APPLIED HUMAN

NUTRITION
SRIJANA BHURTEL
 1.TERMINOLOGY RELATED TO HUMAN
NUTRITION

• Food
Food is defined as any solid or liquid which when ingested will enable the body to carry
out any of its life function. Most foods are made up of several simple substances, which we
call nutrients. There are six nutrients each of which has specific function in the body. Those
that supply energy are the carbohydrates and fats. Those responsible for growth and repair
of tissues cells are proteins. Those, which regulate chemical process in the body, are the
vitamins and minerals. Water is present in most foods and is an indispensable component of
our bodies. It is the means of transportation for most nutrients and is needed for all
cellular activities.
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• Nutrition
Nutrition has been defined as food at work in the body. It includes everything that happens to food from the
time it is eaten until it is used for various functions in the body.
The science of food and nutrients and their action on our health is called Nutrition. Nutrition can also
be defined as the science of foods, nutrients and other substances they contain; and of their actions within the
body including ingestion, digestion, absorption, metabolism and excretion. While this summarizes the physiological
dimensions, nutrition has social, psychological and economic dimensions too.
Nutrition is the sum total of the process by which living things receive and utilize the necessary
materials for survival, growth and maintenance of worn out tissues.
Adequate, optimum and good nutrition are expressions used to indicate that the supply of the
essential nutrients is correct in amount and proportion. It also implies that the utilization of such nutrients in the
body is such that the highest level of physical and mental health is maintained throughout the life-cycle.
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• Nutrients:
The foods we eat contain nutrients. Nutrients are substances required by the body to perform
its basic functions. Nutrients must be obtained from our diet, since the human body does not
synthesize or produce them.There are more than 40 different kinds of nutrients in food.
Nutrients have one or more of three basic functions: they provide energy, contribute
to body structure, and/or regulate chemical processes in the body.
Nutrients are components of foods needed for body in adequate amounts for proper
growth, reproduction and leading normal life. The science of nutrition deals with what nutrients
we need, in what quantity, how to get them and how the body utilizes them.
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• Nutrients include :- macro and micronutrients

Both are equally important for good health. The amount needed to ensure good health
varies from individual to individual depending on their age, gender, body size, activity and state of
good health.
➢ Macronutrients: consumed in relatively large amounts and used primarily to generate
energy or to incorporate into tissues for growth and repair.
i. Water
ii. Carbohydrates
iii. Proteins
iv. Fats
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➢ Micronutrients: needed in smaller amounts and have biological roles in cellular

processes like vascular functions or nerve functions.
i. Vitamins
ii. Minerals
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• Health
According to World Health Organization (WHO) ‘‘Health is the state of complete physical,
emotional, and social well-being, not merely the absence of diseases or infirmity.’’ This definition
has remained unchanged since 1948.
The word health refers to the condition of the body, good health not only
implies freedom from disease, but physical, mental and emotional fitness as well
All of us want to maintain positive health, i.e., a perfect blend of physical, social and
mental. Taking adequate amounts of essential nutrients in our diet is necessary to maintain
positive health.
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• Nutritional status
Nutritional status is the state of our body as a result of the foods consumed and their use by the body.
Nutritional status can be good, fair or poor.
The characteristics of good nutritional status are an alert, good natured personality, a well
developed body, with normal weight for height, well developed and firm muscles, healthy skin, reddish pink color of
eyelids and membranes of mouth, good layer of subcutaneous fat, clear eyes, smooth and glossy hair, good appetite
and excellent general health.
Poor nutritional status is evidenced by a listless, apathetic or irritable personality, undersized poorly
developed body, abnormal body weight (too thin or fat and flabby body), muscles small and flabby, pale or sallow
skin, too little or too much subcutaneous fat, dull or reddened eyes, lusterless and rough hair, poor appetite, lack
of vigor and endurance for work and susceptibility to infections. Poor nutritional status may be the result of poor
food selection, irregularity in schedule of meals, work, sleep and elimination.
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• Malnutrition
Malnutrition means an undesirable kind of nutrition leading to ill-health. It results from a lack, excess or
imbalance between dietary intake and requirements.
Malnutrition can be primarily be due to insufficient supply of one or more essential nutrients; or
it can be secondary, which means it results from an error in metabolism, interaction between nutrients or
nutrients and drugs used in treatment.
It includes: Undernutrition and Overnutrition.
Undernutrition is a state of an insufficient supply of essential nutrients.
Overnutrition refers to an excessive intake of one or more nutrients, which creates a stress in
the bodily function.
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• Diet
Diet refers to whatever you eat and drink each day. Diet is defined as food containing all
the nutrients in a sufficient amount and in proper ratio. Thus it includes the normal diet
you consume and the diet people consume in groups (hostel diet). Diet may also be
modified and used for ill persons as part of their therapy (therapeutic diets).
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• Balanced diet:
A balanced diet is one which includes a variety of foods in adequate amounts and correct proportions to meet the day’s
requirements of all essential nutrients such as proteins, carbohydrates, fats, vitamins, minerals, water, and fiber. Such diet helps to
promote and preserve good health and also provides a safety margin or reserve of nutrients to withstand short durations of
deprivation when they are not supplied by the diet.
A balanced diet takes care of the following aspects.
1. Includes a variety of food items .
2. Meets the RDA for all nutrients.
3. Includes nutrients in correct proportions.
4. Provides a safety margin for nutrients.
5. Promotes and preserves good health.
6. Maintains acceptable body weight for height.
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• Nutritional care
Nutritional care is the use of nutritional knowledge in planning meals and the
preparation of these meals in an acceptable and attractive manner to feed people. It
involves assessment of the exiting meal patterns and improving these in an acceptable
manner. While the nutritional plan may be general for a group of people, the actual
execution is individualized to suit the person’s needs and background. Thus one has to use a
lot of ingenuity to succeed in making nutritional care effective in practical terms.
2. RELATIONSHIP OF FOOD AND NUTRITION
TO HEALTH
❖ Relationship of Food and Nutrition
Food is a basic and foundational part of our lives. Food plays a vital role for human
existence just as the air we breathe and the water we drink. The food we eat is utilized in
the body and assimilated substances are used for growth and maintenance of the tissue.
People who eat right foods rich in nutrients enjoy their lives more, live longer, and are at a
reduced risk of disease.
Good nutrition is critical in preventing not only deficiency diseases, but also
chronic diseases. Nutrition is vital to our bodies as water is to plants. An unhealthy diet
increases the risk of many diet related diseases
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❖ Relationship of Nutrition and Health

Nutrition contributes to the promotion of health. The foods and nutrients that
should be prioritized in our diets and how they can improve our health must therefore
be considered carefully. Diets rich in fruits, vegetables, whole grains, nuts, and lean meats
have a number of documented health advantages, including lowering blood pressure,
improving diabetes patients' glucose control, promoting weight loss, easing arthritis
symptoms, and lowering the risk of cardiovascular disease and cancer. Physical activity is
known to help maintain a healthy weight, enhance mood and sleep patterns, and improve
general health. And it is obvious that a nutritious diet that is well-balanced plays a vital
role to maintain optimal health.
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❖ Nutrition as a Promoter of Good Health

The absence of sickness is only one aspect of health. It is a good trait that
emphasizes all aspects of wellbeing, including mental, emotional, spiritual, and physical. The
foundation of good health is optimal diet, which offers all nutrients in the right kinds and
quantities. The most significant ongoing elements affecting our growth, development,
functional ability, and health are the meals we eat and the nutrients they give. A healthy diet
aids in both the prevention of certain illnesses and their rehabilitation.
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❖ Interrelationship Between Food and Nutrition to Health

There is a strong link between food, nutrition and health. We get the energy and
nutrients we need from food. Eating right kind of food in right amounts ensures good
nutrition and health. Good nutrition is a prerequisite for good health.
Consuming a diet containing all kinds of foods in required amount throughout a
person’s life helps prevent malnutrition in all its forms as well as a range of diet-related
noncommunicable diseases and conditions such as diabetes, heart disease, stroke and
cancer.
3.CLASSIFICATION OF FOODS

• Food : Food can be defined as anything solid or liquid which when swallowed, digested and
assimilated in the body provides it with essential substances called nutrients and keeps it well. It is
the basic necessity of life. Food supplies energy, enables growth and repair of tissues and organs. It
also protects the body from disease and regulates body functions.
Food can be categorized on the basis of their chemical characteristics, functions, essentiality,
concentrations and nutritional value.
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A. Based on the chemical nature

i. Carbohydrates
ii. Proteins
iii. Fats
iv. Vitamins
v. Minerals
vi. Dietary fiber
vii. Water
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B. Based on their function in the body

i. Energy giving foods
The carbohydrates, fats and the protein are considered as calorie nutrients, so that the body can
perform the necessary functions. Rice, chapatti, bread, potato, sugar, oil, butter and ghee are
examples of energy giving foods.
ii. Body building foods
Foods such as proteins, fats and carbohydrates are also called as body-building food. They are
the nutrients that form body tissues. Fish, meat, chicken, eggs, pulses, nuts and milk are some
body building foods.
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iii. Protective foods

Vitamins and minerals are the nutrients that function to regulate body processes. They
protect us from various diseases. Fruits and vegetables are some examples. Thus, we must
eat these regularly.
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C. Based on chemical properties

i. Organic: Organic nutrients are those that contain the element of carbon
ii. Inorganic: Inorganic nutrients are those that don't contain the carbon ele
ment.
Proteins, lipids, carbohydrates, and vitamins are among the organic nut
rients.
Both minerals and water are inorganic.
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D. Based on its mass, depending on the volume required for cells and organisms

➢ Macronutrients: consumed in relatively large amounts and used primarily to generate

energy or to incorporate into tissues for growth and repair.
➢ Micronutrients: needed in smaller amounts and have biological roles in cellular
processes like vascular functions or nerve functions.
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E. Based on its origin

Food has been divided into two categories:

Animal and plant sources depending on where

it comes from.
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F. Based on its nutritive value

• Grain items like millet and cereals

• Nuts and oil-producing seeds

• Fruits and vegetables

• Vegetables with green leaves

• Vegetables without leaves

• Root and tuber systems

• Obstacles: Fruits

• Milk and milk-related items

• Animal products, such as meat, fish, liver, and eggs

• Carbohydrate-rich foods

• Condiments & seasonings.

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• Classification of food into five groups

A classification based on nutrients present will ensure that all nutrients are made available to the
body and offer greater variety within the group. There are five basic food groups suggested by the Indian
Council of Medical Research (ICMR). These include:
1. Cereals, grains and products
2. Pulses and legumes
3. Milk and meat products
4. Fruits and vegetables
5. Fats and sugars
4. CLASSIFICATION, FUNCTIONS,
REQUIREMENTS, DEFICIENCY, SYMPTOMS
AND FOOD SOURCES OF THE FOLLOWINGS
• Carbohydrates
• Proteins
• Fats/lipids
• Water
• Vitamins
• Minerals
WHY HUMAN BEINGS NEED FOOD?

