ANC - 1

11th Part

Q  Prevention of PEM in a community  ( short notes)     5

A  Some of the measures are -

1  Prevention of PEM should start with the mother of the child. The main reason for low birth weight is maternal malnutrition i.e. the mother of the child consumes inadequate quantities of energy and protein during her pregnancy. Therefore, one must ensure that a pregnant woman consumes extra food to meet the additional needs of pregnancy.

2  Mother's milk is the best food for an infant. Lactating mothers should be encouraged to breastfeed their children as long as possible. By the age of about 6 months, however, the mother's milk alone is not adequate for the child. Supplementary food should be provided to the children by the age of six months, in addition to breast milk.

3  Children should be fed 5-6 times a day. As Indian diets are quite bulky and unless the child is fed frequently it cannot meet the energy and protein requirements.  

4  Infections like diarrhoea and respiratory infections increase the risk of PEM. Prompt treatment of these infections is necessary to help to prevent PEM. In addition, during diarrhoea and any other infection, food should not be restricted. The child should be fed as usual.      

5  Protection of children against diseases like tuberculosis or measles, whooping cough by immunization is another important aspect in the prevention of PEM.  

Q  Discuss the main causative factors of protein-energy malnutrition in children. 5

Q  Causative factors of PEM 7

A  Some of the causes of PEM are :

a) Poverty: PEM occurs in poor Indian communities. It is commonly seen in families of landless agricultural labor, and tribal communities without any regular earnings among others. In India, PEM is seen in backward communities of Harijans, nomadic tribes, and children in urban slums. These communities are poor, illiterate, and generally have large families.

b) Maternal malnutrition: The nutritional status of the mother determines the state of nutrition of the child to be born. The main reason for low birth weight is maternal malnutrition i.e. the mother of the child consumes inadequate quantities of energy and protein during her pregnancy.

c)  Infections and poor hygiene:  Infections like diarrhoea and respiratory infections increase the risk of PEM. The mothers may follow unsound and unhygienic methods of feeding the child. Feeding bottles may not be properly sterilized. Flies may be allowed to sit on the nipple of the feeding bottle. This may lead to frequent diarrhoea and lead to marasmus.

d)  Ignorance: Both the forms of PEM occur as a result of ignorance of the mother, in addition to poverty. The mother, due to ignorance;.delays the introduction of supplementary food (in addition to breast milk), even up to the age of 1 year. This has serious consequences because mother's milk alone is not enough for the child by the age of 6 months. The infant should be given supplementary foods in addition to breast milk. Moreover, the mothers restrict the diet when the child is suffering from infections such as diarrhoea, measles, and common fevers. This practice is not good since such a dietary restriction leads to PEM in children who are underfed.

e)  Wrong child feeding practices: The child is usually given the same diet as taken by the adults. The typical Indian diet is based on cereals and is quite bulky for a small child. This would mean that the child can consume only smaller amounts of food at one time. As a result, the child does not get adequate food. Consequently, the child cannot get enough energy, protein which is the major cause of PEM in India.

Q  PEM (Define)                               5

A  PEM can be defined as a range of pathological conditions arising from the deficiency of protein and energy and is commonly associated with infections. Protein-energy malnutrition (PEM) is widely prevalent among young children (0-6 years), however, it is also observed among adolescents and adults, mostly lactating women, especially during periods of famine or other emergencies. PEM has serious consequences for the health of individuals particularly children and can even result in death.  

Clinical features of PEM -

PEM is a condition characterized by two forms:

a) Marasmus

b) Kwashiorkor

The symptoms of are Marasmus - very low body weight for age, loss of fat (fat under the skin), gross muscle wasting. It is observed more frequently in infants and very young children.

Kwashiorkor, on the other hand, is a condition characterized by oedema (excessive accumulation of fluid in the intercellular spaces of tissue) and very low body weight for age. The syndrome is most frequently observed in children aged 1-3 and is precipitated by an infection or by a series of infections.

Enumerate the clinical features and measures for the control of the following disorders :

(a) PEM                                                        5

A  Marasmus -

 (How to identify a child suffering from Marasmus?)

Some common clinical features of marasmus include :

i) Muscle Wasting: The characteristic sign of marasmus is the extensive wasting of muscle with little or no fat under the skin. The ribs are clearly visible. Because of the absence of fat, the skin starts dangling with a number of folds, particularly on the buttocks. The child with marasmus, thus, can be described as a combination of skin and bones.

ii) Failure to thrive: The child suffering from marasmus usually is irritable and fretful. In fact, the child is often so weak that the cry of the child cannot even be heard.

iii) Growth failure: Failure to grow is another important feature of the disease. The children often weigh about 50 percent or less of normal children for their age. For example, a healthy normal one-year-old child weighs about 10 kg, whereas, a marasmic child would weigh only about 5 to 6 kg.

Iv) Deficiency& Infections - The child may also suffer from frequent watery diarrhoea associated with dehydration (loss of fluids). The child may also have other deficiencies particularly, vitamin A deficiency.   

Kwashiorkor 

(How to identify a child suffering from Kwashiorkor?)

Some common clinical features of Kwashiorkor include:

i) Oedema: Oedema is the excessive accumulation of fluid in the intercellular spaces of the tissues. Oedema is usually observed on the lower limbs, but it may also be distributed all over the body including the face. We can detect oedema by pressing the skin of the leg with your fingers. Because of the accumulation of fluid under the skin, when you press there will be a depression at the place where the pressure is applied.

ii) Failure of growth: Children with kwashiorkor weigh only about 60per cent of the weight of normal children for their age. For example, a three-year-old healthy normal boy weighs about 13.5 kgs. whereas, another boy of the same age but suffering from kwashiorkor may only weigh 60 %  i.e about 8 kg. In other words, they are very much lighter than healthy normal children of their age.

iii) Irritability: The child suffering from kwashiorkor is generally irritable and has no interest in his/her surroundings.

iv) Skin Changes; The skin of the child may peel off easily leaving behind cracks or sores.

v) Hair Changes: The hair may become sparse and can be easily pulled off. The hair usually loses its black colour and appears reddish-brown.  

vi) Moon Face: The face of the child suffering from kwashiorkor may appear puffy with the cheeks sagging. This condition is normally known as a moon face.    

vii) Associated deficiencies: The children may have signs of other deficiencies like those of vitamin A and B-complex deficiencies.      

viii) Associated diseases: The child is often suffering from watery diarrhoea (frequent loose motions) or severe respiratory infection (cough). The children may be suffering from measles, a childhood disease.

