Section 1

a) Briefly describe the relationship of nutrition to health (5)

1️⃣ Growth and Development

• Nutrition is directly linked to the growth and physical development of children, as it provides essential nutrients like proteins, vitamins, and minerals necessary for tissue and bone formation.
• Protein is particularly vital during periods of rapid growth (infancy, childhood, adolescence) as it supports cellular multiplication, tissue repair, and hormonal activity.
• Calcium and vitamin D are important for the mineralization of bones and teeth, and deficiencies can lead to rickets in children or stunted growth.
• Iron and iodine play crucial roles in brain development and cognitive functioning; iodine deficiency may lead to goiter or mental retardation.
• Malnutrition in early childhood causes stunting, wasting, and long-term effects on physical, intellectual, and emotional development.
• A well-nourished child shows timely milestones, better academic performance, and stronger resistance to infections.
• Adequate maternal nutrition during pregnancy supports proper fetal growth, brain formation, and reduces the risk of low birth weight or birth defects.
• Balanced nutrition in adolescence ensures proper sexual maturation, hormonal balance, and peak bone mass development.

2️⃣ Disease Prevention

• Balanced nutrition prevents both communicable and non-communicable diseases by strengthening immunity and metabolic function.
• Antioxidants like vitamins A, C, and E protect cells from oxidative stress, thereby lowering the risk of cancer and degenerative conditions.
• A diet low in saturated fats and cholesterol prevents atherosclerosis and reduces the incidence of coronary artery disease.
• Fiber from whole grains and vegetables reduces constipation, regulates blood glucose, and helps lower LDL cholesterol levels.
• Excessive sugar and refined carbohydrate intake can lead to insulin resistance and increase the risk of type 2 diabetes.
• Adequate calcium, vitamin D, and magnesium intake prevent osteoporosis and bone fractures in older adults.
• Nutrient-rich diets lower the risk of anemia, scurvy, pellagra, beriberi, and other classical deficiency diseases.
• Long-term adherence to a healthy diet reduces overall healthcare costs and enhances the quality of life.

3️⃣ Strong Immunity

• Nutrition is central to the function of the immune system, as it provides energy and nutrients to immune cells for defense against pathogens.
• Vitamin A maintains the health of epithelial tissues and mucous membranes, which serve as physical barriers to infection.
• Vitamin C enhances the activity of phagocytes and supports the production of interferons and antibodies.
• Zinc plays a critical role in lymphocyte production, wound healing, and protection from respiratory infections.
• Protein is essential for the synthesis of immunoglobulins (antibodies) and cytokines that mediate immune responses.
• Malnutrition, particularly protein-energy malnutrition (PEM), weakens immune competence, making individuals prone to recurrent infections like diarrhea, pneumonia, and tuberculosis.
• Probiotic-rich foods (e.g., yogurt) support gut immunity and balance beneficial microflora.
• Iron and selenium also support immune function, and their deficiency impairs resistance to infections.

4️⃣ Energy and Vitality

• Carbohydrates are the body’s primary energy source and are essential for brain and muscle function during daily activities.
• Fats act as a dense energy reserve and help in absorption of fat-soluble vitamins (A, D, E, K).
• Proteins provide energy during catabolic states and also support enzyme, hormone, and antibody production.
• Iron supports oxygen transport through hemoglobin, preventing fatigue and ensuring endurance.
• Vitamin B complex (especially B1, B2, B3, and B12) is essential for energy metabolism and nerve conduction.
• A lack of energy-giving nutrients results in tiredness, low concentration, dizziness, and reduced physical productivity.
• Dehydration reduces energy levels by impairing blood circulation and nutrient transport.
• Adequate caloric and nutrient intake restores energy balance, especially in stress, illness, or recovery.

5️⃣ Wound Healing and Recovery

• During illness or injury, the body’s demand for nutrients increases to support the healing and regeneration of tissues.
• Protein is required to rebuild damaged tissue and support immune function during healing.
• Vitamin C is crucial for collagen synthesis, which is a structural protein in skin and connective tissue.
• Zinc accelerates epithelial repair, promotes tissue granulation, and reduces infection risk.
• Vitamin A supports epithelialization and reduces the risk of delayed healing or scarring.
• Iron and folic acid support cell proliferation and blood cell replacement, particularly after blood loss.
• Post-surgical or burn patients require high-protein and calorie-dense diets to enhance tissue growth.
• Poor nutritional status results in delayed wound closure, increased risk of infection, and longer hospitalization.