• Human beings need food to provide energy for the essential physiological functions like:-
• Respiration
• Circulation
• Digestion
• Metabolism
• Maintaining body temperature.
• Growth and repair body Tissue
An adequate supply of nutrients is needed to maintain all the functions of the body and daily activities
at maximum efficiency, thus ensuring healthy living. Health and nutrition are closely linked and to
ensure proper development and life quality they must be adequate from early childhood on and most
vulnerable groups are infants, young children, pregnant women and lactating mothers.
HEALTHY DIET

• A healthy diet is consumed throughout the life course and aids in preventing a number of non-
communicable diseases (NCDs) and disorders, as well as malnutrition in all of its manifestations.
However, there has been a change in dietary patterns as a result of increased production of
processed foods, growing urbanization, and changing lifestyles.
• Nowadays, individuals eat more meals that are heavy in calories, fats, free sugars, and
sodium/sodium, and many people eat insufficient amounts of fruit, vegetables, and other dietary
fiber-rich foods like whole grains.
• Depending on individual characteristics (such as age, gender, lifestyle, and level of physical
activity), cultural context, regionally accessible foods, and dietary habits, a diversified, balanced,
and healthy diet will take on different compositions.
A HEALTHY DIET FOR ADULT

• Fruit, vegetables, legumes (e.g., lentils and beans), nuts and whole grains (e.g., unprocessed maize,
millet, oats, wheat and brown rice).

• At least 400 g (i.e., five portions) of fruit and vegetables per day, excluding potatoes, sweet potatoes,
cassava and other starchy roots.

• Less than 10% of total energy intake should come from free sugars, which is equal to 50 g (or
approximately 12 level teaspoons) for a person of healthy body weight consuming 2000 calories per day.
However, less than 5% of total energy intake is preferable for additional health benefits. All added sugars
to food or beverages, whether by the producer, cook, or consumer, as well as sugars found naturally in
honey, syrups, fruit juices, and fruit juice concentrates, are considered free sugars.
A HEALTHY DIET FOR ADULT

• Less than 30% of total energy consumption should come from fats. Saturated fats, which are present in
fatty meat, butter, palm and coconut oil, cream, cheese, ghee, and lard, as well as trans-fats of all kinds,
including ruminant trans-fats, are to be avoided. These fats can also be found in baked and fried foods,
as well as in pre-packaged snacks and foods like frozen pizza, pies, cookies, biscuits, wafers, and
cooking oils and spreads (found in meat and dairy foods from ruminant animals, such as cows, sheep,
goats and camels). It is advised that trans-fat consumption be kept to less than 1% of total energy intake
and that saturated fat intake be decreased to less than 10% of total energy intake. In particular,
industrially-produced trans-fats are not part of a healthy diet and should be avoided.

• Less than 5g of salt (equivalent to about one teaspoon) per day). Salt should be iodized.
FOR INFANTS AND YOUNG CHILDREN

• In the first 2 years of a child’s life, optimal nutrition fosters healthy growth and improves cognitive
development. It also reduces the risk of becoming overweight or obese and developing Non-
Communicable Diseases later in life.
• Infants should be breastfed exclusively during the first 6 months of life.

• Infants should be breastfed continuously until 2 years of age and beyond.

• From 6 months of age, breast milk should be complemented with a variety of adequate, safe and nutrient-
dense foods. Salt and sugars should not be added to complementary foods
DIETARY GUIDELINES

• Eat a wide variety of foods

• Maintain healthy weight
• Choose a diet low in fat, saturated fat, and cholesterol
• Choose a diet with plenty of vegetable, fruits and grain products
• Use sugar in moderation
• Use salt and sodium in moderation
• If you drink alcoholic beverage, do so in moderation.
5. ENERGY

• Measures of energy
• Forms of energy
• Measurement of energy
• Basal metabolism
• Factors affecting basal metabolism
• Energy requirements for different categories of people
• Effect of energy insufficiency on human health
• Food sources of energy
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• Energy is the capacity to do work. All biologic functions require energy. The carbohydrate,
lipid, and protein macronutrients contain the energy that ultimately powers biologic work,
making energy the common denominator for classifying both food and physical activity.
In physiology and nutrition, energy is defined as the capacity of a body to do work.
Just as a machine needs fuel to keep it operating, the body needs food to provide the energy to
perform its various tasks. Food energy is defined as the energy released from carbohydrates,
fats, proteins, and other organic compounds. When the three major calorigenic nutrients
(carbohydrates, fats, and proteins) in a food are burnt entirely with sufficient amounts of oxygen,
it releases energy or food calories that are expressed in kilojoules (kJ) or kilocalories (kcal).
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Remember
• One gram of
carbohydrate releases 4 Kcal. of energy
protein releases 4 Kcal. of energy
fat releases 9 Kcal. of energy
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• Measures of energy
The energy released in the body from food is measured as a unit of heat the kilocalorie (kcal).
By definition, one kilocalorie is the amount of heat required to raise the temperature of one kg of water
through one degree centigrade (i.e., from 14.5° to 15.5.°C). Some efforts have been made to introduce the
joule (J)1 as a unit of energy. One joule is equal to the energy expended when one kg is moved through
one meter by a force of one newton (N). But joule cannot be used in practical nutrition, until food
composition tables are prepared giving the energy value of foods in joules, and RDA are set in joules. It
must be remembered that the human body uses energy in many forms hence the unit used in measurement
is only an indirect indication of the energy available to the body in various forms (chemical, thermal,
mechanical, electrical, etc.).
Food supplies the energy we need for everything we do. Two components of food, carbohydrates
and fats, supply 85 to 92 per cent of the total energy in the dietary, the rest is provided by proteins.
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• Forms of energy
Energy exists in a number of forms. It may occur as heat generated by chemical,
mechanical or electrical means.
• Examples are:
1. Heat produced by chemical means, e.g., when lime and water are mixed.
2. Heat produced mechanically in the grinding stone when cereals are ground.
3. Heat generated by electric current for boiling water in a tea kettle.
One form of energy can be converted to another form.
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Food contains chemical energy. Chemical energy is energy stored in bonds. Food contains proteins, fats,
and carbohydrates; all of these contain lots of ionic and covalent bonds. All of the energy present in these
bonds is known as chemical energy, and it can be released as ATP in human cells.
As the bonds between the atoms in food loosen or break, a chemical reaction takes place, and
new compounds are created. The energy produced from this reaction keeps us warm, helps us move, and
allows us to grow. Different foods store different amounts of energy.
Chemical energy is stored within chemicals between chemical bonds. Food that is consumed also
consists of different types of chemicals, which are later converted into another form of energy after a
particular type of chemical reaction to benefit the human body or living organisms.
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• Overview of Chemical Energy In Food

Chemical energy is the energy between chemical bonds between the atoms or molecules. A
common example is the burning of wood. Wood is made of cellulose fibers. When it is burnt, we observe
the converted energy in the form of heat or smoke. This is where the atomic bonds inside a particular
matter get broken up and converted into another state of matter like gaseous heat or liquid.
The food that is consumed by living organisms contains adequate energy for the sustenance of
life. The chemicals found inside food items get converted into another form of energy when they are
cooked, boiled, heated or cooled down. The bond between the atoms gets broken up or weakens when this
happens. A balanced diet, which is required for the human body, is a concept of how different types of
chemicals stored inside food sources provide us energy in different ways. Carbohydrates, proteins, fats,
vitamins and fibers are some of the other combinations of organic chemicals that the human body needs
for a healthy life.
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• Count of chemical energy in food

The chemical energy inside different forms of nutrients of food is counted in
terms of calories. It is measured in the form of combustion of food molecules, which is the
stored chemical energy inside the bond when converted into heat energy that helps to
calculate the calorie count. Carbohydrate-heavy food tends to have higher calories, whereas
fruits and vegetables tend to have low calories. This is the reason why in general the food
based on carbohydrates is called an energy supplier.
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• Measurement of energy
Food energy is usually measured by a bomb calorimeter based on the heat of combustion.
➢ Bomb Calorimeter
o Measure the total or gross energy value of various food macronutrients.
o Bomb calorimeters operate on the principle of direct calorimetry, measuring the heat liberated as the
food burns completely.
o Heat of combustion refers to the heat liberated by oxidizing a specific food; it represents the food.
o Bomb calorimetry is used to determine the enthalpy of the combustion, DcombH, for hydrocarbons ’s
total energy value.
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➢ Other calorimeters
i. Benedict’s oxy-calorimeter – measures the volume of oxygen required to burn a known weight of the
food.
ii. Direct calorimetry – The relation between energy output and oxygen consumed has been
determined using the human respiration calorimeter.
Eg. Adult weighing 65 kgs
Amount of heat output in 24 hours – 2400 kcal
Amount of oxygen consumed in 24 hours – 500 litres
Heat output per litre of oxygen consumed – 4.8 kcal
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• Basal metabolism
Energy needs of the body at rest is called basal metabolism. It is the energy required to
carry on vital body processes at rest, which include all the activities of the cells, glands, skeletal
muscle stone, body temperature, circulation and respiration.
A number of processes go on to ensure the continuance of life without any conscious
effort. These include the beating of heart, the circulation of the blood, breathing, the regulation
of body temperature, glandular activities, etc. These processes are known as the basal metabolic
processes.
In persons who are generally inactive physically, basal metabolic needs make up the
largest part, about two thirds, of the total energy requirement.
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• Basal energy expenditure (BEE) or resting energy expenditure (REE) is the energy used
by the body at rest.
• The energy used is measured as the basal metabolic rate (BMR) or resting metabolic
rate (RMR). The terms are used interchangeably. The basal energy needs account for,
about 60 per cent of the total energy requirement for most people.
• The highly active tissues (liver, brain, heart, kidney and gastrointestinal tract), which form
less than 5 per cent of the body weight, use about 60 to 70 per cent of the basal
metabolic energy. The rest of the tissues, which account for most of the body weight,
need much less energy to maintain their basal function.
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• Basal metabolic rate (BMR) is a measurement of the number of calories needed to perform your
body’s most basic (basal) functions, like breathing, circulation and cell production. These includes
processes such as:
• Keeping their brain functioning
• Moving blood throughout the body
• Keeping the heart beating
• Taking oxygen in through the lungs
• Ensuring the kidneys are working, filtering water and waste materials
• Keeping their liver running at full capacity
• Making sure any necessary tissues are being repaired and replaced
• Maintaining contraction of all smooth muscle tissues (which are the tissues of the heart and organs)
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• Measurement of Basal Metabolic Rate (BMR)