Q  Xerophthalmia     2

Q  Briefly describe the clinical features of xerophthalmia.   5

Q  Causative factors of Xerophthalmia                            4

A  Xerophthalmia refers to the eye manifestations (signs) because of vitamin A deficiency. Blindness as a result of xerophthalmia is an important public health problem in India.

Clinical features of xerophthalmia. -

a)  Night Blindness: One of the earliest manifestations of xerophthalmia is night blindness. Individuals suffering from night blindness cannot see in dim light or around dusk. The child will be unable to see even the meal plate kept in front of him/her in dim light.

b)  Conjunctival Xerosis: Xerosis means dryness. In the normal eyes, the membrane covering the white portion of the eye (i.e.conjunctiva) is bright, white, and moist. In the case of xerophthalmia, it becomes discolored (muddy coloured), dry, and loses its brightness. This is known as conjunctival xerosis.

C  Bitot spots: In addition to xerosis, dry foamy, triangular spots may appear on the conjunctiva. These are known as Bitot's spots. If they are neglected, the changes may continue to progress affecting the cornea of the eye and may lead to irreversible blindness.

d)  Corneal xerosis:  When the deficiency of vitamin A becomes severe, the cornea becomes dry and dull and appears like ground glass. This condition is called corneal xerosis which means dryness of the cornea. This condition should be treated as an emergency. If it is not treated immediately with vitamin A, the child can develop ulcers in the cornea. Corneal ulcers when healed leave white scars known as leucoma that interferes with normal vision.  

e)  keratomalacia: The most dangerous form of xerophthalmia is known as keratomalacia. In this condition, the cornea becomes very soft and raw and easily infected. It leads to the destruction of the eye. In other words, the eye gets completely melted and destroyed. This condition leads to irreversible blindness.  

The causative factors of Xerophthalmia -

a) Dietary inadequacy of vitamin A: The primary cause of xerophthalmia is the deficiency of vitamin A in our diet. In the villages and urban slums, among the low-income groups, the intake of vitamin A is less than a quarter of the Recommended Dietary Intakes (RDI).

b)  Maternal Malnutrition: Indian children from very poor rural families are born with low stores of vitamin A in the liver it is because their mothers are also deficient in vitamin A. Due to inadequate consumption of vitamin A, the child develops xerophthalmia.  

c)  Infections and Infestations: Diarrhoea and respiratory infections and worm infestations like roundworm disease are very common in children. These are known to decrease the absorption of vitamin A and lead to deficiency. Measles, one of the childhood infections, is another important cause of xerophthalmia.    

Q  Clinical features of Vitamin A deficiency                6

A   Above

Q  How to prevent Vitamin A deficiency?

A  Consume Vitamin A rich diet: the most rational method of prevention of vitamin A deficiency is to make sure that communities consume foods rich in vitamin A regularly. Inexpensive foods like green leafy vegetables (palak, amaranth, etc.), yellow vegetables (yellow pumpkin and carrots) and fruits (papaya and mango) are good sources of beta carotene.

Periodic administration of Vitamin A: It is possible to build up sufficient vitamin A stores in a child by giving large doses of vitamin A periodically. Under the program, the children between the ages of one and five years are given a massive oral dose of vitamin A (200.000 IU) once every six months. The distribution of vitamin A is carried out by the village level health workers like health workers of the State Governments.  

Q  Explain the causative factors and preventive measures for anaemia.   8

Q  Preventive measures of Iron deficiency                  5

Q  Discuss in detail how nutritional anemia can be prevented.  7

A  Causes - Anaemia occurs due to iron deficiency or folic acid and vitamin B12 deficiency. The various causes of iron deficiency anaemia are -dietary deficits or less absorption of iron and loss of iron from the body.

a) Dietary inadequacy: The deficiency of iron in the body can be due to two reasons - low dietary intake of iron or reduced (low) absorption of iron in the body. The iron requirement is high in the body in certain physiological conditions especially in infants, children & women in reproductive years(as a result of menstruation, pregnancy & lactation). If iron intake during these periods is not adequate, it may result in anaemia. Iron absorption problem

b) Losses of Iron: The second major cause of anaemia is increased loss of iron from the body. In adult women of reproductive age, loss of iron occurs due to menstrual loss, loss of iron occurs during pregnancy, delivery, and lactation. If proper care of women is not taken during these periods, it can lead to anaemia. Iron losses from the body are also more in the case of people suffering from hookworm and other worm infestations. Heavy loss of iron from the body in conditions of surgery or accident can also lead to anaemia.

Folic acid and Vitamin B12 deficiency: Anaemia can also occur due to the deficiency of folic acid and vitamin B12 as they play a major role in blood formation. People who are strict vegetarians but avoid green leafy vegetables or eat no animal products are prone to it.  

Preventive measures for anaemia -  

a) Dietary measures: The most rational method of prevention of anaemia is to ensure the consumption of diets by the population that is rich in iron. The women should be particularly encouraged to consume iron-rich foods regularly. Inexpensive sources of iron are green leafy $vegetables (palak, amaranth, etc), whole wheat flour, rice flakes, other vegetables like (lotus stem), groundnuts, apple, jaggery, amla. These foods should be consumed as they are rich sources of iron, care should be taken that enough vitamin C-rich and protein-rich foods are consumed along with them (as they enhance absorption of iron).  

b) Fortification of foods: Certain food items that are consumed on a regular basis are fortified with iron to improve the iron content in them and subsequently increased consumption of iron by vulnerable sections of the population. Baby foods are fortified with iron to protect infants from anaemia, today many food items are fortified with iron like biscuits, wheat flour.

c) Distribution of iron and folic acid tablets: By consuming iron tablets, the hemoglobin levels in the blood can be raised. For over the last 20 years, iron (60 mg) and folic acid (500pg) tablets are distributed among the vulnerable sections of the community (those who are more prone to deficiency disorders) women, pregnant and lactating women, and children (1-5 years).

Q  Prevention and control of IDD     5

Q  Give any two clinical features of Iodine deficiency disorder.    2

Q  Spectrum of iodine deficiency disorders   5

Q  Give the clinical manifestations of iodine deficiency disorder. 4

A  Causes - In mountainous and hilly regions, iodine deficiency occurs because of the washing down of the soil from iodine content due to heavy rains and glaciers. In the case of plains, repeated floods deplete the iodine content in soil and water. As a result, all animal and vegetable foods dependent on the soil and water are deficient in iodine. Thus, when these foods which are deficient in iodine are consumed, it leads to iodine deficiency.

