nutrition

1. Nutrition
Sagun Lohala

2. Which vitamin plays the role in oxidation?
a) Vitamin A
b) Vitamin B
c) Vitamin C
d) Vitamin D

3. Answer:
c) Vitamin C

4.  Also called Protein Calorie Malnutrition
PEM ( Protein Energy Malnutrition)
Classification of PEM
• Primary PEM: Caused by inadequate nutrient intake
• Secondary PEM: Results from disorders or drugs that
interfere with nutrient use

5.  Lack of knowledge
 Poverty
 Deprivation and vulnerability
 Infections
 Emotional deprivation
 Cultural factors
 Mal-distribution of foodstuffs
 Sex bias
Risk Factors for PEM

6. Mild PEM
 Common in children between age 9 months to 3 years of age
 Occurs with food deficit persistently for longer duration
Clinical Features
 Growth failure
 Repeated infection
 Anemia
 Lethargy
 Delayed development
Types of PEM

7. Moderate PEM
 Easily recognizable form of PEM
 Commonly called “Runch”
 Seen in children between 1 to 4 years of age
Clinical Features
 Easily crying
 Buttocks are flattened
 Wrinkling of skin
 Long body, thin limbs
 Weight less than 70% of expected standard
Cont’d…

8. Severe PEM
 Is of 3 different types
 Marasmus
 Kwashiorkor
 Marasmic - kwashihorkor
Cont’d…
Degree PEM
 Normal- 90-100% of
desired body weight
 Mild: Grade- I- 75 to 89%
 Moderate: Grade II- 60-
74%
 Severe: Grade III-< 60%

9.  A form of severe protein-energy malnutrition
characterized by energy deficiency and thinness.
 Primarily caused by energy deficiency, failed
breastfeeding, inadequate feeding to the infants,
formula feeding, diarrhea
 Develops between the ages of six months and one
year in children who have been weaned from breast
milk
Marasmus

10.  Wasting of subcutaneous fats and muscles with
growth retardation and extreme loss of weight
 Old man face ( monkey face) develops
 Eyes become sunken
 Thin face
 Ribs and shoulders clearly visible through the
skin
 Very loose skin that sometimes hangs in folds
in the upper arms thighs and buttocks
 Persistent dizziness
 Diarrhea
 Active, alert and irritable behavior and crying
all the time
 Frequent infections that don’t show external
signs like fever or lesions
 Abdomen distended (pot belly) due to wasting
 Mental retardation occurs

11.  Also called wet protein-energy malnutrition,
 Caused by severe protein deficiency
 Occurs due to weaned from mother’s milk, and diet low in
protein
 Usually appears at the age of about 12 months when
breastfeeding is discontinued, but it can develop at any time
during a child's formative years.
 Causes fluid retention (edema); dry, peeling skin; and hair
discoloration.
Kwashiorkor

12.  Moon face
 Misery and apathy
 Weak muscles
 Changes in the skin
 Lethargy
 Retarded growth
 Increases susceptibility to
infections
 Poor appetite, nausea, vomiting
 Enlargement of liver and
abdomen
 Mental deficiency
Signs and symptoms of Kwashiorkor

13. Treatment
Marasmus Kwashiorkor
• Nutritious and balanced
diet with lots of fresh
fruits and vegetables
grains and protein adding
Vit B to the diet
• Carbohydrate diet
followed by high
protein foods, dried
milk

14. Prevention of PEM
1. Health promotion
• Measures directed to pregnant and lactating women
(education and distribution of supplement)
• Promotion of breast feeding
• Development of low cost weaning foods: the child should be
made to eat frequently e.g. sarbottam pitho
• Measures to improve family diet
• Nutrition education for correct feeding practices
• Home economics
• Family planning and spacing of births
• Family environment

15. Cont’d…
2. Specific protection
• Immunization
• Food fortification
• The child’s diet must contain protein and energy rich
foods. Milk, eggs, fresh fruits should be given if possible