BMR is normally measured early in the morning, after the subject awakens and is in a postabsorptive
state (10 to 12 hours after the last meal). Depending on its use, the rate is usually expressed per minute, per hour
or per 24 hours.
In clinical cases, the normal exchange of oxygen and carbon dioxide in regular breathing used to be
measured with a calorimeter to determine the BMR. BMR are measured by gas analysis through either direct or
indirect calorimetry, though a rough estimation can be acquired through an equation using age, sex, height, and
weight. Also there are several formulas to calculate the approximate BMR of an individual. Dubois and Dubois
found a formula to calculate the Body surface area of a human being.
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To reach or maintain a healthy weight it is essential to calculate BMR. For this

purpose, either find the number using a formula designed by scientists, you can get it tested
in a lab, or you can use an online calculator. No method is perfectly accurate, but a lab test
will probably give you the best estimate.
But since lab tests can be costly, many dieters and exercisers use one of the other
two methods to determine basal metabolic rate and/or the total number of calories they
burn each day.
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The equation to calculate BMR

The Harris-Benedict Equation is often used to estimate basal metabolic rate.
• Men: BMR = 88.362 + (13.397 x weight in kg) + (4.799 x height in cm) – (5.677 x age in
years)
• Women: BMR = 447.593 + (9.247 x weight in kg) + (3.098 x height in cm) – (4.330 x
age in years)
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• Factors affecting the Basal metabolism

1. Body size and shape
2. Age and growth
3. Sex
4. Sleep
5. Genetics
6. Climate
7. Racial
8. State of nutrition
9. Diseases
10. Hormonal control
11. Pregnancy
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1. Body size and shape

The grater the skin area, the greater will be the amount of heat lost by the body and,
in turn, greater the necessary heat production by the individual. Example: tall person needs more
food than short person with the same weight.
2. Age and growth
They are responsible for normal variation in basal metabolism. The relative rate is
highest during the first and second years and decreases after that, although it is still relatively
high through the ages of puberty. During the adult life there is a steady decreases in rate with a
marked drop in old age.
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3. Sex/gender
Sex probably has little effect on metabolism. Women has lower metabolism than men. Women
usually have a less fat and less muscular development than men.
4. Sleep
Sleep varies depending on individuals, some are restless and others are quiet. The metabolic rate
falls by about 10 per cent while sleeping as compared to the resting rate when awake. This is due to
relaxation of muscles and reduced activity of the nervous system during sleep.
5. Genetics
Some families have faster BMR than others with some genetic disorders also affecting
metabolism
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6. Climate
Climate has little effect on BMR, which is always measured in a room temperature.
Extreme environmental temperatures affect the metabolic energy needs. In hot climate (if the
temperature is greater than 86°F), the metabolic rate increases by about 50 per cent due to
increased activity of sweat glands. The increase in metabolic rate due to cold depends on the
body fat insulation and use of warm clothes.
7. Racial
Differences in metabolism has been noted. Eskimos ( unique indigenous people) have been
reported to have a BMR above accepted standards.
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8. State of nutrition
In starvation or undernutrition, the BMR is lower. The metabolism is decreased due to
malnutrition; the decrease in basal metabolism is proportional to the degree of malnutrition. It is
mainly due to decrease in the amount of active tissue and a decrease in the metabolic rate.
9. Diseases
Diseases such as infection or fevers raise the BMR in proportion to the elevation of
the body temperature. . When one suffers from fever, the increase in temperature of the body
increases metabolism. The increase is about 7 per cent per each degree Fahrenheit above
normal (98.6°F or 37°C).
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10. Hormonal Control

A hormone known as thyroxine, controls the speed of our involuntary activity. The thyroid gland,
situated in our neck, synthesizes this hormone. If too much thyroxine is released, the rate of energy
expenditure is increased; if too little is released, the energy expenditure is reduced. The basal metabolism
may decrease by 30 to 40 per cent when the synthesis of thyroxine is inadequate. On the other hand, the
BMR may almost double due to a hyperactive thyroid gland. These conditions need prompt medical
treatment. Luckily for most of us such abnormalities are not very common. Most of us have a normally
functioning thyroid gland and hence a normal basal metabolic rate.
11. Pregnancy
After four months of gestation the BMR will increase.
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• Energy requirements for different categories of people

Energy requirement is the amount of food energy needed to balance energy expenditure in order
to maintain body size, body composition and a level of necessary and desirable physical activity consistent with
long-term good health.
The amount of food energy needed to balance energy expenditure in order to maintain body size,
body composition and a level of necessary and desirable physical activity, and to allow optimal growth and
development of children, deposition of tissues during pregnancy, and secretion of milk during lactation, consistent
with long-term good health. For healthy, well-nourished adults, it is equivalent to total energy expenditure. There
are additional energy needs to support growth in children and in women during pregnancy, and for milk
production during lactation.
Measurements of energy requirement recommendations are expressed in units of energy (joules, J), in
accordance with the international system of units.
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Energy requirement varies among individuals. It is affected by a number of factors

including age, gender, body weight and physical activity level.
Energy requirements vary at different stages of body development. Children and
adolescents need extra amount of energy to support their rapid growth as well as
increased physical activity levels. Pregnant and lactating women also require additional
energy to maintain normal growth of foetus and for milk production respectively. However,
for an average adult, the energy requirement usually decreases as the age goes up.
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• On the other hand, depending on the Physical Activity Examples of

occupation and daily activities people are Level (PAL) Occupation
engaged in, their physical activity levels do Light Office workers,
vary and so do their energy requirements. salesperson, lecturers,
For example, the energy requirements of hotel attendants
athletes and people engaged in occupation Moderate School workers,
that requires heavy physical activities such electricians,
as labour workers are higher when professional drivers
compared to those who have a sedentary Heavy Athletes, dancers,
occupation such as office workers. construction workers
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• Energy has close association with body weight. When our energy intake is greater than
energy output, weight goes up. When our energy intake is lower than energy output,
weight goes down. Therefore, it is important to pay attention to the balance between
energy intake and output in order to maintain a healthy body weight.
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• Effect of energy insufficiency on human health

The effects of insufficient energy supply throughout life may result in low life
expectancy. For a large section of the rural population, who do not get sufficient food, the
cause may be traced to too many persons per unit of family land; poor yields or poor
harvests; the landless labor may have no work during part of the year. In the cities the
causes may be full or partial unemployment or too many dependents per earning member
in the lower socio-economic groups. A small section of the population may have insufficient
intake due to faulty food habits. These may include missed meals, poor schedules, neglect or
poor health practices.
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The effects of insufficient energy supply vary with the age group affected and the extent of insufficiency. In
adults, it may affect their capacity for work, in children it affects their growth and activity. If the energy supply is
very short of what is needed, the body stores of fat may be used, followed by use of the muscle tissues to meet
the need for minimal function of the body.
1. Working Capacity The energy needs for work are next to the basal metabolic needs in magnitude. When
there is an insufficient energy supply, the body adjusts to the shortage by reducing activity. In children, this
may result in reduced movement or play, depending on the age of the child and may pass unnoticed. In
adults, it results in reduced activity, slow deliberate movement and avoidance of continuous effort. In a
number of studies, dramatic losses in working efficiency have been reported, during periods of food
shortage. In Germany, steel output fell from 120 tons to 80 tons per man per month, when energy supply
for work was reduced from 1900 to 1150 calories per day. In India, where about 65 to 70 per cent of the
population is engaged in agriculture, it will affect the agricultural production adversely.
CONTD…

2. Wasting of Tissue
When adults have to do strenuous(tough) manual work with meagre (inadequate) food
intake, the extra energy needed is mobilized by burning body tissues. This has been
euphemistically called ‘wasting of tissue’. This is what happens to many farm workers who have
very little food reserves. When the planting season comes, and they have to go through the
whole cycle of strenuous operations involved in producing the crop, with meagre food intakes.
The wasting of tissues is observed in adults in pre-harvest periods in many farming communities.
This population goes through the cycle of want annually. What it means in terms of loss of
potential human resources and human misery is hard to estimate. The women folk in these
communities, who have the additional burden of child-bearing, are subjected to greater stress
and it is bound to affect the health of the mother and the child adversely
CONTD…

3. Stunted Growth
It has been observed that underfed mothers tend to have smaller babies, who have very
little reserves of nutrients at birth. Inadequate food during infancy results in stunted growth.
Unfortunately, as most children in such communities suffer from a similar problem, the retarded growth
may not be noticed by the parents. Thus the subnormal may pass for normal growth. This is not a malady in
itself, but insufficient food intake is not only deficient in energy, but in other nutrients, making the child
vulnerable to diseases. Any childhood infection such as diarrhea, dysentery, measles, chicken pox creates a
stress and the body tissues are used up to meet the extra demands imposed by the infection. The child may
not survive, if it suffers from repeated attacks of such infections, in the absence of improved quantity and
quality of food intake. Aged persons, in such families may also suffer from tissue wastage, as they are
dependent on their relatives, who are unable to provide food for them.
CONTD…

• Food sources of energy

Carbohydrates (starches and sugars), fat, and protein within food can all function
as sources of energy when they are metabolized to carbon dioxide and water in respiration
processes in all of our body's cells.
Energy-dense foods with high caloric content are generally those with high
carbohydrate, protein, or fat content - for example, pasta, bread, oatmeal, grits, and other
cooked whole grains and porridges consumed around the world as staples; plant oils or
animal lard present in cooked foods, or meat and cheese.
6. BALANCED DIETS FOR DIFFERENT AGE
GROUPS
• Nutrient loss during preparation, processing and post harvest
• Methods of enhancing nutritive value of foods
CONTD…

• Balanced diet for different age groups

Our dietary requirements fluctuate as we move through different life stages, from
infants to the elderly. It’s essential to consider the additional demands set on your body by
these changes to stay active and healthy. A child prefers brighter colors on plates with small
servings, whereas an older adult with weaker teeth requires a softer, nutrient-dense diet.
Expectant mothers have different dietary needs than women of the same age group. They
need more nutrients, for their growing child inside.
To be fit and healthy, it is important to take into account the extra demands placed
on your body by these changes.
CONTD…

• Infancy (0 to 12 months)
Babies usually double their length and triple their weight between birth and one
year of age. Breastmilk generally supplies a baby with the required amounts of nutrients,
fluids and energy up to about six months of age. It is recommended that infants be
exclusively breastfed up to around six months of age.
Solids should be introduced around six months of age to meet your baby’s
increasing nutritional and developmental needs. However, breastfeeding should continue
until twelve months of age and beyond, or for as long as the mother and child desire.
CONTD…

• Pre school and school going children

Once a child is eating solids, offer a wide range of foods to ensure adequate nutrition. Young
children are often picky with food, but should be encouraged to eat a wide variety of foods. Trying again
with new foods may be needed for a child to accept that food. As many as eight to fifteen times may be
needed.
During childhood, children tend to vary their food intake (spontaneously) to match their growth
patterns. Children’s food needs vary widely, depending on their growth and their level of physical activity.
Like energy needs, a child’s needs for protein, vitamins and minerals increase with age.
Appropriate weight gain and development will indicate whether food intake is appropriate.
CONTD…