Apart from this, certain chemical substances called goitrogens (goiter producing substances) interfere with the utilization of iodine by the thyroid gland. Foods like cabbage and radish are contained goitrogens. Consumption of these foods in large quantities in some cases may lead to iodine deficiency.    

 Two clinical features of Iodine deficiency disorder - Goitre and cretinism

The clinical manifestations of both goitre and cretinism are -

Goitre - Iodine is essential for the normal functioning of an endocrine gland known as the thyroid gland. The thyroid gland secretes a hormone called thyroxine, which is very important for normal human development and health. Iodine helps in the formation of thyroxine. When iodine is inadequate, the thyroid gland enlarges in an attempt to produce thyroxine for the body's needs. Due to the deficiency of iodine in the body, the thyroid gland enlarges in order to trap more iodine (whatever is available). The swelling or enlargement can vary in size depending on the severity of the goitre. The word goitre means swelling/or enlargement of the thyroid gland.

Cretinism: It is the most severe manifestation of IDD. Cretinism refers to the adverse effects of iodine deficiency on the infant and young child. Iodine deficiency interferes with the brain development of the foetus. This means it can cause irreversible brain damage even before birth. If an infant is born to an iodine-deficient mother, he or she is likely to suffer from hypothyroidism. If this condition of iodine deficiency or hypothyroidism continues further even after the birth of the child, the child may suffer from a series of disorders which may include mental retardation, growth failure, speech and hearing defects, neuromuscular disorders, paralysis.

Prevention and Control - Control: Since IDD is due to reduced intake of iodine, the rational method is to ensure a sufficient intake of iodine by the population living in areas where IDD is common. A few methods to increase the iodine intake of people residing in endemic regions include:

1) Use of Iodized salt: The oldest and the most extensively used method is fortification (enrichment) of common salt with iodine (Potassium iodate). For 10 g of common salt about 150ug iodine is added. The iodized salt (common salt to which iodine is added) smells, tastes and even looks exactly like the common salt.

2) Use of tablets of sodium or potassium iodide: The intake of sodium/potassium iodate tablets to school children in areas where goitre and cretinism are severe. The addition of iodine to the drinking water supply has been tried in some countries.    

3) Use of Iodized oil: During the last decade, injection of oil, to which iodine has been added is given in areas where goitre and cretinism is severe. The advantage is that an injection of a 1 ml dose of iodized oil can provide protection to an individual for 3-5 years.   

FST -1

11th Part

Q.  Mention the role of biotechnology in the field of agriculture.   

A.  Due to biotechnology certain favorable changes have been introduced in agriculture by scientists. Some of the examples of biotechnology are the high Yields seeds, resistance to diseases, improved nutritional quality, and adaptation to adverse environmental conditions. An important aspect in the production of improved plants is the breeding process. This enables one to combine, one or more, favorable quality of the parents to be passed on to their progeny. For this purpose, scientists use several methods for raising the plants. The most common methods are:-

(i) the traditional method, in which seeds and root stocks have been used as basic materials for raising plants,

(ii) the other method is the use of plant cells as any plant cell can give rise to a complete plant. These methods are useful not only for the improvement of present-day crops, but also for the creation of novel plants and new crops, which are of short duration, high-yielding-type, and resistant to diseases and other adverse environmental conditions.

Q.  Mention the names of two diseases caused due to protein-calorie malnutrition. State their symptoms.                         

A.  Two severe diseases which are caused due to the deficiency of proteins and protein-calorie are Kwashiorkor and Marasmus, respectively. Millions of children die annually and millions more go through a miserable life because of these diseases. They retard the child's physical growth and weaken its natural immunity to various infections. In extreme cases, children are mentally retarded and they never reach maturity and thus become a burden to the family and the nation.

Symptoms of Kwashiorkor - The symptoms of kwashiorkor include: change in the skin and hair colour (to a rust colour) and texture, fatigue, diarrhoea, loss of muscle mass. failure to grow or gain weight, edema (swelling) of the ankles, feet, and belly. It also leads to the damaged immune system, which can lead to more frequent and severe infections. Hence the child is exposed to diseases. Due to low energy food and protein intake, the child gradually loses the appetite and often develops weaning diarrhoea.

Symptoms of Marasmus - Thin face, Ribs, and shoulders clearly visible through the skin. Very loose skin that sometimes hangs in folds in the upper arms, thighs, and buttocks. Persistent dizziness, Sunken eyes, Diarrhoea, Active, alert, or irritable behaviour, and Frequent dehydration. This is manifested by severe retardation in growth, loss of muscles and subcutaneous fat.

Q.  Why is soil considered a basic resource for agriculture? How can saline and alkaline soils be reclaimed?                     

A. Nature takes more than 50 years to build a centimeter of top soil. But every year, wind, water & human neglect, cause worldwide erosion of over 6,000 million tonnes of soil, along with 2.6 million tonnes each of nutrients like nitrogen and potassium, and 3.3 million tonnes of phosphorus. Though history has taught us that civilizations have vanished because of improper use of soil, still we are diverting millions of tonnes of excellent soil for brick-making and road laying. This wasteful practice should be drastically curtailed by making use of alternative and more durable materials for making bricks and roads. Today, our agricultural land is less than 0.33 hectares to a person, which is below the prescribed limit. It is time we created a country-wide awareness of the value of soil and the importance of scientific land use. We must understand that, if we neglect our soils, our future will be in peril.

             Saline and alkaline soils are the result of centuries of neglect and mismanagement of our soils. About 7 million hectares of land is thus affected. These unproductive soils cover about 2.5 million hectares in arid Rajasthan and Gujarat, 1.4 million hectares in the black-soil region, and 2.1 million hectares in the coastal regions. Alkaline soils contain high amounts of carbonates and bicarbonates of sodium. Saline soils contain chlorides and sulphates of sodium, calcium, and magnesium. In both the above types of soils, salts are present in quantities large enough to interfere with crop growth.

             It is now possible to reclaim alkaline soils with the cultivation of fodder grasses like Brachiaria mutica (Para ghas), Panicum antidotale (Neelon ghas) and Cynodon dactylon (Doob), and tree species like Prosopis chilensis (Vilayati khejri), Acacia nilotica (Kikar) and hybrid Eucalyprus. The trees establish quickly when planted in small holes filled with manure to which a little gypsum is added. In the very first year after reclamation with grasses, this soil can be used for planting other crops. Here, special varieties of rice can be grown as Kharif, and wheat as rabi crop. 

