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NUTRITION
CALORIFIC VALUE
1. Define calorific value. Pon Nov 2006
2. Give the calorific values of carbohydrates and fat. Pon May 2003; May
2005
1. Calorie is the unit of heat. One calorie represents the amount of heat required to
rise the temperature of one gram of water by l0 C. In medical practice, the energy
content is usually expressed in kilocalorie (kcal or C) which is equal to 1000
calories. 1 Cal (1 kcal) = 4.128 KJ
2. Caloric value is defined as amount of heat energy obtained by burning 1.0 gm of
the food stuff completely in the presence of O2.
3. Caloric value of different foodstuffs is determined in vitro in a special apparatus
called bomb calorimeter.
4. Caloric values:
a. Carbohydrate:
b. Fat:
4
9
c. Protein:
d. Alcohol:
4.2
7
BASAL METABOLIC RATE
1. Define BMR. What is the normal BMR of an adult? List 6 factors that affect
BMR. Pon Nov 2011
2. Define BMR. What is the normal values. List the factors affecting BMR. Pon
May 2010
3. Name two conditions which increase BMR. Pon May 2004
Man consumes energy to meet the fuel demands of the three ongoing processes in the
body.
1. Basal metabolic rate
2. Specific dynamic action
3. Physical activity
Basal metabolism: The basal conditions are as follows:
1. Person should be awake but at complete restboth physical and mental.
2. Person should be without food at least 12 to 18 hrs, i.e. in the postabsorptive
state.
3. Should be in recumbent/reclining position in bed.
4. Person should remain in normal condition of environment, i.e. at normal
temperature, pressure and humidity
Basal Metabolic Rate:
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35-38 cal/sq.m/hr.
2. Adult female:
32-35
2.
3.
4.
5.
6.
7.
8.
9.
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Carbohydrate
113 cal
=
105 cal
Protein
130 cal
Mixed diet
110 cal
3. SDA for mixed diet : For a mixed diet, the SDA is not an additive value of different
foods but it is much less. The presence of fats and carbohydrates reduces the SDA of
proteins. Fats are most efficient in reducing SDA of foodstuffs. For a regularly
consumed mixed diet, the SDA is around l0%.
1. Significance of SDA:
a. An addition of 10 % cal should be added in calculating cal requirement to
compensate SDA.
b. Higher SDA for protein implies that it is not a good source of energy. But
consumption of a protein rich diet makes us feel warm and comfortable in cold
weather. This is due to the high SDA of proteins
a. Fat is a good source for its low SDA. However, excessive utilization of fat leads
to ketosis.
a. Hapatectomy abolishes SDA indicating major utilization is in Liver.
b. Consumption of high protein diet makes us feel warm.
GLYCEMIC INDEX
1. Glycemic index may be defined as the area under the blood glucose curve after the
ingestion of a food compared with the area under the blood glucose curve after
taking the same amount of carbohydrate as glucose. lt is expressed as percentage.
2. The glycemic index of a complex carbohydrate (i.e. starch) is lower than a refined
carbohydrate (eg. glucose). This is explained on the basis of slow digestion and
absorption of complex carbohydrates.
3. The glycemic index of carbohydrateis lower when it is combined with protein, fat or
fiber.
4. Low glycemic index foods usually have higher satiety value and may be helpful in
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limiting the caloric intake. Nutritionists are of the opinion that foods with high fiber
content and low glycemic index should be preferred for consumption
5. Examples of glycemic index:
1. Glucose:
100
2. Bread, rice:
70-80
3. Banana, potato
60-70
4. Orange; apple
40-45
35-40
DIETARY FIBER
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must be consumed in the diet are referred to as essential fatty acids (EFA).
Functions of EFA
1. Essential fatty acids are the structural components of biological membranes.
2. Participatei n the transporta nd utilization of cholesterol.
3. Prevent fat accumulation in the liver.
4. Required for the synthesis of prostaglandins
5. Maintain proper growth and reproduction of the organisms
Deficiency of EFA
1. Essential fatty acid deficiency is associated with several complications. These
include impairment in growth and reproduction, increased BMR and high turnover
of phospholipids.
2. The EFA deficiency is characterized by a scaly dermatitis on the posterior and
lateral parts of limbs and buttocks, referred to as phrynoderma or toad skin.
