each lasting less than 55 mins, leads to significant weight loss. Initially,
proposed for Diabetes reversal. Since hypoglycemia is a dangerous complication in Diabetes.
Evidence is inadequate. It’s important to speak with your doctor before starting it and monitor
yourself throughout.
Rainbow Diet The rainbow diet is a health-inspired trend that wants you to eat colourful fruit and vegetables that
are red, orange, yellow, green, and purple. Unlike most diets that want you to eat less and suffer
more with the end goal of rapid and unsustainable weight loss rainbow diet looks at your food
choices. “Eat the rainbow” is the mantra, and all you need to do is add more colourful plant foods
to your meals. So rather than banning carbs, gluten, fat or meat, you just need to include some
vibrant fruit and veg in your weekly diet.
Diabetic Diet A diabetes diet simply means eating the healthiest foods in moderate amounts. Preferring complex
sugars over simple sugars & processed foods. Sticking to small frequent meals. Key elements are
fruits, vegetables and whole grains.
Keto Diet The ketogenic diet is a very low carb, high fat diet. It involves drastically reducing carbohydrate
intake and replacing it with fat. This reduction in carbs puts your body into a metabolic state called
ketosis. When this happens, your body becomes efficient at burning fat for energy. It also turns fat
into ketones in the liver, which can supply energy for the brain

33. EXAM QUESTIONS
1. Prescribe a balanced diet for yourself.
2. Prescribe a balanced diet for a man who is a bank clerk by occupation.
3. Prescribe a balanced diet for a pregnant female in her second trimester having weight of 55
kg and housewife by occupation.
4. Prescribe a balanced diet for a lactating mother who is breast feeding her 5 month old infant
having weight of 55 kg and housewife.
5. Prescribe a balanced diet for a 29 year old male who is a Heavy worker.
6. Prescribe a diet plan for Mr. A who is a 56 year old and newly diagnosed with Hypertension

34. Food Adulteration
Dr. Mandar Baviskar M.D.
Associate Professor-Community Medicine
Dr. Balasaheb Vikhe Patil Rural Medical College
Pravara Institute of Medical Sciences(DU), Loni
Nutrition Practicals Series
CM 5.7
By theendof thissessionyoushouldbe able to
1. Identify various food adulterants
2. Perform basic lab tests to screen for common
adulterants

35. Food Adulteration
Food adulteration is the change in original composition and quality of food by adding, removing
or substituting some ingredients of food, which affects adversely the nature, substance and
quality of food.
Any ingredient, which is added in food and is injurious to health, is an adulterant.
Natural Adulteration
These are the chemicals, organic compounds or radicals which are naturally present in the food
and are harmful to the health.
e.g. many toxic varieties of mushrooms, fish, sea foods etc.

36. Unintentional Adulteration: These are the contaminations occur unknowingly or
incidentally in the food during harvesting, handling, transportation, processing, storage,
distribution etc. because of ignorance or carelessness or lack of proper facilities. These
adulterations may occur because of pesticides and insecticide residues, microorganisms,
heavy metals like arsenic, copper, etc. These are injurious to health if consumed for a long
time and may lead to organ failure and even death. For example: Argemone oil may
contaminate mustard oil accidently.
Intentional Adulteration: The substance is added, removed or substitute knowingly by the
adulterator for the purpose of making money. A large proportion of products available in
market are adulterated. Examples: adding water into milk, if the water is contaminated with
pathogens, it lead to food borne diseases; use of caustic soda, urea and soap solution to
make synthetic milk containing pesticides; adding non-permitted colours like textile dyes,
lead chromate.

37. Turmeric
Non-permitted colours like lead chromate, metanil yellow, auramine, rhodamine B are
used to brighten the foods especially spices, pulses, beverages etc. These are harmful
for the health and may lead to testicular degeneration in males, pathological lesion in vital
organs, anaemia etc.
Procedure
1. Suspend the food sample in water and shake vigorously.
2. Filter the sample and dilute it till it is almost colourless.
3. Add few drops of concentrated HCl to a small portion of diluted sample and observe
for a colour change.
4. Magenta red colour is a positive test i.e. metanil yellow is present.

