ST.

ANN'S COLLEGE FOR WOMEN, HYDERABAD (Autonomous)

DEPARTMENT OF NUTRITION

INTER DISCIPLINARY COURSE – INTRODUCTION TO HUMAN NUTRITION/

NEEDFUL NUTRITION

UNIT 1

Importance of nutrition in maintenance of health 

The role of nutrition in maintaining health and preventing disease. Health is much more than

the absence of disease. ... The foods we eat, and the nutrients they should provide, are the
most important continuing environmental factors influencing our growth, development,
functional abilities, and health.

Concept and definition of terms

Nutrition : Nutrition is the intake of food, considered in relation to the body’s dietary needs.
Good nutrition – an adequate, well balanced diet combined with regular physical activity – is a
cornerstone of good health. Poor nutrition can lead to reduced immunity, increased susceptibility
to disease, impaired physical and mental development, and reduced productivity.

Food: Food is any substanceconsumed to provide nutritional support for an organism. It is

usually of plant or animal origin, and contains essential nutrients, such
as carbohydrates, fats, proteins, vitamins, or minerals. The substance is ingested by
an organism and assimilated by the organism's cells to provide energy, maintain life, or stimulate
growth.

Nutrients: Nutrients are compounds in foods essential to life and health, providing us with
energy, the building blocks for repair and growth and substances necessary to regulate chemical
processes. 

There are six major nutrients: Carbohydrates (CHO), Lipids (fats), Proteins, Vitamins,
Minerals, Water.
 Classification of Nutrients: classified as Macro and micro nutrients. Carbohydrates (CHO),
Lipids (fats), Proteins are called as Macro Nutrients as they provide major portion of energy in
our diet

1 gm of Carbohydrates gives- 4 Kcal

1gm of Fats gives – 9 Kcal
1 gm of protein gives – 4 k cal

Vitamins, Minerals  and Water are called as Micronutrients. They have regulatory functions in
our body and help in maintence of health and prevention of diseases.

Food sources of nutrients:

Carbohydrates: pasta, rice, cereals, breads, potatoes, milk, fruit, sugar

Proteins: meat, dairy, legumes, nuts, seafood and eggs

Lipids (most commonly called fats): oils, butter, margarine, nuts, seeds, avocados and olives,
meat and seafood

Vitamins: common vitamins include the water soluble B group vitamins and vitamin C and the
fat soluble vitamins A, D, E and K

● Fruits and vegetables are generally good sources of Vitamin C and A and folic acid (a B group
vitamin)
● Grains and cereals are generally good sources of the B group vitamins and fibre
● Full-fat dairy and egg yolks are generally sources of the fat soluble vitamins A, D and E
● Milk and vegetable or soya bean oil are generally good sources of vitamin K, which can also be
synthesised by gut bacteria
Minerals: (sodium, calcium, iron, iodine, magnesium, etc.): all foods contain some form of
minerals.
● Milk and dairy products are a good source of calcium and magnesium
● Red meat is a good source of iron and zinc
● Seafood and vegetables (depending on the soil in which they are produced) are generally good
sources of iodine
Water: As a beverage and a component of many foods, especially vegetables and fruits.

● Health:  The word "health" refers to a state of complete emotional and physical well-being.
Healthcare exists to help people maintain this optimal state of health. A healthful diet,
exercise, screening for diseases, and coping strategies can all enhance a person's health.
 ● Balanced diet:

● A balanced diet is one which provides all the nutrients in required amounts and proper
proportions. It can easily be achieved through a blend of the four basic food groups. The
quantities of foods needed to meet the nutrient requirements vary with age, gender,
physiological status and physical activity. A balanced diet should provide around 50-60%
of total calories from carbohydrates, preferably from complex carbohydrates, about
10-15% from proteins and 20-30% from both visible and invisible fat.
● In addition, a balanced diet should provide other non-nutrients such as dietary fibre,
antioxidants and phytochemicals which bestow positive health benefits. Antioxidants
such as vitamins C and E, beta-carotene, riboflavin and selenium protect the human body
from free radical damage. Other phytochemicals such as polyphenols, flavones, etc., also
afford protection against oxidant damage. Spices like turmeric, ginger, garlic, cumin and
cloves are rich in antioxidants..

