Nutrition IN Health and Illness

Course No NUTR-142
• This course is designed to help students develop an understanding of
nutrition as an integral part of the total health care program.

• Nutrition is one of the elements of PHC, which any health

professional needs to be familiar with in his/her holistic effort towards
addressing the health problems of the nation.

• Therefore, teaching nutrition along with other basic and professional

courses aims at equipping students with
-an understanding of normal nutrition,
-methods of detecting deviations from normal nutritional status,
-requirements of nutrients at different physiological states and
-the different options for nutritional intervention at the grass-root
community level.
Course description:
• This course is designed to help students develop an understanding of
nutrition as an integral part of the total health care program.

• Nutrition is one of the elements of PHC, which any health

professional needs to be familiar with in his/her holistic effort towards
addressing the health problems of the nation.

• Therefore, teaching nutrition along with other basic and professional

courses aims at equipping students with
-an understanding of normal nutrition,
-methods of detecting deviations from normal nutritional status,
-requirements of nutrients at different physiological states and
-the different options for nutritional intervention at the grass-root
community level.
General instructional objectives
Determine types of nutrients and their disorders

Explain the different factors involved in malnutrition

Conduct nutritional assessment of the community and an individual

using different method

Organize a nutritional rehabilitation service & supplementary feeding

programs
• Evaluation Method:
• 1. Exams (Mid 30 and final 40) = % each
2.Group Assignment Attendance 30 %
Total 100%
1.1. Definitions & Concepts
Nutrition:
Study of food in relation to man, and study of man in relation to food
Science of food as it relates to optimal health and performance.
Study of foods in relation to needs of living organisms
and the process by which the organism ingests, digests, absorbs,
transports, utilizes and excretes food substances
Human Nutrition: A scientific discipline, concerned with the access
and utilization of food and nutrients for life, health, growth,
development and well-being.
The Science of Nutrition is the science of nourishing the body.
Function :
Proper food and good nutrition, essential for
Survival
Physical growth
Mental development
Performance and productivity
• common terminologies
• DIET: - Is the sequence of meals in a day concerned eating
styles of individuals or a group
• NUTRIENT: - Is an active ingredient in the food that play
specific structural or functional role in the body’s lively
activity

• Macronutrients : are nutrients that are required by our

body in larger quantities on a daily basis

• and need to be transformed in to smaller units by the body

in order to give essential function in the body processes.

• These include-carbohydrates, lipid and proteins

Scope of human nutrition

Public health nutrition

• Studies relationship between dietary intake and disease,
• Uses tools of nutritional epidemiology,
• Knowledge applied for nutrition intervention to prevent disease
Dietetics nutrition
• Science/ art of applying the principles of nutrition in feeding

Clinical nutrition
• Application of nutritional knowledge customized to individual
needs
• Mainly based in hospitals,
• Use of diet in treatment and management of disease

Biological and metabolic nutrition

COMPONENTS OF FOODS AND THEIR CLASSIFICATIONS
Protein
• Conformation of the Protein:
- Globular & Fibrous proteins

• Chemical composition
-Simple /complete hydrolysis/
- Compound/conjugated proteins, protein +Non Protein

• Based on Nutritional Value -complete – Essential , hemoglobin

-incomplete proteins: - non essential ,
• Carbohydrate –
• Free sugars –Monosaccharid & Disaccharides
-Sugar alcohols
-Oligo- saccharides
- Polysaccharides (Complex Carbohydrates)

• Fats and other lipids

-lipids (Phospholipids),
-Metabolic lipids (fatty acids, lipoproteins and sterols)
-and storage lipids (triglycerides).
Vitamins -vitamin A and D are highly stored in the liver

• Water soluble-Vitamin C and B-complexes

• Lipid soluble-Vitamins A, D, E and K

Minerals
-Macro Minerals (Principal Elements) Na, Cl, K...
-Trace Elements (Micro-Minerals) Fe, I, …

• Water - intracellular fluid (ICF)

- extracellular (ECF)
Staple foods
The food that a person or an animal normally eats

Adequacy and balance are key characteristics of a healthy diet.

A Variety of foods are required to obtain all the nutrients needed

since many combination of foods make up a healthy diet

Nutrient density: measures of dietary composition computed by

dividing nutrient values by total caloric intake.

Nutrient dense foods contain relatively high amounts of nutrients

compared to their caloric value.
 Staple foods…

• Foods that contain goitrogenic factors include cabbage, cassava,

beetroot, bamboo shoot are used as staple food and a lot increased
Iodine Deficiency Disorder(IDD),

• This is due to an interaction between iodine and cyanides,

thiocyanates and cyanogenic glycosides
• less uptake of iodine by the thyroid gland and thus produce goiter.