• Adolescence
The growth spurt as children move into adolescence needs plenty of kilojoules and nutrients. For girls, this generally
occurs around 10 to 11 years of age. For boys, it occurs later, at around 12 to 13 years.
Recommendations include:
• The extra energy required for growth and physical activity needs to be obtained from foods that also provide nutrients, instead
of just ‘empty calories’.
• Takeaway and fast foods need to be balanced with nutrient-dense foods such as wholegrain breads and cereals, fruits, legumes,
nuts, vegetables, fish and lean meats.
• Milk, yoghurt and cheese (mostly reduced fat) should be included to boost calcium intake – this is especially important for
growing bones. Cheese should preferably be a lower salt variety.
• Adolescent girls should be particularly encouraged to consume milk and milk products.
CONTD…

• Young Adults
Moving away from home, starting work or study, and the changing lifestyle that accompanies the late
teens and early 20s can cause dietary changes that are not always beneficial for good health. Nutrients
recommendations depend upon lifestyle and physical activity.
Recommendations include:
Make a deliberate effort to keep physically active.
Limit alcohol intake.
Reduce the amount of fats and salt in the daily diet.
Be careful to include foods rich in iron and calcium.
Establish healthy eating habits that will be carried on into later life.
CONTD…

• Pregnant women
A pregnant woman should concentrate on increasing her nutrient intake particularly in the
first and second trimesters.
Recommendations include:
No ‘crash dieting’, as this can have a negative impact on the baby.
Concentrate on diet quality rather than quantity.
Accommodate cravings, but don’t let them replace more nutritious foods.
Nutrients for which there are increased requirements during pregnancy include folate, iron,
vitamin B12 and iodine.
CONTD…

• Iron is required for oxygen transport in the body. Iron supplements can be advised by your doctor
during pregnancy, but do not take them unless your doctor recommends them. Increasing vitamin C
intake can help increase iron absorption from foods.
• Folate is important 3 months before and in the first trimester of pregnancy to avoid neural tube defects
(like spina bifida) in the baby. All women of childbearing age should eat high-folate foods (such as green
leafy vegetables, fruits and legumes). If planning for pregnancy, it’s important to obtain 400 µg folate/ day
and if you are pregnant, this increases to 600 µg/day. This can be obtained from a folate supplement and a
diet high in folate-rich foods (remember to talk to your doctor first). It is now mandatory for all bread-
making flour to be fortified with folic acid (a form of folate that is added to foods). This will help women
reach their recommended intake of folate.
• Iodine is important for normal growth and development of the baby. Iodine supplements are often
advised during pregnancy to meet the increased needs, as food sources (such as seafood, iodised salt and
bread) are unlikely to provide enough iodine. Talk to your doctor about this.
CONTD…

• The recommended intake of calcium does not specifically increase during pregnancy. It is, however, very
important that pregnant women do meet calcium requirements during pregnancy.
• No one knows the safe limit of alcohol consumption during pregnancy. Recommendations are to not drink at
all.
• Pregnant women are advised to avoid foods that are associated with increased risk of the listeria
bacteria (such as soft cheese and cold seafood) and to be careful with foods that are more likely to contain
mercury (such as flake). Listeria can seriously affect your growing baby.
• Being physically active has many benefits. If you are active and fit, and are experiencing a normal pregnancy, you
can remain physically active during your pregnancy. Otherwise, consult your doctor for advice.
• Drink plenty of fluids.
• Do not smoke : both direct and passive smoking is associated with growth retardation, increased risk of
spontaneous abortion, stillbirths, placental complications and low birth weight.
CONTD…

• Lactating women
Breastfeeding mothers need a significant amount of extra energy to cope with the demands of
breastfeeding. This extra energy should come in the form of nutrient-dense foods to help meet the extra
nutrient requirements that also occur when breastfeeding.Vegan mothers who are breastfeeding (and
during pregnancy) should take a vitamin B12 supplement.

Recommendations include:
• Eat enough food – breastfeeding burns through extra kilojoules.
• Eat foods that are nutrient dense – especially those foods that are rich in folate, iodine, zinc and calcium.
• Eat and drink regularly – breastfeeding may increase the risk of dehydration and cause constipation. Fluid
needs are approximately 750–1000 ml a day above basic needs.
• Women should continue to avoid drinking alcohol while breastfeeding.
CONTD…

• Old aged people

Physical activity is not much during old age hence carbohydrates and fats need to
be restricted. But there is muscle loss and fragility of bones is common, hence protein is
required to make up for the loss and for maintaining growth of cells.
Since teeth start falling off hence chewing becomes difficult and thus milk is a good
option for old people. Many people eat less as they get older which can make it harder to
make sure your diet has enough variety to include all the nutrition you need.
CONTD…

• Recommendations include:
-Be as active as possible to encourage your appetite and maintain muscle mass.
-Remain healthy with well-balanced eating and regular exercise.
-Eat foods that are nutrient dense rather than energy dense, including eggs, lean meats, fish, liver,
low-fat dairy foods, nuts and seeds, legumes, fruits and vegetables, whole grain breads and cereals.
-Limit foods that are high in energy and low in nutrients such as cakes, sweet biscuits and soft
drinks.
-Choose foods that are naturally high in fiber to encourage bowel health.
-Limit the use of table salt, especially during cooking.
-Choose from a wide variety of foods and drink adequate fluids.
-Share mealtimes with family and friends.
CONTD…

• Nutrient loss during preparation, processing and post harvest

❖Nutrient loss during postharvest
Postharvest loss can be defined as the degradation in both quantity and quality of a
food production from harvest to consumption. Quality losses include those that affect the
nutrient/caloric composition, the acceptability, and the edibility of a given product. Quantity
losses refer to those that result in the loss of the amount of a product. Loss of quantity is
more common in developing countries (Kitinoja and Gorny, 2010).
Stage Example of waste
1. Harvesting, handling at harvesting Edible crops left in field, ploughed into soil, eaten by pests; timing of harvest not
optimal; crop damaged during harvesting
2. Threshing Loss due to poor technique
3. Drying, transport and distribution Quality and quantity loss of during drying, poor transport infrastructure; loss
owning to spoiling/bruising
4. Storage Pests and disease attacks, spillage, contamination; natural drying out of food
5. Primary processing, cleaning, classification, Process losses; contamination in process causing loss of quality.
hulling, pounding, grinding, packaging, soaking,
winnowing, drying, sieving, milling
6. Secondary processing, mixing, cooking, Process losses; contamination in process causing loss of quality
frying, molding, cutting, extrusion
7. Product evaluation and quality control Product disregarded /out-grades in supply chain
8. Packaging Inappropriate packaging damages produces; grain spillage from sacks; attack by
pests
9. Marketing, selling, distribution Damage during transport; spoilage; poor handling; losses caused by poor storage
10. Post-consumer Poor storage/stock management; discarded before serving; poor food
preparation; expiration
11. End of life disposal of food waste/loss at Food waste discarded may be separately treated, fed to animals, mixed with other
different stages in supply chain. wastes/landfilled
CONTD…

❖Nutrient loss during preparation (cooking)

Cooking food improves digestion and increases the absorption of many nutrients. For
example, the protein in cooked eggs is 180% more digestible than that of raw eggs.
However, some cooking methods reduce several key nutrients.
Following nutrients are often reduced during cooking:
-water-soluble vitamins: vitamin C and the B vitamins — thiamine (B1), riboflavin
(B2), niacin (B3), pantothenic acid (B5), pyridoxine (B6), folic acid (B9), and cobalamin (B12)
-fat-soluble vitamins: vitamins A, D, E, and K
-minerals: primarily potassium, magnesium, sodium, and calcium
CONTD…

• Prevention of nutrient losses during preparation (cooking)

✓ Water-soluble vitamins and minerals: get leached into water when cooked, so it’s
best to limit the amount of water and not overcook (12).
✓ Fat-soluble vitamins (A, D, E, K): some vitamins get released into oil, so it can be
helpful to microwave them or cook them in little oil.
✓ Eat boiled food with the soup or water used for cooking.
✓ Add a small amount of salt during boiling.
✓ Avoid too much boiling.
CONTD…

• Boiling, simmering, and poaching

Boiling, simmering, and poaching are similar methods of water-based cooking.
These techniques differ by water temperature:
1. Poaching: less than 180°F (82°C)
2. Simmering: 185–200°F (85–93°C)
3. Boiling: 212°F (100°C)
While water-based cooking methods cause the greatest losses of water-soluble
vitamins, they have very little effect on omega-3 fats.
CONTD…

• Grilling and broiling

Grilling and broiling are similar methods of cooking with dry heat. When grilling,
the heat source comes from below, but when broiling, it comes from above.
Grilling and broiling provide great flavor but also reduce levels of B vitamins.Also,
grilling generates potentially cancer-causing substances like polycyclic aromatic
hydrocarbons (PAHs), which form when meat is grilled and fat drips onto a hot surface.
CONTD…

• Microwaving
Microwaving is a safe cooking method that preserves most nutrients due to short cooking times.
About 20–30% of the vitamin C in green vegetables is lost during microwaving, which is less than most
cooking methods.
• Roasting and baking
Roasting and baking refer to cooking food in an oven with dry heat. Although these terms are
somewhat interchangeable, roasting is typically used for meat while baking is used for bread, muffins, cake,
and similar foods.
Roasting or baking does not have a significant effect on most vitamins and minerals, except for B
vitamins. Due to long cooking times at high temperatures, the B vitamins in roasted meat may decline by as
much as 40%.
CONTD…

• Sauteing and stir-frying (Healthy way to prepare food)

With sauteing and stir-frying, food is cooked in a saucepan over medium to high heat in
a small amount of oil or butter.
These techniques are very similar, but with stir-frying, the food is stirred often, the
temperature is higher, and the cooking time is shorter. Sauteing and stir-frying improve the
absorption of fat-soluble vitamins and some plant compounds, but they decrease the amount of
vitamin C in vegetables.
• Steaming
Steaming is one of the best cooking methods for preserving nutrients, including water-
soluble vitamins.
CONTD…

• Frying
Frying involves cooking food in a large amount of fat usually oil at a high temperature.
Frying makes food taste delicious, and it can provide some benefits when healthy oils are used.
Fatty fish are the best sources of omega-3 fatty acids, which have many health benefits.
However, these fats are very delicate and prone to damage at high temperatures.
When oil is heated to a high temperature for a long period of time, toxic substances
called aldehydes are formed. Aldehydes have been linked to an increased risk of cancer and
other diseases
The type of oil, temperature, and length of cooking time affect the amount of
aldehydes produced. Reheating oil also increases aldehyde formation.
CONTD…

• Nutrient loss during processing

Food processing is a spectrum that ranges from basic technologies like freezing or milling, to the
incorporation of additives that promote shelf stability or increase palatability.
Invisible loss of nutrients occurs during food processing. Many changes occur in
proteins, fats and carbohydrates due to heat. Heat may diminish nutritive value or even form
toxic substances.
Depending on the degree of processing, many nutrients can be destroyed or removed.
Peeling outer layers of fruits, vegetables, and whole grains may remove plant nutrients
(phytochemicals) and fiber. Heating or drying foods can destroy certain vitamins and minerals.
CONTD…

• Milling
Cereals such as wheat can be ground to remove the fibrous husks. The husks contain
most of the plant’s dietary fibre, B-group vitamins, phytochemicals and some minerals.

