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y spans, J xe er elo oat It is an index of protein quality. It is defined as, , * Bunt of absorbed nitrogen re tained in the body. Biological Value (BV) is a, , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , tative measure of the nutritive value of a protein food. A protein of high BV, o A more nitrogen than a protein of low BV. The perfect protein has a BV of, eta ee 00 BV, milk and fish has 85 and of meat it is 75, Cereals and pulses, Cen © a higher BV than the individual cereal files) AHO:, ne st in cere wil mpensated by the amino acid Uae ee asec es t, BEFECTS OF DEFICIENCY AND BXCESS OF in, \ peduved protein intake over a prolonged period ;, ia, nutritional ema, lowered resistance t ‘, wor otein deficiency is more marked dur rio, © more, eg. during infancy, childhood, pregnan, n sein Energy Malnutrition) or PCM (Protein Calorie, jool children in developing countries like India, : , preschool children is 1 — 2 percent, rte Energy Malnutrition has been identified as 1, oblem in India. It is not only an important cause of childr, vb leads to permanent impairment of physical and mer, s wo clinical forms, Kwashiorkor and Marasmus. There are t lif, ctures at opposite poles of a single continuum, K was K This disease was first reported in 1935 in Africa by Dr C, qs. This is caused by deficiency of proteins in diet. Importan S, <ymptoms are growth failure, oedema diarrhoea, anaemia and changes in sk, al marasmus :~ This is caused by severe deficiency of proteims, ) in diet. This disease is characterized by growth failure, loss of, hydration and mental changes, etc. Principal symptoms of both diseases, table 7.4:, mw Table 7.4 : Principal features of severe PEM, ai a mptoms Marasmus Kwashiorkor, Muscle wasting Obvious Some times hidden by oederr at, 2 Fat loss Severe loss of subcutenous fat No fat loss, edema Not present Usually present on lower, limbs and lower arms, and face, 4 eight for height Very low Some times low, 5 Face looks Like monkey's face Moon face, € Mental changes Sometimes quietand apathetic Very rare, 7 >petite Usually good Poor, Diarrhoea Often Often., Skin changes Usually none Diffuse pigmentation, sometimes, flaky pain, dermatosis, 0 Hair changes Usually none Sparse, silky and easily pulled out, 1 Liver enlargement None Sometimes present due to, — | ee | eccumulation of fat

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food in quantity and quality vad intestinal worms, , ‘ infections @ : a, measles, respiratory - utrients while decreasing, , : a, es and other 1 Seen, os circle, infection contributing, , infection. :, b of causation, viz, , 9, , PEM is due to:, a) An inadequate, b) Infections like diarrhoea, i, which increase requirements for dee, ilizati is, their absorption and utilization. na, malnutrition and malnutrition contributing to —, There are numerous other cone a Serena ealth, failure ee, . a a, lata eee pete ee d adverse cultural practices, lactation, premature, , intake of, , n of breast feeding an, , relating to child rearing and weaning. a, i f : irst indi f PEM is under weight for ag, ion of PEM :- The first indicator 0 De ates to et, , Maintaining of growth chart (Road-to-health) is the most practic PEM. These pie indicate at a glance whether the child is gaining or losing weight., , Road - to - health chart is discussed under the chapter ‘Nutritional assessment’., * Classification of PEM :, , PEM is a spectrum of conditions ranging from growth failure to kwashiorkor, or overt marasmus. Gomez’s and Waterlow’s classification of PEM are given below:, , , , , , 1. Gomez’s classification :- It is based on weight retardation. It locates the, child on the basis of his/her weight in comparison with a normal child of the same, age. The normal reference child is in the 50th centile of the Boston Standards. The, cut off values were set during a study of risk of death based on weight for age at, , admission to a hospital unit. This classificati i, a a ion therefore has a prognostic value for, , , , Fia. Nutritional mara.

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Mouerawe a6, , Preventive Measures, , f actions are, blem of PEM. Many types o ne, apted from the 8th FAO/WHO committee, , tment of PEM., , ition to the pr, , strategy is ad, ention and trea’, , There is simple solu, necessary. The following, on Nutrition for the prev!, A. Health Promotion : 4, 1) Measures are directed to pregnant and lactating women (education anc, , nutritional supplements), 2) Promotion of breast feeding., 3) Development of low cost weaning, foods., 4) Improvement of family diet., 5) Nutrition education., 6) Home economies., 7) Family planning & spacing of birth., B. Specific protection :, 1) Diet of the child must contain protein and energy rich foods such as milk,, eggs, fresh fruits., 2) Immunization against diseases., 3) Food fortification. :, 4) Early detection and treatment :, — Periodic surveilance., — Early diagnosis with degrees of malnutrition., In case of PEM, good quality protein 3 ~ 4 g/kg body weight/day should be, , EFFECTS OF EXCESSIVE INTAKE OF pp oyy ib, d to fat and stored, , An excessive intake of protein is used as energy or converte:, , in the adipose tissue in body., , 2) Excessive intake of protein increases, metabolize and excrete the wastes. If these organs al, tend to accumulate in the body., , 3) A high intake of protein increases the loss of calcium through urine., , 4) Animal proteins such as meat, poultry and whole milk products form a, , substantial part of the high protein diet. There is a risk of high blood levels of, , cholestrol., , oe, , 1), the burden on liver and kidneys to, re diseased, toxic wastes