16. Cont’d…
3. Early diagnosis and treatment
• Periodic surveillance
• Diagnosis of any lag in growth monitoring
• Diagnosis and treatment of infections and diarrhea
• Development of supplementary feeding program during
epidemic
• Deworming of heavily infested children
4. Rehabilitation
• Nutritional rehabilitation services

17.  Promoting healthy, nutritious and
diversified diets for adolescents, pregnant
women, breastfeeding mothers, infants and
young children.
 Fortifying diets of young children aged 6-23
months with multiple micronutrient powder
(MNP).
 Promoting early detection of children 6-59
months who are wasted and supporting
improved access to treatment services
Comprehensive nutrition interventions in Nepal

18.  Promoting iodized salt.
 Supplementing Vitamin A for
children aged 6-59 months.
 Deworming of children aged 13-59
months.
 Supplementing iron folate for
adolescent girls, pregnant women
and breastfeeding mothers
 Nutrition education and
counselling.
Cont’d…

19. The first 1,000 days from the start of a woman’s
pregnancy to a child’s second birthday offer an
extraordinary window of opportunity for preventing
undernutrition and its consequences.
(i.e. 9X30+2X365= 270+730 =1000days)
Golden Thousand Days

20. Probable Question
MUAC is measured by the tape called:
a) Cello tape
b) Shakir tape
c) Inch tape
d) All of the above

21. Answer:
b) Shakir Tape

22. MUAC
• Also called emergency nutritional measurement
• Measured by a tape Shakir tape
• Measures 6 months to 5 years children
• 3 grading
• Normal -> 125 mm
• Mild/ moderate - > 115 – 125 mm
• Severe - <115 mm

23. Growth monitoring
• Weight for age is monitored
• Indicates acute and chronic
malnutrition
• Charted in yellow chart or road
to health chart (designed by
Devid Morley)
• Home based chart
• 0- 23 months children should be
monitored once a month

24. Name Food source Function
Vitamin A
Retinol
(Preformed)
Beta Carotene
(pro vitamin)
Animal:
• Liver
• Egg
• Butter
• Cheese
• Milk
• Fish
• Fish oil
• Meat
• Normal vision: Vitamin A –
Retinal pigments- dim light
vision
• Maintenance of cellular
integrity and normal
functioning of lining of skin,
eyes, respiratory and urinary
tracts
• Supports skeletal system
• Anti-infective
• Anti-cancer

25. Requirement
600-750 microgram (adult)
400mg extra (during lactation)
Deficiency
• Xeropthalmia -dry eye
• Night blindness (1
st
symptom)
• Conjunctival xerosis (1
st
sign)
• Bitot’s spots- foamy spots on bulbar conjunctiva
• Keratomalacia (medical emergency)

26. Which of the following is clinical sign of vitamin A
deficiency?
a) Conjunctival Xerosis
b)Corneal ulcer
c) Bitot’s spot
d)Keratomalacia

27. Answer: a) Conjunctival Xerosis

28. Which is the earliest and most common manifestation of
vitamin A deficiency?
a) Corneal ulcer
b) Night blindness
c) Keratomalacia
d) Corneal Xerosis

29. Answer: b) Night blindness

30. Which of the following is also known as beauty
vitamin?
a) Vitamin A
b)Vitamin C
c) Vitamin D
d)Vitamin E

31. Answer: d) Vitamin E

32.  Dietary improvement
 Decreasing frequency of PEM, diarrhea, measles, RTI
 Prophylaxis dose
Prevention
Treatment
Age/condition Prophylaxis dose of Vitamin A
< 6 months 50,000 single dose
6months to 1 year 1 lakh single dose
>1 year 2 lakh single dose
Lactating mother 2 lakh single dose
Age Dose
< 1 year 1 lakh on day 1st, 2nd, and 14th
> Or equals to 1 year 2 lakh on day 1st, 2nd, and 14th
Not given to pregnant women because of side-effects to
fetus

