MIND SPARK INSTITUTE OF HEALTH SCIENCE AND MANAGEMENT STUDIES (MSISMS)

FACULTY OF HEALTH SCIENCE

DEPARTMENT OF CLINICAL MEDICINE

DIPLOMA PROGRAM

YEAR I

SEMESTER I

COURSE UNIT; NUTRITION

Introduction to Nutrition

BY; Philip Majuch Mum

Tel; 0924646395
Email; philipmajuchmum.99@[Link]
NUTRITION MODULE COURSE OUTLINES;
1. Concept of Nutrition
2. Basic requirements (carbohydrates, proteins,
vitamins, fats, minerals & water)
3. Causes of malnutrition
4. Symptoms & signs of nutritional deficiencies
5. Importance of proper food preservation and
storage
6. Importance of breastfeeding and process of
weaning
7. Factors that influence normal nutrition
 CONCEPTS OF NUTRITION & ITS OBJECTIVES
By the end of this module, students will be
able to illustrate the following;
1. Food and its Functions

2. Nutrients and their functions

3. RDA and Energy requirements

for different activities

4. Energy value of Foods

 Illustration :
Photo, drawing,
clipart…

Foo
d
and
its Functions
 What is food?

• Any substance which nourishes the body and is fit to eat is

called food.
• Food is essential for human life because it is the source of
energy and nutrients.

• Our body is made up of the foods we eat. Food contains

chemical components similar to those that make up the
body.
• These chemical components of food are called nutrients.
 Why
do we need food?

• Foods supply the body with specific nutrients.

• These nutrients are necessary for our:
- Physical growth and development
- Repair and maintenance of normal body functions.
- Protection against infections
• Nutritious food is, thus needed to sustain life and
physical activity.

No single food contains all nutrients. Therefore,

a
combination of varied foods is needed.
 What
is Nutrition?
• Nutrition is the science of food and its relation to health.
• It deals with food and is a basic prerequisite to sustain
life.

• The way our body makes use of these nutrients affects

our health and well being.

Variety in food is not only the spice of life but

also
the essence of nutrition and health
 Why do we need nutritionally adequate food?
• Our diet must provide all essential nutrients in the
required amounts.

• Requirements of essential nutrients vary with age, gender,

physiological status and physical activity.
• Eating too little food during infancy, childhood,
adolescence, pregnancy etc. or too much food at any age
can lead to harmful consequences.
• Therefore, an adequate diet, providing all nutrients, is
needed throughout our lives.

Nutritious food can enhance your physical and mental potential.

 Food and its Functions
Food performs the following functions:

1. Physiological function
• Providing energy to carry out voluntary work.
• Growth or body building.
• Repair or maintenance of the body cells.
• Regulation of body processes.
• Protective function, increasing one’s resistance to
infection.

2. Psychological function
• Food satisfies our emotional need for love, attention and
security.
3. Social function
• Food is an important part of festivals and social
functions.
Nutrient
s and
their
Function
s
 What are Nutrients?

• The food you eat is a source of different nutrients.

• Nutrients are defined as the substances found in
food that keep your body functioning.

Your body needs nutrients to…

• Fuel your energy.

• Help you grow.
• Repair itself.
• Protect us against infections
• Regulate basic body functions
 Nutrients

There are six groups of nutrients which are essential. They are broadly classified as follows:-

• Carbohydrates
• Proteins
• Fats
• Vitamins
• Minerals and
• Water
 Types of Nutrients

When food is eaten, it is digested in the body which allows the absorption of energy and
nutrients.

There are two different types of nutrients:

• macronutrients
• micronutrients.
There are three macronutrients that are required in large amounts and are essential for good health.

These are:

• Carbohydrate
• Protein
• Fat.
Macronutrients are measured in grams (g)
 Carbohydrates

Carbohydrates are the body’s main source of energy and also provide the body’s need for dietary
fiber.
They provide 4 kcals/g.

Food Sources:
Cereals such as wheat, rice, millets (jowar, bajra, ragi etc.), pulses, fruits, roots and tubers; and
sugar, jaggery, sweetmeats and preserves.

Carbohydrates are of two types:

• Sugars or Simple Carbohydrates
• Starches or Complex Carbohydrates
 Simple Carbohydrates

Can you give some examples of sources of sugar in the

diet?

• Fruit and vegetables (fructose)

• Milk and dairy products (lactose)
• Honey
• Jam
• Fruit juice
• Table sugar (sucrose)
• Jaggery, khand (brown sugar)
• Sweets and chocolate
• Sweetmeats like Mithais, ladoos
etc

• Glucon D (glucose)
 Complex Carbohydrates

Starchy carbohydrate
Starch is found in a variety of foods. It is made up of many sugar molecules.

Can you give some examples of sources of starch in the diet?

• Potatoes
• Bread
• Rice
• Roti/ Chapatti

Cereal and cereal products are the main source of

carbohydrate for Indians.

 Starches or Complex Carbohydrates

Food Sources:
Whole grain chappatis, bhakris, rice,
Breads, pasta and all cereal products,
Roots, tubers and other vegetables,
and legumes.

Function in the Body:

• An excellent source of fuel
(energy) for the body.
• Rich in vitamins, minerals and fiber.
 Fibre
Dietary fibre is the plant material that doesn’t break down when food is digested.
Hence does not provide any calories. Many, but not all, complex carbohydrates
contain fiber.

Food Sources:
Whole grain cereals and pulses, bran, green leafy vegetables, fruits and
vegetables with edible seeds and skin, nuts and oilseeds.

Function in the Body

 Increases gastric motility and aids in
digestion.
May reduce the risk of developing some
diseases like heart disease, diabetes and
obesity, and certain cancers.
 Functions of Carbohydrates

• Carbohydrates are the main energy source for the

human brain.

• The body cannot function properly in its absence.

• The simple carbohydrates are high in calories and low in
nutritional value. They are present in high amounts in
junk foods or unhealthy foods.
• Complex carbohydrates may also contain dietary fibre
which cannot be digested in the human digestive tract.
• Sources are fruits and vegetables, whole grain cereals,
millets, pulses and legumes.
• Diets rich in complex carbohydrates are healthier than
low- fibre diets which are high in refined cereals such as
Maida, noodles etc.
 Proteins

Protein is essential for growth and repair and keeping cells healthy.

