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Balanced Diet - Treatment and Prevention of Nutritional Disorders

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Nutrition is the intake of food according to the body’s requirements and is essential for growth, immunity, and overall health.

  • balanced diet
  • nutrition
  • nutritional disorders
  • dietary management
  • health promotion

By Dr. Ayesha Fatima

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  1. Slide 1. BALANCED DIET Dr AYESHA FATIMA Pharm D Assistant Professor Dept Of Pharmacy Practice
  2. Slide 3. • Nutrition refers to the intake of food in relation to the body’s dietary requirements. • Good nutrition involves consuming an adequate, well-balanced diet along with regular physical activity. It is the cornerstone of good health. • Poor nutrition can: Weaken immunity , Increase susceptibility to diseases , Impair physical and mental growth and Reduce productivity • Balanced diet should provide adequate energy + essential nutrients to maintain health and normal body functions. • A well-balanced diet helps maintain overall health and optimal body function. • A Balanced Diet is defined as a diet that contains appropriate proportions of macronutrients and micronutrients required for normal growth, maintenance, and daily activities.
  3. Slide 4. WHO Composition of a Balanced Diet Balanced diet is the diet that contains the required number of calories, vitamins and minerals that are essential to keep a person healthy. A balanced diet is a mix of Carbohydrates (50%), Fats (32%), Proteins (12%), Minerals and Vitamins (3%) and sufficient water COMPOSITION OF A BALANCED DIET • A balanced diet should include: 1. Carbohydrates – 50% (primary energy source) 2. Fats – 30–32% (energy storage, cell structure) 3. Proteins – 10–12% (growth and repair) 4. Vitamins & Minerals – ~3% (regulatory functions) 5. Water – essential for all physiological processes 6. Fruits & vegetables: ≥ 400 g/day 7. Free sugars: < 10% of total energy 8. Salt: < 5 g/day
  4. Slide 5. OBJECTIVES OF A BALANCED DIET A balanced diet aims to: 1. Maintain good health and well-being 2. Provide sufficient energy for daily activities 3. Support growth, repair, and maintenance of body tissues 4. Enhance immunity and disease resistance
  5. Slide 6. WHO provides the following dietary guidelines: 1. Maintain energy balance: Consume calories appropriate to energy expenditure to maintain a healthy body weight 2. Increase plant-based foods : Eat more fruits, vegetables, legumes, whole grains, and nuts 3. Limit unhealthy fats 1. Avoid saturated fats (e.g., animal fats, coconut oil) 2. Prefer unsaturated fats (plant-based oils) 3. Eliminate trans fats 4. Reduce sugar intake: Limit consumption of added sugars 5. Limit salt intake 1. Reduce sodium consumption 2. Use iodized salt Other Important Dietary Recommendations 1. Include protein-rich foods such as fish, meat, eggs, or plant-based sources like soybeans 2. Even vegetarians can obtain all essential amino acids by combining cereals and pulses (e.g., rice + dal) 3. Foods like avocado and pumpkin seeds also provide a good amino acid profile 4. Ensure adequate intake of micronutrients (vitamins and minerals) through a diverse diet 5. Maintain proper hydration RECOMMENDATIONS BY World Health Organization (WHO)
  6. Slide 7. NUTRITION DEFICIENCY DISORDERS Nutritional deficiency disorders arise due to inadequate intake or absorption of essential nutrients such as macronutrients (proteins, fats, carbohydrates) and micronutrients (vitamins and minerals). They can be broadly classified as follows:
  7. Slide 8. Category Nutrient Deficiency Disorder Sign and symptom Protein–Energy Malnutrition Protein & Calories Kwashiorkor Edema, fatty liver, growth retardation Marasmus Severe wasting, muscle loss, no edema Severe early malnutrition Mental Retardation Impaired brain development Mineral Deficiency Calcium Osteoporosis Weak bones, fractures Rickets Bone deformities in children Tetany Muscle spasms, cramps Iodine Goiter Enlargement of thyroid gland Iron Iron Deficiency Anemia Fatigue, pallor, weakness
  8. Slide 9. Vitamin Deficienc y Vitamin A Night blindness, Xerophthalmia Vision problems, dryness of eyes Thiamine Vit B1 Beriberi Neurological & cardiovascular symptoms Riboflavin Vit B2 Ariboflavinosis Cheilosis, glossitis, dermatitis Niacin Vit B3 Pellagra Dermatitis, diarrhea, dementia Pantothenic acid Vit B5 Rare deficiency Paresthesia, fatigue Pyridoxine Vit B6 Anemia, neuropathy Dermatitis, depression Biotin Rare deficiency Neurological symptoms, hair loss Folic acid Megaloblastic anemia Macrocytic anemia Cobalamin Vit B12 Pernicious anemia Neuropathy, memory loss Vitamin C Scurvy Bleeding gums, poor healing Vitamin D Rickets / Osteomalacia Weak or soft bones Vitamin E Neuropathy, hemolysis Muscle weakness, anemia Vitamin K Bleeding disorders Hemorrhage, delayed clotting
  9. Slide 10. Protein Deficiency Disorders Kwashiorkar • "Kwashiorkar" was first identified by a Jamaican pediatrician Dr. Cicely Williams in young children as an acute form of protein-energy malnutrition characterized by edema, irritability, anorexia, ulcerating dermatoses and an enlarged liver with fatty infiltrates. • This situation develops in young children when the mother replaces the breast milk which is rich in proteins and vital amino acids with diet rich in carbohydrates. • As a result of insufficient protein consumption, but with sufficient calorie intake, kwashiorkor develops. Kwashiorkor cases are often seen in areas of poor food supply.
