DJ COLLEGE OF DENTAL SCIENCES AND

RESEARCH

PRESENTED BY:-Dr Venisha Pandita1st Year Post GraduateDepartment of Public Health Dentistry

IntroductionDefinition of diet, food and nutritionBalanced dietComponents of food and their deficiency diseases.Functions of foodNutrient values of foodFood pyramidImportance of diet during different stages of life

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.

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.

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 & maintenanceNIZEL 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.

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.

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.

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 :

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

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.

PROTEINSProteins 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 typesSIMPLECONJUGATEDDERIVED

SOURCES•Animal sources– milk, meat, eggs, cheese, fish.

•Vegetable sources– pulses, cereals, beans, nuts, oil seeds.

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.

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.

PROTEIN REQUIREMENTS.

Recommended Daily Intake GMS/DAY

a} reference man ------------------- 60 b} reference woman -------------- 50 c} pregnant woman ---------------- 65 d) lactating woman ---------------- 75 e} 5-12 yrs children----------------- 30 f} adolescent boy--------------------- 65 g} adolescent girl-------------------- 60

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.

•The first indicator of PEM is under weight.

• PHENYL KETONURIA and NUTRITIONALLIVER DISEASE are the other effects of PROTEIN MALNUTRITION. PEM CHILD

PREVENTIVE MEASURES FOR PEMHEALTH 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 environmentSPECIFIC PROTECTION•Protein and energy rich foods•Immunization•Food fortificationEARLY DIAGNOSIS AND TREATMENT•Periodic surveillance•Early treatment of infections and diarrhea.•De worming of heavily infested children•Development of feeding program's during epidemics

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

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.

Fatty acids are divided into :1. Saturated fatty acids such as lauric, palmitic and stearic acids2. 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.

SOURCES

Animal fats: ghee, butter, milk, cheese, egg, meat, fishVegetable fats: ground nut, mustard, sesame, coconutOthers: 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.

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.

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 groupsFAT SOLUBLE VITAMINS - A D E and KWATER SOLUBLE VITAMINS – B and C

•

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.

SOURCES

Animal Foods- Liver, Eggs, Fish, Meat, Cod Liver OilPlant Foods- Green Leafy Vegetables, Yellow Fruits,carrot.Fortified Foods- Vanaspati, Margarine, Cheese, Icecreams.

VITAMIN A AND DISEASE• Xerophthalmia• Night Blindness• Conjunctival Xerosis• Bitots Spots• Corneal Xerosis• Keratomalacia• Growth Retardation CONJUNCTIVAL XEROSIS

KERATO MALACIA CORNEAL XEROSIS BITOTS SPOTS

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.

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

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

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

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.

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.

Tongue in BERIBERI Severe BERIBERI

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

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.

•Angular stomatitis•Cheilosis•Glossitis•Inflammation of conjunctivae•Dermatitis of the facial skin•vomiting

RIBOFLAVIN DEFECIENCY

ANGULAR STOMATITIS

CHEILOSIS

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.

DEFICIENCY

PELLAGRA – dermatitis, diarrhea, dementia.GLOSSITISSTOMATITISDEPRESSION AND IRRITABILITY

PREVENTION

•improval of living conditions•diet modification

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.

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.

DEFECIENCY

CHELITIS

•Deficiency results in megaloblastic anemia, glossitis , chelitis , diarrhea, distension, flatulence.• Infertility and sterility

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 dayPREGNANCY – 1.5mcg per dayINFANTS – 0.2mcg per day

• Pernicious anemia• weakness and tingling in extremities.• ankle swelling, difficulty in walking, peripheral neuritis.• bright, smooth beefy red tongue.

DEFICIENCY

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

DEFICIENCY

Scurvy – swollen and bleeding gumsDelayed wound healingAnemia and weakness

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.

SOURCESLiver, egg, yolk, fish, meat, cheese, butter.

DAILY REQUIREMENT

ADULTS – 2.5 mcg INFANTS – 5.0 mcgPREGNANCY – 10 mcg

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.

