Community

Nutrition
 Need For Community Programme

• Large scale supplementary nutrition

programme.
• Main aim is to improve nutritional status
in targeted groups.
• Overcome specific disease to fight
malnutrition.
 List of Programme
• Vit-A prophylaxis programme
• Prophylaxis against nutritional anemia H&Fw
• Control of iodine deficiency disorder
• Special nutrition programme Special
• Balwadi nutrition programme welfare
• ICDS Women & child development
• Mid day meal programme
• Mid day meal scheme HR development
 Vit-A prophylaxis programme
• It is initiated in 1970.
• Beneficiary- 6month-5yr
• Objective- to prevent blindness due to Vad.
(VAd- Vit-A deficiency)
• Implement by – PHC and SC
• A single massive dose of vit-A 2lac IU orally
for every 6 month.
 Role
• Prevent respiratory infection.
• Maintain GIT.
• Provide immunity.
• Prevent nutritional blindness.
Prophylaxis against nutritional anemia

• It is initiated in 1970.
• Over 50% pregnant women suffer from
anemia.
• It cause LBW and perinatal mortality, maternal
death.
• Objective – assess prevalence, give treatment,
give prophylaxis, monitoring, education.
Beneficiaries- child 1-5yr
• Pregnant and nursing mother.
• female acceptor of terminal method of family
planning and IUCDs.
Implemented by- PHC and SC
Dosage- Pregnant women 100mg Fe and 0.5mg
Folic acid.
• Children 6-60month- 20mg Fe and 0.1mg FA
• It should be given for 100days.
• Adolescent girl- 100mg Fe and 0.5mg FA
Children 1-5yr-
• Screening test for anemia done at 6month, 1yr
and 2yrs.
• Iron fortification of salt.
 Iodine deficiency disorder
• National goiter control programme was started
in 1962.
• Replace the entire edible salt by iodide salt.
• Fortification of salt with iodine.
Special Nutritional programme-
• Started in 1970 in urban slums. Tribal area,
backward rural areas.
• Main aim is - Child- <6yr
- Pregnant and lactating women
 Balwadi Programme
• This programme was started in 1970 by dept.
of social welfare.
• Beneficiary- preschool children 3-6yr of age
• Activities- 300kcal and 10g protein
- preschool education
 ICDS
• It was launched on 2nd oct 1975.
• Most unique and largest programme.
• India response to the challenge of-
i. Providing pre-school education on one
hand
ii. Break cycle of malnutrition, morbidity,
mortality.
• Need- routine MCH services not reaching
target population.
- Nutritional component not covered by health
services.
- Need for community participation.
Objectives-
• Improve nutritional status and health status of
children in age group 0-6yrs.
• Foundation for proper psychological, physical
and social development of child.
• Reduce incidence of mortality, morbidity,
malnutrition, school dropout.
• Co-ordination of dept. to promote child
development.
• Nutrition and health education to mother.
Beneficiaries-
• Pregnant women
• Nursing mother
• Child <3yrs
• Child 3-6yrs
• Adolescent girl(11-18yr)
Functionaries under ICDS-
-Dist programme officer(DPO)
-Child development project officer(CDPO)
-Supervisor
-Anganwadi worker
-Anganwadi helpers
Services under ICDS-
• Supplementary nutrition
• Immunization
• Health check-up
• Referral services
• Pre-school non formal education
• Nutrition and health education
Supplementary nutrition-