6️⃣ Mental Health and Brain Function

• Omega-3 fatty acids (DHA and EPA) are essential for the development and functioning of the brain and nervous system.
• Vitamin B12 and folate are required for neurotransmitter synthesis and prevention of depression, confusion, and cognitive decline.
• Iron deficiency can lead to poor concentration, irritability, and learning difficulties, especially in children and adolescents.
• Protein provides amino acids like tryptophan, which are precursors for neurotransmitters such as serotonin and dopamine.
• Sudden drops in blood glucose due to poor meals can cause mood swings, anxiety, or faintness.
• Iodine deficiency during pregnancy and early childhood can cause mental retardation and developmental delays (cretinism).
• Micronutrients like magnesium, vitamin D, and zinc also play roles in mood regulation and nerve impulse conduction.
• Consistent, balanced meals improve cognitive function, reduce stress, and maintain emotional stability.

b) Discuss role of nurses in nutrition education (5)

1️⃣ Assessment

• Nurses assess the nutritional needs based on dietary history, food preferences, allergies, and cultural eating patterns.
• They perform anthropometric measurements such as height, weight, BMI, MUAC, and skinfold thickness.
• Nurses observe physical signs of nutrient deficiencies like pale skin, brittle hair, delayed wound healing, or fatigue.
• They identify high-risk groups such as pregnant women, elderly, infants, or patients with chronic diseases.

2️⃣ Health Education

• Nurses educate individuals on the importance of macronutrients and micronutrients in daily life.
• They guide patients on preparing healthy meals at home with correct cooking techniques to preserve nutrients.
• Nurses promote water intake, avoidance of processed foods, and inclusion of natural sources like fruits and vegetables.
• They explain food pyramids, MyPlate models, and meal timing to improve dietary practices.

3️⃣ Disease-Specific Counseling

• Nurses explain the impact of diet on specific conditions like heart disease, kidney failure, and obesity.
• They help patients differentiate between allowed and restricted foods in their condition.
• Nurses clarify the purpose of therapeutic diets and stress the importance of adherence.
• They support long-term dietary behavior change in chronic disease patients through follow-up counseling.

4️⃣ Maternal and Child Nutrition

• Nurses guide adolescent girls on the need for iron-rich foods to prevent anemia.
• They teach mothers about increased calorie and protein needs during pregnancy and breastfeeding.
• Nurses monitor the child’s growth using growth charts and counsel parents on age-appropriate nutrition.
• They educate about Vitamin A, iron, and calcium supplementation in infants and toddlers as per national programs.

5️⃣ Community Awareness

• Nurses conduct nutrition education sessions in anganwadis, schools, and community centers.
• They prepare and distribute nutrition posters, flip charts, and visual aids for better understanding.
• Nurses work with local leaders and NGOs to promote dietary awareness in rural or slum populations.
• They advocate for early identification of malnutrition and encourage community participation in nutrition-related programs.

6️⃣ Therapeutic Diet Supervision

• Nurses ensure the right diet is delivered to each patient according to medical orders.
• They assist in explaining meal plans to patients and family members to encourage cooperation.
• Nurses monitor tolerance to new diets and inform the dietitian of any side effects or aversions.
• They observe food intake and offer alternative food items if the patient refuses to eat.

7️⃣ Behavioral Change Support

• Nurses provide one-on-one dietary counseling using motivational interviewing techniques.
• They help patients set realistic and achievable dietary goals.
• Nurses educate caregivers to reinforce healthy food habits in children and the elderly.
• They use group discussions or peer support models to promote community-wide behavior change.

8️⃣ Monitoring and Documentation

• Nurses maintain food intake charts and nutritional flow sheets during hospitalization.
• They evaluate weight trends, appetite patterns, and food preferences regularly.
• Nurses report nutrition-related complications such as nausea, constipation, or poor oral intake.
• They provide feedback to dietitians and doctors for timely diet modifications or supplementation.

9️⃣ Use of Local Resources

• Nurses promote traditional, regionally available superfoods like millets, green leafy vegetables, and legumes.
• They teach homemakers to plan balanced diets even on a low budget.
• Nurses suggest food storage and cooking methods that preserve nutrient value.
• They demonstrate recipes using local ingredients rich in proteins, iron, and vitamins.

🔟 Support to National Programs

• Nurses participate in nutrition surveys and data collection under government schemes.
• They distribute Iron-Folic Acid tablets, Vitamin A, and deworming medications in schools and anganwadis.
• Nurses educate families about entitlements under schemes like ICDS, PMMVY, and POSHAN Abhiyan.
• They refer malnourished children to Nutritional Rehabilitation Centres (NRCs) when required.

