• Nutrition, also called nourishment, is the provision to cells and organisms
of the materials necessary in the form of food to support life. Our food is
made up of essential, natural substances called nutrients.
• There are seven major classes of nutrients:
• Carbohydrates are the main source of energy in the Indian diet contributing to
55-60% of total energy intake.
• Carbohydrates contribute taste, texture and bulk to the diet.
• Lack of carbohydrates (less than 30%) in the diet may produce ketosis, loss of
weight and breakdown of proteins.
• Carbohydrates are divided into simple carbohydrates (monosaccharide and
disaccharides such as glucose and fructose in fruits, vegetables and honey,
sucrose in sugar and lactose in milk) and complex carbohydrates
(oligosaccharides and polysaccharides such as starch in cereals, millets, pulses
and root vegetables).
• The main source of energy in the body is glucose derived from starch and
sugars present in the diet. Glucose is used as a fuel by the cells and is converted
to glycogen by liver and muscles.
• Excess carbohydrates are converted to fat.
• Carbohydrates provide 4 kcal of energy per gram.
6. • Fiber Dietary fibers include polysaccharides such as cellulose,
hemicelluloses, pectin, gums, mucilage and lignin.
• They have little nutritional value as they are not digested by
the enzymes in the gut.
• Fibers are essential for the normal functioning of the gut,
elimination of waste, bile acid binding capacity and for
maintaining the growth of normal intestinal microflora.
Elements: carbon, hydrogen,
oxygen and nitrogen.
1. It is the only nutrient that
contains nitrogen, which is the
element responsible for growth.
2. These elements make up
units called amino acids.
3. Protein is a number of amino
acids joined together by
peptide links to form a chain.
4.These protein chains are
broken down during the
digestion of food, freeing each
amino acid so that it can be
absorbed into the bloodstream.
• Animal Protein / 1st.Class protein / High Biological Value (HBV)
• Vegetable Protein / 2nd.Class / Low Biological Value (LBV)
• Both classes of protein should be included in the diet.
• The amount of protein required by each person is related to his/her weight.
• RDA of protein is 1 gram of protein per kg of body weight.
• Animal Protein: Meat, fish, milk, eggs, cheese, yoghurt
• Vegetable Protein: Peas, beans, lentils, nuts, cereals
• In the past animal foods were eaten as a major source of protein, there is
now a trend towards eating more plant or vegetable sources of protein
They contain less fat
They contain more fibre
They are cheaper to produce.
1. For the growth of all body cells e.g. skin and bones.
2. The repair of worn out or damaged cells e.g. cuts.
3. The production of hormones, enzymes and antibodies which are
required to keep the body healthy.
4.Excess is used for heat and energy.
• Amino Acids : There are approximately 20 amino acids.
• There are two types:
• Essential amino acids are those which the body cannot be make and
must be supplied by the diet.
• Non-essential amino acids are those which the body can make enough
of and are not therefore a dietary requirement.
12. • About 25-30% of energy intake should be from fat.
• However, in malnourished children, up to 45% of calories can be provided from fat
• In India, almost 10-15% of fat is derived from invisible fat; therefore, visible fat intake
should be restricted to below 20%.
• Saturated fat should not exceed 7% of the total fat intake; polyunsaturated fat should be
restricted to 10% and rest should be derived from monounsaturated fats.
• A minimum of 3% energy should be derived from linoleic and 0.3% from linolenic acid.
13. • NORMAL DIET:
Breastfeeding An infant should be exclusively breastfed till six months of age
• During this phase, additional food or fluid is not required as breast milk is
nutritionally complete for the child's growth and development and it
protects from infections and strengthens immune system.
14. COMPLEMENTARY FEEDING :
• After six months of age, breast milk alone is not enough to make an infant grow well.
• Complementary feeding refers to food which complements breast milk and ensures that
the child continues to have enough energy, protein and other nutrients to grow normally.
