Care and Cure: Balanced diet

Definition:

“A balanced diet is one which contains different types of foods in such quantities and proportions that the need for energy, amino acids, vitamins, minerals, fats, carbohydrates, and other nutrients are adequately met for maintaining health, vitality and general well-being and also makes a small provision for extra nutrients to withstand short duration of leanness.”

Percentage of food items in balanced diet:

Carbohydrate	50-70%
Fat	20-30%
protein	15-20%

Criteria of a balanced diet:

I) easily available

Ii) Sufficient to satisfy taste and appetite.

iii) Diet should be palatable.

iv) It should be easily digestable, absorbable and assimilable.

v) Protein and fat should be obtained both from animal and vegetable sources. At least one third of the protein and fat should be of animal in origin.

vi) It should contain sufficient vegetables and fruits.

vii) Vitamins and minerals should be present in sufficient quantity.

viii) Certain amount of cellulose or roughage should be present to promote peristalsis.

Diet of a pregnant mother:

l i) Energy Intake: An additional minimum intake of 200 Kcal/day during the second and third trimesters.

l ii) Proteins: An additional allowance of 14g/day of dietary protein.

l iii) Other nutrients: A regular and adequate intake of all other nutrients, especially iron, folic acid and calcium. s

Additional allowance for pregnant mother:

Food item	Amount	Calories(Kcal)
Cereals	35g	118
Pulses	15g	52
Milk	100g	83
Sugar	10g	40

Major Malnutrition problems in Bangladesh:

1. Protein- energy malnutrition- Kwashiorkor and marasmas.

2. Vit. A deficiency- Night blindness, xerophthalmia and total blindness.

3. Iron deficiency- Anemia.

4. Iodine deficiency – Endemic goiter.

5. Khesari dhal intoxication- Neurolathyrism.

Protein-Energy malnutrition (PEM)

Protein-energy malnutrition (PEM) in early childhood is a spectrum of disease. At one end there is kwashiorkor, at the other end is nutritional marasmus and in the middle of the spectrum is marasmic kwashiorkor.

Etiological factors of PEM

i) An inadequate diet, both in quantity and

Quality.

ii) Infectious and parasitic diseases,

notably diarrhoea, respiratory, infections, measles and the spectrum is marasmic kwashiorkor.

iii) Poor maternal health.

iv) Large family size.

v) Poor maternal health.

WHO classification of PEM in young children:

	Body weight	odema	Deficit in weight for height
Kwashiorkor	60-80	+	+
Marasmic kwashiorkor	<60	+	++
Marasmus	<60	0	++
Nutritional dwarfing	<60	0	Minimal
Underweight child	60-80	0	+

Welcome classifications

Weight for age	With oedema	Without oedema
60-80%	Kwashiorkor	Undernutrition
< 60%	Marasmic Kwashiorkor	Marasmus

Management of PEM

Severe PEM whether kwashiorkor or marasmus, is dealt with in three phase:

1. Resuscitation –It includes correction of

- Dehydration

- Electrolyte disturbances

- Acidosis

- Hypoglycemia and

- Treatment of infection.

Marasmus

Kwarshiorkor

• Difference Between Maramus and Kwashirkor

Features	Marasmus	Kwashiorkor
Cause	Due to deficiency of calories and other nutrients in addition to protein.	Due to protein deficiency
Essential features Oedema Mental changes. Wasting	Absent Marked, all skin and bone. Usually absent	Present in the lower legs, sometimes face for generalized. Less obvious, child looks flabby.
Variables features: 1. Appetite 2. skin changes 3. hair changes	Usually good Usually none Slight change in texure.	Usually poor Often, diffuse depigmentation. Often sparse – straight and sky, Dyspigmentation-greyish or reddish