Calories Protein
Children 500 12-15
Severe 800 20-25
malnutrition
Preg and lactation 600 18-20
IMMUNIZATION-
• Immunization or pregnant mother and
children.
• Protect against tetanus and reduces
maternal and neonatal mortality.
• Protects children from 6 killer disease.
Health Checkup-
• For children <6yrs, antenatal care, post natal
care of nsg. Mothers.
• Consist of weight recording, immunization,
management of malnutrition, treatment of
diarrhea, deworming, simple medicine for
common illness.
Referral services- sick of malnourished child.
• Prompt medicine attention.
• Referral to PHC, SC.
 ROLE OF AWW
• To elicit community support.
• Weigh and record each child every month.
• Refer cases.
• Organize pre school activities.
• Provide supplementary nutrition.
• Provide health and nutrition education.
• Make home visit.
• Co-ordinate with other staff.
 ROLE OF AWH
• Cook and serve food.
• Clean anganwadi premises.
• Bring small children to anganwadi.
 Mid day meal
• It was started in 1961.
Objectives- improve school attendance.
- improve child nutrition.
Principle-
• Supplement not substitute to home diet.
• 1/3rd of energy, ½ of protein requirement/day.
• Low cost, easily prepared at school.
• Locally available food.
 Mid day meal scheme
• It was started on 1995.
Objectives-
• Universalization of primary education by
increasing enrollment(class 1-5).
• Improve nutritional status of children.
• 300kcal and 8-12g protein.
Challenges-
• Good for improving nutrition of the under
privileged.
• Repeated incidence of food poisoning.
 Nutritional needs for Infant
• According to ICMR energy requirement
of infant-
• <3month – 120kcal/kgbdwt
• 3-5month – 115kcal/kgbdwt
• 6-8month – 110kcal/kgbdwt
• 9-11month - 105kcal/kgbdwt
• 1yr – 112kcal/kgbdwt
Protein-
• 0-3month- 2.3gm/kg
• 3-6 month – 1.8gm/kg
• 6-9 month – 1.8gm/kg
• 9-12 months – 1.5gm/kg
• if not fulfilled leads to PEM.
Fats- 35-45% of calories are provided by fats in
initial stage of infancy.
Carbohydrate- 35-45% of calories.
Fluid -
• Full term require 60ml of fluid/kgbdwt on 1 st
day.
• 2nd – 3rd day-100-120ml of fluid/kgbdwt.
• Preterm baby on 1st day – 70-100ml/kgbdwt
2nd day- 150-170ml/kgbdwt
Minerals-
• Specially calcium and phosphorous.
• Intake of cow’s milk leads to hypocalcaemia
due to high phosphate content.
Vitamins-
• Vit-k administered 0.5-1mg IM to protect them
against hemorrhagic diseases.
• Vit-D in exclusive BF infant and adequate
exposure to sunlight there is no need for vit D
supplementation during 1st 6 months.
• If no sunlight exposure 10microgram/day vit-D.
• Iron store can last upto the age of 6month to start
complementary feeding.
• Oral dose of 1mg/kg/d as prophylactic.
• Vit- A 100000 IU with measles vaccine.
 Breastfeeding
• It is the feeding of an infant or young child
with breast milk directly from female human
breast via lactation rather than using infant
formula from a baby bottle or container.
• Babies have sucking reflex that enables them
to suck and swallow milk.
• Experts recommend that children be breastfed
within one hour of birth, exclusively BF for the
first 6months and then extended until 2yrs.
Cow’s milk is not recommended because-
• Protein is poorly digested in newborn and
cause GI upset.
• Too high in sodium.
• Very low in iron and vit-c.
• Can cause failure to thrive because of the
overall lack of nutrients in cow’s milk.
Complementary Feeding-
• It started from 6month onwards.
• Addition of semisolid foods is desirable which
Provide iron and other nutrients i.e. vit-c.
• Rice is best cereal to begin with.
• Fruit and vegetables are added next.
• No need to extra sugar or salt at the beginning.
6-12m.:
• Breastfeed as the child wants.
• Give adequate servings of:
 Thick porridge made of rice, potato, milk with
starch can add sugar & oil or sesame oil after
8th month.
• Mixture of mashed foods; rice or potato with
green vegetables, beans, chicken, red meat, &
finally fish.
• Give 3 meals/d if breastfed.
• Give 5 meals/d if not breastfed.
• Give nutritious snacks between meals like egg,
banana or bread after 8th month.
• Allergy Foods: peanuts, seafood, cow milk,
egg.
• Regular monitoring of weight and height.
1-2yr-
• Breastfeed as often as the child wants.
• Give adequate servings of; Family foods,
mixture of mashed foods of rice, potato,
cereals, with meat, beans, green vegetables,
carrots+ add sugar &oil mixed with milk.
• Give 3 meals/d +2 snacks.
• Encourage to eat.
2yr & older-
• Family foods 3 meals/d +2 nutritious snacks.
• Encourage to eat.
 Nutrition during childhood
Age Total cal. Cal/kg Total Protein/kg
protein
1-3yr 1300 102 16gm 1.2gm

