1st Clinical Posting

8/20/2019 1st Clinical Posting

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Department of Community Medicine

GMERS Medical College, Gotri, Vadodara

1 st clinical posting

Handouts for academic purpose


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Index

S. no. Topic Page no.

1 Micronutrients and Macronutrients 32 Nutritive value of food items 153 Balanced Diet & Dietary guidelines 234 Food Adulteration, Food Safety & Security Act 325 Nutritional Disorder of Public Health Importance 346 Baroda Dairy 477 National Guidelines on Infants and Young Child Feeding 528 Physical Activity 639 Introduction to Entomology, Cyclops, Rodents 65

10 Flea, Tick, Mite 6811 Housefly, Sand fly, Louse 7112 Mosquitoes 7413 Malaria Filaria Unit 7614 Purification of Water Small Scale 7815 Purification of Water on Large Scale 8116 Surveillance of Water Quality 8417 Meteorological Equipments 8818 Excreta disposal in Unsewered area 9119 Sewage treatment 9420 Biomedical Waste Management 9821 Gujarat Pollution Control Board 10422 Solid Waste Disposal & Ward Sanitary Office 107


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Micronutrients and MacronutrientsThe word nutrition is used to refer to the processes of the intake, digestion andassimilation of nutrients and the application of this knowledge to maintain health and

combat disease.

Food: Food is a substance eaten or drunk to maintain life and growth. The foods aregenerally classified into cereals (wheat, rice, maize etc.), legumes (pulses and peas),nuts and oilseeds, vegetables, fruits, milk and milk products and flesh foods (fish, meatand chicken and egg). Diet, on the other hand is what a person habitually eats anddrinks.

Nutrients: The nutrients are chemical substances that are present in the food we eat.The important nutrients are proteins, fats, carbohydrates, vitamins and minerals.

Energy: Energy is required for maintaining the body temperature and vital activity oforgans, for mechanical work and for growth. Even when an individual is at completerest and no physical work is being carried out, energy is required for the activity ofinternal organs and to maintain the body temperature. Table 1 shows majorcontributors of energy to our diet.

Major contributors of energy to our diet-(some row foods & their energy content per100kg)

Food stuff Energy( kcal ) Food stuff Energy( kcal )Cereals & Millets Non vegetarian foodsWheat flour 341 Egg ( hen ) 173Rice polished 345 Fish ( hulsa ) 273Bajra 361 Chicken 109Maize dry 342 Mutton ( lean ) 118Ragi 328 Pork ( muscle ) 114

Pulses & Legumes Milk & Milk productsBengal gram 360 Milk, cow 67Soya bean 432 Milk, buffalo 117Rajmah 346 Milk, human 65Red gram (arhar) 335 Butter 729Green gram (Moong) 334 Ghee 900Lentil (masoor) 343 Cheese 348Pea dry 315 Curd 60

Fruit & Vegetables NutsBanana 116 Groundnut 567Apple 59 Cashew nut 596Grapes, pale green 71 Coconut, fresh 444Custard apple 104 MiscellaneousJack fruit 88 Jiggery 383Raisins 308 Sugar 398Potato 97 Veg oils 900


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MacronutrientsThere are four macronutrients.ProteinMajor sources including their protein content (g per 100g)

Food item(source) Protein content (g) Food item(source) Protein content (g)Eggs 13.3 Milk ( cow ) 3.2Meat (goat, lean) 21.4 Fish ( hulas ) 21.8Pulses ( red gram ) 22.3 Soya bean 43.2Groundnuts 25.3 Wheat flour 12.1Rice ( raw, milled ) 6.8 French beans 1.7

Quality of ProteinsQuantitatively the quality of a protein is worked out in terms of biological value,digestibility co-efficient, net protein utilization and protein efficiency ratio. The working

formulae for each of these parameters are shown in the Box- 2. The net proteinutilization (NPU) is the most commonly used parameter. A protein with an NPU of morethan 65 is considered as of optimum quality. Egg protein is considered to have an NPUof 100 and is considered as ideal or reference protein against which other proteins arecompared with.

Quality of proteinsThe quality of protein depends upon its amino acid composition. A protein containing allamino acids consider as a ideal. Egg protein is taken as reference protein.Biological value (BV)=

Digestibility co-efficient =

Net protein utilization (NPU) =

Protein efficiency ratio (PER) =

Recommended Dietary Allowance (RDA) for Proteins: The requirement of proteins isgenerally accepted to be 1g/ Kg/day for adults. So the recommended dietary allowance for areference adult male works out to 60g/day and for a reference adult female it is 50g/day. An

additional allowance of 15g/day is recommended for pregnancy. During lactation extraallowance of 25g in the first 6 months and 18g in the subsequent 6 months is recommended.Children have a higher protein requirement. An attempt is also made to elaborate as to how thisrequirement could be met in the typical Indian conditions. Some tips on improving theconsumption of proteins is given here.

Recommendations on Diet for Proteins Eat nutritionally balanced diet to get adequate protein. Meat and fish are good sources. Vegetarians must eat proper combination of plant proteins from both cereal and

pulses groups


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Include Soyabean in your diet Two to three servings of protein-rich food must be ensured every day One serving may be equivalent to :

- One to two cups of cooked meat, poultry, fish

- Half cup of cooked dry beans/ lentils/ legumes- One egg- Handful of fried/roasted- salted groundnuts- Handful of roasted Bengal grams

FatSources of fats:Dietary fats are derived from two main sources:(a) Animal Sources: They are milk and milk products (ghee, butter), lard, egg and fishoils. Animal fats in general are poor sources of essential fatty acids with the exception ofcertain marine fish oils such as cod liver oil and sardine oil, but they are good sources ofretinol and cholecalciferol.

(b) Vegetable Sources: They include various edible oils such as groundnut, gingerly,mustard, cottonseed, safflower, rapeseed, palm and coconut oil. Vegetable oils with theexception of coconut oil are all rich sources of essential fatty acids, but they lack retinoland cholecalciferol except red palm oil which is rich in carotenoids.

Major sources including their fat content (g/100g)

Food item (source) Fat content (g/100g)Eggs(hen) 13.3Milk, cow 4.1Meat (goat lean) 3.6Fish (hilsa) 19.4Ghee 100Butter 81.0Groundnut 40.1Mustard seeds 39.7Coconut ,fresh 41.6

Sunflower seeds 52.1

Visible and invisible fats:The visible fats are generally derived from animal fats e.g. butter or ghee or from plant(vegetable) oils like groundnut, mustard, coconut, sunflower or safflower seeds. It isnow believed that the bare minimal requirement of visible fats to meet the essentialfatty acid requirements is 15 to 25 g per day. The upper limit is fixed at 30% of the totalenergy intake or less than 80 g / day.

Some amount of fat is present in all food stuffs. From the nutritional standpoint,important of them are cereals, pulses, oilseeds, nuts, milk, eggs and meat. Contrary to


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general awareness, this invisible fat contributes substantially to the total fatconsumption and essential fatty acid intake of our diet.

Cereals and pulses which are otherwise perceived to be poor in fats contributesignificantly towards fat intake of an Indian diet. This is because most Indians dependon the ‘staple’ of cereals, consumed in a large quantity. The invisible fats may accountfor 20 to 50% of all fats consumed, depending on the type of diet. It should howevercontribute to not less than 6% of total energy or about 15g of invisible fats per day.

Types of Fatty AcidsSaturated Fatty Acids (SFA) : Saturate (Latin, to fill, in this case with hydrogen).Saturated Fatty acids have a relatively high melting point and tend to be solid at roomtemperature. These are obtained from animal storage fats and their products e.g. meatfat, lard, milk, butter, cheese and cream. Fats from plant origin tend to be unsaturated

with the exception of coconut oil and palm oil. A high intake of SFA is associated with anincrease in LDL and total cholesterol and thus increases the risk of atherogenesis andcardiovascular disease. Some examples of SFAs are Myristic acid, Palmitic acid andStearic acid.

Monounsaturated Fatty Acids (MUFA) : MUFA contain only one double bond and areusually liquid (oil) at room temperature. Olive oil and rapeseed oil are good dietarysources of MUFA. MUFA are also present in meat fat and lard. Dietary MUFA does notraise plasma cholesterol. They lower LDL cholesterol without affecting the HDL. Oleicacid is an example of MUFA.

Polyunsaturated Fatty Acids (PUFA) : PUFA contain two or more double bonds and theytoo are liquid at room temperature. They are easily oxidized in food and in the body.PUFA have a vital role in immune response, blood clotting and inflammation. PUFA aredivided into omega- 3 (ω3) or omega 6 (ω6) groupsof PUFA. Omega -3 (ω)polyunsaturated fatty acids PUFA are found in fish and fish oils. The health benefits ofthese include reducing the cardiovascular risk factors (see Box - 4). Research alsoindicates their beneficial role in cognitive function of brain. Some common omega-3fatty acids are α -linolenic acid (linseed, soyabean, rapeseed, leafy vegetables),

eicosepentaenoic acid (marine algae, fish oils) and docosahexenoic acid (fish oils).

Why fats in diet? : If the contemporary literature is to be believed, one tends to agreethat fats are well known for their role in causation of many chronic diseases rather thanany worthwhile virtue! Then why should fat be consumed at all and how much? Themain functions of fat are elaborated in the Box - 5.

Unlike proteins where the precise intake, assimilation, excretion and thus requirementcan be worked out, the quantity of fats that should be included in a well balanced diet isa matter of conjecture. The following aspects however are important in considering the

recommendation for fat intake:


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a) The quantity of fat intake should be good enough so that requirement of essentialfatty acids (which are a component of fats) is met.b) Absorption of fat soluble vitamins should not be compromised.c) Fat intake should be sufficient enough to make diet palatable.

d) Some stores must be maintained in the body to tide over a lean period.e) It should not be so much in quantity that it causes undesirable effects on health.Quantity of Fat:With an improving economy and a richer lifestyle we tend to consume higher caloriesespecially from the fat source. Higher calories lead to obesity and many other lifestylediseases. A high level of fat in diet is notorious in the causation of atherosclerosis and sois a major risk factor for Cardiovascular Diseases (CVD) including coronary arterydisease and strokes. Any amount that contributes to more than 30% of total calorieintake is considered as high. Low physical activity and sedentary lifestyle furtheraugment the risk.

