Essentials of Nutrition and Biochemistry for Basic BSc Nursing I Clement
Acetone 323
Acetyl CoA 299
formation of 328
Acetylcholine 390
Acid contains carboxyl 337
Acid phosphatase 366, 422
balance 278
maintenance of proper 69
of foods, control 177
test 280
disturbances 281
Acidic amino acids 340
Acidity 107
Acidosis 279
and alkalosis 279, 280
Acquired immunity 406
mechanisms of 406
Acquired immunological tolerance 400
Actin 427
Acute coronary syndromes 367
Acyl carrier protein 317
Addison's disease 136, 141
Adenine 427
Adenoma 427
Adenosine 5’-triphosphate 428
diphosphate 260
triphosphate 94, 108, 127, 299, 303, 304
Adenyl cyclase 427
Adipocyte lipolysis 323
Adipose tissue 321
Adrenal cortex 322
Adrenal gland 130
Adrenaline 295
Adrenocorticotrophic hormone 130
Alanine 339
aminotransferase 363, 367
transaminase 422
Albuminoids 64
Albumins 64, 336
Alcohol, dehydration of 300
Alcohol-induced liver disease 366
Aldolase 363, 422
B 312
Aldosterone 130
Aliphatic side chain 339
Alkaline phosphatase 363, 367, 412, 422
Alkalosis 279
clinical effects of 280
All India Council of Technical Education 231
Allergy response 427
Allosteric regulation 427
Alopecia 393
Alzheimer's disease 379
Amaranthus gangeticus 20
Amaranthus tristis 20
Amaranthus viridis 20
Amino acid 66, 337, 341, 344, 345, 352, 427
absorption, mechanism of 344
activation of 345
and dipeptides, absorption of 344
and proteins
composition of 333
metabolism of 333
aromatic 61, 340
basic 340
catabolism of 347
chemical structure of 339
classification of 338, 341
content of 63
essential 66, 67, 338, 343, 430
isoleucine 67
leucine 67
lysine 67
methionine 67
phenylalanine 67
threonine 67
tryptophan and histidine 67
valine 67
functions of 342, 343
general reactions of 346
heterocyclic 61
intact 342
metabolism 97
non-essential 67, 338
arginine 67
asparaginic acid 67
glutamic acid 67
glycine 67
praline 67
serine 67
non-polar 341
physical classification of 338
polar 341
properties of 341, 354
semi essential 67
sources of 67
structure 338f
synthesis of 348
transport 97
types of 347
Amino acyl-tRNA synthetase 427
Amino group 342
Aminoacyl adenylate 345
Aminoacyl synthetase 345
Aminobenzene 351
Aminotransferases 367, 427
Ammonia toxicity 427
Amylase 363, 422
Anabolism 291, 428
Anaphylasis 400
Anchoring organelles 273
Anderson's disease 310
Anemia 97, 197, 217, 364
among children 222
diet in 210
in adult 222
macrocytic 378
types of 97
Aneurinibacillus thermoaerophilus 287
Angina pectoris 330
Angiotensin converting enzyme 363
Anthropometric approach 234
Anthropometric indices 232
Antiberiberi substance 81
Antibody 409, 428
detection assays 413
formation, theories of 404
production of 68, 404
structure of 400, 409, 409f
Antidiuretic hormone 129
Antigen 408, 428
complete 408
detection assays 412
presentation 402
species specific 408
Antigenic determinants 408
Antihistamines 400
Antioxidant 84
Antipernicious anemia factor 426
Antithyroid drugs 351
Antitoxins 400
Applied Nutritional Program 219, 225
Arachidonic acid 57, 315, 316
Arginine 340
and fumarate, formation of 350
Ascorbic acid See Vitamin C
Ascorbic acid, structure of 383f
Asparagine 340
Aspartate amino transferase 365
Aspartate transaminase 422
Aspartic acid 338, 340
Asthma, types of 172
Atheroembolism 330
Atherosclerosis 329
causes 329
Atrial natriuretic peptides 131
Autoimmune disease 403
Autoimmunity 428
Autosomal recessive trait 353
Babies and children, symptoms in 378
Bacterial cell extensions 264
fimbriae 264
flagella 264
Bad cholesterol 55
Baking soda 282
Balanced diet 185
at high cost 207
calculation of 193
concepts of 187
elements in 185
affecting 190f
influencing 189
food pyramid of 186f
fundamentals of 198
goals of 187
importance of 188
included vitamins 369f
nurses role in 215
planning 206
tips on 187
with low cost 207
with moderate cost 207
Balwadi Nutritional Programs 217, 219, 224
Barfoed's test 306
Basal metabolic rate 8, 31, 75, 77, 428
factors affecting 31, 32t, 78, 78f
of body 31
Basal metabolism 10, 75
Base excision repair 428
Basophils and mast cells 403
Beans, categories of 185
Benedict's reagent 306, 307
Benedict's solution 306
Benedict's test See Benedict's solution
Beriberi 93, 102, 197, 217, 370
Beta-carotene 82, 84
Beta-hydroxybutyric acid 323
Beverages 179
carbonated nonalcoholic 182
soft drinks 182
fruit 181
malted 183
milk 182
nonalcoholic 179, 180
coffee 181
tea 180
nutritional significance 179
soups 183
soy based 182
traditional 183
types of 180fc
Bicarbonate 122, 124
Bile production 56
Bile salts 328, 329
from bile acids, synthesis of 328
Bimolecular lipid layer 250
Biocatalysts 357
Biochemistry 245, 246, 428
history of 246
in nursing, importance of 246
meaning and concept of 246
structural 320
Biogenic amines 347
Biological chemistry 245
Biomolecules 428
Biotin 392, 425
deficiency 393
functions 392
Bitot's spots 25, 86, 102
Biuret test 337
Bladder cancer 379
Blindness 217, 375
cholesterol 329
clotting 108
disorders 172
levels 307
meter 305
monitoring 305
sugar 307
concentrations 291
level, normal 303
level, regulation of 303
post prandial 308
regulation of 44, 303, 304f
test 326
B-lymphocytes 402
Body blood sugar 303
Body building foods 6, 22
Body fluids
consumption of 122
physiology of 121
Body mass index 31, 428
classifications 77
Body stores, absorption and 393
Body substances, synthesis of 42
and teeth, formation and maintenance of 108
formation 383
abnormal 375
maintenance of 84
marrow abnormality 172
remodeling 374
B-oxidation 320
Brain disease 190
Branched-chain alpha-keto acid dehydrogenase 352
Breathing symptoms 378
British Naturopathic Association 213
Buffer systems 279
Burning feet syndrome 390
Calcifriol 123
Calcium 105, 106, 122, 123, 195, 218, 394
absorption 394
and excretion 106
factors increasing 107
deficiency of 109, 109f, 394
description of 106
excretion 107
functions of 108, 108f, 123, 394
ions 295
regulation of 124
sources 394
and losses of 123
Caloric value 36, 52
Calorie 10
and basal metabolic rate 30
diet, low 210
empty 41
requirement 38t, 39t
and obesity 215
types of 172
Carbamoyl phosphate formation 350
Carbohydrate 6, 11, 23, 35, 245, 283, 313, 428
absorption of 43, 290
and fat 192
metabolism 97
chemical classification of 35, 49, 284t
classification 35, 36f, 284
on sugar units 40fc
composition 35, 283
and metabolism of 283
deficiencies of 45
digestion of 43, 290
food sources of 24
functions of 41, 42f, 285
metabolism 291
nurses role in 49
polymers 273
sources of 40, 41t
structure of 283, 284fc
types 283
uses of 283
Carbon dioxide fixation 320
Carboxypeptidases, action of 343
Carcinogen 429
Carcinoma 429
Cardiac disease 366, 367
Cardiac dysrhythmias 280
Cardiac enzymes 367
Cardiac manifestations 142
Cardiac troponin 365, 367
Cardiolipin 429
Cardiomyopathy 378
Cardiovascular disease 137, 328
Carotenes 82
Catabolism See Glycogenolysis
Catalase 429
Catalysts 430
Catecholamines, formation of 351
CD4 T cells 401
CD8 T cells 402
Cell 248, 429
chemical composition of 249
components of 248
extensions 264
mediated immune response 405
membrane 248, 271
decreased permeability of 308
lipids 271
permeability 108
proteins 272
structure 271
structure and functions of 271
support 56
powerhouse of 253
protoplasm, synthesis of 342
structural 401
structure of 249f
wall 264
immune response 400
immunity 403, 407, 429
Cellular destruction 280
Cellular immune response 405
Cellular immunity 403, 407
to tuberculosis 400
Cellular lipid metabolism 320
Cellular microtubules 261
Cellular respiration 299
Cellulase 429
Cellulose 47, 265, 289, 290, 429
Central Food Technological Research Institute 229
Central lymphoid organs 401
Central nervous system 93, 388
disorder 98
Centriole 254
Cephalin 53
Cerebral salt-wasting disease 135
Ceruloplasmin 422
cGMP phosphodiesterase 429
Chemical buffer systems 281
Chemiosmotic coupling 429
Chewing See Mastication
Child weight, measurement of 233f
Chitin 266, 429
Chloride 105, 122, 124
functions of 124
imbalance 115
regulation of 124
Chlorine 115
functions 115
Cholesterol 53, 272, 319, 322, 326, 327, 429
biosynthesis of 328
content in food 329
derivatives of 328
functions of 56, 57f, 327
good 328
health significance of 328
low density 390
metabolism 327
Cholic acid 329
Cholinesterase 422
Chondroitin sulfate 289
Chromium 106, 116, 398
Chromoproteins 64, 337
Chromosomes 429
Chronic diseases, preventive action on 384
Chronic energy malnutrition 217
Chronic fatigue syndrome 390
Chylomicrons 331
Cilia 254
and flagella 261
structure of 262f
Citric acid cycle 299, 301, 302, 429
history of 299
reaction steps 300, 300f
Citric acid, synthesis of 300
Citrulline formation from ornithine 350
Cobalamin 391
Cobalt 115, 398, 429
Coenzyme 362
A 429
cofactors and 360
Q 429
Colchicine 326
Collagen 416, 429
formation 383
Collision theory 359
Colloidal osmotic pressure 128
Communicable disease 159
Complement-mediated bacteriolysis 400
Concentration 107
Conjunctiva 406
Consciousness, level of 144
Consumer protection 175
and serving, principles and methods of 147
meaning of 148
objectives of 147
softens 147
sterilizes food 147
Cooking methods 149
baking 153
blanching 151
boiling 149
combination of 154
braising 154
microwave 154
solar 155
deep frying 154
dry heat 152, 152f
frying 154
grilling 152
moist heat 149, 150f
poaching 151
pressure cooking 151
roasting 152
sauteing 153
shallow frying 154
steaming 150
stewing 150
toasting 153
types of 147f
Cooking, principles of 148, 149f
buy best ingredients 149
cook and eat mindfully 149
cook more often 148
cook seasonally 148
eat less meat, more plants 148
eat more whole foods 148
embrace new variety 148
favor healthy fats 148
learn new techniques 148
Copper 106, 115, 398
Cori cycle 296f
Corn syrup, high-fructose 183
Coronary artery disease 58, 309
Coronary heart disease 54, 58, 196, 197, 416
development of 48
Corticosteroid 429
hormones, synthesis of 384
Corticosterone hormone 84
Creatine kinase 364, 367
Creatine phosphokinase 363, 422
Creutzfeldt-Jakob disease 190
Cristae 253, 273
Crohn's disease 377, 381
Crude fiber 47
Cushing's syndrome 133, 135, 308
Cyanocobalamin 99
characteristics 99
deficiency 100
food source 100
functions 100
Cysteine 339
Cystic diseases 136
Cystine 339
Cytochrome oxidase 429
Cytokine 405
production 402
Cytoplasm 253, 263
structure of 254f
Cytoskeleton 263, 273
Decarboxylation 97, 301, 347
Deep-fat frying 154
Dehydration 131
effects of 131
prevention of 132
Dehydroascorbic acid 383
Dehydrogenase 347
Dementia 96
Dendritic cells 402
Deoxyribonucleic acid 252, 429
glycosylase 430
ligase 430
polymerase 430
Dermatan sulfate 289
Dermatitis 96
Desmosome 262
Detoxification function 42
Dextrins 289
Dextrose 35
complications of 305
signs of 45
symptoms of 45
type 2 198
types of 45
Diabetes mellitus 45, 307
acute complications 45, 309
chronic complications 45, 309
classification of 307
clinical features 308
diagnostic evaluation 308
dietary management 309
etiology 308
medial management 309
non-insulin dependent 241, 308
Diabetic diet 210
Diabetic ketoacidosis 136, 324
Diacylglycerol 429
Diaminomonocarboxylic acid 61
Diarrhea 96
Diet 322
and cancer 14
and chronic diseases 14
and dental diseases 14
and diet therapy 15
and mental health 15
and skeletal disease 15
full-fluid 211
general 185
high-protein 210
in hospital, types of 211
management of special 212
mechanical soft 212
normal 212
regular 209
soft 211, 212
Dietary allowances 192
Dietary calcium deficiency 394
Dietary data collection 236
socioeconomic condition 236
vital statistics 236
Dietary energy intake, level of 74
Dietary fiber 47, 48
adverse effects of 49
functions of 47
mechanism of 47
role of 47
Dietary iron deficiency 111
Dietary lipids 319
Dietary management 352
Dietary protein 107
Dietary reference intake 37, 430
Dietary requirements 11f
Dietetics 430
Diffusion 274, 274f
simple 126, 275
type of simple 275
Digestive disorders 179
Digestive enzymes 356
Dihydroxyphenylalanine 350
Diosgenin 5
Diphtheria 212
Disaccharide 23, 284, 285, 430
classification of 287t
lactose 287
maltose 288
sucrose 287
Discretionary calories, categories of 185
Disease, diet in 209
Diverticula 47
Drink, types of 180
cordials 180
juices 180
nectars 180
squashes 180
syrups 180
Drying food 168
Dynamic action 343
Dysmenorrhea 379
Edman's reagent 342
Eggs 20
Eicosanoids 430
Elastins 416
Electrolyte 118, 122
balance 118
imbalance 135
movement 127f
regulation of 122, 129
sources 122
type 122
Electron transport chain 301, 430
Electrophoresis 430
Elements of nutrients
macro 23
micro 23
ELISA See Enzyme-linked immunosorbent assay
Emulsification 430
Endemic goiter 14
Endergonic reactions 359
diseases 136
glands, secretion of 79
Endocytosis 251, 430
Endoplasmic reticulum 253, 255, 430
smooth 256
three-dimensional structure of 256f
Endothelial cells 381, 401
Energy 73, 194
activation 427
allowance for
adults 39, 192, 194
infants 39, 194, 195
women 40
bonds, high 432
intakes, daily 74
measurement of 76
requirements 74, 75, 430
components of 75, 75f
daily 74
of children 74
supply of 343
units of 73
calorie 73
joule 73
yielding foods 6, 22
Enzyme 298, 299, 301, 319, 357, 430
activation 108
factors affecting 360
mechanism of 358, 359f
and disease conditions 366
and hormones, production of 68
catalyzes 363
characteristics of 356
classification of 357, 357t
common 363
composition and metabolism of 356
concentration of 360
extracellular 357
functions of 357
group of 357
hydrolases 357
isomerases 357
ligases 357
lyases 357
multiple forms of 361
oxidoreductases 357
reaction, velocity of 360, 361
transferases 357
with normal value 422
Enzyme-linked immunosorbent assay 412
competitive 412, 413
direct 412, 413f
indirect 412, 414f
non-competitive 412, 413
principle 412
test, non-competitive 414f
types 412
Eosinophils 403
Epithelial cell 374, 375, 430
Epithelial tissue, maintenance of 84
Erectile dysfunction 47
Escherichia coli 287
Essential acid 52
Esterification 62
Ether 431
Euchromatin 253
Eukaryote 263, 264
cell organization 263
structure of 265f
Eukaryotic cell 263, 273
Evening tea 204
Exercise 322
Exergonic reactions 359
Exocytosis 251, 344
Exon 431
Exonuclease 431
complications 45
dry 373
Fanconi syndrome 353
Fasting blood sugar 308
Fasting triglyceride levels 58
Fat See Water-insoluble lipid
classification of 51
compound lipids 51
derived lipids 51
simple lipids 51
waxes 51
composition 51
deficiency of 58
adults and children 58
infants 58
diet, low 210
dietary sources of 54, 55f
digestion and absorption of 57
functions of 56
in diet, functions of 55
metabolism 41, 57
properties of 53
rancidity in 53
requirements 54t
in men 54
in women 54
storage of 57
Fatty acid 52, 316, 431
activation of 320
biosynthesis of 316, 318, 319
of essential 316
signs of essential 57
symptoms of essential 57
essential 52, 57, 315, 316, 430
esters of 318
functions of essential 316
long and short chain 52
monounsaturated 52
non-essential 52
oxidation of 320
polyunsaturated 52, 316
saturated 52
synthesis of 316
unsaturated 52
Fatty liver 322
Feeding requirements 213
Fehling's solution 306
Ferric iron 27
Fiber 6
in disease prevention, role of 48
recommendation 192
Fibroblasts 401
Filtration 129, 276, 276f
Flagella 254
Flavin adenine dinucleotide 431
Flavin mononucleotide 94
balance, maintenance of proper 69
clean 209
diet, clear 211
extracellular 113, 271
mosaic model light junction 272, 272f
pressure 128
regulation of 129
Fluid and electrolyte
balance, maintenance of 125
movement 126
Fluid volume
characteristics of 133
deficit 132
nursing intervention for 132
excess 133
nursing intervention for 134
Fluoride 106, 112
