Assignment Code: ANC-1/AST-1/TMA-1/2021-22

Course Code: ANC-1

Assignment Name: Nutrition for the Community

Year: 2021-2022

Verification Status: Verified by Professor

Maximum Marks: 100

**Disclaimer: Section B - Q3, Q4 remain unsolved. Kindly solve those questions using the practical manual found at https://egyankosh.ac.in/handle/123456789/14685 *

Section A – Descriptive Type Questions (40 marks)

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

Q1. a) Define malnutrition. Enumerate different dimensions of malnutrition. (2)

Ans) Malnutrition can be defined as a pathological state resulting from relative or absolute deficiency or excess of one or more essential nutrient, which can manifest into overnutrition or undernutrition.

The different dimensions of malnutrition are as follows:

1. Hunger: Hunger is an uncomfortable or painful physical sensation caused by insufficient consumption of dietary energy. It becomes chronic when the person does not consume a sufficient amount of calories (dietary energy) on a regular basis to lead a normal, active and healthy life.

2. Undernutrition: Undernutrition denotes insufficient intake of energy and nutrients to meet an individual's needs to maintain good health. In most literature, undernutrition is used synonymously with malnutrition.

b) “Dietary fiber plays an important role in our body.” Comment on this statement. (2)

Ans) Fiber is important for keeping the gut healthy. Eating enough fiber can prevent or relieve constipation, helping waste to move smoothly through the body. It also encourages healthy gut microbiota. According to a 2015 review, dietary fiber increases the bulk of stool, helps promote regular bowel movements, and reduces the time that waste spends inside the intestines. Hence, dietary fiber plays an important role in our body.

Q2. Give reasons for the following: (1+1+1+1)

a) Vitamin C helps in rapid wound healing

Ans) Vitamin C is required for the synthesis of collagen, a type of protein that is unique to humans. Collagen is formed at the site of a lesion or damage to aid in its healing. This protein is found in connective tissue, which acts similarly to cement in holding together diverse tissues. Collagen, for example, gives blood vessels their firmness. Vitamin C deficiency in the diet can lead to fragile blood vessels that can readily burst.

b) Milk can help in meeting niacin needs

Ans) Tryptophan is abundant in milk. Niacin can be made from tryptophan. This is why milk can assist in meeting niacin requirements.

c) Absorption of iron from plant food sources in low than animal food sources

Ans) Because heme-iron, or rather animal-based iron, is directly compatible with our bodies and so can be quickly absorbed, absorption of iron from plants is lower than from animal sources.

d) Iodine content of food is influenced by the iodine content of soil/water.

Ans) Most foods include a limited amount of iodine, which varies greatly depending on the iodine level of the soil and water. Vegetables, especially those grown in coastal areas with high iodine concentration in the soil, contain significant levels of iodine. The iodine concentration of the soil and water in hilly locations, on the other hand, is low. As a result, the crops grown in these locations are deficient in iodine.

Q3. Briefly explain how the nutrient needs of adults are influenced by the following factors. (4)

a) Activity level

Ans) The greater the level of activity, the greater the demand for energy. To put it another way, the number of food exchanges, such as cereals, roots, and tubers, would rise. The amount of fats and oils to be included would be somewhat increased. As one's level of activity rises, so does one's energy requirement. As a result, more foods that provide energy should be incorporated.

b) Body size/composition

Ans) Although this aspect has a minor impact, it is nonetheless noticeable. The more the person's body mass, the greater the need for nutrition, as there is more metabolism and cells to look after. This factor is counteracted if the person does less physical effort.

c) Age

Ans) From childhood to maturity, the body's metabolism rises, hormone production rises, and the desire for more nutrients rises, but as a person grows older, the body's metabolism declines. As a result, elderly people require less nutrition than adults.

Q4. Explain how nutritional status of the mother influence birth weight of the infant? (3)

Ans) Weight gain during pregnancy is caused by the weight of the foetus, growth of reproductive organs such as the uterus and placenta, and an increase in blood, extracellular fluids, and fat. Low weight gain is harmful to the mother's health. Furthermore, it results in low birth weight in the progeny. The main causes of this scenario include poor diets, excessive physical activity, and a lack of sufficient health care during pregnancy.