Food groups 

Foods are conventionally grouped as:

1. Cereals, millets and pulses
2. Vegetables and fruits
3. Milk and milk products, egg, meat and fish
4. Oils & fats and nuts & oilseeds
However, foods may also be classified according to their functions .
food pyramid : Food guide pyramid
India uses a number of graphical elements to represent the messages of its guidelines, one of
them being a food pyramid. The pyramid is divided into four levels of foods according to
recommended consumption: cereals and legumes/beans at the base should be eaten in sufficient
quantity, vegetables and fruits on the second level should be eaten liberally, animal source foods
and oils on the third level are to be eaten moderately, and at the apex, highly processed foods
high in sugar and fat to be eaten sparingly. Accompanying the pyramid there is a
recommendation to do regular physical activity and warnings against smoking and drinking
alcohol.

RDA & Factors affecting RDA 

Recommended dietary allowance (RDA) are the levels of intake of essential nutrients considered
to be adequate to meet the known nutritional needs of all healthy persons.  It is also used as a
guide to determine the nutritional adequacy of individual diets.  The RDA do not cover abnormal
problems such as premature birth, inherited metabolic disorders, infections, chronic diseases and
use of medications which require special dietary and therapeutic measures.
FACTORS AFFECTING RDA

1. Age (infant, adolescent, aged) - An infant requires more protein per kilogram of body
weight than adolescent, since their metabolic rate is much faster than that of adolescent.
0. Sex (male, female) – Adolescent girls require more iron than adolescent boys in order to
replace iron lost during menstruation every month.
0. Body size (height, weight, surface area, stature) - Tall heavily built man needs more
calories than small statured man, since his body surface area is more than that of the latter.
0. Physical state (pregnancy, lactation) - A pregnant women requires more nutritious food
than ordinary adult woman, since she has to meet the additional nutritional requirements of the
growing foetus.
0. Type of work (sedentary, moderate, heavy) - A sedentary worker require less calories
than a heavy worker, since the former expends less energy than latter during work

USE OF RDA
The RDA of nutrients has a number of practical uses. They are

1. To enable government to predict food needs of the population

2. To provide basis for food distribution quota
3. To guide agricultural planning policy
4. To guide policy of food export and import.
5. To guide planning of nutritionally adequate diets of inmates of larges catering
establishment such as hospitals, hostels, hostels, army canteen, etc.,
6. To evaluate the findings of food consumption surveys of various population groups.
7. To evaluate the adequacy of food supplies in relation to nutritional needs
8. To develop and evaluate new products developed by the food industry.
9. To establish guidelines for labelling of food from the nutritional standpoint
10. To develop nutrition education programmes

Principles of menu planning for Indians.     Meal planning is defined  as a simple practical
exercise which involves applying the knowledge of food, nutrient requirement, individual
preferences to plan adequate and accept able  meals. In other terns, meal planning means
planning for adequate nutrition.

The aims in planning meals are to: 

● Fulfill the nutritional needs of the family members, taking into account the family size
and composition.
● plan meals within the family income, i.e. make maximum use of the money available, in
the best possible way aid in the proper purchase, preparation and service of food
economize on time, labour and fuel provide variety in the diet by making proper selection
of foods from within each of the three food groups.
● Make meals appealing and palatable by proper selection of food in terms of color, texture
and flavour provide nutritious meals taking into account individual preferences.

● plan meals in advance, so that any pre-preparation required can be made and also I the
leftovers from the previous meals can be economically utilized.
 Factors affecting Meal Planning

Elementary idea of Probiotics, Prebiotics:

The lining of our gut, like every surface of our body, is covered in microscopic creatures, mostly
bacteria. These organisms create a micro-ecosystem called the microbiome. And though we don't
really notice it's there, it plays an oversized role in your health and can even affect your mood
and behavior.
Not surprisingly, what we feed your microbiome may have the biggest impact on its health. And
the healthier it is, the healthier you are. The key to a healthy microbiome is nourishing a balance
among the nearly 1,000 different species of bacteria in our gut.
There are two ways to maintain this balance — helping the microbes already there to grow by
giving them the foods they like (prebiotic) and adding living microbes directly to your system
(probiotic).
Probiotics are foods or supplements that contain live microorganisms intended to maintain or
improve the "good" bacteria (normal microflora) in the body. Prebiotics are foods (typically
high-fiber foods) that act as food for human microflora. Prebiotics are used with the intention of
improving the balance of these microorganisms.
Probiotics are in foods such as yogurt and fermented foods. Prebiotics are in foods such as whole
grains, bananas, greens, onions, garlic, soybeans and artichokes. In addition, probiotics and
prebiotics are added to some foods and available as dietary supplements.

