• Nutrition is the selection
of foods and preparation of foods, and their
ingestion to be assimilated by the body. By
practicing a healthy diet, many of the
known health issues can be avoided.
The diet of an organism is what it eats,
which is largely determined by the
perceived palatability of foods.

• 400 B.C. -- Hippocrates, the
"Father of Medicine", said to his
students, "Let thy food be thy
medicine and thy medicine be thy
food". He also said A wise man
should consider that health is the
greatest of human blessings. One
story describes the treatment of
eye disease, now known to be
due to a vitamin A deficiency, by
squeezing the juice of liver onto
the eye. Vitamin A is stored in
large amounts in the liver.

• 1747 Dr. James Lind, a physician in the British Navy,
performed the first scientific experiment in
nutrition. At that time, sailors were sent on long
voyages for years and they developed scurvy. In his
experiment, Lind gave some of the sailors sea water,
others vinegar, and the rest limes. Those given the
limes were saved from scurvy. As Vitamin C wasnt
discovered until the 1930s, Lind didnt know it was
the vital nutrient.
• Early 1800s It was discovered that foods are
composed primarily of four elements: carbon,
nitrogen, hydrogen and oxygen, and methods were
developed for determining the amounts of these
elements.

• 1930s William Rose discovered the essential
amino acids, the building blocks of protein.
• 1940s The water soluble B and C vitamins
were identified
• 1950s to the Present -- The roles of essential
nutrients as part of bodily processes have
been brought to light. For example, more
became known about the role of vitamins and
minerals as components of enzymes and
hormones that work within the body

• NUTRITION - The word Nutrition is the science of foods,
the study of nutrients and other substances therein, their
action, interaction and balance in relationship to disease.

• HEALTH – It is the state of complete
physical, mental and emotional well being
and not merely the absence of disease or
infirmity.
• NUTRIENTS – These are the
components of food that help to nourish the
body. The basic nutrients are CHO,
proteins, vitamins, lipids (fats), minerals and
water.
• NUTRITIONAL STATUS – It is the
condition of the body as it relates to
consumption and utilization of food.

• Malnutrition – defined as a pathological state
resulting from a relative or absolute deficiency or
excess of one or more essential nutrients
• Undernutrition - condition that results when
insufficient food is consumed over an extended
period of time
• Overnutrition – pathological state resulting from
the consumption of excessive quantity of food
over an extended time
• Imbalance – pathological state resulting from
disproportion among essential nutrients with or
without the absolute deficiency of any nutrient
• Specific deficiency – pathological state resulting
from a relative or absolute lack of specific

CLASSIFICATIONOF
FOOD
BASED ON
FUNCTIONS
ENERGY YIELDING
FOOD
CARBOHYDRATES
FATS
BODY BUILDING
FOOD
PROTEINS
PROTECTIVE FOOD
VITAMINS
MINERALS
BASED ON
NUTRIENTS
MACRONUTRIENTS
MICRONUTRIENTS

FATS,
OILS &
SWEETS
MILK & MEAT
PRODUCTS,
EGGS & NUTS
FRUITS &
VEGETABLE GROUP
BREAD, CEREALS AND RICE
GROUP

• Clinical Examination
• Anthropometry
• Biochemical evaluation
• Assessment of dietary intake
• Vital statistics – morbidity and mortality
• Ecological factors

NUTRITIONAL
PROBLEMS
PROTEIN
ENERGY
MALNUTRITION
(PEM)
MICRONUTRIENT
DEFICIENCY
CHRONIC
DISEASES
EATING
DISORDERS

NUTRITION PROBLEMS IN INDIA
WHO IS AT RISK??
 PREGNANT WOMEN
 LACTATING WOMEN
 INFANTS
 PRESCHOOL CHILDREN
 ADOLESCENT GIRLS
 ELDERLY
.
Vijayaraghavan