  10. Slide 11. Signs and symptoms: The signs and symptoms of Kwashiorkar are • Victims of Kwashiorkor fail to produce antibodies following vaccination against diseases, including diphtheria and typhoid. • Generally, the disease can be treated by adding protein to the diet; however, it can have a long-term impact on a child's physical and mental development, and in severe cases this may lead to death. • Management : The children affected with Kwashiorkar should be fed with dietary protein gradually 1. Typical ulcerating dermatosis 2. Pedal edema (swelling of the feet) 3. Distended abdomen 4. An enlarged liver with fatty infiltrates, 5. Thinning hair 6. Loss of teeth, 7. Skin depigmentation and dermatitis. 8. Irritability 9. Anorexia.
  11. Slide 12. Marasmus • The word "Marasmus" comes from the Greek marasmos ("decay") and is defined as the gradual wasting away of the body due to severe malnutrition or inadequate absorption of food. • Marasmus is a form of severe protein deficiency and is one of the forms of protein-energy malfunction (PEM). • The children with marasmus look emaciated and body weight may be reduced to less than 80% of the average weight that corresponds to the height. • Marasmus is often seen prior to one year of age, whereas kwashiorkor is seen after 18 months of age. • Marasmus can be distinguished from kwashiorkor through symptoms of protein wasting with the presence of edema. • The prognosis is better than the kwashiorkor disease. • Causes: Marasmus is caused by a severe deficiency of nearly all nutrients, especially protein and carbohydrates.
  12. Slide 13. Signs and symptoms: The malnutrition associated with marasmus leads to extensive tissue and muscle wasting, as well as variable edema. Other common signs and symptoms include 1. Dry skin, 2. Loose skin folds hanging over the buttocks (glutei) and arm pit (axillae) etc. 3. Drastic loss of adipose tissue from normal areas of fat deposits like buttocks and thighs. 4. Fretful, Irritable, and voraciously hungry. Treatment: It is necessary to treat not only the symptoms but also the complications of the disorder, including infections, dehydration, and circulation disorders, which are frequently lethal and lead to high mortality if ignored.
  13. Slide 15. Cachexia (wasting syndrome) 1. Cachexia is defined as a state of weight loss, muscle atrophy, fatigue, weakness, and significant loss of appetite due to some pathological involvement. 2. Cachexia physically weakens the patients to a state of immobility starting from loss of appetite, asthenia, and anemia. 3. The patients with Cachexia will respond poorly to standard treatment. 4. Cachexia is seen in patients with cancer, AIDS, chronic obstructive lung disease, multiple sclerosis, congestive heart failure, tuberculosis, familial amyloid polyneuropathy, mercury poisoning (acrodynia) and hormonal deficiency. 5. Cachexia is considered as a positive risk factor for death. 6. Treatment: Currently, no FDA-approved drugs are available to treat Cachexia. Cachexia may be treated by steroids, such as corticosteroids, or drugs that mimic progesterone, which increase appetite, may reverse weight loss, but have no evidence of reversing muscle loss.