• Complementary feeding is started at six months of age, while continuing breastfeeding,
Breastfeeding is encouraged up to two years of age in addition to normal food.
• BALANCED DIET:
• Balanced diet is defined as nutritionally adequate and appropriate intake of food items
that provide all the nutrients in required amounts and proper proportions.
• Even at 9 months, infants need small portions of a mix of food groups to be included in
their diet to ensure intakes of all macronutrients and micronutrients.
• A combination of carbohydrate rich food (any cereal, fruit and/or vegetable), a protein
source (milk and milk products, pulse, egg, meat, fish, nuts) and a fat (visible oil or ghee)
and/ or sugar or salt should be used to make nutritionally adequate complementary food
15. • . A balanced diet contains 55-60% calories from
carbohydrates, 10-12% proteins and 25-30% fat.
• Foods are grouped conventionally as: (i) cereals,
millets and pulses; (ii) vegetables and fruits; (iii)
milk and milk products; (iv) egg, meat, fish; and (v)
oils and fats. Cereals, millets and pulses are the
major source of most nutrients in Indian diets.
• Milk provides good quality protein and calcium and
hence, is an essential item of our diet.
• Eggs, flesh foods and fish enhance the quality of diet
but Indians are predominantly a vegetarian society
and most of our nutrients are derived from cereals,
pulse and milk based diets.
• Oils and nuts are calorie rich foods and are useful in
increasing the calorie density. Vegetables and fruits
provide protective substances such as vitamins,
minerals, fiber and antioxidants.
17. Factors the Child to be Considered while
Planning Food for the child
• There are six cardinal factors to be considered while feeding the child:
• 1. Energy density.
• 2. Amount of feed.
• 3. Consistency of feed.
• 4. Frequency of feeding.
• 5. Hygiene.
• 6. Helping the child.
18. Protein energy malnutrition
• Undernutrition is a condition in which there is inadequate consumption, poor absorption
or excessive loss of nutrients.
• Overnutrition is caused by overindulgence or excessive intake of specific nutrients.
• The term malnutrition refers to both undernutrition as well as overnutrition. However,
sometimes the terms malnutrition and protein energy malnutrition (PEM) are used
interchangeably with undernutrition.
• Malnourished children may suffer from numerous associated complications. They are
more susceptible to infections, especially sepsis, pneumonia and gastroenteritis. Vitamin
deficiencies and deficiencies of minerals and trace elements can also be seen.
• Malnutrition in young children is conventionally determined through measurement of
height, weight, skinfold thickness (or subcutaneous fat) and age.
It results from rapid deterioration in nutritional status.
Acute starvation or acute illness over a borderline nutritional status could precipitate this form of undernutrition.
It is characterized by marked wasting of fat and muscle as these tissues are consumed to make energy.
1. The main sign is severe wasting.
2. The child appears very thin (skin and bones) and has no fat.
3. There is severe wasting of the shoulders, arms, buttocks and thighs
4 . Affected children may appear to be alert in spite of their condition iv. There is no edema
• It usually affects children aged 1--4 yr.
• The main sign is pitting edema, usually starting in the legs and feet and spreading, in more
advanced cases, to the hands and face.
• Because of edema, children with kwashiorkor may look healthy so that their parents view
them as well fed.
. General appearance.
1. Child may have a fat sugar baby appearance.
2. Edema. It ranges from mild to gross and may represent up to 5-20% of the body weight.
3. Muscle wasting. It is always present. The child is often weak, hypotonic and unable to
stand or walk.
4. Skin changes. The skin lesions consist of increased pigmentation, desquamation and
dyspigmentation. Pigmentation may be confluent resembling flaky paint or in individual
enamel spots. The distribution is typically on buttocks, perineum and upper thigh.
Petechiae may be seen over abdomen. Outer layers of skin may peel off and ulceration
may occur. The lesions may sometimes resemble burns.
