Assignment Code: ANC-1/AST-1/TMA-1 /21

Course Code: ANC-1

Assignment Name: AOC: Nutrition for the Community

Year: 2020-2021

Verification Status: Verified by Professor

Valid Until: December 31, 2021

Section A – Descriptive Type Questions (40 marks)

There are ten questions in this part. Answer all questions.

Q1. a) Briefly explain the social, psychological and economical aspects of nutrition. (3)

Ans) Social Aspect: Our ancient Vedic tradition emphasizes food as the life-giver. It further attributes specific qualities to specific foods. It is said that sattvic foods, for example, increase intellectual capacity and creativity, energy and cheerfulness. Milk and milk products are regarded as the prominent sattvic foods.

The psychology of eating: How does a person react to food? What psychological factors influence our eating patterns? This is considered in the psychology of nutrition.

The economics of food: Food costs money. It must be within the reach of people and it must be equitably distributed to all sections of the population. The availability of food and its proper distribution are of great importance. You may have heard of people dying of starvation even when plenty of food was available. In India, for example, agricultural production has consistently increased. However, the problem of distributing our food surplus still remains.

b) Briefly explain the digestion, absorption and utilization of protein in our body. (3)

Ans) Proteins taken in the diet are digested to amino acids in the stomach and small intestine. Gastric juice contains enzymes pepsin which digests protein in acid medium. It hydrolyses proteins to polypeptides. In the small intestine, pancreatic and intestinal juices contain proteolytic enzymes. Pancreatic juice contains trypsin, chymotrypsin and carboxyl peptidase. They hydrolyse large protein molecule to smaller polypeptide. Intestinal juices contains polypeptidases & dipeptidases which hydrolyse polypeptide & dipeptide to individual amino acids. There are several peptidases acting on different proteins. When undigested protein enter large intestines, bacteria causes nitrification of proteins leading to foul smelling flatus. Proteins are mainly absorbed in the form of amino acids. Amino acids are absorbed by active transport mechanism in the intestinal cells. Sometimes whole protein may be absorbed by the mechanism of pinocytosis. Absorbed amino acids pass into the portal blood and reach liver where they are converted to proteins. Other amino acids are transported through general circulation and are utilized for protein synthesis in the tissues. The amino acids from digested proteins are absorbed rapidly into the blood and passed onto different tissues to meet their needs. Some non-essential amino acids are synthesized in the liver and also released into the circulation. The amino acids released by hydrolysis of tissue proteins are also added to the amino acid pool in the body.

Q2. a) Briefly explain the role of iron in our body. Enlist some iron rich food sources. (3)

Ans) Iron performs many important functions in the body. It is primarily involved in the transfer of oxygen from the lungs to tissues. However, iron also plays a role in metabolism as a component of some proteins and enzymes.

Iron is toxic to the body in its free state. It is associated with proteins either through ligand binding or by being incorporated into a porphyrin group - a ring-shaped molecule. A complex of the ferrous form of iron and protoporphyrin IX is known as heme. Heme iron is found in proteins connected with oxygen transport, including hemoglobin and myoglobin. Non-heme iron can be found in proteins connected with oxidative phosphorylation and in iron storage proteins like transferrin and ferritin.

Some iron rich food sources include: Beans, lentils, Tofu, baked potatoes, cashews, Dark green leafy vegetables like spinach, etc.

b) What would you suggest to a mother while planning a meal for an infant? (3)

Ans) Breast milk or infant formula should be the main drink in the first 12 months of life. From around 6 months, small amounts of cooled, boiled tap water can supplement breast milk or infant formula.

After 12 months, water and full cream cow’s milk should be the main drinks offered at long day care. Tap water is an important source of fluoride for young children. Clean and safe tap water should be offered where available.

Low fat and reduced fat milks are not recommended in the first 2 years of life, but are suitable for children over the age of 2 years.

Q3. Describe the steps in planning a balanced diet. What points would you keep in mind while planning a diet for an old adult? (5)

Ans)  1) Identify the individual and his or her specific characteristics: You know the individual's characteristics and background would determine the type' of diet planned. Income, socio-economic background, religion and the region where the individual stays are also important, as you are aware, in the planning of balanced diets.

