Nutrition - HIMSR€¦ · Stoss therapy for treatment of Rickets •Give 600,000 IU of Vitamin D 2...

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

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