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.

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.

RICKETS

OSTEOMALACIA

OSTEOMALACIA

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.

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

DEFICIENCY

•Prolonged clotting time and bleeding time.•Gingivitis and periodontal disease.

DAILY REQUIREMENT

0.03 mg/kg body weight.

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.

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

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

MINERALSCLASSIFICATION

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

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 productsGreen leafy vegetablesCerealsFruitsEggs and fish.

SOURCES

Daily requirement of calcium is around 400 mg to 500 mg.

DEFICIENCYOsteomalacia, 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.

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.

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 OSTEOPOROSISOSTEOPOROSISDeficiency 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, phosphate Low serum calcium, phosphate and elevated alkaline and elevated alkaline phosphatase.phosphatase.

Dietary calcium and Vitamin DDietary calcium and Vitamin D

Decline in anabolic hormones Decline in anabolic hormones likelike

Estrogens and pituitary.Estrogens and pituitary.

Decreased ossification.Decreased ossification.

Mineral composition remains Mineral composition remains normal.normal.

Hip and back pain, stooped Hip and back pain, stooped posture, bone fractures.posture, bone fractures.

Normal calcium, phosphate Normal calcium, phosphate levels in serum.levels in serum.

Estrogens, protein, Vitamin DEstrogens, protein, Vitamin D

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.

DEFICIENCY

Magnesium deficiency causes chronic malabsorption syndrome, acute diarrhea, renal failure, weakness, tremors, convulsions, hyper excitability.

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.

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.

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

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.

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

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

Etiological Classification of Etiological Classification of anemiaanemia

Blood loss:Acute Post hemorrhagicChronic blood loss

Deficiency of Hemopoetic factors:-Iron deficiencyFolate and vitamin b12deficiencyProtein deficiency.

Bone marrow aplasia:-Aplastic anemiaPure red cell aplasia

Anemia due to systemic infections:-Due to chronic infectionDue to chronic renal diseaseDue to chronic liver diseaseEndocrinal diseases

Anemia due to bone marrow infiltration:-Leukemia’sLymphomasMyelofibrosisMultiple myelomaCongenital sideroblastic anemia

Anemia due to increased red cell destruction:-Intra-corpuscular defectExtra-corpuscular defect

Morphological classification of anemia:- Microcytic hypochromic Normocytic normochromic Macrocytic normochromic

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.

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.

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

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

CLINICAL MANIFESTATIONS OF ANEMIAWeakness, 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 asPLUMMER VINSON SYNDROME.

ORAL MANIFESTATIONS

Koilonychias

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.

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.

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.

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.

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.

ORAL EFFECTS of iodine deficiency includes retarded jaw growth and delayed eruption of teeth.Root resorption is common.

ENDEMIC CRETINISM

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.

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.

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

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

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 }

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.

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.

Intervention :•Changing the water source •Chemical treatment •Other measures – Fluoride supplements should not be prescribed for children.

Intervention :•Changing the water source •Chemical treatment •Other measures – Fluoride supplements should not be prescribed for children.

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.

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

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.

ASSESMENT OF NUTRITIONAL STATUS

Assessment 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.

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.

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 vascularization3. 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.

CLINICAL EXAMINATIONS OF PATIENTS

ANTHROPOMETRYAnthropometric measurements such as height, weight, skin fold thickness and arm circumferenceare valuable indicators of nutritional status.

In young children, additional measurements such as head and chest circumference are made.

If anthropometric measurements are recorded overa period of time, they reflect the patterns of growthand development, and how individuals deviate from the average at various ages in body size, built and nutritional status. Anthropometric data can becollected by non medical personnel if givensufficient training.

LABORATORY AND BIOCHEMICAL ASSESMENT

LABORATORY TESTS-- HAEMOGLOBIN, URINE AND STOOLS.

BIOCHEMICAL TESTSNUTRIENTNUTRIENT 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

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

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.