2) Consult RDls for energy and protein: Generally diets which meet energy and protein needs meet the needs of other nutrients as well if care is taken to include rich sources of vitamins and

minerals. Therefore in planning diets the total energy and protein needs are specified first.

3) Decide on total amounts of specific groups: The amounts of cereals, fat, sugar, milk, meat/fish/poultry/eggs, pulse, vegetables and fruits to be consumed are decided based on the income. The amount included would be such that RDIs can be met for energy and protein. This will become clear to you when you study the Practical Manual.

4) Decide on number of meals to-be consumed: Meal frequency varies depending on income, the work/school schedule and convenience. People belonging to the higher income group consume more meals. Consider the following lists of meals consumed in a day. Variations are often necessitated because of age. A child may not be able to consume much at a time. So he would need to consume more meals.

5) Distribute total mounts decided between meals: The total amount of each food group decided must be distributed over the day's meals. You will learn how to do this using the Practical Manual.

6) Decide on items and their amounts within each group for each meal: The dishes to be included for each meal are decided based on the amount of each item in each of the three food groups decided on earlier. For specific dishes to be included specific items are selected from each food group as you learnt earlier.

7) Check day's diet for inclusion of specific food groups in the amounts decided: By step 6 we have decided on the menu (i.e. the dishes to be served in each meal) and listed the amounts of each ingredient used in preparation of the dishes. Now we have to check that we have included each item in the amounts decided in step 3 according to the distribution arrived at in step 5.

Q4 a) What are the major causes of food spoilage? Enlist factors that contribute in food spoilage (3

Ans) Following are the major causes of food spoilage:

1) Microorganisms: Foods are normally contaminated with microorganisms. They are present everywhere - in the soil, water and air, on the skin of cattle and the feathers of poultry and within the intestine and all other cavities of the animal body. They are also present on th\e skin and peel of fruits and vegetables and hull of grains and shells of nuts. They are there on all equipment used for cooking, as well as, on the hands, skin and clothing of persons handling food. Fortunately, they are generally not found within healthy living tissue such as flesh of animals or the flesh or juice of plants.

2) Natural food enzymes: Food enzyme is not a new term for you. You are familiar with role of enzymes in the process of digestion. All healthy, food plants and animals have their own set of enzymes which help in the processes that go on inside the cells - digestion, respiration, germination and so on. These enzymes continue to remain active even after the plant has been harvested or the animal slaughtered and the processes they help will continue. Some of the processes are desirable to a certain degree, for example the ripening of papaya, custard apple (shareefa), mangoes and , tomatoes after harvesting.

3) Insects and rodents: They are particularly destructive to cereals grains and to fruits and vegetables. Worms, bugs, weevils, and moths may damage food items both in the field, as well as, in storage at home. In addition to eating away the food, they damage it and thereby expose it to bacterial, yeast and mould infections. A small insect hole in a mango can result in the total decay of that mang- o from bacterial invasion.

The problem with rodents involves not only the quantity of food they may consume but also the filth with which they contaminate food. Rodent urine and droppings harbour several kinds of disease producing bacteria, which infect human beings. Of the almost 10 per cent losses in grains at the farm level in our country insects, rodents and birds are responsible for almost 6 per cent.

The factors that affect food spoilage are:

• Temperature

• Moisture and dryness

• Air and oxygen

• Light

• Time

b) List three measures you would adopt to prevent PEM in a community. (3)

1. Ans)Children should be fed 5-6 times a day. We have already learnt that cereal-based Indian diets are quite bulky and unless the child is fed frequently it cannot m .et the energy and protein requirements.

2. Infections like diarrhoea and respiratory infections increase the risk of PEM. Prompt treatment of these infections would, therefore, help to prevent PEM. In addition, during diarrhoea and any other infection, food should not be restricted. The child should be fed as usual.

3. Protection of children against diseases like tuberculosis or measles, whooping cough by immunization is another important aspect in the prevention of PEM. Under the universal immunization programme all the infants receive immunization against all these diseases which are important contributory factors in child malnutrition. Mothers should be educated to avail of these services.

