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• DR SHIV RK DUBEY
• MBBS (Hons), MD (Pediatrics)
• KGMU, Lucknow
• SR – AIIMS BHOPAL
• RDA stands for Recommended Dietary Allowance, also
commonly known as Recommended Daily Allowances. It
is the recommended daily vitamins and mineral
intake considered adequate for healthy people.
The RDA was last revised in 1989, and is rather
outdated. Parts of it are replaced by the Dietary
Reference Intakes (DRI), the most recent dietary
guidelines by the Food and Nutrition Board of the
Institute of Medicine, National Academy of Sciences,
1997-2001, in a collaboration between the US and
There are two different types of
There are three macronutrients
that are essential for health.
MICRONUTRIENTS – vitamins and
• TRACE ELEMENTS CONSTITUTE ___ % OF BODY
• MOST ABUNDANT SUBSTANCE IN THE BODY? AIPG
• WATER (60%)
• 2nd MOST ABUNDANT SUBSTANCE IN THE BODY ?
The two types of carbohydrate that
provide dietary energy are starch and
Dietary fibre is also a type of carbohydrate
which is not digested to provide energy.
Starchy carbohydrate is an important
source of energy.
1 gram of carbohydrate provides 4 kcal
Structure of carbohydrate
All types of carbohydrate are compounds of carbon, hydrogen and
They can be classified in many different ways. One common way is
according to their structure.
1. Simple carbohydrates – mono and
2. Complex carbohydrates – oligo and polysaccharides
• Which of the following is not an essential AA ? PGI 97
• WHICH OF THE FOLLOWING IS NOT AN INDICATOR
OF PROTEIN QUALITY? DNB 05
• AA score
• Biological value
• Protein energy ratio
• True digestibility
• WHAT IS NPU ( net protein utilisation ) ?
Protein is essential for growth and repair and
keeping cells healthy.
Protein also provides energy:
1 gram of protein provides 4kcal.
Essential amino acids = AH ! MeTTh VIL PhLy
Arginine, histidine (semi essential)
methionine, tryptophan, threonine, valine,
isoleucine, leucine, phenyl alanine, lysine.
• AA Score = No. of mg of one AA per gm of
protein/ No. of mg of same AA per gm of egg
• TD = nitrogen absorbed/ nitrogen intake
• BV = nitrogen retained/ nitrogen absorbed
• NPU = TD × BV
• Egg protein has the highest values for BV and
• Generally, animal proteins have a higher BV than
• MCT ( medium chain TG ) are : UPPG 08
• 6-12 carbon length
• 12-18 carbon length
• Which of the following are immediate source of enenrgy?
• SCT AIPG 05
• All of the above
• A COMMON SOURCE OF MCT IS_______ ?
• Coconut oil
• Major structural element of cell membrane
• Major source of energy
• Carriers for fat soluble vitamins ( A,D,E,K)
• 25-30% of energy intake ( upto 45% in PEM )
• MCT ( 6-12 CARBON LENGTH )
• LCT ( >12 )
MCTs are directly transported to portal vein (
immediate source of energy ) – coconut oil and
• Cannot be synthesised in the body and have to
• Linoleic, linolenic, EPA (eicosapentanoic acid)
and DHA (docosahexanoic acid )
• Important component of grey matter and
enhance intellectual performance.
All foods provide different types of fatty acids in
Butter is often described as a ‘saturated fat’ because it has
more saturated fatty acids than unsaturated fatty acids.
Most vegetable oils are described as ‘unsaturated fats’ as
they have more mono- and polyunsaturated fatty acids
Most saturated fats are solid at room temperature and
tend to come from animal sources.
Most unsaturated fats are liquid at room temperature
and are usually from plant sources.
There are two types of micronutrients:
Vitamins and minerals are needed in
much smaller amounts than
macronutrients. Their amounts are
measured in milligrams (mg) and
• Which of the following is a water soluble vitamin ? MPPG
• Vit A
• DRI of VIT A IN INFANTS IS ? MPPG 02
• 100-200 MCG
• 300-400 MCG
• 750 MCG
• 1000 MCG
• RDA of a 2 year old child is-----1100/1400/1500/1700 kcal
There are two groups of vitamins:
• fat-soluble vitamins, which can
be stored in the body, e.g. vitamins
A, D, E, K.
