nutrition - himsr€¦ · stoss therapy for treatment of rickets •give 600,000 iu of vitamin d 2...
TRANSCRIPT
Nutrition
Reference man
He is between 18-29 years of age and weighs 60 kg with a height of 1.73m with a BMI of 20.3 and is free from disease and physically fit for active work; on each working day, he is engaged in 8 hours of occupation which usually involves moderate activity, while when not at work he spends 8 hours in bed, 4-6 hours in sitting and moving about, 2 hours in walking and in active recreation or household duties.
Reference Woman
She is between 18-29 years of age, non-pregnant non- lactating (NPNL) and weighs 55 kg with a height of 1.61m and a BMI of 21.2, is free from disease and physically fit for active work; on each working day she is engaged in 8 hours of occupation which usually involves moderate activity, while when not at work she spends 8 hours in bed, 4-6 hours in sitting and moving about, 2 hours in walking and in active recreation or household duties.
Age group/
Sex
Category Caloric
Requirement
(Kcal/day)
Protein
requirement
Man Sedentary 2320 1 gm/kg/day
Moderate 2730
Heavy 3490
Woman Sedentary 1900 1gm/kg/day
Moderate 2230
Heavy 2850
Pregnancy +350 +0.5 gm
(1st trimester)
+7 gm
(2nd trimester)
+ 23 gm
(3rd trimester)
Lactation
(0-6 months)
+600 +19 gm
Lactation
(7-12 months)
+520 +13 gm
Recommended metabolizable energy
Protein 4 Kcal/gm
Fat 9 Kcal/gm
Carbohydrates 4 Kcal/gm
Dietary Fiber 2 Kcal/gm
Alcohol 7 Kcal/gm
Healthy Diet
• Fruits, vegetables, legumes (e.g. lentils, beans), nuts and whole grains (e.g. unprocessed maize, millet, oats, wheat, brown rice).
• At least 400 g (5 portions) of fruits and vegetables a day. • Less than 10% of total energy intake from free sugars, but
ideally less than 5% of total energy intake for additional health benefits.
• Less than 30% of total energy intake from fats. Unsaturated fats are preferable to saturated fats. Industrial trans fats are not part of a healthy diet.
• Less than 5 g of salt per day and use iodized salt.
Assessment of protein quality
Amino acid score = No. of mg. of one amino acid per gram of protein X 100
No. of mg. of same amino acid per gram of egg protein
Digestibility coefficient= nitrogen absorbed X 100
Nitrogen intake
Assessment of protein quality
Biological value = nitrogen retained X100
Nitrogen absorbed
Net protein utilization = nitrogen retained X 100
Nitrogen intake
Assessment of protein quantity
Protein efficiency ratio = weight gain in gm
Protein intake in gm
MCQ
The highest percentage of monounsaturated fatty acids is present in-
a) Sunflower Oil
b) Mustard Oil
c) Rice bran Oil
d) Olive Oil
The net protein utilization is defined as-
a) The gain in weight of young animals per unit weight of protein consumed
b) The product of digestibility coefficient and biological value
c) The percentage of protein absorbed into the blood
d) The percentage of nitrogen absorbed from the protein absorbed from the diet
A teacher will be classified as a
a) Sedentary worker
b) Moderate worker
c) Heavy worker
d) Average worker
A ‘safety margin’ of + 2 SD is not incorporated for the RDA of
a) Energy
b) Fats
c) Water soluble vitamins
d) Fat soluble vitamins
For a 60 kg Indian male, the minimum daily protein requirement has been calculated to be 40 g (mean) & standard deviation is 10. The recommended daily allowance of protein would be:
a) 60 g/day
b) 70 g/day
c) 40 g/day
d) 50 g/day
The assessment of protein quality is done by all except-
a) Protein efficiency ratio
b) Biological value
c) Digestibility coefficient
d) Net protein utilization
Egg is deficient in
a) Carbohydrates
b) Vitamin C
c) Both of the above
d) None of the above
The extra energy allowance needed per day during pregnancy is-
a) 150 Kcals
b) 200 Kcals
c) 350 Kcals
d) 550 Kcals
An average sized egg would provide (UPSC CMS 2012)
a) 50 kcal
b) 70 kcal
c) 90 kcal
d) 110 kcal
Vitamins
Vitamin A
Functions:
1) It is vital for the formation of retinal pigment rhodopsin in rods of the retina
2) integrity of cellular structure
3) immune defense mechanism of the body
4) antioxidant property
RDA:
• 2000 IU / 600 µg RE
• Pregnant & Lactating mothers- 950 RE
Vitamin A
Sources:
• Richest source is Halibut liver oil followed by Cod liver oil.
