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📚 How I Can Help You

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📖 NUTRITION & DIETETICS - COMPLETE REVISION NOTES

BSc Nursing | ABVMU Lucknow

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UNIT 1: INTRODUCTION TO NUTRITION

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SECTION A: CONCEPTS

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1. DEFINITION OF NUTRITION & HEALTH

Nutrition is the science of food and its relationship to health. It includes the processes by which an organism ingests, digests, absorbs, transports, utilizes, and excretes food substances.

"Health is a state of complete physical, mental, and social well-being and not merely the absence of disease or infirmity."

• Good nutrition = adequate intake of all essential nutrients
• Poor nutrition leads to disease, decreased immunity, impaired growth
• Nutrition is a fundamental determinant of health

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2. MALNUTRITION - UNDER NUTRITION & OVER NUTRITION

An imbalance (deficiency or excess) in the intake of energy, protein, or other nutrients causing adverse effects on body composition, function, and clinical outcomes.

A. UNDER NUTRITION (Protein-Energy Malnutrition - PEM)

• Weight loss, stunting (short height), wasting
• Pallor, weakness, fatigue
• Poor wound healing
• Increased susceptibility to infections
• Deficiency diseases (scurvy, rickets, beriberi, pellagra, etc.)

B. OVER NUTRITION

• Excessive intake of calories, fat, sugar
• Leads to: Obesity, Type 2 Diabetes, Hypertension, Cardiovascular disease, NASH (Non-alcoholic steatohepatitis)
• BMI >25 = Overweight; BMI >30 = Obese

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3. ROLE OF NUTRITION IN MAINTAINING HEALTH

1. Growth & Development - proteins, calcium, vitamins essential for tissue building
2. Energy production - carbohydrates and fats fuel all body functions
3. Repair & Maintenance - proteins rebuild damaged tissues
4. Immunity - vitamins A, C, E, zinc, iron strengthen immune system
5. Reproduction - folic acid, iron, calcium vital during pregnancy
6. Mental health - B vitamins, omega-3 fatty acids support brain function
7. Prevention of disease - adequate nutrition prevents deficiency diseases and chronic diseases
8. Wound healing - vitamin C, protein, zinc required
9. Regulation of body functions - vitamins and minerals regulate enzymatic processes

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4. FACTORS AFFECTING FOOD AND NUTRITION

• Age (infant, child, adolescent, adult, elderly have different needs)
• Sex (males generally need more calories)
• Physiological state (pregnancy, lactation increase needs)
• Health status (disease, surgery increase demands)

• Income level - affects food purchasing power
• Education - awareness of nutritional needs
• Occupation - physical vs sedentary work
• Food availability and accessibility

• Religious dietary restrictions (fasting, vegetarianism)
• Food taboos and beliefs
• Traditional food habits
• Regional food preferences

• Food preferences and aversions
• Emotional eating, stress
• Eating disorders (anorexia nervosa, bulimia)
• Food habits developed in childhood

• Climate and geography - affects food production
• Season - availability of foods changes
• Water and sanitation - affects absorption

• Local crop production
• Food storage and preservation methods
• Food processing and technology

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SECTION B: NUTRIENTS

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5. CLASSIFICATION OF NUTRIENTS

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6. MACRO & MICRONUTRIENTS

A. MACRONUTRIENTS (needed in large amounts)

• Simple: Monosaccharides (glucose, fructose), Disaccharides (sucrose, lactose, maltose)
• Complex: Polysaccharides (starch, glycogen, fiber)
• RDA: 55-60% of total calories

• Made of amino acids (20 total; 9 Essential amino acids - must come from diet)
• Essential AAs (mnemonic: PVT TIM HaLL): Phenylalanine, Valine, Threonine, Tryptophan, Isoleucine, Methionine, Histidine, Arginine (semi), Leucine, Lysine
• Complete protein = contains all essential AAs (animal sources)
• Incomplete protein = lacks one or more essential AAs (most plant sources)
• RDA: 0.8 g/kg body weight/day (adults)

• Saturated fatty acids (solid at room temp; animal fat - raise LDL)
• Unsaturated: Monounsaturated (olive oil), Polyunsaturated (omega-3, omega-6)
• Trans fats: hydrogenated; most harmful
• Essential fatty acids: Linoleic acid (omega-6), Alpha-linolenic acid (omega-3)
• RDA: 20-35% of total calories

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B. MICRONUTRIENTS (needed in small amounts)

VITAMINS

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MINERALS (Major + Trace)

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7. ORGANIC & INORGANIC NUTRIENTS

• Organic nutrients are broken down during metabolism to release energy
• Inorganic nutrients (minerals) are not broken down; they serve structural and regulatory functions
• Water, though inorganic, is the most essential nutrient (makes up 60-70% of body weight)

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8. ENERGY YIELDING & NON-ENERGY YIELDING NUTRIENTS

Energy Yielding Nutrients (Proximate Principles):

Mnemonic: "Carbs and Protein = 4, Fat = 9"

Non-Energy Yielding Nutrients:

• Vitamins - regulate metabolism but do not provide energy
• Minerals - structural and regulatory; no energy
• Water - essential for all metabolic processes; no energy
• Dietary Fiber - aids digestion but not digested by humans (negligible energy)

• Adult male (moderate activity): ~2500 kcal/day
• Adult female (moderate activity): ~2000 kcal/day
• Pregnancy: +300 kcal/day extra
• Lactation: +500 kcal/day extra

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SECTION C: FOOD

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9. CLASSIFICATION OF FOOD - FOOD GROUPS

ICMR/Indian Classification (5 Food Groups):

International Classification - "Basic Four" Food Groups:

1. Milk and dairy products
2. Meat, fish, poultry, eggs, legumes
3. Fruits and vegetables
4. Bread, cereals, grains

Functional Classification:

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10. ORIGIN OF FOOD

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⚡ QUICK REVISION - KEY FACTS TO REMEMBER

Deficiency Disease Mnemonics:

Energy Values - MUST KNOW:

• Carbohydrate = 4 kcal/g
• Protein = 4 kcal/g
• Fat = 9 kcal/g
• Alcohol = 7 kcal/g

Important Numbers:

• Water makes up 60-70% of body weight
• Human body has 20 amino acids (9 essential)
• RDA of protein = 0.8 g/kg/day
• Normal BMI = 18.5 - 24.9

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📝 PROBABLE EXAM QUESTIONS

1. Define malnutrition. Differentiate between marasmus and kwashiorkor.
2. What are macronutrients? Give examples.
3. List fat-soluble vitamins and their deficiency diseases.
4. Classify nutrients with examples.
5. What are energy-yielding nutrients? Give caloric values.
6. Enumerate the food groups with examples.
7. Define over-nutrition and list its consequences.
8. What factors affect food and nutrition?

1. Classify nutrients. Describe the functions, sources, and deficiency diseases of vitamins.
2. Explain the role of nutrition in maintaining health. Discuss factors affecting food and nutrition.
3. Write a detailed note on protein-energy malnutrition (PEM).
4. Classify food. Describe food groups with examples and nutritional significance.

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📌 Note: Your syllabus image shows only part of the content (it cuts off). If you have more pages (e.g., topics like Dietary requirements, Therapeutic diets, Diet in diseases), please share them and I'll add those notes too!

• Definitions of Nutrition & Health
• Malnutrition - Marasmus vs Kwashiorkor (with comparison table)
• Role of Nutrition in Health (9 key roles)
• Factors affecting Food & Nutrition (Biological, Social, Cultural, Psychological, Environmental)
• Classification of Nutrients (Macro/Micro, Organic/Inorganic, Energy/Non-energy)
• All Vitamins - fat soluble & water soluble (with deficiency diseases)
• All Minerals - major & trace minerals
• Energy values (4-4-9 rule)
• Food Groups - Indian (5 groups) + International (Basic Four)
• Origin of food (Plant, Animal, Mineral, Synthetic)
• Probable exam questions

• Dietary requirements (RDA)
• Diet during pregnancy/lactation
• Therapeutic diets
• Diet in diseases (diabetes, hypertension, etc.)

