Textbook of Human Nutrition Anjana Agarwal, Shobha A Udipi
Page numbers followed by f refer to figure and t refer to table
Abdominal obesity 460
Abelmoschus esculentus 591
Absorption 85, 131
of calcium from food 237
of carotenoids and retinol 179
Acesulfame-K 52
Achras sapota 595
base balance 60, 250, 253, 314
systems in blood 319
production 253
rain 247
Actinidia sinensis 594
Activation of vitamin B12 278
Addison disease 249
Adenosine triphosphate 137, 138f
Adrenal hormones 208, 209
Advantages of mother's milk 390
Aegle marmelos 597
capacity 540
exercises 536
Air displacement plethysmography 165
Alanine 81
Albumin 62
Aldosterone 308
Alkaline phosphatase 267
cepa 586, 589
sativum 586
Alpha linolenic acid 109, 113
cruentus 587
dubius 576, 589
American Association of Cereal Chemists 44
American Dietetic Association 359
acid 56, 66t, 80, 639
metabolism 201, 220, 226
requirements 83t
score 75, 76
peptidases 85
Ammonia buffer 319
Amorphophallus campanulatus 585
Amylase rich food 394, 398
Anacardium occidentale 602
Anemia 72
Angiotensin-I converting enzyme 253
Animal and vegetable proteins 71
Annapoorna scheme 515
Annona cherimola 596
Anorexia nervosa 159
Anthocyanidins 529
Antibodies 58
Antidiuretic hormone 308
Anti-natriuretic peptide 296
Antioxidant 208
defense 274
function 271
Antithrombotic property 79
Antyodya Anna Yojna 515
Apium graveolus 589
Arachidonic acid 107, 109, 110, 112
Arachis hypogea 604
Arginine 82, 84
Asparagine 83
Asparagus officinalis 592
Aspartame 52
Aspartic acid 82, 84
Assessment of
body weight 170
nutritional status 434
Astaxanthin 527
ATP production 540
Autoimmune diseases 126
Avena sativa 574
Bacillus thuringiensis 504, 507
Balancing and stretching exercises 537
Basal metabolic rate 142, 147, 148t
Basic structure of amino acid 56f
Benincasa hispida 591, 592
Beta vulgaris 585, 589
Bicarbonate buffer 317
Binding proteins 59
Binge eating 160
Bioelectrical impedance analysis 165
Biotin 225
Bitot's spot 437
cell synthesis 217
clotting 236
coagulation 274
lipids profile 98t
mass 558
Blurred vision 300
composition 160, 419
fat 162
fluids 558
mass index 17, 165, 166f, 467
temperature 143
weight 167
bank 235
formation 197
mineralization 241
Boron 283
development 412
functions 255
campestris 588
oleracea 588, 589
italica 590
var botrytis 590
rapa 589
glabra 586
Breastfeeding 381, 382
Broca's index 170
Buchanania latifolia 604
Buffer system 242, 317
Bulimia nervosa 160
Butylated hydroanisoquinone 106
Butyric acid 107
Cadmium 285
Calcium 234, 312, 404, 483, 493, 501
supplements 240
Calculation of index of nutritional quality 350
Capillary blood pressure 296
Capsicum annuum 592
Carbohydrate 5, 25, 384, 553
based fat mimetics 128
content of food 40t
counting 478
group 360
loading 544
regime 38
metabolism 216, 226, 251, 278
acid 316
anhydrases 267
exercises 537
function 250
Cardiovascular diseases 109
Carica papaya 596
Carnitine 230
Carotenes 527
Carotenoids 178, 526
Carya illinoensis 603
Causes of
dehydration 298
hypertension 479
iodine deficiency disorders 442
vitamin A deficiency 436
division 267
membrane permeability 237
signaling 60
Cellular functions 26
Cellulose 36
based fat replacers 129
Cephalin 95
Cereal 568
and cereal products 668
Chain length 102
energy 136
influences 662
score 76
Chenopodium album 587
Childhood obesity 466, 468
Chloride 253, 312
Chlorine 252, 253
Cholecalciferol 187
Cholecystokinin 130, 158
Cholesterol 98, 99
content of foods 100t
Chromium 279
Chromoproteins 63
diseases 468
energy deficiency 17, 124
renal failure 482
Chylomicrons 96
Chymotrypsinogen 85
Cicer arietinum 589
Circulatory system 421
Circumference measurements 166
Citrulline 83
Citrullus vulgaris 595
aurantifolia 599
aurantium 599
fruits 599
lemon 599
reticulata 599, 600
sinensis 599
X paradisi 599
Classes of lipids 92t
Classification of
amino acids 65, 65f
anemia 448, 456
carbohydrates 26
fatty acids 106, 106f
flavonoids 530f
high blood pressure 480t
infants based on birth weight 400
lipids 91, 93f
minerals 233, 234f
nutrients 5
nutritional status 434t
protein 61
vitamins 177, 177f
xerophthalmia 437t
Clostridium botulinum 395, 656
Coagulation of blood 60
Cobalt 284
Cocos nucifera 604
Codex alimentarius commission 44
Collagen synthesis 200
Colocasia esculenta 585, 589
Colostrum 383
feeding 392, 393
protein 67
Complications of diabetes 475
Component of
bile acids 99
biological compounds 241
body fluids 290
brain lipids 100
cell membrane phospholipids 241
lipoproteins in blood 91
Composition of
body fluids 290
food 50
Compound lipids 94
Computed tomography 165
source of energy 91
vitamin A solution 441
Concentration of
electrolytes in blood particularly sodium 296
protein 296
Configuration of double bond 102, 104
Confusion 300
Congenital anomalies 444
linoleic acid 117
proteins 61, 63
Conjunctival xerosis 437
Connective tissue formation 274
Consequences of
anemia 455
childhood obesity 467
excess intake of
boron 284
carnitine 230
molybdenum 282
selenium 272
excess sodium intake 249
excessive consumption of fats and oils 126
excessive intake of
biotin 227
calcium 240
carbohydrates 43
choline 228
chromium 281
fluoride 277
folate 222
iodine 265
iron 262
magnesium 245
manganese 279
niacin 214
pantothenic acid 216
potassium 252
protein 72
riboflavin 210
thiamine 207
vitamin B6 219
vitamin B12 225
vitamin C 202
vitamin E 195
zinc 270
excessive of copper 276
high blood pressure 480
inadequate intake of carbohydrate 41
insufficient intake of fats and oils 124
iodine deficiency disorders 443
undernutrition 18
A deficiency 436
D deficiency 191
Controlled atmosphere 668
Copper 273, 449
dependent enzymes 274
Coriandrum sativum 588
scarring 437
xerosis 437
Coronary heart disease 126
Cryptoxanthin 185
Cucumis sativus 590
Cucurbita moschata 591, 603
Curcumin 530
Cushing syndrome 249
Cyamopsis tetragonoloba 590
Cyanogenic glycosides 580
Cyclamates 52
Cysteine 8284
Daucus carota 585
Deep frying 651
Deficiency and excess of inositol 229
Deficiency of
arsenic 283
boron 284
calcium 239
chloride 253
chromium 280
copper 275
essential fatty acids 116
iron 260
magnesium 245
manganese 279
molybdenum 281
niacin 213
phosphorus 242
protein 71
riboflavin 209
selenium 272
sodium 249
sulfur 246
thiamine 205
A 185
B6 218
D 190
E 195
K 198
zinc 269
Degradation of proteins 73
Degree of saturation 102, 103
Dehydration 298
Dental caries 468
Deoxyribonucleic acid 203
Derived proteins 61, 63
Dermatitis 213
body weight 170
ratio of potassium 251
Detoxification 201
Development of mammary glands 373
Dextrin 35
Diabetes 470, 482
Diagnosis of vitamin A deficiency 437
Diet and acid-base balance 322
fiber 43, 525
guidelines for
adolescent 414
adults 418
elders 422
Indians 337
lactating mother 387
pregnant mother 381
inadequacy 428
management of diabetes 476
modification 481
intakes 333
value 332
supplement health and education 533
Digestibility of dietary proteins 69
Digestion 266
and absorption of
carbohydrates 53, 53f
fat 129
LCFA 132f
of proteins 85
Digestive system 420
Dipeptide 57
Disaccharides 26, 30, 53
Distribution of body fluids 291f
DNA transcription 280
Docosahexaenoic acid 109, 112, 114, 216
Drug nutrient interactions 254
beriberi 206
heat methods 645
Dual fortification 502
disorders 159
habits 463
patterns 463
Edema 71
shell 610
yolk 610
Eicosanoids 116
Eicosapentaenoic acid 109, 114, 216
Electrolytes 309, 319, 323
balance 250, 253, 307
in body fluids 302
of extracellular fluids 305
of intracellular fluids 306
Electron transport chain 139
Embryonic period 369
Endomorph 169
Energy 69, 376, 389, 402, 407, 412, 417, 493, 553
balance 141
consuming activities of cells 138
expenditure 141, 541
generating pathways 139
intake 153
metabolism 136, 241, 243, 255, 263, 274
Enhances calcium absorption 188
browning 632, 633
theory 168
Enzymes 58
Epinephrine 474
Ergogenic aids 552
Eriobotrya japonica 600
Erucic acid 109
Erythritol 31, 33
amino acids 65, 80
fat 162
fatty acids 111, 112
consumption of phosphorus 243
intake of
chloride and toxicity 254
vitamin A and toxicity 186
Excretory system 421
buffers 317
fluid 234, 290, 303, 305, 430
Faba vulgaris 590
affecting glycemic index 50
food choices 8f
malnutrition 19t
Fagopyrum esculentum 575
FAO classification of lipids 92f
Fat 375, 386, 389, 403, 407, 413, 418, 639
cell theory 167
exchanges 358
group 361
mimetics 128
replacers 127
soluble vitamins 177, 178
substitutes 128
acid 102, 375
metabolism 256
acyls 92
liver 72
nutrition 373
period 369
Fibrin 62
Ficus carica 597
Five food group plan 338
Flavanols 528, 529
Flavoprotein 63
Flexibility exercise 537
Fluoridation of water 277
Fluoride 501
Fluorine 276
Folic acid 219, 375, 449
and Agriculture Organization 1
choices 7
composition 50
economics 14