• 1 gram of protein provides 4 kcal.

Food Sources
Milk and dairy products, meat, fish, eggs, poultry, pulses and legumes, nuts
and seeds. (Breads, cereals and vegetables also contain small amounts of
incomplete protein)
 Proteins

Function in the Body

• Help to build, maintain, and repair body tissues.
• Regulates body functions
• Proteins are the major structural component of cells.
• Protein is broken down into amino acids, which are
building blocks of protein.
• There are 22 different amino acids.
• The human body is capable of producing 13 of them.
The other 9 called, “Essential Amino Acids” must be
supplied by food sources.
 Types of proteins

Complete Proteins:

• Contain all 9 essential amino acids.

• They are found in animal food sources.
• Milk, Egg, Poultry, fish etc are of high quality as they
provide
all the essential amino acids in right proportions.

Incomplete Proteins:

• Lack one or more of the essential amino acids.

• They are found in plant food sources.
• Cereals lack some amino acids while pulses are lacking in
others.
• The best way to provide the body complete proteins in a
vegetarian diet is to eat cereals and pulses together so
that they supplement each other.
 Fat

Fats are the most concentrated source of energy providing 9 kcal/g

Food Sources:
Butter, ghee, vegetable oils, salad dressings, nuts and oil seeds, dairy products made with
whole milk or cream, and meats.
Structure of fat Structure of Fat
Fat is made up of different types of fatty
acids and glycerol.

The structure of the fatty acids determines:

• their effect on our health;
• their characteristics, e.g. melting point.

Depending on their chemical structure, fatty acids

are usually classified as:
• saturated fatty acids;
• monounsaturated fatty acids;(MUFA)
• polyunsaturated fatty acids. (PUFA)

High intakes of saturated fat may raise blood

cholesterol and increase the risk of heart disease
and stroke.

A diet high in unsaturated fats is associated with a

lower level of blood cholesterol and reduces the risk
of heart disease.
 Functions of Fat

• Fat provides substances needed for growth and healthy skin.

• Enhance the taste and texture of food.
• Fats are needed for the absorption of fat- soluble vitamins
such as A, D, E and K.

• Twenty percent of your daily energy/calorie intake

should come from fats/oils.
• Choose healthy options such as omega-3-rich foods like fish,
walnuts and seed oils like groundnuts, gingelly/ til, mustard.
• Omega-3 aids in growth and development.
• Limit intake of saturated fats such as butter, ghee and
hydrogenated fats and cholesterol from red meat and full-fat
dairy.
• Not more than 10% of total calories from saturated fats and
at least 10% of total calories should come from PUFA.
 Micronutrients

There are two types of

micronutrients:

• vitamins
• minerals.

• Vitamins and minerals

are needed in much
smaller amounts than
macronutrients.
• Their amounts are
measured in milligrams (mg)
and micrograms (μg).
(1mg = 0.001g) (1μg =
0.001mg).
 Vitamins
 Vitamins are chemical compounds required by the body in small
amounts.

 They must be present in the diet as they cannot be synthesized in

the body.

 Vitamins are essential for numerous body processes and

maintenance of structure of skin, bones, nerves, eye, brain, blood
and mucous membrane.

 They are either water- soluble or fat- soluble.

 Fat –soluble vitamins can be stored in the body
while water soluble vitamins are not and get excreted
in urine.
 Vitamins B- complex and C are easily destroyed
by heat, air or during cooking.

 There are 13 different vitamins known to be required each day

for good health.
 Fat soluble vitamins

Vitamin A

Vitamin A is needed for:

• dim light vision;

• healthy skin and eyes;
• resistance to infection.

Sources
• Vitamin A is found pre-
formed in liver and whole milk.
• It can also be produced from
beta-carotene provided by dark
green leafy vegetables,
• carrots and orange
coloured fruits such as
papaya.
 Vitamin D
Functions
• Vitamin D is needed for the
absorption of calcium from foods to
keep bones and teeth strong and
healthy.
• Helps your body use calcium and
phosphorus, two minerals you need
for healthy bones.

Sources
We get most of our vitamin D via the action of UV rays from the sunlight on
skin.
Vitamin D is also provided in small amounts by the diet from oily fish, meat,
egg yolk, fortified milk, and margarine/spreads.
Vitamin E

Function

• Supports the function of all your

tissues by acting as an antioxidant.

• It prevents cellular damage, which

would otherwise cripple cell
function and lead to cell death.
• It is necessary for normal
reproduction.

Food Sources:
Whole-grain breads and cereals; dark green, leafy vegetables; dry
beans and peas; nuts and seeds; wheat germ, vegetable oils; liver.
 Vitamin K

• Function in the Body

– Helps blood to clot.

• Food Sources
– Dark green and leafy vegetables (such as spinach, fenugreek leaves, lettuce, cauliflower and
cabbage). Cheese, egg yolk and liver

– Bacterial synthesis in the intestines

 Water Soluble Vitamins
Functions-
Vitamin C
.
•
Vitamin C - Vitamin C is necessary for the
synthesis of collagen, which provides
structure to blood vessels, bone and
ligaments.

B-complex vitamins - are B-1, B-2,B-3, B-

6,B-12, biotin, folic acid, and pantothenic
acid.
• They work in combination to ensure that
your cells can use the energy they need
to function, by helping you break down
carbohydrates and fats.
• B-complex vitamins also helps
metabolize protein into amino acids.
Water soluble

vitamins The B

vitamins
There are many different B vitamins and each has a
specific function in the body.

These include:

• vitamin B1 (Thiamin);
• vitamin B2 (Riboflavin);
• vitamin B3 (Niacin);
• vitamin B6;
• vitamin B12;
• folate/folic acid.
 Vitamin B-complex

• Function in the Body:

– Helps the body use the
energy from the foods we eat.
– Helps brain, nerves, and muscles function.

• Food Sources:
Whole grain and enriched breads and cereals; dry bean and peas; peanut butter; nuts;
meat; poultry; fish; eggs; milk

– Bacterial synthesis in the intestines

 Vitamin C

• Function in the Body:

– Helps heal wounds.
– Helps maintain healthy bones,
teeth, and blood vessels.