• Protein–energy
malnutrition (or protein–calorie
malnutrition) refers to a form
of malnutrition where there is
inadequate protein and calorie
intake
• It is considered as the primary
nutritional problem in India
• PEM is due to the “food gap”
between the intake and
requirement
• Causes childhood morbidity and
mortality

PEM KWASHIORKOR
MARASMUS
MARASMIC -
KWASHIORKOR

CAUSES AND RISK
FACTORS
Inadequate intake of
food
Diarrhea
Respiratory infections
Measles
Intestinal worms
Infants and pre
schoolers
CONTRIBUTORY
FACTORS
Poor envt. Hygiene
Large family size
Poor maternal health
Failure of lactation
Premature termination
of breast feeding
Delayed
supplementary
feeding
Use of over diluted
cow’s milk

Kwashiorkor is the most
common and
widespread nutritional
disorder in developing
countries. It is a form of
malnutrition caused by
not getting enough
protein in the diet.

• Marasmus is a severe form of
malnutrition that consists of the
chronic wasting away of fat,
muscle, and other tissues in the
body.
• Malnutrition occurs when the body
does not get enough protein and
calories.
• This lack of nutrition can range from
a shortage of certain vitamins to
complete starvation.
• Marasmus is one of the most
serious forms of protein-energy

A malnutrition disease,
primarily of children,
resulting from the
deficiency of both calories
and protein.
The condition is
characterized by severe
tissue wasting,
dehydration, loss of
subcutaneous fat,
lethargy, and growth
retardation

KWASHIORKOR
Acute
illness/infections,
measles, AGE,
trauma, sepsis are
some causes
Protein is principal
nutrient
18 months to 3 years
Rapid, acute onset
Some weight loss
High mortality
MARASMUS
Severe prolonged
starvation,
chronic/recurring
infections
Calories and protein are
principal nutrients
6 months to 2 years
Chronic, slow onset
Severe weight loss
Low mortality unless
related to underlying
disease condition

KWASHIORKOR
Edema, pot belly, swollen
legs
Mild to moderate growth
retardation
Weight masked by edema
Low subcutaneous fat
Muscle atrophy
Round face (moon face)
Dry, flaky peeling skin
Thin dry easily plucked
hair
Enlarged liver
Xerophthalmia
Anemia, diarrhea,
infection
MARASMUS
No edema
Weight loss upto 40%
Severe growth failure
Severe emaciation
Severe loss of subcut fat
Severe muscle atrophy
Wrinkled face (old man’s
face)
Rare skin changes
Common hair changes
Mildly enlarged liver
Anemia, diarrhea,
infection

Gomez Classification
• Weight for age (%) = Weight of child
100
Wt. of normal child of same age
Between 90 – 110% Normal Nutritional Status
Between 75 – 89% Mild malnutrition (1st degree)
Between 60 – 74% Moderate Malnutrition (2nd
degree)
Under 60% Severe Malnutrition (3rd degree)

• Infant – Weight (Kg) = Age in months + 9
2
• Pre schooler – Weight (Kg) = 2 x (Age in years) +
5

• Oral rehydration therapy helps to prevent
dehydration caused by diarrhea
• Exclusive breast feeding for 6 months there after
supplementary foods may be introduced along
with breast feeds
• Immunization for infants and children
• Nutritional supplements
• Early diagnosis and treatment
• Promotion and correction of feeding practices
• Family planning and spacing of birth
• Periodic surveillance
• Nutritional rehabilitation

An LBW
newborn is any newborn
with a birth weight of less
than 2.5kg (including
2.499kg) regardless of
gestational age.

