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NUTRITION - UNIT I

INTRODUCTION

NUTRITION - UNIT I

Nutrition

History, Concepts, Role of nutrition in maintaining health

Nutritional problems in India

National nutrition policy

Factors affecting food and nutrition: Socioeconomic, cultural, traditional, production,


system of distribution, life style and food habits etc.

Role of food and its medical value

Classification of foods

Food Standards

Elements of nutrition: Macro and Micro

Calorie, BMR

INTRODUCTION
Nutrition
The

is

provision

of

the

materials

necessary in the form of food to cells


and organisms to support life.
Healthy

diet prevents or alleviates -

common health problems.

History
Nutrition

is a new field of study -

about 100 years old.


Hippocrates

had recognised diet

on a component of health as early


as 300 BC.

History
Past

100 years - The importance of

CHOs, Lipids and Proteins for normal


growth

and

development

were

recognised.
The

next nutrition breakthrough was

the discovery of vitamins.

History
Vitamin

Vitamin

A in 1913, Vitamin C in 1919,

D in 1925, Vitamin K in 1935,

Vitamin

E,

B1(Thiamine),B6(Pyridoxine)-1936,
Vitamin

B2

(Riboflavin)

in

Vitamin B9 (Folic acid) in 1948.

1935,

History
Nutrition

was

officially

recognized as an independent
field of study in 1928 with the
formation of American Institute
of Nutrition.

History
It

took about half a century more for

nutrition

to

achieve

its

current

status as one of the most talked


about scientific disciplines.

History
Nutrition

encompasses not only the

study

of

vitamins,

other

foods,

but

minerals
also

and

diverse

subjects as alcohol, caffeine and


pesticides.

History
Besides,

nutrition research tries to

find out the impact of food on body


by examining the progress in allied
fields, such as physics, chemistry,
biochemistry and immunology.

CONCEPTS
Nutrition,
Dietetics,
Food,
Diet

CONCEPT - NUTRITION
Nutrition

is defined as the science of

food and its relationship to health.


It
It

is food at work in the body.


includes everything that happens

to food.

CONCEPTS - NUTRITION
It

is the study of nutrients and

processes by which they are used by


the body.
It

is concerned with the part played

by nutrients in the body growth,


development and maintenance.

CONCEPTS - DIETETICS
Dietetics

are the practical

application of the principles


of nutrition, which includes
planning of meals for the
healthy as well as the sick.

CONCEPTS - DIETETICS
Good

nutrition

maintenance

of

means
nutritional

status that enables us to grow


well and enjoy good health.

CONCEPTS - FOOD
Food

is vital for human existence just as

air and water.


Food

may be defined as anything eaten

or drunk, which meets the needs of


tissue building, regulation and protection
of the body and its energy needs.

CONCEPTS - FOOD
Food:

raw material from which bodies

are made.
Intake

of right kinds and amounts can

ensure good nutrition and health evident in ones appearance, well-being


and efficiency.

CONCEPTS - DIET
Diet:

Diet

whatever

refers

people

drink each day.

to
eat,

CONCEPTS - DIET
It

includes

the

normal

diet

people consume and the diet


people consume in groups (hotel
diet), but will also be modified
for the sick as part of their
therapy (diet therapy).

ROLE OF NUTRITION IN MAINTAINING


HEALTH
The basic study of nutrition primary importance as
1. It

is fundamental for own

health.

ROLE OF NUTRITION IN MAINTAINING


HEALTH
2.

It is essential for the health and


well-being of patients and clients
from the time of eating till it is
utilized for various functions.

The scope of the study involves:

ROLE OF NUTRITION IN MAINTAINING


HEALTH
The scope of the study involves:
Nutrition helps growth and
development
Prevents malnutrition
Resists infection
Prevents diseases

ROLE OF NUTRITION IN MAINTAINING


HEALTH
Proper

nutrition

supports

wellness
Wellness is more than the
absence of disease
Physical, emotional, and
spiritual health
Active process

ROLE OF NUTRITION IN MAINTAINING


HEALTH

NUTRITIONAL PROBLEMS IN
INDIA
A

survey

in

south

India

has

revealed that about


1%

children

aged

1-5

years

showed signs of kwashiorkor, 2%


marasmus and
3%-5%

vitamin A deficiency.

NUTRITIONAL PROBLEMS IN
INDIA
Community
Many

studies have shown that

mothers give only breast

milk to children up to 2years.


Thus,

no additional food is added

to the childs diet.

NUTRITIONAL PROBLEMS IN
INDIA
Papaya,

vitamin

rich,

considered which produces more


heat - cause miscarriage - avoided
by pregnant women.