             The crucial factor in the management of saline soils is drainage. Saline soils have a high water-table. Drainage channels one meter deep and 30 meters apart effectively bring down the water table and help in reducing soil salinity. In the soils reclaimed in the above manner, sorghum, maize, and wheat which can tolerate salinity of soil can profitably be raised.

Q.  What is Biotechnology? Describe the underlying techniques of genetic engineering and enzyme immobilization.           

A.  Biotechnology is a branch of science which deals with the use of biological systems, organisms to produce products on a large industrial scale. Due to biotechnology certain favorable changes have been introduced in agriculture by scientists. Some of the examples of biotechnology are the high Yields seeds, resistance to diseases, improved nutritional quality, and adaptation to adverse environmental conditions. An important aspect in the production of improved plants is the breeding process. This enables one to combine, one or more, favorable quality of the parents to be passed on to their progeny. For this purpose, scientists use several methods for raising the plants. The most common methods are:-

(i) the traditional method, in which seeds and root stocks have been used as basic materials for raising plants, 

(ii) the other method is the use of plant cells as any favorable plant cell can give rise to a complete plant. These methods are useful not only for the improvement of present-day crops, but also for the creation of novel plants and new crops, which are of short duration, high-yielding-type, and resistant to diseases and other adverse environmental conditions.

Genetic Engineering - It involves the alteration of the genetic material of a particular plant, by the substitution or addition of new genetic material from some other plants. Presently, the scientists, are trying to transfer the genetic material, that enables legumes to fix nitrogen in the soil, to various economically important plants. If this is achieved, it would be a milestone in agriculture.

Tissue Culture - It makes use of the important quality of plant cells as any favorable plant cell can give rise to a complete plant. Based on this fact, any cell or a group of cells, or part of a plant such as a piece of stem, leaf, etc. can be grown on a nutrient medium under suitably controlled conditions in the laboratory. This method is commonly known as tissue culture. It enables us to get true-breeding types without going through the stages of flowering, production of seeds and their germination. This technique has great potential in our crop improvement programmes, and it has already been used in the improvement of varieties of wheat, rice, corn, and several other plants. This method is useful not only for the improvement of present-day crops, but also for the creation of novel plants and new crops, which are of short duration, high-yielding-type, and resistant to diseases and other adverse environmental conditions. 

              By applying the principles of biotechnology we can raise orchards where the fruit trees will be of desired, manageable height and form. The fruits will be of uniform size, shape, color and weight. They will have the same flavor and nutritional value and will ripen at the same time. This will make harvesting, storage, packing, transport, canning, and processing easy.  

Q.  Discuss the importance of nutrition for the health of a person. State the different nutrient groups with their respective functions.    

A.  To remain healthy and free of disease, our body requires certain kinds of food. The health of an individual is largely determined by the quality of food taken. Moreover, food makes a difference in our appearance, activity, behaviour, and in the quality of life. Foods vary in their composition and no one type of food contains all the required nutrients. A meal lacking in a particular requirement of our body for a prolonged period can result in disease, and even in death. Therefore, a knowledge of the food requirements of our body and various sources of obtaining them is essential. Studies carried out in many countries show that a good diet has promoted proper growth in children and has improved the general health of the people. Conversely, lack of diet, or diet without essential nutrients can lead to a steady decline in the physical and mental growth of these children and they suffer from various deficiency diseases.  Scientists have determined the chemical substances present in different foods and their role in the body. They call these substances "nutrients" and have classified them in different groups. These are Carbohydrates, protein, minerals, fats, water, vitamins. Their functions are -

1.  Carbohydrates and Fats are the main energy source for the body. Carbohydrates are easily available and are the cheapest source of energy. Fats also serve as an "emergency energy store" in the body, to be used, for example, when enough food is not available due to fasting or starvation. Therefore. carbohydrates and fats are called Energy Foods.

2.  Proteins are the raw material used for building muscles, skin, blood, and bones. They repair the tissues which are constantly worn out. Therefore, we need to have proteins every day. Proteins can also serve as an energy source if the energy need of the body is not met by carbohydrates and fats. They also help us to fight infection.

Proteins are called Body Building Foods.

3.  Minerals and Vitamins are not a source of energy but they are necessary in many of the steps involved in the release of energy in the cells. Thus, they help the body to make good use of food. They protect us from illness. Minerals, such as calcium, are the basic components of bones and teeth. Iron is a component of the red pigment of blood called haemoglobin. Minerals are important in the transmission of nerve impulses and for muscle contraction and relaxation. Vitamins and minerals are called Protective Foods.

4.  Water is a component of all body fluids such as blood, digestive juices, etc. Water accounts for about 50 to 70% of the body's weight. It is essential for various metabolic activities. In fact, our body cannot utilize any substance, unless it is first turned into a form soluble in water. Digestion converts food into a soluble form so that it is readily absorbed and is carried by the blood to the sites where it is needed. The waste products like urea are carried by the blood to the kidneys from where they are excreted. Water also plays a role in regulating body temperature, through perspiration. The daily water requirement of the body depends on the climate, activity and the kind of food one takes.

Q.  What is meant by a balanced diet? suggest the composition of a balanced diet needed by an adult working man.       

Q.  What is a balanced diet? Name four items in a meal which would make it a balanced meal.                                

 A Balanced diet is a combination of various foods that fulfill all the basic requirements of the body in essential nutrients. The intake of a balanced diet can fulfill the energy needs of a person and can provide proteins, vitamins, minerals, carbohydrates and fats in proper quantity and proportion. It is required to keep him healthy, active and free from any disease. 

                    Balanced Diet for Various Age Groups

Mixed cereals, Pulses, green leafy vegetables, and milk or milk products are the four important items that should be included in the meal to make it a balanced diet.

Q.  (i) "Agriculture is the bedrock of the Indian economy." Justify the statement.

(ii) Write brief comments on the basic resources for agriculture in India.   

A.  Agriculture is the bedrock of the Indian economy as of the approximately 245 million working people in India, (1981 figures) 149 million people are engrossed in the agriculture sector. About 93 million were cultivators and 56 million were agricultural laborers. Together they constituted more than 60% of the total work-force of India. To these 149 million people, agriculture is not only the main source of income but a way of life. Almost 70%of the total population resides in villages which are completely dependent on agriculture-related activities. We have a total geographic area of about 329 million hectares. The net area under cultivation is 142 million hectares, of which about 31 million hectares are cultivated more than once a year, hence the total cropped area amounts to 173 million hectares. Our farmers and agricultural laborers, who constitute 60.5% of the work-force, contribute 34.7% of our total net national product. Hence, agriculture employs a large chunk of our manpower and provides the means to earn their Livelihood. 