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📖 NUTRITION & DIETETICS - CHAPTER 2 REVISION NOTES

Carbohydrates | Energy & BMR | Proteins

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PART 1: CARBOHYDRATES

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1. COMPOSITION OF CARBOHYDRATES

• Carbohydrates are organic compounds made of Carbon (C), Hydrogen (H), and Oxygen (O)
• General formula: Cₙ(H₂O)ₙ (hence the name "hydrates of carbon")
• The ratio of H:O is always 2:1 (same as water)

Classification / Types of Carbohydrates:

• Starch = storage form in plants (rice, wheat, potato)
• Glycogen = storage form in humans (liver and muscle)
• Cellulose = dietary fiber; humans cannot digest it but it aids bowel motility
• Glucose = the body's preferred energy source; brain runs almost exclusively on glucose

Simple vs Complex Carbohydrates:

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2. FUNCTIONS OF CARBOHYDRATES

1. Primary energy source - 1g carbohydrate = 4 kcal
2. Brain fuel - glucose is the sole energy source for the brain (brain uses ~120g glucose/day)
3. Protein sparing - when carbs are adequate, protein is used for growth (not burned for energy)
4. Fat metabolism - "fats burn in the flame of carbohydrates"; without carbs, incomplete fat oxidation produces ketone bodies
5. Glycogen storage - liver glycogen maintains blood glucose; muscle glycogen fuels exercise
6. Structural role - ribose sugar is part of DNA and RNA
7. Dietary fiber (cellulose):
   • Prevents constipation
   • Lowers cholesterol
   • Controls blood sugar (slows absorption)
   • Reduces risk of colorectal cancer
8. Synthesis - carbs are precursors for synthesis of amino acids, fatty acids, and other compounds

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3. DIETARY SOURCES OF CARBOHYDRATES

Richest sources: Cereals and grains (60-70% carbohydrate content) Poorest sources: Fats, oils, and pure protein foods contain negligible carbohydrates

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4. RECOMMENDED DAILY ALLOWANCE (RDA) OF CARBOHYDRATES

• Sedentary man: 2110 kcal → ~430g rice or equivalent
• Moderate work man: 2710 kcal
• Heavy work man: 3490 kcal

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PART 2: ENERGY & BMR

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5. UNIT OF ENERGY - KILOCALORIE (Kcal)

A calorie (small 'c') is the amount of heat required to raise the temperature of 1 gram of water by 1°C.

1 Kcal = 1000 calories = the amount of heat required to raise 1 kg of water by 1°C

Energy Values of Nutrients (Atwater Factors):

Other Energy Units:

• 1 Kcal = 4.184 kJ (kilojoules)
• Some countries use kJ; most clinical nutrition uses Kcal

Components of Total Daily Energy Expenditure (TDEE):

TDEE = BMR + Physical Activity + Thermic Effect of Food (TEF)

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6. BASAL METABOLIC RATE (BMR)

BMR is the minimum amount of energy required to maintain basic life-sustaining functions (breathing, circulation, cell maintenance, temperature regulation) in a person who is awake, at complete rest, in a thermoneutral environment, 12-14 hours after the last meal.

• Person must be awake (not sleeping - that is RMR)
• Complete physical and mental rest
• Fasting state (12-14 hours after last meal)
• Thermoneutral environment (comfortable temperature)
• Measured in the morning after a good night's rest

BMR Values (Approximate):

How to Calculate BMR:

• Men: BMR = 88.4 + (13.4 × weight in kg) + (4.8 × height in cm) - (5.7 × age in years)
• Women: BMR = 447.6 + (9.2 × weight in kg) + (3.1 × height in cm) - (4.3 × age in years)

• Men: ~1 Kcal/kg body weight/hour
• Women: ~0.9 Kcal/kg body weight/hour

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7. FACTORS AFFECTING BMR

Factors that INCREASE BMR:

Factors that DECREASE BMR:

Summary Table - Key Factors:

Most important regulator of BMR = THYROID HORMONES (T3 and T4)

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PART 3: PROTEINS

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8. COMPOSITION OF PROTEINS

• Proteins are organic macromolecules made of Carbon (C), Hydrogen (H), Oxygen (O), Nitrogen (N) - and sometimes Sulfur (S) and Phosphorus (P)
• Nitrogen is the distinguishing element (carbs and fats do NOT contain nitrogen)
• Proteins are made of amino acids linked by peptide bonds
• 20 amino acids in total; 9 are essential (must come from diet)

Phenylalanine, Valine, Threonine, Tryptophan, Isoleucine, Methionine, Histidine, Leucine, Lysine

Classification of Proteins:

• Example: Rice + Dal (eaten together in Indian diet) = complete protein

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9. FUNCTIONS OF PROTEINS

1. Growth & Repair - building blocks for all body tissues (muscle, skin, organs)
2. Enzymes - all enzymes are proteins (e.g., amylase, pepsin, lipase)
3. Hormones - insulin, glucagon, growth hormone are proteins
4. Antibodies (Immunoglobulins) - immune defense; all antibodies are proteins
5. Transport - hemoglobin (O₂), albumin (drugs, hormones), transferrin (iron)
6. Structural role - collagen (bones, tendons), keratin (hair, nails), elastin (blood vessels)
7. Fluid balance - plasma proteins (albumin) maintain oncotic pressure; deficiency → edema
8. Acid-base balance - proteins act as buffers
9. Energy source - last resort; 1g protein = 4 Kcal
10. Coagulation - fibrinogen, prothrombin are proteins essential for clotting
11. Vision - rhodopsin (rod cells) is a protein

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10. SOURCES OF PROTEIN

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11. RDA OF PROTEIN

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12. PROTEIN DEFICIENCY

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⚡ QUICK REVISION TABLES

Carbohydrates at a Glance:

BMR at a Glance:

Proteins at a Glance:

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📝 PROBABLE EXAM QUESTIONS (This Chapter)

1. Define BMR. List 5 factors that affect BMR.
2. What is the RDA of carbohydrates? List its dietary sources.
3. Enumerate the functions of proteins.
4. Differentiate between complete and incomplete proteins with examples.
5. What is a Kilocalorie? Give the energy values of carbohydrates, proteins, and fats.
6. Classify carbohydrates with examples.
7. What are essential amino acids? Name them.

1. Describe carbohydrates - composition, classification, functions, dietary sources, and RDA.
2. Define BMR. Explain the factors affecting BMR in detail.
3. Describe proteins - composition, classification, functions, sources, and RDA.
4. Explain the components of total daily energy expenditure. How is BMR calculated?

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📌 Your syllabus image is still cut off at "Proteins" section at the bottom. If there are more topics (Fats, Vitamins, Minerals, Therapeutic diets, etc.) in the remaining pages, please share them and I'll write those notes too!

• Composition
• Eight essential amino acids
• Functions
• Dietary sources
• Protein requirements - RDA

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📖 CHAPTER 3: PROTEINS

Complete Revision Notes | BSc Nursing | ABVMU Lucknow

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1. COMPOSITION OF PROTEINS

Key fact: Proteins are the ONLY macronutrient that contains Nitrogen (N). Average nitrogen content of protein = 16% This means: Protein = Nitrogen × 6.25 (used to calculate protein from nitrogen in food analysis)

Building Blocks - Amino Acids:

• Proteins are made of amino acids joined together by peptide bonds
• Every amino acid has:
  • An amino group (-NH₂)
  • A carboxyl group (-COOH)
  • A side chain (R group) - this makes each amino acid unique
• Total amino acids = 20
• Chain of 2 AAs = Dipeptide
• Chain of 3 AAs = Tripeptide
• Chain of many AAs = Polypeptide → Protein

Levels of Protein Structure:

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2. CLASSIFICATION OF PROTEINS

A. By Nutritional Quality (Most Important for Nursing Exams):

• Egg = 100 (reference/gold standard)
• Milk = 93
• Fish = 76
• Beef = 74
• Soybean = 73
• Rice = 64
• Wheat = 65
• Dal/Legumes = 49-60

Complementary proteins: Combining two LBV proteins to make a complete protein

• Classic Indian example: Rice + Dal → together provide all essential AAs
• Chapati + Dal, Khichdi = nutritionally complete combinations

B. By Chemical Structure:

C. By Shape:

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3. EIGHT ESSENTIAL AMINO ACIDS

The 8 Essential Amino Acids (Adults):

Mnemonic: "PVT TIM LL" Phenylalanine - Valine - Threonine - Tryptophan - Isoleucine - Methionine - Leucine - Lysine

9th Essential AA (in some contexts):

Non-Essential Amino Acids (body can synthesize):

Limiting Amino Acid:

• The essential AA present in the smallest quantity in a food relative to its requirement
• Lysine is the most common limiting AA in cereals (rice, wheat)
• Methionine is the limiting AA in legumes/pulses
• This is why cereal + pulse combinations work so well nutritionally