deficiency and excess 113
food sources 113
functions 113
Fluorine 397
Folate See Folic acid
Folic acid 27, 82, 98, 222, 353, 370372, 382, 391
coenzyme 99
components 391
daily requirements 391
deficiency of 391
functions 391
metabolism 384
properties of 391
sources 391
Folin's reaction 337
Folin's test 62
Folinic acid 27
Folk acid 425
Food 3
allergy 198
and medicinal values, role of 18
borne disease 159
budgeting of 205
classifications of 21, 22f
digestion and absorption of 9f
disease 370
enzymes 356
expenditure 206
fads and fallacies 202
functions of 6, 6f
handlers, hygienic practices of 159
handling, sanitation and safe 158
matching meals to budget for 200
materials 172
medicinal values of 18t
apple 18
broccoli 18
cucumber 18
dudhi (melon) 18
egg (egg white) 18
fish 18
garlic 18
home grown sprouts 18
iceberg lettuce 18
juice blender 18
karela 18
lemon 18
milk (skimmed) 18
nuts 18
olive oil 18
peas 18
quality fruit 19
red cabbage 19
strawberries 19
tea 19
varan-bhat (dhal rice) 19
walnuts 19
yoghurt 19
zucchini 19
preparation 147
preservation of 155
pyramid 208f
regulatory 6
stuffs and climate, availability of 202
Food additive 177
functions of 177
side effects 178
types of 178, 178f
Food adulteration 171
and health 171
incidental 172
intentional 172
meaning of 171
metallic contamination 172
packing hazards 173
prevention of 174
types of 172, 172f
Food and Agricultural Organization 227, 227f
functions of 227
objectives of 228
Food and Drug Administration 5
Food and nutrition
factors affecting 16, 17t
nurse's role in 32, 32f
community 33
hospital 32
nursing home 33
preventive care 33
Food and Nutrition Board 192, 226
activities of 226
Food before drying, treatment of 168
drying by osmosis 169
foam-mat drying 169
freeze-drying 169
spray drying 169
sun drying 168
Food budget
factors affecting 206
importance of 206
plans for 206
ways to save on 207
Food contamination
prevention of 159f
sources of 159
Food group 22t, 23t
basic seven 23
common 19f
in balanced diet 185
plans, five 22
total amounts of specific 193
Food preservation 164
and bottling 164
procedures 167, 167f
cellar storage temperatures 165
chilling temperature 166
cold storage 165
commercial methods of 164
dehydrofreezing 166
drying method of 168
freeze drying 164
freezing temperature 166
high temperature in 167f
irradiation 165
low temperature in 165f
machine drying 164
pasteurization 165
principles of 157
quick freezing process 166
slow-freezing process 166
use of
antibiotics 165
high temperature 166
low temperatures 165
Food protection 160
leftovers 162
preparation 161
serving 161
shopping 160
storage 161
thawing 161
Food sanitation 158
Food spoilage 156
causes of 156
Food standards 174
agmark 174
Bureau of Indian 174
Food storage 162
importance of 162
precautions of 162
principles of 163, 163f
Forbe's diseases 310
Forbes-Cori disease 310
Foreign antigens 408
Free energy of activation 359
Free radicals and antioxidants 416
Fruit 20
categories of 185
juices 169
Fumaric acid 301
Furanose 431
G proteins 431
Galactans 290
Galactosemia 311
causes 311
diagnosis of 312
diagnostic investigations 311
prevention 312
symptoms 311
treatment 311
Gallbladder 290
disease 210
Gamma interferon 405
Gamma-glutamyltransferase 363, 366
Gamma-glutamyltranspeptidase 366
Gastric digestion 69
Gastrointestinal tract 9, 131, 406
digestion and absorption from 290t
Gastroparesis 46
Gastrostomy feeding 213
Genetic code 431
Genetic disorders 198
Genitourinary tract 406
Gibbs free energy 431
Globulins 64, 336
Glomerular filtration 276
Glucocorticoids 329
Glucogenic pathway 348
Gluconeogenesis 294, 329, 431
Glucose 35, 303
and brain 305
and diabetes 305
and liver 304
and pancreas 304
formation from non-carbohydrate sources 43
in pancreas, regulation 305f
maintenance 41
obtaining 303
synthesis of 294
tolerance test 44, 306
general instructions 44
interpretation 45
preparation of patient 44
procedure 45
transport of 290
Glucose-6-phosphate dehydrogenase 299
Glucose-alanine cycle 295, 296f
Glucosuria 351
Glutamic acid 98, 338, 340, 391
Glutamic-oxaloacetic transaminase 365
Glutamic-pyruvic transaminase 365
Glutamine 340
Glutelins 336
Glycans 431
Glycemia 305
Glyceraldehyde 285
Glycerophosphatides 332
Glycerophospholipids 318, 431
Glycine 339
Glycocalyces, types of 264
Glycocalyx 264
Glycogen 289, 291, 431
chains 294
storage disease 309, 310
types of 310t, 314
Glycogenesis 294, 431
in body, regulation of 295
pathway of 294f
Glycogenolysis 291, 302, 431
function 302
pathway 303f
reaction of 302
transpires 302
Glycolipids 51, 53, 272, 273, 285, 318, 431
Glycolysis 291, 432
pathway of 293f
products of 291
steps of 292
Glycoprotein 64, 273, 285, 336, 432
molecules 409
Glycosaminoglycans 432
Glycosidic bond 432
Glycosidic bounds 36
Glycosylation 432
Goiter 217
Golgi apparatus 253, 257, 257f, 432
Golgi-derived lysosomal granules 258
Good sanitation, practical rules for 159
Gout 325
advanced 326
might spread 326
recurrent 326
signs of 325
symptoms of 325
G-proteins 432
Grains, categories of 185
Granuloma annulare 380
Guanosine triphosphate 301
Gum disease 46
Hair color, loss of 393
Hair loss 393
Hapten 408
Health, status of 79
Healthy balanced diet, components of 188
Healthy substances of food 20
bitter gourd 20
cruciferous vegetables 20
cucumber 20
green tea 20
tomato 20
Hearing loss 46
and blood vessels 131
attack 364
disease 55, 172, 210, 416
causing 185
developing 55
particular 278
risk factors for 59
risk of 54, 215
muscle 378
problems 46
rate monitoring 432
Heat coagulable proteins 336
Heat shock proteins 432
Helicase 432
Hemicelluloses 290
buffer system 281
synthesis of 97
Hemorrhagic stroke 379
Heparin 289
Hepatic cells See Liver cells
Hepatic disease, stages of severe 354
Hepatobiliary disease, diagnosis of 367
Hereditary fructose intolerance 312
causes 312
complications 313
diagnostic evaluation 312
incidence 312
risk factors 312
symptoms 312
treatment 312
Hers disease 310
Heterochromatin 253
Heteropolysaccharides 288, 289
classifications of 289t
Hexose 432
pathway 432
shunt 296, 297
Histidine 340
Histones 63, 336
formation of 328
synthetase 328
Holoenzyme 361
Homocystinuria 353
Homopolysaccharides, classifications of 289t
Hormonal immunity 432
Hormone 432
production 56
triiodothyronine 10
Human blood groups, discovery of 400
Human immunoglobulin 411
classes 410
Human leukocyte antigen 308, 403, 415
Human plasma, normal 58
Humoral immune response 403
Humoral immunity 403, 406
Humoral response
primary 404
secondary 404
Huntington's chorea 380
Hyaluronic acid 289
Hybridomas 405
Hydralazine 389
Hydration to
form alcohol 301
make alcohol 300
Hydrogen 122, 333
peroxide 416
Hydrogenated oil 53
Hydrogenation 55
Hydrolysis 432
Hydrolytic rancidity 53
Hydrostatic pressure 128
Hydroxy amino acids 339
Hydroxyl group forms 327
Hypercalcemia 135, 141
nursing intervention 141
treatment 141
Hypercholesterolemia 58
Hyperglycemia 307, 351
Hyperkalemia 135, 139, 280
nursing intervention 139
treatment 139
Hypermagnesemia 135, 143
nursing intervention 143
treatment 143
Hypernatremia 135, 137
main characteristics 137
nursing intervention 138
treatment 137
Hyperosmolar hyperglycemic nonketotic syndrome 46
Hyperphosphatemia 145
treatment 145
Hypertension 46
Hypervitaminosis 86, 102, 380, 382
Hypervolemia 133
Hypo and hyper values, causes of 135t
Hypocalcemia 135, 140, 394
nursing interventions 140
treatment 140
Hypocholesterolemia 328
Hypoglycemia 45, 390
Hypokalemia 135, 138
nursing intervention 139
treatment 138
Hypomagnesemia 135, 142
nursing intervention 142
treatment 142
Hyponatremia 135, 136
mild 135
nursing intervention 136
treatment 136
Hypophosphatemia 144
nursing intervention 144
treatments 144
Hypothalamus 129
ICDS Program 220f
IgA 410
IgD 411
IgE 411
IgG 410
structure of 410f
IgM 411
structure of 411f
Immune regulatory theories 400
Immune response 403, 432
Immune system
cells of 401
structure and functions of 401
Immunity 400, 406, 432
active 407
acquired 407
passive 407
herd 408
local 408
passive 407
types of active 407
combined 407
uses of passive 407
Immunochemistry 400
Immunodeficiency 432
Immunoglobulins 49, 409
importance of 411
Immunological function 384
Immunological tolerance 405
Indian Council of Medical Research 192
Infantile beriberi 93
Infections 47
Infectious disease 74, 375
control of 246
resistance to 373
Innate immunity 406, 432
Inositol 1, 4, 5 –triphosphate 432
Insomnia 390
Insulin 295
defective production of 308
dependent diabetes mellitus 307
dose of 308, 309
intermediate acting 309
long acting 309
short acting 309
types of 309
Integral membrane proteins 432
Integrated Child Development Services 219
International Food Technology Training Center 229
Intestinal enzymes, small 344
Intestinal malabsorption syndrome 142
large 290
small 290, 322
Intracellular enzymes 357
Intracellular fluid 113
Intracellular lipid 321
Intracellular membranes 327
Intracellular signal transduction 432
Intra-membranous particles 250
Inulin 289
Iodine 106, 111, 218, 397
food sources 112
functions 112
value ranging 319
Ion and proteins 122
Ion pump 432
Ionic transport 277
Iron 105, 110, 195, 218, 395
absorption, factors affecting 396
and hemoglobin metabolism 383
deficiency 111, 396
symptoms of 397
food sources 110
functions 110, 395
profile, normal values 421
sources of 396
uses of 396
Ischemic stroke 379
Isocitrate dehydrogenase 423
Isoenzyme 364
designation of 362
Isoleucine 339
Isoniazid 389
Isozymes 361
Itchy and peeling skin later 325
Jam 169
Jejunostomy feeding 213
Jelly 169
damage to 326
fluid test 326
severe pain in 325
Joule 433
Juxtaglomerular cells 126
Keratan sulfate 289
Keratin 416, 433
sulfate 289
Keratomalacia 102, 433
Ketoacidosis 46
Ketogenesis 323
Ketogenic amino acids 348
Ketogenic pathway 348
Ketolysis 324
Ketone bodies 42, 323, 433
metabolism of 323
Ketonemia 324
Ketonuria 324
Ketosis 324
Kidney 131, 136
disease 210
types of 377
failure 172
role of 279
stones 326
Killed vaccines 407
Krebs cycle See Citric acid cycle
Kussmaul respiration 324
Kwashiorkor 70, 217
clinical feature of 70
Lactate dehydrogenase 295, 362, 363, 423
Lactic acid cycle See Cori cycle
Lactic acids 363
Lactochrome 386
Lactose 107
intolerance 198
Langerhans cell 402
Langerhans of pancreas 45
Lecithin 53
capsule 414
epithelium 414
fiber 415
protein 413, 415f
structure and functions 414
Less flexibility 325
Leucine 339
aminopeptidase 423
Linoleic acid 52, 315, 316
Linolenic acid 57, 316
Lipase 319, 363, 423
Lipid 24, 51, 245, 433
biological functions of 315
breaking enzymes 319
classification 318
complex 318
composition and metabolism of 315
compound 52
compound/complex 318
derived 52
droplets 320, 321
and tissues 321
functions of 321
in cellular organism 321
properties of 321
in blood 58
metabolism 319
disorders of 322
disorders, common treatments for 322
precursor and derived 318
profile, normal values 421
properties of 318
simple 51, 318
Lipoprotein 64, 318, 330, 337, 433
class 331
function of 56
high-density 54, 328
low density 328, 331
very low density 328, 330
Liquid diet 209
clear 211
Live attenuated vaccines 407
Liver 290, 303, 321
cells 302
chronic 172
enzyme profile for 366
primary 362
severe 353, 354
types of 377
function tests, normal values 421
hypoxia 362
Liver disease See Lung injury
Lunch 204
Lung 131
injury 364
role of 278
Lymphocyte 401
development 401
processing of 401
Lymphoid system 401
Lysine 340
Lysosomes 254, 257, 433
structure of 258f
Macro and micronutrients 23
Macro-minerals 105
Macromolecule 433
Macronutrients 6, 23, 24f, 433
Macrophages 69, 402
Macula adherens See Desmosome
Macular degeneration 380
advanced age-related 380
Macular disease 380
Mad cow disease 190
Magnesium 105, 114, 124, 398
amount of 114
effect of imbalances 115
food sources 114
functions of 114, 124
regulation of 124
sources and losses of 124
Magnetron 155
Maintaining fluid, mechanism of 127f
Malabsorption syndrome 91, 115
Malnutrition 196, 433
and malabsorption syndrome 114
classification of 71
Maltase 358
Maltose 358
Manganese 106
Maple syrup urine disease 352
Marasmic-kwashiorkor 70
Marasmus 69, 217
clinical feature of 70
Marfan syndrome 353
Mastication 9
Maternal and child health division 222
McArdle disease 310
Meal planning 199
factors affecting 200, 201f
goals of 200, 200f
importance of 199
objectives of 200
steps in 203
Meal times 203
Meat poultry and fish 21
Meat, categories of 185
Megaloblastic anemia 82
Melanin, formation of 350
and heat 273
components 273
transport, types of 277
Menaphthone See Vitamin K3
Menaquinone See Vitamin K2
Menaquinones, absorption of 91
Mental health 46
Metabolic acidosis 282
Metabolic alkalosis 282
Metabolic disease
group of 307
management of 352
Metabolic enzymes 356
Metabolic rate 433
Metabolic response to food 75
Metabolism 9, 43
functions of 291
Metalloproteins 64, 337
Methionine 340
Methyl group
acceptor 348
donor 348
Microfilaments 254, 261, 274
Microminerals 105, 116
Micronutrient 6, 23, 25, 433
deficiencies 217
Microscope 266, 433
arm 266
base 266
compound 268
condenser lens 268
confocal laser scanning 268
diaphragm or iris 268
electron 266, 269
eyepiece lens 266
illuminator 266
method of focusing 268
neutron 269
objective lenses 267
optical 268
rack stop 267
revolving nosepiece or turret 267
scanning helium ion 269
stage 267
stereo 268
structure of 267f
tube 266
types of 268
X-ray 269
Microtubules 254, 273, 274
and centrioles 261
and microfilaments 254, 260
Microvilli 254
Mid-day Meal Program 221
Mid-upper arm circumference 233
and milk products 21
categories of 185
Milk-alkali syndrome 141
Millon's reactions 337
Miner's disease 258
Mineral 12, 104, 105, 193, 195, 393, 433
classification of 105
elements 27
calcium 28
fluorine 29
iodine 28
iron 28
magnesium 29
phosphorus 28
potassium 29
sodium 29
function 105, 393
sources 105
Mineralocorticoids 329
Ministry of Rural Reconstruction 225
Ministry of Women and Child Development 230
Mitochondria 253, 259, 433
structure of 259f
Mitochondrial fatty acids entry 323
Molybdenum 106
Monoamine-monocarboxylic acids 61
Monoamino-dicarboxylic acid 61
Monoclonal antibody 400, 405
Monocyte 376
Monosaccharide 23, 35, 284, 285, 434
classification of 285t
diose 285
heptose 287
hexoses 286
pentose 286
tetoses 286
triose 285
Mouth 290
Mucoprotein 64, 336
Mucous membrane 388
Multiple-nutrient deficiency 386
contraction and relaxation 108
disease 364, 365
Mutation 434
Myeloma 405
Myofilament proteins 262
Myosin 416
head 416
Nasogastric feeding 213
National Academy of Sciences 192
National Goiter Control Program 223
National Institute of Nutrition 228
National Institute of Public Cooperation and Child Development 230
National Nutritional Anemia Program 222
National Nutritional Policy 15
National Policy for Children 219
National Program for Prophylaxis 224
National Programs Related to Nutrition 218
Natural acquired immunity 407
Natural healing technique 213
Natural killer cells 402
Natural passive immunity 407
Naturopathic medicine 214
Naturopathic nutrition 214
and diet 213
principles of 214
salient features of 214
Neoplastic disease, malignant 141
Nephritic syndrome 210
Nephritis 210
Nephropathy 46
Nephrotic syndrome 137
Nerve damage, chemotherapy-related 379
Nerve impulse transmission 108
Nervous disorders 179
Nervous system 280
Neural mechanism 131
Neuromuscular irritability 142
Neuromuscular system 358
Neuropathy 46
Neutrophils 403
Newborns for galactosemia 312
Niacin 26, 95, 369, 370, 387, 425
chemistry and characteristics 95
deficiency of 5, 102, 387
effects of deficiency 96
food sources 96
formation of 350
functions 96
importance of 387