          There are three basic resources for agriculture, they are sunlight, soil, and water. 

Sunlight - It is the basic resource of agriculture which is used by plants for producing food during the photosynthesis process. During monsoon, the wettest season, the sky is overcast most of the time and thus the availability of sunlight is minimum. In summers, maximum sunlight is available, but unfortunately, it is the period when water availability is at its minimum. Winter, however, is the best period of the year, as there is enough of sunlight and moisture.

Soil

Soil is another important resource. Nature takes more than 50 years to build a centimeter of topsoil. Soil, which forms the uppermost layer of the land, is the most precious of all resources because it supports the whole life system on Earth. It provides food and fodder in the form of vegetation and stores water essential for life. It contains sand, silt, and clays, mixed with air and moisture. It possesses rich organic and mineral nutrients that are required for agriculture. The type of soil varies from place to place. Those soils which are rich in organic matter are fertile. Fertility is also dependent on the capacity of the soil to retain water and oxygen. There are different types of soils found in our country. Alluvial soils in the North Gangetic plains are the finest, black soils are next in productivity which are followed by red-and-yellow soils. The other kinds of soil available in our country are red soils, deltaic alluvial and Brown, laterite, desert, hill and mountain soils. Deep red soil is good for the cultivation of potatoes, bananas, pineapples, and rubber, etc. Black soil supports crops of sugarcane, groundnut, soybean, cotton, and rice, etc.

Water

Water is the third important resource in agriculture. A major problem in our country's agriculture is its dependence on rain to fulfill the requirements of water. Out of our net cultivated area of 142 million hectares, only 40 million hectares of area is covered by irrigation network. The rest is dependent on rain. In our country, which is situated in the monsoon belt of south-east Asia, the rainfall is neither uniform nor is evenly distributed throughout the year. As a result of it there are many regions in our country which get scanty rainfall resulting in agriculture failure.

ANC - 1

10th Part

a)A male child of one year weighs 4.7 kg as against the normal of 9.5 kg. The child is suffering from ......... form of PEM.

A  Severe (i.e.4.7*100/ 9.5 = 49.5% which is less than 50% of the normal weight for age.) 

b) A child who has extensive wasting of muscle is suffering from ........

A  marasmus

c) In the case of PEM, subclinical forms can be identified by using.

A  body-weight

d) ........................is the condition characterized by sagging cheeks and puffy face.

A moon face

e) .....................................is. the condition, where external medical examination may not show any sign of the disease. 

A  subclinical forms

Q  List 3 measures which you would like to adopt to prevent PEM in a village community.

A   a) Improve maternal nutrition by ensuring adequate intake of energy-rich foods by pregnant women to increase the birth weight of their offsprings.

b) Breastfeed the child as long as possible.

c) Introducing supplementary food in addition to breast milk by the age of 6 months.

d) Children should be fed 5-6 times a day.

e) Prompt treatment of minor ailments like diarrhoea and respiratory infection.

f) Immunization of children against diseases.

Q  List the main causes of PEM in infants.

A  Poverty, Maternal malnutrition, Infections, and poor hygiene. Ignorance, Wrong child feeding practices.  

a) Xerophthalmia is due to the deficiency of. .........................in the diet. 

A   vitamin A

b   Conjunctival xerosis means ................... of the conjunctiva.   

A  dryness 

c) The most dangerous consequence of xerophthalmia is irreversible....…

A   blindness 

d) Dry, foamy, triangular spots appearing on the conjunctiva are called.. .....…

A   bitot spots

Q  The clinical features of xerophthalmia relating to the cornea are: 

A   Corneal xerosis, corneal ulceration, and keratomalacia.

Q  List the main causes of xerophthalmia in India.

A  a) Maternal malnutrition

b) Deficiency of vitamin A in the diets

c) Infections like diarrhoea, measles, and. respiratory infections

d) Infestations like roundworm disease

e) Ignorance leading to avoidance of vitamin A-rich foods  

Q  What advice will you give to a mother of a preschool child in a village to prevent xerophthalmia?  

A  # Give daily one of the inexpensive local foods like green leafy vegetables, carrots, yellow pumpkin, papaya, or mango.

# Provide a massive oral dose of Vitamin A (200,000 IU) once every six months.  

Q  List the population groups at risk of developing anemia.

A   Pregnant women, lactating women, children under the age of five years, and women in the reproductive age group.   

Q  Fill in the blanks :

a) Ninety-five percent of anemia in India is due to. ..................deficiency.

A   Iron

b) Anaemia arises when the transport of ...................by the blood is insufficient to meet the needs of the body. 

A   Oxygen  

c) In pregnant women, the hemoglobin level below ...................in the blood is considered as anaemia.

 A   11 g per 100ml

d) Milk is a ...................source of iron. 

A  poor

Q  Match the following :

a) Intrinsic factor '                  i)  B12

b) Absorption of iron             ii) Animal foods

c) Common salt                     iii) Fortification

d) Iron                                    iv) Folic acid  

Q  Which are the areas in India where iodine deficiency has been prevalent for years 

A   Sub Himalayan belt extending from Jammu & Kashmir in the north to Nagaland in east   

Q  List the methods of control of iodine deficiency disorders.

A  Iodization of salt is the simplest method. In remote areas intramuscular injections of iodized oil can protect the community for 3-5 years against IDD or sodium/potassium iodide tablet can also be given.

Q  Fill in the blanks :

a) Iodine is required for the formation of .................hormone. 

A   thyroxine 

b) We require ....................ug of iodine per day. 

A   150

c) Substances which interfere with the utilization of iodine by the thyroid gland are called..  ......................…

A    goitrogens

d) The most suitable method for control of iodine deficiency in India is the use of. .......

A    (iodized salt)

e) ..........................and ...........................are the most easily recognized forms of IDD.