Q5. Briefly explain the clinical features of vitamin A deficiency and Iodine deficiency disorder. (5)

Ans) The features of vitamin A deficiency are:

a) Night Blindness : One of the earliest manifestations of xerophthalmia is night blindness. Individuals suffering from night blindness cannot see in dim light or around dusk. The

Conjunctival Xerosis : Xerosis in Greek means dryness, Conjunctival xerosis. therefore, means dryness of the conjunctiva'(thin transparent membrane that covers the cornea and lines the inside of the eyelid). In the normal eyes, the membrane covering the white portion of the eye (i.e. conjunctiva) is bright, white and moist. In the case of xerophthalmia, it becomes discoloured (muddy coloured), dry and loses Major Deficiency Diseases-I: its brightness.

b) Bitot spots : In addition to xerosis, dry foamy, triangular spots may appear On the conjunctiva. These are known as Bitot's spots. Usually these are more common on the temporal side (towards the ear) of the eye rather than the nasal (towards the nose) side.

The clinical features of Iodine Deficiency Disorder are:

Goitre and cretinism are the best known and easily recognizable forms of iodine deficiency. However, you should remember that these are not the only manifestations of iodine deficiency disorders. In fact, the term 'Iodine- Deficiency Disorders" includes a spectrum of crippling conditions affecting the health and well being of mankind starting from early in foetal life through adulthood as we mentioned earlier. in case of deficiency of iodine in the body, thyroid gland enlarges in order to trap more iodine (whatever is available). The swelling or enlargement can vary in size depending on the severity of the goitre. Cretinism refers to adverse effects of iodine deficiency on the infant and young child

Q6. a) Enlist the various methods of diet survey. Explain briefly any one method. (3)

Ans) Following are the various methods of diet survey:

• Agricultural data food balance sheet

• Weighment method

• Food record or diary

• Diet history

• 24-hour recall method

• Food frequency

Food frequency consists of asking the individuals (by interview or by a check list) how often (dally, monthly, weekly) specific foods are eaten. Usually, the foods are grouped into categories (based on similarity of nutritive value, function in the diet etc.) and the frequency with which these food groups are consumed is recorded which is used as an index of diet pattern of population

groups.

b) Write the objectives and components of mid-day-meal (MDM) Programme. (3)

Ans) Objectives

The programme has both health and educational objectives. There are:

1. To improve the nutritional status and the attentiveness of school children attending primary sections (1 to 5 classes).

2. To improve school enrolment and attendance on one hand and to reduce dropout rates on the other.

Apart from the above clear cut objectives, this feeding programme, when run in conjunction with nutrition health education programmes, is expected to increase awareness among children about balanced diets, good eating habits and personal hygiene and their importance in maintaining good health.

Components

The main beneficiaries of the programme are children between 6 and 11 years attending elementary or primary schools. The menu provided in this programme is varied. The raw food material supplied by international agencies includes corn soya meal (CSM), wheat soya blend, soya

fortified bulgar wheat-SFB and salad oil.

The raw ingredients are cooked into 'upma' or 'khichri' or some other forms, which are convenient to eat. They are also incorporated into ready-to-eat foods along with flavouring agents and condiments. Even milk powder in some places forms part of the supplies.

Q7. List any one method you will use to preserve the following. Explain the food preservation principle involved in the same.

Ans) a) Milk: Cold storage or refrigeration will cause the micro-organisms to slow down.

Ans) b) Jam or Jellies: When large amounts of sugar are used in a recipe, the sugar also acts as a preservative by inhibiting microbial activity

Q8. Enlist the methods used to assess the nutritional status. Explain any one in detail (4)

Ans) The following methods are used to assess the nutritional status:

Anthropometric Measurements

Clinical Method

Biochemical Assessment

Diet Survey

Biochemical Assessment: Biochemical Assessment deals with measuring the essential level of dietary constituents which is helpful in evaluating the possibility of malnutrition. For example, a measure of the level of Hb in the blood is helpful in evaluating the possibility of iron deficiency anaemia a measure of the level of thiamine in the urine reflects the intake of thiamine in the diet, a measure of the level of vitamin A in blood reflects intake and reserve of vitamin A in the body.

