BALANCED DIET By Dr Afreen Hasan Definition Balanced

BALANCED DIET By Dr Afreen Hasan

Definition ………… Balanced diet include proportionate quantities of food items like carbohydrate, protein , fat , vitamins, minerals which are required for our body selected from different basic food groups They supply calorie as well as all essential nutrients in complete fulfilment of the requirement of the body Basic food groups are 1. Cereal groups –bread , rice , wheat , barley etc 2. Meat group –meat , fish , egg, pulses, beans , nuts 3. Green leafy vegetable group- vegetables and fruits

Balanced diet cont…… • Balanced diet should have calories from carbohydrate , protein and fat in 60: 20 ratio • Balanced diet should be based on • Locally available foods • Should be within economic means of people • Should fit with local food habits • Diet should be easily digestable and palatable • Should contain enough roughage material

How to plan balanced diet • Diet component of balanced diet is highly variable across the globe • Bases on economic condition , dietary habbits , availability of foods and sociocultural aspects • Energy requirements differ as per the age , gender , extent of physical activity and various physiological states

Composition of a typical balanced diet for an adult male doing moderate work (non-veg) high cost diet gms/day cereals 475 pulses 65 green leafy vegetables 125 other vegetables 75 roots and tubers 100 Fruits 30 Milk 100 meat/fish 30 Fat and oils 40 eggs 30 sugars 40

For an adult male doing moderate work Minimum cost balanced diet gms/day Cereals 285 Pulses 100 Green leafy vegetables 200 Potatoes 200 Colocasia 100 Ground nuts 50 germinated Bengal grams 50 Oils 35 Sugars 35

Dietary guidelines for optimum health • Balanced diet is intended to promote optimum health and prevent nutritional deficiencies(undernutrition) and obesity(excess calories) • Eat a mix diet • Balance the food to preserve ideal body weight • Include plenty of whole grains , vegetable and fruits in the diet • Diet low in saturated fat and cholesterol should be encouraged • Restrict the quantity of refined sugar • Choose a diet that is moderate in salt and sodium • Restrict the consumption of alcohol

Principles of prescribing a diet • Calorie requirement has to be assessed based on age , gender , built , health status and physical activity • Protein requirement is decided by age , gender , built , health status and physical activity • Protein requirement is calculated by. 8 gm/kg bodyweight /day • During growing age , pregnancy and lactation it is 2 gm/kg body weight • Calorie yield from protein diet should be 10 -15%of total calorie requirement

Principles of prescribing a diet cont… • Fat can provide 20 -25% of total calorie requirements of the body • Visible fat (eg oil, ghee, butter which we add in the food)should be 20 gm/day • In lactating it is 45 gm/day, in pregnant woman it is 30 gm/day and in growing children it is 25 gm/day • In obese individuals , in persons who are at risk of developing cardiovascular disease it is restricted to <20 gm/day • 55 -65% of calories requirement are fulfilled by carbohydrate • Plenty of whole grains, vegetables and fruits and green leafy food which contain digestable carbohydrate and dietary fibers

Principles of prescribing a diet cont…. • A system of food exchange system –foods with similar nutrient composition are grouped together and they can be exchanged to provide dietary variety and to break the monotony • Various legumes –pulses like Bengal gram , red grams , black grams , green grams can be exchanged one for the other • One chapatti can be exchanged for three spoons of rice or one large slice of bread • Milk and dairy products can be used liberally • Diet contain variety of local available foods • Next slide is of food pyramid

Malnutrition • Malnutrition is defined as imbalance between the body’ s need and the intake of nutrients, which can lead to nutritional disorder • So intake of nutrients in proper amount according to age , gender and other physiological condition is needed • Malnutrition is divided into two main types 1. Under-nutrition 2. Over-nutrition In under-nutrition nutrients are undersupplied, and in over-nutrition nutrients are over supplied both causes nutritional disorders.

• Example of undernutrition is Protein-energy malnutrition is Kwashiorkor and Marasmus • Obesity is example of over nutrition

Overnutrition – obesity • All over the world , obesity is prevalent in affluent people • Obesity is the condition in which excess fat has accumulated • Due to increased energy intake and decreased energy expenditure • Obesity index is an old terminology which is changed into body mass index (BMI) • Calculated by dividing weight in kilograms by the square of height in metres. • A BMI of 25. 0 or more is overweight, while the healthy range is 18. 5 to 24. 9.

