DIET AND NUTRITION

“Tell me what you eat & I will tell you what you are” –
Anthelme brillat – Savarin
Above quotation is true for all persons on the earth. Food is basic
need for energy. Everyone has food according to one’s wish & need. Food
nutrients are used by body for energy production, building of tissues etc
purposes. So Diet affects our health in many aspects. Therefore what we are
is due to our diet. Thus diet is mirror of person’s health.

All chronic non communicable diseases are associated with the

change in dietary pattern of modern era. So to give
preventive measures study of dietary pattern of
patient is necessary.

Diet is the total food that can be consumed by

an individual or it is regulation of food to
requirement of body.

Food means anything or nutrient material

taken in by a living organism for production of
energy or building of tissue.

Nutrition is assimilation of food to diverge

energy for body maintenance.

Nutrients are Nourishing substance like protein, carbohydrate, fats

found in food. Nutrients are of two types:
1. Macronutrients called as proximate principle as they form major bulk
of food.Carbohydrate-65-70%, Proteins 10-15%, Fats 20-30%
2. Micronutrients include vitamins, minerals, trace elements

So for health life it is necessary to have balance in diet.

Balance diet is a diet which contains all the nutrients, vitamins &
minerals in appropriate portion for maintaining health, vitality & General
well being.

WHO CRITERIA FOR BALANCE DIET:-

 Energy provided by diet Should be limited to approximately 20-30% of
energy provided by total daily intake
 Saturated fats should not more than 10% of total energy intake. PUFA
should contribute to remaining of fat intake
 Carbohydrate should provide 50-70% of total energy.
 Protein should account 15-20% of energy provided by total intake.it
should be high in biological value & digestibility coefficient.

“We each day dig our graves with our teeth.” –

Samuel Smiles
This is the fact of life & it is proven by science. Hypertension is one of worst
condition which results from unbalanced diet pattern. High salt intake, high
intake of excessive calories & any derangement of metabolism are
responsible for hypertension. Chart given here shows mechanism of diet in
hypertension.

These all conclusion are study results of science of nutritional epidemiology.

Nutritional Epidemiology includes epidemiology of nutritional status of
communities, dietary survey, Nutritional survey, Nutrition & Growth
monitoring, Nutritional rehabilitation, Nutritional indicators & nutritional in
preventions.
So to prevent & Control hypertension scientific change in pattern of diet is
beneficial. The scientific regulation of food in treating disease is called Diet
therapy which is now evolving way of therapy.
Diet is different for individual persons. So to give proper measurements
assessment of diet is necessary.

DIETARY ASSESSMENT:-
Aims:-
1. To know nutritional status of family
2. To find out any deficiency/excess of proximate principle
3. To find out responsible nutritional factors
4. To educate family regarding diet
METHOD OF STUDY:-
1. Oral Questionnaire method
 Retrospective study in which patient’s diet is analyzed by asking
questions on food that he/she ate at different times of day for past
few days
 Prospective study in which the Performa regarding the age, sex, etc &
food i.e. cereals pulses, vegetables, fruits, oils, ghee & other
 miscellaneous foods consumed at different time of day are given. The
patient has to fill Performa accordingly as & when he/she ate next
day.
2. Weighment methods
3. Stock inventory method
4. Duplicate method
We have chosen Oral Questionnaire method for assessment of
Ratikaka’s diet & taken data about their diet schedule of week. Then we
have made averages of principle food substance in terms of gram per day.
For these we have considered some standards which are as below:
Reference values:-
1 cup milk = 100ml of milk
1 cup tea = 50ml of milk
1 wadki vegetable = 30 gm
1 wadki cooked rice = 20 gm
1 wadki cooked dhal = 20 gm
1 roti = 35 gm wheat flour
1 tea spoon oil = 5 gm oil
1 tea spoon sugar = 5 gm
1000 ml (1 liter) = 910 gm

To measures food quantity we have made menu of daily diet of patient’s

present diet:

Menu of diet of patient:-

Morning Break fast:
1 cup of tea + 2 Bhakhari
Lunch:
6 roti + 2 vadki shak + 1.5 vadki dal + 2 vadki Rice +
pickle,Chhunda,Papad,salad
Evening :
1 cup of tea
Supper:
4 Bhakri/5 roti + 2 vadki mug

So according to these:
Average Daily Consumption of Food Articles by the Patient

No. Food article Consumption

1 Wheat 490gm
2 Rice 40 gm
3 Pulses 70gm
4 Green leafy vegetables 20gm
5 Other vegetables/Fruits 10gm
6 Roots & Tubers 30gm
7 Milk 100ml
8 Oil 70gm
9 Sugar 40gm
 10 Salt 8.3gm

Every food contains some nutrient in different amount. These nutrients are
required for maintenance of health in some specific amount which is called
recommended daily allowance.
So Proximate principles & vitamin C taken by patient per day are as below:

Iron
Protein Fat Carbohydrate Energy Calcium Vit.c
Food Article (
(gm) (gm) (gm) (KCal) (mg) (mg)
mg)
Rice 2.72 0.2 31.28 138 4 0.28 0
Wheat 59.29 8.33 340.06 1670.9 235.2 24 0
Pulses 15.61 1.19 40.32 234.5 51.1 1.89 0
GLV* 0.4 0.14 0.58 5.2 14.6 0.23 5.6
Other vegetable 0.14 0.03 0.4 2.4 1.8 0.04 1.3
Roots and tuber 0.48 0.03 6.78 29.1 3 0.14 5.1
Milk 3.913 5.915 4.55 106.47 191.1 0.18 0
Oil 0 70 0 630 0 0 0
Sugar 0.04 0 39.76 159.2 4.8 0.06 0
2975.7
Total 82.593 85.835 463.73 505.6 26.8 12
7
* green leafy vegetables

Now, for comparison we have taken ideal values & assess deficiency &
excess of nutrients and food articles. For this purpose we have consider Diet
of an Indian reference Man of sedentary lifestyle.

