 Okay, now what are the nutrients essential in children going to go very quickly on this because without this I cannot finish my presentation. This is Professor Michael Golden, okay, he is the Guru of nutrition in children really he worked in Africa for 50 years, he is from Scotland, okay, and he is he is a biochemist and then he is a pediatrician and he he has published about 100 200 papers on malnutrition okay and then he he worked first on he did a lot of experiment on rats and then basically he came up with RUTF ready to use therapeutic food. So it's because of him you know he he recognized what are these nutrients which are lacking in this malnutrition and he developed this special food you know which would bring this children out of malnutrition okay so he basically recognized there are two different types of micronutrients okay and if you know I'm sure you guys know that we required about 40 types of nutrients in our body right I mean not not in the body but we required enough food essential nutrients okay so 40 types okay this is probably new for you but you know this is a concept that doctors are using right now to treat severe good malnutrition okay now this 40 types of nutrients are basically divided into type 1 and type 2 nutrients okay so what are your type 1 nutrients those are functional nutrients and type 2 are your growth nutrients growth nutrients but it is involved in growth of the child functional nutrients but they are basically you know particularly used in particular functions okay so when when the child is deficient say let's talk about type 1 first when the child is deficient in type 1 nutrients this children they grow pretty well in early age okay so early stage there is no problem if children are deficient in type 1 nutrients maybe continue to grow they can and what happens if this type 1 nutrients are stored in the body so for example one of the example of type 1 nutrient is your iron so iron is stored in the body so if suppose child is not getting iron on a day-to-day basis but has a good storage in the liver the child will continue to get iron you know for metabolic functions you know so this is important that most of the nutrient in type 1 more not all most of them have body store so you may not record day-to-day in child's diet okay when they are deficient there are clinical deficiency signs and symptoms okay so again iron if child is deficient you will see clinical signs and clinical symptoms which are other nutrient which are type 1 is your know vitamins vitamin A vitamin B vitamin C all of them have clinical signs if they're deficient right one another one is iodine okay then it only affects specific enzymes so suppose if one particular just not all the metabolic functions only some enzymatic reaction it helps it affects so basically suppose child has anemia you know iron deficient only probably and child will be anemic nothing as the other metabolic function is going on right what is the amount in breast milk type 1 is deficient basically mother's milk will be deficient too so if mother is deficient on iron the breast milk will be deficient in iron so that's important now type 2 we all know about type 1 very well all of us doctors nutritionists we all know iron calcium vitamin D vitamin A we all know about type functional nutrient what we don't know much and that's why we have so much of under nutrition is type 2 nutrient okay and what is the first responsive child is type 2 nutrient deficiency deficiency in their diet is a growth failure which I will stop growing child will not have muscle mass developing child will not grow tall child will not have all this so the first responses child will stop growing why child stopped growing because there is no body store so do you see the body store absent so this type 2 nutrients are not stored in the body so child requires in the diet on a day to day basis every day child requires those type 2 nutrients okay and a child doesn't get it what's going to happen this type 2 nutrients are part of a body so our tissue our muscles our organs are made up of type 2 nutrients okay and if another thing is it is required and for general metabolism so do you see effect it is required for basically full metabolism lot of biochemical reaction right as a coenzyme as a cofactor you know very very important so if you don't have those type 2 nutrients in a diet it's not coming from store so it's it will come from the muscle baby child will start eating up his own muscles to have this micronutrient because it is required for metabolism if you don't have this micronutrient metabolism will eventually stop child will get infected child will die okay so what nature does nature doesn't you know take a bit life in day in a day or two it's slowly slowly baby starts melting you know and all those nutrients which are there in the muscle mass come in the blood okay whatever is required by the body they will keep it all the other rest will will be excreted in the urine okay so this is very important here I've written that basically in breast milk type 2 are stable because it's coming from mothers muscle mass so it's important that you know you know this type 2 nutrients are required okay even for mother if mother is breastfeeding or mother's pregnant okay another thing I want to talk about this entromympometry so it appears late in the deficiency so your functional micronutrient if they are deficient you will see sign-in symptoms that are biochemical test you can do you can do iron test you can do vitamin D test right but for growth type 2 nutrients there are no specific test because there you have to do tissue biopsy which nobody does okay another thing is only way you can diagnose if child is type 2 