– Helps body fight infection.

• Food Sources:
– Citrus fruits, guava, amla, all berries, cabbage,
potato, broccolli, tomatoes.

– Sprouted grains
Vitamin C
Vitamin C is needed to make collagen. This is required for the
structure and function of skin, cartilage and bones. Collagen
acts like cement and keeps cells together

It is an important nutrient for

healing cuts and wounds.

Did you know?

Vitamin C can help with the absorption of iron when foods
or drink containing both vitamin C and iron are eaten at
the same meal.
Sources of vitamin C
• Fresh fruit especially citrus fruits and
berries.

• Green vegetables.
• Peppers.
• Tomatoes.
• New potatoes.

Can you name some citrus fruit?

Sweet lime, orange, grapefruit, Kinu,
tangerine, carambola (star fruit), lemon.

How many different types of berries

can you think of?
Amla, ber, karonda, Blackcurrants, strawberries, raspberries , blueberries,
cranberries, rose apple, zizyphus.
 Minerals
Functions

• Minerals are inorganic elements found in body fluids and

tissues that assist with life-sustaining processes in your
body.
• Your body needs macro-minerals in relatively large
amounts such as calcium& phosphorous.
• Micro minerals are required in small amounts such as
iron, iodine, sodium & potassium.

• While trace minerals are required in traces such as

copper, zinc, chromium, selenium etc.
• They are required for maintenance and health of skin, hair,
nails, blood and soft tissues.

• They also govern nerve cell transmission, acid/base and

fluid balance, enzyme and hormone activity as well as in
blood clotting processes.
• The body requires 16 minerals daily.
 Calcium & Phosphorus

• Function in the Body:

– Helps build and maintain healthy bones and
teeth.

– Helps heart, nerves, and muscles work properly.

• Deficiency of calcium & phosphorus leads to

rickets and osteoporosis.

• Food Sources:
– Dairy Products: milk, cheese, ice cream, green
leafy vegetables, ragi, small fish eaten with
bones.
Calcium
The body contains more calcium than any other mineral. It
is essential for a number of important functions such as
the maintenance of bones and teeth, blood clotting and
normal muscle function.

Did you know?

The skeleton contains about 99% of the body’s calcium
with approximately 1kg present in adult bones.
Iron

Iron is essential for the

formation of haemoglobin in red
blood cells.

Red blood cells carry oxygen and

transport it around the body.

Iron is also required for normal

metabolism and removing waste
substances from the body.

Did you know?

There are two types of iron; one
from animals sources and the
other from plant sources.
Sources of iron

• Liver.
• Red meat.
• Pulses- black gram, red gram
• Nuts.
• Eggs.
• Dried fruits.
• Fish.
• Whole grains.
• Dark green leafy vegetables.
• Garden cress seeds
• Niger seeds
• Flax seeds
Iron in the diet
A lack of iron in the diet means that the stores in the body will
run out.

This can lead to anaemia.

Women and teenage girls need to ensure they have enough
because their requirements are higher than those of men of
the same age

Did you know?

More than 2 billion people worldwide suffer from iron
deficiency anaemia, making it the most common nutritional
deficiency.
Sodium
Sodium is found in all cells and body fluids.

It is needed for regulating the amount of water and

other substances in the body.

Did you know?

Sodium is a component of table salt, known as sodium
chloride (NaCl).
Sodium in the diet

High sodium intake is considered to be one of the risk factors for high
blood pressure, which may lead to heart disease and stroke.

Did you know?

It is recommended that adults and children 11 years and over not to
have more than 5g of salt per day. Young children should eat less.
 Sodium

Food sources

– Processed & prepared foods.

Canned foods such as RTE vegetables,
soups etc
– Preserves -pickles, wafers, papads and
farsan.

– Salt used in cooking and table top.

– Condiments. Table salt, soy sauce,
ketchup, mustard spread, sauces,
chutneys
– Natural sources. Some meats, poultry,
dairy products (esp. cheeses) and green
leafy vegetables.
 Water
• Getting enough water -- both from water-rich
foods, such as fruits and vegetables, and
through drinking fluids keeps your cells and
tissues functional.

• Your body uses water to remove waste

products from your cells.

• Water flushes out toxins that might impede

cell function.

• It helps transport nutrients needed for your

cellular metabolism.

• It also helps you avoid an abnormally high or

low body temperature that would hinder enzyme
function.
Water

Our body is nearly two-thirds

water, so drinking enough
fluid to stay hydrated is very
important.

Water is essential for life

and it is very important to
get the right amount of fluid
to be healthy.

Did you know?

Humans can survive for a few
weeks without food, but they
cannot go without fluids for
more than two to three days.
Water in the diet
Water is the major component of body fluid and has many functions in the body:

• It acts as a lubricant for joints and eyes;

• It is the main component of saliva;
• carries nutrients to body cells
• helps get rid of waste;
• helps regulate body temperature.
The body loses water all the time, when we go to the toilet, from sweat and also
by evaporation from skin. If we do not consume enough water, we become
dehydrated.
Sources of water

Water is provided by food and

drinks.

It has been estimated

that roughly 20% of water
consumed is from food (e.g.
soups, curd (yogurt), fruits and
vegetables), while 80% is
from drinks (water, milk and
fruit juice).
Question-

On average, how much water should

we drink each day?

2-4 glasses/ day

4-6 glasses/ day

6-8 glasses/ day

8-10 glasses/ day

RDA
Energy
Requirement
s for
different
Activities
 Recommended Dietary Allowance

• RDA is defined as the amount of nutrient sufficient for the

maintenance of health in nearly all people.

• The RDA for all nutrients have been calculated for Indians
for all age groups based on activity levels to ensure good
health.

• The RDA’s are suggested for a reference man and

reference woman.

• RDA=minimum requirement + safety margin (individual

variation)

• RDA does not apply to sick people.

 Who is a Reference man and a
Reference woman?

