1. NUTRITION - UNIT I INTRODUCTION

2. 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

3. INTRODUCTION  Nutrition is  The 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.

4. 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.

5. 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.

6. History  Vitamin A in 1913, Vitamin C in 1919,  Vitamin D in 1925, Vitamin K in 1935,  Vitamin E, B1(Thiamine),B6(Pyridoxine)- 1936,  Vitamin B2 (Riboflavin) in 1935, Vitamin B9 (Folic acid) in 1948.

7. History  Nutrition was officially recognized as an independent field of study in 1928 with the formation of American Institute of Nutrition.

8. History  It took about half a century more for nutrition to achieve its current status as one of the most talked about scientific disciplines.

9. History  Nutrition encompasses not only the study of vitamins, minerals and other foods, but also diverse subjects as alcohol, caffeine and pesticides.

10. 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.

11. CONCEPTS  Nutrition,  Dietetics,  Food,  Diet

12. CONCEPT - NUTRITION  Nutrition is defined as the science of food and its relationship to health.  It is food at work in the body.  It includes everything that happens to food.

13. 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.

14. 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.

15. CONCEPTS - DIETETICS  Good nutrition means maintenance of nutritional status that enables us to grow well and enjoy good health.

16. 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.

17. CONCEPTS - FOOD  Food: raw material from which bodies are made.  Intake of right kinds and amounts can ensure good nutrition and health - evident in one’s appearance, well-being and efficiency.

18. CONCEPTS - DIET  Diet: Diet refers to whatever people eat, drink each day.

19. 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).

20. ROLE OF NUTRITION IN MAINTAINING HEALTH The basic study of nutrition - primary importance as  1.It is fundamental for own health.

21. 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:

22. ROLE OF NUTRITION IN MAINTAINING HEALTH The scope of the study involves:  Nutrition helps growth and development  Prevents malnutrition  Resists infection  Prevents diseases

23. 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

24. ROLE OF NUTRITION IN MAINTAINING HEALTH

25. 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.

26. NUTRITIONAL PROBLEMS IN INDIA  Community studies have shown that  Many mothers give only breast milk to children up to 2years.  Thus, no additional food is added to the child’s diet.

27. NUTRITIONAL PROBLEMS IN INDIA  Papaya, vitamin ‘A’ rich, considered which produces more heat - cause miscarriage - avoided by pregnant women.

28. 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.

29. NUTRITIONAL PROBLEMS IN INDIA Nutritional Problems in India ProblemFeatures Low Birth WeightLess than 2.5kg Still birthBirth of dead baby Kwashiorkor Protein deficiency between 1 and 4 years Anaemia 20% adolescent girls and 90% pregnant women

30. NUTRITIONAL PROBLEMS IN INDIA Nutritional Problems in India ProblemFeatures Stunted growthHeight and weight not ideal Night blindness Vitamin A deficiency after 50 years Cataract Vitamin A and Vitamin D deficiency GoitreIodine deficiency in females

31. NUTRITIONAL PROBLEMS IN INDIA Nutritional Problems in India ProblemFeatures Under weight50% adults Overweight 15% Mumbai school children are obese Diabetes About 10% of the total population and about 1/5 above age 50 suffer

32. NUTRITIONAL PROBLEMS IN INDIA Nutritional Problems in India ProblemFeatures Hypertension Male and female suffer more in urban areas Cardiac problemsMore in males CancerMore in females

33. 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.

34. 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.

35. 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.

36. Nutritional Problems in India  Birth weight:  Under 2.5kg at birth and continue to stay underweight 50%  Over 2.5 kg at birth, but underweight now 34%  Under 2.5kg at birth and stunted now 62%  Over 2.5kg at birth, but stunted now 50%

37. Nutritional Problems in India  Prevalence of malnutrition is significantly higher among children from low-income families particularly Muslims, Scheduled Castes and Scheduled Tribes although rates of malnutrition are significant among middle and high income families.

38. Nutritional Problems in India  We cannot hope for a healthy future for India with such a large number of malnourished children.  The government cannot solely depend on Integrated Child Development Services (ICDS) to solve the issue.

39. Nutritional Problems in India  The government is launching a strengthened and restructured ICDS, to start a multisectoral program for 200 high burden districts and initiate a nationwide communication campaign against malnutrition.

40. Cause of Nutritional Problem  Poor Nutrition,  Under Nutrition (Malnutrition),  Overnutrition.

41. Cause of Nutritional Problem  The World Bank estimates that India is ranked 2 nd in the world of the number of children suffering from malnutrition.

42. Cause of Nutritional Problem  Undernutrition is found mostly in rural areas 10% of villages and districts accounting for 27-28% of all underweight children.

43. Cause of Nutritional Problem  Children of scheduled tribes have the poorest nutritional status and the highest wasting.