33. (D2)
Cholecalciferol
(D3)
Increases tubular
reabsorption of phosphate
Name Food source Function
Requirement
 Under adequate sunlight there is no need of dietary requirement
 Daily requirement of Vit D
 Infants= 5 mg (200 IU), Children = 10 mg (400IU)
 Adults= 2.5 mg( 100 IU), Pregnancy/lactation = 10 mg (400 IU)

34. Deficiency : Rickets (children)

35.  Osteomalacia (adult)
• Especially during pregnancy, lactation, and muslim
women
• Defective bone mineralization, bone pain, muscle
weakening
 Cognitive health
 Osteoporosis
 Psoriasis

36.  Educating parents to expose children regularly to sunshine
 Vitamin D fortification of food and periodic dosing of young children
Prevention
Treatment
 Vitamin D (10- 50 mg daily)
 Active vitamin D metabolites (needed in case of chronic renal failure)
 Calcium supplementation

37. Wound healing
Modifies blood fat
Haemolytic anemia
Requirement
Recommended daily amount of vitamin E for adults is 15
milligrams a day
Infants require 3 mg
Name Food source Function Deficiency

38. Vitamin K
(Pylloquinine)
Animal
Cow milk
Plants
Green leafy
vegetables
Fruits
Stimulate production
and/ or release of
coagulating factors
from liver i.e. clotting
factors II, VII, IX, X
Deficiency
Prolonged clotting
time (prothrombin
is decreased)
Met by dietary intake and microbial synthesis in gut
Name Food source Function Deficiency
Requirement
Adults : 0.03 mg/kg day
Premature baby: 0.5 to 1 m IM or 1 or 2 mg oral

39. Name Food source Function Deficiency
Vitamin
C
(Ascorbic
acid)
Fresh fruits
Amala (Richest
source)
Lime
Orange
Tomato
Guava (2nd richest
source)
Germinating pulses
Vegetables
Cabbage, Spinach
Cauliflower
Brinjal, Potato
Radish
Fresh meat and fish
• Important role
in tissue
oxidation
• Formation of
collagen
• Absorption of
iron
• Protection
from infection
and common
cold
Scurvy
• Swollen gum
and bleeding
• Bleeding into
subcutaneous
area bone and
joints
• Delayed wound
healing
• Anemia and
weakness

40. Name Food source Function Deficiency
Vitamin
B1
(Thiamine)
Sunflower seeds,
peanuts, wheat bran,
beet liver, pork,
seafood, egg – yolk,
beans whole grains
and yeast contain
good amounts of
thiamine.
• Required for the health
of the nervous system.
• Manufacture of
hydrochloric acid, and
therefore plays a part
in digestion.
• Required for good
appetite and proper
growth.
Beriberi occurs in
two forms, wet
beriberi and dry
beriberi,

41. •Dry beriberi can damage the central nervous system
(CNS). It disrupts motor functioning (the movement of the
muscles).

42. •Wet beriberi affects the cardiovascular system.
Since it involves the functioning of the heart,
• it's a life-threatening medical emergency that
needs immediate treatment.

43. Name Food source Function Deficiency
Vitamin
B2
(Riboflavin)
Animal source
Organ meats, fish,
cheese, eggs, milk
and lean meat
Plant source
green leafy
vegetables,
legumes, , nuts
whole grains, and
yogurt
• Required by the body to use
oxygen and the metabolism of
amino acids, fatty acids, and
carbohydrates.
• For red blood cell formation,
antibody production, cell
respiration, and growth.
• Helpful in the prevention and
treatment of cataracts.
Angular
stomatitis,
glossitis,
nasolabial
dyssebacia

44. Name Food source Function Deficiency
Vitamin
B3
(Niacin)
(nicotinamide
and
nicotinic
acid) Animal source
Liver, lean meat, and
fish
Plant source
nuts, cereals, legumes,
asparagus, milk, green
leafy vegetables. A cup
of coffee also provides 3
milligrams of niacin.
• Niacin also plays a
role in tissue
respiration
• Synthesis and
breakdown of fats, and
helps to maintain
healthy skin.
Pellagra