Q.2 Enlist four deficiency disease of the following (2×4=8)

i) Vitamin A

1️⃣ Xerophthalmia causes dryness of the conjunctiva and cornea due to long-term vitamin A deficiency.
2️⃣ Night Blindness (Nyctalopia) refers to difficulty seeing in dim light because of impaired retinal function linked to vitamin A deficiency.
3️⃣ Bitot’s Spots appear as foamy, whitish patches on the conjunctiva, indicating prolonged deficiency of vitamin A.
4️⃣ Keratomalacia is a severe corneal softening condition that can lead to permanent blindness in the absence of adequate vitamin A.

ii) Calcuim

1️⃣ Rickets affects children by causing bone deformities and delayed growth due to inadequate calcium and vitamin D.
2️⃣ Osteomalacia develops in adults and results in soft, weak bones due to defective bone mineralization.
3️⃣ Osteoporosis leads to decreased bone density and increased risk of fractures, especially in postmenopausal women and elderly.
4️⃣ Tetany presents with painful muscle cramps and spasms caused by low blood calcium levels (hypocalcemia).

iii) Iodine

1️⃣ Goitre involves enlargement of the thyroid gland due to insufficient iodine intake.
2️⃣ Cretinism results in mental retardation and physical stunting in newborns due to maternal iodine deficiency.
3️⃣ Hypothyroidism causes fatigue, weight gain, and cold intolerance because of reduced thyroid hormone production.
4️⃣ Delayed mental and physical development in school-age children often results from chronic iodine deficiency.

iv) Protein

1️⃣ Kwashiorkor is a protein deficiency disease in children marked by edema, liver enlargement, and changes in skin and hair texture.
2️⃣ Marasmus causes extreme wasting and stunted growth due to severe deficiency of both protein and calories.
3️⃣ Growth Retardation in children results from long-standing inadequate protein intake during developmental years.
4️⃣ Decreased immunity and delayed wound healing occur due to lack of proteins required for tissue repair and immune defense.

Q.3 Write short notes on any two of the following (5×2=10)

i) Methods of cooking

Cooking is the process by which food is prepared using various forms of heat. Each cooking method affects the taste, texture, digestibility, and nutritional value of food. The methods are broadly divided into Moist Heat, Dry Heat, Frying, and Microwave or Modern methods.

1️⃣ MOIST HEAT METHODS

(These involve cooking food using water, steam, or other liquids.)

✅ Boiling

• It is a method in which food is completely immersed in water and heated to its boiling point (100°C), allowing it to cook until soft or tender.
• It is one of the simplest and oldest cooking methods, suitable for rice, lentils, eggs, vegetables, and pasta.
• It helps in destroying most pathogenic organisms, thus making food safe for consumption.
• It is often used in therapeutic and bland diets, especially in patients with gastrointestinal conditions.
• However, it may lead to loss of water-soluble nutrients like Vitamin C and B-complex unless the cooking water is reused.
• Overboiling can make food mushy and less appealing, and it should be avoided.
• Boiling is also helpful in softening fibrous food materials, making them digestible for infants and elderly.

✅ Simmering

• It is a gentle cooking method where food is cooked just below boiling point (85–95°C) for an extended time.
• It produces small, gentle bubbles that allow slow and even cooking, ideal for broths, dals, meat stews, and soups.
• Simmering helps in better flavor extraction, especially when cooking meat or bones for broth.
• It maintains the structural integrity of food, unlike boiling, which may break it down.
• It is widely used in hospital diets for preparing light, nourishing meals.
• It ensures thorough cooking of complex ingredients without overcooking delicate ones.

✅ Steaming

• Steaming is a process in which food is cooked by the heat of steam rather than by water itself, preserving most nutrients.
• It is considered the healthiest cooking method, as it does not require oil or direct heat.
• It is ideal for preparing idli, dhokla, vegetables, momos, and fish, especially in therapeutic diets.
• Steaming helps in preserving color, taste, and texture, especially of green vegetables and fruits.
• It reduces the risk of nutrient loss, particularly water-soluble vitamins, which are easily leached during boiling.
• It is highly suitable for dietary modifications in hypertension, diabetes, and cardiovascular diseases.
• Steam cookers, pressure cookers, or bamboo baskets may be used for this purpose.

✅ Poaching

• Poaching involves cooking food gently in liquid at temperatures ranging from 70°C to 80°C, below boiling point.
• This method is ideal for eggs, fish, pears, and apples, which are delicate and can break with vigorous boiling.
• It is a preferred cooking method in renal and cardiac diets, as it allows food to retain moisture without added fats.
• Poaching retains natural flavors and helps keep the food soft, moist, and nutrient-rich.
• It is often used with flavored liquids (like broth, milk, or fruit juice) to enhance the final dish.
• It ensures food is cooked without the formation of a crust, which is beneficial in texture-sensitive patients.

2️⃣ DRY HEAT METHODS

(These methods cook food without the use of water, using hot air or direct heat.)

✅ Roasting

• Roasting is a method of cooking food using dry heat, either in an oven or over an open flame.
• It is widely used for nuts, root vegetables, meats, paneer, and eggplant to enhance taste and aroma.
• Roasting helps develop a brown crust and smoky flavor, which enhances palatability.
• It results in moisture reduction, making the food crispy and shelf-stable.
• Frequent turning and temperature control are necessary to prevent burning or uneven roasting.
• It is particularly useful in reducing fat content by allowing excess oil to drip off.
• However, excessive roasting may lead to nutrient degradation, especially of sensitive vitamins.

