This document defines diet, food, nutrition and provides information on the components of a balanced diet. It discusses the main nutrients found in food - proteins, fats, carbohydrates, vitamins and minerals. For each nutrient, it describes sources, functions, deficiency diseases and recommendations. Protein-energy malnutrition and its prevention are explained. The roles of specific vitamins (A, B1, B2, B6, B12, folate) in health are also summarized.
2. DJ COLLEGE OF DENTAL
SCIENCES AND RESEARCH
PRESENTED BY:-
Dr Venisha Pandita
1st
Year Post Graduate
Department of Public Health
Dentistry
3. Introduction
Definition of diet, food and nutrition
Balanced diet
Components of food and their deficiency
diseases.
Functions of food
Nutrient values of food
Food pyramid
Importance of diet during different stages
of life
4. Food
Oxford dental dictionary: Any substance
which when taken into the body or an organ
may be used either to supply energy or build a
tissue.
Nizel 1989 : any thing that is eaten , drunk or
absorbed for maintenance of life, growth &
repair of the tissue.
5. Oxford dental dictionary : referred to as food &
drink regularly consumed.
Nizel (1989): total oral intake of a substance that
provides nourishment .
P.M Randelph(1981) : It is the total intake of
substance that furnish nourishment or calories to
the body.
6. Oxford dental dictionary: the sum process in the
growth, maintenance and repair of living body as a
whole or its constituent parts.
W.H.O: nutrition is the science of food and its
relationship to health. It is concerned primarily
with the part played by the nutrient in body
growth, development & maintenance
NIZEL 1989: the science which deals with the study
of nutrient and foods and their effects on the
nature & function of organism under different
condition of age, health & disease.
7. BALANCED DIET
A BALANCED DIET is defined as one
which contains a variety of foods in such
quantities and proportions that the need
forenergy,aminoacids, vitamins, minerals,
fats, carbohydrates and other nutrients is
adequately met for maintaining health,
vitality and general well being and also
makes a small provision for extra
nutrients to withstand short duration of
leanness. - Park
A balanced diet has become an accepted
means to safeguard a population from
nutritional deficiencies.
8. In constructing balanced diet, following principles has to
be followed---
•Daily requirement of protein should be met. This
amounts to 15-20 % of daily energy intake.
•Fat requirement should be limited to 20-30 % of daily
energy intake.
•Carbohydrates rich in natural fibers should constitute
remaining energy intake.
•Requirements of micronutrients should be met.
9. Nutrients: Nutrients are organic and inorganic complexes
contained in food. There are about 50 different nutrients which are
normally supplied through the foods we eat. Each nutrient has
specific functions in the body. Most natural foods contain more than
one nutrient. These may be divided into :
10. 1. Macronutrients: These are proteins, fats, and
carbohydrates, which are often called ‘proximate
principles’ because they form the main bulk of food.
In the Indian dietary practices, they contribute to the
total energy intake in the following proportions
Proteins - 7 to 15 per cent
Fats - 10 to 30 per cent
Carbohydrates - 65 to 80 per cent
11. 2. Micronutrients: These are vitamins and minerals. They
are called micronutrients because they are required in
small amounts which may vary from a fraction of a
milligram to several grams.
12. PROTEINS
Proteins are complex organic nitrogenous compounds composing of
carbon, hydrogen, oxygen, nitrogen and sulphur in varying amounts.
Some proteins also contain iron and phosphorous.
Proteins are made up off smaller units called amino acids.
There are 24 amino acids of which 9 are essential amino acids and
the remaining are non essential amino acids.
Proteins are classified onto 3 types
SIMPLE
CONJUGATED
DERIVED
SOURCES
•Animal sources– milk, meat, eggs, cheese, fish.
•Vegetable sources– pulses, cereals, beans, nuts, oil seeds.
13. FUNCTIONS OF PROTEINS
• Body building
• Repair and maintenance of body tissues
•Synthesis of certain substances like antibodies, plasma proteins,
hemoglobin, enzymes, hormones and coagulation factors.
• Proteins are connected with the immune mechanism.
14. ASSESMENT OF PROTEIN NUTRITION STATUS
The best measure of the state of protein nutrition is probably
serum albumin concentration.
It should be more than 3.5 gm/dl, a level of 3.5 gm/dl is
considered a mild degree of malnutrition, a level of 3.0 gm/dl
is considered severe malnutrition.
16. PROTEIN ENERGY MALNUTRITION
•It occurs primarily in the weaklings and first few years of life.
•2 clinical forms--- MARASMUS and KWASHIORKOR DISEASE
•due to inadequate intake of food both in quantity and quality.
• infections like diarrhea, measles, respiratory infections and intestinal
worms during growth of a infant or a small child.
•It is a vicious circle of infection leading to malnutrition and
malnutrition leading to repeated infections, both acting synergistically.
•Other contributory factors include poor environmental conditions,
poor sanitation, poor maternal health, failure of lactation, unhealthy
diet.
17. •The first indicator of PEM is under weight.
• PHENYL KETONURIA and NUTRITIONAL
LIVER DISEASE are the other effects of
PROTEIN MALNUTRITION.
PEM CHILD
18. PREVENTIVE MEASURES FOR PEM
HEALTH PROMOTION
•Measures directed to pregnant and lactating women
(education, distribution of supplements)
•Promotion of breast feeding
•Measures to improve family diet
•Nutrition education
•Family planning and spacing of births
•Family environment
SPECIFIC PROTECTION
•Protein and energy rich foods
•Immunization
•Food fortification
EARLY DIAGNOSIS AND TREATMENT
•Periodic surveillance
•Early treatment of infections and diarrhea.
•De worming of heavily infested children
•Development of feeding program's during epidemics
19. PROTEINS AND ORAL HEALTH
•Adequate protein diet during pregnancy influences proper bone and
dental development
•Teeth of children with deficient protein results in crowded and
rotated teeth.
•Possibility of a crowded arch
•Delayed eruption and hypoplasia of deciduous teeth.
•Teeth are smaller and more prone to caries in PEM CHILD
•Atrophy of the gingiva seen in protein deficient individuals.
•Degeneration of cementum and supporting periodontal tissues in
PEM CHILD.
Hypoplasia Of Pem Child Malocclusion In A Pem Child
20. FATS AND OILS
Fats are solid at 20 deg c.
They are called oils if they are liquid at that temperature.
Fats and oils are sources of energy.
They are classified as:
(a)Simple lipids triglycerides.
(b)Compound lipids phospholipids
(c)Derived lipids cholesterol
Fats yield fatty acids and glycerol on
hydrolysis.
21. Fatty acids are divided into :
1. Saturated fatty acids such as lauric, palmitic and stearic acids
2. Unsaturated fatty acids : further divided into monounsaturated
fatty acids (oleic acid) and poly unsaturated fatty acids (linoleic
acid).