“Indian reference man is between 20-39 years old & weighs 60 kg. He is free
from disease & is physically active work on each day. He is employed for 8
hours in Occupation that usually involve moderate work. While not at work,
he spends 8 hours in bed, 4-6 hours sitting & moving around & 2 hours in
walking & in Active recreation or household activities.”

Here certain point should be considered that patient’s weight & life style
doesn’t match exactly to the reference man so interpretation should be done
with ruling out these conditions. Patient’s diet is not same for everyday
changes are many and diet which is considered is not exact same many time
error are there from data given by patient.

-:COMPARISION IN TERM OF FOOD ARTICLES:-

Patient’s
Food articles Ideal value Difference Percentage
value
Cereals 460 530 +70 +15.21%
Pulses 40 70 +30 +75%
Green leafy vegetable 40 20 -20 -50%
Other vegetable 60 10 -50 -83.33%
Roots and tuber 50 30 -20 -40%
Milk 150 100 -50 -33.33%
Sugar 30 40 +10 +33.33%
 Oil 40 70 +30 +75%
Salt 5 8.3 +3.3 +66%

-:COMPARISION IN TERM OF NUTRIENTS:-

Patient’s
Nutrient Ideal value Difference Percentage
value
Carbohydrate 450 463.73 +13.73 +3.05%
Protein 60 82.59 +22.59 +37.65%
Fats 20 85.83 +65.83 +329.15%
Energy 2425 2975.77 +550.77 +22.71%
Vit. C 40 12 -28 -70%
Iron 28 26.8 -1.2 -4.28%
Calcium 400 505.6 +105.6 +26.4%

-:Cost of Nutrition per month:-

Food Amount/month Rate in Rupees Cost in Rupees

Jowar 2kg 14Rs./kg 28
Wheat 20kg 14Rs./kg 280
Rice 10kg 15Rs./kg 150
Bajari 4kg 12Rs./kg 48
Sugar 5kg 15Rs./kg 75
Salt 1kg 5Rs./kg 5
Cotton seed 10kg 40Rs./kg 400
oil
Vegetable 15kg 10Rs./kg 150
Milk 30litre 18Rs./litre 540
Tuver dhal 6kg 30Rs./kg 180
Mug dhal 3kg 40Rs./kg 120
Root & tuber 5kg 11Rs./kg 55
Other veg 2kg 18Rs./kg 36
TOTLE 2067

Conclusion:-
1. Diet of patient is excess & deficit in term of nutrition.
Deficit in Excess in
Vitamin C (Anti oxidant) Fats

2. Diet of patient is excess & deficit in term of Food articles.

Deficit in Excess in
Green leafy vegetables Oil
Other vegetables Salt
Milk Sugar
Fruits Pulses
So here patient is requiring modification in diet. With consideration of other
risk factors in Ratikaka, diet is seem to be an important risk factor mainly
responsible for Hypertension.

Recommendation for patient:

Patient need modification in diet in such a way that the cost difference is not
much & patient can afford new diet pattern.

1. Decreasing the oil consumption we can decrease fat intake

2. Increase green leafy vegetables like Spinach, Amaranth etc.

These both ways can reduce the Total & LDL cholesterol level in
serum so dyslipidemia can be controlled.

3. According to the history, patient is not taking fruits in good amount so

patient is advised to take mainly citreous fruits like lemon, orange, amla
etc in good amount.
This way gives relief from oxidative stress of fats to vessel As vitamin c
is anti-oxidant.

4. Salt restriction should be advised but not to extent which lead to

hyponatrimia as India is tropical country. Patient is not taking salt
directly but in pickles, salad (table salt), snacks he is taking much more
of salt. So decrease consumption in this way can be helpful for patient.

5. Patient can also advice to take DASH (Dietary Approaches to Stop

Hypertension) diet which is rich in potassium & calcium But his diet is
already rich in calcium so better to add only potassium supplements like
tomato, chikoo, banana etc

6. More ever if possible replace the cotton seed oil with oil because it
contains 25% saturated fats more rich than other oil. SO it is better to
replace it with sunflower oil or ground nut oil as both have saturated fat
only 5% and 19% respectively. For comparison chart given below is
helpful.

Cotton seed oil Ground nut oil Sunflower oil

Saturated fat 25% 19% 8%

Unsaturated fat 25% 50% 27%

PUFA 50% 31% 65%

So at last not forget the

motto that “Health is
wealth” so be healthy with
healthy diet so wealth of
health is not theft by
diseases.