• There are two types of obesity Android or apple type –abdominal type-common in males Gynecoid type (around breast , hips and thighs )-common in woman obesity is always result from ingestion of food in excess of the body’s need Daily energy expenditure = basal metabolic rate +physical activity+diet induced thermogenesis Genetic predisposition has been suggested No gene responsible for production of obesity

Diseases related to obesity • Sensitivity of peripheral tissues to insulin decreases • Major ill effect of obesity are increased risk of coronary artery disease , diabetes mellitus , hypertension, metabolic syndrome and reduced life span • Best suitable remedy of treatment of obesity is life style modification • Goal is to reduce the intake of calories and fat • Frequent small meals with lots of vegetables (roughage) and water is advised • Patients with higher grades of obesity , drugs may be given to decrease appetite

Regulators of appetite • Hypothalamus is the central control of appetite • Polypeptides that increase appetite are Neuropeptide Y, ghrenin , melanin concentrating hormone , insulin and cortisol • Appetite decreasing factors are : leptin , melanocyte stimulating factors , glucagon related peptide 1 and serotonin • All these above chemicals(peptides) affects hypothalamus

Protein energy malnutrition

Protein energy malnutrition • Sometimes called protein-calorie malnutrition (PCM-is the most common nutritional disorder of the developing countries • PEM is widely prevalent in the infants and pre-school children • Kwashiorkor and marasmus are the two extreme forms of proteinenergy malnutrition

Kwashiorkor

Kwashiorkor cont…. • kwashiorkor was introduced by Cicely Williams (1933) in Africa • Kwashiorkor literally means sickness of the deposed child i. e. a disease the child gets when the next baby is born • Kwashiorkor is predominantly found in children between 1 -5 years • Primarily due to insufficient intake of proteins • Diet of a weaning child mainly consists of only carbohydrates and lacking protein • Major clinical manifestations are stunted growth, edema (particularly on legs and hands), diarrhea, discoloration of hair and skin, anemia, apathy and moon face

Kwashiorkor cont…. • Biochemical manifestations : Kwashiorkor is associated with a decreased plasma albumin concentration (<2 g/dl against normal 3 -4. 5 gm/dl) • Fatty liver due to decreased synthesis of lipoprotein • Deficiency of K+ and Mg++ due to diarrhea. • Edema occurs due to lack of adequate plasma proteins (decreased oncotic pressure) to maintain water distribution between blood and tissues. • Disturbances in the metabolism of carbohydrate, protein and fat metabolism • Several vitamin deficiencies occurs • Plasma retinol binding protein (RBP) is reduced. • The immunological response of the child to infection is very low. • Treatment : Ingestion of protein-rich foods or the dietary combinations of different types of protein to provide about 3 -4 g of protein/kg body weight/day will control kwashiorkor. • Treatment can be monitored by measuring plasma albumin concentration, disappearance of edema and gain in bodyweight.

Marasmus

Marasmus cont…. . • Marasmus means 'to waste‘ • Mainly occurs in children under one year age • Marasmus is predominantly due to the deficiency of calories/energy • Usually observed in children on balanced starvation or insufficient breast milk or diluted milk • Symptoms of marasmus include growth retardation, muscle wasting (emaciation), anemia and weakness • Marasmic child does not show edema or decreased in protein conc is not so marked

Marasmus Age of onset Deficiency of Cause Growth retardation Attitude Appearance Appetite below 1 yr calories early weaning and repeated infection marked Irritable and fretful Shrunken with skin and bones only, dehydrated normal kwashiorkor One to 5 year Protein Starchy diet after weaning , precipitated by acute infection Present Lethargic and apathetic Look plump due to edema on face and lower limb anorexia Skin Dry and atrophic Crazy pavement dermatitis due to pealing and cracking Hair no characteristic change Sparse, soft and thin hairs with flag sign Associated features Serum albumin Serum cortisol Watery diarrhea, muscles are weak and atrophic 2 -3 gm/dl Increased Angular stomatitis and cheilosis, watery diarrhea , muscles undergo wasting < 2 gm/dl Decreased