The poly unsaturated fatty acids are found in vegetable oils
and saturated fatty acids in animal fats.
Coconut oil and palm oil contain saturated fatty acids.
22. SOURCES
Animal fats: ghee, butter, milk, cheese, egg, meat, fish
Vegetable fats: ground nut, mustard, sesame, coconut
Others: cereals, pulses, nuts, vegetables.
FUNCTIONS
• They provide energy -- 9 kcal every gram.
• Fats serve as vehicle for fat soluble vitamins.
• Fats support viscera such as kidney, heart and intestine.
•They act as thermal insulators for skin.
• Essential fatty acids are required for the body growth and
structural integrity.
23. FAT REQUIREMENTS
The Indian council of medical research has recommended a daily
intake of not more than 20 % of total energy intake through fats.
FATS AND DISEASE
• OBESITY
• PHRENODERMA- deficiency of essential fatty
acids in diet is associated with rough and dry skin
(toad skin )
• CORONARY HEART DISEASE
• CANCER
• ATHEROSCLEROSIS
• CHRONIC SWELLING OF PAROTID GLANDS
due to disturbances in lipid metabolism
• Indirect evidence of reducing caries.
24. VITAMINSVITAMINS
They fall into the category of micro nutrients.
Vitamins do not yield energy but enable the body to
use other nutrients.
Vitamins are divided into 2 groups
FAT SOLUBLE VITAMINS - A D E and K
WATER SOLUBLE VITAMINS – B and C
•
25. VITAMIN A
•also referred as RETINOL, RETINOIC ACID
FUNCTIONS
• Contributes to the formation of retinal pigments
which are needed for vision
• Necessary for maintaining the integrity and
normal functioning of glandular and epithelial
tissue which lines intestinal, respiratory and
urinary tracts as well as skin.
• It supports growth especially skeletal growth.
• It helps in building up immune response.
• May prevent epithelial cancers.
• Promotes bone remodeling
• Promotes normal reproduction
• Promotion of health of oral structures.
27. XEROPHTHALMIA
•Means dry eyes. Serious nutritional disorder due to vitamin A
deficiency.
•Can cause blindness in children below 3 yrs.
•Risk factors include poor nutrition, ignorance, faulty feeding
practices, infections particularly measles and diarrhea.
28. INDIVIDUAL ORAL DOSE OF
RETINOL PALMITATE
TIMING
CHILDREN < 12 MONTHS 55 mg ONCE EVERY 4 MONTHS
CHILDREN > 12 MONTHS 110 mg ONCE EVERY 6 MONTHS
NEW BORN 28 mg AT BIRTH
DELIVERED MOTHERS 165 mg WITHIN 1 MONTH OF
GIVING BIRTH
PREGNANT AND
LACTATING MOTHERS
11 mg ONCE EVERY WEEK
VITAMIN A PROPHYLAXIS SCHEDULE
29. VITAMIN A DEFECIENCY AND ORAL DISEASE
•Vitamin A deficiency produces hyperkeratosis and hyperplasia of
gingiva.
• Disturbs the function of ameloblasts and hence retards enamel
formation.
• Causes crowding of teeth.
• Reduces salivary flow and increases chances of dental caries.
•Epithelial metaplasia of oral mucous membrane.
•Excess of vitamin A causes enlarged liver and spleen, yellow
orange discoloration of skin and oral mucosa, and sclera of eyes.
( hyper carotenemia).
HYPER CAROTENEAMIA
30. MANAGEMENT OF VITAMIN A DEFECIENCIES
• Administration of vitamin A 200000 IU or 110 mg of retinol
palmate orally.
• Diet modification.
•RECOMMENDED DIETARY INTAKE
GROUPGROUP RETINOLRETINOL B-CAROTENEB-CAROTENE
ADULTSADULTS 600-800 mcg600-800 mcg 3000 mcg3000 mcg
INFANTSINFANTS 350 mcg350 mcg 1200 mcg1200 mcg
CHILDRENCHILDREN 500 mcg500 mcg 2000 mcg2000 mcg
ADOLESCENTSADOLESCENTS 700 mcg700 mcg 2400 mcg2400 mcg
31. VITAMIN B1VITAMIN B1
•Also called thiamine.
•In thiamine deficiency there is accumulation of pyruvic acid and
lactic acids in tissues and body fluids.
SOURCES
Whole grains, cereals, wheat, grams, yeast, pulses ,oil seeds, nuts,
meat, fish, eggs, Vegetables, milk, fruits.
Thiamine is lost during milling of rice, washing and cooking rice.
Thiamine in fruits is lost due to storage.
32. VITAMIN B1 DEFECIENCY
1. BERIBERI – DRY FORM( NEURAL), WET(CARDIAC),
INFANTILE FORM
2. ORAL MANIFESTATIONS include sensitivity of oral
mucosa, burning tongue, loss of taste.
34. RECOMMENDED ALLOWANCE
Daily requirement of thiamine is 0.5 mg per 1000 k cals of
energy intake.
Diet modification and avoidance of alcohol.
Beriberi tends to disappear when economic conditions
improves.
PREVENTION
35. RIBOFLAVIN
Riboflavin (vit B2) has a fundamental role in cellular oxidation.
It is a cofactor in number of enzymes involved with energy
metabolism.
Helps in the metabolism of carbohydrates, proteins, and fats.
SOURCES
•Milk, eggs, liver, kidney, green leafy vegetables, fish,cereals,
pulses.
REQUIREMENT
Daily requirement 0.6 mg per 1000 k cal of energy intake.
37. NIACIN
Niacin or Nicotinic acid is essential for metabolism of carbohydrate,
proteins, and fat.
It is also essential for normal functioning of skin, intestinal and
nervous system.
It is not excreted in urine, but is metabolized to at least 2 major
methylated derivatives N- METHYL NICOTINAMIDE and N-
METHYL PYRIDONES.
SOURCES
Liver, kidney, meat, fish, legumes, cereals, maize.
REQUIREMENT
6.6 mg / 1000 k cal of energy intake.
38. DEFICIENCY
PELLAGRA – dermatitis, diarrhea, dementia.
GLOSSITIS
STOMATITIS
DEPRESSION AND IRRITABILITY
PREVENTION
•improval of living conditions
•diet modification
39. VITAMIN B 6 (PYRIDOXINE)
•Exists in 3 forms PYRIDOXINE, PYRIDOXAL,
PYRIDOXAMINE.
•Plays an important role in the metabolism of
amino acids, fats, and carbohydrates.
•Widely distributed in milk, liver, meat, fish,
cereals, vegetables, legumes.
