Nutrition, Diet and Community Health
This domain tests the balanced diet, the deficiency diseases and the national programmes that correct them. Expect matching questions (deficiency to sign) and case questions on infant feeding.
Nutrients and energy
- Carbohydrate and protein supply 4 kcal per gram, fat 9 kcal per gram.
- A balanced diet combines cereals, pulses, milk or curd, vegetables and fruit, some fat, and limited sugar and salt.
- Protein-energy malnutrition: marasmus is severe wasting; kwashiorkor shows oedema, enlarged liver and hair changes.
Deficiency map
- Vitamin A: night blindness, Bitot's spots, xerophthalmia.
- Vitamin B1: beriberi. Vitamin B3: pellagra with dermatitis, diarrhoea and dementia. Vitamin C: scurvy with bleeding gums.
- Vitamin D and calcium: rickets in children, osteomalacia in adults.
- Iron: anaemia with pallor and fatigue. Iodine: goitre and cretinism.
Life-cycle feeding
- Colostrum within the first hour, exclusive breastfeeding for six months, complementary feeding from six months with breastfeeding continued to two years.
- Diarrhoea: low-osmolarity ORS after every loose stool, zinc 20 mg daily for 14 days (10 mg if under six months), and continued feeding.
Worked example
A one-year-old has passed four loose stools today, is alert, drinking and has no sunken eyes. Reasoning: this is some dehydration, not severe. Treat in the community with ORS and the full 14-day course of zinc, continue breastfeeding and food, teach the mother danger signs (lethargy, no urine, sunken eyes) and review. Intravenous fluids and referral are for severe dehydration.
Traps that cost marks
- Stopping feeds during diarrhoea.
- Giving plain water instead of ORS.
- Cutting the zinc course short of 14 days.
- Confusing marasmus with kwashiorkor.