44. Causes of Malnutrition in India 1. Population growth 2. Agriculture 3. Parasitic and infectious diseases 4. Religious and cultural food facts 5. Illiteracy and ignorance bout balanced diet

45. NATIONAL NUTRITION POLICY  India’s 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

46. NATIONAL NUTRITION POLICY  NNP goals: 3. Reduction of anaemia to 20% in pregnant women. 4.Universal iodination of common salt to lower- iodine deficiency disorders to less than 1%. 5.Establish special care to geriatric nutrition.

47. 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.

48. NATIONAL NUTRITION POLICY  NNP goals: 8.Decrease incidence of moderate and severe malnutrition in children. 9. Promotion of appropriate diets and healthy lifestyle.

49. NATIONAL NUTRITION POLICY  NNP goals:  Short - term intervention  Long - term interventions.

50. 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 essential foods with nutrients

51. NATIONAL NUTRITION POLICY - Long Term Interventions or Development Policy Instruments  Food security  Improvement of dietary pattern  Increasing purchase power of the population  Streamlining and expanding Public Distribution System (PDS)

52. NATIONAL NUTRITION POLICY - Long Term Interventions or Development Policy Instruments  Strengthening health and family welfare programs  Nutrition and public education  Education and literacy  Nutrition and surveillance  Information and communication  Ensure community participation

53. 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.

54. NATIONAL NUTRITION POLICY - Nutrition Related Ministries  Agriculture  Food production  Civil supplies  Public distribution  Education and literacy

55. NATIONAL NUTRITION POLICY - Nutrition Related Ministries  Health and family welfare  Preventive care  Information and broad casting  Awareness  Forestry and environment protection

56. NATIONAL NUTRITION POLICY - Nutrition Related Ministries  Labor  Rural, urban and tribal development  Transport communications  Formation of high-level committees/councils for identifying factors affecting food and nutrition.

57. Determinants / Factors of Malnutrition 11. Maternal Malnutrition, Low Birth Weight 3. Religious/Traditional 5. Production, 6. System of Distribution 4. Child Rearing Practices - Faulty Child Feeding Practices 7. Life style, 8. Food Habits 9. Frequent Infections 1. Socioeconomic - Large Families, Dietary Inadequacy 10. High Female Illiteracy 2. Cultural, Taboos And Superstitions

58. Factors Affecting Nutritional Status Pregnant women Lactating women Infants Preschool children Adolescent girls Elderly, and socially deprived High Risk Groups are

59. ROLE OF FOOD AND ITS MEDICAL VALUE 1. PROVIDE ENERGY2. BODYBUILDING3. REGULATES BODILY ACTIVITIES4. PROVIDE RESISTANCE TO DISEASES5. SOCIAL FUNCTIONS OF FUNCTION6. PSYCHOLOGICAL FUNCTIONS OF FOOD7. NUTRITIONAL STATUS8. ELIMINATION OF DEFICIENCY DISEASES

60. 1. Origin 2. Chemical Composition 3. Function4. Nutrition Value CLASSIFICATION OF FOODS

61. BASED ON ITS ORIGIN 1. Foods of animal origin 2. Foods of vegetable origin

62. BASED ON CHEMICAL COMPOSITION 1. Proteins 2. Fats, CHO 3. Minerals4. Vitamins

63. BASED ON ITS FUNCTION 1. Body building foods – Amino acids, Proteins 2. Energy giving foods – Carbohydrates (wheat, rice) 3. Protective foods – Vitamins and Minerals

64. Based on Nutrition Value 1. Cereals & Millets 2. Pulses & Legumes 3. Milk, Milk Products & Meat 4. Fruits & Vegetabl es 5. Fats & Sugars

65. 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.

66. FOOD LAWS IN INDIA  Prevention of Food Adulteration Act, 1954  Fruit Products Order,1955  Meat Food Products Order,1973  Vegetable Oil Products (Control) Order, 1947

67. FOOD LAWS IN INDIA  Edible Oils Packaging (Regulation) Order 1988  Solvent Extracted Oil, De- Oiled Meal and Edible Flour (Control) Order, 1967,  Milk and Milk Products Order, 1992.  The Food Safety and Standards Authority of India (FSSAI), 2006.

68. 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.

69. 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.

70. FRUIT PRODUCTS ORDER,1955  Objective: To manufacture fruit & vegetable products maintaining sanitary and hygienic conditions in the premises and quality standards laid down in the Order.

71. FRUIT PRODUCTS ORDER,1955  Minimum requirements for hygienic production and quality standards:  Location and surroundings of the factory  Sanitary and hygienic conditions of premises  Personnel hygiene, Portability of water

72. FRUIT PRODUCTS ORDER,1955  Machinery & equipment with installed capacity  Quality control facility & technical staff  Product standards  Limits for preservatives & other additives

73. MEAT Food Products Order,1973  Fastest growing animal protein in India.  Indian 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.