•Pyridoxine deficiency is associated with
peripheral neuritis, convulsions and rashes
on the nasolabial fold.
• daily requirement is 2 mg per day.
•Balanced diet usually contains pyridoxine,
so deficiency is rare.
40. FOLATE
Also referred as folic acid. Folic acid occurs in 2 forms – free
foliates and bound foliates
• In man free foliate is rapidly absorbed in the small intestine.
•Folic acid plays an important role in the synthesis of nucleic acids and
development of Red blood cells in the bone marrow.
•High requirements in pregnancy and lactation.
SOURCES
Greens, liver, meat, fruits, cereals, eggs, milk.
REQUIREMENTS
Folic acid supplements during pregnancy increases the
birth weight of babies and decreases the chances of
congenital malformations.
HEALTHY ADULTS – 100 mcg per day.
PREGNANCY – 400 mcg per day.
CHILDREN – 100 mcg per day.
42. VITAMIN B 12
•Cobalamin
•Vitamin B 12 is a complex organo – metallic compound
with a cobalt atom.
•Vitamin B 12 helps in the synthesis of DNA.
•Vitamin B 12 maintains the myelin sheath around the nerve
fibers.
SOURCES
Liver, meat, fish, eggs, Vegetables
DAILY REQUIREMENTS
NORMAL ADULTS – 1mcg per
day
PREGNANCY – 1.5mcg per day
INFANTS – 0.2mcg per day
43. • Pernicious anemia
• weakness and tingling in extremities.
• ankle swelling, difficulty in walking,
peripheral neuritis.
• bright, smooth beefy red tongue.
DEFICIENCY
44. Fresh fruits, green vegetables, amla, Guava, germinating
pulses, tomatoes.
Daily requirement is around 30 – 40 mg per day
FUNCTIONS
• Helps in tissue oxidation
•Formation of body collagen
•Provides matrix for the blood vessels
•Maintains integrity of the bones and capillaries
•Facilitates absorption of iron
•Inhibits nitrosamine formation from intestinal mucosa
•Prevention against common cold and infections.
SCORBUTIC TYPE OF GUMS
46. VITAMIN D
•The nutritionally important forms of vitamin D in man are ERGO
CALCIFEROL (V D2)and CHOLE CALCIFEROL (V D3).
•Calciferol may be derived from irradiation of plant sterol, ergo
sterol.
•Cholecalciferol is naturally occurring.
• It is also derived from exposure to UV rays of sunlight which
convert the cholesterol of skin to vitamin D.
•Vitamin D is stored largely in fat deposits.
SOURCES
Liver, egg, yolk, fish, meat, cheese, butter.
DAILY REQUIREMENT
ADULTS – 2.5 mcg
INFANTS – 5.0 mcg
PREGNANCY – 10 mcg
47. FUNCTIONS
•Promotes intestinal absorption of calcium and
phosphorous.
•Stimulates bone mineralization, collagen maturation.
•Increases tubular reabsorbtion of calcium and
phosphorous.
•Permits growth of the tissues.
•Maintains serum calcium and phosphorous levels.
48. RICKETS
DEFICIENCY
•Observed in young children between 6 months to
two years.
•There is reduced calcification of growing bones.
•Disease is characterized by growth deformity,
•Muscular hypotonia, tetany, convulsions.
•There is elevated level of serum alkaline
phosphatase.
•Bony deformities include curved legs, pigeon
chest.
49. OSTEO MALACIA
It occurs in adults especially women during pregnancy
and lactation when VITAMIN D needs are not met.
Bone deformity and joint pains are the most common
symptoms.
legs bend creating a waddling gait.
Excitability of the nerves (tetany) may develop.
51. VITAMIN E
•VITAMIN E serves as a biological antioxidant and protects
cells from destruction.
•Daily requirement of VITAMIN E is 0.8 mcg per day.
•Deficiency of VITAMIN E is rare in humans, might
cause anemia in infants if VITAMIN E stores is depleted.
•Vitamin E deficiency may cause derangement of
ameloblasts.
52. VITAMIN K
•Vitamin K occurs in 2 forms K1 and K2.
•K1 occurs in green plants, K2 is produced by bacterial synthesis in
the intestine.
•Vitamin K3, a synthetic form of vitamin is known asMENADIONE.
•The primary function of vitamin K is to catalyze
the synthesis of blood clotting factor,
prothrombin by the liver.
•Vitamin K is helpful in treating HEMOPHILIAC
patients.
•vitamin K is also essential in production of other
clotting factors like FACTOR 7 ,FACTOR 9 and
FACTOR 10.
FUNCTIONS
54. ACTION OF THE NUTRIENT: required for the maintenance of epithelial
tissue.
Deficiency: marginal gingivitis, gingival bone hypoplasia,pocket
formation, alveolar resorption . periodontal disease.
VITAMINS AND PERIODONTAL
DISEASES
VITAMIN A
ACTION OF THE NUTRIENT: many B vitamins are coenzymes
concerned with intra cellular metabolism, especially carbohydrate
metabolism.
Deficiency:gingival inflammation, epithelial necrosis, resorption of
alveolar bone.
VITAMIN B
VITAMIN E
ACTION OF THE NUTRIENT: anti oxidant and maintains
cell membrane.
no effect on periodontal tissues.
55. ACTION OF THE NUTRIENT: concerned with DNA synthesis and
maturation of red blood cells.
THERAPEUTIC USE : reduction of gingivitis with folic acid mouth
rinses.
ACTION OF THE NUTRIENT: key role in collagen synthesis.
extensive evidence of effect on periodontal tissues and gingival
tissues.
ACTION OF THE NUTRIENT: promotes absorption and retention
of calcium.
Deficiency: Osteoporosis in alveolar bone and over dosing can lead
to osteosclerosis.
FOLIC ACID
VITAMIN C
VITAMIN D
56. Chronic glossitis has been associated with deficiency of most of the
B complex vitamins particularly niacin, riboflavin, folic acid.
MAGENTA TONGUE is seen in riboflavin deficient individuals.
SCARLET TONGUE GLOSSITIS seen in niacin deficiency.
BEEFY RED TONGUE seen in all vitamin B deficiencies.
TONGUE IN VITAMIN B DEFECIENCIES
MAGENTA TONGUE SCARLET TONGUE BEEFY RED
TONGUE
Riboflavin deficiency Niacin deficiency Vitamin B12 deficiency
57. MINERALS
CLASSIFICATION
Major Minerals- Calcium, Phosphorous, Sodium, Potasium,
magnesium
Trace Elements- These are the elements required by the body in
quantities less than a few milligrams per day, ex: Iron, Iodine,
Fluorine, Molybdenum, Selenium, Nickel,Tin, Silicon. Chromium,
Copper.