That is why products such as white bread are less nutritious than wholemeal varieties,
even if they have been artificially fortified with some of the nutrients that were lost after milling.
It is impossible to add back everything that is taken out, especially the phytochemicals.
The ‘fibre’ that is added back to some products is often in the form of resistant starch, which
may not be as beneficial as the fibre removed.
CONTD…

• Blanching
Before a food is canned or frozen, it is usually heated very quickly with steam or water. The
water-soluble vitamins, including vitamin C and B-complex, are sensitive and easily destroyed by blanching.
• Canning
Food is heated inside the can to kill any dangerous micro-organisms and extend the food’s shelf
life. Some types of micro-organisms require severe heat treatment and this may affect the taste and texture
of the food, making it less appealing. Preservatives are generally not needed or used in canned foods.

Water-soluble vitamins are particularly sensitive to high temperatures. Many people believe that
canned foods are not as nutritious as their fresh counterparts, but this is not always the case, as fresh food
often deteriorates more rapidly than canned foods.
CONTD…

• Freezing
The nutrient value of a food is retained when it is frozen. Any nutrient losses are due to the
processing prior to freezing and the cooking once the frozen food is thawed.
• Pasteurisation
Pasteurisation involves heating liquid foods such as milk and fruit juices to specific temperatures
to destroy micro-organisms. The nutrient value of milk is generally unaffected. In the case of pasteurised
fruit juices, some losses of vitamin C can occur.
• High pressure processing
This alternative preservation method subjects a food to elevated pressures, with or without the
use of heat to kill micro-organisms. This method has been used in foods such as fruit juices. As heat is not
required, this process impacts less on the vitamin content, flavour and colour of foods.
CONTD…

• Dehydrating
Drying out foods such as fruits can reduce the amount of vitamin C they retain,
but it can also concentrate other nutrients, particularly fibre in plant foods. Dehydrating
food also makes food products more energy dense, which may contribute to weight gain.
If a dehydrated food is reconstituted and cooked with water, further nutrients are
leached out of the food and lost in the cooking water.
CONTD…

• Methods of enhancing nutritive value of foods

Enhancement, retention or loss of nutrients in foods largely depends upon the
processing and cooking methods that are used for food preparation.
With increasing world population and limited food resources, it’s really important to
get maximum nutritional value out of every bit of food we buy. And we can achieve this by
improving the nutritive quality of foods by preventing or reducing the loss of nutrients in food
preparations and by avoiding wastage of food.
By enhancing the nutritional values in food, we can meet the nutritional
requirements of the body and can prevent deficiency diseases in the body.
CONTD…

• Importance of enhancing nutritive value of food

✓ To meet the nutritional requirements of the body.
✓ To make proper selection and preparation of foods.
✓ To consume food in a balanced manner.
✓ To improve the flavour and texture of the food.
✓ To get variety in food.
✓ To assist in planning the daily menu, keeping in view the nutrient content of the food.
✓ To prevent deficiency diseases in the body.
✓ To develop good food habits.
CONTD…

• Fortification
Fortification is adding nutrients to the food even though the nutrient is already present in
food. It is done to improve the nutritive value.

• Enrichment
The process of improving the nutrients which might be lost during processing in foods by
special methods is called Enrichment.
CONTD…

• Methods of Enrichment of Nutrients

There are three methods by which you can enhance or increase the nutrients present in
food.
i. Combination
ii. Fermentation
iii. Germination
CONTD…

i. Combination
Combination is the process of combining cheaper and commonly available foods from different food groups to
improve the quality of nutrients. Combining of foods from different food groups is the easiest way of eating all nutrients.
Combination of foods improves the quality of nutrients. Cereals lack certain amino acids and these are present in
dhals. On the other hand dhals lack some other amino acids that are present in cereals.The quality of proteins becomes as good as
that of milk.The combination of a variety of foods ensures better availability of nutrients
Combination helps to
i) Eat a diet that has good quality nutrients.
ii) Use cheaper and easily available foods that enhance the nutrient content of food considerably.
iii) Provide balanced diet to the family.
CONTD…

ii. Fermentation
Fermentation is a process in which some micro-organisms are added to the food.
They change nutrients already present in the foods into simpler and better forms and also
make other new nutrients.
Fermentation makes the dough rise and become almost double in quantity. During
fermentation the micro-organisms use up some of the nutrients present in the atta and
change them into other better quality nutrients.They also make some new nutrients.
Curd, bread, etc. are all examples of fermented foods.
CONTD…

• Advantages of fermentation
a) Fermentation improves the digestibility of foods. The micro-organisms which cause
fermentation break the proteins and carbohydrates into smaller parts, which are easier
to digest.
b) During fermentation of cereals and foods like peas, beans etc. the minerals, calcium,
phosphorus, and iron are changed into better quality ones. These are then easily
absorbed by the body.
c) Fermented foods become spongy and soft and are liked by children and adults.
CONTD…

iii. Germination
Germination is a process in which small shoots come out of the dhal or cereal when
these are kept with small amount of water. The grains and pulses to be sprouted need to be
soaked in just enough water so that all of it is absorbed. If the extra water in which they are
soaked is thrown away, a lot of nutrients are lost.
Grains like wheat, bajra, etc. can also be sprouted. Pulses are also sprouted first and
then steamed and consumed. The time and water which each grain or pulse needs for soaking
and sprouting is different. Normally 8-16 hours are needed for soaking and 12-24 hours for
sprouting. The cloth in which the soaked dhal is tied should be kept moist all the time
CONTD…

• Germination helps to
1) Increase the digestibility of foods
a) Some carbohydrates and proteins are broken down into smaller and easily
digestible forms.
b) Grains and pulses become soft after sprouting, so they take less time for
cooking and are easy for you to digest.
2) Increase the nutritive value of food with no additional cost.
Some vitamins and minerals become more when foods are germinated Vitamin B
becomes almost double in quantity while vitamin C increases almost 10 times.
CONTD…

• Food fortification
This includes the process of adding small quantities of nutrients to a food to improve
the nutrient intake of a population. The objective of fortification is:
1. Restore nutrients lost during processing of foods so that the nutrient content is resolved to a
level originally present in the raw food. This is referred to as Restoration. e.g. addition of vitamin
C to packaged fruit juices.
2. Addition of a nutrient to a staple or other widely consumed primary food deficient in one or
more nutrients, to improve, the nutritional quality of the food with a view to ensuring an
improvement in the nutrient intake in the population. This is referred to as Enrichment. E.g. grains
are usually fortified with vitamin A, iron and folic acid.
CONTD…

• Advantages of Fortification
Food fortification does not require people to change their dietary habits and it
does not alter organoleptic or sensory qualities of foods. Therefore, it is socially acceptable.
The other benefits of fortification are
(i) minimum risk of excess intake of the nutrient,
(ii) safe, quick and cheap method of ensuring availability of a nutrient,
(iii) introduction through existing marketing and distribution system without any
extra effort.
CONTD…

• Limitations of fortification
Food fortification requires knowledge of dietary habits and nutrient intakes of the
target group (s). Consumers have to be educated about fortification, particularly if it is
causing any change in the sensory qualities of the food or it necessitates any modification in
the method of preparation of food at home. Food fortification is a temporary method of
improving nutritional status of the people and should ultimately be substituted by the
balanced diet based on better food supply and food usage.
7. ANTI NUTRITIONAL FACTORS PRESENT IN
COMMON FOODS
Anti-nutritional factors are the compounds found in most food substances which are poisonous to humans or in some ways
limit the availability of nutrient to the body. Anti-nutritional factors are present in different food substances in varying amounts,
depending on the kind of food. These are the compounds which reduce the nutrient utilization and/or food intake of plants or
plant products used as human foods. They play a vital role in determining the use of plants for humans.
Many anti-nutrients (oxalate, phytate, etc.) and toxic substances (cyanide, nitrate, phenols, etc.) are present in many
plants and vegetables. Anti-nutrients in foods are responsible for deleterious effects related to the absorption of nutrients and
micronutrients. Antinutritional factors reduce digestion and utilization of nutrient and may produce other adverse effects.
However, some anti-nutrients may exert beneficial health effects at low concentrations. For example, phytic acid,
lectins, tannins, saponins, amylase inhibitors and protease inhibitors have been shown to reduce the availability of nutrients and
cause growth inhibition. However, when used at low levels phytate, lectin, tannins, amylase inhibitors and saponins have also been
shown to reduce the blood glucose and insulin responses to starchy foods and/or the plasma cholesterol and triglyceride.
Common symptoms exhibited by a large number of antinutrients in the body → nausea, bloating , headaches, rashes,
nutritional deficiencies.
CONTD…

Anti-nutrients are chemical substances which reduces the maximum utilization of nutrients especially
proteins, vitamins, and minerals, thus preventing optimal exploitation of the nutrients present in a food and
decreasing the nutritive value.
Anti-nutrients can be divided into two groups: heat-stable group-phytic acid, tannins, alkaloids,
saponins, non-protein amino acids etc. and heat labile group include lectins, cynogenic glycosides, protease
inhibitors and toxic amino acids etc.
Due to the presence of several anti-nutritional factors, legumes possess low protein digestibility.
Most of the toxic and antinutrient effects of these compounds in plants could be removed by several
processing methods such as soaking, germination, boiling, autoclaving, fermentation, genetic manipulation
and other processing methods, but extensive research is still needed to discover elimination methods for
heat stable antinutrients present in various food without altering the nutritional value of food
CONTD…

• Trypsin inhibitors
✓ Proteins → legumes (soybean, lima and kidney bean) and egg white.
✓ Competes with proteins to bind to trypsin
✓ Inhibit the activity of trypsin in the gut and interfere with digestibility of dietary proteins and reduce
their utilization.
✓ Heat labile → the extent and ease of heat inactivation varies from one trypsin inhibitor to another.
✓ Autoclaving at 120oC for 15-30 min → inactivates almost all trypsin inhibitors → improves utilization of
protein present in these foods.
✓ Boiling soybeans for 14 minutes inactivates about 80% of the inhibitor, and for 30 minutes, about 90%
CONTD…