21. 5. Mucous membrane lesions: Smooth tongue, cheilosis and angular stomatitis are common.
Herpes simplex stomatitis may also be seen.
• 6. Hair.: Changes include dyspigmentation, loss of characteristic curls and sparseness over
temple and occipital regions. Hairs also lose their luster and are easily pluckable. A flag sign
which is the alternate bands of hypopigmented and normally pigmented hair pattern is
seen when the growth of child occurs in spurts.
• 7. Mental changes. Includes unhappiness, apathy or irritability with sad, intermittent cry.
They show no signs of hunger and it is difficult to feed them.
• 8. Neurological changes. These are seen during recovery.
• 9. Gastrointestinal system. Anorexia, sometimes with vomiting, is the rule. Abdominal
distension is characteristic. Stools may be watery or semisolid, bulky with a low pH and
may contain unabsorbed sugars.
• 10. Anemia. It may also be seen, as in mild PEM, but with greater severity.
• 11.Cardiovascular system. The findings include cold, pale extremities due to circulatory
insufficiency and are associated with prolonged circulation time, bradycardia, diminished
cardiac output and hypotension.
• 12. Renal Junction. Glomerular filtration and renal plasma flow are diminished. There is
aminoaciduria and inefficient excretion of acid load.
22. • Marasmic Kwashiorkor: It is a mixed form of PEM and manifests as edema occurring in
children who may or may not have other signs of kwashiorkor and have varied
manifestations of marasmus.
28. Prevention of Malnutrition
• Prevention at National Level :
• Nutrition supplementation: This can be done by improvement of food and feeding; by
fortification of staple food; iodination of common salt and food supplementation.
• Nutritional surveillance: Surveillance defines the character and magnitude of nutritional
problems and selects appropriate strategies to counter these problems. Nutritional
• Nutritional planning :involves a political commitment by the government, formulation
of a nutrition policy and planning to improve production and supplies of food and ensure
• Prevention at Community Level
• a. Health and nutritional education: Lack of awareness of the nutritional quality of
common foods, irrational beliefs about certain foods and cultural taboos about feeding
contribute to the development of malnutrition. People should be informed of the
nutritional quality of various locally available and culturally accepted low cost food.
29. • b. Promotion of education and literacy in the community:especially nonformal education
and functional literacy among village women.
• c. Growth monitoring. The growth should be monitored periodically on growth cards.
Velocity of growth is more meaningful than the actual weight of a child
• . d. Integrated health package. Primary health care package should be made available to all
sectors of population including preventive immunization, oral hydration, periodic
deworming and early diagnosis and treatment of common illnesses.
• e. Vigorous promotion of family planning programs to limit family size.
• Prevention at Family Level
• a. Exclusive breastfeeding of infants for first 6 months of life should be vigorously promoted
• b. Complementary foods should be introduced in the diet of infants at the age of 6 months.
• c. Vaccination.
• d. Iatrogenic restriction of feeding in fevers and diarrhea should be discouraged.
• e. Adequate time should be allowed between two pregnancies so as to ensure proper infant
feeding and attention to the child before the next conception.
30. Integrated Child Development SeNices (/CDS)
• The ICDS programme is an intersectoral program which seeks to directly reach out to
children, below six years, especially from vulnerable groups and remote areas.
• The Scheme provides an integrated approach for converging basic services through
community-based workers and helpers. The services are provided at a center called the
• A package of six services is provided under the ICDS Scheme:
• Supplementary nutrition.
31. • Immunization. Immunization of pregnant women and infants is done against the six
vaccine preventable diseases.
• Nonformal preschool education.
• Health check-up. This includes health care of children less than six years of age, antenatal
care of expectant mothers and postnatal care of nursing mothers.
• Referral services. During health check-ups and growth monitoring, sick or malnourished
children are referred to the Primary Health Centre or its subcenter.
• Nutrition and health education.