• water-soluble vitamins, which
cannot be stored in the body and
are therefore required daily, e.g. B
vitamins and vitamin C.
Fat soluble vitamins
Vitamin A is needed for:
• dim light vision;
• healthy skin and eyes;
• resistance to infection.
Vitamin A is found in liver and whole milk. It
can also be produced from beta-carotene
provided by dark green leafy vegetables,
carrots and orange coloured fruit.
• Infants = 300-400 mcg
• Children = 400-600 mcg
• Adolescents = 750 mcg
Vitamin D is needed for the absorption of calcium
from foods to keep bones and teeth healthy.
A lack of vitamin D causes rickets in children,
where the legs are bent, and osteomalacia in
adults, which causes pain in bones and muscles.
We get most of our vitamin D via the action of
sunlight on skin during the summer months.
Vitamin D is also provided by the diet from oily
fish, meat, eggs, fortified breakfast cereals and
• DEFICIENCY OF WHICH MICRONUTRIENT
CAUSES HEMOLYTIC ANEMIA IN PRE TERM
INFANTS ? AI 08
• ALL INSTITUTIONAL DELIVERIES ARE GIVEN
A IM dose of which micronutrient ?
• TOCOPHEROL is : vit A/D/E/K AI 00
• Anti oxidant
• Manifestation of def are – hemolytic anemia,
• RDA = normal infants – 0.4 mcg/kg/day
premature infant – 15-20 mg/day may be
Sources – vegetable oils, green leafy
vegetables and nuts.
• Main role is as a cofactor in ‘post translational
carboxylation’ of glutamic acid to form glutamate
(Gla), which takes place in the liver.
• Sources – green leafy vegetables, normal gut
• RDA – 1 mg im at birth to all newborns.
• Older children 10-30 mcg/day
• PANTOTHENIC ACID is : PGI
• CAN ANYBODY NAME ALL B COMPLEX
• APHONIA/laryngeal nerve palsy is characteristic of which
B COMPLEX vitamin : B1/B2/B3/B5
• Angular cheilosis/ smooth tongue is seen in def of :
• CASAL NECKLACE is seen in def of: B1/B2/B3/B6
Thiamin (vitamin B1)
Thiamin is required to release energy from
It is also involved in the normal function of
the nervous system.
Sources of Thiamin (vitamin B1)
• Whole grains;
• Meat (especially pork);
• Fruit and vegetables;
• Fortified breakfast cereals.
Riboflavin (vitamin B2)
Riboflavin is required to release energy from protein, carbohydrate
It is also involved in the transport and use of iron in the body.
Sources of Riboflavin (vitamin B2)
• Fortified breakfast cereals;
• Green vegetables.
Niacin (Vitamin B3)
Niacin is required for the release of energy from food.
Niacin is also required for the normal function of the
skin, mucous membranes and nervous system.
Sources of Niacin
• Wheat and maize flour;
• Dairy products;
• Niacin/nicotinic acid/nicotinamide
• Def – pellagra, hartnup disease
• 3 D – dermatitis, dementia and diarrhoea
• Casal necklace
• All common food sources – resistant to heating.
• 1 NE = 1 mg niacin = 60 mg tryptophan
• RDA = 6.4-8 NE/1000 kcal.
• Deficiency caused by
• Drugs – INH, Penicillamine, steroids, AED,
FEATURES INCLUDE – irritability, seizures,
Oxaluria, oxalic acid bladder stones
VIT B6 DEPENDENT SYNDROMES –
• PERNICIOUS ANEMIA IS CAUSED DUE TO
DEF OF :
• INTRINSIC FACTOR
• A WOMEN DELIVERED A BABY WITH lumbo
sacral meningomyelocele. Which nutrient def is
• What is the treatment?