Reference man :
– Age:20-39 yr and Weighs.:60 kg
– Healthy, free from disease and fit for active work
– He spends 8 hrs daily on occupational work (moderate
activity)
– While not at work he spends 8 hrs in bed,
– 6 hrs sitting & moving around,
– 2 hrs walking & household work
Reference Woman: has the same criteria as for reference man except her weight is 55 kg
 Recommended Dietary Allowances for Indian
Children

Group Age Energy Proteins Fat Iron Vitamin

Years kcal/d g/d g/d mg/d A
Caroten
e μg/d
Children 4 – 6 years 1350 20.1 25 13 3200

Children 7 – 9 years 1690 29.5 30 16 4800

Boys 10 – 12 2190 39.9 35 21 4800

Years
Girls 10 – 12 2010 40.4 35 27 4800
Years
Boys 13 – 15 2750 54.3 45 32 4800
Years
Girls 13 – 15 2330 51.9 40 27 4800
years
Total Energy Requirement

Energy for basal

metabolism
1 kcal /hr/kg body
wt / per day

Energy for
digestion of
food.
SDA

Energy for
occupational work
(heavy / moderate /
sedentary)
 Do you know what are voluntary and
involuntary functions of the body?
Voluntary
Voluntary :
responses are mainly
under conscious control for
e.g. walking, playing etc.

Involuntary: responses
are not in our control for
Involuntary
e.g. pumping of heart,
breathing, digestion of
food etc.
Energy Expenditure
Energy Expenditure
No Excuse Please,,,,,,,,,,,
Energy
Value of
Food
 Energy providing nutrients

Energy in the diet is provided by the nutrients

carbohydrate, protein, and fat.

1 gram of carbohydrate provides 4 kcal.

1 gram of protein provides 4 kcal.

1 gram of fat provides 9 kcal.

 Which food item gives most nutrients?
Per Energy Carbohydrat Fat Protein
serving e

Chapatti 70 kcal 15g 0 2g

20g

Ghee 10g 90kcal 0g 10 g 0g

Milk 3% 145 12g 7g 8g

fat 1 kcal
glass/
240ml
 Cereals and Pulses

Plain dal
Snacks
Sweets and Desserts
Beverages
Nuts
Fruits
Fruits
ACTIVITIES
 Activity 1
Who am I?
Fill in the blank with the appropriate nutrient.

1. I serve many functions in the body. I help carry nutrients to the body’s cells
and I also help regulate body temperature. I am .
2. I can be converted into energy. I am also used to build, maintain and repair
body tissues. I am .
3. I have a bad reputation in many people’s minds but I do serve many
functions in the body. For example, I am the most concentrated source of
energy and I also am needed for growth and healthy skin. I
am .
4. I am the body’s main source of energy and I come in two forms, simple and
complex. I am .
5. I do not provide energy (calories) but I do help regulate many of the
chemical processes in the body. You need 13 different forms of me
everyday. I am .
6. I am depended on for nearly every process necessary for life. The body
requires 16 types of me everyday from calcium to iron. I am .
 Activity 1 with answers
Who am I?
Fill in the blank with the appropriate nutrient.

1. I serve many functions in the body. I help carry nutrients to the body’s cells
and I also help regulate body temperature. I am Water .
2. I can be converted into energy. I am also used to build, maintain and repair
body tissues. I am Protein .
3. I have a bad reputation in many people’s minds but I do serve many
functions in the body. For example, I am the most concentrated source of
energy and I also am needed for growth and healthy skin. I
am Fat .
4. I am the body’s main source of energy and I come in two forms, simple and
complex. I am Carbohydrates .
5. I do not provide energy (calories) but I do help regulate many of the
chemical processes in the body. You need 13 different forms of me
everyday. I am vitamin .
6. I am depended on for nearly every process necessary for life. The body
requires 16 types of me everyday from calcium to iron. I am
mineral .
 Which food item gives most nutrients?
Per Energy Carbohydrat Fat Protein
serving e

Chapatti 70 kcal 15g 0 2g

20g

Ghee 10g 90kcal 0g 10 g 0g

Milk 3% 145 12g 7g 8g

fat 1 kcal
glass/
240ml
 Malnutrition
■ is a multifactorial condition caused by inadequate inta ke or inadequate digestion of nutrients. It
may result f rom eating an inadequate or unbalanced diet, digestiv e problems or other medical
conditions.
OR

■ "A state of nutrition in which a deficiency, excess or i mbalance of energy, protein, and other
nutrients cause s measurable adverse effects on tissue, function and cl inical outcome." (BAPEN,
British association of parenteral and enteral nutrition)
Causes of Malnutrition
■ (severe Famine hunger).

■ Poverty.

■ Digestive disease.

■ Mal-absorption.

■ Depression.

■ Anorexia nervosa.

■ Bulimia nervosa.
■ Untreated diabetes mellitus.

■ Fasting.

■ Coma

■ Alcoholism and other certain drug addictions

■ Over-consumption of fat and sugar

■ Overpopulation

■ Industrial food processing

Consequences of malnutrition:

■ Impaired immune responses

■ Reduced muscle strength and fatigue
■ Increased difficulties in breathing
■ Impaired thermoregulation
■ Impaired wound healing
■ Apathy, depression and self-neglect
■ Poor libido
■ Longer hospital stay
■ Higher health costs
■ Higher morbidity
■ Higher mortality
Micronutrient deficiencies

■ Iron deficiency

■ Iodine deficiency

■ Vitamin A deficiency

■ Folic acid deficiency

Nutritional assessment

■ Comprehensive process of identifying and evaluation nutritional problems (risk

factors) and needs (nutrient s, education, special diet) and determining nutritional
status, uses appropriate, measurable methods to gathe r and evaluate data, by 4
techniques/categories:
■ History / diet history

■ Clinical /physical examination

■ Anthropometrics (weight, height, mid arm circ umference, BMI etc).

■ Biochemical tests (CBC, vitamins level, TFTs)
■ Height for age (stunting) reflects chronic malnutrition among children.

■ Weight for height (wasting) reflects acute malnutrition.

■ Weight for age (underweight) reflects both acute and chronic malnutrition.
 Protein energy malnutrition

■ Causes and consequences:

Protein-energy malnutrition (PEM) is a problem in ma ny developing countries, most commonly
affecting children between the ages of 6 months and 5 years. The condition may result from lack
of food or from infections that cause loss of appetite while increasing the body’s nutrient
requirements and losses
■ Children between 12 and 36 months old are especial ly at risk since they are the

most vulnerable to infect ions such as gastroenteritis and measles.