Tips on fat intake1) Food preparation 3) Eggs

a) Use minimal oil for preparation a) Avoid more than one egg a dayb) Rotate the types of oil used b)Avoid adding oil to egg preparations

2) Meat c) Use egg white freelya) Prefer fish to poultry 4) Milkb) Prefer poultry to mutton/beef/pork a) Prefer low fat milkc) Limit added oils in meat preparationsd) Use only lean cuts of meat

CarbohydratesClassification: From the nutritional or functional point of view, carbohydrates can bedivided into two categories.(a) Available carbohydrates: These are the carbohydrates which can be digested in theupper gastrointestinal tract, absorbed and utilized. These are further sub-classified aspolysaccharides, disaccharides, monosaccharides.(i) Polysaccharides such as starch, dextrin and glycogen

(ii) Disaccharides such as lactose, sucrose and maltose(iii) Monosaccharides such as glucose, fructose and galactose.

(b) Dietary Fibre: The second category comprises of unavailable carbohydrates ordietary fibre, which are difficult to digest. These are cellulose, hemicellulose, gums,pectins etc.Sources of Carbohydrates : The major source of dietary carbohydrates in an Indian setup is starch from cereal grains, millets, legumes, roots and tubers.

With increasing prosperity as in industrial societies, sugar has replaced complexcarbohydrates as the main source. The presence of monosaccharides (free glucose or


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fructose) is limited to fruits and vegetables; otherwise they are not abundant in naturalfoods. Fructose is found in honey, fruits and vegetables. Sucrose and Lactose are thecommonest disaccharides. Sucrose is extracted from sugar cane. Table sugar is 99%sucrose. Sucrose gets hydrolysed into glucose and fructose. Lactose is found in milk. It is

hydrolysed to glucose and galactose. Maltose is present in malted wheat and barley.Other sources are nuts and seeds.

Requirement of Carbohydrates : In a prudent diet carbohydrates should contribute to60 to 70% of total energy (1). This translates to about 360 to 400g carbohydrates for a2400 Kcal diet.

Micronutrients

There are two classes of micronutrients: Vitamins and Minerals. The following pages

contain useful information of select micronutrients.

IronFunction : needed for haemoglobin synthesis, mental function and body defense.Deficiency Disorder: Anaemia.Iron deficiency is common particularly in women of reproductive age and in children.Iron deficiency during pregnancy increases maternal mortality and low birth weight ininfants. In children, it increases susceptibility to infection and impairs learning ability.Sources:Animal Sources – liver, meat, poultry and fish.Plant sources - legumes, cereals, green leafy vegetables, jaggery, dry fruitsIron bio-availability is poor from plant foods but is good from animal foods. Fruits richin vitamin C like gooseberries (amla), guava and citrus fruits improve iron absorptionfrom plant foods.Beverages like tea bind dietary iron and make it unavailable. Hence, they should beavoided before, during or soon after a meal.

RDA:RDA (mg / day)

Adult Male 17Adult Female 21Pregnant Female 35Lactating mother 21

Prophylaxis:Since iron intake from Indian diets is often inadequate, the following routineprophylactic iron supplements (with folic acid) are recommended per day for thespecial vulnerable groups for at least 100 days a year as per the Policy Guideline on IronFolic Acid Supplementation, 2007, by Ministry of H & FW, GoI.


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a) Pregnant Women & Adolescent Girls - 100 mg Iron, 500 mcg Folic acidb) Children 6 months to 60 months – 20 mg iron and 100 mcg folic acidc) Children 6 – 10 years – 30 mg iron and 250 mcg folic acid

Folic AcidFunction: essential for the synthesis of haemoglobin and DNA and promotes birthweight of infants.Deficiency Disorder: Anaemia, Congenital malformationsDeficiency is common particularly during pregnancy and lactation during whichrequirements are higher.Sources: liver, meat, dairy products, cereals, fruits, green leafy vegetables. Overcookingdestroys folic acid causing deficiency.

RDA:RDA (mcg / day)

Adult male & female 200Pregnancy 500Lactation 300Children 80 – 120

Prophylaxis:500 mcg of folic acid supplementation is advised pre-conceptionally and throughoutpregnancy for women with history of congenital anomalies (neural tube defects, cleftpalate)

IodineIodine is one of the important micronutrients from Public Health Nutrition point ofview. It has also been included in the research and advocacy activities by MicronutrientInitiative (MI), a leading International Health Organization working in the field ofnutrition. There is a separate National Iodine Deficiency Control Programme (NIDDCP)in India launched by GoI in 1962.Function: Iodine is required for formation of thyroid hormones which are necessary for

growth and development.Deficiency Disorder: Hypothyroidism; Goitre; iodine deficiency during pregnancy leadsto cretinism, still births, abortions and retarded physical & mental development of thechild.Sources:Sea Foods and Cod liver oil are richest sources.Major portion of iodine we get comes from food and the remaining from drinking water.With the wide-spread availability and use, Iodised Salt, now, forms the main source ofIodine in Indian Diets.

RDA: 150 mcg per day in Adults.Prophylaxis:


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All households should use only Iodised salt in their food preparation. As per the NIDDCPthe norms for iodine content in salt are

30 parts per million (ppm) Iodine at manufacturer level and15 parts per million of Iodine at consumer level

Spot Testing Kits are also available to estimate the iodine content of the Iodised salt.The Government Department of Health & Family Welfare, Department of Industries,Department of Railways, Department of Civil Supplies and agency like salt nominees areinvolved in the NIDDCP.

Vitamin AFunction: Vitamin A is required in synthesis of rhodopsin pigment required for vision indim light, for maintaining integrity of epithelium, for skeletal growth, and as anti-infective substance especially among children.Deficiency Disorder:Ocular Manifestations- Night Blindness, Conjunctival & Corneal Xerosis, Bitot’s spots,KeratomalaciaExtra-occular manifestations – anorexia, growth retardation, increased due torespiratory and intestinal infections which are important causes of under - 5 morbidityand mortality.Sources:1) Animal –

Liver, eggs, butter, cheese, milk, fish, meat. Fish liver oils are the richest sources but they are generally used as nutritional

supplements rather than as food sources.2) Plant –

Green leafy vegetables (spinach, amaranth) are cheapest sources. Darker thegreen leaves, higher is the carotene content

Green and yellow fruits (mango, papaya, pumpkin) Carrots

RDA:Group Retinol (mcg / day) Group Retinol(mcg/ day)

Adult male & female 600 Children 1 – 6 yrs 400Pregnancy 800 Children 7 – 9 yrs 600Lactation 950 Adolescents 10 – 17 yrs 600Infants 350

Prophylaxis:As per the Guidelines of National Vitamin A Prophylaxis Programme in India Vitamin Asupplementation is given as follows:Children 6 months – 1 year: 1,00,000 IU of Vitamin A in oil (retinol palmitate)

Children 1 – 5 years: 2,00,000 IU of Vitamin A every 6 monthly


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In Gujarat, two doses at 6 monthly intervals are given during the months of Februaryand August (Bi-annual rounds) to all the children under 5 years of age.

Vitamin C

Function: serves as anti-oxidant, needed in collagen formation and increases ironabsorption from vegetable foods.Deficiency Disorder: Scurvy manifested as swollen and bleeding gums, subcutaneousbruising or bleeding into the skins or joints, delayed wound healing, anemia andweakness.Sources: Fresh fruits – amla, guava, lime, orange, tomato

Germinating pulsesGreen leafy vegetables – cabbage, amaranth, spinach

RDA: 40 mg per day for adults

Vitamin DFunction: promotes intestinal absorption of calcium and phosphorus and alsostimulates bone mineralization; thus important in calcium metabolismDeficiency Disorder:Rickets – commonly seen among children 6 m to 2 yrsOsteomalacia – more common in pregnant and lactating womenSources:1) Sunlight: synthesized in body by action of UV rays of sunlight.2) Foods: Vit D occurs only in foods of animal origin e.g. Liver, egg yolk, butter, cheese.3) Others: Fish liver oils although the richest sources, are not taken as food but instead

taken as supplements and foods artificially fortified with Vit D e.g. vanaspati ghee,milk, infant foods

Prevention:With rapid changes in the lifestyle especially among urban Indians there is a tendencyto spend large amount of day time indoors which prevents exposure to sunlight.Therefore it becomes imperative to ensure adequate exposure to sunlight. This is alsoimportant for children and parents should be specifically educated about this.

CalciumFunction: formation of bones and teeth, coagulation of blood, skeletal and cardiacmuscle functioning, milk production, cell membrane integrity, metabolism of enzymesand hormonesDeficiency Disorder: No major deficiency diseases.Sources:

Rich sources are Milk and milk products (cheese, curd, skimmed milk, andbuttermilk), eggs and fish. Calcium in milk occurs in form of calciumcaseinogenate which is easily digested.


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Cheapest sources in Indian diet are green leafy vegetables, cereals and millets.Ragi is particularly rich in calcium. Some limiting factors reduce the absorptionof calcium from green leafy vegetables and cereals.

RDA: 600 mg per day for adults

Prophylaxis:The requirements of calcium increase during pregnancy and lactation hence followingsupplements are commonly given during these periods.Pregnancy – 500 mg calcium everyday for 100 days during the last trimesterLactation – 500 mg daily for first 100 days post-natal

Summary TablesVitamins

Water soluble vitaminsVitamin Function RDA Deficiency Sources

Vitamin C(Ascorbicacid)

Reductant in hydroxylationsin collagen & carnitinesynthesis Metabolism ofDrugs.

