Chapter 1

Basics of Human Nutrition

TOT for Pastoral and Agropastoral

areas
 Presentation Layout

vMalnutrition and its different forms

vCauses of malnutrition

vImpacts of malnutrition on the community

vThe current magnitude of malnutrition

vBasic concepts of human nutrition, food and nutrition security

2
Chapter Objectives

• At the end of this chapter, the trainees will be able to:

vBasic terminologies in nutrition

vDiscuss the concept of malnutrition and its different forms

vIdentify causes of malnutrition

vExplain the effects of malnutrition on the community

vDescribe the current status of under-nutrition nationally and PAP

vDescribe basic concepts of food security and nutrition security

vList down the Importance of dietary diversity

vState dietary recommendations for women and children

 Basic
terminologies
in
nutrition
Basic terminologies in nutrition

Nutrition
• Nutrition refers to the science of food and how it is related
to health.

• Technically it is the intake of food, considered in relation

to the body’s dietary needs.

• It involves the processes where all people receive and

process the nutrients essential for life.

5
 Cont’d

What is Food
• is any substance plant or animal based which is
consumed to provide nutritional support to our body.

What is Meal:
• Food served and eaten at a time

What are Nutrients

• are components in foods that an organism uses to
survive and grow.

6
Nutrients

• Nutrients are broadly classified in to two: Macro nutrients and

Micro nutrients
• Macronutrients are consumed in large amount a day and
provide calories for your body

• Micronutrients are required by your body in smaller

amoutns a day for normal functioning of our body

7
 Cont’d

Nutritional requirements refer to the amount of different

nutrients required by our body for an active and healthy life.

Nutritional requirements differ according to

age, gender, physiological state etc.

Nutritional status is the condition of the body in relation to

food intake and the ability of our body to use it

8
Malnutrition
and
Its Different
Forms
Malnutrition and Its Different Forms

Malnutrition refers to the deficiencies, excesses or imbalances in a

person's intake of energy and/or nutrients

10
• BMI and waist circumference depict your body composition

Body Mass Index

��
BMI =
���

Waist Circumference

11
 Cont’d

Example
• A person with weight of 85kg and a height of 1.8m Would have a
BMI of ?
�� ���� ����
BMI = � BMI = � = �.���� = 26.23
�� �.��

BMI Category
1. Under weight BMI < 18.5
2. Normal weight BMI =18.5-24.9
3. Over weight BMI = 25-29.9
4. Obese BMI >= 30

12
Exercise

1. Calculate your BMI

2 What would be the problem of having a BMI of bellow 18.5

for PAP community(farmer)
 Cont’d

• Under-nutrition is the result of insufficient quantity and quality of

food and frequent episodes of infectious disease.

• Under-nutrition is reflected as a range of conditions including being

1. being thin- low weight for height- wasting
2. Underweight- low weight for age
3. Short- low height for age- stunting
4. Micronutrient deficiency

• A child is defined as undernourished if it is very thin or much shorter

than the average for their age and sex.

14
 Forms of Undernutrition

1. Wasting is the result of acute or short-term insufficient food intake

often combined with frequent illness.
• It results in a child who is very thin (i.e. has a very low weight
for its height and sex).

15
 Cont’d

2. Underweight is an indicator assessing adequacy of weight-for-age.

The causes of which can be both short-term and long-term.

16
 Cont’d

3. Stunting is an indicator of chronic or long-term insufficient

energy or micronutrient intake due to poor diets and non-nutritional
causes such as chronic infections.

• The condition results in a child who is very short (i.e. has a

very short height for its age and sex).

17
 Cont’d
4. Poor micronutrient status is when there is a
deficiency in vitamins and minerals as a result of a poor
quality diet.

• Micronutrient deficiencies can also result from frequent

illness, which may increase requirement or loss of nutrients.

18
 Causes
of
Under
Nutrition
UNICEF conceptual framework of undernutrition

• The conceptual framework developed by UNICEF provides a clear

depiction of the various factors associated with under-nutrition.