✅ Baking

• Baking involves cooking food in dry, hot air inside a closed oven, generally at temperatures between 160–250°C.
• It is used for bread, cakes, cookies, pies, lasagna, and baked snacks.
• Baking is suitable for low-oil or oil-free diets, making it heart-healthy.
• It creates uniform cooking with a golden crust while keeping the inside soft and moist.
• It is important to preheat the oven and avoid overbaking, which may dry out the food.
• Baking is used in clinical nutrition to prepare special diet foods for diabetics, cardiac patients, or obese individuals.

✅ Grilling

• Grilling is a method of cooking food over direct heat, usually from below (as in charcoal or electric grills).
• It is widely used for vegetables, meats, kebabs, fish, and paneer.
• It creates a charred and crispy outer layer while retaining juices inside.
• Grilled food has a distinct smoky flavor, and it requires minimal oil, making it healthy.
• It is necessary to marinate food beforehand to enhance taste and retain moisture during high-heat exposure.
• Prolonged or high-temperature grilling may lead to charring, which can produce harmful compounds if not controlled.

✅ Toasting

• Toasting involves browning food items using dry heat without oil, typically applied to bread, nuts, and spices.
• It is done using toasters, ovens, or open flame.
• Toasting helps remove moisture, making food crispy and improving shelf life.
• It is widely used in breakfast items and for preparing bases for sandwiches or croutons.
• Care must be taken to avoid over-toasting, which may lead to bitterness or burning.

3️⃣ FRYING METHODS

(These methods cook food by immersing or contacting it with hot oil.)

✅ Deep Frying

• Deep frying involves completely submerging food in hot oil at 170–190°C until it becomes golden and crispy.
• It is used for making pakoras, puris, samosas, cutlets, and snacks.
• It enhances taste, texture, and color, making food attractive and palatable.
• However, it is a high-calorie method and unsuitable for therapeutic diets.
• Frequent reuse of oil can lead to oxidation and toxin formation, so oil must be used judiciously.
• Deep-fried food should be drained well on tissue or mesh to reduce excess oil before serving.

✅ Shallow Frying

• Shallow frying uses a small amount of oil in a flat pan to cook food on both sides.
• It is suitable for parathas, dosas, cutlets, omelets, and fish fillets.
• This method requires medium heat and frequent turning for even cooking.
• It uses less oil compared to deep frying and is more suitable for regular diets.
• However, nutrient loss and calorie addition still occur if not carefully monitored.

✅ Sauteing

• Sauteing is a quick cooking method where small pieces of food are stirred or tossed in a small amount of fat over high heat.
• It is widely used for vegetables, paneer, chicken cubes, onions, and spices at the beginning of many dishes.
• It retains crunch, color, and nutrients while enhancing flavor due to caramelization.
• Sauteing is commonly used in Indian curries and continental side dishes.
• It requires constant movement to prevent sticking or burning.

4️⃣ COMBINATION METHOD

✅ Braising

• Braising combines both dry and moist heat methods, where food is first browned by dry heat and then cooked in a small amount of liquid.
• It is used for tough cuts of meat, root vegetables, and stuffed dishes that need slow, gentle cooking.
• The initial browning adds rich color and flavor, while the later liquid phase makes it tender and moist.
• It is ideal for hospital bulk cooking or nutritional meals that must be soft and wholesome.
• It is a time-consuming method but yields rich, concentrated flavors.

5️⃣ MICROWAVE COOKING

• Microwave cooking uses electromagnetic waves to generate heat by vibrating water molecules within food.
• It is a modern, fast, and energy-efficient method suitable for reheating or cooking soft-textured food.
• It is used for vegetables, fish, reheated chapatis, porridges, or baby food.
• Microwaving helps retain most nutrients because of short cooking time and minimal water use.
• It is not ideal for frying, browning, or dry crisp textures, which need conventional ovens or grilling.

ii) Mid day meal program

Definition

• The Mid-Day Meal (MDM) Program is a school-based nutritional intervention launched by the Government of India, under which free cooked meals are provided to school children during the school day to improve nutritional status, school attendance, and learning outcomes.
• It is considered the world’s largest school lunch program, and is one of India’s flagship nutrition and education initiatives.

Historical Background

• The idea was first introduced in Tamil Nadu in 1925 and later expanded to other states.
• The program was officially launched by the Government of India in 1995 as the National Programme of Nutritional Support to Primary Education (NP-NSPE).
• In 2001, the Supreme Court of India directed all states to provide cooked mid-day meals in government and government-aided schools.
• In 2004 and 2006, the program was revised to include upper primary classes (Class VI–VIII) and nutritional standards were also defined.