40mg/day Scurvy: spongy, bleedinggums, fatigue, hemarthrosis

Citrus fruits:-guava, amla,green vegetables,Tomatoes,strawberries

Vitamin B1(thiamine)

Normal growth coenzymefor decarboxylation of2-keto acids &transketolation reactions

0.5mg/1000kcal

Beriberi-cardiac(wet),neuritic(dry)& infantile

Mart, liver,legumes, wheatgerm

Vitamin B2

(Riboflavin)

Normal growth coenzyme

in redox reactions of fattyacids & TCA cycle

0.6mg/

1000kcal

Ariboflavinosis: magenta

tongue, cheilosis ,angularstomatitis, corneal ulcer

Milk, meat, green

,vegetables

Fat soluble vitaminsVitamin Function RDA Deficiency Sources

Vitamin a(retinol,retinal, carotenes,(cryptoxanthins)

Vision, integrityof epithelium,

gene regulation,antioxidant

600µg/day Exophthalmia,dry skin,impaired

immunity, growthand reproduction

Retinol (animalfoods):liver , egg,

meat, milkprovitamin A (plantfoods ) yellow ,green

vegetableVitamin

D(cholecalciferol,D1,(ergocalciferol,D2)

Calciumhomeostasis,

bonemetabolism

100-400 iu/day-(child)

Rickets inchildren

osteomalacia inadults

Synthesized in skinwith exposure tosunlight; fish oils,

milkVitamin E

(Tocopherols)Cellular

membraneantioxidant

12mg/day Ribs breakdown,anaemia, nerve

damage,retinopathy

Vegetable oils, greenvegetables, cerealgerm, nuts, seeds

Vitamin K(phylloquinone,menaquinone,

menadione)

Clotting ofblood, calcium

metabolism

120µg/day(males)90µg/day

(females)

Bleedingtendencies

Synthesis byintestinal bacteria,green vegetables

Soya oil, liver, milk


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Niacin(nicotinicacid,nicotinamide)

Coenzyme fordehydrogenases

6.6mgper 1000kcal

Pellagra ,characterized br3Ds-dermatitis, diarrheal,dementia

Meat, groundnuts,legumes, grains

Vitamin B6 Coenzyme in amino acid

metabolism

2mg/day Anaemia, neuritis,

convulsions

Grains, seeds

,poultry, meatFolic acid Coenzyme in singlecarbon metabolism

100mgper day

Megaloblastic anaemia Liver ,greenvegetables , yeast,fruits

Vitamin B12 Coenzyme in amino acid,propionate & singlecarbon fragmentmetabolism

1mg/day Pernicious anaemia Liver, lean meat,fish ,seafood ,milk

Minerals

The macro mineralsMineral Function RDA Deficiency SourcesCalcium Bone & teeth

formation, bloodclotting, muscle

contraction,nerve

transmission

Adults: 400 mgPregnancy &Lactation 1 g

Tetany Rickets,Osteoporosis

Dairy products,Meat products,

Leafy vegetables

Phosphorus Bone & teethformation,

energymetabolism,nucleic acid

synthesis, acidbase balance

1 g Not seen oftencan cause boneloos, anorexia

Dairy products,Meat products,

Leafy vegetables

Sodium Extracellularfluid component,

water balanceacid base

balance: nervetransmission,muscle action

5 g Cramps, Acid-base imbalance,

Water imbalance

Table salt

Potassium Majorintracellular fluidcomponent, acid

baseBalance: nervetransmission,muscle action

5 g Muscaeweakness,Arrhythmias

Fresh fruits,meats wholegrains,

vegetables

Magnesium Coenzyme inmetabolic

reactions, Nerveconduction

350 g Tremors, spasm Meat, cheese,eggs, nuts,legumes


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The Micro mineralsMineral Function RDA Deficiency SourcesIron Haemoglobin &

MyoglobinFormation ,cellular oxidationreactions, antibodyformation

Male: 28mgFemale:30mgPregna-ncy:38mgLactation:30mg

Anaemia, fatigability,impaired immunefunction

Meat products,liver, greenleafy vegetables

Iodine Thyroxinesynthesis

Adults150mgPregnancy200mg

Goitre, cretinism,hypothyroidism,infertility, still births

Iodized salt,plant productsgrown in iodinerich soil

Zinc Essential enzymeconstituent,

Proteinmetabolism,immune function,insulin storage,sexual maturation

15mg Retarded sexual &physical activity;

impaired woundhealing

Dairy products,meat products,

Eggs, Wholegrains

Selenium Antioxidantfunction formsglutathioneperoxidase ,sparesvitamin E

70mg Impaired immunefunction, Keshenadisease

Liver, meats,whole ,grains,sea food

Fluoride Bone & teethconstituent


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Nutritive value of food itemsCereals

Content per 100 gm of edible portion

Sr.No.

Nutrient BajraParboiled

handpounded Rice

Rice rawmilled

WheatWhole

1 Protein (gm) 11.6. 8.5 6.8 11.82 Fat (gm) 5 0.6 0.5 1.53 Fiber (gm) 1.2 - 0.2 1.24 Carbohydrates (gm) 67.5 77.4 78.2 71.25 Energy (Cal) 361 349 345 3466 Calcium (mg) 42 10 10 417 Iron (mg) 8 2.8 0.7 5.38 Carotene (ug) 132 9 0 649 Thiamine (mg) 0.33 0.27 0.06 0.45

10 Riboflavin (mg) 0.25 0.12 0.06 0.1711 Niacin (mg) 2.3 4 1.9 5.512 Folic acid (ug) 45.5 - 8 36.613 Vit.C (mg) 0 0 0 0

Bajra (Pearl Millet)Bajra can be grown in the dry belts where other cereal crops such as maize or wheat would not survive. Hence, it is primarily consumed in the states of Rajasthan,Gujarat and Madhya Pradesh.The protein in Bajra is deficient in lysine and threonine.The iron and fat content of Bajra is the highest among all cereals and millets.It is also relatively rich in calcium, carotene, riboflavin, niacin and folic acid.

Rice• Rice is the staple diet in southern part of India.• Milling and polishing cause the greatest nutritional loss. During processing the B -

complex vitamins, fibre and proteins are lost to a great extent.• The nutritive losses because of milling, polishing, and other processing and cooking

practices can be prevented by parboiling. It involves soaking the paddy in hot waterfollowed by steaming and drying. This paddy is then finally home pounded ormilled for final use.

• Rice also loses substantial amount of water soluble vitamins and minerals when thewater used for washing and cooking is discarded.

http://en.wikipedia.org/wiki/Cerealhttp://en.wikipedia.org/wiki/Cerealhttp://en.wikipedia.org/wiki/Cerealhttp://en.wikipedia.org/wiki/Maizehttp://en.wikipedia.org/wiki/Maizehttp://en.wikipedia.org/wiki/Maizehttp://en.wikipedia.org/wiki/Wheathttp://en.wikipedia.org/wiki/Wheathttp://en.wikipedia.org/wiki/Wheathttp://en.wikipedia.org/wiki/Wheathttp://en.wikipedia.org/wiki/Maizehttp://en.wikipedia.org/wiki/Cereal


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Wheat wholeWheat is the most widely consumed cereal in North India. It is used to make flour(atta for chapattis and puri), maida for bread, dalia and also suji, to make varioussavouries.

Wheat protein is poor as it is deficient in the essential amino acids lysine andthreonine. Pulse proteins are rich in these deficient amino acids. So, apredominantly cereal diet should be supplemented with other sources of proteinslike the pulses, especially for the vegetarians. This is called as the supplementaryaction of proteins.Hard milling, extraction and discarding the bran causes loss of fibre, vitamins andproteins. It is advisable to consume whole wheat atta and dalia. Products made upof refined flour like white bread, biscuits, cakes, noodles and burgers should bediscouraged.

Pulses

Sr.No.

Nutrient

Content per 100 gm of edible portion

Bengalgram

(Chana)

PeasDry

GreenGram(Mug)

Red gram(Tuvar) Soyabean

1 Protein (gm) 17.1 19.7 24 22.3 43.22 Fat (gm) 5.3 1.1 1.3 1.7 19.53 Fibre (gm) 3.9 4.5 4.1 1.5 3.74 Carbohydrates (gm) 60.9 56.5 56.7 57.6 20.95 Energy (Cal) 360 315 334 335 4326 Calcium (mg) 202 75 124 73 2407 Iron (mg) 4.6 7.05 4.4 2.7 10.48 Carotene (ug) 189 39 94 132 4269 Thiamine (mg) 0.30 0.47 0.47 0.45 0.73

10 Riboflavin (mg) 0.15 0.19 0.27 0.19 0.3911 Niacin (mg) 2.9 3.4 2.1 2.9 3.212 Folic acid (ug) 186 7.5 - 103 10013 Vit.C (mg) 3 0 0 0 -

Pulses and legumes comprise of dried peas, beans, dals and grams and are anintegral part of the Indian diet.Pulses and legumes have high protein content of about 20-25g %. Although they arepoor in methionine and cysteine and the biological values of their protein is inferiorto foods of animal origin (meat, fish eggs and milk), they are a substantial source ofproteins for those not consuming meat.


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Pulse protein is rich in lysine which compensates for the low lysine content ofcereal proteins. They are an important source of vitamins and minerals likecalcium, iron and vitamin B.Germination / sprouting increases the Vitamin C and Vitamin B content of the

pulses and also improve the digestibility.

Soya beanSoya bean is a pulse which has very high protein and fat content. It is also rich iniron, carotene, niacin and folic acid.The nutritive value of soya bean proteins is equivalent to milk proteins even thoughthe protein quality is inferior.The bland taste of unprocessed soya bean can be made up by suitably cooking orprocessing it. It can be simply cooked as dal or can be prepared with other legumes

as mixed dal. Its flour can be mixed in wheat flour to make it more nutritious. Soyamilk and curd is also popular. It can be processed to fried nuggets, which arerelished by the children.The soya bean oil is one of the very few oils rich in alpha-linolenic acid (>5%)besides its high contents of linoleic acid (50 %).

Nuts

Sr.No.

NutrientContent per 100 gm of edible portion

Almonds Cashew Pistachio Walnut Groundnut1 Protein (gm) 20.8 21.2 19.8 15.6 25.32 Fat (gm) 58.9 46.9 53.5 64.5 40.13 Fibre (gm) 1.7 1.3 2.1 2.6 3.14 Carbohydrates

(gm)10.5 22.3 16.2 11

26.1

5 Energy (Cal) 655 596 626 687 5676 Calcium (mg) 230 50 140 100 907 Iron (mg) 5.09 5.81 7.7 2.64 2.5

8 Carotene (ug) 0 60 144 6 379 Thiamine (mg) 0.24 0.63 0.67 0.45 0.90

10 Riboflavin (mg) 0.57 0.19 0.28 0.40 0.1311 Niacin (mg) 4.4 1.2 2.3 1 19.912 Folic acid (ug) - - - - 2013 Vit.C (mg) 0 0 - 0 0

Nut is the common name used for identifying a number of dry fruits or seeds ofsome plants. One interesting fact about nuts is that they can be termed as both fruits

and seeds.