74. 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.

75. EDIBLE OILS PACKAGING (REGULATION) ORDER 1988  Ensure availability of safe and quality edible oils in packed form at pre-determined prices to the consumers.

76. SOLVENT EXTRACTED OIL, DE- OILED MEAL AND EDIBLE FLOUR (CONTROL) ORDER, 1967,  Quality control order to ensure that the quality reached to the consumers for consumption

77. MILK AND MILK PRODUCTS ORDER, 1992.  The objective of the order is  To 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.

78. 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.

79. 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.

80. 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.

81. DUTIES AND FUNCTIONS OF FSSAI  Guidelines for accreditation of certification bodies engaged in certification of Food Safety Management System for food businesses.  Providing scientific advice and technical support to the Central Government and State Governments on food safety and nutrition

82. 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 Phyto- sanitary standards

83. DUTIES AND FUNCTIONS OF FSSAI  Guidelines for accreditation of Laboratories and their notification.  Promote general awareness about Food Safety and Food Standards.

84. DUTIES AND FUNCTIONS OF FSSAI  Collect and collate data regarding  Food 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.

85. ELEMENTS OF NUTRITION: MACRO AND MICRO  Food is composed of a wide distribution of nutrients,  Have very specific metabolic effects on the human body.  Two categories: macronutrients, micronutrients.

86. MACRONUTRIENTS  It constitute the majority of an individual’s diet.  It essential nutrients that are needed for growth and energy - carbohydrates, proteins, fats, and water.

87. 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.

88. 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).

89. 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.

90. 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.

91. 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.

92. Fat  Composed of carbon, hydrogen, and oxygen (these elements are connected together differently than in carbohydrates).

93. 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.

94. Water  Water is a key essential to a healthy body.  The body is roughly 60% water.  An average person needs about 8 cups of water per day depending on their activity levels.

95. 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.

96. 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 to decreases in energy and performance.

97. MICRONUTRIENTS  Micronutrients are vitamins and trace minerals.  Body 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.

98. MICRONUTRIENTS  Needed only in small amounts,  Deficiency leads to critical health problems.  Most of the diseases and conditions are due to deficiency of micronutrients.  WHO - Elimination of micronutrient deficiency, labour efficiency will increase multifold.

99. LIST OF MICRONUTRIENTS MICRONUTRIENTS: VITAMINS  Vitamin A, Vitamin B,  Vitamin C, Vitamin D,  Vitamin E, Vitamin K and  Carotenoids.

100. LIST OF MICRONUTRIENTS  Minerals are - Boron, Calcium, Chloride, Chromium, Cobalt, Copper, Fluoride, Iodine, Iron, Magnesium, Manganese, Molybdenum, Phosphorous, Potassium, Selenium, Sodium and Zinc.

101. LIST OF MICRONUTRIENTS ORGANIC ACIDS  Acetic acid, Citric acid,  Lactic acid, Malic acid,  Choline and Taurine.

102. CALORIE  A calorie is a unit of energy.  In 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.

103. CALORIE  Symbols: kcal, Cal or C  The international unit of energy is Joule (J)  Fat 1 gram = 9 kcal/g Protein 1 gram = 4 kcal/g  Carbohydrates 1 gram = 4 kcal/g

104. THE BASAL METABOLIC RATE  The basal metabolic rate is the energy expenditure necessary to maintain basic physiologic conditions.

105. BASIC PHYSIOLOGIC CONDITIONS  The activity of the heart  Respiration  Conduction of nerve impulses  Ion transport across membranes  Reabsorption in the kidney  Metabolic activity.

106.  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.

107.  A person whose energy expenditure amounts to 2,000 cal/day spends as much as 1200 – 1400 calories to support usual metabolism.

108.  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 person’s daily expenditure.

109. 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.

110. Measurement Basal metabolism  1. Calorimeter directly by measuring the heat dissipated under the basic conditions.  2. Indirectly by measuring oxygen consumption.

111. Factors affecting BMR  The metabolic rate differs among different individuals. It depends on:  1. Variable factors  2. Invariable factors

112. Variable factors affecting BMR 1. Nutritional state 2. Body size or surface area 3. Body composition 4. Endocrinal or hormonal state 5. Environment al temperature or climate 6. Drugs

113.  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

114.  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

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

116. Invariable factors affecting BMR Gender or Sex Women Sex hormone Age

117. Normal Value  BMR values are expressed as ‘kcal or KJ/m 2’ 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.

118. Clinical Applications  BMR estimation is used to diagnose thyroid disorders  BMR is used in calculating food and drugs.