• Top sources of vitamin A include:
• Beef liver
• Egg yolk
• Cheddar cheese
• Fortified milk
Xerophthalmia
Night blindness
Conjunctival xerosis
Bitot’s spots
Corneal xerosis
Corneal ulceration
Corneal scar
Xerophthalmic fundus
Treatment
<6 months 50,000 IU
6m- 1 year
>1 year but weight less than 8 kg
1 lac IU
> 1 year 2 lac IU
The above dose should be given on Day 0,1 and 14
Vitamin A Supplementation
The first dose of 100,000 IU is given at 9 months of age along with measles vaccines. Thereafter, the second and subsequent doses of 200,000 IU are given at 6 monthly intervals till 5 years of age.
Thiamine (B1)
Functions:
• Acts as a coenzyme in many metabolic reactions
• health of the nerve tissue and for normal cardiac and gastro-intestinal functions
RDA:
• 0.5mg per 1000 Kcal
Sources: Yeast, egg yolk, liver, wheat-germ, nuts, red meat and cereals
Deficiency:
Beriberi and Wernicke- Korsakoff psychosis
Wet beriberi is the acute form - CVS
Dry beriberi is the chronic form of disease - PNS
Infantile beriberi occurs in the first few months of life
Wernicke-Korsakoff psychosis (wet brain, alcoholic encephalopathy)is seen in
• chronic alcoholics with poor diet
• in patients undergoing prolonged intravenous therapy without B1,
• gastric stapling
• hunger strikes.
Treatment
Beriberi - Thiamine 500 mg in 10 divided doses
Wernicke-Korsakoff psychosis – Thiamine 1000 mg in 10 divided doses
Riboflavin (B2) Sources: Dairy products, liver, vegetables, eggs, cereals, fruit, yeast
Functions:
(a) Promotion of normal growth
(b) Assisting synthesis of steroids, RBC and glycogen
(c) Maintenance of mucous membranes, eyes and the nervous system
(d) Aiding iron absorption
Riboflavin (B2)
RDA:
• 0.6 mg per 1000 Kcal
Deficiency:
• Cheilosis, angular stomatitis, glossitis, magenta tongue, nasolabial seborrhea and genital (scrotal or vulval) dermatosis
Niacin (B3)
Sources:
• Meat (especially the organs), fish, chicken, eggs, milk, whole meal cereals, groundnuts and pulses are good sources.
• 60 mg of tryptophan is needed to form 1mg niacin
RDA:
• 6.6mg niacin equivalents per 1000 Kcal
Functions:
As coenzymes in metabolism
Deficiency:
Pellagra
(a) Dermatitis: The neck is frequently involved and the distinctive distribution of skin lesions is known as Casal’s Collar.
(b) Diarrhea: This is often accompanied by inflamed scarlet tongue.
(c) Dementia: It may present as mild confusion and disorientation to mania and psychosis.
Pyridoxine (B6)
Functions: Metabolism of amino acids, fats and carbohydrates
RDA: 2mg; Pregnancy and lactation- 2.5 mg
Sources: Milk, liver, meat, egg yolk, fish, cereals, legumes and vegetables.
Deficiency: Peripheral neuritis
Cyanocobalamin (B12)
Functions:
(a) Vitamin B12 plays important role in the synthesis of DNA
(b) It helps in maintenance of myelin in the nervous system
(c) It has an important role in the treatment of pernicious anemia
RDA:
1 μg
Sources:
• not present in any vegetable foods.
• present in animal products - milk, milk products, meat and fish.
• also synthesized by the microorganisms in the gut
Deficiency:
• Megaloblastic anemia
• Peripheral neuropathy
Folic Acid
Functions:
(a) synthesis of DNA.
(b) anti anemia factor
RDA:
• 100 µg
• Pregnancy 400 µg
• Lactation 150 µg
Sources:
It occurs in green leaves, pulse, cereals, liver, kidney, mushroom and yeast
Deficiency:
• Megaloblastic anemia
• Neural tube defects
• Hyperhomocystenemia
Vitamin C
Functions:
• formation of collagen
• enhances the absorption of iron
• anti-oxidant property
RDA:
• 40 mg
• 80 mg for lactating women
Sources:
• Gooseberry (Amla) is the richest source.