Trace Elements With No Known Function – Lead , mercury,
Aluminium
58. CALCIUM
•Calcium is a major element of the body.
•98% of calcium is found in bones. Amount of calcium in blood is
10 mg / dl.
•The dynamic equilibrium between calcium in blood and that in
skeleton is maintained by the interaction of vitamin d,
Parathormone, calcitonin.
Milk and milk products
Green leafy vegetables
Cereals
Fruits
Eggs and fish.
SOURCES
Daily requirement of calcium is around 400 mg to 500 mg.
59. DEFICIENCY
Osteomalacia, rickets, fracture susceptible bones.
Impaired enamel apatite crystals formation.
Low blood calcium causes TETANY.
FUNCTIONS OF CALCIUM
•Provides rigidity and strength to bones and teeth.
•Calcium is deposited in the trabeculae of long bones as a store to
release during pregnancy and lactation.
•Calcium plays an important role in blood coagulation, muscle
contraction, myocardial action, and neuro muscular irritability and is
responsible for integrity of various membranes.
60. PHOSPHOROUS
Phosphorous is the second most abundant mineral in the body after
calcium.
Phosphorous is found in bones, enamel, red blood cells, plasma
FUNCTIONS
• Formation of bone and tooth mineral.
• absorption and transport of nutrients.
• regulates acid – base balance.
• energy released due to metabolism of carbohydrates, fats and
proteins is accomplished by phosphates (ADP).
•Phosphates play an important role in cell protein synthesis. It is
a part of DNA and RNA.
•Intakes of 800 – 1200 mg of phosphorous daily
is recommended daily for an adult.
•Sources of phosphorous are meat, fish,
eggs, milk, nuts, legumes, cereals.
61. Excess dietary phosphorous in animals will increase bone loss
and bone porosity, significantly decrease bone mineral and
cause calcification of kidney, tendons, heart and thoracic aorta
OSTEOMALACIAOSTEOMALACIA OSTEOPOROSISOSTEOPOROSIS
Deficiency due to Vitamin D,Deficiency due to Vitamin D,
Calcium, and phosphorous.Calcium, and phosphorous.
Results in uncalcified osteoid.Results in uncalcified osteoid.
Abnormal mineral composition.Abnormal mineral composition.
General weakness, bone ache.General weakness, bone ache.
Low serum calcium, phosphateLow serum calcium, phosphate
and elevated alkalineand elevated alkaline
phosphatase.phosphatase.
Dietary calcium and Vitamin DDietary calcium and Vitamin D
Decline in anabolic hormonesDecline in anabolic hormones
likelike
Estrogens and pituitary.Estrogens and pituitary.
Decreased ossification.Decreased ossification.
Mineral composition remainsMineral composition remains
normal.normal.
Hip and back pain, stoopedHip and back pain, stooped
posture, bone fractures.posture, bone fractures.
Normal calcium, phosphateNormal calcium, phosphate
levels in serum.levels in serum.
Estrogens, protein, Vitamin DEstrogens, protein, Vitamin D
62. MAGNESIUMMAGNESIUM
Adult human body contains 30 to 65 g of magnesium. It is the third
most abundant mineral in teeth.
Recommended daily dietary allowance for normal adults is 350 mg for
males and 300 mg for females.
Best food sources of magnesium are whole grains, nuts, soybeans,
green leafy vegetables, spinach.
FUNCTIONS
•Magnesium is essential for cellular respiration, functioning chiefly as
an activator for numerous important coenzymes such as
Cocarboxylase and Co enzyme A.
•Plays an important role in synthesis of carbohydrates, fats and
proteins.
•Helps in regulation of acid base balance of the body and transfer of
water in and out of cells.
•Magnesium is present in enamel and dentin but more in dentin.
64. IRON
•The adult human body contains between 3-4 g of iron, of which
60-70 % is present in blood as circulating hemoglobin and the
rest is stored as storage iron.
•Each gram of Hemoglobin contains 3.35 mg of iron.
FUNCTIONS
•Iron is necessary for formation of hemoglobin, brain
development and function.
•Iron regulates body temperature and muscle activity.
•Iron improves immune system as it increases the production of
T CELLS.
•It helps in the production of antibodies.
•Iron binds oxygen to blood cells, and helps in oxygen transport
and cell respiration.
65. SOURCES
•There are 2 types of iron, haem iron and non haem iron.
Haem iron is better absorbed than non haem iron.
•Foods rich in haem iron are liver, meat, poultry, fish. Iron
content in milk is very low.
•Foods containing non haem iron are green leafy vegetables,
legumes, oils, nuts, legumes,jaggery, dry fruits.
66. IRON REQUIREMENTS
AGE GROUP NEEDS
Infants
Children
Adolescents
Male adults
Female adults
Pregnancy
Lactation
0.7 mg
1.0 mg
2.0 mg
1 mg
3 mg
1.5-3 mg
2.5 mg
67. IRON DEFICIENCY
3 stages of iron deficiency are identified.
1. Decreased storage of iron without any detectable
abnormalities.
2. Intermediate deficiency of iron stores getting exhausted
but no evidence of anemia.
3. Overt iron deficiency with decreased hemoglobin
concentration.
WHO expert committee identifies anemia if hemoglobin level
in blood is less than 11 g/dl
For an adult female, 13 g/dl for an adult male and less than 12
g/dl for a child.
MCHC concentration less than 34% is considered anemic for
all groups.
68. Nutritional anaemia is a disease syndrome caused by
malnutrition in its widest sense.
It has been defined by WHO as “a condition in which the
haemoglobin content of blood is lower than normal as a result of
a deficiency of one or more essential nutrients, regardless of the
cause of such deficiency”.
Iron deficiency anaemia is a major nutrition problem in India
and many other developing countries.
Detrimental Effects :
•Pregnancy
•Maternal deaths
•Infection
•Aggravated by parasitic diseases
•Work capacity - Impairment of maximal work capacity
69. Etiological Classification ofEtiological Classification of
anemiaanemia
Blood loss:
Acute Post hemorrhagic
Chronic blood loss
Deficiency of Hemopoetic factors:-
Iron deficiency
Folate and vitamin b12deficiency
Protein deficiency.
Bone marrow aplasia:-
Aplastic anemia
Pure red cell aplasia
70. Anemia due to systemic infections:-
Due to chronic infection
Due to chronic renal disease
Due to chronic liver disease
Endocrinal diseases
Anemia due to bone marrow infiltration:-
Leukemia’s
Lymphomas
Myelofibrosis
Multiple myeloma
Congenital sideroblastic anemia
Anemia due to increased red cell destruction:-
Intra-corpuscular defect
Extra-corpuscular defect
72. TYPES OF ANAEMIATYPES OF ANAEMIA
Macrocytic anemia: Megaloblastic anemia and
non-megaloblastic macrocyctic anemia. Primary
cause of this sort of anemia is collapse of DNA
synthesis with kept RNA synthesis that occurs due
to the division of the divisional cells.