structure of 387f
Niacin deficiency See Pellagra
Nicotinamide See Niacin
Nicotinamide adenine dinucleotide 96, 292, 320, 360, 362, 434
phosphate 96
Nicotinic acid 26, 95, 348, 387, 425
deficiency 26, 96
Night blindness 86, 197, 373, 375
Nitrates 380
Nitrogen 333
Nitrogenous compounds 81
Nitroprusside test 337
Non-alcoholic steatohepatitis 379
Non-oxidative phase 299t
Nonprotein nitrogen 354
substances 354
Nonprotein organic 363
Non-self-antigens 408
Nonsteroidal anti-inflammatory drugs 326
Nontoxic methyl derivative 348
Non-vitamin coenzymes 363
Norepinephrine causes 351
Nourish 434
Nuclear envelope, intracellular membrane systems of 255
Nuclease 434
Nucleic acid 245
precursors of 42
Nucleoid 263
Nucleoproteins 64, 336
Nucleoside 434
Nucleosomes 253
Nucleotide 434
Nucleus 252
morphology of 253
structure of 252f
Numbness and cramps 390
Nurse in nutrition education/teaching, responsibilities of 241
Nurse in nutritional programs, role of 241
Nutrient 3, 7, 434
and storage proteins 64
bioavailability of 106
caloric value of 31t, 37t
into energy, conversion of 9
macro and micro 23
of food, preserving 157
preservation of 147, 155
proportion of 37, 37f
psychological function 7
Nutrition 1, 3, 434
and diseases 14
and health, facts about basic 11
and physical performance 12
assessment guidelines 235
concept of 6
education 240
implications of 239
importance of 239
methods of 240
principles of 240
encompasses 8
Foundation of India 221
history 4, 4t
and concepts 3
in health 12
in maintaining health, role of 10
over 434
physiological functions 6
problems in India 14
protein 225
activities of applied 225
social function 7
Society of India 227
status 3
total parenterally 213
Nutrition to health, relation of 13, 13f
growth and development 13
mortality and morbidity 13
resistance to infection 13
specific deficiency 13
Nutrition, physiology of 8, 8f
absorption 8
digestion 8
excretion 8
ingestion 8
metabolism 8
Nutritional adequacy 200
achieving 200
Nutritional Anemia 111
Control Program 222
Nutritional assessment
concept of 231
methods of 232
Nutritional care 434
Nutritional deficiencies, specific 197
Nutritional disease, diagnosis of 241
Nutritional education
and nurses role 238
approaches to 239
objectives and need for 239
Nutritional marasmus 70
Nutritional megaloblastic anemia 99
Nutritional Problems in India 14f
Nutritional Programs 217
and Agencies 217
horizontal 217
vertical 217
Nutritional status 434
assessment of 231, 231f
Nutritive value
classification by 21
of common foods 19
cereals 19
green leafy vegetables 20
other vegetables 20
pulses and legumes 19
roots and tubers 20
of India mix 226
Nuts and oil seeds 20
Obesity 198
categories of 185
hydrogenated 53
refined 53
Olecranon bursitis 325
Oleic acid 316
Oligosaccharides 36, 284, 285, 288, 434
Oncotic pressure 128
Oral rehydration salt 132
Organ specific antigens 408
Orthomolecular nutrition 5
Osmolality 128
Osmolarity 128
Osmosis 128, 275, 275f
Osteoarthritis 390
Osteomalacia 88, 109, 378
causes 89
prevention 89
symptoms 89
treatment 89
Osteoporosis 89, 109
Overnutrition 196
Oxaloacetic acid 299
Oxidation 300, 301
deamination 347
phase 298
phosphorylation 434
rancidity 53
Packaging food materials and hazards 172
Paget's disease 141
Painful menstruation 379
Pancreas 290, 303
Pancreatic protease 343
Pancreatitis 58, 322
Pantothenic acid 26, 98, 389, 390, 426
deficiency of 390
functions of 389
Para-aminobenzoic acid 98, 383
Parasitic disease 403
Parasitic helminthic disease 411
Parathyroid gland 131
Parathyroid hormone 107
Parenteral feeding 213
Parkinson's disease 380
Pectins 47
Pellagra 26, 96, 102
Penicillamine 389
Pentosans 290
Pentose 434
phosphate 298
phosphate pathway 296
oxidative phase of 298t
phases 298
Pepsin 69
Peptic ulcer 396
disease 172
Peptide 337, 434
bond 434
linkage 335
Peptidoglycan 264
Peptones 337
Peripheral arterial disease 46
Peripheral lymphoid organs 401
Pernicious anemia 27, 100, 391
Peroxisomes 259
buffers 280
effect of 361
on enzyme activity, effect of 361
Phagocytic cells 258
Phagocytosis 400, 402, 434
Phenylalanine 340
Phenylisothiocyanate 342
Phenylketonuria 351, 434
Phosphate 122, 125
buffer system 281
functions of 125
Phosphatides See Phospholipids
Phosphofructokinase deficiency 310
Phosphogluconate pathway 296, 297
Phosphoinositides 332
Phospholipids 51, 53, 254, 318, 331, 434
biosynthesis of 332
Phosphoproteins 64, 104, 336
Phosphoric acid residue 318
Phosphorus 105, 109, 395
deficiency 110, 395
symptoms of 395
food sources 110
functions of 109, 395
sources of 395
Phosphorylation 434
Phosphotungstic acid 335
Phylloquinone 381
Physical activity
extent of 79
level 434
ratio 435
Physiological chemistry 245
Pickling 170
Pinocytosis 344, 435
Pituitary gland 129
Planning balanced diet, steps in 193
Plant cells 265, 266
Plasma cells 401, 403, 409
Plasma enzymes, diagnostic values of 422
Plasma membrane See Cell membrane
Plasmids 263
Plastids 266
Poliomyelitis 212
Polydipsia 308
Polyhydroxy aldehydes 283
Polyhydroxy ketones 283
Polymorphonuclear leukocytes 402
Polypeptide 435
elongation of 345
initiation of 345
termination of 346
Polyphagia 308
Polysaccharide 23, 36, 284, 285,| 288, 313
classifications of 289
complex 36
Polyuria 308
Pompe's disease 310
Poor-blood profile 390
Potassium 105, 113, 122, 123, 398
deficiency 114
food sources 114
functions 114
metabisulfite 170
regulation of 123
sources and losses of 123
Premenstrual syndrome 379
Prevention of Food Adulteration Act 173, 175
Progestogens 329
Prokaryote 263
genetic material of 263
structure of 264f
Prokaryotic cell 264, 435
internal structures of 263
structures 264
Prostate specific antigen 366
Prosthetic groups 435
Protamines 63, 336
Proteases 337
Protective foods 6, 22
Protein 12, 24, 60, 195, 337, 435
during pregnancy and lactation 66
for adults 192
and lipoproteins, production of transport 68
and polypeptides, absorption of intact 344
based biological functions, classifications of 65f
biological value of 67
biosynthesis of 344
buffer system 281
calorie malnutrition 14
carrier 429
composition 60
properties of 62
classification of 24, 62, 63, 63f, 336
on solubility 63f
color reaction of 337
complete 63, 67
complex 64
conjugated 24, 62, 336
contain carbon 333
contractile 64
defense 65
deficiencies of 69
derived 24, 62, 64, 337
diet, low 210
digestion 69, 343, 344
and absorption of 343
energy malnutrition 70
classification 70f
enzymatic 64
fibers 273
foods 19
functions of 68, 68f
general characteristics of 61
general properties of 335
good quality 67
hydrolysate formula 311
incomplete 63, 67
kinase 435
maintenance of structural 68
metabolism 346
disorders 351
motile 64
nonhistone 253
of animal foods 68
partially complete 63, 67
phosphatase 435
physical properties of 62
primary structure of 333
production of structural 68
properties of 61, 61f
quality of 67
quaternary structure of 334
regulatory 65
secondary structure of 333
simple 24, 62, 63, 336
sources of 65
sparing action 41
specialized 416
storage of 342
structural 64
organization of 333
structure of 60, 61f
synthesis 344
tertiary structure of 334
transport or carrier 64
Proteoglycan 435
Proteolysis 435
Provitamin A See Beta-carotene
Pteridine nucleus 391
Pteroylheptaglutamic acid 391
Pteroylmonoglutamic acid 391
Pteroyltriglutamic acid 391
Pyridoxal phosphate 95, 96, 367
Pyridoxine 26, 96, 97, 353, 388, 425
chemistry and characteristics 96
deficiency of 97, 367, 389
food sources 97
functions of 97, 388
pyridoxal and pyridoxamine, structure of 388f
sources of 389
Pyruvate metabolism, disorders of 313
Pyruvic acid 291, 301
Pyruvic and lactic acids 26, 385
Quetelet's index 31
Radioimmunoassay, development of 400
Reabsorption 129
Red blood cell
malnutrition of 20
production 303
Reiters syndrome 416
Renal disease 144, 367
end-stage 367
Renal mechanism 281
Renin 363
Rennin 69
Replication fork 435
acidosis 282
alkalosis 282
mechanism 281
problems 179
symptoms 378
tract 406
Reticuloendothelial system 401
Retinoic acid 82, 373
Retinoids 82
Retinol 373
deficiency 102
Retrolental fibroplasia 380
Rheumatic disease 416
Rheumatoid arthritis 380, 390
Rhodopsin 435
Riboflavin 26, 94, 386, 425
chemistry and characteristics 94
deficiency 102
symptoms of 387
effects of deficiency 95
food sources 95
functions 94
sources of 386
storage 94
structure of 386f
transport 94
Ribonucleic acid 252, 435
Ribosomes 254, 263, 435
Richner-Hanhart syndrome 353
Rickets 87, 103, 197, 370
causes 88
symptoms 88
treatment 88
Road-to-health chart 237f, 238
Rotheras test 323
Sakaguchi reaction 337
Salk vaccine 407
Salt-free diet 210
Sanger's reaction 62
Sanger's reagent 342
Satiety value 202
Saturated fats 55
Scanning electron microscopy 269
Scanning probe microscopes 269
Scleroproteins 64, 336
Scurvy 102, 197
Selenium 106, 116, 399
Serine 339
Seronegative arthritis 416
Serum antitoxin 400
Serum glutamate-oxaloacetate transaminase 365
Sexual function in men 369
Short bowel syndrome 212
Si system 435
Skeletal disease See Cardiac disease
Skeletal muscle 322
Skin 46, 388, 406
diseases, types of 172
problems 179
Sodium 105, 113, 122, 397
balance 126
chloride 113
food sources 113
functions of 113, 122
hypobromite test 354
imbalance 113
pump 277, 278f
regulation of 123
sources and losses of 122
translocation of 278
Sound eating practices 12
Special Nutrition Program 218, 223
Sphingolipids 332
Sphingomylein 435
Sphingophospholipids 318
Splenic cells 405
Starch 289, 435
Steroid 326, 436
hormones 329, 435
secreting cells 256
Sterols 52, 53, 254, 326, 436
Stomach 290
Stress, excessive 390
Stroke 46
Subcellular bodies, group of 258
Substances 283
Substrate 436
Succinic acid 301
Succinyl-CoA, hydrolysis of 301
Sugar and salt, preservation of high concentration 170f
Sugar, reducing 435
Sugarcane juice 183
Sulfur 105
containing amino acid 61, 339
Surveys, type of 232
Sweet urine 307
Syndrome inappropriate to antidiuretic hormone (SIADH) 129
T lymphocytes 401
Tamil Nadu Integrated Nutrition Program 219
Tamoxifen 376
Tardive dyskinesia and dyspraxia 380
Tarui's disease 310
Tender coconut water 183
Tetany 109
Tetrahydrofolate 384
Therapeutic diet 207, 209
nutrients in 208
problems during sickness 208
purpose 207
rules of treatment 207
Thiamine See Vitamin F
Thiamine deficiency See Beriberi
absorption, transport and storage 92
chemistry and characteristics 92
deficiency 93
dietary sources of 385
functions 92, 385
monophosphate 92
pyrophosphate 92
requirements 93
sources 93
symptoms 93
toxicity 94
treatment 94
Thiocarbamides 351
Thiol ester synthesis 301
Threonine 339
Thymine 436
Thymosin 401
Thymus 401
Thyroglobulin 351
gland 350
hormone, formation of 350
stimulating hormone 351
Thyroxine 10, 350, 351, 436
T-lymphocytes 401
Tocopherols 90
Total energy expenditure 436
Toxic proteins 65
Toxicity 89
Trace elements 30, 115, 398
chromium 30
cobalt 30
copper 30
selenium 30
zinc 30
Trace minerals See Microminerals
Trans fatty acids 55
Transaminase 365
Transfer ribonucleic acid 436
deacylase 346
Transmethylase 348
Transmethylation 347, 348
Transmission electron microscopy 269
Transplantation immunology 400
Transport-gluts, passive 290
Triacylglycerol 254, 436
Tricarboxylic acid cycle 260, 299
Triglyceride 52, 322
functions of 56
levels, treatment of high 58
Trypsin 423
Tryptophan 341
metabolism 384
to niacin, conversion of 97
Tube feeding 212
Tumor, benign 428
Tyramine-containing food 33
Tyrosine 340
metabolism 384
Tyrosinemia 353
Unbalanced diets, effects of 196
Undernutrition 197, 436
Unit membrane 248
United States Department of Agriculture 185
Unsaturated fats 55
Unsaturated fatty acid 316, 416
Uracil 436
Urea 354
cycle 349, 349f, 436
formation of 350
Urease test 354
Uremia 210
Uric acid 354
normal values 421
testing 307f
Valine 339
Vegetables, categories of 185
Vision 373
Vital signs 143
Vitamin 12, 25, 81, 193, 196, 369, 436
amount of 372
and minerals, compositions of 369
B-complex 372, 382
B-group 386
classification of 81, 371, 371f
deficiency of 14, 102, 424
discovery of 370
facts 372
fat-soluble 81, 82, 372, 373, 431
types of 369
folic acid 384
function of 424
importance of 370
of B group 81
types of 369
water-soluble 372
types of 369
Vitamin A 25, 56, 82, 84, 157, 196, 218, 224, 315, 370374, 424
absorption 83
factors affecting 83
acid 373
alcohol 373
aldehyde 373
carotenoids 82
deficiency 25, 84, 85, 102, 217, 224, 373, 374
causes of 85
clinical manifestation of 85
statistics of 85
treatment of 86
doses of 373
excess states 375
functions of 83, 84f, 373
sources of 84, 374
structure of 373, 373f
transport and storage 83
Vitamin B complex 424
Vitamin B1 81, 92, 371, 382, 385
Vitamin B12 See Cobalamin
Vitamin B12 27, 82, 222, 371, 382, 393
deficiency 391, 392
functions 100
promotes 27, 391
supplement 382
Vitamin B2 26, 81, 94, 371, 382, 386
Vitamin B3 82, 425
deficiency of 5, 389
Vitamin B5 See Pantothenic acid
Vitamin B5 deficiency, symptoms of 97
Vitamin B6 See Pyridoxine
Vitamin B6 compounds 388
Vitamin C 81, 82, 100, 157, 158, 196, 370372, 382384, 390, 416
absorption 100
chemistry and characteristics 100
deficiency 101, 102, 383, 384
development of 384
severe 385
excellent sources 101
excellent-to-good sources 101
food sources 101
functions of 27, 101, 383
small amounts 101
sources of 384
symptoms 101
toxicity 102
transport and storage 100
Vitamin D 25, 82, 87, 56, 157, 315, 370372, 375377, 424
absorption 87
binding protein 87
chemistry and characteristic 87
deficiency 87, 88f, 103, 109, 376378
categories for 377
causes of 377
severe 378
symptoms of 377
doses of 373, 376
food sources 87
functions of 87, 375
production 56
requirements 87
sources of 376
structure of 375, 376f
transport and storage 87
uses of 376
Vitamin E 25, 56, 82, 90, 157, 315, 370372, 378, 378f, 379, 380, 424
absorption 90
chemistry and characteristic 90
classification of 378
deficiency 90, 379
doses of 373
food sources 90
functions of 90, 378
importance of 379
natural 369
requirement 90
structure of 378
transport and storage 90
Vitamin F 386
Vitamin G 386
Vitamin H See Biotin
Vitamin K 25, 56, 82, 91, 315, 372, 379381, 424
absorption 91
chemistry and characteristics 91
classifications 381
deficiency 91, 103, 381
dietary sources of 381
doses of 373
food sources 91
functions of 91, 381
requirements 91
structure of 380f
toxicity 92
transport and storage 91
Vitamin K1 381
Vitamin K2 381
Vitamin K3 381
Vomiting 282
von Gierke disease 310
and other fluids 12
balance 125
daily input 118
and output of 119f
daily output of 119
functions of 118f
in body, primary functions of 121
metabolism and distribution 120, 121f
Water and electrolyte 117
balance 117
Water intoxication 131, 134
pathophysiology 134
symptoms of, 134
confusion 134
cramps 134
fatigue 134
headache 134
irritability 134
muscle spasms 134
nausea 134
restlessness 134
seizures 134
unconsciousness 134
vomiting 134
treatment 135
Water requirement 117, 118, 119t
and regulation 117
Water technique, doubly labelled 430
Water-insoluble lipids 330
chlorophyll 381
riboflavin 386
vitamins 81, 92, 372, 382
deficiencies of 382
Wet beriberi 93
Wheat-based supplementary nutrition program 219
White blood cells 376
Wilson's disease 313
World Food Program 225
World Health Organization 10, 235
Wounds, healing of 47
Xanthoproteic test 62
Xerophthalmia 25, 102, 373, 375, 436
Yellow fever vaccine, development of 400
Yield energy 41
Yolk sac 322
Zinc 106, 111, 115, 369, 398
functions 111
requirements 111
sources 111
Zonula adherens, well-defined 262
Zonula occludens 262
Zwitterions, formation of 342
Page numbers followed by f refer to figure, fc refer to flow chart, and t refer to table.