Q5. List the dietary considerations that should be kept in mind while planning meals for each of the following: (2 + 2)

a) Lactating mother

Ans) Include protein foods 2-3 times per day such as meat, poultry, fish, eggs, dairy, beans, nuts and seeds. Eat three servings of vegetables, including dark green and yellow vegetables per day. Eat two servings of fruit per day. Include whole grains such as whole wheat breads, pasta, cereal and oatmeal in your daily diet.

b) Adolescent girl

Ans) The dietary considerations of an adolescent girl are:

1. Iron

2. Calcium

3. Protein

4. Energy giving nutrients (carbohydrates & fats)

Adolescent diet including:

1. Items from each food group in each meal.

2. Good energy & protein sources.

3. Good calcium & iron sources.

4. Animal protein

5. Cereal-pulse combinations to improve protein quality.

Q6. What are the objectives and components of: (2+2)

a) Mid-day meal programme

Ans) The MDM programme has both health & educational objectives. There are:

1. To improve the nutritional status & the attentiveness of school children attending the primary section.

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

Components of Mid-day meal programme:

1. The major component of this programme is food supplement. The raw food material supplied by international agencies includes corn soya meal (CSM), soya, wheat soya blend, SFB & salad oil.

2. The raw ingredients are cooked into "Upma" or "Khichri" or some other forms. They are also incorporated into ready to eat foods along with flavouring agents & condiments. Even milk powder in some places forms part of the supplies.

3. The meal provides roughly 450-500 kcal & 20-30 gm protein per child per day, which is expected to meet one-third of the energy & half of the proteins RDIs.

b) ICDS

Ans) The specific objectives of ICDS are to:

1. Improve the nutritional & health status of children in the age group of 0 to 6 the child.

2. Lay the foundation for proper physiological, physical & social development of the child.

3. Reduce the incidence of mortality, malnutrition & school dropout.

4. Achieve effective coordination of policy & implementation amongst the various departments to promote child development.

5. Enhance the capability of the mother to look after the health & nutritional needs of the child through proper nutrition & health education.

Components of ICDS are:

1. Supplementary nutrition.

2. Immunization.

3. Periodic health check-ups, treatment of minor ailments.

4. Growth monitoring.

5. Non-formal pre-school education.

6. Health/Nutrition education to women.

7. Safe drinking water.

Q7. Explain the principle of food preservation involved in the following method: (4)

a) Addition of sodium benzoate to fruit jelly

Ans) Sodium benzoate inhibits growth of mould in jelly.

b) Addition of large amount of salt in the pickle

Ans) When we chop vegetables or raw fruits into pieces, we add common salt, which draws out the water and dries the pieces (thanks to osmosis). Because bacteria cannot multiply without water, salt works as a preservative.

c) Addition of citric acid and phosphoric acid to beverages

Ans) When one organism produces acid during fermentation, it inhibits the growth of another. The rationale behind controlled fermentation is that the acid created by fermentation prevents other organisms from growing.

d) Boiling the milk before use

Ans) Boiling milk kills the germs and enzymes in it, allowing it to be stored at room temperature for 6 to 12 hours. During warmer weather, give it a second boil after 6 hours or so to help it last longer.

Q8. a) What is the importance of menu in a food service unit? (2+2)

Ans) The menu is an important component of food service operations. It serves as a marketing tool, determines inventory, storage space required, skill level and number of cooking staff and service, equipment levels and types.

b)What records would you maintain in a food service establishment? Enlist

Ans) The records I’d maintain in a food service establishment are:

1. Supplier's directory

2. Purchase order

3. Cash memo

4. Requisition slip or indent

5. Menu book

6. Food cost record

7. Sales record

8. Labour cost record

9. Overhead & maintenance

Q9. List the different methods used for assessment of nutritional status. How are anthropometric measurements used in assessment of nutritional status? (1+4)

Ans) The different methods used for assessment of nutritional status are:

1. Anthropometric measurements

2. Clinical Method

3. Biochemical Analysis

4. Diet Survey

The anthropometric measurements are used in assessment of nutritional status as:

Anthropometric measurements are essentially body size measurements. Growth, as measured by weight for age or height for age, encapsulates everything that has happened up until that point in time. Aside from height and weight, measuring body circumference allows for the determination of body fat percentage and the number of lean body tissues (muscles) in the body. It facilitates the detection of PEM and obesity.

The four most commonly used and simple body measurements, therefore, are:

1. Weight for age

2. Height for age

3. Arm circumference for age

4. Weight for height.

Q10. Briefly discuss the dietary modifications/preventive measures for: (2+2)

a) Diabetes Mellitus.