  14. Slide 16. Vitamin Deficiency Disorders • Vitamins are organic components in food that are needed in very small amounts for growth and maintaining of good health. • First time the term "Vitamin" was coined in 1912 by the polish bio chemist Kazimierz Funk. • All vitamins are classified in to 1) Fat soluble vitamins e.g., A, D, E and K. 2) Water soluble vitamins e.g., B-Complex and Vitamin C. Functions of Vitamins • Vitamins have diverse biochemical functions such as 1 . Hormone-in regulating mineral metabolism e.g., vitamin D 2. Regulator of cell and tissue growth and differentiation (e.g., some forms of vitamin A) 3. Antioxidants (e.g., vitamin E and sometimes vitamin C) 4. Precursors for enzyme cofactors that help enzymes in their work as catalysts in metabolism e.g., Vitamin B Complex.
  15. Slide 17. Vitamin A Deficiency Disorder • Vitamin A deficiency is lack of vitamin A in the human body. • Night blindness is the first sign of vitamin A deficiency. • Vitamin A play a major role in phototransduction and its deficiency may result in xerophthalmia, keratomalacia, and complete blindness. • Every year approximately 2-5 lakh children from developing countries are suffering from Vitamin A deficiency and half of them die within a year due to blindness. • Prevalence of night blindness due to vitamin A deficiency is also high among pregnant women in many developing countries. 1. Gene transcription 2. Immune function 3. Embryonic development and reproduction 4. Bone metabolism Functions of Vitamin A
  16. Slide 18. Signs and Symptoms Vitamin A deficiency may cause 1. Night blindness, 2. Xerophthalmia, 3. Keratomalacia 4. Complete blindness 5. Impaired immune function 6. Birth defects Causes Vitamin A Deficiency 1. Lactating mother with vitamin A deficiency contains little vitamin A, which provides a breast-fed child with too little vitamin A. 2. Iron deficiency can affect vitamin A uptake. 3. Excess alcohol consumption can deplete vitamin A
  17. Slide 19. • Management: Deficiency of Vitamin A can be achieved by eating vitamin A rich foods and external supplementation of Vitamin A preparations. • Vitamin A Supplementation: The average daily requirement of Vitamin A 1. For children is 300-600 μg, 2. For adults is 700 μg to 900 μg (3000 IU) and 3. For lactating mothers is 1500-1800 μg (5000 IU to 6000 IU). 1. Liver (beef, pork, chicken, turkey, fish) (6500 μg), including cod liver oil 2. Dandelion greens (5588 IU) 3. Carrot (835 μg) 4. Broccoli leaf (800 μg) 5. Sweet Potato (709 μg) 6. Butter (684 μg) 7. Spinach (469 μg) 8. Pumpkin (400 μg) 9. Cheddar cheese (265 μg) 10. Egg (140 μg) 11. Apricot (96 μg) 12. Papaya (55 μg) 13. Mango(38 μg) Vitamin A is found naturally in many foods:
  18. Slide 20. Vitamin D Deficiency Disorder 1. Vitamin D is a group of fat-soluble secosteroids and is also called as sunshine vitamin. 2. In humans when sun exposure is adequate, vitamin D is synthesized from the body cholesterol. Vitamin D can be ingested as Cholecalciferol (vitamin D3) or Ergocalciferol (vitamin D₂). 3. In the liver, Vitamin D is converted in to calcidiol and is further converted in to calcitriol in the kidneys which is biologically active form of Vitamin D. 4. Calcitriol circulates in the blood as a hormone regulating the concentration of calcium and phosphate in blood and promote the healthy growth and remodeling of bone. 5. Calcidiol is also converted to Calcitriol outside of the kidneys for other purposes, such as the proliferation, differentiation and apoptosis of cells. 6. Calcitriol also affects neuromuscular function and inflammation.
  19. Slide 21. Functions of Vitamin D 1. Maintain the normal calcium and phosphorus levels in the body to build strong bones, teeth and nails. 2. Supporting the cell functions and other neuromuscular functions in the body. 3. Controls the supply of calcium between the bones and the blood and supports bone mineralization (hardening of bones) and bone remodeling by osteoblasts and osteoclasts. 4. Preventing of rickets in children, and osteoporosis or osteomalacia in adults. 5. Vitamin D as a powerful antioxidant and anti-carcinogen, it helps in combating depression, prostate cancer, breast cancer, high blood pressure, cardiovascular diseases, phagocytosis activity and boosts anti-tumor activity. 6. Vitamin D also helps treating conditions like diabetes and obesity, and prevents the onset of multiple sclerosis. 7. Vitamin D helps in maintaining a healthy immune system in the body.
