Nutrition updates points from PSM QRP by

Dr Mukhmohit Singh

9 EAA:

Non-essential amino acids: synthesis in body

o Arginine
o Asparaginic acids
o Serine
o Glutamic acid
o Proline
o Glycine
Prot. Qulty assesment:
i.

Digestible Indispensable Amino Acid Score (DIAAS):**

DIAAS% = 100 [(mg of digestible dietary indispensible amino acid in 1 g of the

dietary protein) / (mg of same dietary indispensible amino acid in 1 g of the reference
protein)]
Currently accepted best to measure protein quality.
ii.

Protein Digestibility Corrected Amino Acid Score (PDCAAS):

PDCAAS% = (mg of limiting amino acid in 1 g of test protein / mg of same amino

acid in 1 g of reference protein) fecal true digestibility%

PDCAAS value of 1 is highest and 0 is the lowest.
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Nutrition updates points from PSM QRP by

iii.

Dr Mukhmohit Singh

Amino Acid Score:

AAS = (mg of amino acid per gm of test protein / mg of the same amino acid per g

of reference protein) 100

The lowest score indicates limiting amino acid.
iv.

Net Protein Utilization (NPU):

NPU = Digestibility coefficient (DC) Biological value (BV) / 100
Or NPU = Nitrogen retained / Nitrogen absorbed 100
In calculating the protein quality, 1 gm of protein is assumed to be equivalent to

6.25 gms of Nitrogen.

NPU of egg- 100%, meat- 80% and milk- 70%.
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VITAMIN A
Richest animal source- fish liver oil
Richest vegetable source- red palm oil*, spinach, amaranth
First symptom in vitamin A deficiency- Nightblindness
First clinical sign of vit. A deficiency- Conjunctival xerosis
RDA: 600 mcg for adults, children 7-9 years and adolescents; 350 mcg for
infants; 400 children 1-6 years.
Vit. A toxicity:
o

Repeated moderately high dose causes teratogenicity.

Acute high dose- nausea, headache, raised intracranial pressure (pseudotumor

cerebri), skin desquamation and hepatomegaly.

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Nutrition updates points from PSM QRP by

Dr Mukhmohit Singh

Chronic high dose cause liver damage and hyperostosis.

VIT A defeciency:
o

Primary changes:
X1A

Conjunctival xerosis

X1B

Bitots spots

X2

Corneal xerosis

X3A

Corneal ulceration / Keratomalacia (<1/3)

X3B

Corneal ulceration / Keratomalacia (>1/3)

Secondary Changes:
XN Night blindness (1st symptom)
XF Fundal changes
XS Corneal scarring

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VITAMIN D
Nutritionally important 2 forms:
o

Calciferol (Vitamin D2) Derived from plant source.

Cholecalciferol (Vitamin D3) Derived from animal source and exposure to UV

rays of sunlight.
Vitamin D is also considered as Kidney Hormone.
Richest source- Fish liver oil
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Nutrition updates points from PSM QRP by

Dr Mukhmohit Singh

Deficiency:
o

Rickets in young children (6 months- 2 years)

Osteomalacia in adults (F>M)

Daily requirement: 400 IU (10 mcg) in children, pregnancy and lactation, 100 IU

(2.5 mcg) in adults.

Vit. D toxicity: large doses cause hypercalcemia (serum CA>10.5mg %)
characterized by nausea, vomiting, constipation, renal failure, metastatic calcification in
arteries, kidneys and result in cardiac arrhythmias and renal failure.
Milk, margarine, vanaspati and infant foods are artificially fortified with vit. D.
=====
IRON

o Hb concentration
o

Serum iron concentration:

More useful index than Hb concentration
Normal range- 0.80-1.80 mg/L
Iron deficiency- below 0.50 mg/L

Serum ferritin:**
Most sensitive tool
Below 10 mcg/L probably indicate an absence of stored iron

Serum transferrin saturation:

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Nutrition updates points from PSM QRP by

Dr Mukhmohit Singh

Should be above 16%

Normal value- 30%
===
milk:
Per 100 g or 100 ml contains:
o

65 kcal

7.4 g carbohydrates

3.4 g fat

1.1 g protein

===
egg
60 grams of egg contains:
o

70 kcal of energy

6 g of protein

6 g of fat

30 mg of Ca

1.5 mg of iron

All vitamins except C.

100 g of egg yields 145 kcal of energy

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PROTEIN ENERGY MALNUTRITION (PEM)

It compares the weight of a child with a normal child of the same age. The

normal reference child is in the 50th centile of Boston standards.

It uses height as the measuring criteria

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Nutrition updates points from PSM QRP by

Dr Mukhmohit Singh

ines height for age (H/A) and weight for height

(W/H)
DIFFERENCE BETWEEN COW MILK AND HUMAN MILK
a)

Human milk has only one third of the protein concentration compared to cow

milk.
b)

Human milk has slightly more fat than cow milk. Also, human milk contains a

lipase enzyme because of which human milk fat is digested easily.

c)

Human milk has almost double the amount of lactose compared to cow milk.

Lactose provides an easily digestible source of energy. High lactose content helps in
myelination in the growing nerve tissue of the baby. Also, part of lactose is converted to
lactic acid in the intestine, which prevents growth of undesirable bacteria in the
intestine.
d)

Human milk contains the bifidus factor, which is a nitrogen-containing

carbohydrate. Bifidus factor is necessary for the growth of Lactobacillus bifidus, which
converts lactose to lactic acid.
e)

Human milk, especially the colostrum, contains large amounts of

Immunoglobulin A, which is not absorbed but acts in the intestine against certain
bacteria [such as E. coli] and viruses.
f)

Lysozyme, an enzyme, is present in human milk in concentrations several

thousand times that of cow milk. Lysozyme breaks down certain harmful bacteria and
also protects against various viruses.

National Helpline: 8699014009, 9814614009, 01722585749