Chapter Notes

Save Clear


Introduction to NutritionCHAPTER 1

Food is prime necessity of life. The food we eat is digested and assimilated in the body and used for its maintenance and growth. Food also provides energy for doing work. Man has exhibited much thought and foresight in cultivating a variety of grains, fruits, vegetables, nuts, and oil seeds; and in rearing birds and animals for use as food. Nutrition deals with the way in which the human body receives and uses all the substances or materials necessary for its growth and development and for keeping it in good condition. This begins in eating food. The food swallowed is then digested as it is passed through the stomach and small intestines. During digestion, the food is broken up into simple substances. These are absorbed into bloodstream and carried to the liver, where they are either stored or changed further or sent out to other parts of the body for use as required.
  1. Food: Food is defined as anything solid, liquid or semi-solid; which when ingested putting into the mouth, digested and assimilated, nourishes the body.
  2. Nutrients: Nutrients are defined as those chemicals substances, which are supplied by food and are needed as a source of energy and as a structural material for every cell of the body.
  3. Food: The edible stuff that provides us with nutrients is termed as food. Food is broadly classified as cereals, pulses, vegetables, fruits, milk, eggs, flesh food, fats and sugar.
  4. Nutrients: These are the constituents in food that must be supplied to the body in suitable amounts. They include proteins, fats, carbohydrates, minerals, water and vitamins.
  5. Nutrition status: It is defined as the extent to which a customary diet meets the body's requirement. In other words, it signifies the condition of the body after the consumption of food. The condition of health of individuals is influenced by the utilization of nutrients. It can be assessed by dietary survey, anthropometry, clinical and laboratory investigations.
Nutrition is the combination of processes by which the living organism receives and utilizes the materials necessary for the maintenance of its function and for the growth and renewal of its components. Nutrition is that condition, which permits the development and maintenance of the highest state of fitness 4in processes or activities by which the human body receives and uses all the food necessary for its growth, development, regulation and repair. It is the science of food, the nutrients and other substances therein, their action, interaction and balance in relationship to health and disease.
History of Nutrition
Nutritional discoveries from the earliest days of history have had a positive effect on our health and well-being. The word nutrition itself means “the process of nourishing or being nourished, especially the process by which a living organism assimilates food and uses it for growth and replacement of tissues.” Nutrients are substances that are essential to life, which must be supplied by food. Today, more than ever, obtaining nutritional knowledge can make a big difference in lives. Air, soil and water pollution, in addition to modern farming techniques, have depleted soil of vital minerals. The widespread use of food additives, chemicals, sugar and unhealthy fats in the diets contributes too many of the degenerative diseases of our day, such as cancer, heart disease, arthritis and osteoporosis. Here is a brief history of the science that offers the hope of improving health naturally.
The first recorded nutritional experiment is recorded in the book of Daniel in the Bible. Daniel was among the finest young men captured by the king of Babylon when the Babylonians overran Israel and was to serve in the king's court. He was to be fed from the king's table of fine foods and wine. Daniel objected and preferred his own choices, which included vegetables (pulses) and water. The chief steward was afraid for his head, but agreed to a trial. Daniel and his friends received his own diet for 10 days and then were compared to the king's men. As they appeared fitter and healthier, they were allowed to continue with their own foods, not defiling themselves with those of the king. The 20th century became the era of the Golden Age of Nutrition, when most of the discoveries of the nutrients took place. Stephen Babcock was instrumental in helping to open the age. Babcock, better known for the Babcock test for milk fat that bears his name, conceived the idea to feed dairy cattle feed from just one source, all corn plant or all wheat plant (Table 1.1).
Table 1.1   Highlights of history of nutrition
Sl. No.
400 BC
Hippocrates, the ‘Father of Medicine’, said to his students, “Let your food be medicine and thy medicine be food”. He also said “A wise man should consider that health is the greatest of human blessings.”Foods were often used as cosmetics or as medicines in the treatment of wounds. In some of the early Far-Eastern biblical writings, there were references to food and health. One story describes the treatment of eye disease, now known to be due to a vitamin A deficiency, by squeezing the juice of liver on to the eye.
Scientist and artist Leonardo da Vinci compared the process of metabolism in the body to the burning of a candle.
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 (a painful, deadly, bleeding disorder). Only non-perishable foods such as dried meat and breads were taken on the voyages, as fresh foods would not last. 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 was not discovered until the 1930s, Lind did not know it was the vital nutrient. As a note, British sailors became known as ‘Limey's’.5
Antoine Lavoisier, the ‘Father of Nutrition and Chemistry’ discovered the actual process by which food is metabolized. He also demonstrated from where the animal heat came from. In his equation, he describes the combination of food and oxygen in the body and that result giving off heat and water.
It was discovered that food is composed primarily of four elements carbon, nitrogen, hydrogen and oxygen, and methods were developed for determining the amounts of these elements.
Justus Liebig of Germany, a pioneer in early plant growth studies, was the first to point out the chemical makeup of carbohydrates, fats and proteins. Carbohydrates were made up of sugars, fats were fatty acids and proteins were made up of amino acids.
Christian Eijkman, a Dutchman working with natives in Java, observed that some of the natives developed a disease called beriberi, which caused heart problems and paralysis. He observed that when chickens were fed the native diet of white rice, they developed the symptoms of beriberi. When he fed the chickens, unprocessed brown rice (with the outer bran intact), they did not develop the disease. Eijkman then fed brown rice to his patients and they were cured. He discovered that food could cure disease. Nutritionists later learned that the outer rice bran contains vitamin B1, also known as thiamine.
McCollum EV, while working for the US Department of Agriculture at the University of Wisconsin, developed an approach that opened the way to the widespread discovery of nutrients. He decided to work with rats rather than large farm animals like cows and sheep. Using this procedure, he discovered the first fat soluble vitamin, vitamin A. He found that rats fed with butter were healthier than those fed with lard, as butter contains more vitamin A.
Casimir Funk was the first to coin the term ‘vitamins’ as vital factors in the diet. He wrote about these unidentified substances present in food, which could prevent the diseases of scurvy, beriberi and pellagra (a disease caused by a deficiency of niacin or vitamin B3). The term vitamin is derived from the words vital and amine, because vitamins are required for life and they were originally thought to be amines—compounds derived from ammonia.
William Rose discovered the essential amino acids, the building blocks of protein.
1. The water soluble B and C vitamins were identified.
2. Russell Marker perfected a method of synthesizing the female hormone progesterone from a component of wild yams called diosgenin.
The roles of essential nutrients as a part of bodily processes have been brought to light. For example, more came to be known about the role of vitamins and minerals as components of enzymes and hormones that work within the body.
Linus Pauling, a Nobel prize winner in chemistry, created the term ‘Orthomolecular Nutrition’. Orthomolecular is, literally, ‘pertaining to the right molecule’. Pauling proposed that by giving the body the right molecules in the right concentration (optimum nutrition), nutrients could be used by people to achieve better health and prolonged life. Studies in the 1970s and 1980s conducted by Pauling and colleagues suggested that very large doses of vitamin C given intravenously could be helpful in increasing the survival time and improving the quality of life of terminal cancer patients.
Have you ever wondered why vitamin bottle labels and nutritional websites include a phrase saying that their products and information are not intended to diagnose, cure or prevent any disease? These also usually state that their health claims have not been evaluated by the food and drug administration (FDA). Here is why: the Dietary and Supplement Health and Education Act was approved by congress in October, 1994 and updated in January, 2000. It sets forth, what can and cannot be said about nutritional supplements without prior FDA review.
Concept of Nutrition
Nutrition is also known as nourishment or aliment in the form of food in order to support life. The diet of an organism refers to what they eat. Many common health problems can be prevented by having a healthy diet. Dietitians are professionals who specializes human nutrition, meal planning, preparation and so on. They are trained people to provide dietary advice, for every individual, in health and disease. There are seven major classifications of nutrients, they are, carbohydrates, fiber, fats, protein, minerals, water and vitamins. These classes of nutrients are categorized as macronutrients, which are needed in relatively large amounts, and micronutrients, which are needed in smaller quantities. Macronutrients are carbohydrates, fats, fibers, water and protein; while micronutrients are vitamins and minerals.
The macronutrients provide energy, which is measured in Joules or kilocalories and written with a capital ‘C’ to distinguish them from gram calories. Carbohydrates and proteins provide 17 kJ (4 kcal) of energy per gram, while fats provide 37 kJ (9 kcal) of energy per gram. Vitamins, minerals, fiber and water do not provide energy, but are necessary for other reasons. Other nutrients include antioxidants and phytochemicals. These substances were recently discovered, which have not have been yet recognized as vitamins or contributed to health, but they are necessary for our body. Phytochemicals may act as antioxidant, but not all of them are antioxidants.
Functions of Food (Fig. 1.1)
Food is the basic necessity of man. It is a mixture of different nutrients such as carbohydrate, protein, fat, vitamins and minerals. These nutrients are essential for growth, development and maintenance of good health throughout the life. They also play a vital role in meeting the special needs of pregnant and lactating women and patients recovering from illness.
Physiological Functions
Energy yielding foods: Foods rich in carbohydrates and fats are called energy yielding foods. They provide energy to sustain the involuntary processes essential for continuance of life, to carry out various professional, household and recreational activities and to convert food ingested into usable nutrients in the body. The energy needed is supplied by the oxidation of foods consumed. Cereals, roots and tubers, dried fruits, oil, butter and ghee are all good sources of energy.
Body building foods: Foods rich in protein are called body building foods. Milk, meat, eggs and fish are rich in proteins of high quality. Pulses and nuts are good sources of protein, but the protein is not of high quality. These foods help to maintain life and promote growth and also supply energy.
Protective and regulatory food: Food rich in protein, minerals and vitamins are known as protective and regulatory foods.
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Fig. 1.1: Functions of food
7They are essential for health and regulate activities such as maintenance of body temperature, muscle contraction, control of water balance, clotting of blood, removal of waste products from the body and maintaining heartbeat. Milk, egg, liver, fruits and vegetables are protective foods.
Social Function
Food has always been the central part of our community, social, cultural and religious life. It has been an expression of get-togethers. Food is served at many social events like teas, breakfasts, banquets, athletic award dinners, dances and meeting of all sorts. On all these occasions, food indirectly serves as an instrument to develop social support.
Psychological Function
Besides other functions, food satisfies certain emotional needs also. People often find it difficult to get adjusted to unfamiliar food, although it may be nutritionally sound. Traditional habits are characterized by certain foods, which are pleasing to people of one culture and distasteful for those of another. In addition to satisfying physical and social needs, foods also satisfy certain emotional needs of human beings. These include a sense of security, love and acceptance. For example, preparation of delicious foods for family members is a token of love and affection.
Relationship of food to main functions: Nutrition is the process or an activity by which the human body receives and uses all the food necessary for its growth, development and functions or activities.
  1. Food supplies heat and energy for work and play.
  2. Food supplies materials for growth and repair of the body.
  3. Food supplies materials for regulation or control of body process and for protection of the body. People are familiar with food, but in order to understand the different types of food that are used in the body, it is necessary to know what substances or materials are present in food. These substances are called nutrients. The nutrients present in food are proteins, fats, minerals, elements and vitamins. An adequate diet should contain liberal amounts of protein rich and protective foods and it should supply all the dietary essentials in the required amounts.
Nutrition: A Basic Human Need
Nutrition is a basic human need that changes throughout the life cycle and along the health-illness continuum. The body requires food to provide energy for organ functions, body movement and work, maintain body temperature and to provide raw materials for enzymes function, growth replacement of cells and repair. Food provides nutrition for both the body and mind. Eating has evolved from being simply a necessity; is an integral component of medical treatment. The science of nutrition encompasses the study of nutrients and how they are handled by the body, as well as the impact of human behavior and environment on the process of nourishment. Nutrients alter specific substances used by the body for growth and development, activity, reproduction, lactation, heath maintenance and recovery from illness or injury. Good nutrition is a basic component of health, growth and development for maintaining health throughout the life. Proper nutrition of the nation is necessary for the nation's growth and economic development.
Nurses must understand the functions of the basic nutrients and metabolism. An understanding of the guidelines for adequate diet is essential so that, nurses can teach about nutrients and answer for the questions related to diet. Nurses must be able to assist the nutrients of the diet. They must also recognize that many divergent factors influence food intake and consider the factors when attempting to modify food intake. The factors that influence nutrient requirements are developmental considerations, i.e. age, 8sex, health status, culture and religion, socioeconomic status, personal preference, medications, alcohol and drugs, etc. Nurse also must be able to identify clients at risk for nutritional problems and be aware of common nutritional conditions.
The term ‘food’ refers to anything, which nourishes the body. It would obviously include solids, semi-solids and liquids, which can be consumed and which help to sustain the body to keep it healthy. The terms ‘food’ and ‘nutrition’ are sometimes used synonymously, but it is not strictly correct. Food is defined as “what one feeds on and is a composite mixture of many nutrient substances ranging from a fraction of a gram in some cases to hundreds of gram in others. The foodstuff is defined as anything, which can be used as food. Therefore, the word ‘nutrition’ is derived from the word ‘nutricus’, which means ‘to suckle at the breast’. Nutrition is defined as combination of dynamic process by which the consumed food is utilized for nourishment, structural and functional efficiency of every cell of the body.
Metabolism refers to all biochemical reactions within the body. It consists of anabolic reactions that build substances, body tissues; and catabolic reactions, those that breakdown substances. Food is ingested, digested and absorbed to produce the energy needed for these reactions. The energy requirement of an awake person at rest is called the ‘basal metabolic rate’ (BMR). BMR is the energy needed at a person's lowest level of cellular functions. Age, body size, temperature, growth, sex, nutritional status, emotional status and good intake affect individual energy requirements beyond the BMR. When energy requirements are completely met by caloric intake in food, people maintain their activity levels without weight change. If the number of calories ingested exceeds energy needs, people gain weight. When the calories ingested fail to meet energy requirements, people lose weight.