• Immediate causes (individual level): Inadequate food intake and disease

are immediate causes of under-nutrition. These are at the individual level.
• Underlying causes (household and community level): Household food
security and social care for mothers and children, access to WASH and
the health environment and access to health services are underlying
causes that contribute to under-nutrition.
• Basic causes (sub-national, national and international level): Political,
cultural, financial and environmental factors also contribute to under-
nutrition at the basic level.
20
 Conceptual framework of undernutrition

Under- Effect
nutrition

Inadequate Disease Immediate

Food intake Causes

Inadequate Poor
Insufficient
maternal & WASH& Underlying
access to Causes
child CARE Health
FOOD
practices Services

Human, economic & organisational RESOURCES

and the way they are controlled
Basic Causes
Potential resources: environment, technology,
people
Group Work

• Identify the different levels of causses of under-nutrition in

your Regions
• Immediate causes

• Underlying causses

• Basic causses
 The Effects
and Impacts
of
Undernutriti
on
Impact of Stunting

Health
• Stunted children are sick more
often and 4X more likely to die.
Ø Poor immunity
Ø Reduces effectiveness of
vaccines
• Increased risk of Non
Communicable disease later in
life
Impact of Stunting

Education
• Reduced cognitive development
combined with poor health
impacts education outcomes.
Impact of Stunting

Earnings
• Reduced education outcomes
combined with poor health impacts
earning potential.
• This perpetuates the cycle of poverty
and malnutrition.
• In women, this also impacts economic
independence and choice.
Impact of Stunting
Economic Growth
• Reduced education
outcomes and earning
potential impacts the future
of entire countries.
• Reduced tax revenue limits
countries abilities to
provide social services
such as education and
health care.
Impact of Stunting

Health System Costs

• Increased burden to
health care system.
• Increased burden to
education system
• Low productivity
 The
Status of
under-
nutrition
Under nutrition in Ethiopia

30
 Cont’d

• Stunting in Rural Ethiopia = 41%.

• Stunting in Urban Ethiopia=26%

• Only less than 10% of under-five

children get optimal diet for their
age.
• Low in diversity
• Low in quantity

31
Regional distribution of Stunting in Ethiopia

48.7

43
41.3

35.6 36.3
34.7
30.5 30.5
Stunting

25.4

17.6
%

13.9

AMHARA AFARA B/G D. DAWA GAMBELA TIGRAI ET SOMALI HARARI A. ABABA OROMIA SNNP

32
 Stunting global vs regional

37
STUNGTING ETHIOPIA
51.5

30.3
STUNTING AFRICA
38.3

9.6
STUNTING LA & CARI
16.9

23.2
STANTING ASIA
38.1

22.2
STUNTING GLOBAL
36.2

0 10 20 30 40 50 60

2017 2000
 Dietary
practice
of
PAP areas
Food consumption in Ethiopia over 15 years

• The amount of food

consumed in Ethiopia Kg of food consumed from 1996 to 2011
500
improved from 447
450
404
288kg/p 1996 to 400 376
350
447kg/p in 2011. 300 288

250
200
150
100
50
0
1996 2000 2005 2011

35
Cont’d

• Energy Supply has

improved over the
years from around
1645 kcal in 2000 to
2400kcal in 2018.

• Diets in Ethiopia
remain low in
diversity and
provide insufficient
amounts of protein,
vitamin A, and zinc.

36
 Healthy diet consumption pattern

45
Diet based indicators
38

20
16
14
7
…

H…
E…
M

w
Children 6-23
mon Women Mothers
consumption consumption consumption
% of calories from (out 7 food (out of 9 food (out 10 food
Region Calories/capita carbohydrates groups) groups) groups)
Amhara 4130 85 1.4 2.1 2.5
Oromia 4262 87 2 2.4 2.1
SNNP 3286 85 1.7 2.4 2.1
Tigray 3541 85 1.8 2.4 2.6
Somali 432 90 1.5 1.5
Afar 666 64 1.3
Progress in the reduction of stunting in Ethiopia

• The progress we are making is Not Sufficient to meet

• The 2020 NNP-II target 26%

• The WHA target of reducing stunting by 40% by 2025.