38. Added colour (Rodamine B)
Addition of artificial colours to pulses, spices and tea is not permitted by PFA act. But
certain colours, which contain lead, arsenic, copper etc. may be added to them by
manufacturers and it may cause symptoms like anaemia, brain damage etc.
Procedure
1. Pour liquid paraffin or mineral oil in a Petri dish.
2. Soak the cotton swab in it.
3. Rub the swab on the surface of a red chilli and observe it for a red colour.
4. Red colour on cotton is a positive test.
5. For chilli powder, shake small quantity (1 tea spoon) of it with paraffin oil. Keep it
for 15 minutes with intermittent shakings. Check the colour.

39. Chalk in Flour
Talc, chalk powder etc. is used as adulterant in flour. These may impair the normal smooth
functioning of the body. Presence of NaHCO3 (Chalk) in the flour can be tested by
treating it with hot HCl. Positive reaction is indicated by emergence of carbon dioxide
(CO2) in the form of effervescence or gas bubbles.
Procedure
1. Take a teaspoon of flour in a test tube and shake it with 10 ml distilled water.
2. Warm 20 ml dilute HCl in a beaker to 50-60oC and add to the test tube containing flour.
3. Observe for the effervescence. If gas bubbles are released, it indicates the presence of chalk
in flour.

40. Adulteration in Ghee
Cheap edible and nonedible oils like argemone oil, white oil, tea seed oil etc. are used as
adulterants in more expensive oils like coconut oil, sesame oil etc. which can cause damage
to body tissues and other ailments on consumption. Sometimes the oil becomes rancid
and are sold as such or mixed with good oils. Use of rancid oil results in destruction of
vitamins A and E in foodstuffs. Sometimes, animal body fat is added in ghee or vanaspati
as adulterant. Use of relatively cheaper vanaspati in ghee is also quite common, though it
does not pose any serious health problem.
For Checking presence of Vanaspati:
1. Take 5 ml of ghee in a stoppered test tube.
2. Add 5 ml of concentrated HCl and shake.
3. Add 5 ml of 2% furfural solution and shake. Observe for
the colour in acid layer.
4. Development of pink colour in acid layer indicates the
presence of vanaspati.
Rancidity Test:
1. Take 5 ml of melted ghee in a test tube.
2. Add 5 ml of concentrated HCl and shake.
3. Add 1 ml of 0.1% Phloroglucinol and observe for
development of a colour. If pink
colour develops, it is a positive test, i.e., ghee is rancid.

41. Milk
Being cheap and easily available, starch is used as a filler in milk, milk powder and milk products.
If the starch added is pure, it produces no health hazard.
Procedure: Follow the steps enumerated herewith for detecting protein, urea, sugar and starch.
Protein Test Urea Test Sugar Test Starch Test
1. Add 0.5 ml of alcohol to
0.5 ml milk.
2. Alcohol helps in curdling
the milk. Observe for the
curdling of milk.
3. Pure milk shows curdling,
whereas, no curdling can
be seen with synthetic
milk as it contains starch,
detergent, urea, etc.
1. To 0.5 ml of milk add 0.5 ml
of DMAB solution (prepared by
dissolving 0.4 gm of
p-dimethyl amino
benzaldehyde powder in 250 ml
of alcohol and 23 ml of
concentrated HCl).
2. Observe for the colour
change. Yellow colour indicates
adulteration in the sample.
1. Take 0.1 ml of milk sample
in a test tube.
2. Add 0.2 ml of resorcinol
solution [0.05 gm. resorcinol
in 100 ml. of dil. HCl (1part
HCl:2 parts of distilled water).
3. Boil for 30 seconds and
observe for colour change.
4. Appearance of off-white
colour indicates positive test.
1. Take 1 ml of milk sample in
a test tube.
2. Add few drops of iodine
solution. (2.5 gm of iodine is
dissolved in water and then
volume is made up to 200 ml.)
3. Examine for colour change.
Appearance of blue colour
indicates the presence of
starch in milk.

42. What People Eat Is Not Calories But Food, And
Consideration Of Fads, Flavours And Variants Of Appetite
Can Make Nonsense Of The Dietician’s Theories
The Doctor said just 1
sandwich a day