45. Name Food source Function Deficiency
Vitamin
B6
(Pyridoxine)
(nicotinamide
and
nicotinic
acid) Animal source
brewer’s yeast, egg,
chicken, fish, liver,
kidney,
Plant source
pea, wheat germ and
walnuts. Roots and
tubers, cabbage,
legumes, molasses,
whole grains, etc.
• Metabolism and proteins, fats
and carbohydrates.
• Maintenance of serum level
of sodium and potassium
• promote red blood cell
production.
• Cancer immunity and fights
the formation of the toxic
chemical homocysteine.
Irritability,
nervousness,
insomnia, anemia,
general weakness,
skin changes such
as dermatitis
Isoniazid is pyridoxine antagonist so needs pyridoxine supplementation

46. Name Food source Function Deficiency
Folic
acid
(Vitamin
B9)
Folic
acid,
folacin,
folate
• Animal
liver, kidney, egg,
yeast etc.
• Plant
Fresh green
vegetable (spinach
and broccoli) fruit,
starchy vegetables,
beans, whole grains
• Required for DNA synthesis
and cell growth (red blood cell
and marrow)
• Formation, energy production
as well as the forming of
amino acids.
• Synthesizing heme, the iron
containing substance in
hemoglobin, crucial for
oxygen transport.
• Development of the nervous
system of a developing fetus.
Macrocytic ,
megaloblastic
anemia, diarrhea,
and flatulence;
fatigue,
depression, and
mental confusion.

47.  Supplementation of folate in pregnancy/ lactation/ growing
children
 Regular balanced diet (folate storage is small)
Prevention

48. Name Food source Function Deficiency
Folic
acid
(Vitamin
B9)
Folic
acid,
folacin,
folate
• Animal
liver, kidney, egg,
yeast etc.
• Plant
Fresh green
vegetable (spinach
and broccoli) fruit,
starchy vegetables,
beans, whole grains
• Required for DNA synthesis
and cell growth (red blood cell
and marrow)
• Formation, energy production
as well as the forming of
amino acids.
• Synthesizing heme, the iron
containing substance in
hemoglobin, crucial for
oxygen transport.
• Development of the nervous
system of a developing fetus.
Macrocytic ,
megaloblastic
anemia, diarrhea,
and flatulence;
fatigue,
depression, and
mental confusion.

49. Name Food source Function Deficiency
 Absorbed only at terminal ileum
 Storage in liver (can supply up to 3 years)
 Only water soluble vitamin that can be stored in body.

50. Minerals
More than 50 minerals in body
Classified as:
Major minerals : Calcium, phosphate, sodium, potassium,
magnesium
Trace elements: (required in few mg per day)
Iron, Iodine, Fluorine, Zinc, Copper,
Cobalt, Chromium, Manganese,
Molybdenum, Selenium, Nickel, Tin,
Silicon, Vanadium

51. Calcium
1-2% of body weight
98% of calcium is present in bone
Calcium metabolism is maintained by vit D, PTH, and
calcitonin
Source:
Milk and milk products, egg, fish, cereals, water, leafy vegetables
Millet- rich in calcium; rice: deficient in calcium

52.  Formation of bones and teeth
 Coagulation of blood and cardiac action
 Metabolism of enzymes and hormones
 Milk production
 Electric and chemical message relay
 Light generation of electric impulses in retina
Function
Daily requirement
 600 mg/day
 1200 mg/ day during pregnancy
Calcium supplementation reduces eclampsia and pre-eclampsia

53. Deficiency
 Tetany
 Prolonged and high doses of antacid causes its deficiency
Excess
 Arrhythmias and renal stone formation

54. Phosphorus
Essential for formation of bones and teeth
Human body contains 400-700 gm of phosphorous
Take part in all metabolisms
Source:
Vegetable foods
Deficiency:
Muscle weakness, bones and teeth problems

55. Magnesium
Present in bones and cells
Contains 25gm of magnesium daily; ½ of it is found in bone
Function:
Normal metabolism of calcium and potassium
Deficiency:
Cardiac arrhythmias and tetany
Common in chronic alcoholics, cirrhosis, toxaemia of pregnancy,
PEM and malabsorption
Daily requirement: 340 mg/day