Nutrition encompasses all of the processes involved in consuming and utilizing food for energy, maintenance and growth. The processes include ingestion, digestion, absorption, metabolism and excretion. Much of the discussion throughout this chapter focuses on ingestion. Because this is the process that, the individual can control and with which, the nurse can assist the client. Basic information is presented about proper nutrition and the role of the nurse in assisting clients to meet their nutritional needs. Topics covered include, specific nutrients and their functions in the body; phytochemicals; promoting proper nutrition; factors influencing nutrition; nutritional needs during the life cycle; nutrition and health; weight management; food labeling; quality and safety; food allergies; and nutrition and the nursing process.
Physiology of Nutrition
Five processes are involved in the body's use of nutrients (Fig. 1.2):
  1. Ingestion
  2. Digestion
  3. Absorption
  4. Metabolism
  5. Excretion.
Ingestion: Nutrition begins with ingestion, taking food into the digestive tract, generally through the mouth.
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Fig. 1.2: Physiology of nutrition
9In special circumstances, ingestion occurs directly into the stomach, through a feeding tube.
Digestion: Digestion refers to the mechanical and chemical processes that convert nutrients into a physically absorbable state. Mechanical digestion includes mastication (chewing), breaking food into fine particles and mixing it with enzymes in saliva and deglutition (swallowing food), the peristaltic waves and mucus secretions that move the food down the esophagus. Chemical digestion includes the digestive juices that changes food into the individual nutrients, which can be used by the body. Digestion begins in the stomach (except in the case of some starches for which digestion begins in the mouth) and is completed in the intestines. Peristalsis [rhythmic, coordinated, serial contractions of the smooth muscles of the gastrointestinal tract (GIT)] forces chyme (an acidic, semi-fluid paste) through the small and large intestines. Only carbohydrates, proteins and fats require chemical digestion to make the nutrients available for absorption (Fig. 1.3).
Absorption: Absorption is the process, whereby the end products of digestion (i.e. individual nutrients) pass through the epithelial membranes in the small and large intestines and into the blood or lymph systems. The nutrients are absorbed and taken to the parts of the body that need them. Most nutrients are water soluble and can be absorbed directly through the villi (finger-like projections that line the small intestine) and into the blood. Fats, which are not water soluble are absorbed first into the lymph system and eventually enter the circulatory system (Fig. 1.3).
Metabolism: The conversion of nutrients into energy by the body is called metabolism. This process is the sum total of all the biological and chemical processes in the body as they relate to the use of nutrients in every body cell. Metabolism involves two processes:
  1. Anabolism.
  2. Catabolism.
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Fig. 1.3: Digestion and absorption of food
10Anabolism: Anabolism is the constructive process of metabolism, wherein new molecules are synthesized and new tissues are formed, as in growth and repair. This process requires energy.
Catabolism: Catabolism is the destructive process of metabolism, wherein tissues or substances are broken into their component parts. This process releases energy. During metabolism, energy is also produced by the process of oxidation, which is the chemical process of combining nutrients with oxygen. The energy produced by the body is used in a number of ways such as electrical energy for brain and nerve activities, chemical energy for metabolism, mechanical energy for muscle contractions and thermal energy to keep the body warm. Metabolic rate is the rate of energy utilization in the body; it is expressed in units called calories. One calorie is the amount of heat required to raise the temperature of 1 g of water by (1°C). Because of the large quantity of energy released during metabolism, the energy is expressed in kilocalories (kcal), each of which is equal to 1,000 calories.
Basal metabolism is the amount of energy needed to maintain essential physiologic functions, when a person is at complete rest, i.e. the lowest level of energy expenditure. The major factor affecting basal metabolism is body composition. Lean muscle tissue has a higher metabolic rate and thus produces more energy than fat tissue. Generally, women have a lower metabolism than men, because they have a higher percentage of fat tissue; however, metabolism increases during menstruation, pregnancy and lactation. Age has also an influence, because growth periods increase metabolism. Glandular activity, especially of the thyroid gland, affects metabolism. The rate of metabolism is governed primarily by the hormones triiodothyronine (T3) and thyroxine (T4). Hypothyroid activity, a decrease in the secretion of thyroid hormones, causes a lower rate of metabolism; whereas hyperthyroid activity, an increase in the secretion of thyroid hormones, causes a higher rate of metabolism.
Excretion: Excretion is the process of eliminating or removing waste products from the body. Dietary fiber and indigestible materials, salts and other products such as bile and water are converted into feces and excreted from the body as solid waste. Other excretory organs that aid the digestive system in the elimination of wastes include the kidneys, bladder, sweat glands, skin and lungs. Most liquid waste is sent through the kidneys and bladder to be excreted as urine. Some liquid waste is removed through the sweat glands of the skin as perspiration. Gaseous waste is eliminated through the lungs.
Health is defined by the World Health Organization (WHO) as the “state of complete physical, mental and social well-being and not merely the absence of disease or infirmity.” To maintain good health and nutritional status, one must eat a balanced food, which contains all the nutrients in the correct proportion.
The essential requisites of health would include the following:
  • Achievement of optimal growth and development, reflecting the full expression of one's genetic potential.
  • Maintenance of the structural integrity and functional efficiency of body tissues necessary for an active and productive use.
  • Mental well-being.
  • Ability to withstand the inevitable process of aging with minimal disability and functional impairment.
  • Ability to combat diseases such as:
    • Resisting infections (immunocompe-tence).
    • Preventing the onset of degenerative diseases.11
    • Resisting the effect of environmental toxins/pollutants.
Till three decades, the role of nutrition in growth and development and tissue integrity alone was clear, but now the persuasive role the nutrition plays in the other dimensions of health is implicit. Hence, an optimal nutritional status is an indication of good health. This recent advance has brought about a large-scale change in dietary habits and practices of the population.
Facts about Basic Nutrition and Health
  • The amount and kinds of food eaten affect his/her health and well-being.
  • Eating the recommended servings of food ‘from the food guide pyramid’ will provide key nutrients and enable a person to meet the dietary recommendations outlined in this concept.
  • Counting food servings is important to assure that adequate choices are made from the pyramid.
  • New dietary guidelines are available to help a person to plan for sound nutrition.
    The number of calories needed per day depends upon the body's metabolic rate (BMR), which in turn, depends upon factors such as age, sex, size, muscle mass, glandular function, emotional state, climate and exercise.
  • Eating well can reduce risk of various health problems and increase quality of life.
Dietary Recommendations (Fig. 1.4)
For fats:
  • Excess fat in the diet, particularly saturated fat, is associated with an increased risk of disease and is inversely related to optimal health.
  • Modified fats and fat substitutes in the diet can have varying health consequences.
  • There are some recommendations that can be followed to assure healthy amounts of fat in the diet.
For carbohydrates:
  • For optimal health, carbohydrates, especially complex carbohydrates, should be the principle source of calories in the diet.
    • There are some recommendations that can be followed to assure healthy amounts of carbohydrate in the diet.
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Fig. 1.4: Dietary requirements
12For proteins:
  • Protein is the basic building block for the body, but dietary protein constitutes a relatively small amount of daily calorie intake.
  • There are some recommendations that can be followed to assure healthy amounts of protein in the diet.
For vitamins:
  • Adequate vitamin intake is necessary to good health and wellness, but excessive vitamin intake is not necessary and can be harmful.
  • There are some recommendations that can be followed to assure healthy amounts of vitamins in the diet.
For minerals:
  • Adequate mineral intake is necessary for good health and wellness, but excessive mineral intake is not necessary and can be harmful.
  • There are some recommendations that can be followed to assure healthy amounts of minerals in the diet.
For water and other fluids:
  • Water is a critical component in the healthy diet. Beverages other than water are a part of many diets. Some beverages can have an adverse effect on good health.
  • There are some recommendations that can be followed to assure healthy amounts of water and fluids in the diet.
Facts about Sound Eating Practices
  • Healthy snacks can be an important part of good nutrition.
  • Consistency (with variety) is a good general rule of nutrition.
  • Moderation is a good general rule of nutrition.
  • Careful selection of food choices is important for those who rely on fast foods as a significant part of their diet.
  • There are some recommendations that can be followed concerning fast foods.
Facts about Nutrition and Physical Performance
  • Carbohydrate loading and carbohydrate replacement during exercise can enhance sustained aerobic performances exceeding 1 hour in length.
  • The timing may be more important than the makeup of the pre-event meal.
  • High protein diets advocated for active people and athletes have been questioned by leading organizations in the areas of health, physical activity and nutrition.
  • People who are interested in enhancing physical performance are especially subject to nutrition quackery.
Importance of Nutrition in Health
Nutrition may be defined as the science of food and its relationship to health. It is concerned primarily with the part played by nutrients in body growth, development and maintenance. The word nutrient or ‘food factor’ is used for specific dietary constituents such as proteins, vitamins and minerals. Dietetics is the practical application of the principles of nutrition; it includes the planning of meals for the well and the sick. Good nutrition means ‘maintaining a nutritional status that enables us to grow well and enjoy good health’.
Nutrition deals with the way in which the human body receives and uses all the substance or materials necessary for its growth and development and for keeping it in good condition.
This begins in eating food. The food is swallowed, then digested as it is passed through the stomach and small intestines. During digestion, the food is broken up into simple substances. These are absorbed into bloodstream and carried to the liver, where 13they are either stored or changed further or sent out to other parts of the body for use as required. Some are used to supply the body with heat and energy and others for the building and repair of the tissues and yet others are used to control the chemical changes taking place in the body or to protect the body from diseases, finally the waste products, which cannot be used are excreted.
Relation of Nutrition to Health (Fig. 1.5): Good nutrition is a basic component of health. The relation of nutrition to health may be seen from the following view points:
  • Growth and development: Good nutrition is essential for the attainment of normal growth and development. Not only physical growth and development, but also the intellectual development; learning and behavior are affected by malnutrition. Malnutrition during pregnancy may affect the fetus resulting in stillbirth, premature birth and ‘small-for-dates’ babies. Malnutrition during early childhood delays physical and mental growth; such children are slow in passing their milestones and are slow learners in school. Good nutrition is also essential in adult life for the maintenance of optimum health and efficiency. In short, nutrition affects human health from birth till death.
  • Specific deficiency: Malnutrition is directly responsible for certain specific nutritional deficiency diseases. The commonly reported ones in India are kwashiorkor, marasmus, blindness due to vitamin A deficiency, anemia, beriberi, goiter, etc. Good nutrition therefore is essential for the prevention of specific nutritional deficiency diseases and promotion of health.
  • Resistance to infection: Malnutrition predisposes to infections like tuberculosis. It also influences the course and outcome of many of the clinical disorders. Infection, in turn, may aggravate malnutrition by affecting the food intake, absorption and metabolism.
  • Mortality and morbidity: The indirect effects of malnutrition on the community are even more striking: a high general death rate, high-infant mortality rate, high-sickness rate and a lower expectation of life.
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    Fig. 1.5: Relation of nutrition and health
    14Over-nutrition, which is another form of malnutrition, is responsible for obesity. Diabetes, hypertension, cardiovascular and renal disease, disorders of the liver and gallbladder. More recent reports suggest that diet perhaps plays an important role in certain types of gastrointestinal cancers. It is now quite well-accepted that diet and certain diseases are inter-related.
Malnutrition is widely prevalent in India. The specific nutritional problems are:
  • Protein-calorie malnutrition: This is due to deficiency of calories and proteins in the diet. A large number of children are victims of kwashiorkor and marasmus in India.
  • Endemic goiter: About 71 million people are estimated to be affected by endemic goiter (i.e. swelling of the thyroid gland in the neck) and other iodine deficiency disorders. This condition is due to iodine deficiency.
  • Vitamin deficiencies: Deficiency of vitamin A is an important public health problem in India especially in the age group, 3–5 years.
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Fig. 1.6: Major nutritional problems in India
Nutrition and Diseases
A balanced dietary intake promotes nutritional health. Genetic predisposition seems to play subsidiary role in dietary intake. Malnutrition in developing countries is essentially because of the nature of undernutrition. Inadequate dietary intake causes health problem in pregnant women, lactating mothers and growing children.
  • Diet and chronic diseases: Modern epidemics of nutrition-related chronic diseases have appeared in developed countries of the world, which is attributed to the intake of ‘affluent diet’. The disease includes hypertension, coronary heart diseases, diabetes, etc. Chronic liver diseases include cirrhosis of liver, which are also prevalent in the affluent classes and are related to excessive intake of alcohol.
  • Diet and cancer: Epidemiological studies carried out all over the world have established that nearly one third of all cancer types are directly related to one or the other dietary components. Diet rich in saturated fats is particularly linked to colon cancer and prostate cancer. Breast cancer and rectum cancer are also related to high-fat intake. Epidemiological studies have revealed that regular intake of fruits and vegetables high in fiber content, low in saturated fats and rich in several antioxidants, vitamins, namely retinol, carotene, vitamin C and vitamin E act as cancer anticarcinogenic agents.
  • Diet and dental diseases: Diet rich in sugar content predispose to dental caries. Sugar has casual association with dental caries; the association is particularly strong during childhood years with sugars that are consumed in between meals rather than with meals. High-starch diet is not carcinogenic obviously because it contains complex sugars.15
  • Diet and skeletal disease: Consumption of diet, poor in calcium, may predispose to osteoporosis. Alcohol intake and smoking habits are also related to osteoporosis. Osteoporosis predisposes to fracture especially in elderly people.
  • Diet and mental health: Inadequate dietary intake deficient in nutrients like iodine, nicotinic acid and iron can retard mental development or impair mental performance. Iodine deficiency can cause an extreme degree of mental impairment as seen in cretinism. Nicotinic acid deficiency can lead to dementia in extreme cases of pellagra.
  • Diet and diet therapy: Dietetics is the word used to describe the practical application of the principles of nutrition to the human body in health and disease. Diet therapy is the science dealing with prescription of appropriate diet to patients, which constitutes an important component of their treatment.
The Government of India, Ministry of Health and Family Welfare developed and published the “National Health Policy” in 1983. The document gave a general exposition of the policies. The biggest omission in the draft is the lack of any discussion on comprehensive and universal health care. In contrast, the NHP 1983 had said: “India is committed to attaining the goal of ‘Health for All by the Year 2000 AD’ through the universal provision of comprehensive primary health care services”. The National Health Policy was endorsed by the Parliament of India in 1983 and updated in 2002. In brief, the draft constitutes a return to the concept of centrally-directed, institution-based health care. If allowed to be enshrined in its present form, the NHP can be used as a tool to legitimize privatization of the health sector. A further perusal of the document throws up many fundamental concerns such as the creation of an infrastructure for primary healthcare; close coordination with health-related services and activities (like nutrition, drinking water supply and sanitation); active involvement and participation of voluntary organizations; provision of essential drugs and vaccines; qualitative improvement in health and family planning services; provision of adequate training; and medical research aimed at the common health problems of the people. The draft recommends an increase in public health expenditure from the present 0.9% of GDP to 2.0% in 2010.
General objective: The general objective of the National Nutrition Policy is to improve the nutritional status of the people.
Specific objectives
  • Promote practices favorable to the improvement of the nutritional status.
  • Reduce the prevalence of diseases linked to nutritional deficiencies and excesses.
  • Prevent mother-to-child transmission of HIV through appropriate breastfeeding infant and young child feeding practice.
  • Assure adequate treatment of malnutrition due to nutritional deficiencies and excesses.
  • Provide nutritional care and support for people living with HIV/AIDS.
Expected outcomes and the link to the Millennium Development Goals (Fig. 1.7):
Goal 1: Reduce poverty: The prevalence rate of protein-energy malnutrition in children under five years of age is reduced from 45–30% for stunting, 22–15% for underweight, 4–2% for wasting.
Goal 2: Ensure primary education
  • The prevalence rate of anemia is reduced from 56–37% in children and from 33–22% in women.
  • Iodine deficiency disorders are eliminated from 26% to less than 5% of total goiter.16
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Fig. 1.7: Millennium development goals
Goal 3: Reduce infant mortality
  • Increase the proportion of women exclusively breastfeeding for the first 6 months with optimal complementary feeding up to 24 months from 74–60%.
  • Reduce Vitamin A deficiency from 25% to 5% in children under five years.
Goal 4: Reduce maternal mortality
  • Reduce vitamin A deficiency (night blindness) in pregnant women from 7% to less than 1%.
  • Reduce the prevalence of anemia in pregnant women from 33–22%.
Goal 5: Combat HIV/AIDS and other diseases
  • Nutritional support is provided to PLWA and other vulnerable people.
  • Nutrition related chronic diseases are prevented.
Strategies for nutrition improvement:
  • Reinforcement of the political commitment.
  • Promotion of optimal infant and young child feeding.
  • Scaling up of community-based nutrition programs.
  • Food fortification.
  • Promotion of household food security.