• Citrus fruits
• Liver, whale skin, oysters, brain are good animal sources
Deficiency:
• Scurvy
Vitamin D Functions: absorption and excretion of calcium; bone mineralization
RDA: 100 IU
Sources: Cod liver oil, other oily fish, milk, margarine, eggs, liver.
Deficiency:
• Rickets in Children
• Osteomalacia in adults
Stoss therapy for treatment of Rickets
• Give 600,000 IU of Vitamin D2 orally
• White line of mineral deposition at the growing ends of bones
• If it fails, then repeat
• If no improvement still, then it’s Vitamin-D resistant rickets.
• calcium 1000 mg/day
• After 3-months, maintenance dose - 400 IU of Vitamin D2
Vitamin K
Functions:
Synthesis of Prothrombin and blood coagulation factors.
RDA: 0.03 mg/kg/day
Sources:
Exogenous: Green leafy vegetables, vegetable oils esp. soya bean oil, eggs, meat and dairy products
Endogenous: Gut bacteria
Deficiency
• Vitamin K Deficiency Bleeding (VKDB)
• All newborns with birth weight of 1000gm or more should be administered 1mg of Vitamin K IM while those weighing less than 1000 gm should receive 0.5 mg dose.
Daily requirement of Thiamine is determined by metabolism of which of the following (AIIMS 2009)
a) Proteins
b) Fats
c) Carbohydrates
d) Cholesterol
Prolonged treatment with Isoniazid leads to deficiency of- (AIPGME 2011)
a) Pyridoxine
b) Thiamine
c) Pantothenic acid
d) Niacin
All of the following are true except (AIIMS 2009)
a) Vitamin K is given in Keratomalacia
b) Hypervitaminosis A causes Pseudotumor cerebri
c) Zinc excess causes pulmonary fibrosis
d) Iodine deficiency causes Goiter
When a patient is cut off the sources of vitamin A its deficiency is manifested after (AIIMS 2008)
a) 1 year
b) Immediately
c) Within weeks
d) Within few days
Which of the following vitamins given as a supplement during the peri-conceptional period to a woman can help prevent the neural tube defects in the baby? (UPSC CMS 2012)
a) Thiamine
b) Riboflavin
c) Vitamin B12
d) Folic acid
Earliest feature of vitamin A deficiency is:
a) Conjunctival xerosis
b) Nyctalopia
c) Bitot’s spots
d) Keratomalacia
Which of the following is not known to have an antioxidant effect?
a) Vitamin A
b) L-Ascorbic acid
c) Alpha-Tocopherol
d) Phylloquinone
Which of these is available only from animal sources?
a) Vitamin B12
b) Vitamin B1
c) Vitamin B6
d) Vitamin B2
The richest source of Vitamin A is
a) Halibut Liver Oil
b) Cod Liver Oil
c) Shark liver Oil
d) Cheddar Cheese
For assessment of Xerophthalmia as a public health problem, the age group of children is-
a) 0-60 months
b) 0-72 months
c) 6-60 months
d) 6-72 months
Casal’s Collar is seen in deficiency of
a) Pyridoxine
b) Niacin
c) Selenium
d) Riboflavin
Minerals
Calcium Sources:
• Milk and milk products, ragi, fish (if eaten whole), dried fruits such as raisins, apricots and dates, and betel leaves with lime, pulses and tofu
Functions:
• providing the structural rigidity to bones and teeth.
• maintenance of optimum excitability of the nervous and muscular tissues.
• role in the coagulation of blood as factor IV
• co-factor for a number of enzymes e.g. lipase
RDA of calcium Mg/day
Men 600
Women 600
Pregnancy 1200
Lactation 1200
Post-menopausal women 800
Infants 500
Children (1-9 years) 600
Children and adolescents (10-18 years) 800
Deficiency
Tetany- twitching of muscles of face, hand and feet, cardiac arrhythmias
Phosphorus
Sources:
Milk and milk products, cereals, meat, fish, nuts, fruits and vegetables
Functions:
• Formation of bones and teeth along with calcium.
• role in all metabolisms
• buffer that prevents changes in the pH of body fluids.