■ Chronic PEM has many short-term and long-term physical and mental effects including :

1. Growth retardation;

2. Lowered resistance to infection, and

3. increased mortality rates in young children

Even after treatment begins it is not uncommon for deaths to result from electrolyte
imbalance, hypothermia, or complicating infections.
Nutritional Marasmus

■ It results from prolonged starvation. It may also result from chronic or recurring
infections with marginal fo od intake. The main sign is a severe wasting and the c
hild appears very thin and has no fat .

■ The affected child (or adult) is very thin (“skin and b ones”), most of the fat and
muscle mass having been expended to provide energy. There is severe wasting of
the shoulders, arms, buttocks and thighs, with no visible rib outlines.
Associated signs of the condition

■ A thin “old man “face.

■ “ Baggy pants “ (the loose skin of the buttocks hanging down).

■ Affected children may appear to be alert in spite of their condition.

■ There is no edema (swelling that pits on pressure) of the lower extremities.

■ Ribs are very prominent.

Kwashiorkor

■ It usually affects children aged 1–4 years, although it also occurs in order children
and adults. The main sign is edema,

■ usually starting in the legs and feet and spreading, in more advanced cases, to the
hands and face.

■ Because of edema, children with kwashiorkor may look “fat”

so that their parents regard them as well fed.
Associated signs

■ Hair changes : loss of pigmentation; curly hair becomes straight easy pluck-able;

■ Skin lesions and hypo-pigmentation, outer layers of s kin may peel off and
ulceration may occur; the lesion s may reassemble burns.

■ Children with Kwashiorkor are usually apathetic, miserable, and irritable. They show
no signs of hunger, and it is difficult to persuade them to eat.
■ The associated signs of Kwashiorkor do not always occur. In some cases, edema may be the only
visible sign
 Chronic malnutrition

Children who suffer from chronic malnutrition fail to grow to their full genetic potential, both
mentally and physically. The main symptom of this measured is stunting - shortness in height
compared to others of the same age group - and takes a relatively long time to develop
 ■ What causes chronic malnutrition?

■ What happens to children who are stunted?

■ How much mortality is caused by malnutrition?

■ How many stunted children are there in the world and

where is the problem the greatest?
 ■ Every year, over 10 million children under the age of
5 die globally; malnutrition is directly or indirectly associated with more than half of these
deaths.

■ According to UNICEF, there were an estimated 170 million stunted children living in
developing countries in 2005. South Asia is the region with the highest percentage of
its under-5 population stunted. Burundi's population has the most severe level of
chronic malnutrition, but India has the largest absolute number of stunted children.
Obesity
WE EAT TO LIVE

NOT LIVE TO EAT

Obesity can be defined as a condition of abnormal or excessive fat accumulation
adipose tissue; to the extent that health may be impaired ( WHO 1998)
■ Body mass index (BMI) is a simple index of weight-for-height that is commonly
used in classifying overweight and obesity in adult populations and individuals. It is
defined as the weight in kilograms divided by the square of the height in meters
(kg/m2).
 WHAT CAUSES OBESITY AND OVERWEIGHT?

The fundamental cause of obesity and overweight is a n energy imbalance between calories
consumed on one hand, and calories expended on the other hand. Global increases in
overweight and obesity are attributable to a number of factors including:
■ a global shift in diet towards increased intake of energ y-dense foods that are high in
fat and sugars but low i n vitamins, minerals and other micronutrients; and

■ a trend towards decreased physical activity due to the increasingly sedentary nature
of many forms of work, changing modes of transportation, and increasing urb
anization
 Obesity, an epidemic

■ World Health Organization, Geneva 2000

Obesity is a health problem in its own right and is considered a major risk factor in the
development of diabetes and cardiovascular disease. There are around 16 million diabetics in
the Eastern Mediterranean Region
. This figure was expected to rise almost 43 million by 2025.
■ Physical exercise had become a leisure activity; people had air-conditioned cars and
bought their food from supermarkets. Along the same lines, dietary habits ha d
undergone a major change as well. Fat consumption rose, fast food outlets were
found everywhere and most inhabitants of the Gulf Cooperation Council countries
reportedly had processed foods at every meal.
Salient features of the obesity epidemic are as

follows

■ Obesity is a complex, multifaceted disorder;

■ Obesity is prevalent in both developing and industrialized countries

■ In many countries, especially developing countries

, obesity co-exists with under-nutrition;

■ Obesity affects children and adolescents, as well as

the adult population
■ More women have become obese than men, while there is a higher proportion of
overweight men than overweight women;

■ Obesity is a major risk factor for serious non-communicable diseases, such as

cardiovascular disease, hypertension, stroke, diabetes mellitus and various
forms of cancer;

■ It is projected that by 2025 approximately 60% of deaths worldwide will be

caused by circulatory diseases and cancers. This evidence suggests that the
prevention and control of the problem of obesity needs to be taken very seriously
in both industrialized and developing countries.
The economic costs of overweight and obesity

■ Determining the economic cost of obesity is an important activity which can highlight
the true impact of the obesity problem for policy-makers in a language the y
understand-money.