  • Prevention and management of mal-nutrition and related diseases.
  • Nutritional support to PLWHA and their families.
  • Communication for behavior change.
Monitoring and evaluation: To ensure effective implementation of planned activities, monitoring and evaluation is essential in all development programs. In addition, periodic evaluations are necessary for establishing level of objective achievement. In order to follow up implementation of nutrition programs, data will be collected regularly at the health center and community level; in addition, other opportunities for nationwide surveys will be identified and utilized. Nutritional surveys and epidemiological surveillance will be conducted regularly, with appropriate indicators, to evaluate the progress and impact of nutritional interventions. Operational research will also be carried out to address specific problems identified during the implementation of nutritional activities. To prevent nutritional emergencies, nutrition unit will reinforce collaboration with all existing structures that collect and analyze bioclimatic, environmental, demographic and agricultural data for early warning and timely intervention measures against disasters that can negatively affect the nutrition.
Habits about eating are influenced by developmental considerations, gender, ethnicity and culture, beliefs about food, personal preferences, religious practices, lifestyle, economics, medication and therapy, health, alcohol consumption, advertising, and psychological factors. Although, the nutritional content of food is an important consideration when planning a diet, an individual's food preferences and habits are often a major factor affecting actual food intake (Table 1.2).17
Table 1.2   Factors affecting food and nutrition
Sl. No.
People in rapid periods of growth (i.e., infancy and adolescence) have increased needs for nutrients. Elders, on the other hand, need fewer calories and dietary changes in view of the risk of coronary heart disease, osteoporosis, and hypertension.
Nutrient requirements are different for men and women because of body composition and reproductive functions. The larger muscle mass of men translates into a greater need for calories and proteins. Because of menstruation, women require more iron than men do prior to menopause. Pregnant and lactating women have increased caloric and fluid needs.
Ethnicity and culture
Ethnicity often determines food preferences. Traditional food (e.g., rice for Asians, pasta for Italians, and curry for Indians) are eaten long after other customs are abandoned. Nurses should not use a “good food, bad food” approach, but rather should realize that variations of intake are acceptable under different circumstances. The only “universally” accepted guidelines are to eat moderately to maintain correct body weight. Food preference probably differs as much among individuals of the same cultural background as it does generally between cultures. Not all Italians like pizza, for example, and many undoubtedly enjoy Mexican food.
Social factors
Food habits are handed over from generation to generation in the society particularly in the developing countries. Though these factors have very little or no scientific basis, people rigidly adhere to them in many parts of India; pregnant women are not allowed to consume papayas as it is believed that papayas produce a lot of heat in the body, which in turn induce abortion.
Religious factors
Many Hindus are vegetarians; Jains do not eat curd and do not eat after sunset. To eat meat is to destroy the seed of compassion. Islamic food laws prohibit the consumption of unclean foods such as swine and animals killed in a manner that prevents their blood from being fully drained from their bodies. Jews do not eat pork and shellfish.
Cultural factors
It is a custom in most of the communities in India that women and girls eat only after men and boys finish their eating. Curd and citrus fruits should not be taken by a person suffering from cold or cough.
Traditional factors
The traditional cooking practices also act as a barrier to achieving a balanced diet, e.g. using polished rice, draining away the rice water and prolonged boiling of vegetables add to the great loss of nutrients. Women should take only bread and coffee for two days after the delivery of a child and a very small quantity of water should be given.
Economical factors
Financial resources determine the type of food, depending on the availability one selects the food. People in lower income groups in India consume a combination of cereals and cheaply available green leafy vegetables, roots and tubers.
Beliefs about food
Beliefs about effects of foods on health and well-being can affect food choices. Many people acquire their beliefs about food from television, magazines, and other media. For example, some people are reducing their intake of animal fats in response to evidence that excessive consumption of animal fats is a major risk factor in vascular disease, including heart attack and stroke. Food fads that involve nontraditional food practices are relatively common. A fad is a widespread but short-lived interest or a practice followed with considerable zeal. It may be based either on the belief that certain foods have special powers or on the notion that certain foods are harmful. Food fads appeal to the individual seeking a miracle cure for a disease, the person who desires superior heath, or one who wants to delay aging. Some fad diets are harmless, but others are potentially dangerous. Determining the needs a fad diet fills for the client enables the nurse both to support these needs and to suggest a more nutritious diet.
Personal performance
People develop likes and dislikes based on associations with a typical food. A child who loves to visit his grandparents may love pickled crabapples because they are served in the grandparent's home. Another child who dislikes a very strict aunt grows up to dislike the chicken casserole she often prepares. People often carry such preferences into adulthood. Individual likes and dislikes can also be related to familiarity. Children often say they dislike a food before they sample it. Some adults are very adventurous and eager to try new foods. Others prefer to eat the same foods repeatedly. Preferences in the tastes, smells, flavors (blends of taste and smell), temperatures, colors, shapes, and sizes of food influence a person's food choices. For example, some people may prefer sweet and sour tastes to bitter or salty tastes. Texture plays a great role in food preferences. Some people prefer crisp food to limp food, firm to soft, tender to tough, smooth to lumpy, or dry to soggy.
The longer that fruits or vegetables sit around waiting to be sold or eaten, the more nutrients they lose. But fruits and vegetables grown for freezing are usually frozen right after they're picked. Therefore, they have less time to lose their nutrients.
Table 1.3   Medicinal values of food
As basic as it may sound, an apple provides you with 13 minerals which our body require daily. A sample mix of apple, walnuts and yoghurt makes a great breakfast to start the day.
The vilayati version of cauliflower is now readily available all over our city. Make good use of it; in a recent survey of greens, broccoli was found to be healthiest, since it is a powerful anticarcinogen.
As chilly as winter is.
Dudhi (melon)
Melon is known to reduce blood pressure. Incorporate dudhi as part of your cuisine to lower your blood pressure, for a healthier heart in general, to lower cholesterol, and many other benefits.
Egg (egg white)
Make it a habit to remove the yolk, since egg whites are a great source of protein.
Omega-3 in some fish prevents cardiovascular disease. Also, a good source of protein. However, avoid canned varied, and over-salted, smoked dishes. Also shell fish, crab and all forms of mussels need to be strictly eaten in moderation.
There are way too many health benefits.
Home grown sprouts
Sprouts, though available in the local grocery, are a much healthier option if grown at home. It's easy to make these at home (soak them overnight), and they make for a quiet tasty snack either in chaats, or raitas, or salads of your choice.
Iceberg lettuce
Another designer food item, which is becoming readily available. This one is great to make salads with, at home. Mix with tofu, sprouts, tomatoes, chicken and fat free yoghurt to get you through the day.
Juice blender
Choose a juice of choice for the year. It could be anything you want. But make sure you make it at home. Most bottled juice come with lots of sugar and preservatives.
As bitter and unappetizing as it may sound. The health benefits of this desi veggie far outweigh its sharp taste. It regularizes blood sugar, aside from a range of other ailments.
Sprinkle your food with lots of lemon. It's got lots of vitamin C that you need to boost your immune system. Besides, by replacing lemon with salt as it condiment for your meals, you're helping your heart in more ways than one.
Milk (skimmed)
Milk (but skimmed), there's no way we've been able to escape milk; it's too ingrained in our culture. So go for it, enjoy your milk, but get a bottle of skimmed milk.
Nuts reduce coronary heart disease. Almonds and walnuts lower serum LDL cholesterol levels. Dieticians frequently recommend nuts to diabetes patients with insulin resistance. And those who eat nuts live two to three years longer than those who don't.
Olive oil
Is clearly the healthiest option to the necessary evil, that is oil. Its high content of monounsaturated fatty acids and its high content of antioxidants make it the best alternative.
Green peas provide good amount of eight vitamins, seven minerals, dietary fiber and protein. In addition, they are a good source of vitamin K1, which activates osteocalcin, the major noncollagen protein in bone.19
Quality fruit
The price of fruits has gone over the top. However, fruits are known to be some of the best antioxidants, are a great source of fiber and nutrients. Load your fridge with quality fruits like berries, apples, bananas, even the tomato.
Red cabbage
Your kids may cringe at sight of regular cabbage. But the flamboyant red cabbage might convince them. Also a source of indole-3-carbinol (13C), which Reduce the risk of breast cancer by 50%.
It helps to prevent cancer. They also bring out flavor in champagne.
Another desi habit we can't give up. So why not substitute chai with green tea or black tea. Regular use is known to strengthen bone and cure osteoporosis.
Sorry but G was taken by garlic. But ginger (adrak) is essential to health.
Varan-bhat (dhal rice)
Simplicity is a virtue. Amidst your hectic socializing and gourmet fantasies, normal ghar ka khana once a day will do wonders for health.
Walnuts reduce the risk of prostate cancer in men.
Again is a great source of calcium, aid in digestion and can be merged with a range of salads, health food items, marinades. Always keep a bowl of fresh, homemade yoghurt handy in your fridge.
This Italian kakadi ids low in calories and contains a high amount of folate, potassium, vitamin A and manganese. Z though is also for zinc. So don't forget to stack up on your spinach, lentils and salmon.
Nutritive Values of Common Foods
Food contains nutrients in different proportions and with different organoleptic properties. Hormonal substances, enzymatic substances and antioxidants are present in various proportions in addition to micro and macronutrients (Fig. 1.8).
  • Cereals: They are rich in carbohydrate, low in protein (6–12%), low in fat, poor in iron and calcium. Rice, barely, ragi, millets and wheat are some of the examples of cereals. Insulin stimulants are present in ragi and millets former is rich in calcium, latter is a source of fiber. Except yellow maize and sorghum, cereals have previtamin A and ascorbic acid. Wheat has acarbose, a chemical helpful to maintain normal blood sugar level. Richest source of iron are bajra and samai (panicum miliare). 100 g of staple food or cereals yield 346 kcal of energy.
  • Pulses and legumes: They are generally called protein foods. They contain 22% protein-soluble and insoluble fiber. They are rich in potassium and vitamin B, deficit in methionine, but rich in lysine. More than 40% of protein is present in soybean. It is the richest source of protein among the plant foods. Calorific value of pulses and legumes are ranging from 315–372 kcal for every 100 g. But green peas and soybean provide 93 and 432 kcal, respectively.
    zoom view
    Fig. 1.8: Common food groups
    20Source of pulses and legumes are bengal gram, black gram, red gram, lentil, rajmah, horse gram, cowpea and field bean.
  • Green leafy vegetables: They are low-calorie foods, having 90% moisture, high-fiber, low-protein, rich vitamins and minerals particularly beta-carotene and calcium. In general, greens do not have protein in sufficient amount, but agathi greens contain 8% protein. Low-cost nutritious food like curry leaves have 800 mg calcium for every 100 g. Araikeerai is richest source of iron. Familiar greens like Amaranthus gangeticus are good for normal cardiac function, as it provides potassium. Amaranthus tristis and A. viridis are excellent source of iron and ascorbic acid, respectively. Commonly used green leafy vegetables are coriander leaves, drumstick leaves, mint, amaranth, celery, spinach and curry leaves.
  • Other vegetables: They are known as low-caloric foods, which contain potassium, soluble fiber, vitamin B and ascorbic acid. Some types of vegetable are good source of calcium, e.g. sundakkai and field beans. Folic acid present in lady's finger and chow chow helps in malnutrition of red blood cell (RBC). Choline of pumpkin and cauliflower is vital and regulates fat metabolism.
  • Roots and tubers: They are poor source of protein, but good source of carbohydrate. Beta-carotene in carrot and yam, ascorbic acid in potato, magnesium in pink radish, and phosphorus in colocasia are particularly helpful to meet normal requirements of recommended dietary allowances for an individual.
Healthy Substances of Food
  • Tomato: It has lycopene, which is anticancer carotenoid.
  • Bitter gourd: It is an insulin stimulant.
  • Cruciferous vegetables: Brussels sprouts, broccoli and which has indole, resist cancer of womb.
  • Cucumber: It is diuretic and has arginine.
  • Green tea: It contains catechins, an antioxidant.
    • Fruits: Fruits are roughage, provide bulk to the stools. Most of the fruits are good sources of vitamins and minerals. Ascorbic acid in alma is richer than fruits such as orange, lime and grapes. 100 g of Indian gooseberry yields 600 mg of vitamin C. Beta-carotene, a precursor of vitamin A, found in mango and papaya helps to maintain good vision because of an action similar to pepsin. Papain relieves the symptoms of episiotomy (surgical incision of vulva during delivery). Watermelon is a very meager energy yielder, whereas dried fruits provide high calories. A report by National Academy of Sciences found that resveratrol, a chemical known to be highly concentrated in grapes skin, acts like estrogen, a hormone known to protect against heart diseases.
    • Nuts and oil seeds: They are rich in saturated fats; contain tocopherol, thiamine and niacin. Almond, cashew nut, groundnut, walnut, sesame seed, linseed are some sources of nuts and oil seeds. Groundnuts contain monounsaturated fatty acid, 25% protein and 40% fat. Nutritious ball made from groundnut and jaggery is a healthy food for children. Coconut meals raises hemoglobin content, as it provides approximately 70 mg iron. Most of the nuts and oil seeds are energy yielder and rich in phosphorus. Short-and medium-chain fatty acid of coconut oil is good for infant-intestine.
    • Eggs: They are good mixture of all nutrients except carbohydrate and fiber; supplies essential amino acids and termed as good quality proteins. Raw egg white contains antinutritional factor avidin, which binds with biotin and makes it unavailable. Ovalbumin, ovomucoid, flavoprotien are egg white proteins. 21One egg yolk contains 200 g cholesterol and proteins such as lipovitellin and phosvitin. 13% fat, 170 kcal energy, 2 mg iron, 60 mg calcium, 220 mg phosphorus can be obtained from 100 g of egg. Cooked egg is better than raw egg.
    • Meat poultry and fish: Beef meat is richest source of iron among meat products. Protein in the meat and meat products are superior compared to vegetable proteins. Essential amino acids and biological value are responsible to upgrade the quality. Protein value of mutton is less than that of chicken, but fat percentage is higher than fish and chicken. They all are moderate source of phosphorus. Common fish varieties rohu and katla have 1.4% and 2.4% of fat, respectively. Cat fish is free from fat. Fatty fish are hilsa, tapsee and dried chela. Omega fatty acid content of fish is helpful in preventing cardiac diseases. Consumption of cod-liver oil protects eyes from night blindness.
    • Milk and milk products: Milk is ideal food from infant to aged. Skimmed milk, cheese, tinned milk powder, khoa and supplementary foods are made from milk. Cow milk, buffalo milk and processed milk are widely consumed. Protein content of cow milk is higher than human milk, but buffalo milk is rich in fat. High protein and calcium content among milk products is in skimmed milk powder. This group of foods have sufficient phosphorus, thiamine, niacin, but deficit in iron and vitamins. Energy value of 100 g cow milk, buffalo milk, goat milk, human milk is 67, 117, 72 and 65 calories, respectively.
Food does much more that satisfy your appetite. It provides nutrients that the body uses for growth and health. There are five types of nutrients that fall into two broad categories: macronutrients and micronutrients. Macronutrients, which are required in large amounts include carbohydrates, proteins and fats. In contrast, micronutrients are required in small amounts that include vitamins and minerals. A sixth category includes water, which is essential to life.
Classification by Origin
  • Food of animal origin
  • Food of vegetable origin
Classification by Chemical Composition
  • Carbohydrates
  • Proteins
  • Fats
  • Vitamins
  • Minerals.
Classification by Predominant Function
  • Body building foods, e.g. milk, meat, poultry, fish, eggs, pulses, ground nuts, etc
  • Energy giving foods, e.g. cereals, sugars, roots and tubers, fats and oil
  • Protective foods, e.g. vegetables, fruits, milk.
Classification by Nutritive Value
  • Cereals and millets
  • Pulses (legumes)
  • Vegetables
  • Nuts and oil seeds
  • Fruits
  • Animal foods
  • Fats and oil
  • Sugar and jaggery
  • Condiments and spices
  • Miscellaneous foods.
Since, the food is varying in their contents of various nutrients, they have been broadly grouped under three categories from the nutritional point of view (Fig. 1.9).22
  1. Energy yielding foods.
  2. Body building foods.
  3. Protective foods.
These are briefly discussed below:
Energy yielding foods: Food rich in carbohydrates and fats are called energy yielding foods. Cereals, roots and tubers, dried fruits, sugars and fats are included in this group. Cereals contain, in addition, fair amounts of proteins, minerals and certain vitamins and form the important sources of the above nutrients.
Body building foods: Food rich in proteins are called body building foods. Milk, meat, fish, eggs, pulses, oil seeds and nuts and low-fat oil seed flours are included in the group of body building foods.