Anti oxidants : Antioxidants are compounds produced in your body and found in foods. They
help defend your cells from damage caused by potentially harmful molecules known as free
radicals.When free radicals accumulate, they may cause a state known as oxidative stress. This
may damage your DNA and other important structures in your cells. chronic oxidative stress can
increase your risk of chronic diseases such as heart disease, type 2 diabetes and cancer
.Fortunately, eating a diet rich in antioxidants can help increase your blood antioxidant levels to
fight oxidative stress and reduce the risk of these diseases

ROLE OF PIGMENTS AS ANTIOXIDANTS: Different pigments found in various color-groups

of foods.

Red Foods
Red foods such as tomatoes, pink grapefruit, watermelon and papaya are rich in the antioxidant
Lycopene (a carotenoid). In addition to its antioxidant activity, lycopene has been shown to
suppress the growth of tumors in both laboratory and animal experiments

Lycopene is especially effective at quenching the free radicals that can damage cell membranes.
Purple & Red Foods
Purple & reddish fruits and vegetables such as blueberries, cranberries, blackberries, eggplant
and plums, contain compounds called Anthocyanins, a class of flavonoids, which have been
found to help reduce risk of cancer, stroke and heart disease. Some studies have shown that the
consumption of blueberries is linked with improved memory function and healthy aging. 
Some anthocyanins have anti-inflammatory properties, It’s also thought that anthocyanins
possess possible anti-viral and anti-microbial properties.
Dark Green Foods
Dark green foods such as spinach, kale, bok choi and cabbage contain lutein, another
free-radical-quenching carotenoid antioxidant, that’s especially important for skin and eye health.
Lutein is also present in the yolks of eggs. Dark green foods also tend to be a good source of the
B-vitamin folate, which gets its name from the Latin word folium, for leaf. Folate helps produce
and maintain new cells. Folate is essential for the formation of DNA and RNA, the building
blocks of cells. It also helps to prevent the types of DNA changes within cells that may lead to
cancer.
Orange, Yellow and Green Foods
Orange, yellow and green foods like sweet potatoes, carrots, mangoes, spinach and pumpkin (a
superfood, and one of the richest-known sources of carotenoids) contain beta carotene, which
can be converted by the body into retinol, a bioavailable source of vitamin A. This potent
antioxidant is beneficial for eye health, immune system function and a healthy heart. Zeaxanthin,
which is also found in yellow and green foods like spinach, collard greens as well as egg yolk, is
beneficial for the eyes and immune system. Many beta-carotene rich foods such oranges,
papayas, bell peppers & kiwis also contain vitamin C, which helps to protects cell from free
radical damage as well as promoting skin and immune system health.
White Fruits and Vegetables 
White fruits and vegetables such as bananas, parsnips, potatoes and garlic take their ‘color’ from
pigments called anthoxanthins. These contain health-promoting chemicals such as allicin, which
may help lower cholesterol and blood pressure and their role in helping to reduce the risk of
stomach cancer and heart disease in humans is under study. Some white foods like potatoes and
bananas are also good sources of potassium, needed for nerve and muscle function as well as
blood pressure – which in turn is associated with diabetes, kidney failure and Cushings disease.

Organic Food: Organic foods are produced without synthetic (man-made) fertilizers and
pesticides, growth hormones, antibiotics and genetically modified organisms (GMOs). Organic
farmers use crop rotation, plant compost and composted manure to enrich the soil. Animals that
are raised organically are fed only organic feed. Antibiotics, growth hormones and insecticides
are not allowed. Some non-organic farmers also use a combination of organic farming practices
such as crop rotation, composted manures and avoidance of synthetic fertilizers. 

The benefits of organic food

How your food is grown or raised can have a major impact on your mental and emotional health
as well as the environment. Organic foods often have more beneficial nutrients, such as
antioxidants, than their conventionally-grown counterparts and people with allergies to foods,
chemicals, or preservatives often find their symptoms lessen or go away when they eat only
organic foods.
Organic produce contains fewer pesticides. Chemicals such as fungicides, herbicides, and
insecticides are widely used in conventional agriculture and residues remain on (and in) the food
we eat.
Organic food is often fresher because it doesn’t contain preservatives that make it last longer.
Organic produce is often (but not always, so watch where it is from) produced on smaller farms
near where it is sold.
Organic farming is better for the environment. Organic farming practices reduce pollution,
conserve water, reduce soil erosion, increase soil fertility, and use less energy. Farming without
pesticides is also better for nearby birds and animals as well as people who live close to farms.
Organically raised animals are NOT given antibiotics, growth hormones, or fed animal
byproducts. Feeding livestock animal byproducts increases the risk of mad cow disease (BSE)
and the use of antibiotics can create antibiotic-resistant strains of bacteria. Organically-raised
animals are given more space to move around and access to the outdoors, which help to keep
them healthy.
Organic meat and milk are richer in certain nutrients. Results of a 2016 European study
show that levels of certain nutrients, including omega-3 fatty acids, were up to 50 percent higher
in organic meat and milk than in conventionally raised versions.
Organic food is GMO-free. Genetically Modified Organisms (GMOs) or genetically engineered
(GE) foods are plants whose DNA has been altered in ways that cannot occur in nature or in
traditional crossbreeding, most commonly in order to be resistant to pesticides or produce an
insecticide.