• Lipid and/or CHO utilized as stable food - over wt leads to

non communicable chronic diseases (NCD)
Food Guide
Pyramid
►The guidelines aim not to provide enough of essential
nutrients (that is the purpose of RDI) but to reduce
the chance of developing chronic degenerative
diseases

►Dietary guidelines or goals start not from zero intake

(as RDIs do) but from the present estimated diet.

►They are not expressed as nutrients but as food

groups, proportions of food behaviors(fat,
carbohydrates, protein, alcohol
• Causes of protein energy malnutrition are multi-
factorial having a number of interwoven factors
operating simultaneously.

• The causes could be categorized as immediate,

underlying and basic.

• The following diagram depicts the causes operating at

different levels.
 Manifestations
Nutritional Status

Immediate
Diet Health Causes

Household Environ. Health, Underlying

Care of Mother
Food Security Hygiene & Sanitation Causes
& Child

Human, Economic, &

Institutional Resources

Political & Ideological Structure Root

Ecological Conditions Causes
Adapted from UNICEF Potential Resources
Basic Causes
Every community has potential resources for production & supply
of services; human, economic & institutional resources

However, they are affected by basic factors:

-Political/ideological structure/decisions
-Ecological resources/constraints
-Social & cultural factors
-Technical & technological capacity
-Population
Underlying Causes

• Insufficient household food security

• Inappropriate care for mother & child
• Inadequate health care
Immediate causes:

• Inadequate dietary intake

Adequate amt of food- quality & safe food throughout the year
To meet all nutritional needs for growth & maintenance

• Disease (infections); reciprocal r/ship

Intake, digestion, absorption & utilization of food
Increase requirement; genesis of fever & acute phase reactants
2-GROWTH AND DEVELOPMENT
a) Weight during pregnancy and birth

• Evidence is mounting that the health of a woman is influenced

by her experiences as a fetus and
• that these experiences influence her functionality during her own
pregnancies.

• Certainly, the egg that will go on to form her own fetus first
forms when the mother herself is an early embryo in her
mother’s uterus.

• It thus follows that each individual is influenced by the

environment during the first trimester of his or her maternal
grandmother’s pregnancy.
• Several studies have demonstrated that the birth weight of
a mother and infant pair are highly correlated.

• This has been attributed to differences in the growth of the

female reproductive tract in women who are born small,

• which in turn influences the growth of the next generation

as fetuses.

• It is probable that a woman’s metabolism is influenced by

antenatal programming when she herself was a fetus.
2-GROWTH……
Pregnancy weight gain

BMI Weight Gain (kg)

Underweight 12.7-18.2
BMI < 18.5

Normal Weight 11.4-15.9

BMI 19-24.9

Overweight
BMI 25-29.9 6.8-11.4

Obese
6.8
BMI > 30.0
2-GROWTH……
Composition of weight gain
• Infant at birth………………………………….. 3-4 kg
• Placenta/amniotic fluid…………………………1-2kg
• Tissue fluid………………………………..……2-3kg
• Maternal blood………………………………… 1-2kg
• Enlargements of uterus……………………………1kg
• Breasts…………………………………………….1kg
• Maternal “stores” …………………………… .. 2-4 kg
• 1-2 kg in first
trimester

• Gradual &
consistent gains
thereafter
2-GROWTH……

• Maternal previous experience during her foetal life status

• Maternal malnutrition

• Lacked Intervention programs that improve maternal nutrition

which directly benefit the health and nutrition status of mothers and
children.

• low maternal weight and stature at conception and low weight gain
during pregnancy.

• These are attributable to born infant with Low birth weight

2-GROWTH……
• Low birth weight related extensively in public health and relevance as
maternal and child health indicator.
• Low birth weight has been defined as weight at birth of less than
2,500 grams.
• This is based on epidemiological observations that infants weighing
less than 2,500 gram approximately 20 times more likely to die than
heavier babies.
• Infancy is a period of rapid growth and critical nutrition needs
• Infants double their birth weight in six months and triple it in one
year.
• Breastfeeding ensures the best possible health as well as the best
developmental and psychosocial outcomes for the infant.“
b) Development after.......

• Baby will go through various stages in its early live.

• However, each baby is also unique and might not learn various until it
is older or actually be a fast learner and not follow the typical
development stage either.

• In the first twelve month,

- baby will have an eventful life and will change more than once
completely.