• Phytate
✓ Widely distributed→ seeds, grains, nuts and legumes.
✓ Unrefined cereals and millets are richest sources of phytates.
✓ Store phosphorus as phytic acid in their husks in the form of phytate salt.
✓ Phytate is hexaphosphate of inositol → acts as a source of bound phosphorus → seeds during germination.
✓ Phytates → strong binding affinity → iron, zinc, calcium and magnesium → results in highly insoluble salts →
poorly absorbed by the GIT → lower bioavailability of minerals.
✓ Phytate content reduces due to enzymatic breakdown of phytate during germination of grains.
✓ Improved iron availability in germinated grains can be partly attributed to a reduction in phytate content.
CONTD…

• Tannins
✓ Major group of antioxidant polyphenolic compounds
✓ Widely distributed in plant kingdom
✓ Present in high amount in seed coat of most legumes, spices, tamarind, turmeric, green tea, in
certain vegetables and fruits- grapes.
✓ Millets - bajra, ragi, sorghum → a fair amount of tannin.
✓ Bind iron irreversibly → interfere with iron absorption.
✓ Also known to bind proteins and reduce their availability.
CONTD…

• Lectin
✓ Vegetables - tomatoes, potatoes, peppers, and eggplant, legumes - lentils, beans, and
chickpeas, peanuts, peanut based products - peanut butter and peanut oil
✓ Cause flatulence
✓ Consuming legumes and grains in their raw form → nausea, diarrhea and vomiting.
✓ Inactivated → heat and fermentation
CONTD…

• Oxalates
✓ Oxalic acid → form soluble (potassium and sodium) or insoluble (calcium, magnesium, iron) salts or esters called oxalates.
✓ Widely distributed → green leafy vegetables , green vegetables and some legumes.
✓ Interfere with calcium absorption by forming insoluble salts
✓ Insoluble salts cannot be processed out of the urinary tract once processed through the digestive system..
✓ Calcium oxalate can have a deleterious effect on human nutrition and health by accumulating kidney stones.
✓ Stone patients are advised to avoid high oxalate foods.
✓ Most people can induct normal amounts of oxalate rich foods, while people with certain conditions, such as enteric and primary
hyperoxaluria, need to lower their oxalate intake.
✓ In sensitive people → small amounts of oxalates → burning in the eyes, ears, mouth, and throat
✓ Large amounts → abdominal pain, diarrhea, nausea and muscle weakness.
CONTD…

• Goitrogens
✓ Disrupt the production of thyroid hormones by interfering with iodine uptake in the
thyroid gland.
✓ Triggers pituitary to release thyroid-stimulating hormone (TSH) → promotes the growth
of thyroid tissue → leading to goiter.
✓ Leaves and vegetables - cabbage, cauliflower, radish, rapeseed, mustard, soybean, peanut,
lentils.
✓ Thiocyanate, isothiocyanates and their derivatives.
 CONTD…

Anti-nutrients Effects on body

Phytates Reduce Ca and Fe absorption
Oxalates Reduce Ca absorption, encourage kidney stone
formation
Cyanide Respiratory inhibitors
Lectins (Hem agglutinins) Prevent absorption of digestive end products in
the small intestine.
Protease inhibitors Substances reduce protein digestion
Phenol Compounds They reduce bioavailability of some minerals
(especially zinc). They may negatively affect pH
mechanism, reduce protein digestion.
CONTD…

• Antinutrients are found at some level in almost all foods

Traditional methods of food preparation → reduce certain antinutrients → increase
the nutritive quality of plant foods.
1) Soaking : in distilled water, 1% NaHCO3 and mixed salt solutions → reduced total phenols, tannins
and phytates by 33, 35 and 21 %, respectively.
2) Fermentation : assorted grain flour with L. acidophilus at 37°C for 24 h → reduction of phytic acid and
polyphenol content.
3) Germination : one of most effective processes → reduction of phytate levels.
4) Heating : Cooking whole grains, beans and vegetables → reduce phytic acid, tannins, oxalic acid and
Protease inhibitors.
8.MALNUTRITION

• Causes of malnutrition
• Effect of malnutrition on outcome of pregnancy, physical, mental and
intellectual development
• Strategies to combat malnutrition
CONTD…

• When a person's diet is inadequately nutrient-rich, malnutrition results. The body's

essential organs and processes suffer harm as a result. Malnutrition is most commonly
caused by a lack of food in developing and underdeveloped nations.
However, the explanation may be more varied in industrialized or developed
nations like the UK or the USA. For instance, those with a high calorie diet deficient in vital
vitamins and minerals are also considered malnourished. This covers people who are
overweight and obese.
CONTD…

❑The causes of malnutrition include:

• Lack of food: this is common among the low income group as well as those who are
homeless.
• Those having difficulty eating due to painful teeth or other painful lesions of the mouth.
Those with dysphagia or difficulty swallowing are also at risk of malnutrition. This could be
due to a blockage in the throat or mouth or due to sores in the mouth.
• Loss of appetite: Common causes of loss of appetite include cancers, tumours, depressive
illness and other mental illnesses, liver or kidney disease, chronic infections etc.
• Those with a limited knowledge about nutrition tend to follow an unhealthy diet with
not enough nutrients, vitamins and minerals and are at risk of malnutrition.
CONTD…

• Elderly living alone, disabled persons living alone or young students living on their own often have
difficulty cooking healthy balanced meals for themselves and may be at risk of malnutrition.
• The elderly (over 65 years of age are), especially those living in care facilities are at a higher risk of
malnutrition. These individuals have long term illnesses that affect their appetite and ability to absorb
nutrients from food and they may also have difficulty feeding themselves. In addition, there may be
concomitant mental ailments like depression that affect appetite and food intake.
• Those who abuse drugs or are chronic alcoholics.
• Those with eating disorders like anorexia nervosa have difficulty maintaining adequate nutrition.
• Those with diarrhea or persistent nausea or vomiting.
CONTD…

• Anorexia nervosa
It is an eating disorder and serious mental health condition.
People who have anorexia try to keep their weight as low as possible by not eating
enough food or exercising too much, or both. This can make them very ill because they start to
starve.
They often have a distorted image of their bodies, thinking they're fat even when
they're underweight.
Men and women of any age can get anorexia, but it's most common in young women
and typically starts in the mid-teens.
CONTD…

• Bulimia nervosa
It is a psychological eating disorder in which you have episodes of binge eating
(consuming a large quantity of food in one sitting). During these binges, you have no sense of
control over your eating. Afterward, you try inappropriate ways to lose weight such as:
Vomiting
Fasting
Excessive use of laxatives and diuretics
Compulsive exercising
CONTD…

• Those with digestive illnesses like ulcerative colitis or malabsorption syndrome have difficulty in
assimilating the nutrients from diet and may suffer from malnutrition.
• Some medications tend to alter the body’s ability to absorb and break down nutrients and taking these
may lead to malnutrition.
• Among children lack of knowledge of adequate feeding among parents is the leading cause of
malnutrition worldwide.
• Premature babies are at a higher risk of malnutrition as are infants at the time of weaning.
• Childhood cancers, heart defects from birth (congenital heart disease), cystic fibrosis and other major
long term diseases in children are the leading cause of malnutrition.
• Neglected children, orphans and those living in care homes are at risk of malnutrition.
CONTD…

• Causes of Malnutrition

▪ Immediate cause
a. Reduced dietary intake
b. Reduced absorption of macro and/or micro nutrients
c. Increased losses or altered requirements
d. Increased energy expenditure (in specific disease processes)
▪ Underlying cause
a. Food insecurity (4 pillars of food security: availability, access, utilization and stability)
b. Inadequate care and poor public health
▪ Basic causes
a. Political, legal and cultural factors
CONTD…

• Effect of malnutrition on outcome of pregnancy, physical, mental and

intellectual development
Malnutrition affects physical and mental development, immunity, and overall health.
Pregnant and lactating women and young children less than three years are most vulnerable
to malnutrition. Severe malnutrition during the early years of life, especially the first two
years, leads to retarded brain growth, permanent reduction in brain size and defective
intellectual development. Malnutrition has, therefore, been rightly blamed as one of the
main causes of mental retardation
CONTD…

• Pregnancy
It is a critical period during which maternal nutrition has a major effect on a mother and baby’s
health. . The nutritional status of a woman before and during pregnancy is important for a healthy pregnancy
outcome. Lack of adequate nutrition of good quality and quantity during pregnancy can cause health
problems for both the mother and her fetus. Maternal malnutrition is a key contributor to poor fetal
growth, low birthweight (LBW) and short- and long-term infant morbidity and mortality. In addition to this,
Maternal malnutrition increases the risk of gestational anemia, hypertension, miscarriages and fetal
deaths during pregnancy, pre-term delivery and maternal mortality.
For newborn, it can cause low birth weight, fetal intrauterine growth retardation that may have
long life consequences on newborn development, quality of life and health care costs as well as has an
adverse effect on the development of the immune system of the newborn.
It is necessary to identify maternal nutrition and fetal development relationship because there is
a significant relationship between maternal malnutrition and maternal and newborn outcomes.
CONTD…

• Every newborn baby has to go through a complex process of growth & development at
various levels to ultimately emerge as a normal adult. Any deviation in these stages of
development may lead to developmental disability. According to UNICEF's State of the
World's Children's report, Malnutrition is the hidden cause behind disability for
hundreds of millions of children worldwide, The research outlines the scale of the
problems caused by poor diet, which can leave young children vulnerable to conditions
that may lead to physical and intellectual disabilities. Children exposed to severe
acute malnutrition in early life have poor cognitive function, poor school achievement and
behavioural problems.
CONTD…

• Optimal nutrition in infancy and early childhood is essential to meet the demands of rapid growth and
development. Under-nutrition reduces immunological capacity to defend against diseases, and recurrent
infections, in turn reduce and deprive the body from essential nutrients. This leads to the dismal growth
of children which adversely affect child's mental and physical development and, learning
capacity in future life.Under nutrition, which is an important determinant of maternal and child health,
has significant negative effects on brain and cognitive development of children. . Malnourished children do
not achieve the same levels of intellectual development and ability as adequately nourished children.
• Childhood disability is mostly a consequence of developmental delay & challenge, in various domains like,
motor, cognitive, visual, auditory and social development, leading to motor disabilities (cerebral palsy),
mental retardation, visual impairment, hearing impairment, speech delay, behavioral problems and learning
disabilities.
CONTD…

• Malnutrition during pregnancy

Consumption of lack of nutrients during pregnancy occurs due to various reasons throughout the world. Malnutrition
increases the risk of stillbirth, premature delivery, perinatal mortality, congenital disabilities, and underdeveloped organs in the fetus.
Causes of malnutrition during pregnancy include are as follows:
-Ignorance.
-Illness and infection.
-Mental illness like depression.
-Socio-economic conditions.
-Dental neglect and problems.
-Medication.
-Morning sickness.
-Insufficient consumption of nutrients.
CONTD…

❑ Effect of maternal malnutrition

• Malnutrition increases the risk for certain disorders in the mother the following:

-Maternal mortality.