Prevention of loss of nutrients during cooking:

Cooking is not only a culinary art but also a source of nutrition, taste and good health.

Though we all try to eat healthy and cook healthy, we often overlook or forget that all foods must
be had as freshly and with as little handling as possible to retain their maximum benefits.
Becoming aware of what happens to the food when it is over-handled, will enable you to adjust
how you prepare your food and how best to retain its nutrients. 

● The most easily destroyed nutrients are the water soluble ones. E.g. Vitamin B complex
and C are lost by exposure to excess water, air, heat, and light.
● Fat-soluble vitamins on the other hand e.g. A, D, E, and K are more stable. Cooking in
acid media has a protective effect against vitamins.
● Proteins are not lost much in daily cooking. They may get denatured if overcooked.
● Minerals leach out from boiled legumes but their loss is lesser then vitamins.

Amongst the various cooking methods, microwave and pressure cooking are usually best at
preserving nutrients in vegetables because food cooks faster and requires no added water. There
is little nutritional loss when reheating leftovers or cooking frozen foods in the microwave. 

Whichever cooking method is chosen, some care is necessary.

Ways to  prevent nutrient losses

1. When peeling the skin of vegetables do peel as thinly as possible.

 2. The nutrients in vegetables and fruits are concentrated just below the skin, so peeling
before boiling increases the loss of Vitamin C, Folic Acid and other B vitamins. The
peels of carrot, radish, gourd and ginger can be scraped instead of peeling. Peel only
when absolutely necessary.
3. Do not cut vegetables into very small cubes as each small part comes in contact with
oxygen, destroying vitamins.
4. Do not soak vegetables in water to prevent discoloration. Almost 40 %  of the water
soluble vitamins and minerals are lost in the soaking water. If you must soak, use up the
soaking water to knead dough, prepare soups and
gravies.                                                                                               
5. Root vegetables should be boiled with skins on and then peeled after boiling. This helps
the nutrients to migrate to the center of the vegetables, helping better retention of its
nutrients. Do eat with skin on whenever possible.
6. Certain amount of minerals and vitamins are lost even during preliminary washing before
cooking. Washing may remove as much as 40% of the thiamine and nicotinic acid. Thats
why it is preferable to wash rice with minimum amount of water.
7. Salads should be prepared just before serving and should be served in closed dishes to
avoid excessive exposure to air.
8. Do not throw away the excess water drained after boiling rice or vegetables. When
preparing cottage cheese, the water left over after curdling is called whey. It is extremely
rich in good quality proteins and vitamins and should be used up in preparing gravies,
kneading dough or simply had as a refreshing drink after flavoring with lemon juice and
salt and pepper.
9. Do not keep milk open or exposed to light, as considerable destruction of riboflavin can
occur.
10. Baking soda makes cooking water alkaline and thus helps retain the color of vegetables
as well as speed up the cooking process, BUT  it destroys thiamin and vitamin C.
11. Cooked vegetables when exposed to the atmosphere before serving may also result in
loss of vitamin C. It is preferable to cook vegetables in minimum amount of water
keeping the vessel covered and to consume it as soon as possible. Reheating cooked
vegetables further destroys vitamins.
 Such extra care can save precious nutrients. Instead of cooking only for taste and relish, we
should try to get the most from our food.
Role phytonutrients and their impact on health.: Phyto nutrients and their health benefits.
Some of the best-known phytonutrients are carotenoids (such as beta-carotene, lutein, lycopene
and Zeaxanthin) and flavonoids (such as isoflavones, anthocyanins and flavones).
Some of the health benefits of consuming the phytonutrients contained in colorful foods, include
enhancing immune system activity, protecting against cancer, supporting eye and heart health,
improving communication between cells and repairing DNA damage. Antioxidants also help to
slow down the signs of aging by cleaning up the by-products of oxidation which takes place
within the body’s cells.
 UNIT IV