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.

Types of Diet Surveys

- 24 Hour Recall Diet Surveys - Food Frequency Questionnaire - Diet History - Food Diary

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 INFANTMORTALITY RATE, SECOND YEAR MORTALITY RATE, LOW BIRTH WEIGHT BABIES, and LIFE EXPECTANCY.

•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.

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 following1. 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.

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.

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

•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.

FOOD 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.

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.

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 consumer1. paying more money for food stuff of lower quality.2. Some forms of adulteration are injurious to health.

FOODFOOD

COMMON ADULTERANTSCOMMON ADULTERANTS

GHEEGHEE VANASPATIVANASPATI

MILKMILK WATER,FAT EXTRACTS, STARCH.WATER,FAT EXTRACTS, STARCH.

BUTTERBUTTER ANIMAL FATANIMAL FAT

TEATEA TAMARIND SEEDS DUST, SAW DUST,USED TEA DUSTTAMARIND SEEDS DUST, SAW DUST,USED TEA DUST

COFFEECOFFEE DATE HUSK , CHICORYDATE HUSK , CHICORY

BLACK BLACK PEPPERPEPPER

DRIED PAPAYA SEEDSDRIED PAPAYA SEEDS

HALDIHALDI LEAD CHROMATE POWDERLEAD CHROMATE POWDER

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 leadto death or serious consequences punishment may go upto life imprisonment and a fine of Rs.5000.

•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.

FOOD STANDARDS

CODEX ALIMENTARIUS

PFA STANDARDS

THE AGMARK STANDARDS

BUREAU OF INDIAN STANDARDS

COMMUNITY NUTRITIONAL PROGRAMS IN INDIACOMMUNITY NUTRITIONAL PROGRAMS IN INDIA

PROGRAMMEPROGRAMME MINISTRYMINISTRY

VITAMIN A PROPHYLAXISVITAMIN A PROPHYLAXIS MINISTRY OF HEALTH MINISTRY OF HEALTH AND FAMILY WELFAREAND FAMILY WELFARE

NUTRITIONAL ANEMIA PROPHYLAXISNUTRITIONAL ANEMIA PROPHYLAXIS “”“”

IODINE DEFECIENCY CONTROL IODINE DEFECIENCY CONTROL PROGRAMMEPROGRAMME “” “”

SPECIAL NUTRITION PROGRAMMESPECIAL NUTRITION PROGRAMME MINISTRY OF SOCIAL MINISTRY OF SOCIAL WELFAREWELFARE

BALWADI NUTRITION PROGRAMMEBALWADI NUTRITION PROGRAMME “” “”

ICDS PROGRAMMEICDS PROGRAMME “” “”

MID DAY MEAL PROGRAMMEMID DAY MEAL PROGRAMME MINISTRY OF MINISTRY OF EDUCATIONEDUCATION

FUNCTIONS OF THE FOODPhysiological functionSocial functionPsychological 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

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.

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.

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.

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.

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.

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= 4.18kJCarbohydrates ---- 4.1 kcal/gFats -------- 9.45 kcal/gProteins ------ 5.65 kcal/g

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

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)

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)

FOOD PYRAMID

Carbohydrates: take most food from this group (rice, pasta, bread, potatoes)

Carbohydrates: take most food from this group (rice, pasta, bread, potatoes)

Fruit and vegetables: take 5 portions a day from this group

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

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)

THE MAIN FOOD GROUPS

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

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

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

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

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.

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.

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.

References :References :

Park J .Park’s Text book preventive and social medicine ; Blanot;21st ed: 430-454Abraham E. Nizel .Nutrition and preventive dentistry;2nd edAndrew J. Rugg- Gunn, June H.Nunn.Nutrition, diet, and oral health Soben Peter.Essentials of preventive and community dentistry.3rd ed:270-359Harsh Mohan .Text Book Of PathologyDavidson .Principles Of General MedicineNorman O Harris. Preventive Dentistry 6th Edition