4-6yr 1800 90 24gm 1.1gm

7-10yr 2000 70 28gm 1gm

Minerals and vitamins-
• Preschool children ar at risk for development
IDA. Attention to good source of iron foods.
• Calcium should be adequate for bone
mineralization and growth maintenance.
• Child should learn food pattern during this
period.
• Careful assessment of growth is important for
early diagnosis of malnutrition.
 Nutrition During adolescence:
• Adolescent is a period between the onset of
puberty & adulthood(10-20y).
• Puberty is anabolic period with incr. in Ht.
&wt, a growth spurt is experienced by
every organ system in the body with the
exception of lymphoid system& CNS
which remain stable.
• Rapid growth for girls between 10-13y &
for boys 12- 15y (last for 3yr)
• Nutrient needs are greatest during the
pubescent growth spurt & gradually decrease
as individual achieve physical maturity.
Energy and protein- Boys

Age Total cal Cal/kg Total protein

11-14yr 2500 55 45gm

15-18yr 3000 45 59gm

19-24yr 2900 40 56gm

Girls
Age Total cal Cal/kg Total
protein
11-14yr 2200 47 46gm
15-18yr 2200 40 44gm
19-24yr 2200 38 46gm
Vitamins & minerals:
• All are needed in increased amount in
proportion to energy requirements.
• Calcium, iron, zinc, are needed during growth
spurt;
• Ca RDA 1200mg/d (from dairy foods =4
cups/d).
• Fe RDA 12mg/d for male &15mg/d for
female.
• Zn RDA 15mg/d for male &12mg/d for female
is necessary for growth & sexual maturity
(from meat, sea foods, eggs,& milk).
• Energy requirements begin to differ between
males and females beginning in adolescence,
males have higher kcal requirements due to
increased muscle mass.
• Body composition of females differ from males
higher body fat composition at onset of
menstruation.
• Cal needs are based on body composition (height
and weight), age, and physical activity.
• Encourage healthy eating habits and lifestyle,to
prevent adult onset of diseases related to nutrition
e.g cardiovascular diseases, diabetes,
osteoporosis and cancer.
• Common Nutrition Related Problems During
Adolescence
• Obesity 1 in 5
• Eating Disorders
• Dental Caries
• Iron deficiency anemia seen in adolescent
girls.
• Calcium deficiency decrease in bone size.
 Nutrition During Pregnancy
1. ↑Basal metabolic rate (BMR): Fetal growth & development
increases the BMR by 5% during 1st trimester and 12% during
2nd & 3rd trimester. This increases the total energy
requirement.
2. Gastrointestinal changes: There is an alteration in GI
functions which causes nausea, constipation & vomiting. In
later trimester of pregnancy absorption of nutrients like
vitamin B12, iron and calcium increases in order to meet the
increased needs of the mother & fetus.
3. Changes in body fluid: Mother's blood volume increases so as
to carry the appropriate amount of nutrients to the fetus and
metabolic waste away from the fetus. With increase in the
blood volume the concentrations of plasma proteins,
hemoglobin and other blood constituents is lowered.
 Importance of good nutrition during
pregnancy
1. Mother has to nurture the fetus, health of the
newborn depends on nutritional status of the mother
during and prior to conception.
2. A well nourished woman prior to conception enters
pregnancy with reserve of several nutrients that
meets the needs of the growing fetus without
affecting her own health.
3. A well nourished woman suffers fewer complications
during pregnancy & there are few chances of
premature births.
4. A well nourished mother will give birth to a healthy
child.
5. Maternal diet during pregnancy has a direct
influence on fetal growth, size & health of the
newborn.
6. Poor nutrition during pregnancy increases the
risk of complications such as prolonged labor
and even death.
7. During pregnancy the nutrient needs
increases to develop maternal organs such as
uterus, placenta and breast tissues.
8. To build up body reserves to be utilized at the
time of delivery and lactation.
Important Nutrition Tips for Pregnant
and Lactating women
• Eat more food during pregnancy.
• Eat more whole grains, sprouted grams and
fermented foods.
• Take milk/meat/eggs in adequate amounts.
• Eat plenty of vegetables and fruits.
• Do not use alcohol and tobacco.
• Take iron, folate and calcium supplements
regularly, after 14-16 weeks of pregnancy and
continue the same during lactation.
 KEY NUTRIENTS DURING PREGNANCY