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4. FUNCTIONS OF PROTEINS

A. STRUCTURAL FUNCTIONS:

1. Growth and repair of tissues - proteins are the building material of all cells: muscle, skin, organs, hair, nails
   • Collagen: most abundant protein in the body; gives strength to bones, tendons, ligaments, skin
   • Keratin: forms hair, nails, skin surface
   • Elastin: gives elasticity to blood vessels and lungs

B. REGULATORY FUNCTIONS:

1. Enzymes - ALL enzymes are proteins; catalyze every biochemical reaction in the body
   • Examples: Amylase (digests starch), Pepsin (digests protein in stomach), Lipase (digests fat)
2. Hormones - many hormones are proteins/peptides
   • Insulin & Glucagon (blood sugar control)
   • Growth Hormone (GH)
   • ADH (antidiuretic hormone)
   • Oxytocin (Note: steroid hormones like cortisol, estrogen are NOT proteins)
3. Antibodies (Immunoglobulins) - all antibodies are proteins; provide immunity against infection
4. Fluid balance - Plasma proteins (mainly albumin) maintain oncotic pressure in blood vessels
   • When protein is low → albumin falls → fluid leaks into tissues → edema (especially in kwashiorkor)
5. Acid-base balance - proteins act as buffers maintaining blood pH at 7.35-7.45

C. TRANSPORT FUNCTIONS:

1. Transport of substances in blood:
   • Hemoglobin transports O₂ and CO₂
   • Albumin transports fatty acids, drugs, bilirubin, hormones
   • Transferrin transports iron
   • Ceruloplasmin transports copper
   • Lipoproteins (HDL, LDL) transport fats and cholesterol

D. OTHER FUNCTIONS:

1. Blood clotting (Coagulation) - clotting factors (fibrinogen, prothrombin, factors VII, VIII, IX, X) are all proteins
   • Deficiency → bleeding tendency
2. Muscle contraction - Actin and Myosin (contractile proteins) enable all movement
3. Vision - Rhodopsin (in rod cells of retina) is a protein; enables night vision
4. Energy source (last resort) - 1g protein = 4 Kcal; used for energy only when carbs and fats are inadequate (starvation, very low carbohydrate intake)
5. Synthesis of other important molecules:
   • Tryptophan → Serotonin (mood) and Niacin (Vit B3)
   • Phenylalanine → Dopamine, Adrenaline, Noradrenaline
   • Tyrosine → Thyroid hormones (T3, T4), melanin (skin pigment)
   • Glycine → Heme (in hemoglobin), bile salts
   • Arginine → Nitric oxide (vasodilator)

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5. DIETARY SOURCES OF PROTEIN

Animal Sources (High Biological Value - Complete Proteins):

Plant Sources (Low Biological Value - Incomplete, EXCEPT Soybean):

Best Sources Summary:

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6. PROTEIN REQUIREMENTS - RDA

RDA (Recommended Dietary Allowance) for Protein:

Increased protein needs in:

• Fever, infections (every 1°C rise = ~10-13% increase in protein catabolism)
• Post-surgery, burns, trauma (catabolic states)
• Cancer, HIV/AIDS
• Hyperthyroidism
• Pregnancy and lactation
• Growing children and adolescents
• Athletes and bodybuilders (up to 1.2-2.0 g/kg/day)
• Nephrotic syndrome (protein lost in urine)

Protein Energy Ratio:

• In a balanced diet: Protein should provide 10-15% of total calories
• For a 2000 Kcal diet → protein = 200-300 Kcal = 50-75 g protein/day

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7. PROTEIN DEFICIENCY DISEASES

Kwashiorkor vs Marasmus - Key Differences:

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⚡ QUICK REVISION

Essential Amino Acids - PVT TIM LL:

Phenylalanine | Valine | Threonine | Tryptophan | Isoleucine | Methionine | Leucine | Lysine (+ Histidine for infants)

Key Numbers to Remember:

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📝 PROBABLE EXAM QUESTIONS

1. Name the 8 essential amino acids with their functions.
2. What is Biological Value (BV) of protein? Give examples.
3. Enumerate the functions of proteins in the body.
4. What is the RDA of protein for a pregnant woman?
5. Differentiate between complete and incomplete proteins.
6. What is the composition of proteins? Name the elements present.
7. List high biological value protein sources.
8. Define limiting amino acid. Give examples.

1. Describe proteins - composition, classification, functions, dietary sources, and RDA.
2. Enumerate the essential amino acids. Describe the dietary sources and protein requirements (RDA) for different age groups.
3. Write a detailed note on Protein Energy Malnutrition (PEM) - Kwashiorkor and Marasmus.

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📌 Note: The syllabus specifically mentions "Eight essential amino acids" - so for your exam, learn the 8 adult essential AAs (PVT TIM LL). You can mention Histidine as the 9th for infants.

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📖 CHAPTER 4: FATS (LIPIDS)

Complete Revision Notes | BSc Nursing | ABVMU Lucknow

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1. INTRODUCTION TO FATS

• Fats are also called Lipids
• They are organic compounds made of Carbon (C), Hydrogen (H), and Oxygen (O) - same elements as carbohydrates BUT fats have much less oxygen and much more hydrogen
• Fats are insoluble in water but soluble in organic solvents (ether, chloroform, benzene)
• Basic unit of fat = Fatty acid + Glycerol
• Most dietary fats are in the form of Triglycerides (1 glycerol + 3 fatty acids)

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2. CLASSIFICATION OF FATS

A. BASED ON PHYSICAL STATE:

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B. BASED ON FATTY ACID COMPOSITION (Most Important):

1. SATURATED FATTY ACIDS (SFA)

• Palmitic acid (C16) - most common; found in palm oil, meat, dairy
• Stearic acid (C18) - beef, cocoa butter
• Lauric acid (C12) - coconut oil
• Myristic acid (C14) - dairy, coconut

2. UNSATURATED FATTY ACIDS (UFA)

a) Monounsaturated Fatty Acids (MUFA):

b) Polyunsaturated Fatty Acids (PUFA):

3. TRANS FATTY ACIDS (TFA)

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C. BASED ON CHEMICAL STRUCTURE:

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D. BASED ON ORIGIN:

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3. CALORIE VALUE OF FATS

1 gram of fat = 9 Kilocalories (Kcal)

• Fat molecules have a much higher proportion of C-H bonds
• C-H bonds release more energy when oxidized compared to C-O bonds (which are already partially oxidized in carbohydrates)

• 1 teaspoon of oil (5g) = 45 Kcal
• 1 tablespoon of ghee (15g) = 135 Kcal
• 100g of butter = 900 Kcal

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4. FUNCTIONS OF FATS

12 Important Functions:

1. Concentrated energy source - 9 Kcal/g; provides more than double the energy of carbs or protein; important for high-energy needs
2. Absorption of fat-soluble vitamins - Vitamins A, D, E, K require fat for absorption in the intestine; a fat-free diet leads to deficiency of these vitamins
3. Essential fatty acids - provides linoleic acid and alpha-linolenic acid which the body cannot synthesize; needed for prostaglandin synthesis, cell membranes, brain function
4. Cell membrane structure - Phospholipids (made from fat) form the bilayer structure of ALL cell membranes
5. Insulation and protection - subcutaneous fat layer insulates the body against cold; visceral fat cushions and protects vital organs (kidneys, heart) against physical shock
6. Satiety (feeling full) - fat slows gastric emptying; provides prolonged satiety after meals
7. Palatability - fat adds flavor, taste, and texture to food; makes food enjoyable
8. Hormone synthesis - cholesterol (a lipid) is the precursor for all steroid hormones (cortisol, estrogen, testosterone, progesterone, aldosterone) and bile acids
9. Brain and nervous system - brain is ~60% fat; myelin sheath (insulation of nerves) is made of lipids; DHA (omega-3) is critical for brain development in infants
10. Carrier of fat-soluble vitamins - acts as a vehicle for vitamins A, D, E, K from food to intestinal absorption
11. Synthesis of bile salts - cholesterol is converted to bile acids (needed for fat digestion)
12. Body temperature regulation - subcutaneous fat acts as thermal insulator

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5. DIETARY SOURCES OF FATS AND FATTY ACIDS

Animal Sources:

Plant Sources:

Summary - Best Sources by Type:

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6. FAT REQUIREMENTS - RDA

Recommended Dietary Allowance (RDA):

Specific Recommendations:

• Saturated fat: < 10% of total calories
• Trans fat: < 1% of total calories (ideally ZERO)
• PUFA: 6-10% of total calories
• MUFA: remaining fat calories
• Omega-6 : Omega-3 ratio: should be 5:1 to 10:1 (most Indian diets have 20:1 - too high in omega-6)
• Cholesterol: < 300 mg/day

Practical Example:

• Fat = 25% × 2000 = 500 Kcal from fat
• 500 ÷ 9 = ~55 grams of fat per day
• Visible fat (cooking oil/ghee): 20-25 g/day
• Invisible fat (from food): ~25-30 g/day

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7. EFFECTS OF EXCESS FAT INTAKE

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⚡ QUICK REVISION TABLE

Comparison of Fat Types:

Key Numbers:

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📝 PROBABLE EXAM QUESTIONS

1. Classify fats with examples - saturated and unsaturated.
2. What is the calorie value of fat? How does it compare to carbohydrates and proteins?
3. Enumerate the functions of fats in the body.
4. What are essential fatty acids? Give examples and sources.
5. What are trans fatty acids? Why are they harmful?
6. List the dietary sources of fats and fatty acids.
7. What is the RDA of fat for an adult?