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Nuts have a very high nutritive value. Nuts have a high fat and protein content andhence a high energy value.They are a good source of vitamins, minerals and antioxidants.Pistachio is rich in iron, containing 7.7 mg/100g.

Almond and cashew nuts are also moderate sources of iron and proteins.Ground nut

Groundnuts are the cheapest and arguably the most nutritious of all nuts. It contains almost as much oils and fats as an oilseed does (40%). Its MUFA

content is one of the highest amongst all Indian oilseeds, at 50% (exceeded onlyby mustard and rape seed). Its protein content is very high (25.3%). Its niacincontent is 5 to 20 times higher than other nuts.

A household item in many Indian states, it is relished boiled, roasted, fried orsimply salted. Groundnut chikki (with jaggery) is not only favourite with

children, but is extremely nutritious even for the pregnant and lactating. Multipurpose food used in national nutritional programme is made using amixture of 75 percent groundnut flour and 25 percent roasted red gram. It isfurther fortified with vitamins and minerals. It is a rich source of proteins.

EggSr. No. Nutrient Content per 100 gm

1 Protein (gm) 13.32 Fat (gm) 13.3

3 Fibre (gm) -4 Carbohydrates (gm) -5 Energy (Cal) 1736 Calcium (mg) 607 Iron (mg) 2.18 Carotene (ug) 4209 Thiamine (mg) 0.1

10 Riboflavin (mg) 0.411 Niacin (mg) 0.1

12 Folic acid (ug) 78.313 Vit.C (mg) 0

Egg has a high nutritive value. An egg contains about 6 g protein and 6 g of fat andprovides about 70 Kcal.The proteins are of a high biological value. The NPU of egg protein is 100 and istaken as the standard protein, to compare other proteins with.It also has a high cholesterol content of 250mg. The fat present in the yolk is finelyemulsified and hence easily assimilated.

The minerals and vitamins exist in the yolk, which is also a valuable source ofcalcium, phosphorus, iron and vitamins A and D.


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The white of the egg is one of the best sources of riboflavin. It is however deficient inVitamin C.

Milk

Sr. No. Nutrient Content per 100 gmCow Buffalo Human

1 Protein (gm) 3.2 4.3 1.12 Fat (gm) 4.1 6.5 3.43 Fibre (gm) - - -4 Carbohydrates (gm) 4.4 5 7.45 Energy (Cal) 67 117 656 Calcium (mg) 120 220 287 Iron (mg) 0.2 0.2 -

8 Carotene (ug) 53 48 419 Thiamine (mg) 0.05 0.04 0.02

10 Riboflavin (mg) 0.19 0.1 0.0211 Niacin (mg) 0.1 0.1 -12 Folic acid (ug) 8.5 5.6 -13 Vit.C (mg) 2 1 3

• Milk is the complete food on which the young one may subsist for up to six months.The human milk might be poorer than cow’s or buffalo’s milk, but is adequate for the

infant.• Milk is used to prepare curd, yogurt, butter, ghee and buttermilk. These are used

extensively for the preparation of many traditional Indian sweets.• All the important nutrients are well represented in milk except for iron and nicotinic

acid. Milk proteins are caseinogens (85%), lactalbumin (12%) and lactglobulin (3%).These proteins are of high biological value and are rich in tryptophan and cystein.Calcium caseinogenate is a complex formed with calcium in milk.

• Milk fat is an emulsion of extremely fine particles of the glycerides of butyric,palmitic and oleic acid rendering it easily digestible and this is especially so in cow’s

milk. Milk is also rich in linoleic acid and oleic acid.• Milk is a good source of vitamin A and D as well. Milk contains more than 30 types of

sugars, Lactose being the most predominant of them. Milk is also very rich incalcium and phosphorus.

• Curd: Curd is traditionally relished in the Indian diet. It is produced by the action oflactobacilli on lactose (in milk), which is broken down to lactic acid. Curd and wholebutter milk are easily digestible. They have the same nutritive value as that of theoriginal milk from which they were prepared, being very good sources of protein,calcium, vitamin A and riboflavin.

• Cream, Butter and Ghee: Cream, butter and ghee are the various types of fatsextracted from milk. Cream can be extracted by centrifugation of unboiled milk.


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Butter is the fat extracted from buttermilk. Ghee is the clear fat extracted afterboiling butter. Cream has nutritive value in between whole milk and butter. 100gmbutter yields about 729 Kcal. On the other hand, ghee is almost 100% fat, 100 g ofghee yielding 900 Kcal.

• Skimmed and Toned Milk: The milk available in market may be pure milk from cowor buffalo or a mixture of both. Skimmed milk is the one from which fat has beenremoved. This is useful for those who have been recommended low fat in diet.

• Toned milk can be manufactured by adding 1 part water and 1/8 part skimmed milkto 1 part milk. It becomes quite similar to cow’s milk.

• Tinned Milk: Powdered or tinned milk could be an alternative to whole milk whenfresh milk cannot be made available. Condensed, evaporated or homogenized milkcan be tinned. It could be sweetened or unsweetened. Condensed milk contains 50percent cane sugar, which is a good preservative. Dried or powered milk isreconstituted by adding 7 volumes of boiled water just before consumption. Tinnedmilk should be reconstituted as per instructions.

FruitsFruits hold a special place in the nutrition of man. Being eaten raw and fresh, theminerals, vitamins and phytochemicals present in them, do not get destroyed throughheat and fire. Fruits can be classified into citrus, non-citrus and dry fruits.

Nutritive Valuea) Vitamins and Antioxidants: Citrus fruits like oranges, lime, lemon, mosambi, malta,etc are rich sources of vitamin C. Guava and amla too are very rich sources of vitamin C.Papaya and mango are rich in carotene and moderately rich in vitamin C. Pineapples,strawberries and papaya are moderately rich sources of vitamin C. Yellow peaches are agood source of carotene. Banana, orange and strawberries are moderate sources offolates. Dried fruits like dry figs provide thiamin, niacin and riboflavin. Dried apricotsand prunes are rich in vitamin Ab) Minerals: Watermelon is rich in iron. Custard apple is rich in phosphorus and iron.Apricots, lime, guava and figs are rich in calcium. Apricots are rich in zinc too. Bananaand apples are moderately rich in potassium. Dried fruits: Raisins, figs, dates and dry

apricots are rich in iron. Dried figs are also rich in phosphorus, calcium, potassium andzinc.c) Energy: Banana and plantain have high energy value.d) Fibre: Fruits are rich in fibres. Their soluble fibre is particularly useful in inhibitingthe rapid absorption of glucose and lipids from the intestine. This is helpful inprevention of hyperglycemia and hyperlipidaemias.

Fruits and VegetablesHow much should we consume?

The Indian Council of Medical Research recommends that every individual shouldconsume at least 300 g of vegetables (GLV: 50 g; Other vegetables: 200 g; Roots &


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Tubers: 50 g) in a day. In addition, fresh fruits (100 g) should be consumed regularly.Since requirements of iron and folic acid are higher for pregnant women they shouldconsume 100g of leafy vegetables daily. High calorie vegetables and fruits should berestricted for over weight/ obese subjects.

Which vegetables and fruits should be consumed?One should consume fresh, locally available seasonal vegetables and fruits. They havemore micronutrients and are tasty. However no single fruit or vegetable provides all thenutrients one needs. The key lies in eating a variety of them and in different colours.Include commonly consumed leafy greens, tomatoes and other vegetables, apart fromthose which are yellow, orange, red, deep red, purple coloured citrus fruits.What care needs to be taken while consuming fruits and vegetables?Vitamins are lost during washing of cut vegetables and cooking of foodstuffs. However,proper methods of cooking can substantially reduce these losses. Nutrient loss is highwhen the vegetables are washed after cutting or when they are cut into small pieces forcooking. Consumption of properly washed raw and fresh vegetables is always beneficial.

Green leafy Vegetables (GLVs)Greens that are commonly used in Indian recipes include spinach (palak), fenugreekleaves (methi), mustard greens (sarson ka saag), amaranth (thotakoora), drumstickleaves, Colocasia leaves and Cabbage Lettuce.Dark GLVs are rich sources of minerals (iron, calcium, potassium, and magnesium)and vitamins (vitamins K, C, E and many of the B vitamins). They also containimportant phytochemicals, anti-oxidants and fibre.

Greens are low in calories, have no cholesterol, and are fat-free.The phytochemicals in GLVs are required for delaying ageing and preventing theprocesses which lead to diseases such as cataract, cardio-vascular diseases, diabetesand cancer.Dietary fibre from GLVs is important for proper bowel function, to reduce chronicconstipation, diverticular disease, haemorrhoids coronary heart diseases, diabetesand obesity. They also reduce plasma cholesterol. The protective role of dietary fibreagainst colon cancer has long been recognized.Antioxidants present in GLVs restrict the damage that reactive oxygen free radicals

can cause to the cell and cellular components. They are of primary biological value ingiving protection from certain diseases which have origin in deleterious free radicalreactions. They are atherosclerosis, cancer, inflammatory joint diseases, asthma anddiabetes.

MeatMeat is a word commonly used for the flesh of cattle (beef), goat and sheep (mutton),pig (pork) or chicken. It is regarded as a food of high nutritive value. Where a typicaldiet is heavily dependent on one type of cereal or root crop, meat, even in small

amounts, complements the staple food.Nutritive Value:


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• It is a good source of high quality protein (15 to 20g per 100g). Moreover thisprotein is qualitatively as good as that of fish, egg, milk, cheese and other dairyproduce, since it contains all essential amino acids.