RISK FACTORS
o Maternal malnutrition
o Anemia
CAUSES
o Illness/infections
o Short maternal stature
o Very young age
o High parity
o Close birth intervals
o IUGR
o Hard physical labor
during pregnancy
o Smoking

LOW BIRTH
WEIGHT
PRE TERM
BABIES
SGA BABIES
SPONTANEOUS
PRE TERM
BIRTH
PROVIDER
INITIATED PRE
TERM BIRTH

• Identification of mothers at risk – malnutrition, heavy work
load, infections, disease and high BP
• Increasing food intake of mother, supplementary feeding,
distribution of iron and folic acid tablets
• Avoidance if smoking
• Improved sanitation methods
• Improving health and nutrition of young girls
• Early detection and treatment of medical disorders – DM
HTN
• Controlling infections – UTI, rubella, syphillis, malaria

MICRONUTRIENTS
VITAMINS
VITAMIN A
VITAMIN B
COMPLEXES
VITAMIN C
VITAMIN D
VITAMIN K
MINERALS
MAJOR
MINERALS
CALCIUM
PHOSPHORUS
SODIUM
POTASSIUM
MAGNESIUM
TRACE
ELEMENTS
IRON
IODINE
FLUORINE
ZINC

Overweight and obesity are defined as abnormal or
excessive fat accumulation that presents a risk to health. A
crude population measure of obesity is the body mass
index (BMI), a person’s weight (in kilograms) divided by the
square of his or her height (in meters). A person with a BMI
of 30 or more is generally considered obese. A person with
a BMI equal to or more than 25 is considered overweight.

Xerophthalmia i.e., dry
eyes refers to all the
ocular manifestations of
vitamin A deficiency in
man
It is the most widespread
and serious nutritional
disorder leading to
blindness

RISK FACTORS
Poor SE status
Faulty feeding
practices
Weaning
PEM
Infections
1-3 years
CLINICAL FEATURES
Corneal ulcers
Softening of cornea
Keratomalacia
Bitot spot

PREVENTION AND CONTROL
Administering large doses of vitamin A
orally on a periodic basis
Regular and adequate intake of vitamin A
Fortification of certain food with vitamin A –
sugar, salt, tea and skimmed milk

Nutritional anemia is a condition where the
hemoglobin 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.

RISK FACTORS
 Infants and children
 Pregnant women
 Pre menopausal
women
 Adolescent girls
 Older adults
 Alcoholism
 Chronic/ critically ill
 Excessive exercise
CAUSES
 Inadequate diet
 Insufficient intake of
iron
 Iron malabsorption
 Pregnancy
 Excessive menstrual
bleeding
 Hook worm infestation
 Malaria
 Close birth intervals
 GI bleed

• Increases risk of maternal and fetal
morbidity and mortality
• Abortions, premature births, PPH, low birth
weight are associated with anemia during
pregnancy
PREGNANC
Y

• Anemia can be aggravated by
parasitic infections like malaria,
intestinal parasites
• Iron deficiency may repair cellular
response and immune functions
• More severe the anemia, greater the
reduction in work performance
INFECTION
WORK
CAPACIT
Y

Estimation of Hb to assess degree of
anemia
Blood transfusion in severe cases of
anemia (<8g/dL)
Iron and folic acid supplements
Food fortification with iron
Changing dietary habits
Control of parasites
Nutritional education and awareness

IDD leads to a
much wider
spectrum of
disorders
commencing with the
intrauterine life and
extending through
childhood to adult life
with serious health
and social

DISORDERS
Goiter
Hypothyroidism
Subnormal intelligence
Delayed motor milestones
Mental deficiency
Hearing defects
Speech defects
Mental retardation
Neuromuscular weakness
Endemic cretinism
Intrauterine death

PREVENTION
• Iodized salt
• Iodine monitoring
• Public awareness and
education
COMPLICATIONS
• Thyrotoxicosis
• Iodide goiter
• Iodinism
• Lymphocytic thyroiditis

In many parts of the world where
drinking water contains excessive amounts of
fluorine (3-5mg/L), endemic fluorosis has been
observed.