How do biochemical tests help in the assessment of nutritional status? Biochemical assessment basically works on the principle that any variation in the quantity and composition of the diet is reflected by changes in the concentration of nutrients or their compounds in tissues and body fluids and by appearance or disappearance of specific substances. Measuring these essential dietary constituents would therefore, help assess nutritional status. The following example will help us to understand this aspect. In the last section, you remember we considered the

example of an individual complaining of lack of concentration, laziness, irritability. In such a case, measuring the level of Hb in the blood, would help relate the clinical findings to iron deficiency. If the level of Hb falls below 14 mg/ 100 ml blood (in males) it is indicative of iron deficiency manifesting as lethargy, irritability and lack of concentration.

Biochemical assessment, therefore, is very useful for assessing nutritional status as well as for the purpose of diagnosis. Correlating clinical findings with biochemical tests can surely lead to right diagnosis.

Section B – Application Question (AQ) (40 marks)

Q1. What is balanced diet? Based on the steps involved in planning balanced diet prepare a diet for a lactating mother belonging to low socio-economic group. (10)

Ans) A balanced diet is a healthy diet is a diet that helps to maintain or improve overall health. A healthy diet provides the body with essential nutrition: fluid, macronutrients, micronutrients, and adequate calories. A healthy diet may contain fruits, vegetables, and whole grains, and includes little to no processed food and sweetened beverages. The requirements for a healthy diet can be met from a variety of plant-based and animal-based foods, although a non-animal source of vitamin B12 is needed for those following a vegan diet. Various nutrition guides are published by medical and governmental institutions to educate individuals on what they should be eating to be healthy. Nutrition facts labels are also mandatory in some countries to allow consumers to choose between foods based on the components relevant to health.

Identify the individual and her specific characteristics. We know that the mother is belonging to the low socio-economic group so we will plan our diet accordingly.

1. Consult RDls for energy and protein

2. The amounts of cereals, fat, sugar, milk, meat/fish/poultry/eggs, pulse, vegetables and fruits to be consumed are decided based on the income.

3. Decide on number of meals to-be consumed: Meal frequency varies depending on income,

4. Distribute total mounts decided between meals

5. Decide on items and their amounts within each group for each meal

6. Check day's diet for inclusion of specific food groups in the amounts decided

Q2. Prepare any two nutritious snacks – one for a preschool child and second for an elderly.(10)

Your answer must specify:

i)Name of the snack

ii) List of Ingredients

iii) Method of preparation

iv) Food sources contributing to the important nutrients required by the specific individuals.

v) Justify the selection of snack (from nutritional stand point) for the children and for the elderly.

Ans) Nutritious Snacks for Preschool Child:

1. Name of the snack: Yogurt with Fruit

2. List of Ingredients: Yogurt, Water, Fruit, honey

3. Method of preparation: Combine the ingredients and add honey to taste

4. Food sources contributing to the important nutrients required by the specific individuals: Some yogurts also contain live bacteria, which benefit the digestive system Most yogurts marketed to kids are high in sugar. Instead, choose plain, full-fat yogurt and sweeten it with fresh fruit or a drizzle of honey. Still, make sure not to give honey to infants under 12 months old, as they’re at a greater risk of a serious infection called botulism

5. Justify the selection of snack (from nutritional stand point) for the children: Yogurt is an excellent snack for kids because it’s a good source of protein and calcium. Calcium is especially important for kids’ developing bones

Nutritious Snacks for Elderly person:

1. Name of the snack: Vegetables with Hummus

2. List of Ingredients: Carrot, Celery, Coriander, Asparagus, Cucumber, Chickpeas, Olive Oil, Salt, Tahini, Garlic

3. Method of preparation: Prepare the vegetables by cutting them into bite sized pieces. For the hummus, Once your chickpeas are tender, drain and add them to a food processor. Throw in some garlic, tahini, lemon juice, and salt — the basics. A little olive oil adds creaminess and flavor, but it can be subbed with water if you’re avoiding oil. Blend until creamy and smooth. Then add in fresh herbs or any other flavor you crave: think roasted jalapeño, roasted red pepper, lots of basil, lots of cilantro, or even curry paste! The sky is the limit.