• It is also a good source of most B vitamins like nicotinic acid. Meat is rich in

phosphorous but poor in calcium.• Liver, a component of meat, too has not only high quality proteins but also vitamin A

and vitamin B complex.• Meat is also rich in minerals especially iron and zinc. The iron content of meat is of

the heme variety which has high bioavailability.• Meat has a high content of fat including the saturated fatty acids, which may be a

risk for good health.Meat also needs to be inspected in slaughter houses since it may contain larval forms ofsome parasites which are harmful to man.

FishFish is called "rich food for poor people," since it provides essential nourishment,especially quality proteins and fats (macronutrients), vitamins and minerals(micronutrients). Fish also contributes to food security as an importantaccompaniment to rice based diets in Asia.Fish has high quantity of proteins (15 - 25g/100g), which are of high biological valueand are easily digestible.The fat content of fish varies depending on the species as well as the season but, in

general, fish have less fat than red meats. Fat from fish contain unsaturated fattyacids including the omega 3 fatty acids.Fish is a rich source of vitamins, particularly vitamins A and D from fatty species, aswell as thiamin, riboflavin and niacin. Vitamin A from fish is more readily availableto the body than from plant foods. Vitamin D present in fish liver and oils is crucialfor bone growth.The minerals present in fish include iron, calcium, zinc, iodine (from marine fish),phosphorus, selenium and fluorine. Sea fish is particularly rich in Iodine.Freshness of fresh-water fish is indicated by a stiff body, bright, clear and bulgingeyes, reddish gills, tight scales and absence of stale odour or discolouration. Freshfish will not show any pitting on finger pressure.


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Balanced DietWhat is a balanced diet?A balanced diet is one which provides all the nutrients in required amounts and properproportions. It can easily be achieved through a blend of the four basic food groups. Thequantities of foods needed to meet the nutrient requirements vary with age, gender,physiological status and physical activity. A balanced diet should provide around 50-60% of total calories from carbohydrates, preferably from complex carbo-hydrates,about 10-15% from proteins and 20-30% from both visible and invisible fat.

In addition, a balanced diet should provide other non-nutrients such as dietary fibre,antioxidants and phytochemicals which bestow positive health benefits. Antioxidantssuch as vitamins C and E, beta-carotene, riboflavin and selenium protect the humanbody from free radical damage. Other phytochemicals such as polyphenols, flavones,

etc., also afford protection against oxidant damage. Spices like turmeric, ginger, garlic,cumin and cloves are rich in antioxidants.

Recommended Dietary Allowances or Intakes (RDA or RDI)The RDA of a nutrient is the amount (of that nutrient) sufficient for the maintenance ofhealth in nearly all people (11). It is an estimate that corresponds to mean intake of thegiven nutrient + 2 Standard Deviation (that is about 25% of the mean has been added).It covers the requirement of 97.5% of the population. This is the safe level of intake andthe chances of this level being inadequate is not more than 2.5%. This ‘safe level’approach is however not used for defining the energy requirement, as any excess of

energy intake is as undesirable as its inadequate intake. Hence for defining the RDA ofenergy only the average requirement is considered.Can the RDA be Applied to Individuals?It must be appreciated that the RDA is the mean requirement figure for a nutrient(except energy), to which an allowance corresponding to 2 SD has been added. Thereare several individuals in a population whose requirement is actually well below orabove the RDA. If all the students in a class of 100 were to eat food exactly as per theirRDA about half would loose and the other half would gain weight, to the extent of beingseriously undernourished or obese after a year! It is because the RDA for energy is a

catering average; individuals however consume as per their appetite, which followstheir energy expenditure. The RDA can therefore, not be used as standard to determinewhether or not a given individual’s requirement of a nutrient has been met. It istherefore important to keep the principles of probability in mind and be cautious, whenapplying RDA at an individual level.Please refer to the textbook for the RDA for various nutrients for various groups.

The following is a suggested guideline for distribution of food articles in a balanced diet.


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Balanced diet for Adults- Sedentary/Moderate/Heavy activity (No of portions)

Type of workg/portion Sedentary Moderate Heavy

Man Woman Man Woman Man Woman

Cereals andmillets

30 12.5 9 15 11 20 16

Pulses 30 2.5 2 3 2.5 4 3Milk and milk

products100ml 3 3 3 3 3 3

Roots and tubers 100 2 2 2 2 2 2Green leafyvegetables

100 1 1 1 1 1 1

Other vegetables 100 2 2 2 2 2 2Fruits 100 1 1 1 1 1 1

Sugar 5 4 4 6 6 11 9Fat 5 5 4 6 5 8 6

Balanced diet for infants, children & adolescents (number of portions)

FoodGroups

Gm /portion

Infants6-12months

Years1-3 4-6 7-9 10-12 13-15 16-18

Girls Boys Girls Boys Girls BoysCereals& &millets 30 0.5 2 4 6 8 10 11 14 11 15Pulses 30 0.25 1 1.0 2 2 2 2 2.5 2.5 3

Milk(ml)&milkproducts 100 4a 5 5 5 5 5 5 5 5 5

Roots & tubers 100 0.5 0.5 1 1 1 1 1 1.5 2 2Green leafy vegetab 100 0.25 0.5 0.5 1 1 1 1 1 1 1Other vegetable 100 0.25 0.5 1 1 2 2 2 2 2 2Fruits 100 1 1 1 1 1 1 1 1 1 1Sugar 5 2 3 4 4 6 6 5 4 5 6Fat/oil(visible) 5 4 5 5 6 7 7 8 9 7 10

Quantity in dictates top milk, for breastfed infants, 200ml top milk is required.One portion of pulse may be exchanged with one potion (50g)of egg/meat/chicken/fish.

For infants introduce egg/meat/chicken/fish around 9 months.Specific recommendations as compared to sedentary women/men/children:

1-6 years- ½ to 3/4 the amount of ordeals, pulses and vegetable and extra cup ofmilk.

7-12years-extra cup of milk. Adolescent girls-extra cup of milk. Adolescent boys-Diet of sedentary man with extra cup of milk.


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PORTION SIZES & MENU PLANPortion Size Of Foods (raw) & Nutrients

g/portion Energy(kcal) Protein(g) Carbohydrate Fat(g)Cereals & millets 30 100 3.0 20 0.8pulses 30 100 6.0 15 0.7egg 50 85 7.0 - 7.0Meat/chicken/fis 50 100 9.0 - 7.0Milk(ml)& milkproducts

100 70 3.0 5 3.0

Roots & tubers 100 80 1.3 18 -Green leafyvegetables

100 46 3.6 - 0.4

Other vegetables 100 28 1.7 - 0.2Fruits 100 40 - 10 -sugar 5 20 - 5 -Fat & oils(visible) 5 45 - - 5.0

Common MeasurementsHere is an indicative list of the common measurements used in diet history. One shouldtry to be more precise whenever possible while taking diet history.

Utensil Gm/ml Equivalent1 Cup 200 ml1 Katori of cooked vegetable 30 gms

1 Katori of cooked rice 40 gms1 teaspoonful 5 gms/ 5 ml1 tablespoonful 15 gms/ 15 ml1 Roti (medium sized) 35 gms

Methods of Diet Survey1) Weighment of Raw food:Weighing of all food that is going to be cookedDisadvantage: wastage is also included

2) Weighment of cooked food:Cooked food is weighted before consumption.Disadvantage: not easily accepted by people.3) Oral Questionnaire method:It is Useful for carrying out diet survey of large number of people in a short time.Inquiry about their usual diet pattern is made (both quality and quantity).Disadvantage: Forgetfulness, overestimation or underestimation.4) 24-hour Recall:Inquire about the diet which was taken since same time yesterdayDisadvantage: lunch or dinner at feast / festival.5) Diet diary:


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Note down all the food articles consumed in a note book for 1 week.Disadvantage: not useful for illiterate people6) Stock inventory method:Ask about the food stocks stored at the house.

7) Duplicate sample method:Keep a duplicate sample of whatever diet is consumedDisadvantage: not easily acceptable8) Food frequency method:Number of time a given food article is consumed in a month, week, days,Disadvantage: not useful as an individual method. Quantity of food not estimated.

Quick methods for Diet HistoryCereals Stock inventory method , stock divided

by the number of membersPulses Weighment of raw foodGreen leafy vegetables Weighment of raw food

Frequency: daily, weeklyOther vegetables and fruits Weighment of raw food

Frequency: daily, weeklyRoots and tubers Weighment of raw food

Frequency: daily, weeklyMilk Stock inventory method , stock divided

by the number of membersOil Stock inventory method , stock divided

by the number of membersSugar and Jaggery Weighment of raw foodEggs Frequency: daily, weeklyNon-vegetarian food Frequency: daily, weeklySnacks, Junk foods, Fast-foods Frequency: daily, weekly


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Dietary guidelines1) Eat variety of foods to ensue a balanced diet

a) Variety in food is not only the spice of life but also the essence of nutrition andhealth.

b) A diet consisting of foods from several food groups provides all the requirednutrients in proper amounts.

c) Cereals, millets and pulses are major sources of most nutrients.d) Milk which provides good quality proteins and calcium must be an essential item

of the diet, particularly for infants, children and women.e) Oils and nuts are calorie-rich foods, and are useful for increasing the energy

density specially in children. This is particularly useful for undernourishedchildren.

f) Inclusion of eggs, flesh foods and fish enhances the quality of diet. However,

vegetarians can derive almost all the nutrients from diets consisting of cereals,pulses, vegetables, fruits and milk-based diets.

g) Vegetables and fruits provide protective substances such as vitamins/ minerals/phytonutrients.

h) Diversified diets with a judicious choice from a variety food groups provide thenecessary nutrients.

2) Ensure provision of extra food and healthcare to pregnant and lactating women.a) Eat more food during pregnancy.b) Eat more whole grains, sprouted grams and fermented foods.

c) Take milk/meat/eggs in adequate amounts.d) Eat plenty of vegetables and fruits.e) Avoid superstitions and food taboos.f) Do not use alcohol and tobacco. Take medicines only when prescribed.g) Take iron, folate and calcium supplements regularly, after 14-16 weeks of

pregnancy and continue the same during lactation.3) Promote exclusive breastfeeding for six months and encourage breastfeeding till

two years.a) Start breast-feeding within an hour after delivery and do not discard colostrum.

b)

Breast-feed exclusively (not even water) for a minimum of six months if thegrowth of the infant is adequate.c) Continue breast-feeding in addition to nutrient-rich complementary foods

(weaning foods), preferably upto 2 years.d) Breast-feed the infant frequently and on demand to establish and maintain good

milk supply.e) Take a nutritionally adequate diet both during pregnancy and lactation.f) Avoid tobacco (smoking and chewing), alcohol and drugs during lactation.g) Ensure active family support for breast-feeding.