• constituent of nucleic acids, phospholipids and membranes
RDA:
1 gm
Deficiency:
Unlikely
Sodium
Sources:
• Salts, MSG, meat, milk, eggs, vegetables and fruits
• Preserved foods and canned foods
Functions:
• blood pressure regulation along with potassium.
• Acid-base regulation
• maintains the osmotic pressure.
RDA:
5 gm of sodium chloride (2 gm of sodium)
Deficiency:
• Muscle cramps and severe dehydration and hypovolemia.
Excess:
• High intake of salt (sodium chloride) is associated with high blood pressure and stomach cancer.
Potassium
Sources:
• Fruits like melons, apricots, fruit juices, vegetables including potatoes, pulses, meat and whole grain cereals.
Functions:
• Regulation of osmotic pressure
• Acid base regulation
• Release of insulin by pancreatic cells
RDA:
• 4.7 gm
Deficiency:
• Cardiac arrhythmias and muscle weakness
Iron Sources:
• Haem iron sources:
Meat, fish and eggs.
• Non-haem iron:
Cereals, dark green leafy vegetables, pulses, nuts and dry fruits
Functions:
• component of haemoglobin and myoglobin.
• constituent of important enzymes
RDA
RDA of Iron Mg/day
Man 17
Woman 21
Pregnancy 35
Lactation 25
Deficiency:
Iron deficiency anemia
Confirmed case:
• A case of pallor with or without associated weakness, tiredness and breathlessness at rest with hemoglobin and/or hematocrit levels less than normal
Group Hemoglobin threshold
(g/dl)
Hematocrit
threshold (l/l)
Children 6 - 59
months
11 0.33
Children 5 - 11 years 11.5 0.34
Children 12- 14 years 12 0.36
Pregnant women 11 0.36
Non- pregnant
women
12 0.33
Men 13 0.39
Treatment of mild anemia
Children 1-5 years 20 mg Iron and 100 mcg Folic
acid
Children 6-11 years 40 mg Iron and 200 mcg folic
acid
Adolescents and adults 60 mg Iron
Pregnant women 100 mg iron and 500 mcg Folic
acid
Iodine
Sources:
• Seafood and vegetables grown on iodine-rich soils
• Dairy products, eggs, cereal grains, legumes and green leaves (spinach)
• Functions:
• Component of thyroid hormones
RDA
RDA of Iodine µgm/day
Infants 90
Young children (1-5 years) 90
School age children (6-11
years)
120
Adolescents and adults (> 12
years)
150
Pregnant and lactating women 250
NIDDCP
• Process indicators: Indicators to monitor and evaluate the salt iodization process
Under FSS Act
• Iodine content of salt at production level must be 30 ppm
• And at consumption level it must be 15 ppm.
• Potassium iodate is used in India for iodisation of salt
Impact indicators: indicators to assess iodine status and to monitor and evaluate the impact of salt iodization on the population
• Median urinary iodine
• Goitre assessment
• TSH levels in neonates
• the principal impact indicator recommended is the population median urinary iodine level.
Sustainability indicators: indicators to assess whether iodine deficiency has been successfully eliminated
A combination of median urinary iodine levels in the population, availability of adequately iodized salt at the household level, and a set of programmatic indicators
Fluorine
Sources:
• Drinking water, tea, Fluoridated toothpastes and mouthwashes
• Concentration of 0.5 to 0.8 mg/l in water is considered a safe limit
Deficiency:
• Dental caries
Excess:
• Dental fluorosis (>1.5 ppm)
• Skeletal fluorosis (> 5 ppm)
Indicators for sustainable elimination of IDD
Salt iodisation- proportion of households using
adequately iodized salt
>90%
Urinary Iodine excretion
Median in general population 100-199 μg/l
Median in pregnant women 150-249 μg/l
Not an essential mineral? (AIIMS 2010)
a) Pb
b) Mn
c) Na
d) Fe
Iron is absorbed predominantly in (UPSC CMS 2012)
a) Stomach
b) Jejunum
c) Ileum
d) Colon
The daily requirement of calcium during normal pregnancy is (UPSC CMS 2011)
a) 250 mg
b) 500 mg
c) 1000 mg
d) 2000 mg
Which of these is not a constituent of metallo-enzymes?