Feeding of pregnant and lactating mothers

Pregnancy is a demanding physiological state. In India, it is observed that diets of women from the
low socioeconomic groups are essentially similar during prepregnant, pregnant and lactating
periods. Consequently, there is widespread maternal malnutrition leading to high prevalence of low
birth weight infants and very high maternal mortality. Additional foods are required to improve weight
gain in pregnancy (10-12 Kg) and birth weight of infants (about 3 Kg). It is hence important to ensure
provision of extra food and healthcare to pregnant and lactating women

Key points regarding nutrition for pregnant and

lactating women
● Pregnancy is physiologically and nutritionally a highly demanding period. Extra food is required to
meet the requirements of the foetus.
● A woman prepares herself to meet the nutritional demands by increasing her own body fat deposits
during pregnancy.
● A lactating mother requires extra food to secrete adequate quantity/ quality of milk and to safeguard
her own health.

Important nutrition tips for pregnant and lactating

women
● Eat more food during pregnancy.
● Eat more whole grains, sprouted grams and fermented foods.
● Take milk/meat/eggs in adequate amounts.
● Eat plenty of vegetables and fruits.
● Avoid superstitions and food taboos.
● Do not use alcohol and tobacco. Take medicines only when prescribed.
● Take iron, folate and calcium supplements regularly, after 14-16 weeks of pregnancy and continue
the same during lactation.

Nutrients that require special attention during

pregnancy and lactation period
The daily diet of a woman should contain an additional 350 calories, 0.5 g of protein during first
trimester and 6.9 g during second trimester and 22.7 g during third trimester of pregnancy. Some
micronutrients are specially required in extra amounts during these physiological periods. Folic acid,
taken throughout the pregnancy, reduces the risk of congenital malformations and increases the birth
weight. The mother as well as the growing foetus needs iron to meet the high demands of
erythropoiesis (RBC formation). Calcium is essential, both during pregnancy and lactation, for proper
 formation of bones and teeth of the offspring, for secretion of breast-milk rich in calcium and to
prevent osteoporosis in the mother. Similarly, iodine intake ensures proper mental health of the
growing foetus and infant. Vitamin A is required during lactation to improve child survival. Besides
these, nutrients like vitamins B 12 and C need to be taken by the lactating mother.

Ways to meet the nutritional demands during

pregnancy and lactation
● The pregnant/lactating woman should eat a wide variety of foods to make sure that her own
nutritional needs as well as those of her growing foetus are met.
● There is no particular need to modify the usual dietary pattern. However, the quantity and frequency
of usage of the different foods should be increased.
● She can derive maximum amount of energy (about 60%) from rice, wheat and millets. Cooking oil is
a concentrated source of both energy and polyunsaturated fatty acids.
● Good quality protein is derived from milk, fish, meat, poultry and eggs. However, a proper
combination of cereals, pulses and nuts also provides adequate proteins.
● Mineral and vitamin requirements are met by consuming a variety of seasonal vegetables
particularly green leafy vegetables, milk and fresh fruits.
● Bioavailability of iron can be improved by using fermented and sprouted grams and foods rich in
vitamin C such as citrus fruits.
● Milk is the best source of biologically available calcium.
● Though it is possible to meet the requirements for most of the nutrients through a balanced diet,
pregnant/lactating women are advised to take daily supplements of iron, folic acid, vitamin B and
calcium.

Importance of eating Folate-Rich Foods

● Folic acid is essential for the synthesis of haemoglobin.
● Folic acid deficiency leads to macrocytic anaemia.
● Pregnant women need more of folic acid.
● Folic acid supplements increase birth weight and reduce congenital anomalies.
● Green leafy vegetables, legumes, nuts and liver are good sources of folic acid.
● 500 mg (0.5mg) folic acid supplementation is advised pre-conceptionally and throughout pregnancy
for women with history of congenital anomalies (neural tube defects, cleft palate).

Importance of eating Iron-Rich Foods

● Iron is needed for haemoglobin synthesis, mental function and to provide immunity against diseases.
● Deficiency of iron leads to anaemia.
● Iron deficiency is common particularly in women of reproductive age and children.
● Iron deficiency during pregnancy increases maternal mortality and low birth weight infants.
● In children, it increases susceptibility to infection and impairs learning ability.
● Plant foods like green leafy vegetables, legumes and dry fruits contain iron.
● Iron is also obtained through meat, fish and poultry products.
● Iron bio-availability is poor from plant foods but is good from animal foods.
● Vitamin C - rich fruits like gooseberries (Amla), guava and citrus improve iron absorption from plant
foods.
● Beverages like tea bind dietary iron and make it unavailable. Hence, they should be avoided before
during or soon after a meal.
● Commonly consumed plant based diets provide around 18mg of iron as against recommended
intake of 35mg per day. Therefore, supplementation of iron (100 mg elemental iron, 0.5 mg folic acid)
is recommended for 100 days during pregnancy from 16th week onwards to meet the demands of
pregnancy.