-It will grow and prosper – be sure to take advantage of this wonderful
time together.
b) Development after.......
Ages Milestones in infant development
Birth to -Respond to mother’s wails -notice voice, face & touch
month -can focus 8-12 inches distance -black & white patterns draw her/his attention

1st to 3rd -baby lift her/his head & turn it to side but need support
months -arms move jerkily &hands close to her mouth
-make eye contact, talk, sing, & read to his/her play
4th -6th -Babies can hold up their heads and move them around.
months -The suck-swallow reflexes are not as strong,
-and food is no longer automatically pushed out of their mouths with their tongues
during feeding.

5th -6th Babies can sit up in a high chair with support.

months

6th-9th Babies begin to use their thumb and forefinger in a pincer-like movement. They pick
up pieces of food and grab what they want

9th -12th Babies are able to chew soft foods. Muscle control and hand-eye coordination is
good. They may still need help drinking from a cup.
• Why do we know nutritional requirements?
• Determining food and nutrition adequacy of population food intakes

• Setting of national food and nutrition guidelines by countries

worldwide.

• Determining nutrient needs, and evaluating and ensuring the

adequacy of ration quality and quantity for vulnerable groups
(refugees, in times of conflict or famine )

• Mapping and monitoring (potential and actual) food shortages and

undernutrition in developing countries and globally, including Early
Warning Systems
• Dietary reference value (DRI) serve as a reference values that are
quantitative estimates of nutrient intake to be used for planning and
assessing diets for healthy people

Underlying principles and assumptions for setting nutrient

reference values
• Requirements for health in already healthy persons
• System only used for nutrients; not for energy
• Assumes that nutrient requirements and intakes are not correlated
• Nutrient intake refers to usual intakes
• Requirements focus on prevention of nutrient deficiencies &
prevention of chronic disease
• Assume requirements for energy and other nutrients are met
• Revised framework for multiple nutrient reference levels
1. Estimated Average Requirement (EAR)
2. Recommended Dietary Allowances (RDA)
3. Adequate Intake (AI)
4. Tolerable Upper Intake Level (UL)
• Estimated Average Requirement (EAR) is a reference level
▫ That average daily intake level of a nutrient will meet the needs of
half (50%) of the people in a particular category(any life-
stage/gender)
• Used to assess probability that usual intake is inadequate for
individuals
• And used to assess prevalence of inadequacy for groups
• Recommended Dietary Allowances (RDA)
▫ The average daily intake level required to meet the needs of
97 – 98% of people in a particular category
▫ 2SD above EAR(satisfies >97% of persons)
• Adequate Intake (AI)
▫ Recommended average daily intake level for a nutrient
• Based on observations and estimates from experiments that
appears to sustain a defined nutritional state
• Used when the RDA is not yet established: e.g., calcium, vitamin D,
vitamin K, fluoride
• Used when insufficient data to set an EAR
• Tolerable Upper Intake Level (UL)
• Risk of excessive intakes very low, possibly affecting 3% population
• Highest average daily nutrient intake level that is not likely to have
adverse effects on the health of most people
• Consumption of a nutrient at levels above the UL is not considered
safe
▫ for some nutrients only
• Tolerable Upper Intake Level (UL)
• Risk of excessive intakes very low, possibly affecting 3% population
▫ Highest average daily nutrient intake level that is not likely to have
adverse effects on the health of most people
▫ Consumption of a nutrient at levels above the UL is not considered
safe
▫ for some nutrients only
• Includes intakes from all sources:
• Food, water, nutrient supplements, pharmacological agents

Dose-response assessment built upon 3 terms:

* NOAEL (no-observed-adverse-effect level): highest continuing
• intake of a nutrient at which no adverse effects have been observed.
When no data to define this, then use:
* LOAEL (Lowest-observed-adverse-effect level): lowest continuing
intake at which an adverse effect has been identified
* Uncertainty factor (UF):
• Larger UF applied for animal data
• When over-consumption of nutrient is serious

• Lower Reference Nutrient Intake (LRNI)

– Equivalent to 2SD below EAR
– Intakes below this level will almost certainly be inadequate for
most individuals
Reference Nutrient Intake (RNI)
– EAR + 2 SD: satisfies >97% of persons

The distribution of nutrient requirement within a population

• Energy requirement is the amount of food energy needed to
balance energy expenditure in order to

• maintain body size,

• body composition and
• a level of necessary and desirable physical activity consistent with
long-term good health.

• This includes the energy needed

- for the optimal growth and development of children,
-for the deposition of tissues during pregnancy,
- and for the secretion of milk during lactation consistent with the good
health of mother and child.