Microcytic anemia: Sort of anemia occurs due to
hemoglobin synthesis shortage or collapse.
Normcytic anemia: Occurs when Hb levels
decreases overall. Size of RBC is often normal.
Heinz Body anemia: Considered a cell abnormality
that usually occurs in cells under anemia.
73. Iron-deficiency anaemia – hypochromic
microcytic anemia characterized by low
serum iron, increased serum iron-binding
capacity, decreased serum ferritin, and
decreased marrow iron stores.
Megaloblastic (pernicious) anaemia –
predominant number of megaloblastic
erythroblasts, and relatively few
normoblasts, among the hyperplastic
erythroid cells in the bone marrow
Hemolytic anaemia – increased rate of
erythrocyte destruction.
74. Sickle cell anemia – autosomal recessive
anemia characterized by crescent- or
sickle-shaped erythrocytes and accelerated
hemolysis, due to substitution of a single
amino acid - chromosome 11
Aplastic anemia – greatly decreased
formation of erythrocytes and hemoglobin,
usually associated with pronounced
granulocytopenia and thrombocytopenia
Chronic anemia
Anemia of folate deficiency
75. Cooley's anemia (beta thalassemia) –
syndrome of severe anemia resulting from
the homozygous state of one of the
thalassemia genes or one of the
hemoglobin Lepore genes with onset, in
infancy or childhood, of pallor, icterus,
weakness, splenomegaly, cardiac
enlargement, thinning of inner and outer
tables of skull, microcytic hypochromic
anemia with poikilocytosis, anisocytosis,
stippled cells, target cells, and nucleated
erythrocytes
76. CLINICAL MANIFESTATIONS OF ANEMIA
Weakness, fatigue, pallor, tingling of extremities, brittle nails.
Spoon shaped nails (koilonychias), altered hair growth.
•Inflammation of the tongue, atrophy of tongue.
•Smooth shiny red appearance of tongue.
•Dysphagia, grayish mucous membrane.
•Angular stomatitis.
•Combination of above all features is termed as
PLUMMER VINSON SYNDROME.
ORAL MANIFESTATIONS
Koilonychias
77. Interventions :
•Iron and folic acid supplementation
•Dosage :
Mothers – One tablet of iron and folic acid
containing 60 mg of elemental iron (180 mg of ferrous
sulphate) and 0.5 mg o folic acid should be given daily.
Children – One tablet of iron and folic acid
containing 20 mg of elemental iron (60 mg of ferrous
sulphate) and 0.1 mg of folic acid should be given daily.
•Iron fortification
Hyderabad showed that simple addition of ferric ortho-
phosphate or ferrous sulphate with sodium bisulphate
was enough to fortify salt with iron.
78. IODINE
•Iodine is an integral part of the thyroid hormones THYROXIN
and tri IODO THYRONINE whose function is to maintain the
control of energy metabolism of the body.
• Most important in synthesis of thyroid hormone is the ability of
the thyroid gland to trap and oxidize iodide molecules into free
iodine.
•Adult body normally contains about 15 – 30 mg of iodine; about
8mg is concentrated in
thyroid gland and rest occurs in the circulating blood.
•Daily adult requirement of iodine is 0.15 mg.
•Sources of iodine include lobsters, fish, oysters, vegetables
grown in iodine rich soil.
79. DEFICIENCY
HYPOTHYROIDISM
•When a deficiency exists thyroid enlargement called as GOITER
develops in front of the neck.
•CRETINISM and MYXEDEMA are pathological conditions
resulting from low thyroid activity. When the hypothyroidism is
due to physiological atrophy from advancing age, or due to surgery
or neoplasia non pitting type of edema termed as MYXEDEMA
results. Skin is dry and coarse and tongue is thick. Metabolism is
slow.
•When hypothyroidism affects the foetus CRETINISM develops.
Thick lips, enlarge tongue, arrested skeletal development, mental
retardation, slow BMR are the features.
80. HYPERTHYROIDISM
•The excessive activity of the thyroid gland that is brought on by
an deficiency of iodine produces an enlarged excretory gland as a
result of hyperplasia of the cells lining the follicles along with
increased colloidal material characterized by increased pulse rate,
temperature and blood pressure with nervousness , irritability,
sweating, weight loss, dyspnea, and tiredness. Patients may also
develop EXOPTHALOMOUS.
81. ORAL EFFECTS of iodine deficiency includes retarded jaw
growth and delayed eruption of teeth.
Root resorption is common.
ENDEMIC CRETINISM
82. Iodine Deficiency Disorders (IDD) :
•It has always been thought in India that goiter and
cretinism were only found to a significant extent in the
“Himalaya goiter Belt’ which is the world’s biggest goiter
belt.
•It stretches from Kashmir to the Naga Hills in the east,
extending about 2400 km and affecting the northern States
of Jammu and Kashmir, Himachal Pradesh, Punjab,
Haryana, Delhi, Uttar Pradesh, Bihar, West Bengal,
Sikkim, Assam, Arunachal Pradesh, Nagaland, Mizoram,
Meghalaya, Tripura and Manipur.
83. Goitre Control :
There are four essential components of national goiter
control programme.
These are iodized salt or oil, monitoring and surveillance,
manpower training and mass communication.
•Iodized Salt :
•30 ppm at the production point and not less than 15
ppm of iodine at the consumer level.
•Iodized oil – Intramuscular injection of iodized oil
•Iodized oil, oral
•Iodine monitoring
•Manpower training
•Mass communication
•Hazards of iodization
84. Fluorine a trace element, is a halogen and a very reactive
gas . It is not found in free elemental form in nature. Rather it
appears in a compound form.
DIETARY SOURCES
Drinking water { 1 ppm }, mineral water.
Sea foods {2 ppm – 10 ppm }
Vegetables like jowar, banana, potato and
tubers { 0.3 ppm – 1 ppm }
Tea leaves { 75 – 100 ppm }
Wine and beer. { 0.2 ppm – 0.9 ppm}
Cereals { 0.15 ppm – 3 ppm }
85. BENEFITS OF FLUORIDE
•Fluoride is known to prevent dental caries formation. Mechanisms
involved in prevention of dental caries are
1} an increase in the enamels resistance to acid solubility as a result
of high concentration of fluoride in outer enamel surface,
2} ability to remineralize demineralized and hypo mineralized
enamel,
3} fluorides anti bacterial effects on plaque growth, glycolysis,
glycogen synthesis, acid production
•Variable doses of fluoride ( 25 -150 mg/ day upto 1 year ) have been
used therapeutically for treatment of osteoporosis.