56. Sodium
Found in all body fluids
Human body contains 100 gm of sodium
Lost in urine and sweat
Source: Many foods and salt
Depletion: Muscular pain
Requirement: increases with hard work and in hot climate.
5gm/day, >10 gm/ day may increase risk for hypertension

57. Potassium
Widely distributed in foods
Deficiency is rare
Human body contains 250 g of potassium
Potassium supplementation lower blood pressure. Potassium is
important for maintaining blood pressure, cardiac function and rhythm
Deficiency: Muscle spasm, cardiac arrhythmia and blood pressure
changes
Daily requirement: 250 mg/ day

58. Iron
60% of iron in blood
3.34 mg iron/ gm of Hb
1 gm of iron produces 2 ml of blood
Absorbed in duodenum and upper small intestine and
absorption is promoted by Vit C and inhibited by milk, tea and
egg
Depletion: Muscular pain
Requirement: increases with hard work and in hot climate

59. Name Food source Function Deficiency
Iron
liver, meat, fish,
etc.
Fresh green leafy
vegetable, cereals
• Central function of iron is
oxygen transport and cell
respiration
• Body temperature regulation
• Immunity and production of
antibody
• Formation of Hb
• Development of brain and
cognitive function
Iron deficiency
anemia is most
common type of
anemia
(Macrocytic ,
hypochromic
anemia).

60. According to WHO Hb level 10-11 gm/dl has been defined as early
anemia and <10gm/dl is marked anemia
• Prevalence of anemia among children age 6–59 months is 43%
• Prevalence of anemia among women age 34% in 2022.
(NDHS, 2022)

61. Blood loss
• Physiological loss: Child birth and menstruation (2 mg of iron
lost during menstruation)
• Pathological loss: Hookworm, hemorrhoids, peptic ulcer
Iron loss
Deficiency occurs due to
 Disease of duodenum
 Greater demand: Pregnancy and growth
 Hemorrhage
 Deficient intake

62. Iodine
• Necessary component of two hormones produced by the thyroid
gland (thyroxine and triiodothyronine).
• These thyroid hormones are critical in regulating the body’s
metabolic rate.
• For normal growth and development
Food sources
The amount of iodine present in a particular food depends on the
amount of iodine in the environment in which that food was raised.
Therefore, food from the sea lobsters, oysters, sardines etc.

63. Deficiency
• Enlargement of the thyroid gland, known as goiter (specially
in Himalayan region).
• Hypothyroidism
• Retarded physical development and impaired mental function
• Increased spontaneous abortion and still birth
• Neurological cretinism: deaf mutism
• Myxedematous cretinism: dwarfism with severe mental
retardation

64. Zinc
• Found in the bones and muscles.
• Necessary for optimal activity of many enzymes and bodily
processes, including the following:
• Protein metabolism, wound healing, and growth
• Metabolism of DNA, the genetic material
• Development of sexual organs and bones
• Immune responses
• Memory formation
• Alcohol metabolism
• Particularly high needs for zinc occur during growth and
development.

65. Food sources
Meat, fish, eggs, milk and nuts are rich sources.
Requirement is increased during pregnancy and lactation.
Deficiency
• A zinc deficiency impairs protein synthesis, collagen
formation, and energy production; it also decreases alcohol
tolerance.
• Growth failure
• Sexual infantism in adolescence
• Loss of taste sensation and delayed wound healing

66. •Daily requirement of:
•Infants: 3-5mg
•Child (1-10 years) : 10-15 mg
•Pregnancy and lactation: 20-25 mg
•Adult: 15.5 mg

67. Absorption of iron is enhanced by:
a) Vitamin A
b)Vitamin B
c) Vitamin C
d)Vitamin D

68. Answer: Vitamin C

69. Congenital neural tube defect is associated with:
a) Sodium
b)Potassium
c) Folic Acid
d)Ascorbic acid

70. Answer: Folic Acid