• Only non veg diet
• IF (STOMACH) + B12 --------->
RECEPTOR IN ILEUM-enterohepatic
• So deficiency in – strict veg, IF def
(pernicious anemia, IBD, ileal resection.
• Hyperpigmentation of knuckles, involuntary
movements, developmental regression.
• Deficiency in pregnancy causes NTDs.
• 400 mcg/day before conception and in first
trimester of pregnancy.
• KESHAN DISEASE is caused by def of
• SELENIUM ( CARDIOMYOPATHY )
• GLUCOSE INTOLERANCE/DIABETES has
been attributed due to def of which trace
Vitamin C is needed to make collagen. This is
required for the structure and function of
skin, cartilage and bones.
It is an important nutrient for healing cuts
Did you know?
Vitamin C can help with the absorption of
iron when foods or drink containing both
vitamin C and iron are eaten at the same
Sources of vitamin C
• Fresh fruit especially citrus fruits and berries;
• Green vegetables;
• New potatoes.
Minerals are inorganic substances required
by the body in small amounts for a variety of
The body requires different amounts of each
People have different requirements,
according to their:
• physiological state (e.g. pregnancy).
The body contains more calcium than
any other mineral. It is essential for a
number of important functions such as
the maintenance of bones and teeth,
blood clotting and normal muscle
Did you know?
The skeleton contains about 99% of the
body’s calcium with approximately 1kg
present in adult bones.
Sources of calcium
Milk, cheese and other dairy products are
good sources of calcium in the diet.
Calcium is also provided by :
• fortified soya products;
• fish eaten with the bones, e.g.
sardines, tinned salmon.
Iron is essential for the formation of
haemoglobin in red blood cells.
Red blood cells carry oxygen and transport it
around the body.
Iron is also required for normal metabolism and
removing waste substances from the body.
Did you know?
There are two types of iron; one from animals
sources and the other from plant sources.
Sources of iron
• Red meat;
• Dried fruits;
• Whole grains;
• Dark green leafy vegetables.
Iron in the diet
A lack of iron in the diet means that the stores in the
body will run out.
This can lead to anaemia.
Women and teenage girls need to ensure they have
enough because their requirements are higher than
those of men of the same age due to menstruation.
Sodium is found in all cells and body fluids.
It is needed for regulating the amount of
water and other substances in the body.
Sources of sodium
Most raw foods contain very small
amounts of sodium chloride (salt).
Salt is often added during the processing,
preparation, preservation and serving of
About 20% of salt we eat is added at
home during cooking and at the table.
High sodium intake is considered to
be one of the risk factors for high
blood pressure, which may lead to
heart disease and stroke.
• About RDA
The Recommended Daily Allowances below incorporate
the DRI figures.
Recommended Daily Allowances / Dietary Reference
In the Recommended Dietary Allowance charts below,
amounts marked with a * indicate AI (Adequate Intake)
figures taken from the Dietary Reference Intakes (DRI).
• #1 As cholecalciferol. 1 µg cholecalciferol = 40 IU vitamin D.
• #2 : As 10 to 30 percent of older people may malabsorb food-bound
B12, FNB advises those older than 50 years to meet their
Recommended Daily Allowances for it by consuming foods fortified
with B12 or a supplement containing B12.
• #3 : In view of evidence linking folate deficiency with neural tube
defects in the fetus, FNB recommends that women capable of
becoming pregnant consume 400 µg of folate from supplements or
fortified foods, in addition to intake of food folate from a varied diet.
• #4 : Men from 31 to 50 need slightly more magnesium (420 mg) than
those from 19 to 30 years old (400 mg). Women from 31 to 50 also
need slightly more magnesium (320 mg) than those from 19 to 30
years old (310 mg).
#5 : Adults over 70 years need slightly different levels of vitamin D
(15µg), sodium (1.2g), and chloride (1.8g).
• #6: Pregnant women from 31 to 50 need slightly more magnesium
(360 mg) than those between 19 to 30 years old (350 mg). Women
from 31 to 50 who are breastfeeding also require slightly more
magnesium (320 mg) than those between 19 to 30 years old (310