a) Copper
b) Zinc
c) Iron
d) Nickel
For a patient to suffer from dental fluorosis, the fluorine intake through water has to be at least
a) 1.5 ppm
b) 1.0 ppm
c) 0.5 ppm
d) 5.0 ppm
The RDA of Iron during pregnancy is-
a) 21 mg
b) 35 mg
c) 25 mg
d) 100 mg
The target for the proportion of households using iodized salt is -
a) 70%
b) 80%
c) 90%
d) 100%
Malnutrition
BMI
Body Mass Index (Quetelet’s Index)
= Weight in Kg
(Height in m)2
BMI Classification
BMI Classification
<18.5 Underweight
18.5- 23 Normal
23-27.5 Pre-obese
>27.5 Obese
Waist Circumference
Males Females
< 90 cm < 80 cm
Waist-Hip ratio
Males Females
< 0.9 <0.8
Broca’s Index:
Normal weight = (Height-100 cm)
Ideal weight = 90% Normal weight
Ponderal’s Index = Weight in Kg
(Height in m)3
Corpulence index = actual weight divided by desirable weight.
WHO criteria for Severe Acute Malnutrition
• Weight for height <-3SD
• MUAC < 115 mm
• Bilateral pedal edema
WHO criteria for Moderate Acute Malnutrition
• Weight for height between -2SD to -3SD
• MUAC between 125mm to 115 mm
Food Hygiene
Pasteurization
Method Description
Holder (Vat) method Milk is heated up to 63-63.5 o C for 30 min
and then rapidly cooled to 5 o C
High Temperature
Short time (Flash
method)
Milk is heated to 72 o C for 15 seconds and
then rapidly cooled to 4 o C
Ultra High
Temperature
Milk is heated to 125-150 o C for few
seconds under pressure and then rapidly
cooled to 4 o C
Testing of Milk Laboratory test Remarks
Specific gravity Should be 1.03
Measured using Lactometer or Pyknometer
Gerber’s test Estimation of fat, must be atleast 3.5 gm/dl
Measured using fat meter
Solids not fat Must be atleast 8.5 gm/dl
Iodine test Tests the addition of starch as adulterant
Testing of Milk
Methylene blue test Tests keeping quality and bacterial
contamination
Phosphatase test Tests efficiency of pasteurization
Bacteriological
tests
Standard plate count
Coliform count
Specific tests for Mycobacterium
tuberculosis, Bacillus abortus
Food Toxicants Food
toxication
Organism/toxin Food involved Clinical features
Neurolathyris
m
Neurotoxin β-oxalyl-L-
α,β-diaminopropionic
acid (ODAP)
β- N- oxalyly-amino-L-
alanine (BOAA)
Kesari dal / Grass
Pea (Lathyrus
sativus)
Neurolathyrism
(Spastic
paraplegia)
Aflatoxicosis Caused by fungi
Aspergillus flavus,
Aspergillus parasiticus
Aflatoxin
Infestation of nuts
and cereals
Hepatocellular
carcinoma,
hepatitis
Ergotism
(St.
Anthony’s
Fire)
Claviceps fusiformis
Claviceps purpura
Ergotamine
Ergocristine
Cereals
Abdominal
cramps,
vomiting,
drowsiness
Burning in
extremities,
peripheral
gangrene
Fusarium
toxication
Fusarium incamatum
Dexanevalinone
Fumonisin
Cereals
Diarrhea,
vomiting
Epidemic
dropsy
Sanguinarine
Dihydrosanguinarine
Argemone
Mexicana
seeds/oil
contaminating
mustard
seeds/oil
Bilateral
pedal edema,
CCF
Endemic
ascites
Pyrrolizidine
alkaloids
Crotalaria
(jhunjhunia)
mixing with
Gondhli
(Panicum
miliare)
Ascites,
jaundice
Food Poisoning
Salmonella
food
poisoning
Agent - Salmonella typhimurium, Salmonella
cholera-suis, Salmonella enteridis.
Source- farm animals, rodents transmit.
Incubation – 12-24 hours
Mechanism- acute enteritis and colitis
Fever with chills
Staphyloco
ccal food
poisoning
Agent- Coagulase positive staphylococcus aureus
Mechanism- Enterotoxin-heat stable (intradietetic)
Incubation- 1-6 hours
Botulism
• Agent- Clostridium botulinum, a gram - negative, strict anaerobe, spore-forming bacillus
• Source- Home-canned, home preserved foods
• Pre-formed toxin acts on parasympathetic nervous system
• Incubation- 12-36 hours
• Mechanism- exotoxin- parasympathetic activation
• Symptoms - vomiting, dysphagia, diplopia, ptosis, dysarthria, muscular weakness.