Ans) The dietary modifications/preventive measures for Diabetes Mellitus are:

1. Regulations governing the meals taken are critical. Diabetics should be urged to eat at regular intervals.

2. All of your primary meals should have a sufficient number of calories.

3. Foods from all three fundamental good groups should be included with care. To maintain control, appropriate changes must be made within each group.

These modifications are:

1) Energy-giving group

a) Cereals

b) Sugar

c) Fat

2) Body-building group

a) Milk

b) Pulses

c) Eggs

d) Flesh foods

3) Protective group

a) Fruits

b) Vegetables

b) Iron Deficiency Anaemia

Ans) The following preventive measures can help to prevent Iron Deficiency Anaemias:

1. Dietary Measures: In expensive sources of iron are green leafy vegetables, rice, ground nuts. If these foods are consumed as sources of iron, care should be taken that enough vitamin C rich & protein-rich foods are consumed along with them.

2. Fortification of Foods: The method by which the nutritive value of diets is improved by the addition of one or more nutrients to a food item is known as fortification of food. The food selected for this should be consumed by all, particularly the needy poorer segments of the populations with very little daily variation in the quantities consumed.

3. Distribution of Iron & Folic Acid Tablets: With the help of iron tablets, the haemoglobin levels in the blood can be raised. Iron tablets contain iron (60mg) & folic acid (500mg) women pregnant & lacing family planning acceptors intrauterine contraceptive device.

Section B - Practical Activities (40 marks)

There are four exercises in this section. These exercises are based on Practical Manual 1. Answer all four.

Q1. What is a balanced diet? List the steps involved in preparing a balanced diet. Using these steps plan a balanced diet for a pregnant women in the 2nd trimester of pregnancy belonging to low socio-economic group. (1+2+7)

Ans) A balanced diet is one that includes a variety of meals in sufficient quantities and proportions to meet the body's needs for calories, minerals, vitamins, and other nutrients, with a tiny allowance for extra nutrients to help with short-term leanness.

The steps involved in preparing a balanced diet are:

1. Identify the person and his or her unique features.

2. For calories and protein, consult RDls.

3. Decide on the overall amount of each group.

4. Decide on the quantity of meals you'll eat.

5. Distribute the total mounts among the meals.

6. For each meal, decide on the items and their quantities within each group.

7. Examine the diet for the day to ensure that certain food groups are represented in the amounts determined.

Balanced diet for pregnant women in the trimester:

A meal plan is a list of total amounts of various food exchanges that should be included in a day's diet, as well as their calorie and protein contributions.

Q2. Plan a snack rich in iron, energy and protein suitable for a 10-12 year old girl. Your answer must specify. (10)

1. Name of the snack

2. List of ingredients

3. Method of preparation

4. Sources of iron, energy and protein included.

Ans) Name of the Snack: Sandwich.

List of Ingredients: Whole-Grain Bread, Meat, Cheese, Onion, Tomato, Cucumber.

Method of Preparation: Apply green coconut chutney on the inner side of two breads. Cut the vegetables into thin slices and place on the bread. Boil the meat and add salt to taste. After meat is boiled, shred it into pieces and place it on the vegetable slices. Grate some cheese on top of the shredded meat and place the other bread slice on top. Press it down so that the ingredients are places firmly inside.

Sources of Iron, Energy and Protein: Energy - 437 kcal, Protein - 32 g and Iron - 3.1 mg.

Q3. Look up Table 5.3, Section 5 of PracticalManual-1 giving a food plan for Pushpa, a sedentary woman. How would you explain this table to Pushpa in simple language? Explain in detail.

(You need to explain the concept of use of different food groups, food exchanges, use of food exchanges in meal planning and conversion of exchanges to the nutrient requirement for a balanced diet planning as per the RDA to Pushpa.) (10)

Ans)

Q4. Look up Annexure 4, “Proforma on Regional Patterns”. Fill up the proforma as per the directions given and submit along with this assignment for assessment. (10)

Ans)

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

Q1. Comment on the interrelationship of the following in 2-3 sentences: (10)

i. Protein quality and Cereal–Pulse combination

Ans) When cereals and pulses are combined in the same meal, the protein quality rises. The protein quality of plant foods can thus be increased by combining one or more types of plant foods.