Objectives of Mid-Day Meal Program

• To improve the nutritional status of children in government and government-aided schools.
• To encourage enrollment, retention, and attendance in schools, especially among children from disadvantaged sections.
• To act as a form of social equity, reducing caste and gender discrimination by bringing all children together at the same meal.
• To improve children’s concentration, learning ability, and school performance by addressing short-term hunger.
• To serve as a platform for nutrition education and hygiene promotion among young students.

Target Beneficiaries

• Children studying in Class I to VIII in government, government-aided, and local body schools.
• Also includes children in Education Guarantee Scheme (EGS), Alternate and Innovative Education (AIE) centers, and Madrasas supported under Sarva Shiksha Abhiyan (SSA).

Nutritional Standards (Per Child per School Day)

Primary School (Class I–V)

• Calories – 450 kcal
• Protein – 12 grams
• Food grains – 100 grams (mainly rice/wheat)
• At least one seasonal vegetable and a source of protein (e.g., pulses, eggs, soya)

Upper Primary (Class VI–VIII)

• Calories – 700 kcal
• Protein – 20 grams
• Food grains – 150 grams
• Inclusion of vegetables, legumes, and oils for calorie balance.

Implementation Mechanism

• Meals are cooked and served within the school premises or through centralized kitchens (like Akshaya Patra).
• Cooks and helpers are appointed from the local community, often women from disadvantaged groups.
• The program includes hygiene education, handwashing before meals, and emphasis on safe food handling and storage.
• Fund sharing is between the Central and State Governments under a cost-sharing model.

Role of Nurse and Health Worker in MDM Program

• Nurses and community health workers help in monitoring nutritional status of school children, identifying undernourished children using height, weight, and MUAC.
• They conduct nutrition education sessions to promote healthy eating habits and hygiene practices among students.
• They assist in growth chart maintenance and anemia screening, especially among adolescent girls.
• They provide deworming tablets, Vitamin A, and Iron-Folic Acid supplements as part of school health services.
• They report any foodborne illness, malnutrition, or hygiene issue to the education and health departments.

Monitoring and Evaluation

• Schools maintain daily attendance and meal distribution registers.
• Mid-day meal committees (including teachers, parents, and community members) ensure food quality and safety.
• Regular inspection, nutritional audits, and growth monitoring help evaluate the effectiveness of the program.

Challenges Faced

• Issues of poor infrastructure, storage, and water supply at some schools.
• Irregular supply of food grains or poor quality ingredients can disrupt services.
• Occasional reports of food contamination, lack of hygiene, or caste-based discrimination during meal distribution.
• Inadequate training or low wages for cooks and helpers can affect program quality.

Recent Initiatives and Developments

• The program is now integrated under PM POSHAN (Prime Minister’s Poshan Shakti Nirman Yojana) since 2021.
• The focus has shifted to fortified foods, millets inclusion, and gender-sensitive approaches.
• Handwashing stations and clean water supply are being added as part of WASH (Water, Sanitation and Hygiene) in Schools.

iii) Balanced diet

Definition

• A balanced diet refers to a nutritional intake that contains all the essential nutrients—carbohydrates, proteins, fats, vitamins, minerals, fiber, and water—in appropriate proportions and quantities required to maintain normal physiological functions, support growth and development, and promote optimal health and immunity in the individual.
• It is the foundation of preventive nutrition and healthy living, ensuring that the body gets sufficient energy and nutrients to perform metabolic activities, repair tissues, and maintain organ function.
• The components of a balanced diet should be selected according to age, gender, physical activity, physiological state (e.g., pregnancy, illness), and socio-economic background.

Objectives of a Balanced Diet

1️⃣ It is to provide adequate energy to meet the daily caloric demands of the body based on the individual’s basal metabolic rate (BMR) and level of activity.

2️⃣ It is to supply the necessary macro and micronutrients required for growth, tissue repair, and immune protection.

3️⃣ It aims to prevent nutritional deficiencies, such as anemia, scurvy, rickets, and goiter, and also to avoid excess intake, which may lead to obesity, hypertension, or cardiovascular disease.

4️⃣ It promotes good digestion, regular bowel movement, and metabolic health, and reduces the risk of chronic illnesses like diabetes, cancer, and osteoporosis.

5️⃣ It supports mental well-being, cognitive function, and helps maintain healthy skin, hair, and hormonal balance.

Components of a Balanced Diet

1️⃣ Carbohydrates

• Carbohydrates are the primary source of energy, and they should contribute about 55–65% of the total daily calorie intake.
• They are present in foods like rice, wheat, maize, potatoes, fruits, sugar, and jaggery, and are essential for brain function and physical activity.
• Complex carbohydrates like whole grains and millets are preferred over simple sugars for long-lasting energy and better glycemic control.

2️⃣ Proteins

• Proteins are required for growth, tissue repair, production of enzymes, hormones, and antibodies, and they should make up about 15–20% of total daily calories.
• Sources include milk, eggs, fish, meat, pulses, legumes, soy, paneer, and nuts, and both animal and plant-based proteins should be included.
• They are especially vital for children, pregnant women, lactating mothers, and recovering patients.