86. THE OTHER SIDE OF FLUORIDE
• ENDEMIC FLUOROSIS OR MOTTLED ENAMEL
Mottled enamel is characterized clinically as
white or brown spotty staining of tooth enamel
surfaces due to exposure of tooth surfaces to high
concentrations of fluoride{2 ppm or more }.
• SKELETAL FLUOROSIS
At fluoride water levels over 8 ppm skeletal
fluorosis develops. Severe pain in bones, joints,
hips, stiffness in joints and spine. Outward
bending of legs hands in advanced stages called
as KNOCK KNEE SYNDROME can occur.
Pregnant ladies, lactating mothers and children
are the most vulnerable group.
87. Intervention :
•Changing the water source
•Chemical treatment
•Other measures – Fluoride supplements
should not be prescribed for children.
88. DIETARY FLUORIDE SUPPLEMENTS
Fluoride supplements were first introduced in the late 1940’s
and were intended as a substitute for fluoridated water for
children in non fluoridated areas.
Most common dietary fluoride supplements are:
•Fluoride drops with/without vitamins.
•Fluoride tablets with/without vitamins.
•Lozenges.
•Oral rinse supplements.
•Fluoridated salts.
•Fluoride milk.
89. TRACE ELEMENTS
SELENIUM
• It is speculated that incorporation of selenium during the period
of active tooth development changes the protein content of tooth
and makes the enamel more susceptible to caries.
MOLYBDENUM
•high molybdenum content in water was responsible for the low
caries incidence among children
90. SODIUM
•Sodium serves as an important and essential nutrient by
maintaining extra cellular fluid volumes and cellular osmotic
pressures. It also aids in transmission of nerve impulses,
permeability of cell membrane and muscular contractions.
•Common salt and foods of plant origin and animal origin supply
sodium in diet.
HYPERTENSION
HYPERTENSION is associated with damage to the heart( coronary
heart disease) , brain (stroke)and kidney (renal failure).
•Higher the blood pressure more serious is the Atherosclerotic
diseases.
•Mild blood pressure elevations in young persons are more serious
than in older persons. Among adults men are more prone to
hypertension than women, but after menopause women tend to
catchup with men.
91. ASSESMENT OF NUTRITIONAL STATUS
essment methods of nutritional status includes:
1. Clinical examination.
2. Anthropometry.
3. Biochemical evaluation
4. Functional assessment.
5. Assessment of dietary intake.
6. Vital and health statistics
7. Ecological studies.
92. CLINICAL EXAMINATION
• Clinical examination is an essential feature of all nutritional
surveys since their ultimate objective is to asses levels of health of
individuals or of population groups in relation to the food they
consume.
• It is also the simplest and the most practical method of ascertaining
the nutritional status of a group of individuals. There are a number
of physical signs, some specific and some non specific known to
be associated with states of malnutrition.
• When two or more clinical signs characteristic of a deficiency
diseaseare present simultaneously there diagnostic significance is
greatly enhanced.
93. WHO expert committee classified signs used in
nutritional surveys into 3 categories
1. Not related to nutrition. Ex.. alopecia, pyorrhea.
2. That need further investigation. Ex. Malar
pigmentation, corneal vascularization
3. Known to be of value. Ex.. Angular stomatitis,
bitots spots. Beri Beri, Goiter.
However clinical signs has following drawbacks….
• Malnutrition cannot be quantified on basis of
clinical signs.
• Many deficiencies are unaccompanied by physical
signs
• Lack of specificity and subjective nature of most
of the physical signs.
95. ANTHROPOMETRY
Anthropometric measurements such as height,
weight, skin fold thickness and arm circumference
are valuable indicators of nutritional status.
In young children, additional measurements such
as head and chest circumference are made.
If anthropometric measurements are recorded over
a period of time, they reflect the patterns of growth
and development, and how individuals deviate from
the average at various ages in body size, built and
nutritional status. Anthropometric data can be
collected by non medical personnel if given
sufficient training.
96. LABORATORY AND BIOCHEMICAL ASSESMENT
LABORATORY TESTS-- HAEMOGLOBIN, URINE AND STOOLS.
BIOCHEMICAL TESTS
NUTRIENTNUTRIENT METHOD OF TESTMETHOD OF TEST NORMAL VALUENORMAL VALUE
VITAMIN AVITAMIN A SERUM RETINOL TESTSERUM RETINOL TEST 20 mcg/dl20 mcg/dl
THIAMINETHIAMINE TPP STIMULATION OF RBC ACTIVITYTPP STIMULATION OF RBC ACTIVITY 1.00-1.231.00-1.23
RIBOFLAVINRIBOFLAVIN RBC GLUTATHIONE ACTIVITYRBC GLUTATHIONE ACTIVITY 1.0-1.21.0-1.2
NIACINNIACIN URINE N-METHYL NICOTINAMIDEURINE N-METHYL NICOTINAMIDE Not reliableNot reliable
FOLATEFOLATE SERUM FOLATESERUM FOLATE 6.0 mcg/ml6.0 mcg/ml
VITAMIN B12VITAMIN B12 SERUM VITAMIN B12 CONCENTRATIONSERUM VITAMIN B12 CONCENTRATION 160 mcg/ml160 mcg/ml
VITAMIN CVITAMIN C LEUCOCYTE ASCORBIC ACIDLEUCOCYTE ASCORBIC ACID 160 mg/l160 mg/l
VITAMIN KVITAMIN K PROTHROMBIN TIMEPROTHROMBIN TIME 11-16 secs11-16 secs
PROTEINPROTEIN SERUM ALBUMIN CONCENTRATIONSERUM ALBUMIN CONCENTRATION 35g/l35g/l
97. FUNCTIONAL INDICATORS
SYSTEMSYSTEM NUTRIENTSNUTRIENTS
STRUCTURAL INTEGRITYSTRUCTURAL INTEGRITY VIT E, VIT C,VIT E, VIT C,
SELENIUM, COPPER.SELENIUM, COPPER.
HOST DEFENCEHOST DEFENCE ZINC AND IRONZINC AND IRON
HEMOSTASISHEMOSTASIS VITAMIN KVITAMIN K
REPRODUCTIONREPRODUCTION ENERGY AND ZINCENERGY AND ZINC
NERVE FUNCTIONNERVE FUNCTION VIT B1, VIT B12, VIT AVIT B1, VIT B12, VIT A
ZINCZINC
WORK CAPACITYWORK CAPACITY VIT C AND IRONVIT C AND IRON
98. ASSESMENT OF DIETARY INTAKE
A diet survey can be carried out in the following methods:
1. WEIGHMENT OF RAW FOODS.
• Survey team visits the household and weighs all foods that is
going to be cooked and eaten as well as that is wasted and
discarded.