NUTRITIONAL PROBLEMS IN
INDIA
Belief

- if a pregnant woman eats

more, the baby will be big and


delivery

difficult,

so

expectant

mothers are not fed adequately


both in quality and quantity.

Nutritional Problems in India


Problem
Features
NUTRITIONAL
PROBLEMS
IN
INDIALess than 2.5kg
Low Birth Weight
Still birth

Birth of dead baby

Kwashiorkor

Protein deficiency between 1


and 4 years

Anaemia

20% adolescent girls and 90%


pregnant women

Nutritional Problems in India


Problem

Features

NUTRITIONAL PROBLEMS IN
Stunted growth
Height
and
weight
not
ideal
INDIA
Night blindness
Cataract
Goitre

Vitamin A deficiency after 50


years
Vitamin A and Vitamin D
deficiency
Iodine deficiency in females

Nutritional Problems in India


Problem

Features

NUTRITIONAL PROBLEMS IN
Under weight INDIA
50% adults
Overweight

15% Mumbai school children are


obese

Diabetes

About 10% of the total population and


about 1/5 above age 50 suffer

Nutritional Problems in India


Problem
NUTRITIONAL
PROBLEMSFeatures
IN
INDIA

Hypertension

Male and female suffer more


in urban areas

Cardiac problems

More in males

Cancer

More in females

Nutritional Problems in India


The

hunger and malnutrition survey

report 2011 covered


7,300

households

in

112

districts

across 9 states and more than 1 lakh


children and 74,000 mothers.

Nutritional Problems in India


The key findings of the survey
42%

children under 5 are underweight; 59% are

stunted.
66%

of mothers did not attend school. Rates of

child underweight and stunting are higher among


mothers with low levels of education.

Nutritional Problems in India


By

2 years, 42% children are underweight

and 58% stunted in the 100 focus districts.


Prevalence

of

child

underweight

has

decreased from 53% in 2004 to 42% in


2011.

Nutritional Problems in India


Birth

weight:

Under

2.5kg

at

birth

and

continue

to

underweight 50%
Over

2.5 kg at birth, but underweight now 34%

Under
Over

2.5kg at birth and stunted now 62%

2.5kg at birth, but stunted now 50%

stay

Nutritional Problems in India


Prevalence

among

of malnutrition is significantly higher

children

particularly

from

Muslims,

low-income
Scheduled

families

Castes

and

Scheduled Tribes although rates of malnutrition are


significant
families.

among

middle

and

high

income

Nutritional Problems in India


We

cannot hope for a healthy future for

India

with

such

large

number

of

malnourished children.
The

government cannot solely depend on

Integrated Child Development Services


(ICDS) to solve the issue.

Nutritional Problems in India


The

government

strengthened

is

and

launching

restructured

ICDS, to start a multisectoral program


for

200

high

initiate
communication

burden
a

districts

and

nationwide
campaign

against

Cause of Nutritional Problem


Poor

Nutrition,

Under

(Malnutrition),
Overnutrition.

Nutrition

Cause of Nutritional Problem


The

World Bank estimates that India

is ranked 2nd in the world of the


number of children suffering from
malnutrition.

Cause of Nutritional Problem


Undernutrition

is found mostly in

rural areas 10% of villages and


districts accounting for 27-28%
of all underweight children.

Cause of Nutritional Problem


Children

of

scheduled

tribes have the poorest


nutritional status and the
highest wasting.

NATIONAL NUTRITION POLICY


Indias

nutritional policy was formulated in the

year 1993 by an act of the parliament


With

the following goals:

1. Reduction of incidence of low birth weight


2. Elimination of nutrition blindness

NATIONAL NUTRITION POLICY


NNP

goals:

3. Reduction of anaemia to 20% in pregnant


women.
4. Universal iodination of common salt to loweriodine deficiency disorders to less than 1%.
5. Establish special care to geriatric nutrition.

NATIONAL NUTRITION POLICY


NNP

goals:

6. Increase annual food grain production to 250


metric tons.
7. Steps to create household food security through
poverty alleviation.

NATIONAL NUTRITION POLICY


NNP

goals:

8. Decrease incidence of moderate and severe


malnutrition in children.
9. Promotion of appropriate diets and healthy
lifestyle.

NATIONAL NUTRITION POLICY


NNP

goals:

Short

- term intervention

Long

- term interventions.