Exchange Lists of Indian Dietetic Association 354
guide pyramid 334
irradiation 511, 649
security 488, 518
sources of
biotin 226
boron 284
calcium 239
carbohydrates 39
chloride 253
choline 228
chromium 280
copper 275
dietary fiber 48
fat 122
fluoride 277
folate 220
inositol 229
iodine 264
iron 258, 259
magnesium 244, 245
manganese 279
molybdenum 281
niacin 212, 213t
pantothenic acid 215
phosphorus 242
potassium 251
protein 70, 70t
riboflavin 209, 210
selenium 272
sodium 248
sulfur 246
thiamine 204, 205
total folic acid 221
vitamin B6 217
vitamin A 184
vitamin B 223
vitamin C 201
vitamin E 195
vitamin K 198
zinc 268, 269
Forced expiratory volume 407
Formation of
acetylcholine 227
adipose tissue 26
blood clot 197
bones 189
eicosanoids 117f
hemoglobin and antibodies 215
important biological compounds 211
mature red blood cells 219
neurotransmitters 217
niacin 217
red blood cells 208
skeletal structure 234
thyroid hormones 271
Fortification 457, 496
folic acid 493
foods 361
Fructo-oligosaccharides 29, 33
Fructose 29
Full fat soy flour 582
Functions of
amino acids 84
arsenic 282
biotin 226
boron 283
calcium 234
carbohydrates 26
chloride 252
choline 227
chromium 280
cobalt 285
copper 274
dietary fiber 44
fluorine 276
folic acid 219
food 3, 4f
irradiation 512
inositol 229
iodine 263
iron 255
lipids 90
magnesium 243
manganese 278
molybdenum 281
niacin 211
nutrients 5
omega-3 fatty acids 113
pantothenic acid 214
phosphorus 241
placenta 370
potassium 250
protein 57
riboflavin 208
selenium 271
sodium 248
sulfur 246
thiamine 203
A 181
B 223
B6 216
C 200
D 188
E 194
K 196
zinc 266
Galactopoiesis 382
Galactose 29
aminobutyric acid 203
linoleic acid 110, 111
Gastrin 78
malabsorption 482
system 213
tract 53, 429, 451
Gene expression 189, 267, 563
Genetically modified foods 506
diabetes mellitus 381
weight gain 371
Globular protein or spheroprotein 62
Glucagon 78, 474
Glucocorticoids 474
amino acids 65
and ketogenic amino acids 65
Glucose 28
Glutamic acid 82
Glutamine 82, 84
Glutathione 78
index 49
load 51
Glycerolipids 92
Glycerophospholipids 92
Glycine 81, 84
Glycogen 38
stores 540
Glycolipids 95
Glycolysis 139
Glycoproteins 63
Goiter 444, 445t
Goitrogens 580
Grain structure 568
Grewia asiatica 601
Growth 267, 280, 366
and development 3, 263
and maintenance 223
hormone 474
promotion and monitoring 516
retardation 72, 437
Guizotia abyssinica 604
Hamper proper growth and development 468
Hamwi's equation 170
Headaches 300
Helianthus annuus 604
Helicobacter pylori 223
infection 260
Heme iron 257
Hemicelluloses 36
Hemoglobin 57
density lipoprotein 59, 91, 98
fructose corn syrup 29
glycemic foods 49
risk of adulthood obesity 468
Histidine 66, 81, 83, 84
Homeostasis 295
Homocysteine 225
Hordeum vulgare 574
influences 144
regulation of food intake 156
Hormones 58
genome 562
milk bank 387
Hydrochloric acid 316
Hydrogenated starch hydrolyzate 33
Hydrolytic rancidity 636
Hydrostatic weighing 165
Hypercalcemia 240
Hyperkalemia 311
Hypernatremia 249, 310
Hyperphosphatemia 313
Hyperplasia 367
Hypertension 479
Hyperthyroidism 482
Hypertonic solution 305
Hypertrophy 367
Hypoglycemia 477
Hypokalemia 311
Hyponatremia 310
Hypophosphatemia 313
Hypotonic solution 305
function 261, 271
system 420, 437
Impact of malnutrition 20f
fasting glucose 472
glucose tolerance 472
absorption of fat-soluble vitamins 91
large bowel function 44
Index of nutritional quality 350
Indian Dietetic Association 353
Indicators of
anemia 453
childhood obesity 467
Infantile beriberi 206
Inositol 229
Integrated child development services 435, 515
Inter conversions of amino acids 73
Interstitial fluid 291, 306, 307
Intracellular fluid 59, 290, 301, 309, 311
Intrauterine growth retardation 379
Iodination of tyrosine 263
Iodine 262, 500
deficiency 233
disease 441
disorder 233, 441, 445t, 446
Ion transport 244
Ipomoea batatas 584
Iron 254, 404, 493
absorption 200, 258f
balance 256
deficiency 449
anemia 449, 450, 452, 453
erythropoiesis 453
folate supplements 516
Isoflavones 484, 529
Isokinetic exercises 536
Isoleucine 66, 81, 83, 84
Isomalt 31, 32
Isometric exercises 536
exercises 536
solution 305
Juglans regia 603
Kangaroo care 401
Keratin 57, 62
Ketogenic amino acids 65
Kidney 320, 429
Kinetic energy 136
Kishori Shakti Yojana 517
Koilonychia 453
Kwashiorkor 432434
Lactation 143, 381
Lactic acid 316
Lactitol 31, 32
Lactobacillus helveticus 609
Lactose 30
intolerant 30
Lactuca sativa 588
Lagenaria siceraria 591
Lathyrogens 580
Lauric acid 105, 107
Lean body mass 161
Lecithin 95
Lepidium sativum 604
Leptin 157
Leucine 66, 80, 83, 84
Limiting amino acids 65, 66
Linoleic acid 109, 110, 111
Linum usitatissimum 604
Lipid 6, 89
content of lipoproteins 96f
metabolism 216, 226, 280
peroxidation 106, 637
Lipoic acid 231
Lipoproteins 59, 63, 96
List of free foods 362t
Long chain fatty acids 103, 108
body stores of iron 452
lipoprotein 59, 91, 126
polyethylene 668
glycemic foods 49
serum retinol 438
cholesterol in blood 45
reference nutrient intake 332
Luffa acutangula 591
Lungs 294, 319
Lycopene 185, 528
Lycopersicon esculentum 591
Lysine 66, 80, 83, 84
Macrocytic anemia 225, 448, 449
Macronutrients 5
Magnesium 243, 313, 484
Magnetic resonance
imaging 165
tomography 165
Mahatma Gandhi National Rural Employment Guarantee Program 517
causes of diabetes 474
sources of hydrogen ions 315
acid-base balance 248
water and electrolyte balance 248
Maintenance of
blood volume and blood pressure 248
life 3
membrane potential 250
pH 60
Malaria eradication 458
Maltase 53
Maltodextrins 129
Malto-oligosaccharides 33, 34
Malus sylvestris 593
Mangifera indica 597
Mannose binding
lectins 29
protein 29
Marasmic kwashiorkor 433, 434
Marasmus 433, 433t, 434
fatty acids 103, 108
triglycerides 265
fat soy flour 582
glycemic foods 49
of heat transfer 90
Megaloblastic anemia 225, 448
Menkes' syndrome 275
Mentha arvensis 588
acidosis 320, 321
alkalosis 320, 321
equivalent of task 147, 150, 151
stress 541
water 293
Metabolism of nutrients 267
Methionine 66, 80, 83, 84
Methods of fortification 498
Methylsulfonylmethane 247
anemia 448
hypochromic anemia 218, 448
Microencapsulation 561
Micronutrient 6, 69, 378, 407
malnutrition 426
Mid-upper-arm circumference 434, 435
Milk and milk products 605, 668
Milk exchanges 356
Minerals 6, 233, 378, 384, 386, 390, 413, 418
Mixed water and electrolyte depletion 298
Moist heat methods 643
Moisture content of commonly consumed foods 293
Molecular structure 61
Molybdenum 281
Momordica charantia 591
Monosaccharides 26, 27
Monounsaturated fatty acid 109
Moringa oleifera 588
Mucopolysaccharides 38
Mucoproteins 63
Murraya koenigii 588
Musa paradisiaca 590, 595
activity 250
and bone 558
contraction and relaxation 236
endurance 261
relaxation and muscle contraction 244
wasting 72
Musculoskeletal structure 59
Myristic acid 107
Nanosensors 561
Food Security
Bill 518
Mission 518
Horticulture Mission 518
Institute of Nutrition 353
Iodine Deficiency Disorders Control Program 446
Nutrition Monitoring Bureau 492
Nutritional Anemia Prophylaxis Program 459
Rural Health Mission 518
Sample Survey Organization 492
Urban Health Mission 518
calcium balance 482
energy balance 141
nitrogen balance 74
Nephelium litchi 600
fibers 91
transmission 215, 237
Nervous system 223, 421
dietary protein energy ratio 75, 76
protein utilization 75, 76
Niacin 211, 493
Nicotinamide adenine dinucleotide phosphate 211
Night blindness 437, 438
balance 74
metabolism 278
Nomenclature of fatty acids 104
Non-carotenoid terpenoids 528
Non-enzymatic browning 632, 633
Non-essential amino acids 65, 81
Non-glyceride components 100, 102
Non-Governmental Organizations 439
Non-heme iron 257
Non-proteinogenic amino acids 66, 83
Non-starch polysaccharides 27, 34, 36
Normal muscle irritability 248
Normocytic normochromic anemia 448
energy 136
receptors 189
Nucleoproteins 63
Nutrient 4
density 349
requirements of adults 417
Nutrigenomics 562
Nutrition 3
and food habits 22
and health education 440
education 458
anemia 448
composition of complementary foods 394
deficiencies 423
requirements during
adolescents 412
pregnancy 374
preschool age 402
requirements of
lactating mother 385
normal healthy infants 388
school age child 407
Nutritious food 3
Obesity 47
in children and adolescents 466
Oleic acid 109
Oligopeptide 57
Oligosaccharides 26, 28, 33
Ornithine 84
Oryza sativa 571
Osmolality 296
Osmolarity 296
Osmolytes 303
Osmoreceptors 296
Osmosis 303
Osteoblasts 235
Osteoclasts 235
Osteocytes 235
Osteomalacia 192
Osteoporosis 192, 482, 483, 485
Overnutrition 18
Oxidation of iodide 263
phosphorylation 140
rancidity 636
stress 541, 542
Oxygen transport 255
Oxytocin 78
Palmitic acid 105, 107
Palmitoleic acid 109
Pancreas 429