A    Goitre, cretinism

ANC - 1

9th Part

Q  A relationship between nutritional status & infection exists 5

Q  Infection can influence nutritional status.     5

A  Effect of Infection on Nutritional Status -

Nutritional status is the condition of the health of an individual as influenced by the utilization of nutrients. 

a) Reduced food intake: When a child is suffering from infections like diarrhea or respiratory infection, one of the first changes noted by the mother is the loss of appetite. Quite often, the child may not like or tolerate food. As a result of this, the child consumes less food or there is reduced dietary intake. Furthermore, the antibiotics used in the treatment of infection may also reduce the appetite in the child leading to reduced food intake.   

b) Effect on the absorption of nutrients - during digestion various nutrients are absorbed and they enter the bloodstream. Any decrease in the absorption of nutrients can lead to a deficiency of the particular nutrient. It is observed that in the case of infections

like diarrhea, measles, and respiratory disease there is a reduction in the absorption of nutrients. Only 60-70 percent of the nutrients consumed are available to the body. Even worm diseases like roundworm disease usually reduce the absorption of nutrients, thus, leading to ill-health.

c) Loss of protein: In some of the infections and fevers, few nutrients, particularly proteins are excreted i.e. lost from the body. This naturally increases the requirement of protein during infections and fevers. The overall effect of the infections on the dietary intake of the child is substantial. In a poor rural child, who is already on a deficient diet, the effect of the infections can, therefore, be devastating.    

Q  Enumerate the effect of infection such as diarrhea on the nutritional status of an individual. It also gives the dietary management of diarrhea.     4+4

A  Diarrhoea and Nutritional Status

Diarrhoea is a symptom that is characterized by the sudden frequent onset of stools of a watery consistency, abdominal pain, cramping, weakness, and sometimes fever and vomiting. Diarrhoea is very common among children and it can reduce the appetite of the child considerably. As a result, the child does not eat properly.

Further in diarrhoea fluids are lost from the body. Along with the fluids, important minerals such as sodium and potassium (usually known as electrolytes) are also lost. This loss of fluids and electrolytes during diarrhoea leads to dehydration. It is this dehydration that is responsible for the high death rate in children with diarrhoea. In the villages and slum areas in the cities, the children generally suffer from frequent and repeated attacks of diarrhoea. Repeated attacks of diarrhoea lead to significant weight loss in children. If we examine the nutritional status of children affected with diarrhoea we notice that the bodyweight of these children is much lower than the normal children. Similarly, diarrhoea are also associated with kwashiorkor and marasmus, the clinical features of PEM. 

Q  Enumerate the clinical features and measures for the control of Obesity       5

Q  Dietary management of Obesity                  5

A  We can call a person obese if he or she weighs 20 percent above the ideal body weight (if a person's ideal body weight is 45 kg and he weighs 55 kg i.e. higher than 20 percent of his ideal body weight, he is obese). However, the term overweight is applied only to persons who weigh 10 percent to 20 percent more than the ideal body weight. Ideal body weight refers to the average or desirable weight of a healthy individual according to height and body frame. 

The different measures to control obesity are dietary modifications, physical exercise, and psychological support. 

Dietary management of Obesity - 

i) Food restrictions: For dietary modification, firstly make a note of foods(no of meals) one (obese individual) eats throughout the day. Don't forget to count the foods one eats in between meals like biscuits, namkin, a piece of sweet, toffee, or chocolates. Calculate the total energy intake. Energy restriction has to be slow and gradual. Start reducing 200-300 Kcal per day and slowly more restrictions can be placed. Do not start energy restriction with main meals. First cut down on the extra titbits one tends to eat in between. Give smaller meals at regular intervals. Don't let the person miss a meal. In general, a restriction of 500 Kcal per day results in a loss of about 450 g a week and 1000 Kcal leads to a loss of about 900 g a week. 

ii) Cut down the intake of fat and fat-rich foods: Restrict the intake of visible fat. Give visible fats in the form of vegetable oils. Avoid giving ghee, butter, or hydrogenated fats as they contain saturated fats and cholesterol.    

iii) Give more protein-rich foods: Add enough of protein-rich food in the diet. Around 1 g protein/kg body weight can be given. Milk (toned milk or whole milk from which cream has been removed), pulses, lean meats, chicken, fish.

iv) Give more of leafy vegetables and yellow and orange fruits: They provide the basic protective and regulatory nutrients.

v) Give more fiber-rich foods: Add more fibrous foods in the diet as they have more satiety value. They not only satisfy hunger but also provide less energy (calories). Whole cereals, whole pulses, fibrous fruits, and vegetables.   

Q  Enumerate the risk factors for obesity.             5    

A  Over-eating: Eating too much-is a habit with many people. If one has the habit of eating more food in general or consuming energy-rich foods like butter, cakes, pastries, jam, jellies, wafers and other rich snacks and desserts, one is likely to gain weight. Some people prefer to eat less during mealtime, but keep on munching snacks throughout the day in between meals which also adds to the weight. 

Sedentary lifestyle: Besides food intake, another factor that is responsible for gaining bodyweight is lesser physical activity. In urban areas, especially the affluent or rich class people lead a sedentary lifestyle. Most of the time they are involved in some kind of mental work and do very little of running or walking around. Today housewives are equipped with electric gadgets like a vacuum cleaner, mixer, washing machine, etc. to make work simpler for them. Such people tend to spend or use very little calories they have consumed as part of the food. As a result of it, they gain weight.

Psychological factors: Some people tend to eat more when they are tense or bored or lonely. These people use food as the outlet for the release of tension and boredom. Because of this, such people gain weight and become obese.   

Genetic influence: Obese parents do tend to have obese children. This fact has been proved by medical research investigations. If both the parents are obese, the chances that children will be obese goes up to 80 percent.   

Q  Discuss the factors which favor the development of obesity and list the dietary measures you would adopt to prevent this condition.  8

A  above 2 questions 

Q  Principles of treatment of obesity    5  

A  I) PRINCIPLES OF TREATMENT OF OBESITY: The main principles are -

#  slow and gradual reduction of body weight till it is closer to ideal body weight

#  maintenance of weight loss achieved

#  prevention of complications like heart disease or diabetes mellitus.

2) THE MODIFIED NUTRITIONAL NEEDS: The modifications needed for obese individuals are-

Energy - In general, a restriction of 500 Kcal per day results in a loss of about 450 g (1 pound) a week and 1000 Kcal leads to a loss of about 900 g (or 2 pounds) a week. In many studies, it has been found that a daily intake of 1400-1600 Kcal results in satisfactory weight reduction. However, it is not the same for every individual. Start reducing 200-300 Kcal per day and slowly more restriction can be placed, one can go up to 1000 to 1200 Kcal depending upon requirements of an individual.    

Protein: Add enough protein-rich foods in the diet. Around 1 g protein/kg body weight can be given.