-Risk of miscarriage.

-Osteomalacia.

--Anemia.

-Preeclampsia (a serious blood pressure condition that develops during pregnancy)

• Long-term effects of malnutrition during pregnancy lead to disorders in infants that are as follows:

-Type-2 diabetes.

-Cardiovascular disorders.

-Osteoporosis.

-Cognitive disabilities.

-Low intelligence quotient (IQ).

CONTD…

• Strategies to combat malnutrition

The best way to prevent malnutrition is to eat a healthy, balanced diet.
There are two major approaches in addressing malnutrition.
1. Nutritional planning
2. Direct nutrition and health development
CONTD…

1. Nutritional planning
This involves political commitment by the government. A well planned and well executed long
term project can accelerate the developmental process and the benefits can be rewarding and permanent.
Nutritional planning involves formulation of a nutrition policy and overall long term planning
to improve production and supplies of food, ensure its equitable distribution and programs to increase the
purchasing power of people. This may include, land reforms, proper guidance in agriculture to help farmers
to get better yields from their lands, help in proper marketing of farm produce. To help increasing the
capacity of people to buy nutritious food in adequate quantity, income generating activities for the weaker
sections of the community, making available good quality food in affordable prices through proper public
distribution system, etc. are some of the plans for the government to implement.
CONTD…

2. Direct nutrition and health system (interventions)

Infections like malaria, measles and diarrhea are prevalent in our society and they
precipitate acute malnutrition among children and infants. A good health care system that
provides immunization, oral rehydration, periodic deworming, early diagnosis and proper
treatment of common illnesses can go a long way in preventing malnutrition in the society.
CONTD…

• Nutrition education
People can be educated on
1) The nutritional quality of common foods
2) Importance and nutritional quality of various locally available and culturally accepted low cost foods
3) Importance of exclusive breastfeeding for six months and continuing to breast feed up to two years or beyond.
4) Damage caused by irrational beliefs and cultural practices of feeding
5) Recipes for preparing proper weaning foods and good supplementary food from locally available low cost foods.
6) Importance of including milk, eggs, meat or pulses in sufficient quantities in the diet to enhance the net dietary protein value.
7) Importance of feeding children and adults during illness
8) Importance and advantages of growing a kitchen garden
9) Importance of immunizing their children and following proper sanitation in their day to day life
CONTD…

• Early detection of malnutrition and intervention

✓ The longer the developmental delays remain uncorrected, the greater the chance of permanent effects
and hence intervention must occur during pregnancy and first three years of life.
✓ A well recorded growth chart can detect malnutrition very early.Velocity of growth is more important
than the actual weight at a given time
✓ If growth of the child is slowed or is arrested as shown by flat curve on the growth card, physician
should be alerted and any hidden infection or any reason for nutritional deficiency must be evaluated and
taken care of.
✓ If growth chart is not maintained, anthropometric indices like, weight, height mid arm circumference, and
chest circumference etc. can be measured and used for evaluation of nutrition.
CONTD…

• Nutrition supplementation
Usually, biologically vulnerable groups like pregnant women, infants, preschool going and school
going children are targeted by various welfare measures conducted by the government. Calories, proteins
and micronutrients like iron, vitamin A and zinc can be supplemented.
• Objective of nutrition supplementation of infants and children includes
✓ To treat and rehabilitate severely malnourished subjects .
✓ Improve the general health and wellbeing of children, increase the resistance to infectious illnesses and
thereby decrease morbidity.
✓ Accelerate the physical growth and mental development of children.
✓ Improve the academic performance and learning abilities of children.
CONTD…

• Objective of supplementing pregnant and lactating women include

✓Preventing anemia in the mother thus improving her health and the pregnancy
outcome.
✓Improving calorie intake and prevent low birth weight baby, thus breaking the
vicious cycle of intergenerational cycle of growth failure.
✓Supplementing calcium to prevent osteoporosis.
9. NUTRITIONAL DEFICIENCY DISEASES IN
DEVELOPING COUNTRIES AND THEIR
PREVENTION MEASURES
• The nutritional problems of developing countries are conditioned by poverty, near
exclusive reliance on plant sources of nutrients, and high rates of infections. Common
deficiency diseases include protein-energy malnutrition (marasmus and kwashiorkor)
and micronutrient deficiencies.
Population subgroups at particularly high risk are the children and women of poor
families.
Control of these nutritional diseases requires systematic diagnosis of the existing
situation and appropriate intervention strategies such as targeted food and specific
micronutrient supplementation, food fortification, nutrition education, and reductions in
infections as well as general improvements in economic conditions and social equity.
CONTD…

• In children, protein–energy malnutrition is form of malnutrition that is defined as range of

pathological conditions arising from coincident lack of dietary protein and/or energy (calories)
in varying proportions
Protein energy malnutrition usually manifests early, in children between 6 months
and 2 years of age and is associated with early weaning, delayed introduction of complementary
foods, a low-protein diet and severe or frequent infections.
Kwashiorkor and marasmus are the two main types of severe protein
energy undernutrition recognized by healthcare providers worldwide.The main difference
between them is that kwashiorkor is predominantly a protein deficiency, while marasmus is a
deficiency of all macronutrients i.e. protein, carbohydrates and fats.
CONTD…

Kwashiorkor (predominantly a protein deficiency)

Children with this disease, which is characterized by a swollen belly due
to edema (fluid retention that occurs when the fluid isn't removed from the tissues ), are
weak, grow poorly, and are more susceptible to infectious diseases, which may result in
fatal diarrhea. Other symptoms of kwashiorkor include apathy, hair discoloration, and dry,
peeling skin with sores that fail to heal. Weight loss may be disguised because of the
presence of edema, enlarged fatty liver, and intestinal parasites; moreover, there may be little
wasting of muscle and body fat.
CONTD…

Marasmus
It is a condition of an absolute food deprivation with grossly inadequate amounts of both energy
and protein. An infant with marasmus is extremely underweight and has lost most or all subcutaneous fat.
The body has a “skin and bones” appearance, and the child is profoundly weak and highly susceptible to
infections.
The cause is a diet very low in calories from all sources (including protein), often from
early weaning to a bottled formula prepared with unsafe water and diluted because of poverty. Poor
hygiene and continued depletion lead to a vicious cycle of gastroenteritis and deterioration of the lining of
the gastrointestinal tract, which interferes with absorption of nutrients from the little food available and
further reduces resistance to infection. If untreated, marasmus may result in death due
to starvation or heart failure.
CONTD…

• Treatment of PEM has three components.

(1) Life-threatening conditions such as fluid and electrolyte imbalances and infections
must be resolved.
(2) Nutritional status should be restored as quickly and safely as possible; rapid weight
gain can occur in a starving child within one or two weeks.
(3) The focus of treatment then shifts to ensuring nutritional rehabilitation for the long
term.
The speed and ultimate success of recovery depend upon the severity of malnutrition,
the timeliness of treatment, and the adequacy of ongoing support. Particularly during the first
year of life, starvation may result in reduced brain growth and intellectual functioning that
cannot be fully restored.
CONTD…

• Micronutrient deficiencies
Micronutrient deficiencies, also known as ‘hidden hunger’, are determining and
aggravating factors for health status and quality of life. Three nutritional problems that have
serious consequences are deficiencies of iron, vitamin A and iodine.
Deficiencies in iron, iodine, vitamin A and zinc are still major public health
problems in developing countries, but vitamin C, D and B deficiencies have declined
considerably in recent decades. Micronutrient deficiencies affect at least 2 billion people
worldwide. Dietary diversification, fortification of foods and supplementation with
pharmaceutical preparations are included in response to these deficiencies.
CONTD…

• Micronutrient deficiency is a global challenge to health as in developing countries like

Nepal. In developing countries, the targeted beneficiaries are less aware about importance of
micronutrients, which has resulted in low intake of foods rich in micronutrients. Micronutrient
deficiencies have huge impact on health of vulnerable population like women and children and
have jeopardized the national economy and prosperity of developing countries including
Nepal. The major causes of micronutrient deficiencies were poor diet, diseases and
infestations, and poor health caring practices. The results of micronutrient deficiencies were
unwanted child and maternal mortality, impairments of lives, and reduction in productivity and
intellectual capacity. School health and nutrition education and supplementation and
fortification of essential micronutrients proved to be effective while dietary diversification
and economic growth and poverty eradication seemed promising.
CONTD…

▪ Causes
The causes of micronutrients deficiencies are listed below:
-Improper Diet
-Diseases and Infestations
-Underlying Causes
The underlying causes of micronutrient defeciencies are
insufficient access to food, inadequate health care, and poor caring practices that inhibit
growth and health.
CONTD…

▪ Consequences
The micronutrient deficiencies
always have negative effects in physical and
mental health, which hinders the social
progress and economical prosperity of an
individual and nation as a whole. This
condition perpetuates the vicious cycle of
poor economic growth, health
impairments, and low social status.
CONTD…

▪ Prevention and Control of Micronutrient Deficiencies

The control of micronutrient deficiencies should no longer be focused on one
deficiency at a time but multiple micronutrient deficiencies simultaneously, which can be
operationally effective.
• School Health and Nutrition (SHN) Education
School is the first place where one can learn about advantages of better nutrition. The
major advantage of school education on nutrition is behavior change and its sustainability’ When
the target audience is motivated and educational intervention is well designed and delivered, the
chances of success are high.
CONTD…

• Dietary Diversification
There are several instances where dietary diversification can help to reduce
micronutrient deficiencies. The strategies employing agricultural interventions, animal husbandry,
or aquaculture have the potential to increase intakes of total or absorbable zinc. Similarly, where
there is increased dietary diversity, there is increased consumption of β-carotene rich vegetables
and fruit, increased intake of other vegetables and fruit, increased intake of legumes, and
improved complementary foods. Diversification of crop cultivation and making a wider
selection of foods with a high vitamin and mineral content available for purchase can be adopted
so that the consumers prepare more varied meals and have a more balanced diet.
CONTD…

• Supplementation
✓ Supplementation of vitamin A for children under five years of age under vitamin A
supplementation (VAS) program is cost effective.
✓ Supplementation of iron/folate at no cost to pregnant women and lactating mothers
through the network of government health system.
✓ Providing zinc to manage diarrhea among children, which, however, needs monitoring and
evaluation at regular intervals. Supplemental administration of zinc can expedite the
healing process and results in faster resolution of clinical symptoms in children with
pneumonia.
CONTD…

✓ Supplementation of vitamin D.
✓ Similarly, zinc syrup supplemented to children less than two years from primary health
center.
✓ Supplementation only works if the supplements are available and accessible and the
intended individuals actually take them.
CONTD…