Pantothenic acid 214, 215
Para-aminobenzoic acid 230
Parathyroid hormone 234
Peak bone mass 235
Pepsinogen 85
Peptides 78
and amino acids 525
Periconceptional period 369
Pernicious anemia 225, 448
Peucedanum graveolens 588
Phaseolus vulgaris 590
Phenolic acids 529, 529t
Phenylalanine 66, 80, 83, 84
hydroxylase 255
Phenylketonuria 80
Phoenix dactylifera 602
Phosphate buffer 318
Phosphatidylcholine 227
Phospholipids 94
Phosphoproteins 63, 242
Phosphoric acid 316
Phosphorus 241, 313, 483
Phosphorylation 242
Photosynthesis 25
Physalis peruviana 598
Phytochemicals 7, 525
Pillars of food security 489
Pinus gerardiana 604
Pistacia vera 603
Pisum sativum var arvense 590
falciparum 260, 458
vivax 458
Polycystic ovarian syndrome 234
Polydextrose 46, 52, 129
Polyethylene terephthalate 665
Polyketides 92
Polyolefins 665
Polypeptide 57
Polyphenol 528
oxidase 633
Polyphenolic amides 529, 530
Polysaccharide 26, 28, 34
in animals 38
in plants 35
Polyunsaturated fatty acids 91, 109, 110, 110t, 525
Polyvinylidene chloride 665
Position of double bond in chain length 102, 104
energy balance 141
nitrogen balance 74
Potassium 250, 311
renal acid load 322
uses of nanotechnology 560
Pre-menstrual syndrome 111
Prenol lipids 92
Prevalence of
anemia 456
undernutrition 17
vitamin A deficiency 438
Prevention of
dehydration 299
thiamine deficiency 206
vitamin A deficiency 440
Prevents fatty liver 228
derived proteins 64
hemochromatosis 262
Production of energy 3
Prolamines 62
Proline 82, 84
Promoters of childhood and adolescent obesity 466
Promotes immune function 201
Prostate cancer 113
Protection of body 3
Protein 5, 57, 58, 375, 377, 383, 386, 389, 403, 407, 413, 417, 484, 554, 639
and amino acids 56
based fat mimetics 128
digestibility 74, 75
amino acid score 77
corrected amino acid score 75
efficiency ratio 75, 76
energy malnutrition 427, 428, 429t, 435
homeostasis 73
in food 67
metabolism 216
modification 256
sparing action 26
synthesis 251
turnover 74
armeniaca 600
avium 600
domestica 600
dulcis 602
persica 594, 600
Psidium guajava 596
Psychological stress 541, 543
Puberty 411
Public distribution system 328, 515
Punica granatum 596
Pure water depletion 298
Pyridoxine 216
Quaternary structure 65
Rajiv Gandhi
Drinking Water Mission 518
Scheme for Empowerment of Adolescent Girls 517
Raphanus sativus 585, 588
Rashtriya Krishi Vikas Yojana 518
Recommended dietary allowance for
adolescents 413t
adults 417t
biotin 226
calcium 238
carbohydrates 39
chloride 253
chromium 280
copper 275
dietary fiber 48
fats and oils 119
fluoride 277
folate 220, 221
infants 389t
iodine 263
iron 258, 259
lactating women 386t
magnesium 244
manganese 279
niacin 212, 212t
pantothenic acid 215
phosphorus 242
potassium 251
pregnant woman 375t
preschool children 403t
protein 68
riboflavin 209, 209t
selenium 271
sodium 248
sulfur 246
thiamine 204
B12 223
B6 217
C 201
D 190
E 195
K 197
zinc 268
Red blood cell 372, 448
formation 223
phytic acid 657
storage substances 656
Regulation of
blood pH 267
body fluid balance 59
iron in body 256
water balance 295
carbohydrates 27
starch 46
acidosis 320
alkalosis 320
and acidosis 321
Retinal dehydrogenase 255
Retinaldehyde 178
Retinoic acid 178
Retinol binding protein 59, 429
Ribes nigrum 601
Riboflavin 207, 449, 493
Ribonucleic acid 203
Rich sources of vitamin C 202
Rickets 192
Ripeness of fruit 50
Role of
calcium in muscle contraction 236f
carbohydrate in sports 544
fat in sports 548
food exchanges in meal planning 354
functional foods 524
interstitial fluid in electrolyte balance 306
kidneys in fluid balance 297
lipoproteins 97t
liver 86
micronutrients in sports 548
nutrients 375
protein in sports 546
vitamin D in calcium absorption 188f
water and electrolytes in sports 549
Rubus idaeus 598
Saccharin 52
Saccharolipids 92
Salt replacers 249
Sampurna Gramin Rozgar Yojna 517
Saturated fatty acids 105, 107, 107t
School Mid-day Meal Program 517
Selenium 270, 501
Serum ferritin 454
Sesamum indicum 603
Set point theory 168
Severe acute malnutrition 435
Shock absorber 91
Short chain fatty acids 103, 108, 532
lipids 92
proteins 61
Single nucleotide polymorphism 563
Small intestine 54, 130
Sodium 247, 309
imbalance 309
melongena 591
tuberosum 584
Solid foods 293
Sorbitol 31
Sound energy 136
Source of
carbon 26
eicosanoids 91
essential fatty acids 91
vitamin D 190
Soy protein isolate 582
Sphingolipids 95
Spinacia oleracea 588
Stabilizing glucocorticoid receptor 281
Stages of anemia 261, 453
Standardization of serving sizes and recipe 362
Stearic acid 105, 107
Sterilization 659
Sterol lipids 92
Stevioside 52
Storage fat 163
Strength building exercises 536
Stress 144
Structural component of cell membrane 99
Structure of
glycerophospholipid, sphingolipid and glycosphingolipid 95f
sterols 99f
adiposity 460
fat 163
Sucralose 52
Sucrose 30
Sugar alcohols or polyols 31
spring 247
toxicity 247
Sulfuric acid 316
Superoxide dismutase 106
Supports energy generation 211
Swarna Jayanti Gram Swarozgar Yojna 517
Synthesis of
carnitine 201
dispensable amino acids 73
fat and cholesterol 215
hormones 100
more polyphenols 658
neurotransmitters 201
proteins 73
taurine from cysteine 281
C 657
Syzygium cumini 601
Targeted public distribution system 515
Teen pregnancy 380
Texturized soy protein 582
Theory of thermogenesis 168
Thermal insulation of body 91
Thiamine 203
Threonine 66, 83, 84
Thyroid hormones 256
Thyrotropin-releasing hormone 78
Thyroxine binding globulin 442
Timing of ingestion of nutrients 540
antioxidant capacity 644
body water 167, 290
dietary fiber 48f
energy expenditure 141, 146, 147, 152
essential amino acid 83
sanitation campaign 518
Toxicity of vitamin K 198
Trans fatty acid 119
Transcellular fluid 291
Transformation of amino acids 73
Transmembrane proteins 64
Transmission of nerve impulses 60
Transport proteins 59
Treatment of
anemia 456
vitamin A deficient
cases 439t
children 441
Triglycerides 93, 98
Trigonella foenum-graecum 588
Triticum aestivum 569
Trypsin inhibitor 580
Tryptophan 66, 80, 83, 84, 255
Types of
food packaging 667
gums 37t
nutrients 5f
physical activities and exercises 536
space food 557
Tyrosine 82, 84
3-monoxygenase 255
Undernutrition 15
Underwater weighing 165
United Nations Children's Fund 435
Unsaturated fatty acids 109, 109t
Urinary tract infection 437
Uses of
anthropometry 165
composition tables 339
groups 338
infant formulas 399
LIC tables 171
nutrient density 350
standardization 363
corymbosum 598
macrocarpon 598
Vacuum packaging 667
Vascular endothelial growth factors 78
Vegetable sources 122
long chain fatty acids 103, 109
low density lipoprotein 97
Virus proteins 64
Visceral fat 163
Vitamin 6, 378, 384, 386, 390, 413, 418
A 178, 375, 432, 449, 493, 499
deficiency 426, 438, 440
supplementation 439
and minerals 525, 554
B1 639
B12 222, 449
B2 639
B3 211, 639
B6 216, 375, 639
C 199, 432, 449, 493, 639
D 187, 499, 501
E 193, 432, 449
K 196, 484
deficiency bleeding 198
Vitis vinifera 601
Vomiting 299
circumference 166, 462
to hip ratio 166
Warm-up and cool-down exercises 537
and electrolyte balance 540
balance 292
imbalance 298
intoxication 300
compounds 500
vitamins 177, 199
Welling of brain 300
encephalopathy 206
syndrome 206
Wet beriberi 206
Wilson's disease 276
World Health Organization 15, 435
Xerophthalmic fundus 437
Xylitol 31, 32
Zinc 266, 432
fingers 268
Ziziphus jujuba 601
Chapter Notes

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Food, Nutrition and Health1

Food is a necessity of life and its use is a skill and science
Since the dawn of civilization, man has harnessed natural resources for survival. Over the centuries, man evolved from being a hunter-gatherer to a cultivator of several food crops and domesticated animals to ensure food supply. With progress of time, industrial development and mechanization has changed the scenario of food production. Further, scientific advances in molecular biology, genetics, plant breeding, nutrition science and biotechnology, have brought sea changes in accessibility to food and health services. From the “green revolution” in the 1960's, the world is now sailing rapidly towards “gene revolution”. In India, the green revolution made remarkable contributions towards meeting the growing demands of the continually increasing population. After decades of research, there has been a paradigm shift from a focus largely on food security to now encompass nutrition and health security. Many technologies like food irradiation, biofortification, food fortification and approaches such as dietary diversification have not only helped to achieve adequate food supplies but supported efforts for ensuring good nutrition and health of the population.