3. Poor wound healing and hair loss is also observed in EFA deficiency.
EFA content of foods
1. The essential fatty acids, also called polyunsaturated fatty acids (PUFA), are
present in vegetable oils and fish oils.
2. The sources include sunflower oil, cofton seed oil, corn oil, soyabean oil etc. The
fat of animal origin (exception-fish), contain less PUFA e.g. butter, fat of meat, pork
and chicken.
Dietary intake of EFA
1. 30% of the dietary fat should contain PUFA.
2. Excess PUFA, unless accompanied by antioxidants (vitamin E, carotenes) is
injurious to the cells due to the overproduction of free radicals.
PROTEINS
COMPLETE PROTEIN
1. What do you mean by complete protein? Give example. Pon Nov 2006
1. A complete protein contains an adequate amount of all of the essential amino acids
that should be incorporated into a diet.
2. Animal proteins are complete proteins as compared to those of vegetable proteins
(Incomplete proteins).
3. Whole egg and milk proteins, specially Lactalbumin rank highest in this respect and
they contain the highest percentages of the essential amino acids.
4. Meat, fish, poultry and glandular tissues occupy next position in the scale. In the
same class, are also yeast and soyabean.
5. Cereals, legumes (peas, beans, etc) and nuts are generally poor because they lack
some essential amino acids and thus they are incomplete proteins and are of poor
quality.
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NITROGEN BALANCE
1. What do you mean by the term nitrogen balance? Which are the
conditions in which positive nitrogen balance is observed? Pon Apr 2002
1. A normal healthy adult is said to be in nitrogen balance, because the dietary intake (I)
equals the daily loss through urine (U) feces (F) and skin (S).
I=U+F+S
2. When the excretion exceeds intake, it is negative nitrogen balance. When the
intake exceeds excretion, it is a state of positive nitrogen balance.
3. Nitrogen balance can be measured by calculating the dietary intake of protein
nitrogen (16% of the weight of protein) and measuring the daily excretion.
4. Factors Affecting Nitrogen Balance
a. Growth: During the period of active growth, a state of positive nitrogen balance
exists. On an average when a person gains 5 kg, about 1 kg proteins are added to
the body.
b. Hormones: Growth hormone, insulin and androgens promote positive nitrogen
balance, while corticosteroids cause a negative nitrogen balance.
c. Pregnancy: A pregnant woman will be in a state of positive nitrogen balance
due to the growth of fetus.
d. Acute illness: Negative nitrogen balance is seen in subjects immediately after
surgery, trauma and burns.
e. Chronic illness: Malignancy, uncontrolled diabetes mellitus and other
debilitating diseases show negative nitrogen balance.
f.
g. Protein deficiency: The deficiency of even a single essential amino acid can
cause negative nitrogen balance. Prolonged starvation is another important
cause.
5. Maintenance of Nitrogen Balance
a. Obligatory nitrogen loss is 3.5 g of N/day for a 65 kg person due to urinary,
fecal and cutaneous loss. This could be equivalent to 22 g of protein.
b. Protein requirements for growth. This is applicable in the case of infants,
children, adolescents, pregnancy, lactation and convalescence. As growth
stops, protein requirement also decreases.
6. Positive nitrogen balance:
a. This is a state in which the nitrogen intake is higher than the output. Some
amount of nitrogen is retained in the body causing a net increase in the body
protein.
b. Positive nitrogen balance is observed in growing children, pregnant women or
during recovery after serious illness.
7. Negative nitrogen balance:
a. This is a situation in which the nitrogen output is higher than the input. The
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result is that some amount of nitrogen is lost from the body depleting the body
protein.
b. Prolonged negative nitrogen balance may even lead to death. This is
sometimes observed in children suffering from kwashiorkor or marasmus.
c. Negative nitrogen balance may occur due to inadequate dietary intake of
protein (deficiency of even a single essential amino acid) or destruction of
tissues or serious illness. In all these cases, the body adapts itself and
increases the breakdown of tissue proteins causing loss of nitrogen from the
body.
8. Other factors influencing nitrogen balance
Hormones : Growth hormone and insulin promote positive nitrogen balance while
corticosteroids result in negative nitrogen balance.
Disease states: Cancer and uncontrolled diabetes cause negative nitrogen
balance.