■ The costs of obesity are usually divided into three components:

ss

■ Direct costs: health care resources for the management

of obesity and related illness
■ Indirect costs: loss of economic activity due to illness and premature death associated with
obesity.
■ Intangible costs: social and personal loss associated with obesity and its related illnesses.
MDG (millennium development goals)

■ Eradicate extreme poverty and hunger Achieve universal primary education

■ Promote gender equality and empower women

■ Reduce child mortality

■ Improve maternal health

■ Combat HIV/AIDS and other diseases

■ Ensure environmental sustainability

■ Develop a global partnership for development

Balanced nutrition contributes to:

■ Child survival

■ Better education

■ Poverty alleviation

■ Reproductive health

■ Sustained economic growth

■ Global equity, stability and prosperity

NUTRITIONAL DEFICENCY DISORDERS
INTRODUCTION;
A nutritional deficiency occurs when the body doesn’t absorb or get from food the necessary amount
of nutrient.
Deficiency can lead to variety of health problems. These can include digestion problems, skin
disorders, stunted or defective bone growth and even dementia.
DEFINITION OF NUTRITIONAL DEFICIENCY;
An inadequate supply of essential nutrients (vitamins and minerals) in the diet resulting in
malnutrition or disease.
FOUR FORMS OF NUTRITIONAL DEFICIENCY DISORDERS;
 Undernutrition
 Specific deficiency
 Over nutrition
 Imbalance
PROTEIN ENERGY MALNUTRION (PEM)
PEM, sometimes called protein energy undernutrition (PEU) is a form of malnutrition that is defined
as a range of pathological condition arising from coincident lack of dietary protein and/or energy
(calorie) in varying proportions. The condition has mild, moderate, and severe degrees.
CLASSIFICATION OF PEM;
 Kwashiorkor
 Marasmus
 Marasmic-kwashiorkor
KWASHIORKOR
Is the most common and widespread nutritional disorder in developing countries. It is a form of
malnutrition caused by not getting enough protein in the diet.
ETIOLOGY
  Very low protein but with calories from CHO
CLINICAL MANIFESTATIONS
DIAGNOSTIC SIGNS;
 Edema
 Muscle wasting
 Psychomotor changes
COMMON SIGNS;
 Hair changes
 Diffuse depigmentation of skin
 Moon face
 Anemia
OCCASIONAL SIGNS;
 Flaky-pain rash
 Hepatomegaly
MARASMUS;
Is a severe form of malnutrition that consists of the chronic wasting away of fat, muscles and other
tissues in the body. Marasmus is one of the serious form of PEM in the world.
ETIOLOGY
 Balanced starvation
 Insufficient breastmilk
 Dilute milk
 Mixture or lack of hygiene
CLINICAL MANIFESTATIONS;
 Wasting
 Muscle wasting
  Growth retardation
 Mental changes
 No edema
 Variable-subnormal temperature, slow pulse rate, good appetite, often with diarrhea etc
MARASMIC-KWASHIORKOR;
A malnutrition disease, primarily of children resulting from the deficiency of both calories and
proteins. The condition is characterized by severe tissue wasting, dehydration, loss of subcutaneous
fat, lethargy and growth retardation.
TREATMENT;
 I.V Ampicillin at least for 2 days, then oral Amoxicillin.
 I.V Gentamycin or Amikacin for 7 days.
If no improvement within 48 hrs;
 I.V Ceftriaxone
 I.V Cefotaxime
PREVENTION;
 Hygiene
 Measles vaccination

OBESITY
DEFINITION;
Child obesity is when excess body fat negatively affects a child’s health and/or wellbeing.
ETIOLOGY
 Excessive food intake compared with use.
 Genetic constitution
 Psychic disturbance
  Endocrine & metabolic disturbances rare.
 Insufficient exercise or lack of activity.
CLINICAL MANIFESTATIONS
 Fine facial features on heavy looking taller child.
 Large upper arms & thighs.
 Genu valgum common
 Relatively small hands & fingers tapering.
 Adiposity in mammary regions.
 Pendulous abdomen with striate
 In boys, external genitalia appear small but actually average in size.
 In girls, external genitalia normal and menarche not delayed.
 Psychologic disturbances common.
TREATMENT;
 Diet and exercise
 Weight loss medication, include; liraglutide, lorcaserin, topiramate/phentermine, 18 years and
above only.
 Bariatric suegery.

IRON DEFICIENCY ANEMIA

DEFINITION;
Anemia is defined as reduction of the hemoglobin concentration or red cell (RBC) volume below the
range of values occurring in healthy persons.
CAUSES;
 Dietary factors
 Hemorrhage
 Hemosiderinuria, hemoglbinuria and pulmonary hemosiderosis.
  Malabsorption of iron
 Iron-refractory iron deficiency anemia (IRIDA)
CLINICAL MANIFESTATIONS;
 Below average body weight.
 Pale skin and mucous membrane
 Anorexia
 Growth retardation
 Listlessness
TREATMENT;
 Oral iron supplementation 4-6gm/kg/day of elemental iron
 Reticulocytes start to rise in 3-4 days.
 Hb after 4-5 days
 After Hb normalization, continue Fe therapy 1-2 months to replace Fe stores.
 Iron-rich foods; animal proteins, green vegetables, iron fortified cereals.
 Folate, vit C

IODINE DEFICIENCY DISORDERS;

DEFINITIO;
Iodine deficiency disorders refer a spectrum of health, consequences resulting from inadequate
intake of iodine. The adverse consequences of iodine deficiency lead to a wide spread of problems
ranging from abortion and stillbirth to mental and physical retardation and deafness, which
collectively known as iodine deficiency disorders (IDDs).
DISORDERS;
Iodine deficiency disorders include;
 Goiter
 Cretinism
  Lathyrism

GOITRE;
Thyroid glands grow larger than normal from the lack of iodine.
CAUSES;
 Lack of iodine
 Grave’s disease (over active goiter)
 Thyroid cancer
 Pregnancy
 Inflammation

CRETINISM;
A type of intellectual disability and bodily malformation caused by severe uncorrected thyroid
deficiency in infancy & early childhood..

LATGYRISM;
It is paralyzing disease of human and animal. Also referred to as neurolathyrism as it affects the
nervous system.

VITAMIN DEFICIENCY DISORDERS

Most of the vitamins are not synthesized inside the body, so they need to be supplied via diet.
Vitamin also acts as a co-factor in many enzymes systems so essential for various body functions.
Any type of lowered supply of vitamin may lead towards the various diseases.
TYPES;
1. Fat soluble vitamins; vit A,D,E,K
2. Water soluble vitamins; vit B complex and C.
FAT SOLUBLE VITAMIN
VITAMINS DISORDERS DEFINITIONS
Vitamin A Xerophthalmia An abnormal dryness of the eyeball
produced usually by long continued
inflammation and subsequent atrophy of
Night blindness the conjunctiva.
Inability to see in dim light
Bitot’s spot
Appears as greyish white triangular
plaques, firmly adherent to the
conjunctiva due to increased thickness of
conjunctiva in certain areas.
Vitamin D Rickets Disease of infant & childhood
characterized by softening of the bones,
leading abnormal bone growth and
caused by lack of vitamin D in the body.
When the disorder occurs in the adult, it
is known as osteomalacia.
Vitamin E Jaundice Yellowish appearance of the skin, sclera
& mucous membrane due to an
increased bilirubin concentration in the
Hemolytic body fluids.
anemia
A condition in which red blood cells are
destroyed and removed from the blood
Muscular stream before their normal lifespan is
dystrophy over.
 Growth failure A decrease in the mass of muscle.