Despite this tremendous improvement in food production, accessibility to nutritional and health services seemingly lag behind. The report of the Food and Agriculture Organization (FAO, 2009) indicated that in the world, 2 billion people sleep hungry, with more than 60% being from South Asian countries including India. In spite of the economic progress in our country, a substantial proportion of the population suffers from one or more nutritional problem and malnutrition looms large on India's horizon.
Maternal nutrition plays a critical role in the unresolved problem of malnutrition. Low birth weight babies are born of undernourished, underweight and anemic mothers. Such infants are at high risk of morbidity and mortality. Mortality among infants and children under 5 years of age is primarily because of the deficiency of energy, protein and other important nutrients.2
Survival, however, does not guarantee good health and productivity. Undernourished children continue to have impaired growth, maturation and poor adjustments with self and the environment. In adulthood, they may tend to become victims of non-communicable diseases. Genes for these metabolic conditions may be programmed during intrauterine life and further unhealthy lifestyle, poor dietary habits and vocational demands set the stage for chronic poor health conditions.
Where is the real crisis? Health indicators for India including hunger index, malnutrition, poverty, morbidity and mortality indicate that there is need for serious concern. Innumerable studies and surveys at various levels reveal that one important factor is the poor availability of food to people from low socioeconomic background as well as distribution within the family. Sociocultural biases play a strong role in dietary patterns. Inadequate knowledge with regard to nutrition and health among both educated and uneducated people is another contributory factor.
At the turn of this century, increasing globalization, improvements in transportation and technological development have changed dietary practices and lifestyles especially in cities. A wide variety of foods, such as bread/chapatti/rice, milk, fruits, vegetables are commonly consumed. Besides this, pulses and legumes/beans, nuts or egg/meat/fish, etc. are also part of the daily meals. However, many foods are manufactured or modified in the food industry, such as soy nuggets, non-dairy cream, instant noodles, beverages, ready to eat snacks, breakfast cereals, etc. A wide array of processed foods is available, some of which are good for health but some may have unfavorable effects. Interestingly, many unhealthy foods are more attractive, palatable and irresistible. Many of them are produced by street vendors and help in satisfying appetite. Frequent indulgence in such foods, due to ignorance about their health consequences, may have adverse effects on health and nutritional status. Globalization and industrialization have further amplified prevalence of degenerative diseases like obesity, diabetes, hypertension, heart disease and cancer.
Since the early 1900's the arena of nutrition knowledge has widened through exhaustive research in nutrition science and it is recognized that nutrition is one of the core contributing factors to health and wellbeing. Scientific investigations on the sociocultural effects on diet and lifestyle have further changed the face of nutrition science. Renaissance of health systems has highlighted the tremendous potential of hidden valuable components in food, which are beneficial in health and healing. These components are functional foods, phytochemicals, nutraceuticals and dietary supplements. Many health conscious people are looking forward to naturally occurring food components in food products, to protect them from harmful effects of processing, use of chemical fertilizers and pesticides, occupational challenges, environmental fluctuations and thereby improve health status.
Food is one of the basic needs to sustain life. It is a reservoir of nutrients and other beneficial compounds. The health of a person is interlinked with the quantity as well as the quality of food eaten. Every person, irrespective of age, race, religion and culture eats food. There is uncountable number of cuisines and dishes in every region, community and religion to satisfy biological and sensory requirements. A considerable proportion of every person's life revolves around food; from thinking about it, procuring it, preparing and serving it to family/friends and for special occasions. Many people have to work hard to earn their daily ‘bread’ whereas for others, it is a matter of pleasure and enjoyment. Food is also a topic for discourse, discussion, research and development. Most industries are connected directly or indirectly with food. It is an integral part of our value systems, is associated with power and status, and is used as a symbol of hospitality and for pursuit of pleasure and happiness. Some parents may use food as a reward or punishment.3
Food is an edible substance obtained from plant or animal sources. It nourishes the body and sustains life. Food must satisfy hunger and fulfills physiological, psychological, social and sensory needs. It also protects the body from diseases. Food contains the substances called nutrients that are necessary for growth, survival and different processes of the body.
Nutritious Food
Nutritious food is that which can fulfill the primary functions of the food. It provides sufficient energy and essential nutrients, helps in maintaining all biological processes of the body, maintains body weight and protects us from invasion of any harmful microorganisms and onset of any disease.
Food is a consumable commodity and its functions vary widely. From the nutritional point of view, food must provide nourishment for:
  • Maintenance of life
  • Growth and development
  • Functioning of vital organs
  • Production of energy
  • Protection of body
Food also fulfills psychological and social functions that are listed in Figure 1.1.
Nutrition is the science of food and its components, their actions, interactions and balance within the body. It includes the study of processing of food within the body (digestion, absorption, transport, function and disposal of end products) for its utilization for (i) provision of energy, (ii) building of body tissues and their repair (iii) protection from microorganisms, heat and other stressors.
“Human nutrition describes the processes whereby cellular organelles, cells, tissues, organs, systems and the body as a whole obtain and use necessary substances obtained from food (nutrients) to maintain structural and functional integrity” (Vorster and Haustvast, 2002). It also includes the influence of social, cultural, environmental, political and economic on food intake and thereby on nutrition and health.
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Figure 1.1: Functions of food
Nutrition is a multidisciplinary science that includes combined knowledge of the physical (physics, chemistry) and biological sciences (physiology, molecular biology, biochemistry, genetics, microbiology, food science, pathology, and immunology) and social sciences (psychology, sociology, anthropology, economics, communication and marketing). Physical, social, psychological and economic factors greatly influence the nutritional and health status of the individual, society as well as the nation. Therefore, a nutritionist is required to integrate the relevant concepts from the varied disciplines.
The study of nutrition helps to make healthy food choices by understanding the following:
  • The role of different nutrients in our body
  • The nutritive value of foods
  • Which foods are nutritious and healthy
  • The Recommended Dietary Allowances (RDA) for different life stages
  • What can happen if the right kind and right amount of food is not eaten
  • How to design nutritious recipes
  • How different processing methods can alter the nutritional quality of food
  • Role of food and nutrition in health and disease.
A nutrient is a chemical substance inherently present in numerous food sources that the body uses to obtain energy, build tissues and regulate biological functions. Nutrients play a critical role in health, 5nutrition and disease. The presence of nutrients in the diet is essential because their deficiencies can have adverse effects on health. The deficiency disorder can be reversed by putting the specific nutrient back into the diet. Thus, the significance of nutrients lies not only in promoting health but also in maintaining and bringing back the body into optimal health, e.g. severe deficiency of vitamin A can cause blindness, and excess intake causes hypervitaminosis.
Functions of Nutrients—Nutrients are required for:
  • Regulation of body processes like temperature control, blood pressure, metabolism and waste disposal
  • Structural integrity of bones, muscles and other tissues and cell membranes
  • Energy production for physical activity, muscle contraction and other cellular functions
  • Growth, development and repair
  • Resistance to infection and protection from disease.