Importance of Breast milk, Advantages of exclusive breast feeding colostrums 

The World Health Organization (WHO) recommends that infants be exclusively breastfed for the
first six months, followed by breastfeeding along with complementary foods for up to two years
of age or beyond. Exclusive breastfeeding can be defined as a practice whereby the infants
receive only breast milk without mixing it with water, other liquids, tea, herbal preparations or
food in the first six months of life, with the exception of vitamins, mineral supplements or
medicines 

 Breastfeeding an infant exclusively for the first 6 months of life carries numerous benefits such
as lowered risk of gastrointestinal infection, pneumonia and urinary tract infection in the infant
while mothers return to her pre-pregnancy weight very rapidly and have a reduced risk of
developing Type 2 diabetes

CHARACTERISTICS OF BREAST MILK

“Breast milk is unique in its physical structure and types and concentrations of protein, fat,
carbohydrate, vitamins and minerals, enzymes, hormones, growth factors, host resistance
factors, inducers and modulators of the immune system, and anti-inflammatory agents”  . There
12

are three phases of milk namely, colostrum, transitional milk and mature milk each with distinct
characteristics.
 
Infant’s first milk-colostrum
The first milk that is synthesized by the breast for the baby right after birth is thick,
yellow-coloured fluid called colostrum. The yellow color is owing to the high concentration of
beta-carotene, a precursor of vitamin A which is required for the protection against infection and
for early retinal development  . It has also been stated that the amount of colostrum obtained is
38

limited but it rich in nutrients and substances that the infant needs in the first days of life  . The
12

“liquid gold” is rich in proteins, fat-soluble vitamins, minerals, and immunoglobulins A- sIgA . It 33

should be noted that IgA protects the infant’s immune system by identifying and destroying
foreign objects such as bacteria and viruses . Another advantage of colostrum is that the mother
12

will have less blood loss because the uterine contracts as the baby suckle. Furthermore, colostrum
also contains white cells which help to prevent infection in the infant and it also consists of
lactose which prevents hypoglycemia and at the same time helps the newborn to pass meconium  . 38

This in turn, promotes the excretion of bilirubin.

 Complementary feeding & Nutritional importance weaning:

Complementary feeding or weaning

Complementary feeding (commonly known as weaning) means introducing a variety of foods
gradually to a baby, alongside the usual milk feeds, until he or she is eating the same healthy foods
as the rest of the family. The weaning stage is an opportunity to emphasise eating a well-balanced
diet including a variety of foods and help parents set up good eating habits and a healthy diet for life
for their children.
When to begin weaning
Research recommends weaning babies should begin at around six months. This is due to the
developmental readiness of babies’ digestive systems and their kidneys and in the first six months of
life it is best for a baby to get all their nutritional needs from breast milk (or formula milk if not
breastfeeding).   However, while feeding practices are changing, most mothers in 2010 were not
following the UK guidelines, since three-quarters of mothers (75%) had introduced solids by the time
their baby was five months old. Weaning at six months, rather than earlier, means a reduction in the
risk of asthma, eczema, digestive problems, allergies and obesity in later life. Weaning is also easier
at six months because there is no need to puree food.  Signs that an baby is ready to start weaning
include:

● Baby can stay in a sitting position and hold her head steady
● Baby can reach out and grab things accurately; for example, look at food, pick it up and put it in her
mouth all by herself
● Baby can swallow food. Babies who are not ready will push their food back out so they have more
on their face than in their mouths 
As feeding an infant contributes substantially to the bonding and attachment between parent and
child, moving to solid foods is a change to the parent-child relationship and should be treated
sensitively. Emphasis should be on providing a variety of foods with different colours and textures
and avoiding foods that are inappropriate for babies and young children. To support the transition
parents can be advised to:

● choose a time of day when they are relaxed

● mix feeds between breast or formula milk and solids to gently introduce new feeding
● make sure they have plenty of time – many babies are slow to eat at the beginning
● allow the baby to feed themselves, using fingers as soon as they show interest
● eat together with baby to help them feel more included and helps develop social skills.