Protective foods: Food rich in protein, vitamins and minerals are termed protective foods. Milk, eggs, liver, green leafy vegetables and fruits are included in this group. Protective foods are broadly classified into two groups:
  1. Food rich in vitamins, minerals and proteins of high biological value, e.g. milk, eggs and liver.
  2. Foods rich in certain vitamins and minerals only, e.g. green leafy vegetables and fruits.
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Fig. 1.9: Classifications of food
Five Food Group Plans
The nutritional expert group of Indian Council of Medical Research, India suggested a five food group plan and the nutrients supplied by each food group are given in Table 1.4.
Table 1.4   Basic five food groups
Sl. No.
Cereals, roots and tubers: These entire nutrients primarily supply energy. This group includes foods like wheat, jowar, bajra, ragi and other cereals. Tapioca, potato, sweet potato, arbi and yam come under roots and tubers. This group provides calories, protein, iron and vitamins. These foods are cheap and are taken in large amounts by the low-income groups. This also provides thiamine and niacin.
Protein-giving foods: The food stuffs in this group are primary sources of protein; though cereals also furnish protein. Dals, grains, peas, beans, groundnuts, cashew nuts, almonds, coconut, milk, curd, buttermilk, paneer (cottage cheese) khoya, eggs, fish, mutton, chicken, pork and other flesh foods come under this group. It provides protein both from the vegetables and animal kingdom. Milk and dairy products also provide calcium and riboflavin. Meat, fish and eggs are good sources of protein, iron and niacin.
Fats/oils, sugar/jaggery: All these food stuffs supply energy. These include–vegetable oils, vanaspati oil, ghee, butter, cream, sugar and jaggery. This group constitutes about one-sixth of the energy value of the diet, but does not add appreciably to the protein, mineral or vitamin levels. Butter is a good source of vitamin A.
Protective vegetables and fruits: These are rich sources of minerals and vitamins. These include green leafy vegetables, yellow or orange fruits and vegetables, and citrus fruits.
Other vegetables: They provide variety in taste and texture, and furnish roughage in the diet. These include fruits, stems, leaves and flowers of plants, lady's finger, brinjals, bitter gourds and cauliflower, etc. They are fair sources of certain vitamins and minerals.
Basic Seven Food Groups
The seven food group plan was developed by US department of agriculture in 1943. The seven groups with their nutrient contribution are given in Table 1.5.
Review of nutrients: Macro and Micro nutrients: Nutrients which are needed by the body for good nutritional status are provided by the food. An individual nutritional status is dependent on the provision of sufficient nutrients and the good utilization of these nutrients. Status of nutrition may be caused by eating food, i.e. inadequate in amount and kind, or it may be caused by failure in digestion and utilization of these nutrients. The nutrients present in food fall into three major categories: proximate, vitamins and minerals. The proximate usually referred to as proximate principles include only those nutrients that yield energy on oxidation, i.e. carbohydrates, proteins and fats. Nutrients are organic and inorganic complexes contained in food.
Macro and Micronutrients: Macro nutrients are carbohydrate, protein and fats which are often called “proximate principles” because they form a main bulk of the food.
These are vitamins and minerals. They are called micronutrients because they are required in small amounts. A vitamin is an organic compound that cannot be manufactured by the body and is needed in small quantities to catalyze metabolic processes. When these vitamins are lacking in the diet, metabolic deficits results. Minerals are found in organic compounds and inorganic compounds as free ions. On oxidation, minerals leave an ash, which can be acid or alkaline.
Carbohydrates: Carbohydrates are the chief, cheapest and main source of energy. Carbohydrate normally should provide 50–60% of total caloric requirements. All the carbohydrates contain carbon, hydrogen and oxygen. All the carbohydrates are changed in the body to simple form called glucose (Fig. 1.10).
Carbohydrate can be classified into three categories:
  1. Monosaccharide—Glucose, fructose, galactose
  2. Disaccharides—Maltose, lactose, sucrose
  3. Polysaccharides—Starch, glycogen
Table 1.5   Basic seven food groups
Sl. No
Green and yellow vegetables—provide carotene, ascorbic acid and iron.
Oranges, grape fruits, tomatoes or raw cabbage or salad greens. These give ascorbic acid (vitamin C).
Potatoes, other vegetables and fruits. There are good sources of vitamin and minerals in general and fiber.
Milk and milk products are sources of calcium, phosphorus proteins and vitamins.
Meat, poultry, fish and eggs provide proteins, phosphorus, iron and vitamin B.
Bread flour and cereals provide thiamine, niacin, riboflavin, iron, carbohydrates and fiber.
Butter or fortified margarine are rich sources of fat and vitamin A.
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Fig. 1.10: Macronutrients
Food sources of carbohydrates include sugars, cereal grains, legumes and dried fruits, which are the richest sources of carbohydrates. White sugar is almost pure carbohydrate but cereal grains, legumes and dried fruits may vary in their carbohydrate content. One gram of carbohydrate gives 4 calories of energy on burning. Intake of carbohydrate is ordinarily greater than that of fat for energy. Carbohydrates are also useful in the detoxication of ammonia. The main functions of carbohydrates have a variety of functions in the animal and human body. They supply energy for body functions and for doing work. They are essential for the oxidation of fats. They exert a sparing action on proteins and they add flavor to the diet. Diabetes mellitus is a chronic disease in which blood glucose level is raised above 180 mg per 100 mL blood and glucose is excreted in urine. This disease is primarily due to the insufficient production of hormone-insulin by the beta cells of the islets of Langerhans of the pancreas.
Proteins: The name “protein” was suggested by Mulder in 1838 to the complex organic nitrogenous substances found in animal and plant tissues. Protein constitute about one-fifth (20%) of animal body on the fresh weight basis. They are essential for life processes. They play an important role in many biochemical and biophysical processes in the body.
Classification of proteins:
  • Simple proteins: These include albumins, globulins, glutelins, prolamins, fibrous proteins, histones and protamins.
  • Conjugated proteins: These include nucleoprotein, glycoprotein, phosphoproteins, hemoglobin and lecithoproteins.
  • Derived proteins: These include proteins, metaproteins, coagulated proteins, peptones and peptides.
    The main functions of proteins are to replace the daily loss of body protein, to provide amino acids for the formation of tissue proteins during growth, and to provide the amino acids necessary for the formation of enzymes, blood, proteins and certain hormones of protein nature, and to provide amino acids for growth of fetus in pregnancy and for the production of milk proteins during lactation. Disease due to the deficiencies of protein and calories occur commonly among weaned infants and preschool children in India and other developing countries. They may be classified into three group–kwashiorkor, nutritional marasmus and marasmic- kwashiorkor.
  • Lipids: The term “lipids “is applied to a group of naturally occurring substances characterized by their insolubility in water, greasy feel and solubility in some organic solvents. Fats are solid at 20°C, they are called “oils” if they are liquid at that temperature. They are classified as 1. Simple lipids e.g. triglycerides 2. Compound lipids, e.g. phospholipids 3. Derived lipids, e.g. cholesterol.
Sources of fats may be classified as:
  • Animal fats (fat of meat and fish), ghee, butter, milk and eggs.
  • Vegetable fats (some of the plants store fat in the seeds (e.g. ground nut, mustard, sesame, coconut, etc.)25
  • Other sources from cereals, pulses, nuts and vegetables.
The fats are high energy foods, providing as much as 9 kcal for every gram. Fat in the body support viscera such as heart, kidney and intestine, and fat beneath the skin provides insulation against cold. Cholesterol is essential as a component of membranes and nervous tissue and is a precursor for the synthesis of steroid hormones and bile acid, A diet, rich in fat can pose a threat to human health encouraging obesity, phrenoderma, coronary heart disease, and cancer and skin lesions of kwashiorkor. When the cholesterol level is over 250 mg/100 mL, the incidence of atherosclerosis and coronary heart disease is high.
Vitamins: Vitamins may be defined as organic compounds occurring in small quantities in the different natural foods and necessary for the growth and maintenance of good health in human being and certain experimental animals. Vitamins may be classified into two groups (a) Fat soluble vitamins, e.g. vitamin A, D, E, and K. (b) Water soluble vitamins, e.g. vitamins of the B group and vitamin C.
  • Vitamin A: Vitamin A occurs only in foods of animal origin. Vitamin A activity is also possessed by carotenoids found in plants. Hence, carotenoids are called provitamin A. Vitamin A is not synthesized in the body and must by supplied by food supplements. One of the best defined roles of vitamin A is its requirements for normal vision. Vitamin A is necessary for the health of the epithelial cells. Vitamin A deficiency is one of the main causes of blindness in India. The signs of vitamin A deficiency are predominantly ocular. They include night blindness, conjunctival xerosis, Bitot's spots corned xerosis and keratomalacia. The term “xerophthalmia” (dry eye) comprises all the ocular manifestations of vitamin A deficiency ranging from night blindness to keratomalacia.
  • Vitamin D: Although, deformed bone conditions had been known countries, it was not until 1922 that the cause of rickets was discovered. Many investigations noted that a poor environment, consisting of poor hygiene, lack of sunshine and exercise and often city dwelling was associated with the incidence of rickets. In 1824, cod liver oil was recommended as a remedy for rickets. Vitamin D helps in absorption of calcium and phosphorous and makes them more available for the development of bones. Rickets is the disease caused due to deficiency of vitamin D. The disease is characterized by deformities of the bones like knock knees and bow legs which may last throughout, fish liver oils provides the most potent sources of this vitamin. Also ultraviolet rays of sunlight help in the synthesis of vitamin D in skin.
  • Vitamin E: Vitamin E is the generic name for a group of closely related and naturally occurring fat soluble compounds, the tocopherols, of these alpha–tocopherol is biologically the most potent. Vitamin E is widely distributed in foods. The usual plasma level of vitamin E in adult is between 0.8 and 1.4 mg per 100 mL. A deficiency of vitamin E in various species of animals results in reproductive failure, macrocytic anemia and shorter lifespan of red blood cells. Recently, the cytotoxic effect of vitamin E on human lymphocytes, in vitro, at high concentrations has been reported.
  • Vitamin K: Vitamin K is necessary for the synthesis of prothrombin, an enzyme synthesized by the liver; prothrombin is required for normal clotting of blood. Vitamin K is found in plants. Good sources are cauliflower, spinach and soyabean. In contrast, fruits, cereals and animal products contain little vitamin ‘K’. It is also 26synthesized in the intestinal tract by the bacteria.
    In the newborn babies, intestinal bacteria are not sufficiently developed for the synthesis for vitamin ‘K’. Thus some infants, especially those who are immature, show susceptibility to hemorrhage. Vitamin K is given to infants immediately after birth especially to those who show hemorrhage tendency.
  • Thiamine: Thiamine (vitamin B1) is a water soluble vitamin. It is essential for the utilization of carbohydrates. In thiamine deficiency, there is accumulation of pyruvic and lactic acids in the tissues and body fluids. Thiamine occurs in all natural foods, although small amounts. Important sources are whole grain cereals, wheat gram, yeast, pulses, oilseeds and nuts especially groundnut, meat, fish eggs, vegetables and fruits contain smaller amounts. Thiamine functions in the release of energy from the metabolism of carbohydrate. As a result, thiamine is related to the maintenance of a normal appetite, normal muscle tone in the gastrointestinal tract and healthy nervous system. More advanced deficiencies result in the disease beriberi. There are two types of beriberi. The dry form is characterized by severe muscular wasting, loss of sensation in the skin, loss of weight and paralysis of lower limbs. The wet form produces marked edema which usually starts from lower limbs and develops upward. When it reaches the trunk, involves heart and the result is heart failure.
  • Riboflavin: Riboflavin (Vitamin B2) is a member of B group vitamins. It has fundamental role in cellular oxidation. It is a cofactor in a number of enzymes involved in energy metabolism. Its richest natural sources are milk, eggs, liver, kidney and green leafy vegetables. Meat and fish contain small amounts. There are no real body stores of riboflavin. Low dietary intake of riboflavin may result in fissures at the angle of the mouth, accompanied by the yellow cast. The tongue may exhibit glossitis, turning to purplish-red in color, accompanied by a painful burning sensation.
  • Nicotinic acid (Niacin): Nicotinic acid contains a pyridine nucleus. It is essential for the metabolism of carbohydrate, fat and protein. Nicotinic acid is essential for the normal functioning of the skin, intestinal tract and the nervous system. Food rich in niacin or tryptophan are liver, kidney, meat, poultry, fish, legumes and groundnut. Milk is a poor source of niacin. Nicotinic acid deficiency causes the disease “pellagra” in human beings. This disease is characterized by three D's—dermatitis, diarrhea and dementia. The dermatitis and diarrhea are two distributions and occurs in the hands, feet and neck.
  • Pyridoxine (B6): Pyridoxine (vitamin B6) exists in three forms, pyridoxine, pyridoxal and pyrioxamine. It plays an important role in the metabolism of amino acids, fats and carbohydrates. Rice dietary; sources are dried yeast rice polishing, wheat gram and liver. Pyridoxine is essential for maintaining the nerves in normal condition. Pyridoxal phosphate acts as coenzyme in the metabolism of amino acids. Effects of deficiency in human adults are seborrhea like lesion developed around the eyes, nose and mouth within 2–3 weeks. In infants, deficiency seen as nervous irritability and convulsive seizures.
  • Pantothenic acid: Pantothenic acid is one of the vitamins of the vitamins B complex, which can prevent or cure a specific type of dermatitis (chick pellagra) in chicks fed on vitamin B2 deficient. Pantothenic acid in the form of coenzyme A takes part in the metabolism of carbohydrates and fats. It is essential for the oxidation of pyruvic acid. Burning feet syndrome was observed in prisoners of war during World War II 27in Japan, and Burma. This syndrome was associated with neurological and mental disturbances. Gopalan (1946) found that burning feet syndrome observed in Indian subjects responded to treatment with calcium pantothenate (20–40 mg).
  • Folic acid: Folic acid was known under different names from 1933 by its curative effects in deficiency states in man and in different experimental animals. It is essential for the maturation of red blood cells. It acts as a coenzyme in the synthesis of methionine and of purine and pyrimidine rings. Foods such as liver, meat, dairy products, eggs, milk, fruits and cereals are as good dietary sources as leafy vegetables. Overcooking destroys much of folic acid and thus contributes to folate deficiency in man. Nutritional megaloblastic anemia in adults, the classical studies of Wills (1931) in India showed that the megaloblastic anemia is prevalent in pregnant women of the low income groups substituting on poor vegetarian diets. Megaloblastic anemia has been reported to occur among malnourished children in the developing countries.
  • Vitamin B12 (cyanocobalamine): Cyanocobalamine was found effective in curing pernicious anemia when administered intramuscularly; in small quantities (5–10 mg); for the absorption of vitamin B12 from the intestines; a factor called “Intrinsic factor” (IF) secreted by the stomach is essential to store vitamin B12 in fair amount in the liver. Vitamin B12 promotes the maturation of red blood cells. It acts on the narrow elements and is involved in the formation of white blood cells and blood platelets. It cures the neurological symptoms of pernicious anemia. It acts as a coenzyme in the synthesis of methione. Vitamin B12 deficiency causes the disease “pernicious anemia”.
  • Ascorbic acid: Ascorbic acid is essential for the production of collagenous or intracellular material which holds the cell in proper relation to each other. It is also important for healthy development of teeth, bones and cartilage and connective tissues. It is an important factor in the healing of wounds and in the ability to withstand stresses of injury and infection. A well-balanced diet for school children and adults should contain 30–50 mg of vitamin C per day. The major functions of vitamin C is oxidation of tyrosine, reduction of ferric iron to ferrous iron in gastrointestinal tract so that iron is more readily absorbed, and conversion of folic acid into its active form folinic acid. Scurvy is the drastic consequence of vitamin C deficiency. The principle symptoms of scurvy are restlessness, loss of appetite generally soreness to touch, sore mouth, bleeding gums and loosening of the health.
Mineral Elements
There are a number of minerals or inorganic elements that play an important role in nutrition. Mineral elements are present in organic compounds, such as hemoglobin, phospholipids; and in thyroxine inorganic compounds, such as in sodium chloride and calcium phosphate; and as free ions. They enter the structure of every cell of the body. Hard skeletal structures contain the greater proportions of some elements, such as calcium, phosphorous, and magnesium, while soft tissues contain relatively higher proportions of potassium.
Mineral elements enter into numerous regulatory activities of the body. The contraction of muscles, the normal response of nerves to stimulation, the control of water balance, the maintenance of acid base equilibrium and the water balance of the food-stuffs are common functions. Sodium, potassium, calcium, phosphorus and chloride 28are the essential constituents of body fluids. Calcium, magnesium, phosphorus and others are bone constituents. Iron, copper and cobalt function in an intendated manner together with protein, vitamin B12 and other nutrients for the synthesis of hemoglobin and red blood cells.
  • Body contains calcium in greater amount than other minerals.