There are six classes of nutrients, namely carbohydrates, proteins, lipids, vitamins, minerals and water (Figure 1.2). In each class, there are a number of nutrients. More than 40 nutrients are involved in performing specific functions in relation to growth, development and maintenance of the human body. Nutrients have largely been divided into two categories based on the amount required by the body:
Macronutrients are organic nutrients needed in large quantity, generally in grams. They are indispensable sources of energy that humans and other living organisms require to perform all physical, physiological and metabolic activities. Their structures range from simple small molecules to large complex ones. Each of the large complex compounds consists of smaller building blocks that are eventually broken down in the body to perform metabolic functions. One of the common building blocks of carbohydrates is glucose. Proteins are made up of amino acids and fat is made from fatty acids.
Carbohydrates literally mean, “hydrates of carbon” and are composed of carbon, hydrogen and oxygen. Dietary carbohydrates are broken down into smaller units, generally ‘glucose’ in the alimentary canal. Glucose circulates through blood and reaches cells and tissues to release energy that is used for physical and metabolic activities. Carbohydrates occur in abundance in nature, particularly in plant foods. Cereals, pulses, sugar, milk and fruits are rich sources of carbohydrates whereas animal tissues contain very small amounts or are devoid of carbohydrates. Carbohydrates are a major source of energy (4 kcal/g).
Proteins are made up of small molecules called amino acids. They contain nitrogen in addition to carbon, hydrogen and oxygen. The human body requires approximately 20 amino acids.
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Figure 1.2: Type of nutrients
Amino acids are obtained after protein is digested by the gastrointestinal tract. Protein and amino acids are required to form new molecules like proteins, hormones, enzymes, cells, tissues, organs. A wide variety of protein molecules is used to build and maintain the body structure and to regulate body processes. Dietary protein also provides energy (4 kcal/g). Meat, fish, poultry, egg, milk and milk products, pulses/legumes and nuts as well as cereals are sources of protein. Vegetables and fruits are, in general, poor sources of protein.
Lipids are substances present in the body such as triglycerides, cholesterol, phospholipids and fatty acids. The term lipids and fats are often synonymously used in nutrition science. Lipid/fat is obtained from dietary fats and oils like butter, ghee, groundnut/sunflower/safflower oil, etc. Lipids and dietary fats are made up of various fatty acids. They supply 9 kcal/g, i.e. two and a half times more energy than carbohydrates or protein. Besides supplying energy, lipids are carriers of fat-soluble vitamins; are precursors for synthesis of hormones and structural material for cell membranes. The amount of fat intake and the fatty acid composition influence the risk of developing non-communicable, chronic diseases.
These are required in small amounts, generally in milligram or microgram quantities. Micronutrients comprise vitamins and minerals. Vitamins have elaborate chemical structures and are organic in nature. They participate in biochemical reactions as coenzymes. They do not provide energy but some of them help in regulation of energy production and other functions. Minerals are inorganic, generally found in the earth's crust and water.
Vitamins are comprised of a large group of organic compounds, some of which are soluble in fats and oils, and others in water. The fat-soluble vitamins are Vitamins A, D, E and K. Water-soluble vitamins include thiamin, folic acid and vitamin C among many others. Vitamins play a vital role in energy release from carbohydrates, lipids and proteins; blood clotting and numerous metabolic processes.
Minerals are simple, singular inorganic elements and perform diverse functions in the body. Some of them are needed in relatively more quantity particularly when they are structural components of the body, such as calcium, phosphorus and magnesium. Some electrolytes like sodium and potassium also belong to this category. Some minerals are required in very minute amounts (µg) and hence are known as trace elements, e.g. selenium, manganese, chromium. Many minerals are cofactors for enzymes. They have specific functions and their deficiencies can cause havoc in the body.
This is one of the most important nutrients for survival. The human body contains more than 60% water; however, its proportion is even higher in infancy and childhood. Water is present outside as well as inside cells and helps in transporting the nutrients and metabolic products in and out of 7the cell. Acid-base balance, temperature regulation and lubrication of joints are other major functions of water. Body must maintain water balance.
Besides nutrients, there are other chemical substances that are important for health but may not be classified as nutrients. Plants synthesize two types of metabolites—primary and secondary. Primary metabolites include carbohydrates, proteins, lipids, vitamins, minerals that are basically used as nutrients. Secondary metabolites are enzymes, essential oils and phytochemicals. These phytochemicals are also important for life. Primary nutrients provide energy or perform other important functions in the body. Secondary metabolites promote and protect the human body from unwanted microorganisms and diseases. Phytochemicals include a wide range of compounds that exhibit health benefits.
Phyto is a Greek word meaning ‘plant’. Phytochemicals are non-nutrient, bioactive, chemical compounds found in different parts of plants. They have potential health benefits, help in promotion of health and provide protection against many infectious and non-communicable, chronic diseases. Though the mechanism of action of different phytochemicals is not fully clear, research data indicates that they confer beneficial effects on health, through their influence on hormonal, enzymatic and other regulatory processes occurring in the body.
Phytochemicals act as antioxidants and behave like anti-inflammatory, antiviral and antibacterial agents. They help in boosting immunity and some delay the aging process. They also help in detoxification of environmental pollutants and toxins. Richly colored foods like vegetables, fruits, tea, chocolate, nuts, flax seeds and legumes are rich in phytochemicals. Regular consumption, particularly of fruits and vegetables can work wonders. However, plants may also contain compounds like toxic substances or anti-nutrients that can have harmful effects and hence should be consumed with caution, care and guidance. Some commonly known phytochemicals include polyphenols, carotenoids, flavonoids, isothiocyanates, terpenes, etc. Food exhibiting health benefits due to the presence of these phytochemicals are called functional foods. These ingredients have also been incorporated in many health foods that are similar in appearance of popular food like biscuits, energy bars, nutribars, chywanprash, etc. Nutraceuticals and dietary supplements are also sources of ingestible bioactive compounds in the form of powders, capsules, gels. Bioactive compounds are also obtained from marine and other animal sources.
Nature has presented man with innumerable food sources. Thus, man has access to a very wide range of foods. Yet human beings do not always choose foods from the health point of view. Invariably, people choose food for many other reasons.
Food choices begin early in life and develop under the influence of environmental exposures and experiences. Initially, it is often guided by parents and people surrounding the child. Thus, the child develops certain food choices/food preferences by imitating them. From the beginning, taste, texture and gestures of people in relation to food, contribute the most in shaping food choices. Food habits formed during childhood are difficult to change later in life, especially in adulthood and old age. Individuals might adapt to new foods in different situations, but still relish most of the foods they liked and ate in their childhood.8
Food choice is a process of decision making and sets a pattern of selection of food items for consumption. A wide range of determinants strongly influences food choices. These include age, gender, marital status, family composition, vocational demands, socioeconomic status, culture beliefs, climate, personality traits, and attitudes toward food.
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Figure 1.3: Factors influencing food choices
Over a period of time, remarkable changes have occurred in food choices. Traditionally, people used to choose food on the basis of social and cultural beliefs, which were mainly governed by religion and agriculture. In modern times, media and migration play important roles in food selection and consumption patterns. Besides these, several other factors that undoubtedly affect our food choices. These factors can be grouped under following categories depicted in Figure 1.3.
Biological Factors
Biological factors determine individual variations in food choices. Hunger, appetite and taste are biological determinants of food choice that vary widely in different age groups. Choices are influenced by physiological conditions and gender. Biological factors influencing food choices are as follows:
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Age and Gender
Age and gender determine food preferences. With age, taste and nutritional needs may vary. Many young children like sweets and elders may prefer bitter and bland foods. Girls may choose lighter fancy delicacies while boys may go for rich sumptuous meals. During each life stage, an individual makes or is required to make food choices as per his/her physical, physiological and psychological conditions. Children generally imitate adults and their food intakes especially among young children are controlled by their parents and older persons. Adolescents try new foods and their choices are often influenced by body image, their peer group and media. Food choices of the elderly are largely determined by the health condition, socioeconomic conditions as well as availability of food. Eating problems may stem from loneliness, a lack of desire or ability to cook, financial worries or physical problems.
Social support can have a beneficial effect on food choices and facilitate adoption of healthy dietary habits. Social support from within the household and from co-workers has been found to be positively associated with improvements in fruit and vegetable consumption and with the preparative stage of shaping eating habits in childhood. Social support may enhance health promotion through fostering a sense of group belonging and help people to be more competent and self-efficacious.
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Physiological State
As the person passes through different stages of the life cycle, food choices vary and food choices tend to change temporarily under certain physiological conditions like pregnancy and lactation as well as during sickness. These are vulnerable periods of life when requirements for nutrients are greater, thus food choices may be influenced by the body's needs. Pregnant women are given more food to cater to the needs of the growing fetus and in some cultures, lactating mothers are given galactogogues to increase milk output.
Health Status
There are people who may be allergic to some foods and others who may not be able to tolerate specific foods. For example, some babies may have lactose intolerance and cannot digest milk or milk products. Often during illness, there is lack of appetite and taste is affected, which in turn may alter food choices. Even presence/absence of teeth determine the choice of foods in terms of texture.
Our physiological needs are the basic determinants of food choices that can make or mar health. Sickness often necessitates modifications in food and those who do not alter their selection of food can delay healing. In some health conditions, certain foods are restricted or specifically included, e.g. a diabetic person is asked to refrain from sweets and a person with hypertension (high blood pressure) is asked to avoid pickles/papads/sauces because of their high sodium content. A hungry person may make a different food choice than a person who has finished his/her meal. Hunger or loss of appetite can affect the choice of food. During depression, stress and anxiety, some individuals may experience cravings for certain foods whereas some others may not eat or dislike certain foods. Cravings are in general for sweets, alcoholic beverages, chocolates and junk food that can lead to obesity and other health problems.