Obesity- definition, causes, Grades, management, dietary guidelines.

Lifestyle modifications.
Obesity is a medical condition in which excess body fat has accumulated to the extent that it may
have a negative effect on health. People are generally considered obese when their body mass
index (BMI), a measurement obtained by dividing a person's weight by the square of the person's
height, is over 30 kg/m2, with the range 25–30 kg/m2 defined as overweight.
Obesity increases the likelihood of various diseases and conditions, particularly cardiovascular
diseases, type 2 diabetes, obstructive sleep apnea, certain types of cancer, osteoarthritis and
depression.
What causes obesity?
Eating more calories than you burn in daily activity and exercise (on a long-term basis) causes
obesity. Over time, these extra calories add up and cause you to gain weight.

Common specific causes of obesity include:

1. eating a poor diet of foods high in fats and calories

2. having a sedentary (inactive) lifestyle
3. not sleeping enough, which can lead to hormonal changes that make you feel hungrier and
crave certain high-calorie foods
4. genetics, which can affect how your body processes food into energy and how fat is stored
growing older, which can lead to less muscle mass and a slower metabolic rate, making it easier
to gain weight
5. pregnancy (weight gained during pregnancy can be difficult to lose and may eventually lead to
obesity
Grades of obesity :
Weight that is higher than what is considered as a healthy weight for a given height is described
as overweight or obese. Body Mass Index, or BMI, is used as a screening tool for overweight or
obesity.

Adult Body Mass Index (BMI)

Body Mass Index (BMI) is a person's weight in kilograms divided by the square of height in
meters. A high BMI can be an indicator of high body fatness.

To calculate BMI, see the Adult BMI Calculator or determine BMI by finding your height and
weight in this BMI Index Chart.

If your BMI is less than 18.5, it falls within the underweight range.
If your BMI is 18.5 to <25, it falls within the normal.
If your BMI is 25.0 to <30, it falls within the overweight range.
If your BMI is 30.0 or higher, it falls within the obese range.
Obesity is frequently subdivided into categories:

Class 1: BMI of 30 to < 35

Class 2: BMI of 35 to < 40
Class 3: BMI of 40 or higher. Class 3 obesity is sometimes categorized as “extreme” or “severe”
obesity.

Management of Obesity 
Management of obesity can include lifestyle changes, medications, or surgery. The main
treatment for obesity consists of dieting and physical exercise.[1] Diet programs may produce
weight loss over the short term,[2] but maintaining this weight loss is frequently difficult and
often requires making exercise and a lower calorie diet a permanent part of an individual's
lifestyle.
Management of obesity can include lifestyle changes, medications, or surgery. The main
treatment for obesity consists of dieting and physical exercise.[1] Diet programs may produce
weight loss over the short term,[2] but maintaining this weight loss is frequently difficult and
often requires making exercise and a lower calorie diet a permanent part of an individual's
lifestyle.
Eat Healthfully and Enjoy It!
A healthy eating plan that helps you manage your weight includes a variety of foods you may not
have considered. If “healthy eating” makes you think about the foods you can’t have, try
refocusing on all the new foods you can eat—
1.Emphasizes fruits, vegetables, whole grains, and fat-free or low-fat milk and milk products
2.Include lean meats, poultry, fish, beans, eggs, and nuts
3. include  low saturated fats, trans fats, cholesterol, salt (sodium), and added sugars
4. Stay within your daily calorie needs. 

Lifestyle modifications for obesity 

Lifestyle treatments for weight loss focus on reducing energy intake and increasing physical
activity through diet, exercise and behavioural measures.Beyond the specific measures
highlighted above, it is also important that you maintain an overall balanced and healthy
lifestyle. You should avoid stress, depression, boredom and frustration as these can be triggers to
unhealthy eating behaviours. Keeping yourself occupied with enjoyable activities such as sports
or socializing with friends and family can help you achieve a healthy lifestyle. If you eat
excessively due to stress you could consider enrolling in relaxation programs.
Physical activity for weight loss
In addition to reducing your energy intake, increased physical activity is essential for the
maintenance of weight loss and should form part of any weight loss program. However, to
achieve significant weight loss from exercise alone, a very high level of activity is required,
which can be challenging.

You should gradually build up your exercise as your personal fitness allows. You can start with
simple measures such as walking to nearby places rather than driving, or climbing the stairs
rather than using an elevator or escalator. Thirty minutes of walking 3-5 times per week is a good
starting point.