1. Describe fats - classification (saturated and unsaturated), calorie value, functions, dietary sources, and RDA.
2. Write a note on essential fatty acids - types, sources, functions, and deficiency.
3. Compare saturated, monounsaturated, and polyunsaturated fatty acids with examples and health effects.

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🔑 MUST-REMEMBER FACTS FOR EXAM:

• Fat = 9 Kcal/g (highest energy density)
• Fat-soluble vitamins = A, D, E, K (need fat for absorption)
• Essential fatty acids = Linoleic acid (omega-6) + Alpha-linolenic acid (omega-3)
• Best omega-3 source = Fatty fish (animal) / Flaxseeds (plant)
• Worst fat = Trans fat (vanaspati/dalda)
• Cholesterol is precursor of all steroid hormones + bile acids
• RDA of fat = 20-30% of total calories

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📖 CHAPTER 5: VITAMINS

Complete Revision Notes | BSc Nursing | ABVMU Lucknow

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INTRODUCTION TO VITAMINS

• Vitamins are organic compounds required in small amounts for normal growth, metabolism, and health
• They do NOT provide energy (0 Kcal) but are essential for regulating metabolic processes
• Most vitamins cannot be synthesized by the body and must come from the diet
• Discovered by Sir Frederick Hopkins (1906); term "vitamine" coined by Casimir Funk (1912)

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CLASSIFICATION OF VITAMINS

Two Main Groups:

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PART A: FAT-SOLUBLE VITAMINS

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VITAMIN A (RETINOL)

Chemical Forms:

• Retinol - active form; in animal foods
• Beta-carotene - provitamin A (precursor); in plant foods; 6 mcg beta-carotene = 1 mcg retinol
• Stored in liver (up to 6 months supply)

Functions:

1. Vision - component of rhodopsin (visual purple) in rod cells; essential for vision in dim light
2. Epithelial integrity - maintains healthy epithelium (skin, cornea, mucous membranes, respiratory, GI, urinary tracts)
3. Growth - essential for growth of bones and teeth
4. Immunity - maintains immune defenses; "anti-infective vitamin"
5. Reproduction - required for normal reproductive functions
6. Antioxidant - beta-carotene is a powerful antioxidant

Deficiency (VERY IMPORTANT for exam):

Most common cause of preventable blindness in children worldwide = Vitamin A deficiency

Dietary Sources:

RDA:

RAE = Retinol Activity Equivalent National Program: Vitamin A supplementation given to children 9 months - 5 years in India (every 6 months)

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VITAMIN D (CALCIFEROL)

Chemical Forms:

• D2 (Ergocalciferol) - from plant sources/fungi
• D3 (Cholecalciferol) - from animal sources + skin synthesis by sunlight
• Called the "Sunshine Vitamin"
• Activated in: Liver (25-OH-D3) → Kidney (1,25-OH₂-D3 = Calcitriol = active form)

Functions:

1. Calcium absorption - increases absorption of calcium from intestine (most important function)
2. Phosphorus absorption - increases phosphorus absorption
3. Bone mineralization - deposits calcium and phosphorus into bones → bone strength
4. Kidney function - promotes calcium reabsorption in kidney tubules
5. Muscle function - needed for normal muscle contraction
6. Immunity - activates immune cells
7. Hormone-like action - regulates gene expression in many tissues

Deficiency:

Dietary Sources:

Most Indians are Vitamin D deficient despite abundant sunlight - due to indoor lifestyle, dark skin, sunscreen use

RDA:

Toxicity (Hypervitaminosis D): Hypercalcemia → nausea, vomiting, kidney stones, calcification of soft tissues

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VITAMIN E (TOCOPHEROL)

Chemical Forms:

• Alpha-tocopherol = most active and important form
• 8 forms exist (alpha, beta, gamma, delta tocopherols and tocotrienols)

Functions:

1. Antioxidant - MOST IMPORTANT function; protects cell membranes from oxidative damage (prevents lipid peroxidation)
2. Protects RBCs - prevents hemolysis (destruction of red blood cells)
3. Immune function - enhances immune response
4. Antiplatelet effect - prevents abnormal blood clotting
5. Skin health - protects skin cells from oxidative damage
6. Reproduction - essential for normal reproductive function (original name "tocopherol" = Greek for "to bear offspring")
7. Works with Selenium - both are antioxidants; they work synergistically

Deficiency:

• Hemolytic anemia in premature infants (most common deficiency sign)
• Peripheral neuropathy
• Muscle weakness (myopathy)
• Ataxia (loss of coordination)
• Retinopathy
• Impaired immune response
• Note: Deficiency is rare in healthy adults with normal fat absorption

Dietary Sources:

• Wheat germ oil (richest source)
• Vegetable oils (sunflower, safflower, corn oil)
• Nuts (almonds, hazelnuts, peanuts)
• Seeds (sunflower seeds)
• Green leafy vegetables (spinach)
• Egg yolk, butter

RDA:

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VITAMIN K (PHYLLOQUINONE / MENAQUINONE)

Chemical Forms:

• K1 (Phylloquinone) - from plants (green vegetables)
• K2 (Menaquinone) - produced by gut bacteria (intestinal flora); also in fermented foods
• K3 (Menadione) - synthetic form

Functions:

1. Blood clotting - MOST IMPORTANT; cofactor for synthesis of clotting factors II (Prothrombin), VII, IX, X and anticoagulants Protein C, Protein S
2. Bone metabolism - activates osteocalcin (bone protein); essential for bone mineralization
3. Carboxylation reactions - acts as cofactor for gamma-carboxylase enzyme

Deficiency:

• Hemorrhagic disease - prolonged bleeding, easy bruising
• Hemorrhagic disease of newborn (HDN) - serious bleeding in newborns (newborns have sterile gut - no bacteria to make K2; no stores; breast milk has low Vit K)
• Prolonged PT (Prothrombin Time) - measured in lab
• Rare in adults (gut bacteria make K2)

Clinical application: All newborns receive Vitamin K1 injection (1 mg IM) at birth to prevent HDN Warfarin (anticoagulant drug) works by BLOCKING Vitamin K action

Dietary Sources:

• Green leafy vegetables (richest source - spinach, cabbage, broccoli, lettuce)
• Produced by intestinal bacteria (K2)
• Vegetable oils
• Liver
• Fermented foods (natto - highest food source of K2)

RDA:

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PART B: WATER-SOLUBLE VITAMINS

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VITAMIN B1 - THIAMINE

Functions:

1. Carbohydrate metabolism - coenzyme in pyruvate dehydrogenase and alpha-ketoglutarate dehydrogenase reactions (energy production from glucose)
2. Nerve function - maintains myelin sheath; needed for nerve impulse transmission
3. Muscle function - especially cardiac muscle

Deficiency Disease: BERIBERI

Beriberi is common in rice-eating populations where polished white rice is the staple (polishing removes the bran which contains thiamine)

Dietary Sources:

• Unpolished/brown rice, whole wheat (richest cereal sources)
• Legumes and pulses
• Pork (richest meat source)
• Yeast
• Nuts and seeds
• Green vegetables

RDA:

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VITAMIN B2 - RIBOFLAVIN

Functions:

1. Energy metabolism - component of FAD (Flavin Adenine Dinucleotide) and FMN - coenzymes in electron transport chain and energy production
2. Cellular respiration - involved in oxidation-reduction reactions
3. Antioxidant - component of glutathione reductase

Deficiency Disease: ARIBOFLAVINOSIS

Dietary Sources:

• Milk and dairy products (best source; "milk riboflavin")
• Organ meats (liver, kidney)
• Eggs
• Green leafy vegetables
• Whole cereals and pulses
• Yeast