micronutrient deficient is by looking at anthropometric abnormality so you look at your height you look at your weight you look at your muoc test and you know you will see that child is you know small they are stunted anorexia so if child has type 2 deficiency after certain age what will happen or after certain stage the metabolic function will be so poor in this children that they will have anorexia since they will have you know the appetite will go down and this are called complicated SAM okay and this children need to be in the hospital right away but in type 1 deficiency your child does not have loss of appetite so appetite is perfect okay so this here this I wanted to just show you what a type 1 type 2 nutrients okay so if you look at type 1 nutrient those are iron iodine copper calcium this all your type 1 okay you have by and large the storage type 2 is your essential amino acids you know your potassium magnesium phosphorus sulfur zinc all this thing at type 2 we know about protein we know about fat but we don't know much about potassium magnesium phosphorus sulfur zinc we don't know much sorry we don't know which food gives magnesium maybe some little one or two thing but we need to focus on type 2 to prevent malnutrition so this is what is this is type 1 and type 2 look at the muscle mass what's happening the muscle mass has been melted right you see look at this muscles are gone completely gone child has such poor metabolism that look at this child is absolutely exhausted do you see it metabolism is absolutely poor child is so exhausted brain is not getting enough energy right look at the tummy do you see in both of them do you see how tummy is big what is happening because the mortality of gut is so slow because child is not getting enough energy you know what is happening now to the interesting this decreased mortality and what will happen will be something called sebo small interest in bacterial overgrowth there's a lot of bacterial overgrowth so this children we have to start in amoxicillin first okay you see look at this all the muscle mass is gone right because type 2 is not available in the diet child is just getting the type 2 nutrient from his muscle mass right how long the children will survive do we know how many children do we have in India like this San children how many children 1 crore we have 1 crore children who are like this in India presently and now with covert I don't know what would be the number I have no idea probably double triple I don't know because they children young children it takes just maybe five weeks or six weeks to become like this okay because they don't have fat storage as much as adults so they they become deteriorated very fast and they start gaining also very fast so that's important to basically take care of in a nutrition for young children okay now that what do we saw I told you about this this becomes you know this children have this kind of problem within six weeks you see this but if this children survive okay and they become say they survive and they become older okay but what will happen now their height will suffer because they haven't you know gotten those type 2 nutrient it is our same age children look at this is about three and a half year old child this is three and a half year old three and a half year old look at the difference between their height same thing this is the Guatemalan children okay here nine year old children should be here this all nine year old kids but look at their height you see how they hide what has happened children have not gotten type 2 nutrients in a diet and that's why they have their height is suffered and all this children whose height has suffered this children have not gone type 2 nutrients when they were growing up in first thousand days okay because first thousand days that's when your height is growing really fast and when height is not developed what is not developed their brain so this children will not do well in the school too welcome to the spoken tutorial on type 1 and type 2 nutrients this tutorial is about the difference between type 1 and type 2 nutrients let us begin food gives us energy and nutrients nutrients are necessary for the growth and maintenance of our body some of these nutrients cannot be produced by our body such nutrients are called essential nutrients there are 40 essential nutrients that we must obtain from food we cannot get adequate amounts of these nutrients from nutrient poor foods such foods even in large amounts can satisfy only the feeling of hunger however we can be deficient in one or more of the essential nutrients this is known as hidden hunger essential nutrients are divided into two types type 1 nutrients or functional nutrients and type 2 nutrients or growth nutrients iron calcium iodine and copper are type 1 nutrients manganese fluorine and selenium also belong to the same group vitamin B C A D E and K are type 1 nutrients as well sulphur chlorine and protein or essential amino acids are type 2 nutrients sodium potassium magnesium phosphorus and zinc also belong to the same group essential fatty acids like omega 3 are type 2 nutrients as well let's understand the difference between type 1 and type 2 nutrients type 1 nutrients are required for specific functions in the tissues therefore they are concentrated in a particular tissue or group of tissues let's take calcium and vitamin A as examples calcium is required for strong bones vitamin A is required for healthy eyes by contrast type 2 nutrients are required for the overall growth of the body they form part of the structure and function of each and every cell in the body therefore they are present in all body tissues let's discuss the response of our body to type 1 