4) Feed home based semi solid foods to the infant after six months.a) Breast-milk alone is not enough for infants after 6 months of age.


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b) Complementary food should be given after 6 months of age, in addition to breast-feeding.

c) Do not delay complementary feeding.d) Feed low-cost home-made complementary foods.

e)

Feed complementary food on demand 3-4 times a day.f) Provide fruits and well cooked vegetables.g) Observe hygienic practices while preparing and feeding the complementary food.h) Read nutrition label on baby foods carefully.

5) Ensure adequate and appropriate diets for children and adolescents both in healthand sickness.a) Take extra care in feeding a young child and include soft cooked vegetables and

seasonal fruits.b) Give plenty of milk and milk products to children and adolescents.c) Promote physical activity and appropriate lifestyle practicesd) Discourage overeating as well as indiscriminate dieting.

EAT CALCIUM-RICH FOODS Calcium is needed for growth and bone development. Children require more calcium Calcium prevents osteoporosis (thinning of bones). Milk, curds and nuts are rich sources of bio-available calcium (Ragi and GLV

are also good dietary sources of calcium). Regular exercise reduces calcium loss from bones. Exposure to sunlight maintains vitamin D status which helps in calcium

absorption

DURING ILLNESS Never starve the child. Feed energy-rich cereal-pulse diets with milk and mashed vegetables. Feed small quantities at frequent intervals. Continue breast-feeding. Give plenty of fluids during illness.

Use oral rehydration solution to prevent and correct dehydration duringdiarrhoeal episodes.

6) Eat plenty of vegetables and fruits.a) Normal diet, to be wholesome and tasty, should include fresh vegetables and

fruits, which are store houses of micronutrientsb) Vegetables/fruits are rich sources of micronutrients.c) Fruits and vegetables also provide phytonutrients and fibre which are of vital

health significanced) They help in prevention of micronutrient malnutrition and certain chronic

diseases such as cardiovascular diseases, cataract and cancer.e) Fresh fruits are nutritionally superior to fruit juices.


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f) Include green leafy vegetables in daily diet.g) Eat as much of other vegetables as possible daily.h) Eat vegetables/ fruits in all your meals in various forms (curry, soups, mixed

with curd, added to pulse preparations and rice)

i)

Consume raw and fresh vegetables as salads.j) Grow the family's requirements of vegetables in the kitchen garden ifk) Green leafy vegetables, when properly cleaned and cooked, are safe even for

infants.l) Let different varieties of vegetables and fruits add colour to your plate and

vitality to your life.m) Beta carotene rich foods like dark green, yellow and orange colored vegetables

and fruits (GLVs, carrots, papaya and mangoes) protect from vitamin Adeficiency.

7) Ensure moderate use of edible oils and animal foods and very less use of ghee/butter/ vanaspati.a) Take just enough fat.b) Substitute part of visible fat and invisible fat from animal foods with whole nuts.c) Moderate the use of animal foods containing high fat, SFA and cholesterol.d) Limit use of ghee, butter and as a cooking oil.e) Choose low fat dairy foods in place of regular whole fat.f) Eat foods rich in a-linolenic (n-3) acid like legumes, green leafy vegetables, and

fenugreek and mustard seeds.g) Eat fish more frequently (at least 100-200g fish/week prefer it over meat and

poultry and limit/avoid organ meats (liver, kidney, brain etc)).h) Egg has several important nutrients but is high in cholesterol. Limit the

consumption to 3 eggs/ week.i) Minimize consumption of premixed ready- to- eat fast foods, bakery foods and

processed foods prepared in hydrogenated fat.j) Use of re heated fats and oils should be avoided.k) Consume variety of foods and maintain moderation to get good proportions of all

fatty acids and derive optimal health benefits.8) Overeating should be avoided to prevent overweight and obesity.

a) Slow and steady reduction in body weight is advised.b) Severe fasting may lead to health hazards.c) Achieve energy balance and appropriate weight for heightd) Encourage physical activitye) Eat small meals regularly at frequent intervals.f) Cut down on sugar, salt, fatty foods and alcohol.g) Promote complex carbohydrates and fiber rich dietsh) Increase consumption of fruits and vegetables, legumes, whole grains and nuts.i) Limit energy intake from total fat and shift fat consumption from saturated to

unsaturated


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j) Eliminate the use of trans-fatty acids rich vanaspati in foods (bakery productsand sweets).

k) Use low fat milk.9) Exercise regularly and be physically active to maintain ideal body weight.

a)

A minimum 30-45 minutes brisk walk/physical activity of modern intensityimproves overall health.

b) Include ‘warm -up’ and ‘cool - down’ periods, before and after exercise regimen.c) Forty five minutes per day of moderate intensity physical activity provides many

health benefits.10) Use salt in moderation/ Restrict salt intake to minimum.

a) Restrict the intake of added salt from an early age.b) Develop a taste for foods/diets low in salt.c) Restrict intake of preserved and processed foods like papads, pickles, sauces,

ketchup, salted biscuits, chips, cheese and salted fish.d) Eat plenty of vegetables and fruits to provide adequate potassium.e) Use always iodized salt.

11) Ensure the use of safe and clean foods.a) Buy food items from reliable sources after careful examination.b) Wash vegetables and fruits thoroughly before use.c) Store the raw and cooked food properly and prevent microbial, rodent and insect

invasion.d) Refrigerate perishable food items till consumption.e) Maintain good personal hygiene and keep the cooking and food storage areas

clean and safe.12) Practice right cooking methods and healthy eating habits.

a) Avoid food faddism and discard erroneous food beliefs.b) Do not wash food grains repeatedly before cooking.c) Do not wash vegetables after cutting.d) Do not soak the cut vegetables in water for long periods.e) Do not discard the excess water left over after cooking. Use only sufficient water

for cooking.f) Cook foods in vessels covered with lids.g) Prefer pressure/steam cooking to deep frying/roasting.h) Encourage consumption of sprouted/fermented foods.i) Avoid use of baking soda while cooking pulses and vegetables.j) Do not reheat the left over oil repeatedly.

13) Drink plenty of water and take beverages in moderation.a) Drink enough of safe and wholesome water to meet daily fluid requirements.b) Drink boiled water, when safety of the water is in doubt.c) Consume at least 250 ml of boiled or pasteurized milk per day.d) Drink natural and fresh fruit juices instead of carbonated beverages.

e) Prefer tea over coffee.f) Avoid alcohol. Those who drink, should limit its intake.


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14) Minimize the use of processed foods rich in salt, sugar and fats.a) Prefer traditional, homemade foods.b) Avoid replacing meals with snack foods.c) Limit consumption of sugar and unhealthy processed foods which provide only

(empty) calories.d) Prefer fortified processed foods.e) Always read food label (given on containers) regarding nutrients, shelf-life and

the additives used15) Include micronutrient rich foods in the diets of elderly people to enable them to be

fit and active.a) Eat a variety of nutrient-rich foods.b) Match food intake with physical activity.c) Eat food in many divided portions in a day.d) Avoid fried, salty and spicy foods.e) Consume adequate water to avoid dehydration.f) Exercise regular


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Food Adulteration, Food Safety & Security Act

Fortification: Process whereby nutrients are added to foods (in relatively smallquantities) to maintain or improve quality of diet

Iodization of salt Vitamin A & D in Vanaspati ghee Vitamin A & D in Milk Fluoridation of water

Food enrichment: Synonymous with fortification and refers to the addition ofmicronutrients to a food which are lost during processing.

Micronutrients to white rice

Food additives: Non nutritious substances which are added intentionally in foodgenerally in small quantity to improve its appearance, flavour, texture or storageproperties.

First category: Coloring agents (Turmeric) Flavoring agents (Vanilla essence) Sweeteners (Saccharine) Preservatives (Acetic acid)

Second category: Contaminants

Food adulteration Mixing, Substitution, Concealing the quality, Putting up decomposed food for sale, Misbranding or giving false labels Addition of toxicants to the food articles. Adulteration of food

( Common Adulterants )Prevention

1. Food Safety Laws2. Prevention of Food Adulteration Act, 19543. Fruit Products Order, 19554. Meat Food Products Order, 19735. Vegetable Oil Products (Control) Order, 19476. Edible Oils Packaging (Regulation) Order, 19887. Solvent Extracted Oil, De-oiled Meal and Edible Flour (Control) Order, 1967

8.

Milk and Milk Products Order, 19929. Any order under Essential Commodities Act, 1955 relating to food


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10. Food Safety and Standards Act (FSSA)11. In 2006 Food Safety and Standards Act, 2006 came into enforcement with

two objective :a. To introduce a single statute relating to food and

b.

To provide for scientific development of the food processing industry

PFA, 1954 FSSA, 2006Multiple Authorities Single AuthorityAdulteration SafetyInspection / Control Monitoring SurveillanceInsufficient Enforcement Full time District Officer, Food

Safety Personnel officer under FSC

Penalty fees:

Penalty for substandardfood

Rs 5 lacs

Penalty for misbranded food Rs 3 lacs

Penalty on misleadingadvertisement

Rs 10 lacs

Food containing extraneous

matter

Rs 1 lac

Penalty for unhygienicprocessing of food

Rs 1 lacs

Punishment for unsafe foodWhich--Does not result in injuryNon-- ‐grievous injury Grievous injuryDeath

6 Months Imprisonment and 1 lacs1 Year Imprisonment and 3 Lacs6 Y Imprisonment and 5 Lacs7 Y or Life Imprisonment and 10 Lacs

Compensation to consumerDeathGrievous injury

5 lac rupees3 Lac1 Lac


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Nutritional Disorder of Public Health Importance

They are Low Birth Weight (LBW)

Protein Energy Malnutrition(PEM) or Protein Calorie Malnutrition(PEM) Xerophthalmia Nutritional anaemia Iodine deficiency disorder Endemic fluorosis Lathyrism

Low Birth Weight (LBW) It’s a major public health problem in many developing countries

Birth weight less than 2500 gm About 28 % babies born in India are LBW as compared to 4 % in developedcountries

proportion of LBW high -suffering from fetal growth retardation proportion of LBW low- pre-term Maternal malnutrition and anemia appears to be significant risk factors in its

occurrence. Also other causes are like hard physical labour during pregnancy, and illnesses

especially infections.