RDA:

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VITAMIN B3 - NICOTINIC ACID (NIACIN)

Functions:

1. Energy metabolism - component of NAD (Nicotinamide Adenine Dinucleotide) and NADP - essential coenzymes in over 200 metabolic reactions
2. Cellular respiration - hydrogen carrier in electron transport chain
3. DNA repair - involved in DNA synthesis and repair
4. Cholesterol metabolism - high-dose niacin raises HDL cholesterol

Can be synthesized from tryptophan (60 mg tryptophan = 1 mg niacin) - so high-protein diet can prevent deficiency

Deficiency Disease: PELLAGRA

"The 4 D's of Pellagra"

Pellagra is classically seen in populations who eat maize (corn) as staple food - corn is low in niacin AND tryptophan

Dietary Sources:

• Meat, poultry, fish (richest sources)
• Groundnuts/peanuts (best plant source)
• Whole grains and cereals
• Legumes
• Liver and kidney
• Mushrooms

RDA:

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VITAMIN B5 - PANTOTHENIC ACID

Functions:

1. Coenzyme A (CoA) synthesis - essential component of CoA; needed for metabolism of carbohydrates, fats, and proteins
2. Steroid hormone synthesis
3. Acetylcholine synthesis
4. Wound healing - needed for synthesis of fatty acids in skin

Deficiency:

• Extremely rare (found in ALL foods - "pantothenic" = Greek for "everywhere")
• Burning feet syndrome - burning sensation in feet (seen in prisoners of war/starvation)
• Fatigue, headache, irritability

Dietary Sources:

• Widespread in almost all foods (meat, eggs, milk, legumes, whole grains, vegetables)
• Yeast, liver, kidney
• Avocado, sweet potato

RDA: 5 mg/day for adults

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VITAMIN B6 - PYRIDOXINE

Functions:

1. Amino acid metabolism - coenzyme (as PLP - pyridoxal phosphate) for transamination, decarboxylation reactions
2. Hemoglobin synthesis - needed for synthesis of heme (part of hemoglobin)
3. Neurotransmitter synthesis - synthesis of serotonin, dopamine, GABA, norepinephrine
4. Glycogen metabolism - glycogenolysis
5. Immune function
6. Reduces homocysteine (along with B12 and folate)

Deficiency:

• Peripheral neuropathy - numbness, tingling in hands and feet
• Microcytic hypochromic anemia (reduced Hb synthesis)
• Seborrheic dermatitis
• Cheilosis and glossitis (similar to B2 deficiency)
• Convulsions especially in infants
• PMS - B6 supplementation helps premenstrual syndrome

Drug interaction: Isoniazid (INH) used to treat TB is a Vit B6 antagonist → patients on INH must take B6 supplements to prevent neuropathy

Dietary Sources:

• Meat, fish, poultry (best sources)
• Potatoes and starchy vegetables
• Bananas (notable plant source)
• Legumes
• Whole grains
• Nuts

RDA:

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VITAMIN B7 - BIOTIN

Functions:

1. Carboxylation reactions - coenzyme for carboxylase enzymes in fatty acid synthesis, gluconeogenesis
2. Fatty acid synthesis - essential for making new fatty acids
3. Amino acid metabolism
4. Gene regulation - involved in gene expression

Deficiency:

• Rare in normal diet
• Dermatitis - scaly, red skin rash around eyes, nose, mouth
• Hair loss (alopecia)
• Conjunctivitis
• Neurological symptoms - depression, lethargy, hallucinations
• Caused by: Raw egg whites contain avidin (a protein that binds biotin and prevents its absorption) - eating large amounts of raw eggs causes biotin deficiency

Dietary Sources:

• Egg yolk (rich source - but raw egg WHITE blocks absorption)
• Liver and kidney
• Nuts (almonds, peanuts, walnuts)
• Legumes
• Mushrooms
• Produced by gut bacteria

RDA: 30 mcg/day for adults

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VITAMIN B9 - FOLIC ACID (FOLATE)

Functions:

1. DNA synthesis - essential for synthesis of purines and pyrimidines (DNA bases); needed for cell division
2. Red blood cell formation - required for maturation of RBCs in bone marrow
3. Prevention of neural tube defects - CRITICAL in early pregnancy for closure of neural tube (brain and spine development of fetus)
4. Reduces homocysteine - works with B12 and B6

Deficiency: MEGALOBLASTIC ANEMIA

CRITICAL NURSING POINT: Folic acid supplementation (5 mg/day) must begin BEFORE conception (at least 1 month before) and continue through 1st trimester to prevent neural tube defects

Dietary Sources:

• Green leafy vegetables (richest source - "folate" from "foliage")
• Legumes and pulses (dal, rajma, chana)
• Liver and kidney
• Yeast
• Fortified cereals
• Citrus fruits (orange, lemon)
• Asparagus, broccoli

RDA:

DFE = Dietary Folate Equivalent

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VITAMIN B12 - COBALAMIN (CYANOCOBALAMIN)

Chemical features:

• Only vitamin that contains a metal - Cobalt (Co) in its structure
• Only found in animal products (synthesized by bacteria)
• Stored in liver for 3-5 years (largest store of any water-soluble vitamin)
• Absorption requires Intrinsic Factor (IF) - a glycoprotein secreted by parietal cells of stomach

Functions:

1. Myelin sheath synthesis - maintains myelin sheath of nerves → nerve conduction
2. DNA synthesis - works with folate; needed for cell division
3. RBC maturation - essential for normal red blood cell formation
4. Metabolism of folate - activates folate (converts methyl-THF to THF)
5. Reduces homocysteine (cardiovascular protection)
6. Energy metabolism - methylmalonyl-CoA mutase reaction

Deficiency:

High-risk groups for B12 deficiency:

• Strict vegetarians/vegans (B12 only in animal foods)
• Elderly (reduced intrinsic factor)
• People after gastric surgery
• Patients on long-term Metformin (reduces B12 absorption)
• People on long-term Proton Pump Inhibitors (PPIs)

Dietary Sources:

• ONLY in animal products - meat, fish, eggs, dairy
• Liver (richest source)
• Shellfish (oysters, clams)
• Fish (tuna, salmon, sardines)
• Meat (beef, chicken)
• Milk and dairy products
• Eggs
• No plant sources (vegans must supplement)

RDA:

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VITAMIN C - ASCORBIC ACID

Functions:

1. Collagen synthesis - MOST IMPORTANT; hydroxylation of proline and lysine in collagen formation; needed for wound healing, skin, blood vessels
2. Antioxidant - powerful antioxidant; protects cells from oxidative damage
3. Iron absorption - converts non-heme Fe³⁺ to Fe²⁺ (ferrous form) → enhances absorption of plant-source iron by 3x
4. Immune function - stimulates WBC production and activity; "anti-cold vitamin"
5. Wound healing - collagen synthesis needed for tissue repair
6. Neurotransmitter synthesis - required for synthesis of norepinephrine, serotonin
7. Regenerates Vitamin E - reduces oxidized Vitamin E back to active form
8. Steroid hormone synthesis - adrenal glands are richest in Vit C; needed for cortisol synthesis

Deficiency Disease: SCURVY

Dietary Sources:

Important: Vitamin C is destroyed by heat, light, and prolonged cooking. Eat fruits and vegetables raw or lightly cooked.

RDA:

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⚡ MASTER REVISION TABLE - ALL VITAMINS

Fat-Soluble Vitamins:

Water-Soluble Vitamins:

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📝 PROBABLE EXAM QUESTIONS

1. Classify vitamins with examples.
2. What is the function of Vitamin A? Name its deficiency disease.
3. What is Rickets? What causes it and how can it be prevented?
4. Write a short note on Pellagra (4 D's).
5. What is Scurvy? List its signs and sources of Vitamin C.
6. Why is folic acid important in pregnancy?
7. What is Pernicious Anemia? Which vitamin deficiency causes it?
8. List fat-soluble vitamins and their RDA.
9. What are the functions of Vitamin K? Why is it given to newborns?
10. Differentiate between fat-soluble and water-soluble vitamins.

1. Classify vitamins. Describe fat-soluble vitamins - functions, dietary sources, deficiency diseases, and RDA.
2. Write a detailed note on water-soluble vitamins - B-complex and Vitamin C.
3. Describe Vitamin A - its functions, deficiency stages, sources, and RDA. Add a note on national supplementation programme.
4. Compare fat-soluble and water-soluble vitamins. Describe any two vitamins in detail.