  20. Slide 22. Sources of Vitamin D 1. The main source of vitamin D is exposure of an individual is to the sun's UVB rays. 2. Apart from this, Vitamin D is found in various types of fish such as herring, mackerel, salmon, and sardines. 3. It is also available in other food sources such as egg yolks, orange juice, cereals, green leafy vegetables, fish liver oils, yogurt, cheese, etc. 4. Fortified foods are other common sources of vitamin D. In fact, one cup of vitamin D fortified milk provides one-half of the recommended vitamin D for people between the ages of 19 and 50 years.
  21. Slide 23. Vitamin D Deficiency Disorders 1. A diet deficient in vitamin D causes osteomalacia (softening of the bones) in elders and rickets in children. 2. Avoiding the exposure to sun may result in low blood Calcidiol (25-hydroxy-vitamin D) and that may cause Vitamin D deficiency disorder. Management Dietary supplementation of Vitamin D₂ (Mushrooms) and Vitamin D, (Fish liver oils, Egg and Beef liver.
  22. Slide 24. Vitamin E Deficiency Disorders • Vitamin E is a group of eight fat-soluble compounds that include both tocopherols and tocotrienols. Among the tocopherols, a-Tocopherol is biologically active form of vitamin E. • Tocotrienols is much less studied. Some in vivo studies have observed that tocotrienols have specialized roles in protecting neurons from damage and cholesterol reduction by inhibiting the activity of HMG-CoA reductase, delta-tocotrienol blocks processing of sterol regulatory element-binding proteins (SREBPs). • Oral consumption of tocotrienols is also thought to protect against stroke-associated brain damage Dietary Sources 1. Vitamin E is found most abundantly in wheat germ oil, sunflower oil, safflower oil, nuts and nut oils, like almonds and hazelnuts, palm oil. 2. It is also found in high-value green, leafy vegetables like spinach, turnip, broccoli, avocados, asparagus, kiwifruit (green), pumpkin, sweet potato, mangoes, tomatoes, rockfish, and papaya. 3. It is an antioxidant that stops the production of reactive oxygen species formed when fat undergoes oxidation.
  23. Slide 25. Functions Vitamin E has following functions: 1. Prevents the oxidative damage of the cell membranes 2. Prevents unnecessary growth of the smooth muscle. 3. Responsible for the repair of wounds. 4. Vitamin E plays a role in neurological functions 5. It inhibits platelet aggregation. 6. Vitamin E also protects lipids and prevents the oxidation of polyunsaturated fatty acids (PUFAs.)
  24. Slide 26. Deficiency Disorders of Vitamin E Dietary deficiency of Vitamin E causes 1. Spinocerebellar ataxia 2. Myopathies 3. Peripheral neuropathy 4. Ataxia 5. Skeletal myopathy 6. Retinopathy 7. Impairment of the immune response 8. Erythrocyte hemolysis 9. Male infertility. Treatment • Individuals who cannot absorb fat may require a vitamin E supplement because some dietary fat is needed for the absorption of vitamin E from the gastrointestinal tract. • Anyone diagnosed with cystic fibrosis, individuals who have had part or all of their stomach removed, and individuals with malabsorptive problems such as Crohn's disease, liver disease or pancreatic insufficiency may not absorb fat and may require supplemental vitamin E. • Dose of Vitamin E The recommended dietary allowance (RDA) for vitamin E is quite low, 15 to 20 International Units (IU) per day. The most commonly recommended dosage of supplemental vitamin E for adults is approximately 300 to 800 IU per day.
  25. Slide 27. Vitamin K Deficiency Disorder • Vitamin K is an essential, lipid-soluble vitamin that plays a key role in the production of coagulation proteins. • Vitamin K is a mixture of three types. • They are K-1 (also known as phylloquinone or phytonadione), which is derived from plants; K-2 (menaquinone), which is produced by the intestinal flora; and • K-3 (menadione), which is a synthetic, water-soluble form commonly used for treatment. • Estimated daily requirement of Vitamin K is 100-200 mcg/day. About 80-85% of Vitamin K is absorbed mainly in the terminal ileum into the lymphatic system; therefore, bile salts and normal fat absorption, as well as normal-functioning villi of the ileum, are necessary for the effective uptake of Vitamin K.
  26. Slide 28. Symptoms of Vitamin K Deficiency 1. Symptoms Vitamin K deficiency include ecchymosis, petechiae, hematomas, oozing of blood at surgical or puncture sites, stomach pains; risk of massive uncontrolled bleeding; cartilage calcification; and severe malformation of developing bone or deposition of insoluble calcium salts in the walls of arteries . 2. In infants, it can cause some birth defects such as underdeveloped face, nose, bones, and fingers. Dietary Sources of Vitamin K 1. Vitamin K is found in green, leafy vegetables and in oils, such as soyabean, cottonseed, canola, and olive oils. 2. It can also be synthesized from colonic bacteria. 3. Diet is the main source of Vitamin K.