BIOLOGICAL VALUE (BV) OF PROTEIN
1. Define biological values of protein. Pon May 2010
1. It is the ratio between the amount of nitrogen retained and nitrogen absorbed during
a specific interval.
BV =
2. For the measuremenot f BV, the experimental animals, namely weaning albino rats
are chosen Suppose 127 mg of a particular protein was consumed by a rat in a day
and 4 mg is recovered in feces and 24 mg is seen in urine. Then
Amount ingested =
127 mg
123 24
= 123 mg
= 99 mg
= 81%
94
b. Milk protein:
84
c. Fish:
85
d. Meat:
75
e. Rice:
68
f.
58
Bengal gram:
g. Soya
65
5. The biological value provides a reasonably good index for the nutritive value of
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proteins.
6. The drawbacks: It cannot take into account the nitrogen that might be lost during the
digestion
7. Net protein utilization (NPU) is a better nutritional index than biological value, since it
takes into account the digestibility factor. The experimental procedure for NPU is
similar to that of BV. Net protein utilization can be calculated as
NPU = Nitrogen retained x 100
Nitrogen ingested
MUTUAL SUPPLEMENTATION OF PROTEINS
1. What do you mean by the term mutual supplementation of proteins? Pon
Apr 2002
2. What is the nutritional basis for ingesting combination of cereals and
pulses? Pon Dec 2003
1. Limiting amino acids: Certain proteins are deficient in one or more essential
amino acids. If this protein is fed to a young rat as the only source of protein, it fails
to grow. This amino acid is said to be the limiting amino acid. Limiting amino acid is
that which limits the weight gain when a protein is supplied to an animal
2. The animal proteins are superior in their nutritive value compared to the proteins of
vegetable origin. But some of the essential amino acids are limiting in vegetable
proteins. For instance, rice and wheat proteins are limiting in lysine and threonine
while the protein of Bengal gram is limited in sulfur-containing amino acids
(methionine and cystine).
3. This problem can be overcome by supplementation of the essential amino acids in
one food to the other that lacks such essential amino acids. This phenomenon is
referred to as mutual supplementation.
4. Example: diet with cereals (wheat, rice) is taken along with pulses (dal). The
limitation of lysine and threonine in cereal proteins is overcome by their
supplementation from dal proteins. Simultaneously, the limitation of sulfur containing
amino acids in dal is also compensated by the cereals, which are rich in them.
5. The principle of mixed diet takes care to supply adequate quantities of essential
amino acids to the people subsisting on pure vegetarian diets. lt has to be
remembered that the effect of mutual supplementation in proteins is best observed
with the same meal or on the same day.
PRESCRIPTION OF DIET
1. Calculate the daily energy requirement of a 20 year old sudent. Pon Nov
2011
Energy requirement of MAN or calculation of your veg. diet
General Principles:
299
240 Kcal
60 gm
350 kcal
350/9 = 35
gm
Carbohydrate to provide 1410 C (1760 - 350 = 1410/4= 320) 1400 kcal
1400/4=
350 gm
Calcium
400 mg
Iron
25 mg
Step 3:
Composition:
Cereals
350 gm
Pulses
75
gm
Oil
40 ml
Milk
250 ml
Leafy vegetables
200 gm
Sugar
25 gm
Step 4:
Servings:
Proteins in gms
Energy in Kcal
in gms
Break fast:
2 chappatis or 2 idlis
100 ml milk
CH2O
=
=
50 gm channa
30
3
=
140
5
12
60
30
170
Lunch:
100 gm Rice
10
75
350
50 gm Bengal gram
1 Banana
=
=
12
30
10
170
50
20
30
140
Dinner:
2 chappatis or 2 idli
300
50 gm rice
35
175
50 gm green gram
12
30
170
100 ml milk
60
1 Banana
10
50
50 gm oil
10
10 gm Sugar
100 gm Green leafy veg
Total
450
40
4
73
303
20
2065
4. A diet that is more deficient in protein than energy may be more likely to cause
kwashiorkor than
marasmus.
2.
albumin level in serum is very low (2 g/dl) in kwashiorkor and slightly low in
marasmus.
3.
4.
5.
Hypoglycemia is common.
301
6.
7.
7. Treatment:
1.
a planned diet manipulation by providing 150-200 Kcal and 3-4 gm protein per kg
is often used.