NATIONAL NUTRITION POLICY - Short term intervention


Expanding

the nutrition intervention net (ICDS)

Empowering

mothers with nutrition and health

education
Teaching

adolescent girls to avoid anaemia

Ensuring

better nutritional coverage for expectant

women.
Controlling

micronutrient deficiencies and fortifying

NATIONAL NUTRITION POLICY - Long


Term Interventions or Development
Policy Instruments
Food

security

Improvement
Increasing

of dietary pattern

purchase power of the population

Streamlining

System (PDS)

and expanding Public Distribution

NATIONAL NUTRITION POLICY - Long


Term Interventions or Development
Policy Instruments
Strengthening
Nutrition

and public education

Education
Nutrition

and literacy

and surveillance

Information
Ensure

health and family welfare programs

and communication

community participation

NATIONAL NUTRITION POLICY


A

nutritional plan of action was formulated in 1995

To

implement the short and long term policy

instruments with sectorial commitment by the


following nutrition related ministries.

NATIONAL NUTRITION POLICY Nutrition Related Ministries


Agriculture
Food
Civil

production
supplies

Public

distribution

Education

and literacy

NATIONAL NUTRITION POLICY Nutrition Related Ministries


Health

and family welfare

Preventive

care

Information

and broad casting

Awareness
Forestry

and environment protection

NATIONAL NUTRITION POLICY Nutrition Related Ministries


Labor
Rural,

urban and tribal development

Transport
Formation

communications
of high-level committees/councils

for identifying factors affecting food and


nutrition.

2. Cultural,
Taboos And
Superstitions

1. Socioeconomic
- Large Families,
Dietary
Inadequacy
11. Maternal
Malnutrition,
Low Birth
Weight

3.
Religious/Tradition
al

Determinan
ts / Factors
of
Malnutritio
n

10. High Female


Illiteracy

4. Child Rearing
Practices - Faulty
Child Feeding
Practices
5. Production,
6. System of
Distribution

7. Life style,
8. Food Habits

9. Frequent
Infections

Factors Affecting Nutritional


Status
High
Risk
Groups
are

ROLE OF FOOD AND ITS MEDICAL


VALUE

1. Origin

2. Chemical
Composition

CLASSIFICATI
ON OF FOODS
3. Function

4. Nutrition
Value

BASED ON ITS ORIGIN

BASED ON CHEMICAL
COMPOSITION

Based on Nutrition Value


1.
Cereals
&
Millets

2.
3. Milk,
4. Fruits
Pulses
Milk
&
&
Product
Vegetab
Legume
s&
les
s
Meat

5. Fats
&
Sugars

FOOD STANDARDS
Definition:

Food standards are a set of criteria that

a food must meet and it should be suitable for


human consumption, such as source, composition,
appearance, freshness, permissible additives, and
maximum bacterial content.

FOOD LAWS IN INDIA


Prevention

of Food Adulteration Act, 1954

Fruit

Products Order,1955

Meat

Food Products Order ,1973

Vegetable

1947

Oil

Products

(Control)

Order,

FOOD LAWS IN INDIA


Edible

Oils Packaging (Regulation) Order 1988

Solvent

Extracted Oil, De- Oiled Meal and

Edible Flour (Control) Order, 1967,


Milk
The

and Milk Products Order, 1992.


Food Safety and Standards Authority of

India (FSSAI), 2006.

PREVENTION OF FOOD
ADULTERATION ACT, 1954
PFA

Act

covers

food

standards,

general

procedures for sampling, analysis of food,


powers

of

authorized

officers,

nature

of

penalties and other parameters related to


food.

PREVENTION OF FOOD
ADULTERATION ACT, 1954
It

deals with parameters relating to food

additives,

preservative,

colouring

matters,

packing & labelling of foods, prohibition &


regulations of sales etc.

FRUIT PRODUCTS ORDER,1955


Objective:

To manufacture fruit & vegetable

products maintaining sanitary and hygienic


conditions

in

the

premises

standards laid down in the Order.

and

quality

FRUIT PRODUCTS ORDER,1955


Minimum

requirements

for

hygienic

production and quality standards:


Location
Sanitary

premises

and surroundings of the factory


and

hygienic

conditions

of

FRUIT PRODUCTS ORDER,1955


Machinery

& equipment with installed

capacity
Quality

control facility & technical staff

Product

standards

Limits

for preservatives & other additives

MEAT Food Products Order ,1973


Fastest
Indian

growing animal protein in India.

consumers prefer to buy fresh meat from the

wet market, rather than processed or frozen meats.


Meat

& meat products are highly perishable in

nature and can transmit diseases from animals to


human-beings.