• The duration of survey may vary from 1-21 days , but 7 days
constitute 1 dietary cycle.
2. WEIGHMENT OF COOKED FOODS
• Foods should be analyzed in the state in which they are normally
consumed, but this method is easily not accepted by the people.
99. 3. ORAL QUESTIONNAIRE METHOD
• This is useful in carrying out a diet survey of a large number of
people in a short time.
• Inquiries are made retrospectively about the foods eaten during
the previous 24-48hrs, nature and type of food, dietary habits and
practices.
• The information obtained will be valuable for planning health
education activities, but will also allow an assessment to be made
of the extent and nature of changes needed in the agriculture and
food production industries.
100. Types of Diet Surveys
- 24 Hour Recall Diet Surveys
- Food Frequency Questionnaire
- Diet History
- Food Diary
101.
102.
103.
104.
105.
106. VITAL STATISTICS
•Analysis of vital statistics – mortality and morbidity data will
identify groups at high risk and indicate the extent of risk to the
community. Mortality in the age group 1-4 years is particularly
related to malnutrition. In developing countries the death rate due to
malnutrition is alarming.
The other rates commonly used for this purpose are INFANT
MORTALITY RATE, SECOND YEAR MORTALITY RATE,
LOW BIRTH WEIGHT BABIES, and LIFE EXPECTANCY.
107. •These rates are influenced by nutritional status and thus may be
the indicators of nutritional status.
•Data on morbidity ( hospital data from community health and
morbidity surveys) particularly in relation to PEM, anemia,
xeropthalmia and other vitamin deficiencies, Goiter, diarrhea,
measles, parasitic infections can be of a value in providing
additional information contributing to the nutritional status of the
community.
108. ASSESMENT OF ECOLOGICAL FACTORS
• Mal nutrition is the end result of many interacting ecological factors.
• In any nutritional Survey it is necessary to collect ecological
information of the given community in order to make the nutritional
assessment complete.
• A study of ecological factors comprise the following
1. Food balance sheet
• This is an indirect method of assessing food consumption, in which
supplies are related to census population to derive levels of food
consumption in terms of per capita supply availability.
2. Socio economic factors
• Food consumption patterns are likely to vary among various socio
economic groups.Family size, occupation, income, education,
customs, cultural patterns in relation to feeding practices of children
and mothers all influence food consumption patterns.
109. 3. Health and educational services
• Primary health care services, feeding and immunization
programs should also be taken into consideration.
4. Conditioning influences
• These include parasitic, bacterial and viral infections
which precipitate malnutrition.
• It is necessary to make an ecological diagnosis of the
various factors influencing nutrition in the community
before it is possible to put into effect measures for
prevention and control of malnutrition.
110. FOOD ADDITIVES
• Food additives are defined as non- nutritious substances which are
added intentionally to food generally in small quantities to
improve its appearance, flavor, texture or storage properties.
Food additives may be classified into 2 categories:
1. coloring agents – saffron
preservatives – sorbic acid
flavoring agents – vanilla
sweeteners – saccharine
acidity imparting agents – citric acid
microbial inhibitors – sodium chloride
2. Contaminants incidental through packing, processing steps,
farming practices or other environmental conditions
111. •The use of food additives are subjected to government
regulations throughout the world.
•In India 2 regulations viz.
PREVENTION OF FOOD ADULTERATION ACT and FRUIT
PRODUCTS ORDER govern the rules and regulations of food
additives.
•Any food that is not permitted as additive is considered
adulterated. The nature and quantity of the additive must be
clearly printed on the label. If artificial color is used
“ ARTIFICIALLY COLOURED” must be mentioned on the
label.
•Nitrates and Nitrosamines have been implicated in cancer
etiology.
112. OOD FORTIFICATION
WHO has defined food fortification as process whereby nutrients are
added to foods in relatively small quantities to maintain or improve the
quality of diet of a group, a community or a population.
Ex: fluoridation of water, iodization of salt, vitamin D to milk,
vanaspati.
113. In order to qualify as a suitable for fortification, the vehicle
and the nutrient must fulfill certain criteria:
• the vehicle fortified must be consumed consistently as a part
of regular diet by the relevant sections of the population or
total population.
• the amount of the nutrient added must provide an effective
supplement for low consumers of the vehicle without
contributing a hazardous excess to high consumers.
• addition of the nutrient should not cause any change in the
smell, taste, appearance or consistency.
• cost of the fortification must not raise the cost of the food
beyond the reach of the population in greatest need.
Finally an adequate system of surveillance and control is
indispensable for the effectiveness of food fortification.
114. ADULTERATION OF FOODS
• Adulteration of food is a age old problem.
• It consists of mixing, substitution, concealing the quality,
putting up decomposed foods for sale, misbranding, false labels
and addition of toxicants.
Adulteration results in 2 disadvantages for the consumer
1. paying more money for food stuff of lower quality.
2. Some forms of adulteration are injurious to health.
116. PREVENTION OF FOOD
ADULTERATION ACT 1954
•Enacted by the Indian parliament in 1954 and amended in 1964,
1976 and 1986 to make the act more stringent.
•A minimum imprisonment of 6 months with minimum fine of
Rs.1000 is envisaged under the act for cases of proven adulteration,
whereas in cases of adulteration which may lead
to death or serious consequences punishment may go upto life
imprisonment and a fine of Rs.5000.
117. •Rules are framed and revised by expert body called
CENTRAL COMMITTEE FOR FOOD STANDARDS
which is constituted by the central government of India.
•Food adulteration is a social evil. The general public, food
inspectors, traders are all responsible for perpetuating this
social evil.
•Public for the lack of awareness and dangers of food
adulteration, traders for greed of money, and food inspectors
who find food adulteration a fertile ground to make easy
money.
119. COMMUNITY NUTRITIONAL PROGRAMS IN INDIACOMMUNITY NUTRITIONAL PROGRAMS IN INDIA
PROGRAMMEPROGRAMME MINISTRYMINISTRY
VITAMIN A PROPHYLAXISVITAMIN A PROPHYLAXIS MINISTRY OF HEALTHMINISTRY OF HEALTH
AND FAMILY WELFAREAND FAMILY WELFARE
NUTRITIONAL ANEMIA PROPHYLAXISNUTRITIONAL ANEMIA PROPHYLAXIS
“”“”
IODINE DEFECIENCY CONTROL PROGRAMMEIODINE DEFECIENCY CONTROL PROGRAMME
“”“”
SPECIAL NUTRITION PROGRAMMESPECIAL NUTRITION PROGRAMME MINISTRY OF SOCIALMINISTRY OF SOCIAL
WELFAREWELFARE
BALWADI NUTRITION PROGRAMMEBALWADI NUTRITION PROGRAMME
“”“”
ICDS PROGRAMMEICDS PROGRAMME
“”“”
MID DAY MEAL PROGRAMMEMID DAY MEAL PROGRAMME MINISTRY OFMINISTRY OF
EDUCATIONEDUCATION
120. FUNCTIONS OF THE FOOD
Physiological function
Social function
Psychological function
PHYSIOLOGICAL FUNCTION:
• supply energy.