and 2 nutrient deficiencies during a type 1 nutrient deficiency the body continues to grow normally body takes this nutrient from the specific tissues in which it is stored let's take calcium as an example in calcium deficiency the body uses the calcium stored in the bones as a result the concentration of that nutrient in the tissues decreases then the organs dependent on that nutrient are affected therefore the person becomes ill the sick person then shows a specific sign of deficiency let's understand this with the help of four examples bone thinning and increased risk of fractures are signs of calcium deficiency anemia is a sign of iron deficiency night blindness is a sign of vitamin A deficiency and hypothyroidism is a sign of iodine deficiency on the other hand there is only one sign of type 2 nutrient deficiencies that sign is called growth failure growth failure means the body reduces the rate of two major processes formation of new cells and replacement of old cells the body stops growing and making new tissues this leads to low body weight short height and decreased muscle mass all the cells of the body including the immune system are affected this increases the risk of infections eventually it can cause death type 2 nutrients are not stored in the body in a deficiency the body may start to break down its tissues or muscles this releases the type 2 nutrient in which the body is deficient this nutrient will then be used for other tissues of the body when tissue breakdown becomes severe the functions of the cells are affected also there is a reduction in the appetite the tissue breakdown provides the nutrient in which the body is deficient however it also releases all the other type 2 nutrients from the tissues these nutrients are then excreted from the body so all type 2 nutrients must be provided in a type 2 nutrient deficiency correcting a type 1 nutrient deficiency does not require all type 1 nutrients it can be treated by giving only the nutrient in which the body is deficient next let's discuss the availability of type 1 and 2 nutrients from breast milk breast milk contains stable stores of type 2 nutrients they do not change even if the mother is undernourished the baby of an undernourished mother can grow well with adequate breastfeeding by contrast the quantity of type 1 nutrients in breast milk is not stable it varies as per mother's self nourishment let's take vitamin D as an example breast milk of a mother deficient in vitamin D has less amount of vitamin D next let's discuss the diagnosis of type 1 and type 2 nutrient deficiencies a type 1 nutrient deficiency is commonly diagnosed in two ways first the unique symptoms of the deficiency are recognized then the level of the nutrient in the body is measured by a blood test let's take iron and iodine as examples in iron deficiency symptoms such as pale skin and fatigue are recognized the level of hemoglobin in the body is measured by a blood test iodine deficiency is also diagnosed by its unique symptoms and tests symptoms such as swelling of the neck weight gain and hair loss are recognized the level of iodine and thyroid hormones in the body is measured by blood test type 1 nutrient deficiencies are well recognized and treated there are various ways to correct a type 1 nutrient deficiency one can take the recommended amount of these nutrients in the diet supplements are also recommended for these nutrients iron vitamin C and folic acid supplements are commonly prescribed food is fortified with type 1 nutrients in areas where deficiency is common a well-known example is salt that is fortified with iodine a qualified nutrition expert can provide guidance on these methods diagnosis and treatment of a type 2 nutrient deficiency is difficult there is only one way to diagnose any type 2 nutrient deficiency it is to measure and track the weight height and mid upper arm circumference however this will only help in detecting growth failure growth failure is caused by every type 2 nutrient deficiency it is difficult to determine which specific nutrient the body is deficient in so correcting a type 2 nutrient deficiency requires all type 2 nutrients food rich in all type 2 nutrients must be given in such a deficiency increasing only the quantity of previously given food will not work previously given food failed to provide type 2 nutrients to the body the quality of food must be changed for normal growth of the body please consult a qualified nutrition expert for further guidance food sources of type 1 and type 2 nutrients are discussed in other tutorials please visit our website for more details this brings us to the end of this tutorial so from this session onward we are going to introduce you to different recipes you know depending upon which nutrient that we're talking about i want to reiterate this is recipes mainly for older children and adults you know lactating mothers pregnant mothers adolescent just regular adults i also want to mention that we have separate recipes for younger children so we have separate recipes for six months seven months you know eight to eleven months 12 to 18 months because it depends upon a child's age right so those recipes will come later on when i'm taking session on complementary feedings okay so these are general recipes do watch them i won't be asking any questions on them but definitely it will be helpful if you understand at what ingredients to use to increase you know those nutrient content you know so it's more of a learning thing you don't have to necessarily kind of make it at home but you know if you can try it you know hey you will become an expert to tell anybody else at what to cook how to cook you know all that so so do watch them okay thank you