Abnormally slow growth velocity

Vitamin K Chronic diarrhea Production of loose stools with or without
increased stool frequency or more than 4
weeks.
Malabsorption
syndrome It is a state arising from abnormality in
absorption of food nutrients across G.I.T

Worm Are long term diseases, produced few

infestation symptoms in their early stage and
sometimes serious effects at well-
developed stages or may be quite fatal at
times.

WATER SOLUBLE VITAMINS

VITAMIN DISORDERS DEFINITIONS
S
Vitamin Wernicke-korsak Is a neurological disease characterized by
B1 off syndrome inability to coordinate voluntary
movement (ataxia), and eye (ocular)
abnormality.
Beri Beri
A disease causing inflammation of the
nerves and heart failure, ascribed to a
deficiency of vitamin B1.
Vitamin Ariboflavinosis A disease due to inadequate intake of
B2 riboflavin and characterized by sores on
the mouth.
Angular stomatitis
Inflammation of the corners of the mouth
associated with a wrinkled or fissured
epithelium that does not involve the
mucosa
Vitamin Dermatitis A common skin condition marked by itchy
B3 and inflamed patches of skin.

pellagra A disease with skin lesions and mental

confusion due to niacin or vit B3
deficiency
Vitamin Paresthesia An abnormal sensation of caused by
B5 chiefly presence or damage to peripheral
nerves.
Vitamin Dermatitis A general term for skin inflammation
B6
Vitamin Heart Heart conditions that include diseased
B7 abnormalities vessels, structural problems and blood
clots.
Vitamin Anemia Deficiency of red cells or hemoglobin in
B9 the blood, resulting in pallor/weariness.

Diarrhea Passage of abnormally liquid or unformed

stools at increased frequency.
Vitamin Neurological Paroxysmal disorder in which cerebral
B12 disorders cortical neuron results in intermittent
attacks of of altered consciousness motor
 or sensory function behavior or emotion

Vitamin C Muscles weakness A lack of muscle strength.

IMPORTANCE OF PROPER FOOD PRESERVATION AND STORAGE

Introduction
Food hygiene refers to cleanliness from production to consumption of food. As contaminated food
can cause several infections and diseases, hence, it is necessary to observe “food clean chain” under
which management is done to keep food free from contamination and infection during its production,
storage, transportation, preservation, cooking serving or consumption.

Methods of Preservation
a. Drying
b. Refrigerator
c. Freezing
d. Vacuum packing
e. Salt
f. Sugaring
 g. Smoking
h. Artificial food activities
i. Picking
j. Canning

Food Preparation Technique

a. Baking
b. Broiling
c. Frying
d. Roasting
e. Smoking
f. Microwaving

IMPORTANCE OF BREASTFEEDING AND PROCESS OF WEANING

BREASTFEEDING

Definition of Breastfeeding;
 Breastfeeding is the feeding of an infant or young child with breast milk directly from female
human breast ( i.e via lactation) not from a baby bottle or other container.
 Breastfeeding is the first fundamental right of a child. It greatly improves the quality of life by
providing unique nutritional, immunological, economical, ecological, psychological and child
spacing benefits.
 Breastfeeding also enhances maternal health.
 Exclusive breastfeeding for first six (6) months of life is the most effective child survival
intervention in developing countries.
  WHO and UNICEF launched the Baby Friendly Hospital Initiative (BFHI) in 1992 as a primary
intervention strategy for promoting breastfeeding and strengthening national health services.
 Exclusive Breastfeeding; Only breast milk, no other food or drink even water.
 Predominant Breastfeeding; Main source of nutrition is breast milk but child also receiving other
fluids like water or water based drinks such as juices.
 Partial Breastfeeding; Giving a child non-human formula or cereal based foods in addition to
breast milk.

ADVANTAGES OF BREASTFEEDING;

Benefit To Baby;
Nutritional superiority;
a. It contains the right kind of proteins, fats, lactose, vitamins, iron, minerals, water, and enzymes
in the amount necessary for the baby. It meets all the nutritional needs of the body for the first
six months.
b. Iron in breast milk is better absorbed thus protecting against iron deficiency anemia.
c. Breast milk contain plenty of vitamin A and C and largely fulfil their needs even in the second
year of life.

Immunological superiority;
a. Breast milk contains a number of protective factors such as immunoglobulin, mainly secretory
IgA, macrophages, lymphocytes, lactoferrins, lysozymes & interferons.
b. Breastfed babies are less likely to develop infection.
c. A breast fed baby is 14 times likely to die of diarrhea and almost 4 times less likely of
respiratory infections.
d. Breast milk contain number of growth factors, enzymes, and and hormones. It promotes growth
& development of baby
 e. Breastfeeding enhances brain development and breastfed babies have been shown to have a
higher intelligence quotient (IQ)
f. It is clean, free from pathogenic bacteria and has no chances of contamination.
g. It is easily digested and assimilated. Breastfed babies do not suffer from constipation.
h. It enhances the emotional bond between the child and the mother and provides warmth, love,
and affection to the baby.

Benefit To The Mother;

a. It reduces anemia due to reduction in postpartum hemorrhage and reduced blood loss because
of delayed menstruation.
b. It is convenient, needs no preparation and is readily available at the right temperature.
c. It helps the mother to regain her normal figure.
d. It promotes early uterine involution.
e. It has a protective effect against breast and ovarian cancers.
f. Breastfeeding helps in delaying another pregnancy.

Benefits To The Society;

a. Breastfeeding is economical and hardly costs the family anything extra.
b. Breastfeeding lowers healthcare costs to the society by reducing illnesses among children.
c. Breastfeeding is eco-friendly and does not cause any environmental pollution.