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🔑 EXAM-READY MNEMONICS:

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📖 CHAPTER 6: MINERALS

Complete Revision Notes | BSc Nursing | ABVMU Lucknow

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INTRODUCTION TO MINERALS

• Minerals are inorganic elements (do NOT contain carbon)
• They make up about 4-5% of body weight (~2.8 kg in a 70 kg person)
• They provide NO energy (0 Kcal)
• They cannot be synthesized by the body - must come from diet
• They are NOT destroyed by heat or cooking (unlike vitamins)
• Required for structural, regulatory, and metabolic functions

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CLASSIFICATION OF MINERALS

Two Main Groups:

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PART A: MAJOR MINERALS

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1. CALCIUM (Ca)

Most abundant mineral in the body Body contains ~1000-1200g calcium; 99% in bones and teeth, 1% in blood and cells

Functions:

1. Bone and teeth formation - gives hardness and strength to skeletal system (with phosphorus as hydroxyapatite crystals)
2. Muscle contraction - Ca²⁺ triggers actin-myosin interaction → muscle contraction (including heart)
3. Nerve impulse transmission - calcium regulates nerve excitability
4. Blood clotting - Ca²⁺ is Factor IV in coagulation cascade; essential for clot formation
5. Enzyme activation - activates many enzymes (ATPase, phospholipase, etc.)
6. Cell signaling - second messenger in many hormone signaling pathways
7. Membrane permeability - regulates transport across cell membranes
8. Cardiac rhythm - maintains normal heartbeat

Absorption:

• Absorbed in small intestine (duodenum and jejunum)
• Vitamin D increases calcium absorption (most important factor)
• Factors that increase absorption: Vitamin D, Vitamin C, lactose, acidic pH, low calcium diet
• Factors that decrease absorption: Phytates (in cereals), oxalates (in spinach), excess fat, alkaline pH, deficiency of Vit D

Deficiency:

Trousseau's sign: Carpal spasm on inflating BP cuff Chvostek's sign: Facial muscle twitch on tapping facial nerve

Dietary Sources:

RDA:

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2. PHOSPHORUS (P)

Second most abundant mineral in body Body contains ~600-700g; 85% in bones and teeth (as hydroxyapatite), 15% in soft tissues and blood

Functions:

1. Bone and teeth formation - combines with calcium as hydroxyapatite [Ca₁₀(PO₄)₆(OH)₂]
2. Energy metabolism - component of ATP (adenosine triphosphate) - the universal energy currency
3. DNA and RNA structure - phosphate forms the backbone of nucleic acids
4. Cell membranes - component of phospholipids (phosphatidylcholine, etc.)
5. Acid-base balance - phosphate buffer system in blood and urine
6. Enzyme activation - phosphorylation activates/deactivates enzymes
7. B vitamin function - B vitamins need phosphorylation to become active coenzymes

Deficiency: Hypophosphatemia

• Rare (found in most foods)
• Muscle weakness, bone pain
• Hemolytic anemia
• Rickets (phosphopenic rickets) in children
• Seen in: prolonged antacid use (aluminum antacids bind phosphorus), alcoholism, premature infants

Dietary Sources:

• Meat, fish, poultry (richest sources)
• Milk and dairy products
• Eggs
• Whole grains and cereals
• Legumes and nuts
• Almost all protein-rich foods contain phosphorus

RDA:

Calcium:Phosphorus ratio in diet should be 1:1 to 2:1

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3. SODIUM (Na)

Main cation (positive ion) of EXTRACELLULAR fluid Normal serum sodium: 135-145 mEq/L

Functions:

1. Fluid balance - chief determinant of extracellular fluid volume (osmolality); where sodium goes, water follows
2. Nerve impulse transmission - sodium influx creates action potential in nerves
3. Muscle contraction - sodium-potassium pump maintains membrane potential for muscle contraction
4. Acid-base balance - sodium bicarbonate (NaHCO₃) is a major buffer in blood
5. Nutrient absorption - sodium-dependent glucose and amino acid transport in intestine
6. Blood pressure regulation - sodium retention increases blood pressure

Deficiency: Hyponatremia (Na < 135 mEq/L)

• Nausea, headache, confusion
• Muscle cramps, weakness
• Seizures and coma (severe)
• Causes: excessive sweating, vomiting, diarrhea, excess water intake, Addison's disease

Excess: Hypernatremia

• Causes hypertension (high blood pressure)
• Edema
• Increased risk of heart disease, stroke, kidney disease
• WHO recommends: < 5g salt/day (= < 2g sodium/day)

Dietary Sources:

RDA:

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4. POTASSIUM (K)

Main cation of INTRACELLULAR fluid Normal serum potassium: 3.5-5.0 mEq/L Body contains ~150g; 98% inside cells

Functions:

1. Fluid balance - chief intracellular cation; works opposite to sodium
2. Nerve impulse transmission - K⁺ efflux repolarizes the nerve membrane after action potential
3. Muscle contraction - including heart muscle (cardiac function)
4. Blood pressure - LOWERS blood pressure (opposes sodium); high-potassium diet is cardioprotective
5. Acid-base balance - K⁺ shifts in/out of cells in exchange for H⁺
6. Glycogen synthesis - needed for glycogen storage in liver and muscle
7. Enzyme activation - activates Na⁺/K⁺ ATPase pump

Deficiency: Hypokalemia (K < 3.5 mEq/L)

Causes: vomiting, diarrhea, diuretic use (especially furosemide), poor diet

Excess: Hyperkalemia (K > 5.0 mEq/L)

• Cardiac arrhythmias → peaked T waves on ECG → ventricular fibrillation → fatal
• Muscle weakness

Dietary Sources:

RDA:

Sodium vs Potassium - Key difference:

• Sodium (Na) = extracellular, raises BP
• Potassium (K) = intracellular, lowers BP
• They work in opposition via the Na⁺/K⁺ ATPase pump

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5. MAGNESIUM (Mg)

Body contains ~25g magnesium 60% in bones, 39% in cells, 1% in blood Normal serum magnesium: 1.5-2.5 mEq/L

Functions:

1. Enzyme cofactor - cofactor for over 300 enzymes including ATP-related enzymes (most important function)
2. Energy metabolism - ATP is active as Mg-ATP complex; needed for glycolysis, Krebs cycle
3. Protein synthesis - required for ribosome function and protein synthesis
4. Bone formation - part of bone mineral structure
5. Nerve and muscle function - regulates calcium entry into cells; acts as natural calcium channel blocker
6. DNA/RNA synthesis - needed for nucleic acid synthesis
7. Heart rhythm - maintains normal cardiac rhythm
8. Blood pressure - helps relax blood vessels (vasodilator)

Deficiency: Hypomagnesemia

• Tremors and muscle spasms
• Cardiac arrhythmias (atrial and ventricular)
• Hypertension
• Weakness, fatigue
• Tetany (similar to hypocalcemia)
• Confusion, depression, anxiety
• Causes: alcoholism, diabetes, diuretics, malabsorption, poor diet

Dietary Sources:

• Green leafy vegetables (chlorophyll contains Mg in its center - like Hb has Fe)
• Nuts (almonds, cashews - richest sources)
• Seeds (pumpkin seeds, sunflower seeds)
• Whole grains (brown rice, oats, wheat bran)
• Legumes (black beans, lentils)
• Dark chocolate
• Fish (mackerel, tuna)
• Banana, avocado

RDA:

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PART B: TRACE ELEMENTS

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6. IRON (Fe)

Most studied trace mineral Body contains ~3-5g iron; 70% in hemoglobin, 10% in myoglobin, 20% stored as ferritin/hemosiderin

Forms of Iron in Food:

Functions:

1. Oxygen transport - component of hemoglobin (Fe in heme group carries O₂ in RBCs)
2. Muscle oxygen storage - component of myoglobin (O₂ storage in muscles)
3. Energy production - component of cytochromes (electron transport chain)
4. Enzyme function - component of catalase, peroxidase enzymes
5. Immunity - required for immune cell function
6. Brain development - critical for myelination and cognitive function in infants/children

Deficiency: IRON DEFICIENCY ANEMIA (IDA)

Most common nutritional deficiency worldwide

• Pallor (skin, conjunctiva, palms, nails)
• Fatigue, weakness
• Koilonychia (spoon-shaped nails)
• Angular stomatitis, glossitis
• Pica (craving for non-food items - mud, chalk, ice)
• Breathlessness on exertion
• Poor concentration, cognitive impairment
• In children: growth retardation, poor school performance

Dietary Sources:

RDA:

National program: IFA (Iron-Folic Acid) tablets given free to pregnant women and adolescent girls in India