Short maternal stature, very young age, high parity, smoking, close birth intervalare associated factors.

Protein Energy Malnutrition (PEM) or Protein Calorie Malnutrition(PCM)

• ‘A state of nutrition in which a deficiency or excess (or imbalance) of energ y,protein and other nutrients causing measurable adverse effects on tissue/bodystructure and function and clinical outcome’

• Protein energy malnutrition is the term applied to a class of clinicalmanifestations of protein lack and energy inadequacy

• Terminology PEM was adopted by WHO as the major limiting factors in the dietare both energy and protein

• Deficiency of the protein is never isolated and is always associated with lack ofenergy

• It’s a Major health and nutrition problem in India • Occurs particularly in weakling and children in the first year of life• Not only an important cause of childhood morbidity and mortality but also to

permanent impairment of physical and mental growth of those children• According to NFHS III in India 46%children


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• In Gujarat according to NFHS III 47% children


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Also this history linked with the mother’s health and nutritional status

Malnutrition is measured by ANTHROPOMETRY:•

Measured by weight for age, height for age and weight for height.• Low wt for age means?• Low ht for age means?• Low wt for ht means?

ANTHROPOMETRIC MEASUREMENTS(A) Age Dependent Measurements

• 1. Weight:

• Formulas for calculating weight:• 0-1 year- X+9/2 X is age in months of 1 st year• 1-6 years- 2x+8 X is age in completed years• 7-12 years- 7X-5/2 X is in completed years

• 2. Height:

• Formulas:• 0-1 year – 50+2X X is completed months of 1 st year

• 1-2 year – 75+X X is completed months of 2 nd • 2-12 year -6X+77 X is completed year

• 3. Head Circumference:

• 4. Chest Circumference:• Normally chest circumference

• Crosses that of head at the age of 9• Months it is delayed in chronic

• Malnutrition.

• Weight for age (%)=• Weight of the child / Weight of a normal child of same age X 100

• Height for age (%)=• Height of the child /Height of a normal child of same age X100

(B). Age independent.


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1. Weight for height (%) =Weight of the child / Weight of a normal child at same height

X 1002. Mid arm circumference:3. Reliable estimation of muscle mass4. Used for child in age group 1-5 buy

ETIOLOGY Poverty: commonest cause- inability to buy food. Under nutrition Diminished work capacity Low earning and poverty Maternal malnutrition Infection Population growth : in birth rate is disproportionate to in food production Inadequate distribution of food in the family Feeding habits

High pressure advertising of baby foods Socio-cultural factors

Theories regarding etiology of PEM:1. Classical Theory:Oedema in kwashiorkor is due to Hypo-albuminemia, whereas marasmus occurs primarilydue to lack of energy.2. Gopalan’s disadaptation theory:Outcome of the PE deficiency is determined by the body response of a child.

Chronic adaptation→ Marasmus Acute response (fails to adapt) →Kwashiorkor

3. Gopalan’s theory of free radicals: • Most recent• Imbalance in free radical generation and safe disposal


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Classification of PEM:Etiological classification:

Primary malnutrition: Primarily due to dietary deficiency Secondary : As an effect of some other illness

IAP classification:Grade Wt./age(%)

1 80-712 70-613 60-514


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Malnutrition classification:Wasting wt. /ht.(%) Stunting ht. /Age (%) Malnutrition

↓ Normal Acute MalnutritionNormal ↓ Chronic malnutrition

↓ ↓ Acute on chronic malnutritionWasting wt. /ht.(%) Stunting ht. /Age (%) Malnutrition

↓ Normal Acute MalnutritionNormal ↓ Chronic malnutrition

↓ ↓ Acute on chronic malnutrition

Colour coded classification by Mid- upper arm circumference in cm by Sakir’s tape:

Based on subcutaneous fat (Udani’s Classification): • Grade I: Loss of fat from axilla• Grade II: Loss of fat from abdominal and gluteal region• Grade III: Loss of fat from chest and neck

• Grade IV: Loss of fat from buccal pad

Kanavati’s Formula: Grade KF=MAC/HC

Normal >0.31Mild 0.31-0.28

Moderate 0.279-0.25Severe ≤0.249

Clinical Classification:•

Kwashiorkor-Primarily due to lack of protein associated with energy.• Marasmus-result of lack of energy accompanies with protein deficiency• Marasmickwashiorkor :Overlap of clinical picture of both

Clinical features:• Mild to moderate under-nutrition:

If the dietary intake is less for a short period Child appear slow and less energetic

If persist for a longer time Growth may be affected more in weight than in height Crossing of chest circumference over head circumference is delayed

Buttocks flattened


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Winging of the scapula Abdomen become distended

If persist for a long time child may develop marasmus or kwashiorkor

Marasmus

• The term is derived from Greek word• Usually seen in child


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The term is introduced by Prof. Williams, for the disease in Ghana, meaning “redboy” because of pigmentary changes due to a disease.

Markedly retarded growth Common among older infants and preschool children

Upper limb muscles become wasted, lower limb appears swollen. Wasting is masked by oedema• Psychomotor changes:

Lethargic Show little interest in surrounding Appetite become impaired

• Oedema:• Pitting in nature• Causes

HypoalbuminemiaRetention of fluid and waterFree radical induced damage

• Starts from LL and involve upper limb and face• Face appear moon shaped and puffy-moon faces

Other changes:• Hepatomegaly• Hair changes: flag sign-partly pigmented and partly hypopigmented• Skin changes: flaky paint dermatosis-erythema followed by hyperpigmentation,

this hyperpigmented skin disquamate to expose raw hypopigmented skin.• Repeated infections

TreatmentBased on severity:A) Treatment of complication :( SHIELDED)S-Sugar deficiencyH-hypothermiaI-InfectionsEL-Electrolyte imbalanceDE-DehydrationD-Deficiency of Fe/Vitamins

B) Dietary Therapy :( BEST) (1-6 weeks)B- Beginning of feeding (0-7days): Start with 80kcal/kg/day and 0.7gm/kg/day on firstday upto 150 kcal/kg/day and protein 2-3gm/kg/day on 7 dayE- Energy dense food-150-220/kcal/kg/day and 4-5 gm/kg/day with the help of energydense homemade food e.g.BesanPanjiri giving 500 kcal& 9 gm protein/100gm,Hyderabadi mixture

Khichdi with added oil/ghee/curdS- Stimulation-human contact and emotional support including tender loving care(TLC)


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T- Transfer to home based dietTreatment in mild to moderate malnutrition:

• Home based treatment• 150 kcal/kg/day and protein 2-3gm/kg/day•

Food prepared at home• Keep surveillance to stop from slipping down in severe grade.Preventive measures:

No simple solution for malnutrition Many types of action are necessary For prevention of PEM

a) Health promotionb) Specific protectionc) Early diagnosis and treatmentd) Rehabilitation

(A) Health promotion For pregnant and lactating women(education & distribution of supplement) Promotion of breast feeding Development of low cost weaning foods Measures to improve family diet Nutritional education Home economics

Family planning and spacing of birth Family environment(B) Specific protection

Child’s diet must contain protein and energy rich foods, milk, egg, fruits also. Immunization Food fortification

(C) Early Diagnosis and treatment: Periodic surveillance Early diagnosis of any lag in growth Early diagnosis and treatment of infections and diarrhoea Deworming of heavily infested children Supplementary feeding programmes

(D) Rehabilitation Nutritional rehabilitation services Hospital treatment Follow-up care


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Difference between Clinical features of Marasmus and Kwashiorkor:Features Marasmus Kwashiorkor

Muscle wasting Obvious May hidden by oedemaFat wasting Severe loss of subcutaneous fat Fat usually retained

Oedema Absent Present involving lower legs,face and arms

Weight for height Very low Low or normal (masked byoedema)

Mental changes Irritable ApathicAppetite Good Poor

Diarrhoea Often OftenSkin changes None Diffuse pigmentation, flaky

paint dermatosisHair changes Seldom Sparse, silky, easily pulled out

Hepatic enlargement None sometimes

Xerophthalmia All the ocular manifestation of Vit A deficiency Most common in 1-3 yr Related to weaning Associated with PEM Skimmed milk is a major culprit Rice eating states: Andhra, TN, Karnataka, Bihar, west Bengal.