BREASTFEEDING RECOMMENDATIONS
a. Initiate breastfeeding immediately after birth.
b. The first fed should always be mother’s milk.
c. Give breastfeed on demand.
d. Baby should exclusively be breastfed for six months.
e. Complementary feeding should begin in all babies at six months of age.
 f. Continued breastfeeding along with complementary feeding should be done till at least 2 years
of age.
g. Mothers and family should be motivated, educated and supported regarding healthy feeding
practices for maintaining and sustaining healthy infant feeding practices.

COMPOSITION OF BREAST MILK

1. Colostrum;
Milk secreted during the initial 3-4 days after delivery, small quantity, yellow and thick, contain large
amount of antibody and immune competent cells and vitamin A,D,E,K.
2. Transitional milk;
Milk secreted 3-4 days until 2 weeks.
Immunoglobulin and protein content decreases while fat and sugar content increases
3. Mature milk;
Follows transitional milk, thinner and watery but contains all the nutrients.
4. Pre-term milk;
Milk delivered before 37 weeks, contains more proteins, sodium, iron, immunoglobulins & calorie
5. Foremilk;
Secreted at the start of feed.
Is watery and rich in protein, sugars, vitamins, minerals & water.
Quenches baby’s thirst.
6. Hind milk;
Comes later towards the end.
Rich in fat that provides more energy and sense of satiety.

CONTRAINDICATION OF BREASTFEEDING
1. Infants with special dietary requirements;
 a. Galactosemia
b. phenyltosuria
2. Maternal infection;
a. Cytomegalovirus (CMV)
b. Herpes
c. HIV
d. T.B
3. Maternal drugs;
a. Chemotherapy agent
b. Drugs of abuse
c. Primaquine & Quinine
d. Metronidazole
e. Sulfa drugs
f. Radioactive isotopes

WEANING
Weaning is not sudden withdrawal of child from the breast. It is gradual process of starting around
the age of 6 months of age, because the mother’s milk alone is not sufficient to sustain the growth
beyond 6 months.
It should be supplemented with other foods rich in proteins and other nutrients.
ADVANTAGES OF WEANING
a. Nutritional balance.
b. Introduce more dietary items
c. Eat and enjoy foods.
d. Improves self confidence
e. Child growth
 f. More active

IMPORTANCE OF BALANCE DIET

Introduction
Balanced diet is one which contains different types of foods such as cereals, pulses & vegetables in
such quantities & proportion so that the need for calorie, proteins fats, minerals & vitamins is
adequately met.
A balanced diet should provide;
a. 60-70% of total calories from carbohydrate
b. 10-12% of protein
c. 20-25% of fat

Definition I;
A balanced diet is one that provides the body with the essential nutrients required to maintain cells,
tissues & organs as well as to function correctly.

Definition II;
Balanced diet is food preparation which provides complete nutrients as well as supplies
carbohydrate, protein, fat, vitamins, minerals & fiber in their normal proportion.
Goals of Balance Diet
a. A well balanced diet provides enough energy & nutrition for optimal growth & development.
b. When an individual chooses to eat a wide variety of foods & drinks from all the food groups,
he/she is eating a balanced diet.
 c. The main goal of this dietary regimen is to take nutrients that an individual needs for his or her
health.

Some Tips of Balanced diet;

Mnemonic; B.A.L.A.N.C.E.D. D.I.E.T
a. B; Be sure to allocate time for digestion. Have at least 5 hours’ interval between meals & the
last meal of the day should be taken at least 3 hours before sleeping
b. A; Avoid tea, coffee, carbonated beverages (soft drinks) & alcoholic beverages.
c. L; Light dinner, moderate lunch, heavy breakfast are advisable.
d. A; At least one serving of dark vegetables a day is good for baby.
e. N; Never skip meals.
f. C; Choose food of the right kind at right time & interval & in right amount. Eating in a relaxed
atmosphere is ideal.
g. E; Establish regular eating habits.
h. D; Drinks at least 8 glasses of water in a day
i. D; Do not hurry your meal. Take time to enjoy your food.
j. I; Include variety of foods in each meals.
k. E; Eat more fresh fruits.
l. T; Take time to refer food intake.

IMPORTANCE OF BALANCE DIET

1. Helps in weight control.
2. Keeps you energized
3. Supports heart health
4. Prevent illnesses
5. Boost immune systems
 6. Provides all important nutrients

Components of Healthy Balanced Diet;

1. Dairy
2. Protein
3. Fruits
4. Vegetables
5. Grains
6. Fats & oils

Factors Influencing Balance Diet;

a. Religion
b. Social class
c. Personal preferences
d. Peer pressure
e. Media
f. Geographic location
g. Availability of food
h. Financial resources

Effects of Unbalanced Diet

1. Under nutrition; Insufficient intake can result into malnutrition.
2. Over nutrition; There are some conditions that are related to eating too much of a certain
nutrients. E.g;
a. Coronary artery disease
b. Heart attack
 c. Obesity
d. Type 2 Diabetes

Specific Nutritional Deficiencies;

1. Iron deficiency; anemia
2. Vitamin D deficiency; Rickets & Osteomalacia
3. Vitamin A deficiency; Night Blindness
4. Vitamin B1; Beri Beri
5. Vitamin B2; Arbiflavinosis
6. Vitamin C; Scurvy
7. Vitamin K; Blood clotting problems
8. Protein; Kwashiorkor
9. Carbohydrate; Marasmus

FACTORS AFFECTING FOODS & NUTRITION;

a. Age/development
b. Gender
c. Ethnicity & culture
d. Social factors/superstition
e. Religious factors
f. Traditional factors
g. Economic factors
h. Geographic factors
i. Production & transport
j. Life style
Other Factors;
1. Health status
2. Agriculture
3. Availability
4. Education status

REFERENCES;
1. Community nutrition for East Africa by Ann Burges, Edition 1994
2. Severe malnutrition, 1st edition 2000
3. WHO Pocket Book of Hospital Care for children 1st edition 2007

THANKS …………. GOODLUCK …………………………..

PHILIP MAJUCH MUM
WHATSAPP NUMBER; 0924646395
EMAIL; philipmajuchmum.99@[Link]