4. Food sources contributing to the important nutrients required by the specific individuals: Hummus is Rich in Ingredients Proven to Help Fight Inflammation, High in Fiber That Promotes Digestive Health and Feeds Your Good Gut Bacteria, It Has a Low Glycemic Index, So May Help Control Blood Sugar Levels. It is Great for Those With Intolerances, as It’s Naturally Gluten-, Nut- and Dairy-Free

5. Justify the selection of snack (from nutritional stand point) for the children and for the elderly: Hummus is Super Nutritious and Packed With Plant-Based Protein, Contains Heart-Healthy Ingredients That May Reduce Heart Disease Risk, It also Promotes Weight Loss and Helps You Maintain a Healthy Body Weight. It is Incredibly Easy to Add to Your Diet

Hummus is a popular Middle Eastern dip and spread that is packed with vitamins and minerals.

Research has linked hummus and its ingredients to a variety of impressive health benefits, including helping fight inflammation, improving blood sugar control, better digestive health, lower heart disease risk and weight loss. Moreover, hummus is naturally free of common food allergens and irritants, such as gluten, nuts and dairy, which means it can be enjoyed by most people.

 Add hummus to your diet by following the recipe above — it’s incredibly easy to make and takes fewer than ten minutes. All in all, hummus is a super simple, healthy and delicious addition to your diet.

Q3. Describe in details any four cooking practices common in your region for preparing pulses/ Rice/Wheat/Maize etc. Predict the nutrients which are likely to be lost to a substantial degree in each. (10)

Ans) Most of the time, rice, pulses, wheat, maize etc, are cooked and eaten instead of having them raw.

Rice is cooked and made into different rice varieties like jeera rice, vegetable pulao, etc., apart from having it like plain cooked rice along with curries or dal. Wheat is usually used for making chapatis, puris, and parathas. Maize is used for making porridge, soups, rotis, etc. Pulses are cooked and used for making different varieties of dal by adding various vegetables, and spices to it. Sometimes, rice, along with certain pulses are soaked and then ground into a batter to make dishes like idly, dosa etc.

The advantages of cooking are that it makes food easily digestible and it improves the texture, taste, and appearance of the food. Also, cooking the food kills most of the harmful bacteria present in it.

The disadvantages of cooking are that - most nutrients may be lost while boiling rice and pulses. So, it is advised to use the boiled water while cooking soups, gravies, sambar etc, without wasting it. Although stewing slowly takes time, it conserves the nutrients in the food substances. Steaming is the best way to cook as cooks the food quickly and it also preserves the nutrients.

Most of the water-soluble vitamins and minerals are lost while cooking in open pans, pressure pans, etc.

Q4. Record the food intake of a college going girl for one day using the following table: Evaluate the meal and comment whether the diet is balanced. (10)

Ans)Points to Remember While Following a Balanced Diet

• There should be a minimum of 5 to 6 small meals daily.

• Your diet should have 50-60 % of carbohydrates like oats, chapatti, rice, bread, and potatoes, etc.

• Your diet should have 25-30 % protein.

• Your diet should have 10-15 % of fats which should be a combination of unsaturated as well as saturated fats (oil + ghee).

• You should never skip breakfast.

• You should always consume a protein snack while going to bed.

• You should drink 33 ml of water per kg of your ideal body weight.

• You should perform 30-45 minutes of exercise on a daily basis like walking, aerobics, physiotherapy exercises, swimming and cycling, etc.

• You should avoid consumption of alcohol, smoking and tobacco chewing.

• Take a minimum of 7 hours sleep daily.

Once you are clear about the above daily food chart points, it will be easy for you to follow the below balanced diet chart.

Balanced Diet Chart

Early Morning

1 glass of lukewarm water with half a lemon squeezed in it.

Or

Drink 1 glass of lukewarm water with a pinch of cinnamon powder.

Breakfast

1 glass of vegetable juice + 1 plate vegetable oats+ 2 whole egg + 4 almonds (Soaked)

Or

1 cup milk + 1 green moong dal dosa + groundnut chutney + 1 slice of multigrain bread (Soaked).