• Calories
✓ First trimester : No or little extra
Second trimester : +340 kcals/day
Third trimester : +450 kcals/day
• Protein : +25 g/day (or 1.1 g/kg
body weight)
• Carbohydrate : 175 g/day
• Folate
✔Non-pregnant women : 400 µg/day
Pregnant women : 600 µg/day
• B12
Non-pregnant women : 2.4 µg/day
Pregnant women : 2.6 µg/day
• Iron
✓ Premenopausal women : 18 mg/day
Pregnant women : 27 mg/day
• Zinc
Non-pregnant women : 8 mg/day
Pregnant women : 11 mg/day
• Vitamin D
✓ Does not increase during pregnancy.
✓Critical for bone and teeth development.
• Calcium
✓Does not increase during pregnancy.
Absorption and retention increases.
Deficiency common; needed to conserve
maternal stores.
 1st Trimester
• A time of rapid cell division, organ
development, and preparation for the
demands of rapid fetal growth that occur
during 2nd and 3rd trimester.
• Critical Nutrition during this phase include:
1. Protein
2. Folic acid
3. Vitamin B12
4. Zinc
 2nd & 3rd Trimesters
• Energy Intake: is especially important since
90% of fetal growth occurs during the last half
of gestation.
• Critical nutrients during this phase include:
1. Protein
2. Iron
3. Calcium
4. Magnesium
5. Vitamin B6, Omega 3, fatty acid, DHA
(Docosahexaenoic acid)
 Nutrition During Lactation
ENERGY
• An additional 500 kcal for the first six months, and 400
kcal during the next six months, are required for a
lactating mother. This can be met by eating.
• Simply eating more of the usual balanced diet should
allow you to meet the higher energy demand while you
breastfeed. On average, 100 ml of human milk gives 70
kcal of energy.
• During the first six months after delivery, 750 ml of
breast milk is produced daily. If the extra demand for
energy is not met from dietary sources, then your
reserved fat stores will be used instead.
PROTEIN
• The increase in protein requirements
during lactation are minimal compared to
that of energy. However, if the energy
intake is low, protein will be used for
energy production.
• The additional protein requirements
during lactation can be met by consuming
protein rich foods (e.g. one egg or 25 g of
cheese or 175 g of milk)
 Nutrition During Old Age
• Old age is best defined as age of
retirement that is 60 years and above.
• Nutrition for old age is known as
Geriatric Nutrition.
• Aging brings physiological,
psychological and immunological
changes which in nutritional status
• Geriatrics: the branch of the medicine
dealing with health problems of the
elderly i.e. delaying the onset of severely
degenerating aspects of aging and treating
the disease of the aged.
• Gerontology: Broad area of science
concerned with all the psychological,
social, economic, physiological and
medical problem of elderly
Changes Associated With Ageing
PHYSIOLOGICAL CHANGES-
• Loss of teeth
• Decreased neuromuscular coordination
• Impaired hearing and falling vision
• Diminished sense of taste and smell
• Anorexia
• Physical discomfort
• Change in GI tract
• Change in CVS
• Change in respiratory function
• Change in skeletal tissue
SOCIO PHYSIOLOGICAL CHANGES-
• Food habit
• Economic aspects
• Loneliness
• Lack of nutritional knowledge
• Depression
• Anxiety
• Loss of self esteem
• Loss of independence
 Nutritional requirement for elderly
• Basal metabolic rate decreases (15-20 percent)
due to reduced muscle mass and other
metabolically active tissue mass.
• Reduced physical activity.
• Increase in fatty tissue.
• SedentaryModerateMale1883 kcalFemale1706
kcal2216 kcal2007 kcal
 Sedentary moderate
MALE 1883KCAL 2216KCAL