Prevention & Control:WHO has given 3 categories for the prevention:

Short term: Vitamin A prophylaxis schedule

Individual Oral dose TimingChildren< 12 months 1lakh IU Once every 4-6 monthChildren> 12 months 2 lakh IU Once every 4-6 monthsWomen child bearing age 3 lakh IU Within 1 month of deliveryPregnant and lactating women 20000 IU Once every week

Medium term: Food fortification

Long term: Green leafy vegetables Breast feeding Safe and adequate water supply Construction of sanitary latrine Immunization against infectious diseases Prompt treatment of diarrhoea Better feeding and health education


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Vitamin A deficiency in India: About 5.7% of children suffer from eye sign of Vit A deficiency Prevalence of Bitot’s spot is 0.5 % only 21% of 12 to 35 months receive Vit A

in 1970 national program for prevention of blindness for preschool children In 1992 children aged 9 months to 3 years Under RCH new guide lines covers all children up to 5 yr

Nutritional anaemia: Haemoglobin content of the blood below normal as a result of deficiency of one

or more essential nutrients regardless of the cause of such deficiency 2/3 rd of pregnant and ½ of non pregnant are anaemic in developing countries Silent emergency

Except Punjab all other states have prevalence of 50% among pregnant women. As per DLHS adolescent girls -72.6% prevalenceCauses of Anaemia:

Poor bioavailability Menstruation Malaria, hook worm

Detrimental effects of Anaemia: Pregnancy Infection Work capacity

Interventions: If severe Hb


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Strabismus, nystagmus Spasticity(extra pyramidal) Neuro muscular weakness Endemic cretinism

IUDEpidemiological assessment of iodine deficiency:

Prevalence of goitre Prevalence of cretinism Urinary iodine excretion T3 T4 TSH Prevalence of neonatal hypothyroidism(sensitive indicator for environmental

iodine deficiency )Goitre control:

Iodized salt (PFA act )30 ppm at production level15 ppm at consumer level

Salt fortified with iodine and iron Iodized oil- IM injection 1 ml will provide protection for 4 years ,less practicable Oral iodized oil Iodine monitoring Man power training for legal enforcement and public education Mass communication

Endemic fluorosis Where fluorine 3-5 mg/dl WHO limit 1.5 mg/dl international 1.0 mg/dl 0.5 -0.8 mg/dl recommended acceptable limit

Types:1. Dental flu0rosis2. Skeletal flu0rosis3. Genu valgum In AP & TN- where Jowar as a staple diet

Intervention:1. Changing the water supply- running surface water2. Chemical treatment- NEERI Nagpur –Nalgonda technique –addition of lime and

alum –flocculation –sedimentation – filtration3. Fluoride tooth paste- not recommended for children below 6 yr

Lathyrism: Its paralyzing disease of humans and animals In human it is neuro-lathyrism because it affects the nervous system, and in

animal it is osteo-lathyrism because pathological changes occur in bones


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resulting in skeletal deformities. Neurolathyrismis a crippling disease of the nervous system characterized by

gradually developing spastic paralysis of lower limbs, occurring mostly in adultsconsuming the pulse, lathyrus sativus in large quantities.

Prevalent in parts of MP, UP, and orissa. Also in Maharashtra, west Bengal, Gujarat, Assam.

Lathyrus sativus i s commonly known as “Khesari Dhal” Also name like teora dhal, batra, gharas, matra. Seed of L.sativus have triangular shape and grey color. Over 30 % of this dhal if taken over a period of 2-6 months will result in neuro-

lathyrism. The toxin present in see ds has been identified as “Beta Oxalyl Amino Alanine

(BOAA)” crysline and water soluble. Diseases mainly occurs in young men 15-45 years

Stages:A. Latent stage: apparently healthy, if stress –ungainly gait-important for

prevention-if pulse is withdrawn from the dietB. No stick stage: short jerky stepsC. One stick stage: crossed legs-walk on toes, muscle stiffnessD. Two stick stage: excessive bending of knee, 2 crutchesE. Crawler stage: knee joint can not bear wt.

Interventions:1. Vitamin C prophylaxis2. Banning of crop: it should never be more than quarter of total cereal and pulses

taken per day3. Removal of toxin

Steeping method –soaking in hot water Parboiling-soaking in lime water Education Socio economic changes Genetic approach-selective cultivation of lathyrus containing


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Baroda Dairy

Baroda dairy known as ‘Baroda District Co-Operative Milk Producers Union Limited,Vadodara’ is a district level milk processing industry established in the year 1957

registered under Gujarat state co-operative societies act. There are total 1405 primarymilk co-op societies under Baroda dairy (2014).

The farmers own the dairy; their elected representatives manage the village societiesand the district union. They employ professionals to operate the dairy and manage itsbusiness. The dairy aims to provide remunerative returns to the milk producers andserve the interest of Indian consumers by providing quality milk products through thefederation - M/S Gujarat Co-Operative Milk Marketing Federation Limited.

The plant can process up to 5 lac litres of milk per day. The main process of the plant – pasteurization is done with the help of HTST (High Temp Short Time) Pasteurization.The milk is standardized in various Fat/SNF contents and packed.

Type of Milk Fat (%) SNF (%)Amul Gold Milk 6.0 9.0Amul Shakti Milk 4.5 8.5Amul Cow Milk 3.5 8.5Amul Slim n Trim Milk 1.5 9.0

Quality ManagementThe union is certified for ISO 22000:2005, Food Safety Management System in the year2009.Environment Management System complies AS/NZS ISO14001:2004.

Milk HygieneThere is a potential of disease causation through milk when it is not handledhygienically. Diseases which can be conveyed through milk are bovine tuberculosis, Qfever, food poisoning, diarrhoea and dysenteries, septic sore throat, cholera, enteric

fever, viral hepatitis, diphtheria etc.The milk hygiene begins at its source of production namely the dairy farm.

A dairy consists of the farm, the milk depot and the pasteurization and bottling/ packingplant, staff changing rooms, and a manure disposal yard. The dairy proper has milkreceiving, pooling, cooling and blending room.

To prevent outbreaks of milk borne diseases, hygiene of cattle, personnel, equipment,process (of milking and pasteurization), as well as sanitary packing and delivery shouldbe ensured. A periodical medical examination of personnel, inspection of premises and

equipments, veterinary inspection of cattle, scrutiny of the process in the dairy,


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inspection of functional efficiency of the farm, depot and plant, and laboratory tests forpurity and quality of pasteurization are required to be carried out.

These measures should ensure the following:Care of Cattle:A clean, airy, cool and spacious cattle shed is of prime importance. Ample water supplyfor drinking, to wash the cattle sheds and bathe the cattle should be available. Fodder,cottonseed, oilcake, bran and meal consisting of a coarsely crushed mixture of grainsmust be given to each animal. Stores should be rat proof. Sick animals must beimmediately isolated and contacts segregated. Cattle should be inspected by aveterinary surgeon at least once a month.Cow Sheds:The cow shed should be well drained and higher than the surrounding ground. The floorarea per cattle head should be minimum 6 m2. The walls should be of reinforcedconcrete and whitewashed inside. Good cross ventilation is essential. The shed shouldbe well lit. The whole flooring should be of impervious concrete. The sheds should bewashed every day and cleaned twice a day. They should be sprayed with insecticideonce a week.Disposal of Cattle Dung and Sullage :All channels carrying Sullage and liquid cattle dung should always be made of concrete.Semisolid cattle dung, a potent source of fly breeding, should be removed daily to a cowdung depot made of concrete and situated at least 200 m away from the cattle sheds.Ant fly measures must be ensured.

Health of Workers:Medical inspection of the employees should be carried out very regularly andfrequently, strict attention being paid to personal cleanliness. A regular immunizationagainst enteric group of fevers must be ensured. All cases of illnesses, especiallydiarrhoea, dysentery, enteric fever, infected fingers or boils, running nose or ears, sorethroat, or cough must be attended to. Exclusion of carriers of communicable diseasesshould also be rigidly enforced. All indoor workers should scrub their hands thoroughlywith soap, hot water and a nail brush and change into their working clothes includingcotton masks. All workers should have adequate sanitary and bathing facilities. They

should wash their hands with soap and water before entering the processing premisesor milking.Pasteurization:Boiling kills the microorganisms but is likely to adversely affect the quality, taste andflavour of milk, as milk constituents are heat-labile. Pasteurization involves rapidlyheating milk (to less than the boiling point), maintaining it uniformly over a definiteperiod and rapidly cooling it. This destroys most of the pathogenic microorganisms,reduces the total quantity of all the microorganisms without affecting its inherentqualities (taste and flavour). It may not sterilize milk but makes it non-infective, retains

its nutritive and aesthetic qualities and improves its keeping quality. The importantpathogens that are destroyed by pasteurization of milk are M tuberculosis, B abortus,


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Streptococci and Staphylococci and the non-lactose fermenting pathogenic organisms ofthe Salmonella-Shigella group. The subsequent rapid cooling of the heated milk inhibitsthe multiplication of any viable residual microorganisms or of the ones subsequentlygaining access to the liquid. The low temperature must be maintained till the milk is

consumed. The nutritive value of pasteurized milk remains reasonably satisfactory. Itsfat, protein, calcium, phosphorus, and vitamins A and D contents are not affected. Thereis a 10% loss of vitamins B and 20% loss of vitamin C. Pasteurization improves thekeeping quality of milk, reduces the number of bacteria, and destroys tuberculosisbacilli and other pathogenic organisms except spores and thermoduric bacteria.However, milk with a high bacterial count in a raw state will not pasteurize so efficientlyas clean milk. Pasteurized milk can be preserved for 8 to 12 hours at 18°C.

Methods of Pasteurization:(a) Holder (Vat) method: This method consists of heating the milk to the temperaturesbetween 63ºC and 65.5º C and holding it in large tanks at that temperature for 30 minbefore cooling it rapidly to 5°C. Milk gets heated efficiently and pathogenic bacteria arekilled with certainty. From these holding tanks, the milk runs directly to the cooler andthen to the packing / bottling machine through a closed system.(b) Continuous Flow Method: This method is the modification of the Holder method.The milk is first heated to 63ºC or more and then led through a series of heated metalcoils so that the milk remains at that temperature in the apparatus for 30 minutes.(c) High Temperature Short Time (HTST) Method: In this method milk is heated to 72°Cfor 15 seconds and then rapidly cooled to 4ºC.(d) Ultra high temperature (UHT) Method: Milk is rapidly heated usually in two stages,the second stage being under pressure, between 125º to 150º C for a few seconds only.It is then rapidly cooled and packed / bottled as quickly as possible.(e) Pasteurization in Bottles: The filled bottles can also be pasteurized. They are wellsealed and heated by a shower of hot water or steam. The simplest method is to placethe milk bottles in water-bath brought to 63ºC held there for 30 min and then chilled.The theoretical risk of contamination after pasteurization is entirely eliminated.

Supervision of Pasteurization Process:

The pasteurization process needs constant supervision and the following are the mostimportant factors to ensure efficient pasteurization:(a) Raw milk must be clean and free from extraneous matter.(b) A pasteurization chart should show the range of and the period for which thetemperature, as specified for the method, was maintained.(c) Milk must be protected from contamination during cooling and bottling / packing;unprotected open coolers are undesirable.(d) Excessive foaming of milk must be avoided as the temperature of the foam is too lowto kill pathogens and may even encourage the growth of thermophilic organisms.(e) The apparatus must be efficiently cleaned and sterilized after each day’s work.

1st Clinical Posting

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