3️⃣ Fats

• Fats are a concentrated source of energy (9 kcal/g), and are necessary for absorption of fat-soluble vitamins (A, D, E, K), and for brain and nerve function.
• It should contribute 20–30% of daily energy intake, and include healthy fats like unsaturated fats (from nuts, seeds, olive oil, fish) while limiting saturated fats and avoiding trans fats.
• Sources are ghee, butter, oil, meat, fish oil, and avocados.

4️⃣ Vitamins

• Vitamins are organic compounds essential in small quantities for metabolic activities, immune function, vision, blood clotting, and cell protection.
• Fat-soluble vitamins include A, D, E, and K, while water-soluble vitamins include B-complex and vitamin C.
• Deficiency of vitamins leads to specific disorders like night blindness (Vit A), scurvy (Vit C), rickets (Vit D), and beriberi (Vit B1).

5️⃣ Minerals

• Minerals are inorganic elements required for bone formation, nerve conduction, muscle contraction, oxygen transport, and enzymatic reactions.
• Major minerals include calcium, phosphorus, sodium, potassium, magnesium, and trace minerals include iron, iodine, zinc, selenium, copper.
• Examples :
   Iron is found in green leafy vegetables and meat, prevents anemia.
   Iodine is found in iodized salt and prevents goiter.
   Calcium from milk and cheese supports bone health.

6️⃣ Water

• Water makes up 60–70% of body weight, and is essential for digestion, circulation, temperature regulation, excretion, and cell function.
• An average adult needs about 2.5 to 3 liters of water daily through food and beverages.
• It helps in hydration, detoxification, and nutrient transport.

7️⃣ Dietary Fiber

• Fiber is a type of complex carbohydrate that aids in digestion, prevents constipation, and reduces risk of colon cancer, obesity, and diabetes.
• Found in whole grains, fruits, vegetables, legumes, and seeds, it promotes satiety and blood sugar control.
• Soluble fiber lowers cholesterol, while insoluble fiber improves bowel movement.

Factors Affecting a Balanced Diet

1️⃣ Age – Infants, children, adults, and elderly have different nutritional needs.

2️⃣ Sex – Males generally have higher calorie requirements than females.

3️⃣ Activity level – Sedentary, moderate, and heavy workers need different amounts of calories and proteins.

4️⃣ Physiological conditions – Pregnancy, lactation, illness, surgery increase nutrient demands.

5️⃣ Socioeconomic status – Determines access to quality food and meal variety.

6️⃣ Cultural and food preferences – May restrict or emphasize certain foods.

Role of Nurse in Promoting Balanced Diet

1️⃣ It is the nurse’s responsibility to assess the nutritional status of patients and community members by observing signs of malnutrition, recording anthropometric data, and reviewing dietary habits through history taking and physical examination.

2️⃣ It is important for the nurse to provide nutrition education and counseling to individuals, families, and groups, emphasizing the significance of consuming a balanced diet tailored to age, gender, and physiological needs.

3️⃣ The nurse should actively participate in government health programs like ICDS (Integrated Child Development Services), Mid-Day Meal Scheme, and POSHAN Abhiyaan, and ensure that beneficiaries receive proper nutritional supplements and services.

4️⃣ The nurse must collaborate with dietitians and nutritionists in healthcare settings to prepare therapeutic diet plans for patients with specific conditions such as diabetes, hypertension, renal failure, or gastrointestinal disorders.

5️⃣ It is the duty of the nurse to monitor patients’ dietary compliance during hospitalization and community visits, encourage the intake of locally available nutritious foods, and advise on cost-effective meal planning.

6️⃣ The nurse plays a vital role in early identification and referral of individuals with severe nutritional deficiencies, such as protein-energy malnutrition, anemia, and vitamin A deficiency, to higher health centers or nutrition rehabilitation units.

7️⃣ The nurse should organize and conduct awareness sessions and demonstrations on balanced diet, healthy cooking methods, and food hygiene practices in schools, Anganwadi centers, and community gatherings.

8️⃣ It is necessary for the nurse to maintain accurate nutrition records including growth charts, diet history, supplement distribution, and monitor progress over time, especially in high-risk groups like under-five children and pregnant women.

9️⃣ Nurses can play a major role in promoting breastfeeding, timely weaning, and age-appropriate complementary feeding practices through direct counseling to new mothers and caregivers.

🔟 The nurse must educate individuals with lifestyle disorders such as obesity, hypertension, and diabetes about the role of balanced diet in disease prevention and long-term management, and promote physical activity alongside dietary control.