• build & maintain the cells & tissues
• regulate body process :
movement of fluids
control acid & base balance
coagulation of blood
activation of enzyme
121. SOCIAL FUNCTIONS OF FOOD:
• Acts as media to develop social rapport in the
society.
• Is an integral part of social phase of university
living.
PSYCHOLOGICAL FUNCTION OF FOOD:
• Satisfies of certain emotional needs.
• Used to express feelings:
a) Token of friendship
b) Serving of favorite foods - expression of special
attention.
c) Withholding of wanted foods - punishment.
122. Energy-yielding Foodstuffs
Foodstuffs form the great bulk of the ordinary
diet.
They supply energy to keep the body warm and
are hence known as ‘fuel-food.’
A few examples of energy-yielding foodstuffs
are cereals starchy vegetables, pulses, nuts,
sugars, and oils.
123. Body-building foodstuffsBody-building foodstuffs
Contain a satisfactory amount of the
nutrients needs to build the body and
replace the worn-out tissues.
Milk and its products, meat, fish, and eggs
are the best representatives of this group of
foodstuffs.
The other examples are legumes, dals, dried
beans, peas and nuts.
Cereals also contain some body-building
nutrients.
124. Protective foodstuffsProtective foodstuffs
Provide large number of the protective
substances needed by the body.
Almost all natural foodstuffs contain one or
more of these protective nutrients.
There is no single foodstuff in which all the
different protective substances are present
in quantities sufficient to meet the daily
needs of the body.
This is why a combination of different kinds
of foodstuffs is essential in a diet.
125. Best examples of this group of foodstuffs
are green vegetables, fresh fruits, milk,
meat, fish, and eggs.
Protective foodstuffs contain sufficient
amounts of one or more of the protective
nutrients so that a combination of them
yields enough to maintain life.
126. NUTRIENT VALUES OF FOOD
Kilocalories - the amount of heat required
to raise the temperature of 1kg (2.2lb) of
water in 1°c(14.5-15.5)
• SI -Joule
• 1 kcal= 4.18kJ
Carbohydrates ---- 4.1 kcal/g
Fats -------- 9.45 kcal/g
Proteins ------ 5.65 kcal/g
127. Calculated by sum of 3 factors:
a) Basal metabolism.
b) Energy for physical activity.
c) Small amount of additional energy expended during
digestion and absorption of carbohydrates, proteins
fats in GIT – specific dynamic action (SDA) of food.
Energy requirement= BM + Physical Activity +
SDA
128. B.M.R:
Metabolic rate at basal conditions.
Basal condition is a condition when the subject is
at complete mental, physical rest (but not
sleeping) 12-14 hrs after the last meal, at ambient
temp of about 25°c & free from all illness.
• Males – 40 kcal (168kJ/sq m/hr)
• Females- 37 kcal( 155 kJ/sq m /hr)
129. Specific Dynamic Action (SDA):
The expenditure of calories during the
digestion & absorption of food.
• SDA of diet – app10% of the consumed
calories.
• E.g.; person energy needs is 2000kcal + 200
kcal (heat expended in SDA)
131. Carbohydrates: take most food
from this group (rice, pasta,
bread, potatoes)
Fruit and vegetables: take 5
portions a day from this group
132. Carbohydrates: take most food
from this group (rice, pasta,
bread, potatoes)
Fruit and vegetables: take 5
portions a day from this group
Meat, fish and dairy:
take something from
this group
133. Food Pyramid
Carbohydrates: take most food
from this group (rice, pasta,
bread, potatoes) ( 6-11
servings)
Fruit and vegetables:
( 3-5 serving)
Meat, fish and dairy:
take something from
this group(2-3 servings)
Foods high in fats and sugars:
take only small amounts from
this group( use sparingly)
135. Fruit and Vegetables
•Vegetables include carrots, broccoli, beans, peppers, lettuce, and
tomatoes
•green, orange, and red – vary your colors for the best balance of
vitamins and nutrients
•Children need 2½ cups of vegetables a day
•Fruits contain a wide variety of vitamins
•Fruit like pineapples apples, oranges,
peaches, apricots, and pears are readily
available
•Children need 1½ cups of fruit every day
136. Grains and Pulses
•Some examples of grains are: oatmeal, wheat, rye, and
barley
•Whole grain wheat bread is better for you than white
bread
•Children should have 6 servings of grains a day
137. Dairy Products
•Calcium rich foods include milk and cheeses
•Calcium builds strong bones and teeth, and
helps your muscles become stronger
•Children need 3 cups of milk or cheese a day
138. Meat, Fish and Eggs
•Meats and beans give you protein to grow
strong muscles and improve brain function
•Chicken , meat , fish, sea food ,etc.
•Children need 5 ounces of protein a day
139. IMPORTANCE OF DIET DURING
DIFFERENT STAGES OF LIFE
Nutrient dense low fat foods:
For being physically active and healthy.
Nutritionally adequate diet with extra food
for child bearing/rearing:
For maintaining health productivity and
prevention of diet-related disease and to
support pregnancy/lactation.
140. Body building and protective foods:
For growth spurt, maturation and bone
development
Energy, body building and protective food
(milk, vegetables, and fruits):
For growth, development and to fight
infections.
Breast-milk, energy rich foods (fats, sugar):
For growth and appropriate milestones.
141. Conclusion:Conclusion:
Food intake is essential for sustenance of
life. The main purpose of food is the
provision of adequate nutrition to carry out
the daily activities of life. With so many
varieties of food types available, it is
essential to know the basics of diet and
nutrition so as to obtain the benefits of all
the micronutrients and macronutrients.
Thus, as a Public Health Dentist it becomes
necessary for us to understand the diet and
nutrition and its role in oral health.
142. References :References :
Park J .Park’s Text book preventive and social medicine ;
Blanot;21st
ed: 430-454
Abraham E. Nizel .Nutrition and preventive dentistry;2nd
ed
Andrew J. Rugg- Gunn, June H.Nunn.Nutrition, diet, and
oral health
Soben Peter.Essentials of preventive and community
dentistry.3rd
ed:270-359
Harsh Mohan .Text Book Of Pathology
Davidson .Principles Of General Medicine
Norman O Harris. Preventive Dentistry 6th
Edition