Environmental Factors
People living in different geographical locations have different food choices. These are largely associated with the agro-climatic conditions. Climate not only affects the cultivation of food crops but also post-harvest handling and storage. Several environmental factors work together:
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Demography and Family Structure
Demography is the scientific study of the population in terms of its size and composition, pattern of living, fertility, migration, literacy rate, mortality and morbidity in a given geographical location. Nuclear families may have different kinds of food choices compared to traditional joint families where more than one generation may live together. Family structure and daily living habits play a significant role in food selection. Older persons may like to have simple basic meals whereas youngsters prefer more zesty foods like noodles, pizza, carbonated soft drinks, cakes, etc. People living alone often compromise with one dish meals like sandwiches or roti.
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Besides family composition, the type of dwelling also determines the food choice. People staying in concrete houses may have elaborate, varied cuisines owing to better cooking and storage facilities. Consumption of processed, ready-to-eat foods is also common and they can also store drinking water, food and beverages for later use. In contrast, for people living in temporary dwellings such as in rural and slums areas and refugee shelters, limited resources limit the food choices.
Climate and Season
Climate determines the season and crop cultivation varies with season. In India, there are mainly two crops depending upon the season, i.e. “rabi” crop and ‘kharif’ crop. In Rabi or “winter crop” the seeds are sown in October/November and the crops are harvested in March/April. Rabi crops are wheat, grams, barley; potato, etc. ‘Kharif’ or summer season crop starts from June/July and lasts until September/October. Rice, maize, groundnut, cotton, pulses, jowar, etc. are cultivated in this season. Staple food crops are usually cultivated seasonally or once a year but are used throughout the year. Sometimes a third crop called ‘zayad’ is also considered, in which fruits and vegetables are generally grown in summer. It has been suggested that foods contain maximum nutrients when freshly harvested. Traditionally in India, foods are chosen in accordance with the season. It is believed that consumption of off season foods may harm the body and increase risk of diseases, whereas consuming seasonal foods confer maximum health benefits.
Crops undergo various environmental stresses like rain, drought, and insect pests. Further, dramatic changes in climate may seriously affect food security and modify food choices. Droughts, famines and heavy rainfall may sweep away the crop and affect food supplies, compromising food availability and choice. On the other hand, seasonal surpluses increase availability, cost and hence consumption pattern. Cottage industries and food industries can transform the raw food material into totally new products that can help increase food availability and variety even during off season. However, accessibility to food in cities is not largely dependent on seasons, as it is in rural areas.
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Geographic Location
On a daily basis, people depend on locally available foods. Food choices of people residing in hilly areas are different from people from coastal areas. Food grown in forests, hills, valleys, land pastures, dry land, and coastal areas are different that naturally affects the food choices of the residents and their cuisines. People in hilly areas usually select specific berries, fruits, leaves and spices whereas people from coastal areas may prefer fish and sea foods. Kashmiris may select “yakhini” and Goans may like fish curry. Walnuts are cultivated in Jammu and Kashmir and cashew nuts in Goa. Coconut, banana and tamarind may be integral ingredients of food in South India as they are cultivated there, whereas rajma, black gram (udad), ‘makki ki roti’, ‘chhole bhature’, ‘kachori’, ‘samosa’, etc. are popular in North India.
Transport, geographical location, availability of vehicles and fuel determine the cost of food and hence food choice. Food is transported from one place to another, from region to region and now from nation to nation. Transport facilities have increased the accessibility of wide variety of foods 11for most people. However, even today, people living in remote areas have limited food choices as they do not have means of transport. Periodically, they go to nearby markets and procure food materials for several days or months. Women, children, elders and handicapped persons may not be able to go out alone because of their age, gender, social and physical limitations. Hence, they are dependent on others for transport and their food choices may be limited. Food choice for some people is determined by the food available at home or in nearby shops or markets. Famines, droughts, heavy rainfall, cyclones, road blockages due to bad weather and transport strikes greatly affect transport and hence the food supply. If such conditions continue for a prolonged period of time, food choices may be considerably limited. On the contrary, in large cities and metros, those who own a vehicle or know driving, may frequent restaurants or food courts and tend to consume snacks or meals whether they are hungry or not, sometimes just for fun. The latter practice is not desirable since it can adversely affect health.
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There has been tremendous advancement in cultivation practices, post-harvest systems, food product development, food preservation techniques, food packaging, food delivery system and the equipment used in food preparation like microwaves. These changes have influenced every aspect of our life including our food choices. Food manufacturers are able to use several technologies to satisfy the consumer. Fast-paced lifestyle and consequent lack of time for cooking especially in urban areas, has gradually led to a shift from consumption of primarily home-cooked foods to an increasing reliance on ready-to-eat, ready-to-cook, convenience and processed foods. In addition, better technology has made it possible to prolong shelf life of foods, making it easier to obtain seasonal fruits and vegetables, for much longer periods and to reach such produce to far-off, distant places. Thus, home-cooked food is gradually being replaced by food prepared commercially and delivered to the home. The market is flooded with ready-to-eat, ready-to-cook, health foods, dietetic foods, microwaveable meals, chilled and frozen foods, fast foods to fulfill the needs and desires of consumers especially in urban areas.
Urbanization implies more concrete buildings, better transport and communication, better opportunities for education and earning and to avail wide variety of food and food products even outside the home. However, there is less agricultural land to grow fresh foods locally and urban people depend on market supply of food. Urbanization tends to change the socio- economic status and food availability, accessibility and affordability and thereby food choices. It has brought sea changes in interest, aptitude, attitude of the people towards cooking and eating. The availability of food processing, food storage appliances and food delivery systems has changed selection of food preparations.
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Women who were previously, primarily responsible for providing (cooking, etc.) food to the family members, now also go out to work. There are more nuclear families and persons living alone. People face time constraints and sometimes lack the desire to cook, thus use of convenience foods and eating out is increasing. Canteens in schools, workplaces and vending machines have influenced people's choices. People tend to select food items that do not require much processing/cooking without compromising the taste.
Cultural Factors
Food culture is based on traditional beliefs, folklore associated with food and religious rituals. In every culture and religion, there are restrictions and some foods may even be forbidden. Some foods are specifically prescribed and are linked with festive occasions like Diwali or physiological requirements like pregnancy. Culture shapes our food choice, pattern of cooking, eating and serving. People can easily change their speech or dress code and imitate other cultures, but a food choice that is born out of culture and tradition is more difficult to change. Culture regulates the food habits that tend to remain stable through generations. The following factors affect food selection:
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Food cultures evolved out of agriculture practices and production, religious practices, type of family structure and socioeconomic status. In the past, people blindly followed them out of fear of God's fury or ignorance, often without a rational basis. Friends, neighbors and elder women in the family often dictated food choices to be followed in one's life and the entire family.
Man has an inherent desire to be accepted and appreciated in a given social group. Food is a means of communication, a symbol of status and pride. There is hardly any social meeting or gathering or any occasion, where food and drink are not used to indicate hospitality and served as a token of friendliness and social warmth. Conversation about food also adds knowledge about several issues and can influence eating habits, sometimes favorably but not always. During childhood and adolescence, peer groups influence most food choices.
Many Hindus frown at meat consumption, which is permitted in Islam and Christianity. Some religions permit occasional consumption of fish, poultry and mutton but forbid beef because the cow is considered sacred. Milk and milk products are also animal products but they are consumed as they do not involve killing and support growth of the human body rather than causing harm. Most vegetarians also favor ‘ahimsa’ and from the nutritional perspective, research data suggest that 13animal foods may not be always healthy. Serving good food and serving the head of the family first is customary in many cultures without looking into the needs of others in the family or considering whether they are hungry.
Culture determines the approved pattern of selection, preparation and serving of food. In South India, the main course consists of rice, sambar, vegetable, pickle and buttermilk, served on a plantain leaf and eaten by hand. However, in North India, people prefer to eat chapattis or rotis with dal and ‘sabji’ and sweets may be eaten with the meal. The new generation is undergoing a phase of changing food habits out of necessity or desire to try new foods and be innovative. Often people of one culture migrate from one place to another, where the culture is different. Migration and the need for survival and/or social acceptance have made people modify their dietary habits.
Media, Marketing and Advertisements
Food choice is remarkably influenced by advertisements. Television is a strong medium that influences food choices. Many foods are promoted through print/electronic media, exhibitions, home visits, and distribution of free samples, etc. People, particularly children may blindly trust the information that is given and select a particular brand without knowing its true worth. Diverse messages, tall health claims and nutritional labels are meant for consumers but some of these can be fads or quackery. However, media and marketing are very powerful tools if they are used for promoting health education and creating awareness about “healthier” food choices. Simple, actionable and accurate messages that the public can readily understand and incorporate into everyday lives, can help people have a clear idea about the quality, cost and use so that they can make informed and healthier choices about foods.
Personal Factors
Personal choice wins over all sociocultural and environmental barriers. A person may travel long distance just to eat food of his desired choice to satisfy the sensory appeal. Quite often, a person is not aware of his own nutritional needs and makes wrong food choices that are based on taste, appearance, cravings, availability and easily get swayed by peer pressure and media. Literacy level and occupational needs also affect food choices. The following factors affect personal food choices:
Education and Knowledge
Education has been found to influence dietary behavior during adulthood. In young persons, nutrition knowledge may not influence dietary habits much but among adults and older individuals, it has shown an impact. Information on nutrition disseminated through different sources can be understood and promote adoption of good dietary practices.