  • About 2%of the body weight of an adult is due to calcium, out of which about 99% is contained in bones and teeth.
  • Calcium is the most important factor in building skeleton and teeth, is more important during growing years.
  • Normal behavior of heart, nervous system and blood clotting process, etc. depend on the presence of calcium.
  • Human body at different levels of intake has suggested the desirability of a daily intake of about 0.4–0.6 g of calcium by an adult, in the case of growing children, pregnant and lactating mothers the requirement is 1.0 g per day.
  • Milk and milk products are the richest sources of calcium. Green leafy vegetables, such as spinach, amaranth are rich in calcium, but at the same time they are oxalate-rich foods.
  • Phosphorus takes a second place in regard to the total amount of minerals present in the body and constitutes about one-fourth of all body minerals.
  • About 80% of the phosphorus is found in bones combined with calcium and the rest is found in bones combined with calcium and the rest is found in soft tissues and body fluids.
  • Phosphorus plays an important role in the formation of teeth and bones, maintenance of acid base balance of the blood, and supplying energy to the muscles for contraction.
  • Phosphorus is found in good amount in the foods which are rich in protein and calcium. Thus milk, cheese, egg yolk, meat, fish are good source of phosphorus.
  • Deficiency of calcium and phosphorous causes rickets in children which is generally contributed by the lack of vitamin D. Osteomalacia, the adult rickets, may also be due to calcium deficiency, but usually, the situation is complicated by the deficiency of phosphorus and vitamin D as well as other factors.
  • Amount of iron in the adult body is about 3–5 g; of which 70% is in circulating hemoglobin, 4% in the myoglobin of the muscles and 25% in the stores held in liver, bone marrow, spleen and kidneys.
  • Iron is essential for the oxidation of the body. Hemoglobin combines with oxygen in the lungs to form oxyhemoglobin and is carried to the tissues by blood circulation.
  • Iron containing oxygen in the muscles makes the oxidation of carbohydrate, fat and protein possible within the intact cell.
  • Iron is stored chiefly in the liver, spleen and bone-marrow. The amount is variable, ranging from 1–2 g.
  • Recommended allowances based on the availability and utilization of iron, it is recommended that 20–30 mgs of iron per day is sufficient for an adult. The requirements increases in special conditions like pregnancy.
  • Nutritional anemias are due to the deficiency of iron, folic acid, etc.
  • Liver is an excellent source of iron. Other meat products and egg yolk also have generous amount of this mineral.
  • Iodine is considered to be an important dietary nutrient because normal functioning of thyroid gland depends upon adequate supply of it in the body. It is an essential component of thyroxine 29and other iodine containing compounds of thyroid glands.
  • Primary function of thyroxine is to influence the rate of oxidation in the cells of the body. Thyroxine also helps in normal growth and development in the youngs of all the species.
  • Sources of iodine vary widely under different soil and fertilizer conditions. Marine or deep sea fish and shell fish are high in iodine content. The leaves and flowers of plants have higher concentration of iodine than roots.
  • The recommended daily allowances of iodine have been reported to be about 100–150 mg.
  • Prolonged deficiency of iodine not only develops goiter but also causes sterility in many cases. Development of goiter or enlargement of thyroid gland, pregnancy need special requirement of iodine.
  • Fluorine is found primarily is the bones and teeth. Small amount fluorine brings about striking reduction in tooth decay because this mineral makes tooth enamel more resistant to the action of acid.
  • Dental caries is reduced due to more resistance to the action of acid; water is flourinated at the rate of 1 part per million.
  • Sources of fluorine—food as well as water by fluorination of the water at the rate of 1 part per million.
  • The recommended level of fluorides in drinking water in this country is accepted as 0.5–0.8 mg per liter.
  • Fluorine is often called a two-edged sword. Prolonged ingestion of fluorides through drinking water, in excess of the daily requirement, is associated with dental and skeletal fluorosis, and inadequate intake with dental caries.
  • The adult human body contains about 100 g of sodium ion. It is distributed entirely in the extracellular fluid (plasma, tissue fluid and lymph) of the body.
  • The main functions of sodium is regulation of acid–base balance of the body, regulation of osmotic pressure of plasma or tissue fluids; and sodium play a special role in originating and maintaining heartbeat.
  • Low sodium diets are prescribed for patients suffering from high blood pressure.
  • The adult human body contains about 250 g potassium which is present almost in the cells of different tissues, muscle, etc.
  • The functions of potassium is regulation of pH of the cell contents, regulation of the osmotic pressure of cell contents; and potassium ion increases the relaxation of heart muscle which is antagonized by cell contents calcium.
  • Potassium deficiency causes weakness and muscular paralysis. In animals, hyper-trophy of the heart has been observed.
  • Consumption of excessive amounts of potassium causes muscular weakness and apathy-symptoms, similar to those of potassium deficiency.
  • Magnesium is a constituent of bones and is present in all body cells.
  • Human adult body contains about 25 g of magnesium of which about half is found in the skeleton.
  • It appears that magnesium is essential for the normal metabolism of calcium and potassium.
  • Magnesium deficiency may occur in chronic alcoholic, cirrhosis of liver, toxemias of pregnancy, protein–energy malnutrition and malabsorption syndrome.
  • The principle clinical features attributed to magnesium deficiency are irritability, tetany, hyperreflexia and occasionally hyporeflexia.30
  • The requirements are estimated to be about 200–300 mg/day for adults.
Trace Elements
  • The healthy human adult body contains about 100–150 mg of copper. Copper is present in the blood in the form of copper protein complex hemocuprin in red blood cells and ceruloplasmin in plasma.
  • Anemia produced in infants, fed exclusively on milk, can be cured only by giving copper salts along with iron. The estimated average daily intakes in adult diet range from 2–3 mg.
  • The high intake of copper in Indian diets may due to contamination of copper from brass vessels used in cooking.
  • Zinc is active in the metabolism of glucides and proteins, required for the synthesis of insulin by the pancreas and for the immunity function.
  • Zinc is present in small amount in all tissues. Plasma zinc level is about 96 mg per 100 mC for healthy adults and 89 mg per 100 mC for healthy children.
  • The average adult body contains 1.4–2.3 g of zinc. Zinc deficiency in the diet has been reported to the cause of anemia, growth retardation (dwarfism) and delayed genital maturation in children.
  • Zinc is a constituent of insulin—the hormone present in the islets of Langerhans of pancreas.
  • Cobalt occurs in small amounts in all tissues, highest concentration occurring in liver and kidneys. Most of the cobalt is present in vitamin B12.
  • It is suggested that cobalt may be necessary for the first stage of hormone production. Cobalt may interact with iodine and affect its utilization.
  • The chromium content of an adult human body is estimated to be 6 mg. Most adult tissues contain 0.02–0.4 ppm of chromium on dry basis. The blood contains about 0.009–0.055 ppm.
  • Chromium plays an important role in carbohydrate, lipid and protein metabolism.
  • Chromium deficiency is characterized by impaired growth and disturbances in glucose, lipid and protein metabolism.
  • Selenium administration to children with kwashiorkor resulted in significant weight increase.
  • Studies indicate that human selenium deficiency may occur in protein– energy malnutrition.
  • Selenium deficiency especially when combined with vitamin E deficiency, reduces production.
The scientific definition of a calorie is a unit of energy or heat, in particular. One calorie is the amount of heat that increases the temperature of 1 kg of water by 1°C. Any food may contain one or more nutrients, but carbohydrates, fats and protein are the nutrients which gives calories to the body. The caloric value of these nutrients and of any common food have been determined by burning a known weight of the nutrient or food in an atmosphere of oxygen, in what is known as a bomb calorimeter. The caloric values of the nutrients are given in Table 1.6.
The following examples of calorie intake are based on US Department of Agriculture (USDA) guidelines: A person's daily calorie intake should be based on age, gender and physical activity level.31
Table 1.6   The caloric values of the nutrients
Sl. No.
Caloric value
Men generally need more calories than women and active people need more calories than sedentary (inactive) people.
  1. Children aged between 2 and 8: 1,000–1,400.
  2. Active women aged between 14 and 30: 2,400.
  3. Sedentary women aged between 14 and 30: 1,800–2,000.
  4. Active men aged between 14 and 30: 2,800–3,000.
  5. Sedentary men aged between 14 and 30: 2,000–2,600.
  6. Active men and women above 30: 2,200–3,000.
  7. Sedentary men and women 30: 1,800–2,200.
Body Mass Index and Basal Metabolic Rate of Body
Body mass index (Quetelet's Index): The body mass index is used as a reference standard for assessing the prevalence of obesity in the community.
Body mass index = weight in kg/height in meters. Ideal body mass index:
  • Ideal body mass index for Indian women: 19–24.
  • Ideal body mass Index for indian men: 20–26.
Once the body mass index exceeds the normal limit, the person can be termed as overweight or obese.
Basal metabolic rate: The Basal metabolic rate is the minimum number of calories needed to maintain vital functions, such as breathing and keeping the heart beating. It is the energy expenditure necessary to maintain basic physiologic conditions such as respiration, cardiac contraction, conduction of nerve impulses, metabolic activity such as synthesis of macromolecules under standard conditions, reabsorption of kidney, iron transport across impulse. These functions occur continuously without one's own conscious or awareness. Basal metabolic needs are surprisingly large, a person whose total energy expenditure amounts to 2,000 calories/day spends as much as 1,200–1,400 calories to support usual metabolism.
  • Basal metabolism is the minimum amount of energy needed by the body for the maintenance of life when the person is at post absorptive state, physical and emotional rest.
  • Basal metabolic rate is a measure of the energy required by the activities of resting tissue which can be measured directly from the heat produced (using a respiration calorimeter and metabolic chamber) or indirectly from O2 intake and CO2 expenditure when the subject is at rest.
Normal Values
  • Basal metabolic rate values are expressed as kcal or kJ per square meter of body surface per hour.
  • In adults, basal metabolic rate for healthy males 40 kcal/h (168 KJ) per hour and in healthy females is 37 kcal/h(155 KJ).
Factors Affecting Basal Metabolic Rate
There are many factors, which affect the basal metabolic rate, the most common factors are (Table 1.7):32
Table 1.7   Factors affecting basal metabolic rate
Sl. No.
Caloric value
Surface area of the body
The larger the surface area of the body in relation to its bulk, the greater is the heat lost by radiation.
The basal metabolic rate is higher per square meter of body surface area in men than in women for According to western standards the requirements are: (a) 40 cal/m2/h men. (b) 37 cal/m2/h for women.
Growing children and adolescents have high-basal metabolic rates in relation to their weight than adults.
Some diseases, especially of thyroid gland, may raise or lower the basal metabolic rates. A rise of body temperature of 1°F is found to increase basal metabolic rate by about 7%.
Nutritional status
Basal metabolic rate is lower in starvation and under nourishment as compared to well-fed state. In prolonged or chronic under nutrition, the basal metabolic rate is decreased.
Psychological stress and tension caused by worry or stress will increase the basal metabolic rate.
Environmental factors
In cold climate, the basal metabolic rate is increased and in tropical climate, the basal metabolic rate is proportionally low.
Smoking (nicotine), coffee (caffeine) intake increases the basal metabolic rate, whereas β-blockers tend to decrease energy expenditure.
Why is nutrition so important and what is the nurse's role in nutrition? Nutrition is essential because it's required for growth, healing and all body functions. The nurse's role in nutrition is to educate patients about good nutrition to promote health. In this research paper, we will be discussing the nurse's role in nutrition and strategies that can be implemented in the hospital, nursing home and community.
  • Hospital: In a hospital setting, physicians will issue orders for a diet type just as they write orders for medications or treatments. Knowledge of nutrition plays a role for the nurse because she must be aware of the significance of each diet. A nurse must know the component of each diet because if a patient asks for a carton of milk for a clear-liquid diet, this is not permitted. A full-liquid diet permits dairy products, however, knowing low-sodium and low-sugar choices for cardiac and diabetic patients, respectively, is also important for ensuring that the patient does not eat food that would adversely affect him. Nutrition is believed to be a key issue for healthcare professionals in hospital settings, yet the management of nutritional problems is often poor.
    zoom view
    Fig. 1.11: Nurse's role in food and nutrition
    33According to O'Regan (2009), “nutrition should be viewed as an integral and central component of patient care irrespective of the patient's physical diagnosis, condition, age or psychological status”. A failure to address the issue of malnutrition is a failure of the duty of nurses to protect the health of patients. In hospital environments, nurses are obliged to make observations about physical status, food intake, weight changes and response to therapy.
  • Nursing home: The nurse's role in nutrition can affect the nutritional status of residents of a nursing home. Many nutritional issues arise in residents of a nursing home. Nurses play a major role in ensuring that the resident's nutritional needs are met. Documenting changes in weight loss, decreased appetite, oral health, and physical activity are examples of the important role that they play in their evaluation of the nutritional status of their patients. Morley and Silver (1995) raise the important fact that, “Without input from staff, the physician is not likely to be successful in evaluation and treatment”. It is important that we include nutrition as we evaluate our patients and plan their care. Authors, Morley and Silver (1995), stressed “Careful attention to the nutrition of nursing home residents is both a clinical and a quality-of-life issue”.
  • Preventive care: Nurses are constantly engaged in teaching moments, particularly for preventive care. For example, if a patient has a family history of high blood pressure, a nurse may wish to teach him/her about healthy choices, such as a low-sodium diet, that can slow the onset of high blood pressure. Nurses also can help to review a patient's current diet to pinpoint areas where he/she can make healthier food selections.
  • Nutrition knowledge and medications: Nutrition plays a further role in nursing when it comes to reviewing a patient's medication list. For example, patients who are on therapies to prevent blood clotting may need to avoid leafy, green vegetables and other vitamin K containing foods. This is because vitamin K can decrease the beneficial effects of blood thinners. Some food such as grapefruits and food containing tyramine, an amino acid or building block of protein responsible for regulating blood pressure, can interfere with medication therapies. Examples of tyramine-containing food include aged cheeses, soy sauce and draft beer. When educating a patient on a new medication, nutrition must be a key component discussed to ensure safe drug administration.
  • Community: People in the community that was studied show their lack of knowledge when they make poor food choices. The nurse's role in nutrition is to educate patients on how to improve eating habits to promote good health. To effectively manage and prevent malnutrition in either setting, it is important to recognize the barriers to nutritional care for patients. According to Dupertuis as cited by O'Regan (2009), inadequate nutrition can lead to an increase in hospitalization and mortality. As nurses provide nutritional care for patients in each of these settings, they should be educated on the importance of nutrition and the healing process to assist patients in avoiding a failure to thrive diagnosis.
The importance of food in the care and treatment of hospital patients has been championed by the nursing profession for many years. Nonetheless it is still a neglected branch of nursing. The Salmon Report (1966) on senior nursing staff structure is widely believed to have diminished the importance of nutritional care as a key nursing role, so much so that the UKCC (now NMC) wrote to all registered nurses reminding them of their responsibilities in this area. As 34nurses and nurse practitioners become more involved with nutritional interventions, the health of patients will improve. Starting in the community, with meaningful nutrition interventions, patient outcomes and health can be changed, for much of the result depends on nursing's focus. In the busy lives of nurses, patients often get looked at as a disease; while that is not a nursing concept, it is often a fact of life. Instead if we see clients as the complex individuals that they are, the advantage of early nutrition intervention becomes obvious.
Proper nutrition is important for staying healthy and is particularly vital for the elderly. The nutritional state of a patient often affects patient outcomes during illness and recovery. The nurse is the logical person to provide nutritional information because nurses are the primary interface between the patient and the healthcare system. Nursing plays a key role in nutrition education because nutrition is a part of patient outcomes. The healing of the body can take place only when the nutrients, that provide the building blocks for repair, are present. The nurse as a nutrition educator is a vital role in the overall healthcare system. Prehospital nursing has the opportunity to provide nutrition education that can help to preserve the health of all populations and particularly of older adults, much has been written about eating dysfunction in the geriatric population. In the role of nutrition educator, nurses can work to prevent frailty in the older population.
Long Essay
  1. Define nutrition; explain briefly about the history of nutrition.
  2. Discuss the role and importance nutrition in maintaining health.
  3. Explain various types/classification of food.
Short Essay
  1. Explain the various functions of food.
  2. Enumerate the physiology of nutrition.
  3. Describe nutritional problems in India.
  4. Discuss national nutrition policies in India.
  5. Explain the factors affecting food and nutrition.
  6. Describe the role of medicinal values of food.
  7. Explain micro and macronutrients.
  8. Define basal metabolic rate, explain factors affecting BMR.
  9. Describe the role of nurse in nutrition.
Short Answers
  1. Metabolism
  2. Nutrition and disease
  3. Nutritional values of common foods
  4. Green leafy vegetables
  5. Five food group plan
  6. Mineral elements
  7. Calorie.