Vegetable Oil Products (Control)


Order, 1947
Regulated

by this order through the directorate of

Vanaspati, vegetable oils & fats, department of


food, public distribution, ministry of consumer
affairs, and food & public distribution.

EDIBLE OILS PACKAGING


(REGULATION) ORDER 1988
Ensure

edible

availability of safe and quality


oils

in

packed

form

at

determined prices to the consumers.

pre-

SOLVENT EXTRACTED OIL, DEOILED MEAL AND EDIBLE FLOUR


(CONTROL) ORDER, 1967,
Quality

control order to ensure that the

quality reached to the consumers for


consumption

MILK AND MILK PRODUCTS


ORDER, 1992.
The
To

objective of the order is

maintain and increase the supply of liquid milk

of desired quality in the interest of the general


public and
Also

for regulating the production, processing

and distribution of milk and milk products.

THE FOOD SAFETY AND


STANDARDS AUTHORITY OF
INDIA (FSSAI), 2006.
Regulating

body related to food safety and

laying down of standards of food in INDIA.


FSSAI

creates science based standards for

articles of food.

THE FOOD SAFETY AND


STANDARDS AUTHORITY OF
INDIA (FSSAI), 2006.
FSSAI

regulates their manufacture, storage,

distribution,

sale

and

import

to

ensure

availability of safe and wholesome food for


human consumption.

DUTIES AND FUNCTIONS OF


FSSAI
Framing

of Rules, Regulations, Standards and

Guidelines in relation to articles of food.


Procedure

and the enforcement of quality

control on any article of imported into India.

DUTIES AND FUNCTIONS OF


FSSAI
Guidelines for accreditation of certification
bodies engaged in certification of Food Safety
Management System for food businesses.
Providing

to

the

scientific advice and technical support


Central

Government

and

Governments on food safety and nutrition

State

DUTIES AND FUNCTIONS OF


FSSAI
Training

programmes for various stakeholders in

food safety and standards.


Contribute

to the development of international

technical standards for food, sanitary and Phytosanitary standards

DUTIES AND FUNCTIONS OF


FSSAI
Guidelines

for accreditation of Laboratories and

their notification.
Promote

general awareness about Food Safety

and Food Standards.

DUTIES AND FUNCTIONS OF


FSSAI
Collect
Food

and collate data regarding

consumption,

Incidence

and prevalence of biological risk,

Contaminants

in food, Residues of various contaminants,

Identification

of emerging risks and Introduction of rapid

alert system
Creating

information dissemination network across the


country about food safety & issues of concern.

ELEMENTS OF NUTRITION:
MACRO AND MICRO
Food

is

composed

of

wide

distribution

of

nutrients,
Have

very specific metabolic effects on the human

body.
Two

categories: macronutrients, micronutrients.

MACRONUTRIENTS
It
It

constitute the majority of an individuals diet.


essential nutrients that are needed for growth

and energy - carbohydrates, proteins, fats, and


water.

MACRONUTRIENTS
Carbohydrates,

proteins,

and

fats

are

interchangeable as sources of energy.


Fats

yielding 9 calories per gram,

Protein

and carbohydrates each yielding 4 calories

per gram.

Carbohydrates
Composed

of carbon, hydrogen, and oxygen, and

constitute the main source of energy for all body


functions, particularly brain functions, and are
necessary for the metabolism of other nutrients
(Mosby 260).

Carbohydrates
It

is the easiest form of food to convert into energy.

Ingested

carbohydrates are turned into glucose,

which circulates in the bloodstream being readily


available, and into glycogen which is stored in the
liver and muscle cells, for later use.

Protein
Large

combinations of amino acids containing the

elements carbon, hydrogen, nitrogen, and oxygen,


It

the major source of building materials for

muscles, blood, skin, hair, nails, and internal


organs.

Protein
It

is used by the body to build, repair, and maintain

muscle tissue.
The

ingested protein is broken down into peptides

and amino acids which are vital for proper growth,


development, and maintenance of health.

Fat
Composed

of carbon, hydrogen, and oxygen (these

elements are connected together differently than


in carbohydrates).

Fat
3

primary functions are:

They

are the major source of stored energy for the

body,
They

serve to cushion and protect the major organs,

They

act as an insulator, preserving body heat, and

protecting against excessive cold.

Water
Water
The
An

is a key essential to a healthy body.

body is roughly 60% water.


average person needs about 8 cups of water

per day depending on their activity levels.

Water
Typically,

the thirst mechanism is not a good sign

to indicate when the body needs water.


This

mechanism is activated when dehydration has

already occurred.

Water
Dehydration

can lead to heat illnesses - heat


exhaustion and heat stroke because of the
inability to sweat.