• Frequently fatal - death occurring 4 to 8 days later due to respiratory or cardiac failure.
Clostridium
perfringens food
poisoning
Contaminated meat
Incubation- 6-24 hours
Bacillus cereus
Spores germinate and multiply and release
toxin
Emetic form incubation- 1-6 hours
Diarrheal form incubation- 12-24 hours
Endemic ascites is caused by- (AIIMS 2006, 2008)
a) Aflatoxin
b) Sanguinarine
c) Pyrrolizidine alkaloids
d) Ergot alkaloids
The following are characteristics of staphylococcal food poisoning, except- (AIIMS 2004)
a)Optimum temperature for toxin formation is 37o C
b)Intra-dietetic toxins are responsible for intestinal symptoms
c)Toxins can be destroyed by boiling for 30 minutes
d)Incubation period is 1-6 hours
The following tests are used to check the efficiency of pasteurization of milk except- (AIPME-2005)
a)Phosphatase test
b)Standard plate count
c)Coliform count
d)Methylene blue reduction test
Characteristic of Bacillus cereus food poisoning is (AIIMS 2010) a)Presence of fever b)Presence of pain abdomen c)Absence of vomiting d)Absence of diarrhea
Pasteurized milk is most commonly tested by: (AIPGME 2011) a)Phosphatase test b)Coliform test c)Catalase test d)Oxidase Test
Which of the following will be abnormal in both acute and chronic malnutrition- (AIIMS 2007, 2012)
a) Weight for age
b) Height for age
c) Weight for height
d) BMI
The health indicator obtained by dividing height by cube root of weight is: (UPSC CMS 2013)
a) Quetelet’s index
b) Brocca index
c) Corpulence index
d) Ponderal index
Beta oxalyl amino alanine (BOAA) is found in: (UPSC CMS 2014)
a) Argemone mexicana
b) Lathyrus sativus
c) Aspergilus flavus
d) Crotolaria medicagenia
Weight divided by height raised to 2 is used as an index known as (JIPMER 2003)
a) Broca’s index
b) Quetelet Index
c) Ponderal’s Index
d) Corpulence Index
The test, which is not done to test for pasteurization is (JIPMER 2003)
a) Methylene Blue test
b) Coliform count
c) Plate test
d) Phosphatase test
Which of the following indicators does not include the value of a person’s height in its formula? (UPSC CMS 2011)
a) Quetelet’s Index
b) Ponderal Index
c) Lorentz’s Formula
d) Corpulence Index
The criteria for Severe Acute malnutrition includes –
a) Weight for height <-3SD
b) MUAC < 115 mm
c) Bilateral pedal edema
d) All of the above
In Flash method of pasteurization, milk is heated to____ degrees Celsius
a) 63
b) 72
c) 100
d) 125
Which of the following toxin is associated with Neurolathyrism?
a) Dexanevalinone
b) Phalloidine
c) Diamino propionic acid
d) Pyrrolizine alkaloids
All are food fortification except
a) Addition of colour to saccharin
b) Addition of Vit A to food stuff
c) Addition of extra nutrients to food stuff
d) Iodization of salt
Following are true of Botulism except
a) Frequently fatal
b) Bloody diarrhea
c) Dysphagia
d) Absence of fever
The food poisoning with highest mortality of the following is-
a) Salmonella food poisoning
b) Botulism
c) Staphylococcal food poisoning
d) Clostridium perfringens food poisoning
Hb Threshold (mg%) to label Anemia in Non-pregnant women (≥15.00 yr) is _____________
a) 13.0
b) 12.0
c) 10.5
d) 11.0
Stunting is __________ weight for height but _________height for age-
a) Normal; Low
b) Low; Normal
c) Low; Low
d) High; low
Acute malnutrition may be indicated by:
a) Stunting
b) Wasting
c) Stunting and wasting
d) All of the above
With regards to food-borne pathogens, the danger zone of temperature is …………… 0 C for more than two hours.
a) 30 to 45
b) 21 to 50
c) 5 to 60
d) 10 to 45
Cereals and pulses are considered complementary because:
a) Cereals are deficient in methionine
b) Cereals are deficient in methionine and pulse are deficient in lysine
c) Cereals are deficient in lysine and pulses are deficient in methionine
d) Cereal proteins contain non-essential amino-acids, while pulse proteins contain essential amino acids
кінець