  27. Slide 29. Deficiency Disorders of Vitamin B complex • Vitamin B complex is a group of water-soluble vitamins, easily dispersed throughout the body. • Most of the B vitamins must be replenished regularly, since any excess is excreted in the urine. This can result in the production of bright green-yellow color urine. • The B complex vitamin was once thought to be a single vitamin, referred to as vitamin B. However the research findings have suggested that they are chemically distinct and often coexist in the same foods. • B vitamin supplements are referred as B complex named specifically by different names for each vitamin (e.g., B1, B2, B3 etc.). • Following are the vitamin B Complex. 1. Vitamin B1 (thiamine) 2. Vitamin B2 (riboflavin) 3. Vitamin B3 (niacin) 4. Vitamin B5 (pantothenic acid) 5. Vitamin B6 (pyridoxine) 6. Vitamin B7 (biotin) 7. Vitamin B9 (folic acid) 8. Vitamin B12 (Cyanocobalamin)
  28. Slide 30. Functions of Vitamin B Complex The Vitamin B Complex is essential to 1. Support and increase the rate of metabolism 2. Maintain healthy skin, hair and muscle tone 3. Enhance immune and nervous system functions 4. Promote cell growth and division, including that of the red blood cells that help 5. prevent anemia 6. Reduce the risk of pancreatic cancer 7. Reduce the symptoms of attention deficit hyperactivity disorder.
  29. Slide 31. • Several diseases may result due to inadequate intake of B vitamin supplements. • Deficiencies of B-Complex vitamins result in symptoms that are not part of a named deficiency disease. • Dietary Sources of Vitamin B Complex 1. B-Complex vitamins are found in whole unprocessed foods. 2. Processed carbohydrates such as sugar and white flour tend to have lower B vitamin than their unprocessed counterparts. 3. For this reason, thiamine, riboflavin, niacin, and folic acid is added to white flour after processing. 4. B vitamins are richly present in tuna and turkey meat and in fish liver. 5. Good sources for B vitamins include whole grains, potatoes, bananas, lentils, chilli peppers, tempeh, beans, nutritional yeast, brewer's yeast, and molasses.
  30. Slide 32. Vitamin Name Deficiency Disorder Key Symptoms B ₁ Thiamine Beriberi, Wernicke– Korsakoff syndrome Weight loss, neuropathy, edema, heart failure, confusion, memory loss B ₂ Riboflavin Ariboflavinosis Cheilosis, angular stomatitis, glossitis, dermatitis, photophobia B ₃ Niacin Pellagra Dermatitis, diarrhea, dementia, confusion B ₅ Pantothenic acid Rare deficiency Acne, paresthesia B ₆ Pyridoxine Anemia, neuropathy Microcytic anemia, dermatitis, depression, ↑ homocysteine B ₇ Biotin Rare deficiency Neurological symptoms, impaired growth (infants) B ₉ Folic acid Megaloblastic anemia Macrocytic anemia, ↑ homocysteine Neuropathy, memory loss,
  31. Slide 33. 1. Daily requirement of Vitamin B Complex: On individual basis, Vitamin B complex is required in different doses. 2. However elderly people and athletes may require additional B₁₂ and other Vitamin B supplementation 3. type 1 and type 2 diabetics may require thiamine based supplementation. 4. This is may be due to high prevalence of low plasma thiamine concentration and increased thiamine clearance associated with diabetes. 5. Vitamin B, (folic acid) deficiency in early embryo development has been linked to neural tube defects. Thus, women planning to become pregnant are usually encouraged to increase daily dietary folic acid intake and/or take a supplement.
  32. Slide 34. RDA of Balanced Diet as per Government of India • According to the Indian Council of Medical Research (ICMR), the recommended dietary intake for a balanced diet in an average adult is: 1. Energy: 1900–2400 kcal/day (depends on age, gender, activity) 2. Proteins: 0.8–1 g/kg body weight (~50–60 g/day) 3. Fats: 20–30% of total energy 4. Carbohydrates: 55–65% of total energy 5. Calcium: ~600 mg/day 6. Iron: 17–21 mg/day 7. Vitamins: As per daily requirements 8. Water: ~2–3 liters/day

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