It

also can cause electrolyte imbalance and


malfunction of the body systems.

This

can lead
performance.

to

decreases

in

energy

and

MICRONUTRIENTS
Micronutrients
Body

are vitamins and trace minerals.

requires them in very small amounts.

Vitamins

are organic substances that we ingest with

our foods, and that help to trigger other reactions in


the body.

MICRONUTRIENTS
Needed

only in small amounts,

Deficiency
Most

leads to critical health problems.

of the diseases and conditions are due to

deficiency of micronutrients.
WHO

- Elimination of micronutrient deficiency,

labour efficiency will increase multifold.

LIST OF MICRONUTRIENTS
MICRONUTRIENTS: VITAMINS
Vitamin

A, Vitamin B,

Vitamin

C, Vitamin D,

Vitamin

E, Vitamin K and

Carotenoids.

LIST OF MICRONUTRIENTS
Minerals

are

Boron,

Calcium,

Chloride,

Chromium, Cobalt, Copper, Fluoride, Iodine,


Iron, Magnesium, Manganese, Molybdenum,
Phosphorous, Potassium, Selenium, Sodium
and Zinc.

LIST OF MICRONUTRIENTS
ORGANIC ACIDS
Acetic

acid, Citric acid,

Lactic

acid, Malic acid,

Choline

and Taurine.

CALORIE
A
In

calorie is a unit of energy.


nutrition and everyday language, calories refer to

energy consumption through eating and drinking


and energy usage through physical activity.
For

example, an apple may have 80 calories, while a

mile walk may use up about 100 calories.

CALORIE
Symbols:kcal,CalorC
The

international unit of energy is Joule (J)

Fat1

gram = 9 kcal/g

Protein1 gram = 4 kcal/g


Carbohydrates1

gram = 4 kcal/g

THE BASAL METABOLIC RATE


The

basal metabolic rate is the

energy expenditure necessary to


maintain
conditions.

basic

physiologic

BASIC PHYSIOLOGIC CONDITIONS


The

activity of the heart

Respiration
Conduction
Ion

of nerve impulses

transport across membranes

Reabsorption
Metabolic

in the kidney

activity.

About

60% of the energy - supports the ongoing

metabolic

work

of

the

body

cells,

the

basic

metabolism.
This

is the work that goes on all the time, without

conscious awareness.

person whose energy expenditure amounts to

2,000 cal/day spends as much as 1200 1400


calories to support usual metabolism.

Basal

metabolic energy required to support the

basic processes of life - circulation, respiration,


temperature maintenance, etc. It excludes digestion
and voluntary activities.
BMR

constitutes the largest proportion (2/3) of a

persons daily expenditure.

Definition
The

BMR is defined as the energy expenditure of a

subject at complete physical and mental rest,


awake (and not during sleep) having normal body
temperature and in the post-absorption state (12
hours after the last meal) and 8 12 hours after any
significant physical activity.

Measurement Basal metabolism

1.

Calorimeter directly by measuring the heat

dissipated under the basic conditions.


2.

Indirectly by measuring oxygen consumption.

Factors affecting BMR


The

metabolic

rate

differs

individuals. It depends on:


1.

Variable factors

2.

Invariable factors

among

different

1.
Nutritiona
l state
6. Drugs

5.
Environme
ntal
temperatu
re or
climate

Variable
factors
affecting
BMR
4.
Endocrina
l or
hormonal
state

2. Body
size or
surface
area

3. Body
compositio
n

Lean

Body

Mass

is a component of

body

composition, calculated by subtracting body fat


weight from total body weight: total body weight
is lean plus fat.
In

equations: LBM = BW BF Lean Body Mass

equals Body Weight minus Body Fat

LBM

+ BF = BW. Lean Body Mass plus Body Fat

equals Body Weight.


Eg

A man with 165 cm height should have 65 kg as

per normal BMI


Suppose

consider he is 85 kg. then the lean body

mass = 85 - 20 = 65 kg

HIGHER THE
PERCENTAGE
OF
adipose
tissue
Lower the BMR
per
kilogram
body weight.

Invariable factors affecting BMR

Gender or
Sex
Women
Sex
hormone

Age

Normal Value
BMR

values are expressed as kcal or KJ/m2 of body

surface per hour.


In

adults, BMR for healthy males is 40 kcal (168kJ)

per hour and


Healthy

females is 37 kcal (155kJ) per hour.

Clinical Applications
BMR

estimation

is

used

to

diagnose

disorders
BMR

is used in calculating food and drugs.

thyroid