Q.4

a) Prepare a menu plan for Mrs. Radhika 22 years old, 50 kg weight, moderate worker and lactating mother of a 5 months old baby (8)

Client Profile Summary

• Mrs. Radhika is a 22-year-old woman currently in the lactation phase, with a 5-month-old breastfeeding baby.
• She weighs 50 kg and is engaged in moderate daily physical work (e.g., household tasks, child care).
• Her body requires extra energy, proteins, calcium, iron, and fluids to ensure good health for herself and optimal breast milk production for the baby.
• This menu plan aims to meet the Recommended Dietary Allowance (RDA) for a lactating mother with moderate activity, as per ICMR guidelines.

Nutritional Requirements (Estimated Daily Needs)

Nutrient	Daily Requirement (Approx)
Energy	2700 kcal/day
Protein	78–80 g/day
Calcium	1200 mg/day
Iron	25 mg/day
Fluids	3.0 – 3.5 liters/day
Fiber	30 g/day
Vitamins	A, D, B12, C, Folic Acid (↑ needs)

Detailed Point-Wise Menu Plan (Full Day)

Early Morning (6:30 AM – 7:00 AM)

• Start the day with 1 glass of lukewarm water with lemon juice, which helps in digestion and detoxification.
• Consume 5 soaked almonds and 2 walnuts, which are rich in omega-3, protein, and good fats, useful for hormone regulation.
• Take 1 glass of warm milk (200–250 ml) with a pinch of turmeric or jaggery, which provides calcium, helps in post-delivery healing, and enhances immunity.

Breakfast (8:00 AM – 8:30 AM)

• Take 2 stuffed vegetable parathas (with spinach, carrot, or methi), providing complex carbs, iron, and fiber.
• Include 1 bowl of curd or 50–75 grams of paneer, which adds calcium, protein, and probiotics for gut health.
• Add 1 boiled egg or 1 scrambled egg for high biological value protein and vitamin D.
• Eat 1 seasonal fruit (banana/orange/papaya) for vitamins A and C, and digestive fiber.

Mid-Morning Snack (11:00 AM – 11:30 AM)

• Drink 1 glass of freshly squeezed juice (pomegranate/orange) or buttermilk, both of which aid hydration and increase vitamin C.
• Take 1 small bowl of sprouted moong salad with lemon, onion, and tomato, providing plant-based protein, zinc, and folic acid.
• Optionally, include a handful of roasted chana or peanuts for energy and iron.

Lunch (1:00 PM – 1:30 PM)

• Eat 1 cup of steamed rice and 2 chapatis (whole wheat) to fulfill carbohydrate and fiber requirements.
• Include 1 bowl of dal (moong, arhar, or masoor) for protein and iron.
• Add 1 bowl of green leafy vegetable curry (e.g., spinach, methi, or cabbage), which supplies iron, calcium, and folate.
• Take 1 bowl of curd or raita, rich in calcium and helpful for digestion.
• Eat 1 plate of salad (cucumber, carrot, beetroot, tomato) to boost vitamin and mineral intake.
• Finish with a piece of jaggery or 2 dates for natural iron.

Evening Snack (4:00 PM – 5:00 PM)

• Have 1 cup of tea/milk with 2 whole grain or digestive biscuits for a light energy boost.
• Include a bowl of poha, upma, or boiled sweet potato, which gives iron, fiber, and complex carbohydrates.
• Take 1 fruit (guava/apple/pear) for additional vitamins and hydration.

Dinner (8:00 PM – 8:30 PM)

• Eat 2 chapatis (made from wheat + bajra/jowar mix) for iron and energy.
• Include 1 bowl of khichdi or dalia, which is easy to digest and rich in carbs, protein, and fiber.
• Take 1 serving of cooked vegetables (e.g., bottle gourd, carrot, pumpkin) to provide vitamins and minerals.
• Consume 1 glass of buttermilk or 1 bowl curd, which helps digestion and improves calcium levels.
• Optionally, include a small bowl of fruit custard or ragi kheer for additional calcium and energy.

Bedtime (10:00 PM)

• Drink 1 glass of warm milk with a pinch of cardamom or turmeric, which improves sleep, supports bone strength, and continues lactation support.
• Optionally, have 2 dates or a small spoon of ghee, which provides iron and maintains bowel regularity.

Special Dietary Tips for Lactating Mothers like Mrs. Radhika

• Take iron-rich foods such as green leafy vegetables, jaggery, dates, and beetroot to prevent anemia.
• Consume calcium-rich foods like milk, curd, sesame seeds, and ragi to protect bones and teeth.
• Include omega-3 fatty acids through nuts, flax seeds, or fish (if non-vegetarian) for brain health and milk quality.
• Drink at least 10–12 glasses of fluids per day, including water, soup, buttermilk, and milk, to maintain hydration and milk supply.
• Avoid fried, stale, and spicy foods, as they may cause bloating or discomfort and indirectly affect the baby.
• Take doctor-prescribed supplements such as iron, calcium, and multivitamins regularly.
• Practice food hygiene and handwashing to avoid gastrointestinal infections in mother and baby.

b) State the principles of menu planning (4)

Menu planning is the systematic process of selecting a combination of meals that meet the nutritional, economic, cultural, and individual needs of the person or group. A well-planned menu ensures that food is nutritious, affordable, appealing, and suitable for the health condition of the person.

