NUTRITION science of food and nutrients related to health, supplying

body with the food it need.

NUTRITION TRANSITION
High Prevalence of Malnutrition > Famine > Focus on famine > Increase
Non-Communicable disease > Focus on medical intervention, policy change,
behavioral change
PHN CYCLE - IGOTDIE
1.
Identify key nutrition problem
2.
Set goal
3.
Define objectives
4.
Create quantitative targets
5.
Develop program
6.
Implement program
7.
Evaluate program
NUTRITIONAL ASSESSMENT - ABCD
Anthropometry
o
Measure dimension and composition of human body
Biomarkers
o
Asses the nutrient intake / impact to body
Clinical Assessment
o
Assess clinical consequences of nutrition intake
imbalance
Dietary Assessment
o
Estimate food and diet intake
TOTAL FOOD AVAILABLE
Food balance
Domestic food + Imported Food + Food taken from storage Food
export and used for non-food purpose / no of people in population
= food available per person
HOUSEHOLD MEASUREMENT - FIRH
Food accounts record all food acquired (cost/quantities)
o
Adv: Cheap, representative, subgroup analysis
o
Disadv: Incomplete, home food only, overproducing
bias
-

Inventory record all food comes into house including larder

(beginning and end)
o
Adv: Cheap, take larder into account, representative,
subgroup analysis
o
Disadv: Home food, incomplete, based on food
composition, larder may distort purchase pattern

Household record household measuring / weight and estimated,

allow preparation waste, recall and record (interviewer call in
morning and ask respondent to recall)
o
Adv: Take larder into account, subgroup analysis,
measure actual food consumption
o
Disadv: Home food, no individual data, observer may
distort normal consumption

List-recall structured survey, respondent list, recall amount and

cost of food obtained (weekly)
o
Adv: Cheap, representative, measure food use, single
interview
o
Disadv: recall bias, incomplete (sweets, beverages not
included), based on food composition tables, Observe
bias

Measurement
o
Prospective - DuWeHoFI

Duplicate Diet weight and record food

intake at time of eating, at same time
duplicate same portion for analysis

Weighed Inventory subject record,

weight immediately food taken using
portable food scale (limitation due to under
report)

Household Measure Technique using

standard household measures (cup, spoon,
glass), to simplify

Food Checklist common food list, tick

when eat

Integrated Dietary Analysis handheld

computer link to weighing machine, subject
choose food from list
o

Retrospective - ReDF

24 Hours Diet Recall recall food item for

last 24 hours using household measurement

Diet History similar like 24 hours, but

will need elaboration in 2 hours interview to
discuss each meal, range of food, diff
weekend and weekdays.
Food Frequency & Amount
Questionnaire pre printed food list,
subject state amount of food and frequency
consumed

MALNUTRITION
Negative impact on nutritional status of an individual, may be over
or under nutrition

RISK STRATIFICATION (PHYSICAL ACTIVITY)

Low Risk
o
No sign symptoms of CVD, pulmonary or metabolic
disease or no diagnose but with NO MORE than 1 risk
factor for CVD
o
Allow to perform physical activities safely
Moderate Risk
o
No sign and symptoms / diagnose have CVD etc but
have 2 or more risk factor for CVD
o
Risk increase, may safely engage with low to moderate
physical activity without medical clearance
o
Advice for medical test before initiation of vigorous
activity (> 60%)
High Risk
o
One or more symptoms of CVD, pulmonary, or
metabolic disease, or diagnose as one
o
High risk of CVD, thus need examination and need
clearance before doing physical activity at any intensity
EXERCISE PRESCRIPTION FITTE
Frequency no of session per day
Intensity level of demand, heart rate / O2 demand
Type aerobic, cardio etc
Time duration / per session / per week
Enjoyment
BREAST MILK CHANGES
1-3 days = colostrum
3-7 days = transitional
7+ = mature
BABY FRIENDLY HOSPITAL
Written policy to encourage breast milk
Give newborn only breast milk, on demand
Practice rooming in
No artificial teat/pacifier
Initiate BF at least hour after delivery
Show mother how to BF, inform benefit
Train all staff to support BF
PROTEIN ENERGY MALNUTRITION
Not meeting the energy and protein requirement for active and
healthy life
Due to infection, insufficient intake, or both
Marasmus / Kwashiorkor
Indicator
o
Wasted weight for height below 2SD, recent / acute
deficiency

Mild, moderate, severe

o
Stunted height for age below 2SD, past / chronic
deficiency
o
Underweight weight for age below 2SD, wasting /
stunting or both
MICRONUTRIENT DEFICIENCIES
Iodine goiter (iodine salt, reduce cassava, water iodination)
Vit A - xeropthalmia
Iron / Folate anemia
NUTRITION IN PREGNANCY
Preconception intervention to improve pregnancy outcome
Need additional 360 kcal
Risk assessment
o
Individual and social condition age, diet, education
o
Adverse health behaviors tobacco, alcohol
o
Medical condition
o
Psychological condition stress, anxiety, personal
readiness
o
Environmental condition workplace hazard

o
Barrier to family planning, prenatal care, PH
Nutritional requirement
o
Carbohydrate, fat
o
Protein
o
Micronutrients calcium, folate, iron, zinc

CHILDREN WITH SPECIAL NEEDS

Those who have or at risk for chronic physical,
developmental, behavioral, or emotional condition
Require health related services beyond the requirement of
children generally
FOOD POLICY 3PD
Area of public health concerning food production,
processing, distribution and purchasing
ELDERLY

Defined by WHO, age 65 y.o and above, Malaysia 60 y.o

and above (NPO)

If more than 10% of population aged 60 and above =

population aging
NUTRITIONAL SCREENING

wind that alter the composition of global atmosphere with

observable variability with time
FUNCTIONAL FOOD
Processed food that has at least one functional component,
proven to be beneficial, and no negative effects
Must be at certain level of amount, if more or less
considered FOOD
e.g. garlic low cholesterol, improve blood pressure
Health claim relationship between food / substance and
reduced risk of disease or health condition
-

Type
o
o
o

Dietary fiber food with naturally occurring

bioactive substance
Probiotics, antioxidants food supplements
with bioactive substance
Prebiotics derived food ingredients
introduced to conventional food

PROBIOTICS
Living organism when consumed will give benefit to host
E.g. lactobifidus, bifidobacterium
Mostly dairy product yogurt
-

Requirement
o
Resistant to oral cavity enzyme, survive thru
GI tract
o
Able to proliferate and colonize GI tract
o
Safe and effective
o
Able to maintain effectiveness and potency for
duration of shelf life

PREBIOTICS
Food for probiotics
Selective ingredients that change composition and activity
of GI microbiota thus giving benefits to host health

FOOD SECURITY - AvAUS

Access and availability for safe, sufficient, and nutritious
food to maintain healthy and active lifestyle
Pillars
o
Availability supply, production, stock, trade
o
Access physical and economic
o
Utilization consumption, preparation,
distribution
o
Stability sustainable
CLIMATE CHANGE
A change in climate over 30 years that is influenced by
temperature, precipitation, and shifting off season and

Requirements
o
Resistance to GI enzymes
o
Able to be fermented by colon microflora
o
Bifidogenic and pH-lowering effects

Types
o
o
o
o
o

Oligosaccharide
Disaccharide
Polyols
Oligofructose
Polysaccharides

Source - cow milk, soya beans, garlics, onions

MEDICAL NUTRITION THERAPY IN DIABETIC

MANAGEMENT - AITE
-

Assessment of status and knowledge

Identification, negotiation for nutrition goal
Treatment
Evaluation