Fat: Restrict the intake of visible fat. Give visible fats in the form of cooking oils. Avoid giving ghee, butter or hydrogenated fats-they contain saturated fats and cholesterol

Vitamins and minerals: Diet should provide vitamins and minerals in adequate amounts according to recommended dietary intakes.   

DIETARY MODIFICATIONS above 

Q  Explain briefly the modifications needed in the amount of energy, protein, carbohydrate, and fat in the diet of an : (i) Obese individual                    6

A  above 

Q  List the clinical features & measures you would adopt to prevent Diabetes mellitus  5

A  Clinical features - If an individual has increased thirst, increased urination, increased hunger, or weight loss all of a sudden, it can be due to diabetes. Other symptoms that indicate the presence of diabetes are blurred vision, weakness or loss of strength, pain in legs.

However, in order to confirm the presence of diabetes in an individual, one has to depend on blood and urine tests. A test called the glucose tolerance test (GTT) is performed to confirm the presence of diabetes in an individual.The three measures commonly adopted for control of the disease are:

a)  dietary management alone

b)  dietary management and oral drugs

c)  dietary management and insulin doses.

I) MAIN PRINCIPLES OF TREATMENT: The principles for the treatment of diabetes mellitus are -

a)  maintain ideal body weight and general well-being

b)  keep the person relatively free of symptoms

c)  prevent further complications.   

2) MODIFICATIONS IN NUTRITIONAL NEEDS: The following modifications are needed in RDIs for various nutrients.

Energy: Control of energy intake in order to maintain ideal body weight is essential. If the individual is underweight, then an increase in total energy intake is recommended. However, if an individual is overweight energy restriction is essential. The main aim of treatment is to maintain the ideal body weight.

Protein: For diabetic individuals, the protein intake considered is 1 g/kg body weight.    

Carbohydrates - Around 80-100g carbohydrates should be given to prevent too much breakdown of fat and accumulation of its by-products (ketosis). However, most of the carbohydrates taken should be in the form of complex carbohydrates (having more fiber). Refined or simple carbohydrates need to be avoided. Fibre reduces the fasting blood sugar level and insulin requirements. On the other hand, simple carbohydrates tend to increase fasting blood glucose levels. They are readily absorbed and immediately raise blood sugar.  

Fat: The diabetic individual should not be allowed to take more than 15 to 20-g fat per day. This is because he/she is more at risk of developing heart disease. Foods high in saturated fat and cholesterol should be limited. Effort should be made to give fats having unsaturated fatty acids.  

Q  Indicate two risk factors- of diabetes.    2   

A  Age: Although diabetes can begin at any age, middle-aged people are prone to it.

Malnutrition: Undernutrition and overnutrition both play a role in the development of the diseases. Thus, both underweight and obese (overweight) individuals are more at risk.

Heredity: People whose parents, grandparents, or siblings are suffering from the disease are at higher risk.

Gestation: Some women develop diabetes during pregnancy (gestation). In most of the cases, it gets cured after delivery. Such women who had diabetes during pregnancy are at risk of developing the disease later.

Stress: Some of the studies have indicated that some factors like emotional stress, anxiety, etc. can lead to the development of the disease in the body.

Q  Dietary modifications for diabetic individuals  5    

A  Dietary modifications are - 

Energy-Giving croup

Cereals- Use of whole-grain cereals like whole wheat flour is recommended. The use of refined cereal products like maida, suji, etc. should be restricted or avoided.

Roots.and tubers- Use of roots and tubers like yam, colocasia, potato, sweet potato should be in moderation as they contain more refined or simple carbohydrates.

Sugar- Sweeteners like table sugar, jaggery, honey, glucose, and others like jams, jellies, marmalade, and concentrated sweets (like toffees, chocolates, burfi, gulab jamuns, and other such sweets) should be avoided.

Fat- Not more than 15 to 20 g of visible fat should be allowed. Unsaturated fats like groundnut oil, soya oil, corn oil, etc. Should be used in moderation. Saturated fats and cholesterol-rich foods should be avoided. 

Body-Building Group

Milk- Milk should be taken literally. The use of milk products like paneer, curd, khoya, etc. should be encouraged. However, the use of full-fat milk or buffalo's milk should be restricted. 

Pulses- Use of pulses (especially the whole pulses) should be encouraged. This is because whole pulses are not only rich in protein but also fiber. {In order to ensure adequate intake of protein and fiber in the diet, one could mix the flour of Bengal gram (whole) in atta (whole wheat flour) used for making chapatis for a diabetic individual in the proportion of 1:2 (1 part of Bengal gram (whole) flour and 2 parts of atta (whole wheat flour).}  

Egg- Eggs (especially egg yolk) should be consumed in moderation. If one is fond of taking eggs, one can take the egg white and discard the yolk portion (as it is a rich source of cholesterol).

Flesh foods- Avoid Organ meats like liver, kidney, etc. As they are rich sources of cholesterol. Consume lean meat for diabetic individuals or preferably use chicken or fish. 

Protective/regulatory Group

Vegetables: Increase the intake of vegetables especially fibrous vegetables (like leafy vegetables, lotus stem, brinjal, beans, etc.).

Fruits: Fruits, as they are sweet, need to be taken with caution. One should take very sweet fruits like mango, grapes, sapota, watermelon, sugarcane juice, all canned foods, banana, and apple, etc. with caution. If one wants one can just have a piece of it occasionally. Others like guava, apples, oranges, mausmbi etc. can be taken in moderation (just one or two a day).

Q  Explain the dietary management of the following disorders: Diabetes mellitus   8

A  1) Regulation of the meals consumed is essential. Diabetic individuals should be encouraged to have meals at regular intervals. It is advisable for him/her not to skip meals or keep a fast.

2) AII the main meals consumed should provide a fairly even amount of calories.

3) Care should be taken to include foods from all three basic food groups.

However, suitable modifications are needed within each group to ensure control. Let us see what these modifications are:

above answer 

Q  What is IDDM & NIDDM. 

A  Insulin-dependent diabetes mellitus (IDDM)- In this type of diabetes mellitus (in order to function normally) body is dependent on insulin doses from an exogenous source (outside source). It occurs more frequently in young children and adolescents.

Non-Insulin dependent diabetes mellitus (NIDDM)- In this type of diabetes mellitus, there is a lack or insufficiency of insulin in the body which can be brought under control by either diet alone or a combination of diet and certain drugs. The body is not dependent on insulin from an outside source. This is frequently observed in adults (especially those who are overweight).     