Despite the fact that supplementation of vitamin A, zinc, and iron/folate has
positive impact on health of the vulnerable population, there are other various
micronutrients that are equally essential and should be incorporated into national
supplementation program. Therefore, the government and concerned organizations need to
be serious using multiple micronutrient supplementations, along with the traditional
iron/folate and vitamin A, and monitor the compliance rate.
CONTD…

• Fortification
Food fortification with single, dual, or multiple micronutrients is a public health approach that
has been widely used and is potentially an effective strategy to address micronutrient
malnutrition . Food fortification is very economical therefore, food fortification can be very cost
effective even in developing nations like Nepal.
For example, reduction of iodine deficiency by fortification of salt with iodine.
In addition to this, there are also other foods such as biscuits, noodles, cookies, oil, sugar, flour,
milk, and tea that are consumed by almost all the population and can be used as fortification
tools; however universal consumption should be guaranteed.
This provides a tremendous advantage in terms of coverage and efficiency. However, fortification
of foods requires active governmental leadership, policy, and political will.
CONTD…

• Economic Growth and Poverty Eradication

Whatever other causes may be, the root cause of micronutrient malnutrition is
poverty and sluggish economic growth and perpetuating the vicious cycle of poverty and
malnutrition. General economic growth is a lagging predictor of nutritional improvement. It is
important to break the vicious cycle of poverty and micronutrients malnutrition in order to
prosper. A recent report from Food and Agriculture Organization (FAO) summarizes
that policies aimed at enhancing agricultural productivity and increasing food availability,
especially when smallholders are targeted, can achieve hunger reduction even where poverty is
widespread, which can guide policy makers in developing countries like Nepal.
CONTD…

❖In the context of Nepal

At present the Government of Nepal along with other organizations is working to
combat against micronutrient deficiencies in Nepal. However, the effects in the national level are
still lacking. Therefore, it is the responsibility of the government to scale up and promote
effective programs. In addition, there is a need of an effective body for surveillance, research, and
monitoring of micronutrient deficiencies in the nation.
While it will be imperative to scale up direct nutrition interventions, success will be
enhanced and sustained by addressing underlying determinants of nutrition through action in
multiple sectors such as poverty alleviation, education, agriculture, social protection, water, and
sanitation. Furthermore, an improved mechanism is required within the National Planning
Commission to coordinate the varied multisectoral activities to improve nutrition.
10. ASSESSMENT OF NUTRITIONAL STATUS

• The nutritional status of an individual

➢ is a balance between the intake of the nutrients and the expenditure of these in
processes of growth, reproduction and health maintenance.
➢ is influenced by food intake , quantity , quality and physical health.
The spectrum of nutritional status spreads from obesity to severe malnutrition.
CONTD…

❑Nutritional Assessment is important in order to

▪ obtain precise information on prevalence and geographic distribution of nutritional problems
of given community.
▪ identify individuals or populations
-who are at risk of becoming malnourished and
-who are already malnourished
▪ develop health-care programs.
▪ measure the effectiveness of nutritional programs and interventions once initiated.
CONTD…

• Methods of Nutritional Assessment

1. Direct – deal with the individuals and measure the objective criteria
2. Indirect – use community health indices that reflect nutritional influences
CONTD…

1. Direct methods of nutritional Assessment

These can be summarized as ABCD
i. Anthropometric methods
ii. Biochemical, laboratory methods
iii. Clinical methods
iv. Dietary evaluation methods
CONTD…

2. Indirect methods of Nutritional Assessment

These include three categories
i. Ecological variables : Ecological variables including crop production
ii. Economic factors i.e. per capita income, population density & social habits
iii. Vital health statistics particularly infant & under 5 mortality & fertility indices
CONTD…

• Direct methods
A. Anthropometric methods
Anthropometry is the measurement of Height, Weight & other measurements like Mid Upper-
arm circumference, Skin fold thickness, Head and chest circumference, Hip/waist ratio.
1. Height measurement
i. The subject stand erect on stadiometer.
ii. The movable head piece is leveled with head vault
iii. Height is recorded to nearest 0.5 cm.
iv. For infants infantometer is used.
CONTD…

2. Weight measurement
▪ Can be used to assess infants, children, pregnant women and adults.
▪ Uses a regularly calibrated electronic or balanced-beam scale.
▪ Measured in light clothes nearest to 100g.
3. Mid Upper-arm Circumference (MUAC)
▪ Circumference left upper arm at mid point between acromion process and olecranon process
▪ Fiber-glass tape which does not stretch
CONTD…

MUAC
▪ Used for below years of age.
▪ <13.5 cm : Malnutrition
▪ Shakir tape is used to measure MUAC

<13.5 cm GREEN Normal

12.5-13.5 cm YELLOW Borderline Malnutrition

>12.5 cm RED Wasted

CONTD..

4. Skin-fold thickness
✓ Skin fold calipers are used (Harpenden and Lange) that measures the thickness of the
skin and subcutaneous fat using constant pressure applied over a known area.
✓ Common sites: triceps and in the sub-scapular region.
✓ It has value in assessing the amount of fat and therefore the reserve of energy in the
body.
5. Head and chest circumference
CONTD…

6. Waist/hip ratio
▪ Waist measurement
Measured at the level of umbilicus nearest to 0.5cm
Subject stands erect with relaxed abdominal muscles, arms at the side and feet
together
Measurement taken at the normal expiration
CONTD…

▪ Hip measurement
Measured at the point of greatest circumference around hips to nearest 0.5cm
Close contact with the skin without indenting the soft-tissues
Subject should be standing and measurer beside him.
▪ Interpretation of WHR
▪ High-risk WHR=>0.8 in females and =>0.95 in males indicates central obesity and
considered high-risk for diabetes and cvs disorders.
CONTD…

• Advantages
✓ Objectives with high specificity and sensitivity.
✓ Measures many variables of nutritional Significance. (ht, wt, MUAC, WHR , BMI)
✓ Readings are numerical and gradable on standard growth charts.
✓ Readings are reproducible.
✓ Non-expensive and needs minimal training
CONTD…

• Limitations of Anthropometry
✓ Inter-observers error in measurement.
✓ Limited nutritional diagnosis.
✓ Problems with reference standards i.e. local versus international.
CONTD…

B. Biochemical & laboratory methods

I. INITIAL LABORATORY ASSESSMENT
✓ Hemoglobin estimation
✓ Haematocrit or packed cell volume (PCV)
✓ Red cell counts and blood films
✓ Stool examination
✓ Urine examination
CONTD…

II. SPECIFIC LAB TESTS

a. Measurement of nutrients in body fluids e.g. serum retinol, serum iron.
b. Measurement of abnormal metabolites e.g. urinary iodide, urinary creatinine/
hydroxyapatite ratio
CONTD…

• Advantages
✓ Useful in detecting early changes in body metabolism and nutrition.
✓ Precise , accurate and reproducible.
✓ Useful to validate data obtained from dietary methods e.g. comparing salt intake with 24-hour urinary
excretion.
• Limitations of biochemical & laboratory methods
✓ Time consuming and expensive.
✓ Cannot be applied on large scale
✓ Reveal only current nutritional status
CONTD…

C. Clinical methods
• Essential feature of all nutritional surveys
• Simplest and most practical method
• Utilizes a number of physical signs (specific and non-specific) that are known to be
associated with malnutrition and deficiency of vitamins and other micro-nutrients.
• General Clinical examination with special attention to organs like hair, angles of mouth,
gums, nails, skin, eyes, tongue, muscles, bones & thyroid gland.
• Detection of relevant signs helps in establishing the nutritional diagnosis.
CONTD…

D. Assessment of dietary intake

• This is actually an assessment of food consumption through dietary surveys.
• It provides information about dietary intake patterns, specific foods consumed and estimated nutrient
intakes.
• Reviewing dietary data may suggest risk factors for chronic diseases and help to prevent them.
• Diet surveys may be carried out by the following methods:
1. weighment of raw foods
2. weighment of cooked foods
3. Oral questionnaire method
CONTD…

• Other methods include

1. Food records or diaries (including weighed intakes)
2. Food frequency questionnaires (FFQ’s)
3. Dietary histories
4. Observed intakes
11. PROBLEM, PREVENTION AND CONTROL
OF OVERFEEDING
• Overfeeding usually occurs when caloric needs are overestimated. This can happen when actual body
weight is used to calculate the basal energy expenditure in critically ill patients with significant fluid
overload and/or significant obesity. Estimated dry weight or adjusted lean body weight should be used to
calculate the BEE in these circumstances.
Overfeeding can lead to increased oxygen consumption, increased CO2 production, prolonged
ventilatory requirements, fatty liver, suppression of leukocyte function, hyperglycemia, and increased
susceptibility to infection. Intentional overfeeding or eating more calories than required to maintain
bodyweight is a common practice among athletes, especially bodybuilders, looking to increase their
skeletal muscle mass.
CONTD…

• Overfeeding in baby/child
Overfeeding a baby often causes the baby discomfort because he or she
can't digest all of the breast milk or formula properly. When fed too much, a baby may also
swallow air, which can produce gas, increase discomfort in the belly, and lead to crying.
Overfeeding a child is giving more food than the child needs to be healthy and
grow. This can cause children to spit up, have diarrhea (frequent, loose watery stool), or
become overweight or obese.
CONTD…

• Signs of overfeeding in baby/child

1. Spitting continuously
2.Vomiting
3. Feeling gassy and bloated
Overfeeding can lead to bloating, cramps and diarrhea.
4. Fussy, irritated, and constantly cries after eating
5. Choking
CONTD…

6. Burping
If your baby keeps burping all the time, you are overfeeding him/her
7. Sleep problems
Overfeeding the little one can lead to sleep disturbances. If your baby has poor
sleep habits and is waking often, it may be time to look at how much they have been eating.
8. Flatulence and foul-smelling stools
CONTD…

Effects of overfeeding a baby/child

1. Weight and obesity
Weight is not an indicator of overfeeding, but it is an outcome for sure. “Overfeeding can cause
abnormal weight gain and double the chances of sleep apnoea, high blood pressure, and heart disease in
later life. Baby may also encounter bone or joint problems, shortness of breath, liver and gallbladder issues.
2. Gastroesophageal reflux disease (GERD)
Overfeeding can cause your baby to feel gassy and sick. In fact, if the baby has an acidity problem,
overfeeding can worsen the condition.
3.Vomiting
Overfed babies tend to vomit after every feed. Chronic vomiting can invite a host of problems in
the long run.
CONTD…

• Prevention of overfeeding in baby/child

Don't automatically feed baby just because your baby is crying—see if there's
another reason for the crying.
Don't give baby a bottle as an activity or let the baby have a bottle all the time.
Don't reward good behavior with food,
Don't make child finish food when not hungry.