FEMALE 1706KCAL 2007KCal

Carbohydrate
• Requirement reduces.
• Impaired glucose intolerance can lead to
hypoglycemia, hyperglycemia, and type
II diabetes mellitus.
• Insulin sensitivity can be enhanced by
balance energy intake, weight
management and regular physical
activity.
• 50 percent energy should derive from
carbohydrate.
Protein
• Decreased skeletal tissue mass.
• Decrease in store of protein is inadequate to
meet the need of protein synthesis.
• Intake of 1.0gm/kg is safe during old age.
• Protein rich food with milk and curd should be
included.
• Due to decrease appetite and poor digestion,
old people consume less protein which may
lead to edema, anemia, and low resistance to
infections.
Lipid
• Dementia and CVD may share risk factors like
high intake of dietary total fat.
• Emphasis should be placed on reducing the
intake of saturated fat and choosing mono
saturated or poly saturated fat sources.
• Sufficient intake of w-3 fatty acids helps in
visual acuity, hair loss, tissue inflammation,
improper digestion, poor kidney function and
mental depression.
Minerals
• Calcium: 800mg/day.
• To compensate age related bone loss, to
improve calcium balance and to decrease
prevalence of fracture.
• Ca absorption efficiency decreases,
vitamin D level decreases so need more
Ca.
• Total food consumption decrease so Ca
supplements needed.
• Iron: 30mg/day.
• Deficiency is seen in elderly due to
inadequate iron intake, blood loss due to
chronic disease or reduced non-heam iron
absorption.
• Vitamin C deficiency also reduce iron
absorption.
• Mild anemia affect health due to less
efficient circulation of blood.
• Zinc Some features like delayed wound
healing, decreased taste sensitivity and anorexia
are associated with zinc deficiency.
• But healthy elderly don't show zinc deficiency.
• Vitamins Elderly are at risk of Vitamin D
deficiency due to decreased exposure to
sunlight or decrease in renal mass.
• Dietary supplements with calcium and vitamin
D improves bone density and prevent fractures.
• People with Parkinson disease have low
vitamin D levels.
• Stress, smoking, and medication can increase
vitamin c requirement.
• The antioxidant vitamins such as vitamin E,
carotinoids and vitamin c enhances health of
elderly.
• Vitamin C may be protective against cataract
at an intake level of b/w 150-250 mg/day.
• Vitamin E is potent nutrient for reducing
decline in cellular immunity that occur in
elderly.
• Changes in immune system can be overcome
by taking 200 mg of vitamin E.
• Requirement of vitamin B6 increased due to
atrophic gastritis, interferes with absorption.
• Alcoholic and liver dysfunction are additional
risk factor for deficiency of vitamin B6.
• Food sources of vitamin B6 (pyridoxine)
include beans, legumes, nuts, eggs meats, fish
breads and cereals
• Vitamin B6 have significant role in immune
system.
 Nutrition Related Problems Among
Elderly
• Obesity
• Under nutrition and malnutrition
• Osteoporosis
• Cardiovascular diseases
• Diabetes
• Cancer