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Purchasing Power
Household/family income, family size and cost of food have always been important determinants of food choices in almost every household. In families, which lack financial resources, food choices 14are generally limited to staple foods and do not allow the family to include a variety of foods in the diet. Thus, their diets may be unbalanced and inadequate in several important nutrients because of non-inclusion of valuable nutritious foods like milk and milk products, eggs, meat, vegetables and fruits.
Food price determines food selection and rise in prices of commonly used food commodities like cereals, flours, sugar, milk, vegetables and oils seriously affects the food budget. It especially affects the poor and even the rich today. On the other hand, people from higher income group can afford and may consume foods like aerated soft drinks, ice creams, chocolates, imported foods, etc. Many of these foods contain too much fat and/or sugar and less of valuable nutrients. Eating too much of these can have adverse influence on health. Availability of financial resources does not guarantee healthy food choices.
Sensory Appeal
People are more often concerned about satisfying their sense. ‘Taste’ is a major factor that determines whether a person accepts or rejects the food. Smell, appearance, flavor and texture of food also influence food choices significantly. From an early age itself, taste and familiarity are important. The pleasure someone experiences with a particular food is proportional to palatability. Sweet and high-fat foods have an undeniable sensory appeal and hence may often be preferred more than more-nutritious foodstuffs.
Eating Away From Home
Eating behaviors and dietary quality are influenced by the places where food is consumed—at home, school, or away from home at restaurants and fast food establishments. Frequently eating out may negatively affect the nutritional quality of the diet as well as increase the risk of food infection/poisoning and related diseases. Eating out is generally done for enjoyment but most of time, the food items selected, are rich in energy, fat and sugar. Regularly eating out, needs rethinking from health point of view, since hygiene and nutrition are of prime importance.15
Emotions and Stress
Emotions are deep seated in the brain. One can recall events/incidents or experiences associated with a particular food even after 20–30 years. Stress is a common feature of modern urban life and can modify behavior that affects lifestyle, such as physical activity, smoking as well as consumption of alcohol. Generally happy mood and happy events call for eating food preferably, sweets and other rich food. However, some people indulge in eating anything available when they are anxious/stressed/in a sad mood. Certain foods may contain some specific chemical substances that may trigger mood-regulating hormones. Chocolates and coffee may elevate the mood and people tend to crave.
Food choices and food intake are influenced by myriad factors that critically affect the nutrition and health of the person. When the diet supplies adequate amounts of all necessary nutrients and the individual is healthy, the person is well-nourished. A well-nourished person is able to obtain and utilize foods at all levels and conditions and still maintain the health in different phases of life. However, intakes that do not match the body's requirements result in poor nutrition.
Good nutrition implies optimal intake of energy and other nutrients in accordance with the individual's requirements. Such a person is said to be well nourished. The person is healthy, cheerful and can perform to a satisfactory level. Good nutrition helps to achieve good health.
However, across the world, we find that there are masses of people who do not have adequate food or even two meals in a day. There are many whose diets lack one or more nutrient. Conversely there are a large number who consume too much food or who consume certain foods and/or nutrients in amounts that are more than their bodies require. All of these situations have adverse impacts on the human body and health, resulting in malnutrition. Table 1.1 indicates the characteristics associated with good and poor nutrition.
Malnutrition is rampant throughout the world. It inflicts avoidable suffering on millions of people, particularly children and women resulting in poor health and quality of life of the malnourished and hungry population. Malnutrition is an undesirable state of health resulting from imbalance in nutrient intake (deficient or excess amount) and /or nutrient utilization in relation to the requirements of the individuals. It can be considered as a pathological problem since it adversely affects metabolic and cellular functioning and causes clinical symptoms.
The World Health Organization (WHO) defines malnutrition as "the cellular imbalance between the supply of nutrients and energy and the body's demand for them to ensure growth, maintenance, and specific functions."The term “malnutrition” is often used interchangeably with the term “undernutrition”. However, in reality it refers not only to deficiencies but also to excess or imbalance of energy, protein and other essential nutrients. Technically, there are two types of malnutrition:
Undernutrition: Because of deficiency of energy and nutrients.
Overnutrition: Because of excessive intake of energy and nutrients.
Undernutrition encompasses both protein-energy malnutrition and micronutrient deficiencies. It occurs when, over a considerable period of time, food intake in terms of quantity and nutritional quality is not adequate enough to meet the dietary and nutritional requirements.16
Table 1.1   Characteristics of good nutrition and poor nutrition
Good nutrition
Poor nutrition
Physical features
General appearance
Alert and healthy
Listless, apathetic, especially if food and nutrient intake(s) are inadequate
Normal for height/stature and frame size
Underweight or overweight/obese
Sagging shoulders
Firm and good tone
Wasted muscles
Well proportioned strong bones
Bowed legs, beaded ribs
Knock knees
Increased risk of bone pain/fracture
Bright, good vision
Dull, poor eyesight, blindness in extreme cases
Shiny and lustrous
Brittle, discoloration of hair, dull, limp hair
Rounded and pink
Spoon shaped, brittle
Healthy, smooth skin
Dry or greasy, discoloration
Physiological features
Brain and nerves
Good attention span, cheerful, lack of irritability, normal IQ and reflexes, sound sleep
Lack of concentration, poor attention span, irritability, mental confusion, IQ and reflexes may be affected
Insomnia or feel sleepy
Gastrointestinal function
Good appetite, digestion, regular elimination
Anorexia, indigestion, constipation, diarrhea
Physically active Person is vigorous and has endurance, Not easily fatigued
Easily fatigued
Health status and quality of life
Resistance to infection and disease
Frequency, duration and severity of illness is less
Fast recovery
High risk of infection
Frequent episodes of infections
More severe illness
Prolonged period of illness
Slow recovery
Productivity and economic status
Ability to work efficiently and effectively good work capacity high productivity, better incomes and good purchasing power
Inefficient, low work capacity, low productivity
Low salaries/wages
Poor purchasing power
Mental and emotional health
Ability to cope with stress Well-adjusted individual
Inability to cope with stresses of day-to-day living
Poorly adjusted
In some cases, food intake may be sufficient but a person can have problems with digestion and absorption of food or utilization/metabolism in the body may be disturbed. Whatever the cause, the result is low body weight for age and deficiency disease(s) of minerals and vitamins. In children, undernutrition is measured in terms of underweight, stunting and wasting (Figure 1.4).17
Underweight implies low body weight for a given age compared to reference standards. It reflects body size and the level of food and nutrient intake as well as the presence of disease. It is a sensitive measure and reflects acute changes in body weight over a short duration.
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Figure 1.4: Terms of measurement of undernutrition
Stunted means low height for the age compared to reference standards. It signifies deprivation of adequate energy and nutrients for a long period of time, i.e. prolonged undernutrition. In developing countries, such as India, stunting can be a result of undernutrition from fetal stage. It is not affected by immediate circumstances.
A low body weight for given height compared to reference standards is indicative of wasting.
For adults, undernutrition or overnutrition is assessed in terms Body Mass Index (BMI) and BMI below 18.5 indicates undernourishment and if the BMI is below 16, the individual is said to be severely undernourished. Another term used is Chronic Energy Deficiency (CED).
Prevalence of Undernutrition
According to the National Family Health Survey (NFHS III- 2006), 47.0% children were underweight; 45.5% stunted and 15.5% wasted and the prevalence of chronic energy deficiency was 33% in women and 30% in men. In 21 out of 92 countries, about 10% of wasting among children requires immediate attention, because they are at high risk of death. In South Asia, wasting is about 19%, which is alarmingly high. Stunting is a much bigger problem because nearly one-third of less than 5-year-old children in developing countries are stunted. There is hardly any gender difference for underweight but child population from rural areas, urban slums and economically poor households have a higher percentage of undernourished children (UNICEF, 2012).
Groups Vulnerable to Undernutrition
  • About 0–6 years of children especially infants in the first 18–24 months of life
  • Adolescent girls
  • Pregnant and lactating women
  • Aged population.
Reasons for Undernutrition
Undernutrition signifies inadequate supply of nutrients to the cells for optimal functioning of the body. Poverty and hunger (lack of nutrition not just food alone) are leading causes of undernutrition that result in low intake of food, inefficient utilization of nutrients or loss of nutrients from the body (Figure 1.5).
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Figure 1.5: Reasons for undernutrition
Causes of undernutrition include economic and many environmental factors. Various biological, social, cultural, ecological, environmental, economic and political factors are directly or indirectly responsible for omnipresent malnutrition and there are many confounding factors that play a significant role (Table 1.2).
Some of the factors are specific in different life stages. Infants, children and adolescents are undernourished due to poor sanitation and hygiene, inadequate availability of water, infections and illness, inadequate parenting (care) and poor feeding practices. During pregnancy, increased nutrient demands vis-a-vis requirements increases risk of undernutrition. Adults and elders are at risk of being undernourished due to inadequate food and nutrient intake for various social, economic and personal reasons.