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7. IODINE (I)

Body contains only ~20-25mg iodine 70-80% in thyroid gland

Functions:

1. Thyroid hormone synthesis - ONLY known function; iodine is essential component of T3 (triiodothyronine) and T4 (thyroxine)
2. Thyroid hormones regulate:
   • Basal metabolic rate (BMR)
   • Growth and development (especially brain)
   • Protein synthesis
   • Temperature regulation

Deficiency: Iodine Deficiency Disorders (IDD)

Cretinism is the most devastating consequence - irreversible brain damage if iodine deficient in 1st trimester Prevention: Universal Salt Iodization (USI) - use of iodized salt is the most cost-effective strategy

Dietary Sources:

Goitrogens - substances that interfere with iodine uptake by thyroid:

• Cabbage, cauliflower, broccoli, turnip, cassava
• Soybean (raw), bajra
• Inactivated by cooking

RDA:

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8. ZINC (Zn)

Body contains ~2-3g zinc; mainly in muscles, bones, skin, liver, prostate

Functions:

1. Wound healing - essential for collagen synthesis and cell proliferation
2. Immune function - needed for T-lymphocyte development and function
3. Growth and development - essential for protein synthesis and cell division
4. Taste and smell - component of gustin (carbonic anhydrase VI) needed for taste
5. Reproductive function - essential for testosterone production; male fertility
6. Enzyme cofactor - component of >200 enzymes (carbonic anhydrase, alkaline phosphatase, etc.)
7. Antioxidant - component of SOD (superoxide dismutase)
8. Insulin storage - zinc ions stabilize insulin crystals in pancreas
9. Vitamin A metabolism - needed to mobilize Vitamin A from liver

Deficiency:

Dietary Sources:

• Oysters (richest source)
• Red meat (beef, mutton, liver)
• Poultry
• Shellfish
• Legumes and pulses
• Nuts and seeds (pumpkin seeds)
• Whole grains

RDA:

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9. FLUORIDE (F)

Functions:

1. Tooth enamel hardening - fluorapatite replaces hydroxyapatite → enamel is harder and more resistant to acid
2. Dental caries prevention - inhibits bacterial enzymes; promotes remineralization of enamel
3. Bone strength - contributes to bone mineral density

Deficiency:

• Dental caries (tooth decay) - most common consequence

Excess: FLUOROSIS

Endemic fluorosis in India: Rajasthan, Gujarat, Andhra Pradesh (high fluoride in groundwater) Optimal fluoride in water: 0.5-1.0 mg/L (for caries prevention without fluorosis)

Dietary Sources:

• Fluoridated drinking water (main source)
• Tea (especially black tea)
• Seafood and marine fish
• Naturally fluoridated well water

RDA:

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10. COPPER (Cu)

Functions:

1. Hemoglobin synthesis - copper enzyme (ferroxidase) oxidizes Fe²⁺ → Fe³⁺ needed for transferrin loading
2. Enzyme component - cytochrome c oxidase (energy), superoxide dismutase (antioxidant), dopamine beta-hydroxylase
3. Collagen and elastin synthesis - lysyl oxidase (copper enzyme) cross-links collagen
4. Melanin production - tyrosinase (copper enzyme) makes melanin pigment
5. Myelination - needed for myelin sheath formation

Deficiency:

• Menkes disease (genetic copper deficiency): kinky hair, neurodegeneration, connective tissue defects in infants
• Microcytic anemia (despite adequate iron)
• Bone fragility
• Loss of hair/skin pigmentation

Wilson's Disease: Copper excess (genetic) - copper accumulates in liver, brain, kidneys → Kayser-Fleischer rings in cornea

Dietary Sources:

• Liver and organ meats (richest)
• Shellfish (oysters)
• Nuts and seeds
• Legumes
• Whole grains
• Dark chocolate

RDA: 900 mcg (0.9 mg)/day for adults

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11. SELENIUM (Se)

Functions:

1. Antioxidant - component of glutathione peroxidase (GPx) - protects cells from oxidative damage
2. Thyroid function - deiodinase enzymes (convert T4 → active T3) require selenium
3. Immune function
4. Antiviral properties
5. Reproduction - needed for sperm motility

Deficiency:

• Keshan Disease - cardiomyopathy (heart muscle disease); seen in selenium-deficient areas of China
• Kashin-Beck disease - osteoarthropathy (joint disease)
• Impaired immune function

Dietary Sources:

• Brazil nuts (richest single food source; 1-2 nuts provides daily requirement)
• Seafood and fish
• Meat and poultry
• Eggs
• Cereals (selenium content depends on soil)

RDA: 55 mcg/day for adults

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⚡ MASTER REVISION TABLE - ALL MINERALS

Major Minerals:

Trace Elements:

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KEY COMPARISONS FOR EXAM

Sodium vs Potassium:

Calcium vs Phosphorus:

Iron deficiency vs Iodine deficiency:

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📝 PROBABLE EXAM QUESTIONS

1. Define minerals. Classify with examples.
2. What are the functions of calcium? What is its RDA?
3. What is iron deficiency anemia? List its signs and symptoms.
4. What is goiter? Which mineral deficiency causes it?
5. Differentiate between major minerals and trace elements.
6. What are the functions of sodium and potassium? Name their dietary sources.
7. What is the role of fluoride in the body? What happens in excess?
8. List the functions of zinc with dietary sources.

1. Classify minerals. Describe major minerals - functions, dietary sources, and RDA (with special focus on calcium and iron).
2. Write a detailed note on iron - functions, types, absorption, deficiency disease, sources, and RDA.
3. Describe trace elements - iodine, zinc, fluoride with functions, deficiency diseases, sources, and RDA.
4. Compare and contrast calcium and phosphorus - composition, functions, sources, and RDA.

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🔑 EXAM MNEMONICS:

"Can People Not Keep Making Clever Songs"

Fat needs bile → bile needs calcium → remember ADEK with Ca

Liver, Meat, Fish, Eggs, Spinach

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📌 Exam tomorrow note: Your syllabus specifies the 5 major minerals (Ca, P, Na, K, Mg) by name, so focus especially on those. Know at least 3-4 trace elements (Iron, Iodine, Zinc, Fluoride) in detail.

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📖 CHAPTER 7: THERAPEUTIC DIETS

Complete Revision Notes | BSc Nursing | ABVMU Lucknow

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SECTION A: INTRODUCTION

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1. DEFINITION OF THERAPEUTIC DIET

A therapeutic diet (also called a modified diet or medical nutrition therapy) is a diet that is modified in one or more nutrients, consistency, texture, or method of feeding to treat a specific disease or medical condition.

• It is a planned diet prescribed by a doctor/dietitian
• It is an integral part of medical treatment
• Also called: Hospital diet, Special diet, Clinical diet, Diet therapy

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2. OBJECTIVES OF THERAPEUTIC DIET

1. To maintain or restore good nutritional status of the patient
2. To correct nutritional deficiencies resulting from disease
3. To provide rest to a diseased organ (e.g., low-fat diet for liver disease)
4. To adjust the diet to the body's ability to digest, absorb, and metabolize
5. To eliminate specific foods that may be harmful (e.g., gluten in celiac disease)
6. To control intake of specific nutrients (e.g., restrict sodium in hypertension)
7. To achieve and maintain ideal body weight
8. To aid recovery and promote healing after surgery or illness
9. To prevent complications of existing diseases
10. To improve quality of life of patients with chronic diseases

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3. PRINCIPLES OF THERAPEUTIC DIET

1. Adequacy - must provide all essential nutrients in adequate amounts
2. Balance - proper proportion of all nutrients
3. Calorie control - adjust calories as per disease requirement
4. Nutrient density - choose foods high in nutrients relative to calories
5. Moderation - avoid excess of any nutrient
6. Individual needs - consider age, sex, weight, disease, activity level, food preferences, cultural/religious habits
7. Economy - should be affordable
8. Palatability - must be acceptable to the patient (taste, texture, temperature)
9. Safety - must be free from harmful substances
10. Based on normal diet - therapeutic diet is a modification of normal diet, not a totally different one

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SECTION B: MODIFICATIONS IN THERAPEUTIC DIETS

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4. MODIFICATIONS

A. CONSISTENCY MODIFICATIONS:

B. NUTRIENT MODIFICATIONS:

C. FEEDING TECHNIQUES:

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SECTION C: DIET IN SPECIFIC DISEASES

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5. DIET IN OBESITY

Diet Goals:

• Create a calorie deficit of 500-1000 Kcal/day → weight loss of 0.5-1 kg/week
• Target: 5-10% reduction in body weight initially

Dietary Recommendations:

Foods to AVOID:

• Sugary drinks, colas, fruit juices
• Fried foods (samosa, chips, poori)
• Sweets, mithai, cakes, biscuits
• Refined foods (maida products)
• Full-fat dairy, fatty meat
• Alcohol

Foods to ENCOURAGE:

• Fruits and vegetables (low calorie, high fiber)
• Whole grains (brown rice, oats, whole wheat)
• Lean proteins (dal, low-fat dairy, fish, chicken)
• Salads, soups (without cream)
• Sprouts

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6. DIET IN DIABETES MELLITUS (DM)

• Type 1 DM - insulin deficient; autoimmune
• Type 2 DM - insulin resistant; lifestyle-related (most common)

Goals of Diet in DM:

1. Maintain near-normal blood glucose levels
2. Achieve/maintain ideal body weight
3. Prevent complications (cardiovascular, renal, eye disease)
4. Maintain normal lipid levels

Dietary Recommendations:

Glycemic Index (GI):

Foods to AVOID:

• Sugar, sweets, mithai, honey, jaggery
• White rice (in excess), maida products
• Fruit juices, cold drinks
• Fried foods
• High-fat dairy

Foods to ENCOURAGE:

• Bitter gourd (karela) - natural blood sugar lowering
• Fenugreek (methi) seeds - reduces blood sugar
• High-fiber vegetables (leafy greens, brinjal, lady finger/bhindi)
• Whole grains, oats, barley
• Dal and pulses (low GI, high fiber and protein)
• Small frequent meals

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7. DIET IN CARDIOVASCULAR DISEASE (CVD)

Goals:

• Reduce LDL cholesterol
• Raise HDL cholesterol
• Lower blood pressure
• Reduce body weight
• Prevent thrombosis

Dietary Recommendations (Heart-Healthy Diet / DASH Diet):

DASH Diet (Dietary Approaches to Stop Hypertension):

• High in: Fruits, vegetables, whole grains, low-fat dairy, nuts
• Low in: Sodium, saturated fat, red meat, sweets
• Most evidence-based diet for hypertension and CVD

Foods to AVOID:

• Fried foods (chips, pakoras, french fries)
• Red meat, organ meats
• Full-fat dairy (butter, cream, ghee in excess)
• Vanaspati, trans fats
• High-sodium foods (pickles, papad, processed foods)
• Sugary drinks and sweets

Foods to ENCOURAGE:

• Fatty fish (salmon, mackerel, sardines - omega-3)
• Oats (beta-glucan fiber lowers LDL)
• Garlic (lowers blood pressure)
• Nuts (walnuts, almonds - MUFA, omega-3)
• Green leafy vegetables
• Fruits (especially berries, citrus)

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8. DIET IN UNDERWEIGHT

Goals:

• Achieve healthy weight gain of 0.5-1 kg/week
• Build lean muscle mass, not just fat

Dietary Recommendations:

Foods to ENCOURAGE:

• Full-fat milk, curd, paneer
• Nuts and seeds (almonds, cashews, peanuts)
• Dried fruits (dates, raisins, figs)
• Ghee, peanut butter
• Banana, mango, avocado
• Whole grains, khichdi, dalia
• Eggs, chicken, fish
• Protein shakes (if needed)

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9. DIET IN RENAL DISEASES

• Chronic Kidney Disease (CKD)
• Nephrotic Syndrome
• Nephrolithiasis (Kidney stones)

A. DIET IN CHRONIC KIDNEY DISEASE (CKD):

High Potassium Foods to AVOID in CKD:

High Phosphorus Foods to AVOID in CKD:

B. DIET IN NEPHROTIC SYNDROME:

• High protein (1.0-1.5 g/kg/day) - to replace urinary protein losses
• Low sodium - controls edema
• Low fat - often have hyperlipidemia
• Adequate calories

C. DIET IN KIDNEY STONES (Nephrolithiasis):

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10. DIET IN HEPATIC (LIVER) DISEASES

A. DIET IN HEPATITIS (Acute Liver Disease):

B. DIET IN LIVER CIRRHOSIS:

C. DIET IN HEPATIC ENCEPHALOPATHY:

Key principle: Ammonia from protein metabolism → hepatic encephalopathy → restrict protein

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11. DIET IN CONSTIPATION

Dietary Recommendations (HIGH FIBER, HIGH FLUID DIET):

Types of Fiber for Constipation:

• Insoluble fiber (most helpful) - wheat bran, whole grains, vegetable skins - adds bulk to stool
• Soluble fiber - oats, fruits, psyllium - softens stool

Foods to ENCOURAGE:

• Whole wheat bread, brown rice, oats, whole grain cereals
• Fruits with skin (apple, pear, guava, papaya)
• Vegetables (especially leafy greens, beans, broccoli)
• Isabgol (psyllium husk) - excellent natural laxative
• Prunes, figs, dates (natural laxatives)
• Plenty of water and fluids
• Warm water in the morning (stimulates bowel)

Foods to AVOID:

• Refined/processed foods (maida, white rice, white bread)
• Cheese and dairy (binding)
• Red meat
• Insufficient fluids

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12. DIET IN DIARRHEA

Immediate Priority: REHYDRATION

ORS (Oral Rehydration Solution):

• Salt (NaCl): 3.5 g
• Sugar (glucose): 20 g
• Potassium chloride: 1.5 g
• Sodium bicarbonate: 2.5 g
• Water: 1 litre Or WHO ORS packet dissolved in 1L water

Dietary Recommendations:

BRAT Diet (for acute diarrhea):

Banana - Rice - Apple (sauce) - Toast

• Easy to digest
• Binding foods (firm up stool)
• Banana: replaces potassium lost in diarrhea

Foods to AVOID:

• Spicy, oily, fried foods
• Raw vegetables and fruits with skin
• High-fiber foods (during acute phase)
• Dairy (lactose intolerance may develop temporarily)
• Caffeine, alcohol
• Very cold or very hot foods

Foods to ENCOURAGE:

• ORS, coconut water, rice water (kanji)
• Banana, boiled potato, plain rice
• Plain boiled dal (khichdi)
• Toast, plain biscuits
• Curd/yogurt (probiotics help restore gut flora)
• Boiled or steamed vegetables

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13. PRE-OPERATIVE AND POST-OPERATIVE DIET

A. PRE-OPERATIVE DIET (Before Surgery):

• Correct anemia (iron, folic acid, B12)
• Ensure adequate protein (for wound healing)
• Correct vitamin deficiencies
• Adequate hydration
• Control blood sugar (in diabetics)

B. POST-OPERATIVE DIET (After Surgery):

Nursing point: Post-surgical patients are in a catabolic state - their metabolism is raised by 20-50%. Adequate nutrition is essential to prevent muscle wasting and ensure recovery.

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⚡ QUICK REVISION TABLE - ALL DISEASES

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📝 PROBABLE EXAM QUESTIONS

1. Define therapeutic diet. What are its objectives?
2. What is the diet recommended for a diabetic patient?
3. Describe the post-operative diet progression.
4. What is ORS? Give its composition.
5. What dietary modifications are made in constipation?
6. What is BRAT diet? When is it used?
7. What are the feeding techniques used in clinical settings?
8. Describe the diet in liver disease/hepatitis.
9. What dietary restrictions are made in chronic kidney disease?
10. What is DASH diet? When is it used?

1. Define therapeutic diet. Explain its objectives, principles, and modifications.
2. Describe the diet in diabetes mellitus - goals, modifications, foods to avoid and encourage.
3. Write a detailed note on diet in liver diseases (hepatitis, cirrhosis, encephalopathy).
4. Describe the diet in cardiovascular disease. What is the DASH diet?
5. Explain pre-operative and post-operative diet management in detail.
6. Describe therapeutic diets for constipation and diarrhea.

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🔑 NURSES' ROLE IN THERAPEUTIC DIETS:

1. Assess patient's nutritional status and dietary habits
2. Plan and implement dietary modifications as prescribed
3. Educate patient and family about diet therapy
4. Monitor patient's response to dietary changes
5. Ensure meals are served correctly (right diet to right patient)
6. Document food intake and report poor intake
7. Motivate patient to follow dietary restrictions
8. Coordinate with dietitian for specialized diet planning

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🎯 This is one of the most important chapters for your exam - almost guaranteed to have at least one long answer question on it. Focus especially on: Diabetes diet, CVD diet, Pre/Post-op diet, and Diarrhea/Constipation diet.