ii. Food fortification and salt

Ans) The recommended minimum level of potassium iodate fortification in common salt is 25 parts per million. A person who consumes roughly 10 g of salt per day should be able to get 150 micrograms of iodine, according to k.

iii. ORS and Diarrhoea

Ans) Oral rehydration solution (ORS) is the standard of care for acute diarrhea in paediatric patients. Although effective in reducing mortality, ORS does not alleviate diarrheal symptoms, thus reducing caregiver compliance and therapeutic efficacy.

iv. Amylase rich food (ARF) and digestibility

Ans) ARF is germinated cereal flours which are extremely rich in the enzyme alpha-amylase. Tiny catalytic amount of any germinated cereal flour can instantly liquify or reduce the dietary bulk of any viscous multi-mix gruel but where cereal flour is the main ingredient. It has certain advantages like digestibility is improved, viscosity is lowered and it can be kept without refrigeration.

v. Adolescence and Catch-up growth

Ans) Growth failure occurs in childhood and adolescence due to a variety of chronic diseases and malnutrition; after recovery, catch-up growth may occur. The amount of growth failure that can be compensated for is determined by the timing, intensity, and length of the growth failure, as well as the aetiology and pathogenesis of the condition that limits growth and development.

vi. Blanching and Food preservation

Ans) Blanching (scalding vegetables in boiling water or steam for a short time) is a must for almost all vegetables to be frozen. It stops enzyme actions which can cause loss of flavour, colour and texture. Blanching cleanses the surface of dirt and organisms, brightens the colour and helps retard loss of vitamins. It is an important intermediate thermal processing step to enhance preservation and quality of foods by inactivating enzymes that can cause loss of flavour and colour.

vii. Lathyrus sativus and crippling paralysis

Ans) Lathyrus sativus is a hardy plant whose pulse is combined with more expensive Bengal gramme to make Bengal gramme flour. It is also utilised as a wage for farm labour in Madhya Pradesh and Uttar Pradesh communities. In boys and men aged 5 to 45, it can induce a form of debilitating paralysis. The condition is known as lathyrism. The disease begins with stiffness in the knees and legs, as well as pain in the back thighs and around the knee and ankle joints.

viii. Prophylaxis and nutrition programmes

Ans) The majority of individuals who live in slum areas in rural and urban areas are economically and socially disadvantaged. Their limited purchasing power prevents them from including enough healthful foods in their diets. As a result, they are susceptible to a range of dietary deficiencies. As a result, the government has initiated a few nutrient deficiency control or prophylaxis programmes to regulate and avoid the adverse impacts of deficiency illnesses.

ix. Dietary fat intake and coronary heart disease

Ans) Increased saturated fat intake would raise total blood cholesterol levels, cancelling out the beneficial effects of reduced salt intake, smoking, and physical inactivity on CHD mortality. Small, easily implemented dietary adjustments, on the other hand, could significantly lower CHD mortality. Furthermore, it is readily possible to replace "bad" saturated fat with "healthy" monounsaturated and polyunsaturated fats.

x. Mid-day meal programme and school enrolment

Ans) Due to the introduction Mid-Day Meals Programme percentage of retention has been enlargement. The Headman has expressed their opinion in support of introducing of Mid-Day Meals programme at the primary level. The Mid- Day Meals programme helps increasing the attendance and enrolment of the poor Primary School students.

Q2. List the deficiency disorder(s) and rich food sources of the following nutrients/substance: (2×5)

i. Iodine

Ans) Deficiency disorder: hypothyroidism.

Rich food sources: Seaweed, crab, squid, tuna, milk, cheese, yoghurt, eggs, iodized salt.

ii. Folic acid

Ans) Deficiency disorder: Anaemic.

Rich food sources: Beef liver, boiled spinach, black-eyed peas, asparagus, brussels sprouts, lettuce, avocado, broccoli.

iii. Niacin

Ans) Deficiency disorder: Pellagra.

Rich food sources: mixed cereal, jowar, rice, wheat, milk, pulses.

iv. Riboflavin

Ans) Deficiency disorder: Ariboflavinosis.

Rich food sources: Green leafy vegetables, whole cereals, pulses, cheaper nuts.

v. Vitamin A

Ans) Deficiency disorder: Night blindness.

Rich food sources: yellow, red and green (leafy) vegetables, such as spinach, carrots, sweet potatoes and red peppers. yellow fruit, such as mango, papaya and apricots, cheese, eggs, oily fish, fortified low-fat spreads, milk and yoghurt.