Consequences of Undernutrition
Malnutrition affects every facet of life and people of all age groups living in all geographic areas. Millions of newborns, young and old children, youth, adults, pregnant and lactating women, and senior citizens, even sick and hospitalized people are victims of malnutrition. Malnutrition adversely influences individuals, families, communities and nations. There is perhaps no harm in being lean or short, if one is healthy. These characteristics in many are genetically determined. Undernutrition during childhood reduces the chances of normal physical and mental development. Worldwide, deficiencies of vitamin A, iodine, iron and zinc are prevalent and contribute to the high rates of morbidity and mortality particularly among infants and young children. Micronutrient deficiencies are also termed as “hidden hunger”. The effects of undernutrition/malnutrition are shown in Figure 1.6.
Excessive intake of energy and nutrients for a prolonged period of time may result in overnutrition and the risk of overnutrition is much higher when the physical activity is also less. Overnutrition is characterized by overweight and poor body stature, lack of stamina and impaired functioning of body. BMI or Body Mass Index is used to determine the level of overweight and obesity (See Chapter 5).
Overweight and obesity are associated with excess accumulation of fat in adipose tissue. Fat deposition varies with age, gender and different parts of the body. In some persons, fat is deposited on abdominal area that is referred as abdominal obesity. Obesity is known to alter the metabolic functions and increases risk of various morbidities. Obesity is discussed in detail in Chapter 12. Vulnerable age groups for overweight and obesity include school age children, adolescents and adults.
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Table 1.2   Factors influencing malnutrition
Major factors
Main features
Food availability and food accessibility
Food production
Geographic conditions
Agricultural techniques—Use of hybrid seeds, fertilizers, pesticides
Insufficient amount of food
Poverty and hunger
Shops and market nearby living area
Food industries
Government programes for food distribution
Ecological factors
Agroclimatic conditions
Geographical area—coastal, hill, plain, etc.
Rain fall
Type of soil
Natural disasters—drought, floods, cyclone, earthquakes
Environmental factors
Population density
Environmental sanitation
Personal hygiene
Availability of water for irrigation, industry, etc.
Safe drinking water
Heavy traffic and pollution
Terror attacks, communal violence
Use of radioactive substances
Industrial affluent
Unhealthy food habits due to family culture, peer group or mass media exposure
Sociocultural factors
Family size and age composition
Trend of food preparation and distribution
Cultural taboos and beliefs
Illiteracy and ignorance about nutrition
Care capacity of caregivers and household
Gender bias
Economic factors
Purchasing power
Personal and family income
Amount of money spent on food
Unaffordability of nutrient rich foods
Pathological conditions
Frequent episodes of infectious diseases like diarrhea, respiratory infections, malaria, etc.
Chronic degenerative diseases like diabetes, high blood pressure, etc.
Malabsorption syndromes
Infestations with hookworm, roundworm, etc.
Sickness and hospital stay
Accidents, injury, operation, trauma
Eating disorders
Obesity or underweight
Personal factors
Appetite and hunger
Sedentary lifestyle
Irregular meal times—leads to more compromised food intake
Ad libitum snacking and drinking soft drinks
Tension and violence in house at meal timings
Poor food habits during childhood
Wrong examples of dietary habits by elders and influential people
Poor selection and combination of food
Poor skill in food preparation
Inadequate or delayed weaning
Unavailability of the desired food within the reach
Inadequate rest
Excessive working hours, odd working hours, shift duties, and traveling
Lack of time or intention to cook food for self or family
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Figure 1.6: Impact of malnutrition
Strategies to Combat Malnutrition
All human beings wish to be healthy and well nourished. Man tries the best possible ways within the given resources. Since the size of population is increasing, the number of malnourished persons in this country is also high. Although the national food production database reflects increased food production and there is progress in reduction of malnutrition, the picture is still dismal. Malnutrition is not restricted to India. It is a global problem, hence for last many decades it has been tackled at all levels but “no one size fits all”. Even today whether it is at the World Health Organization (WHO) or at National Institute of Nutrition (NIN), India, Nobel laureates, professors, scientists, economists and policy makers are trying hard to tackle the problem of malnutrition. Overcoming malnutrition requires tackling following challenges:
  • Hunger and food insecurity
  • Poor health and disease
  • Conflicts—domestic violence to political conflicts, terrorism21
  • Inequality in gender, socioeconomic status and intra-household food distribution
  • Education and status of women in society
  • Climate change—affecting natural resources for food and safe drinking water, creating pollution, damaging land for cultivation.
Interventions are required from the macro level (national level) to the micro level (family and individual levels).
Interventions at the family and individual levels:
  • Dietary diversification
  • Exclusive breastfeeding from 0–6 months of age
  • Adequate and timely complementary feeding from 6–24 months
  • Adequate hygiene practices at every stage of food handling and eating
  • Extra care for infants, adolescents girls and pregnant and lactating women and elders with regard to food behavior
  • Deworming
  • Nutrition and health education.
Interventions at National level in India:
  • Green revolution was one of the major strategies to reduce hunger and death due to grain shortage
  • Several nutrition programes and health schemes were launched after Independence
  • Establishment of agricultural universities and other universities for higher education, medicine and technology and subsidies to farmers for seeds, fertilizers and pesticides; attention to horticulture, dairy, fish culture
  • Improved access to health care services through primary health care centers, hospitals and ICDS anganwadi centers
  • Favorable health care facilities—Doctors, trained paramedical staff and availability of medicine and needed infrastructure
  • Better sanitation facilities
  • Access to safe drinking water
  • Improvement in food access and enhancement in household food security through public distribution system and fair price shops.
The World Health Organization (WHO), the apex body on health, states “Health is a state of complete physical, mental and social wellbeing and not merely the absence of disease or infirmity”. Over the years several definitions have been given to reflect different concepts about health. Some of them are briefly discussed herein.
Health is a sum total of the supply and utilization of food and nutrients for the soul, mind and body. Health is a self-promised, self-regulatory and self-practiced phenomenon. “Swastha” in Sanskrit 22indicates the ‘swa’ and ‘astha.’. ‘Swa’ means self and ‘astha’ denotes faith or commitment. It is a promise given to self to take charge of one's own health. Health resides within one's body, mind and soul and is reflected through physical, physiological, emotional, mental, and spiritual attributes. It is one of the highest pursuits of life and a way of life to achieve its goal. Health can be viewed as an active process used by persons to adapt to his or her environment that is always dynamic and changing. Good health is critical for wellness. Wellness is defined as a dynamic state of health, in which a person progresses toward a higher level of functioning, achieving an optimum balance between internal and external environments. In simpler terms, it is a condition of good physical, mental and emotional health, especially when maintained by an appropriate diet, exercise, and other lifestyle modifications. Lifestyle includes the way of living—self designed and determined daily habits related to eating, exercise, occupation, social life, managing emergencies and still smiling while coping with stresses. Health is influenced by numerous factors:
  1. Hereditary or genetics: Phenylketonuria is an inborn error of metabolism. Sickle cell anemia is a genetic disorder. Mental retardation and congenital abnormalities in some cases are also inherent problems.
  2. Age and gender: Youth suffer less health problems while elders are more likely to have health problems especially chronic ones like arthritis.
  3. Physical condition of the individual: Stature, physical disability, work capacity and body weight are related to health and nutritional status. Disability, smaller body size and reduced work capacity can be caused by poor nutrition during fetal life or later in life.
  4. Nutrition and food habits: Consuming nutritious, well-balanced diets as per the individual's requirements are important for promoting and maintaining good health as well as preventing problems. Nutrition knowledge, interest and motivation for skillful cooking, support promoting and maintaining good health.
  5. Personality characteristics: Calmness and confidence are usually observed in healthy persons. Healthy persons are able to cope with every day stresses of life. Persons who do not enjoy good health may feel stressed, some may be depressed, some may respond with anger and aggression.
  6. Environment: Housing, soil, climate, waste and sewage disposal, environmental pollution presence of plants, trees, animals and the sociocultural features of the region where a person lives are important factors. Markets, transport and storage facilities for food, also affect health.
  7. Lifestyle: Cultural and behavioral pattern, sleep, physical activity, smoking and use and abuse of alcohol, narcotic drugs all influence health.
  8. Economic status: Food prices, income, literacy, occupation, purchasing power play important roles in health promotion and protection.
  9. Social status: Residence and country of origin and social network and social integration are some issues.
  10. Access to and availability of health services: Availability of and access to provision of safe water and other preventive measures, primary health care, immunization services and hospitals are important for preventing diseases as well as maintaining and promoting health.
Good nutrition has a preventive role and promotes good health and wellbeing in multidimensional ways:
  • To maintain body weight appropriate for height, age and sex
  • To maintain muscle mass
  • To remain mentally alert and active23
  • To be energetic and active
  • To provide resistance to infection
  • To help cope with stress
  • To decreases risk of disability
  • To prevent illness
  • To alter the course of illness (reduce the duration)
  • To increase longevity
  • To Perform better and increase productivity
  • To improve the social and economic status
  • To improve the quality of life.
  1. Define food as per FSSA (2006).
  2. What are the functions of food?
  3. Which other areas of science are linked with nutrition?
  4. What is the difference between macro and micronutrients?
  5. How do you perceive wellness?
  6. What is malnutrition?
  7. Which factors affect malnutrition?
  8. What is the current status of overnutrition and undernutrition in India?
  9. Suggest some ways to combat malnutrition in your local area.
  10. What do you understand by dual burden of malnutrition?
  1. Observe the current food choices in your neighboring area and which factors affect their choices?
  2. Observe the people (50) who are undernourished or overnourished in your neighboring area, identify their characteristics and differentiate between them.
  3. Design some strategies and make a presentation (verbal/PPT, etc.) to improve their health and wellbeing?
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