• It occurs when excess fluoride is ingested during
the years of tooth calcification – first 7 years of
life
• Characterized by molting of dental enamel which
has been reported above 1.5mg/L intake
• Fluorosis seen on the incisors of upper jaw

• Associated with life time
daily intake of 3-6mg/L or
more
• Heavy deposition of
fluoride in skeleton
• Crippling occurs leading to
disability

• Changing the water sources
• Chemical defluorination
• Preventing use of fluoridated toothpaste
• Fluoride supplements not prescribed for
children consuming fluoridated water

• It is a paralyzing disease of human
and animals
• Also referred to as Neurolathyrism as
it affects the nervous system
• Lathyrus Sativus is commonly known
as ‘khesari dhal’, a good source of
protein but its toxins affects the nerves
• The toxin present in lathyrus seed has
been identified as BETA OXALYL
AMINO ALANINE (BOAA) which has
blood brain barrier

• Latent stage
• No stick stage
• One stick stage
• Two stick stage
• Crawler stage

• Vitamin C prophylaxis
• Banning the crop
• Removal of toxin
• Education and awareness
• Genetic approach – producing low toxin
variety of crop
• Socio economic changes

• Vitamin A Prophylaxis Program
• Prophylaxis against Nutritional Anemia
• IDD Control Program
• Specific Nutrition Program
• Balwadi Nutrition Program
• Integrated Child Development Scheme
• Mid – day Meal Program
• Mid – day Meal Scheme

Obesity is an epidemic diseases, which consists of body
weight that is in excess of that appropriate for a person’s
height and age standardized to account for differences,
leading to an increased risk to health related problems

Overweight and obesity
are defined as abnormal or
excessive fat accumulation
that presents a risk to
health. A crude population
measure of obesity is the
body mass index (BMI), a
person’s weight (in
kilograms) divided by the
square of his or her height
(in metres). A person with
a BMI of 30 or more is
generally considered
obese. A person with a
BMI equal to or more than

• Anorexia nervosa is
an eating
disorder characterized by
immoderate food restriction,
inappropriate eating habits or
rituals, obsession with having
a thin figure, and an irrational
fear of weight gain, as well as
a distorted body self-
perception.

• Bulimia nervosa is an eating
disorder characterized by binge
eating and purging, or consuming a
large amount of food in a short
amount of time followed by an
attempt to rid oneself of the food
consumed (purging), typically
by vomiting, taking
a laxative, diuretic, or stimulant,
and/or excessive exercise, because
of an extensive concern for body
weight.

• Amenorrhea
• Obvious, rapid, dramatic weight loss at
least 15% under normal body weight[
• May engage in frequent, strenuous, or
compulsive exercise
• Perception of self as overweight despite
being told by others they are too thin
• Intolerance to cold and frequent complaints
of being cold. Body temperature may lower
in an effort to conserve energy
• Hypotension and/or orthostatic hypotension

• Bradycardia or tachycardia
• Depression: may frequently be in a sad, lethargic
state
• Solitude: may avoid friends and family; becomes
withdrawn and secretive
• Swollen joints
• Abdominal distension
• Halitosis (from vomiting or starvation-
induced ketosis)
• Dry hair and skin, as well as hair thinning
• Fatigue
• Rapid mood swings

Good nutritional habits and a balanced diet aren't
developed in one day, nor are they destroyed in
one unbalanced meal. Healthful eating means a
lifestyle of making choices and decisions,
planning, and knowing how to make quick and
wise choices when you haven't planned.

• Metformin is a drug commonly used to treat
type 2 diabetes. But new research published
in the Proceedings of the National Academy
of Sciences (PNAS) finds the medication may
also slow the aging process and increase
lifespan.

• Overweight and obesity among children –
TNNMC journal of CHN
• Nutritional status of pre school children
attending balwadi – Indian Journal of
nutrition and dietetics

• Dudek Susan G – Nutrition essentials for nursing practice
• K Park – Textbook of preventive and social medicine
• John Sheila – Essentials of nutrition and dietetics for
nursing
• Fraser Diane, Cooper Margaret A – Myles textbook for
midwives
• Swaminathan K – Nutrition and dietetics