• The 2019 EDHS report shows 37% of stunting in <5yrs

children
Group discussion on Impact of Malnutrition

Impact of Malnutrition at Individual, Community and Region/Country Level

Individual Community Country Level

39
The Concepts
of Food and
Nutrition
Security
How can good nutritional
status be Achieved?
 Cont’d
• Food security is a situation where all people, at all
times have
• Physical, Social and Economic access
• to safe, sufficient and nutritious food to meet their
dietary needs and food preferences for an active and
healthy life (World Food Summit, 1996).

41
Pillars of Food Security

1.

2.

3.

4.

42
 ……cont’d
1. Availability refers to the physical existence of food.
• Crop production
• Stock
• Trade

2. Access is ensured when all households have enough resources

to obtain food in sufficient quantity, quality and diversity for a
nutritious diet.
• Income
• Price
• Markets
• Food distribution etc.

43
 Cont’d

3. Utilization refers to
• The socio-economic aspects of household food and nutrition security,
determined by knowledge and habits
• Biological utilization[healthy environment, food preparation,
processing

4. Stability
• refers to stability for access to food

44
 Cont’d

• Nutrition security is when all people at all times consume food

of sufficient quantity and quality in terms of variety, diversity,
nutrient content and safety to meet their dietary needs and food
preferences for an active and healthy life, coupled with a sanitary
environment, adequate health and care (FoodSecurity,2013FAO).

45
 The
Concept
of
Dietary
Diversity
 Food groups

• Foods are combinations of nutrients, and naturally contain a lot

of one nutrient and less of other.

• Foods are hence often grouped according to the nutrient that

they contain in abundance.

• There are a number of food classifications containing five, six,

seven and ten food groups according to different literature.

47
 The Six food groups

1. Staples: Foods in this category include cereal grains, roots and tubers
• They are basic sources of energy.

2. Legumes and nuts: This group includes beans and nuts

• They are protein rich and are important
for growth, repair and body building

48
 Cont’d

3. Animal source foods:

• They provide protein, fats, vitamins and minerals.
• Important for the health and growth of a child

4. Vegetables: This group includes colored green leafy vegetables

• They provide mostly vitamins, minerals and water and fiber.

5. Fruits
• Contain carbohydrates, vitamins and water.

6. Fats/oils: This group includes fats from plant and animal origin.
• Fats provide an additional energy, essential fatty acids and fat-soluble
vitamins. 49
 Dietary diversity

• Dietary diversity is a measure of the number of individual foods or

food groups consumed in a given time period.

• Low dietary diversity is a particular problem in Ethiopia where the

diet is frequently based on starchy staples
e.g. teff, maize, sorghum, enset, and wheat

• The diet often lacks animal-source foods, (meat, fish, eggs and
dairy) and fruits and vegetables.

50
 Dietary recommendations

• Women and children are the most affected segments of our population
with a high rates of maternal and child under-nutrition.

• Attaining healthy nutritional status demands consumption of food based

on our body’s dietary requirement.

• Responsible parties need to give due emphasis for

• Own production
• Market access and
• Other means
to acquire relevant food groups for healthy dietary practice
 Cont’d

• Child Nutrition
• Exclusive breast feeding for the first 6 moths and continued BF
until the first 2 years of a child is very important
• After the six moth,(181st day), breast milk is not adequate

• At six moths of age children need to start complementary food

• Made from 1…… 2…… 3…… 4….. 5…..

6……

• How many times ?

 …..cont’d
• Maternal Nutrition
• During Pregnancy
• One extra meal to account for the
physiological change taking place

• During Lactation
• Two extra meal

• For the regular woman

• As diverse as possible with at least
4 food groups from the six food groups
to meet MDD_W
• Other HH members
• As diverse as possible
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