Q  Risk factors for Coronary Heart Disease     4 

A  There are various factors responsible for the disease can be clubbed in three categories:

#  personal characteristics

#  learned behavior

#  background conditions 

Personal characteristics- These include factors like sex, age, a family history that are not in control of a person. These factors are -

Age - The incidence of CHD rises with aging particularly after middle age.

Sex - Men are more prone to CHD than women.

Family history- Those persons who have a family history of CHD (i.e. their parents or grandparents are suffering from it) are more prone to CHD.

Learned Behaviour- The factors that have a definite influence on coronary heart disease.

Sedentary lifestyle- Sedentary individuals (who are engaged in light physical activity and remain sitting most of the time in a day) are more prone to CHD.

Stress- Anxiety and emotional stress increase, the chances of CHD.

Smoking- Many research investigations have proved the definite influence of smoking on CHD. Heavy smokers are more prone to CHD than non-smokers.

Diet- Consumption of diets rich in saturated fat and cholesterol increases the chances of CHD.

Obesity- Obese individuals. are more prone to CHD, than those having a normal weight.

Background Conditions- These include other disease conditions like diabetes mellitus, hypertension, higher levels of cholesterol in the blood, etc. by which one might have been suffering. The persons suffering from these diseases are at increased risk of developing CHD.    

Q  Discuss the dietary management of coronary heart disease. 8

A  The main objective of dietary management is to provide a fat controlled and energy-restricted diet to the patient. Some points are 

Energy restriction: You need to make the following modifications:

#  Cut down the intake of total food.

#  Avoid consumption of fat-rich foods. 

#  Give cereals in moderation. Cut down the intake of refined cereals, encourage the use of whole-grain cereals.

#  Give more of pulses especially the whole pulses. Other body-building foods like milk and milk products and flesh foods have to be given by taking their fat content into consideration.

# Increase the intake of fruits and vegetables (especially fibrous ones).

#  Cut down the intake of sugar and other sweeteners.

Fat restriction: i)  Reduce the intake of fats and oils.

ii)  Replace saturated fats like ghee, hydrogenated fats, butter with unsaturated fats like groundnut oil, soya oil, safflower oil.

iii)  Oils like mustard oil and coconut oil have more saturated fatty acids than unsaturated fatty acids. Their use should be limited.

iv)  Use low-fat milk or toned milk instead of whole milk. Whole milk can be given after removing the fat or cream (which comes on top after boiling).

v)  Give eggs in moderation. If possible not more than one egg should be given to the patient (or otherwise, 'it should be given after removing the yolk portion of it).

vi)  Avoid giving fat-rich flesh foods. Select lean cuts of meat. Fish can be given.

vii)  Use roasting, baking, boiling, and steaming as methods of cooking instead of frying (both shallow and deep-frying).

viii)  Don't give nuts like groundnuts, cashew nuts, walnuts, etc. They are rich in fat.

ix)  Avoid giving other fat-rich desserts and fried snacks like cakes, pastries, samosas, etc.

Sodium restriction- Since hypertension or high blood pressure can lead to CHD. Sodium intake should be in moderation as it increases the risk of CHD also.     

Q  List the clinical features and measures you would adopt to prevent Hypertension   5

A   Hypertension' is a condition of the body in which blood pressure is higher than normal. Normal blood pressure is 120/80 mmHg. The upper figure is called systolic pressure and the lower figure is called diastolic pressure. Hypertension is classified into mild, moderate, and severe hypertension depending upon the range of increase in diastolic pressure. 

Mild Hypertension-If diastolic pressure is 90 to 104 mm Hg, it is termed as mild hypertension.

Moderate Hypertension- If diastolic pressure is 105 to 119 mm Hg, the condition is known as moderate hypertension.

Severe hypertension- If diastolic pressure is 120 to 130 mm Hg and above, the condition is known as severe hypertension.  

The diet for hypertension patients like any other heart disease involves a check on the intake of fat and total energy. The fat controlled and energy-restricted diet as prescribed for CHD patients is applicable here also. In addition, you need to carefully monitor the intake of sodium by these patients. It has also been found that restriction of sodium intake accompanied by fat restriction can effectively control mild or moderate hypertension. 

Q  What dietary modifications would you advocate for a hypertensive patient?   7

A  Dietary management and modifications are similar to CHD Above 

The only addition is -

 In mild hypertension, just restriction of intake of common salt can be helpful. However, for moderate and severe hypertension patients, no salt is recommended to be used for cooking. In addition, patients have to give up foodstuffs that are rich in sodium.     

Q  Consequences of Maternal Malnutrition  5

A  # Maternal malnutrition also affects the health and well-being of the foetus, the infant, and the young child. It often results in the death of the child. Even if the child survives, it can condemn the child to a lifetime of poor health. 

# Poor maternal nutrition and low birth weight are related. The frequency of births with weights below 2.5 kg among poor income groups is more because of extensive malnutrition among the women.   

#  Children with low birth weights are at a higher risk of death as compared to those with normal weights. This is one of the reasons for high death rate among infants (referred to as infant mortality rate). The lower the birth weight, the higher will be the risk of death in the case of the child. Besides high mortality rates, low birth weight babies also tend to have:

- greater incidence of infections

- fewer brain cells

- lower growth rates and

- greater incidence of mental retardation  

#  the prevalence of anemia is very high in pregnant women . Severe anaemia leads to premature births (birth before. 37 weeks of pregnancy) and low birth weights. There are risks for the mother as well. In anaemic pregnant women, the deaths during delivery are also more. Anaemic women will not be able to do normal physical work. 

Q  What is maternal malnutrition? What are its causes and consequences? 3+3+4

A  "Maternal malnutrition" therefore means malnutrition of mothers. It can be extended to include women in the reproductive age. The physiological stress of added nutrient demands makes pregnancy and lactation high-risk periods in the life of a woman. 

Causes - less food and not enough food of the right kind. This accounts for the lower heights and weights of women particularly in rural areas and urban slums. It also explains why so many Indian women suffer from anaemia and vitamin B-complex deficiencies. The diets of these women are inadequate largely because they are poor and do not have the money to purchase enough food. Ignorance adds to their problems. They do not have the knowledge to make wise food choices for themselves or their families. In fact, we do not often realize that maternal malnutrition begins with poor nutrition during the years of adolescence. Our health and nutrition programs should also be targeted at adolescent girls so that they can be better equipped for safe motherhood.