Midmorning

1 glass buttermilk

Or

1 glass coconut water + 1 egg white boiled

Lunch

1 cup raw vegetable salad + 2 chapatti + 1 cup rice + 1 cup vegetable + 1 cup dal + 1 cup pulses vegetable + 1 cup curd

Or

1 cup raw vegetable salad + 2 cups rice + 1 cup vegetable + 2-3 pc of chicken/Fish + 1 glass buttermilk.

Afternoon (2 hours Post Lunch)

Drink 1 cup of green tea + 1 fruit.

Evening Snack

1 bowl sprouts.

Dinner

1 bowl soup + 1 chapatti + ½ cup rice + 1 cup vegetable + 1 cup curd.

Or

1 bowl chicken soup + 1 cup rice + 2-3 pc chicken/Fish/1 egg + 1 cup vegetable.

Bedtime

1 cup milk with a pinch of turmeric

Or

1 cup green tea+2 almonds (soaked).

Now that you have got an idea about the proper diet chart to follow for a healthy life, also look at some general health tips.

Section C – Objective Type Questions (OTQ) (20 marks)

Q1.Define the following terms:

a) Standardized Recipe

Ans) A standard recipe is a method of standardizing recipes in such a way so that there is tight control on cost and quantity. ... The standard recipe lays down all the ingredients, method of production and quantities used. It indicates the number of portions to be served.

b) Enhancers

Ans) Taste enhancer is a substance that helps to modify or increase the intensity of the perceived taste or smell of food and have no taste of its own.

c) Essential Amino-Acids

Ans) Amino acids are organic compounds composed of nitrogen, carbon, hydrogen and oxygen, along with a variable side chain group. Your body needs 20 different amino acids to grow and function properly. Though all 20 of these are important for your health, only nine amino acids are classified as essential. These are histidine, isoleucine, leucine, lysine, methionine, phenylalanine, threonine, tryptophan and valine.

d) Work Schedule

Ans) plans that distribute the work among different individuals within a food service unit in order to carry out specific activities according to a set time and procedural requirements.

e) Adolescent growth spurt

Ans) the rate of growth slows down during the school years and then increases again in adolescence. This sharp increase in rate of growth is called the adolescent growth spurt.

f) PUFA

Ans) Polyunsaturated fatty acids (PUFAs) are fatty acids that contain more than one double bond in their backbone. This class includes many important compounds, such as essential fatty acids and those that give drying oils their characteristic property.

g) Keratomalacia

Ans) The most dangerous form of xerophthalmia is known as keratomalacia. In this condition, the cornea becomes very soft and raw and easily infected. It leads to destruction of the eye. In other words, the eye gets completely melted and destroyed

h) Lathyrism

Ans) Lathyrism is a condition, caused by eating certain legumes of the genus lathyrus. There are three types of lathyrism: neurolathyrism, osteolathyrism, and angiolathyrism, all of which are permanent but differ in symptoms and the affected tissues.

i) Synergism

Ans) the interaction or cooperation of two or more organizations, substances, or other agents to produce a combined effect greater than the sum of their separate effects.

j) Growth Monitoring

Ans) Growth monitoring (GM) is the process of following the growth rate of a child in comparison to a standard by periodic anthropometric measurements in order to assess growth adequacy and identify faltering at early stages.

Q2.List the disorder(s) caused by the deficiency of the following nutrients/substance:

a) Thiamine

Ans)

Beriberi

Brain disease

Wet Beriberi

Gastrointestinal beriberi

b) Folic acid

Ans) Anaemia

c) Fluorine

Ans) Tooth decay

Osteoporosis

d) Riboflavin

Ans)

endocrine abnormalities

skin disorders

hyperemia (excess blood)

edema of the mouth and throat

angular stomatitis

e) Vitamin D

Ans)  Rickets

Q3. List any one important point you would keep in mind while selecting:

a) Cereals

Ans) Undamaged and nutritional value

b) Fruits

Ans) Ripeness

c) Milk and milk product

Ans) Freshness

d) Fats & oils

Ans) The Ideal Ratio Of Omega-6 To Omega-3.

e) Nuts                                                                  

Ans)

Inherent sugar content