Principles of Menu Planning

1️⃣ Nutritional Adequacy

• The menu should provide all essential nutrients such as carbohydrates, proteins, fats, vitamins, minerals, fiber, and water in correct proportion.
• Meals should meet the Recommended Dietary Allowance (RDA) for the specific age, sex, and physical activity level of the individual.
• Food from all groups (cereals, pulses, fruits, vegetables, dairy, and fats) should be included daily.
• Nutrient-dense foods like green leafy vegetables, fruits, milk, and eggs should be prioritized over calorie-rich junk food.

2️⃣ Age and Physiological Needs

• The food quantity and type should be adjusted according to the age group—children need more protein for growth, elderly need easy-to-digest foods.
• In pregnancy and lactation, meals should be rich in iron, calcium, folic acid, and additional calories.
• A growing adolescent needs high energy and protein foods for puberty-related changes.
• For sick or bedridden patients, the menu should support recovery and may require soft or bland diets.

3️⃣ Economic Consideration

• The menu should use locally available, seasonal, and affordable food items to reduce food costs without compromising on nutrition.
• Cost-effective protein sources like pulses, soy, or eggs can replace expensive items like meat or paneer.
• Planning ahead helps in buying items in bulk or when on sale, reducing waste and cost.
• Substituting expensive fruits or vegetables with local, nutritious alternatives ensures savings and balance.

4️⃣ Variety and Acceptability

• Menu should offer variety in color, taste, aroma, shape, and preparation method to maintain interest in food.
• The same food item should not be repeated in consecutive meals or days.
• Using different combinations (e.g., mixing grains or vegetables) enhances nutrition and visual appeal.
• Serving familiar and favorite foods occasionally increases acceptance, especially in children and elderly.

5️⃣ Cultural and Religious Preferences

• The food should respect the religious beliefs (e.g., no beef or pork, fasting-friendly foods) of the individual or group.
• Cultural habits like use of spices, traditional recipes, or festival-specific items should be considered.
• Menu should be adapted for vegetarian or vegan individuals without compromising nutritional needs.
• Community-level meal planning (e.g., hostels, hospitals) must ensure inclusiveness and tolerance in food selection.

6️⃣ Seasonal Availability

• Using seasonal fruits and vegetables ensures better taste, nutrition, and affordability.
• Seasonal foods are fresher, less chemically treated, and more nutritious.
• Certain traditional seasonal items (e.g., amla in winter, cucumber in summer) also have medicinal or cooling properties.
• Local produce reduces transportation cost and supports the regional economy.

7️⃣ Cooking Skills and Facilities

• Menu should match the available kitchen tools (stove, oven, refrigerator) and storage capacity.
• Simple, time-saving recipes should be preferred if the cook has limited experience.
• Institutions with bulk cooking may need standardized recipes and easy-to-prepare items.
• Cooking methods (boiling, steaming, grilling) should retain nutrients and avoid excessive fat/oil use.

8️⃣ Time and Convenience

• Menu should balance between nutrition and ease of preparation, especially in working families or institutions.
• Meals requiring long preparation time should be planned on holidays or special occasions.
• Quick meals (e.g., poha, upma, khichdi) can be included for breakfast or evening snacks.
• Leftovers from one meal can be reused safely in another (e.g., leftover dal in paratha dough) to save time.

9️⃣ Leftover Utilization and Waste Reduction

• Planning meals in appropriate quantity helps avoid excess food and wastage.
• Safe use of leftovers (e.g., rice to make pulao, chapati to make rolls) adds value and reduces cost.
• Menu should include ideas for reusing peels, stalks, or seeds in chutneys or soups.
• Proper storage and hygiene practices should be followed to prevent spoilage of food.

🔟 Therapeutic Needs (If applicable)

• For diabetic patients, the menu should be low in simple sugars and include high-fiber foods.
• In renal patients, menu must restrict salt, potassium, and protein depending on the disease stage.
• Patients with cardiovascular issues should avoid saturated fats and high-sodium foods.
• Soft diets may be needed for dental problems, post-operative recovery, or gastrointestinal disorders.

Q.5 Fill in the blanks (1×5=5)

i) Hemoglobin is necessary for the transport of ……… from lungs to tissue

Oxygen

ii) Accumulation of abnormal of ketone bodies in tissue and body fluid is called ……..

Ketosis

iii) …….. are the complexes of proteins and lipids

Lipoproteins

iv) …….. Is the main storage form of carbohydrate in plants

Starch

v) Vit. D deficiency in children is called as ……..

Rickets