If you are very overweight, some exercises (especially those that require weight bearing) can be
physically difficult. In this case you could try activities such as swimming, walking in water or
cycling. Once your fitness levels improve you could change to other exercises in the long term.
You should try to choose activities that you enjoy, as you will be more likely to continue them in
the long term. Participating in team sports or exercising with a friend or family member can help
you to remain motivated. It may be useful to see a physiotherapist or exercise physiologist to
help you develop an appropriate exercise program. Try to focus on overall lifestyle measures as
they tend to produce greater long term adherence.

Exercise has benefits beyond modest reductions in weight. Increasing your physical activity can
improve your cardio-respiratory fitness, metabolic health, quality of life and general wellbeing.
However, strenuous exercise can be risky in some patients such as those with cardiovascular
problems. You should consult your doctor to discuss what level of physical activity will be safe
for you.
Behavioral Therapy for weight loss :
Behavioural techniques may be useful in conjunction with diet and exercise programs to improve
long-term weight loss. Behavioural treatment is usually performed by a psychologist who
analyses your eating, physical activity and thinking habits. Cognitive behavioural therapy (CBT)
is a classic example which encourages you to change these behaviours and take responsibility for
your lifestyle changes. Other strategies may include stress management, relapse prevention,
counselling, and techniques such as hypnosis and psychotherapy. However, some of these
behavioural techniques can be very time consuming and expensive.

Some basic steps may include:

1. Self monitoring: Identifying and recording any adverse patterns of behaviour.

2. Stimulus control: This involves removing factors that encourage you to eat badly. For
example, you should shop carefully and remove trouble foods (such as chocolates and chips)
from the house so you cannot be tempted.
3. Problem solving: Identifying and addressing problems associated with eating and physical
activity. You should consider which factors have led to your excess weight and address them
appropriately.
4. Reward systems: You could reward yourself for positive behaviours such as exercise by
treating yourself to new clothes.
5. Social support: Strong social support from your friends and family can improve weight loss. It
may be beneficial for you to enrol in a commercial program which offers a social support
network.

Diabetes-definition, causes, types, symptoms, diagnosis,

management, dietary guidelines
Diabetes is a disease that affects your body’s ability to produce or use insulin. Insulin is a
hormone. When your body turns the food you eat into energy (also called sugar or glucose),
insulin is released to help transport this energy to the cells. Insulin acts as a “key.” Its chemical
message tells the cell to open and receive glucose. If you produce little or no insulin, or are
insulin resistant, too much sugar remains in your blood. Blood glucose levels are higher than
normal for individuals with diabetes. There are two main types of diabetes: Type 1 and Type 2.
Type 1 Diabetes :
When you are affected with Type 1 diabetes, your pancreas does not produce insulin. Type 1
diabetes is also called juvenile diabetes, since it is often diagnosed in children or teens. 
Type 2 Diabetes :
Type 2 diabetes occurs when the body does not produce enough insulin, or when the cells are
unable to use insulin properly, which is called insulin resistance. Type 2 diabetes is commonly
called “adult-onset diabetes” since it is diagnosed later in life, generally after the age of 45
Gestational Diabetes :
Gestational diabetes occurs during pregnancy. Gestational diabetes usually goes away after
pregnancy, but once you've had gestational diabetes, your chances are higher that it will happen
in future pregnancies.
Causes:
Genetics, diet, obesity and lack of exercise may play a role in developing diabetes, especially
Type 2 diabetes. 
What are the symptoms of diabetes?
Extreme thirst
Frequent urination
Blurry vision
Extreme hunger
Increased tiredness
Unusual weight loss
Sometimes a routine exam by an eye doctor or foot doctor will reveal diabetes. Diabetes affects
the circulation to your feet and the tiny blood vessels in your eyes. If your eye doctor or your
foot doctor suspects you have diabetes, he will recommend you see your regular physician for a
blood sugar level test.

The most common test is a fasting blood glucose test. After not eating for at least eight hours,
usually overnight, your doctor will take a blood sample. The normal, non-diabetic range for
blood glucose is 70 to 110 mg/dl. If your level is over 140 mg/dl, you may have diabetes.
How is diabetes managed?
There is no cure for diabetes, but it can be treated and controlled. The goals of managing
diabetes are to:

Keep your blood glucose levels as near to normal as possible by balancing food intake with
medication and activity.
Maintain your blood cholesterol and triglyceride (lipid) levels as near the normal ranges as
possible by decreasing the total amount of fat to 30% or less of your total daily calories, and by
reducing saturated fat and cholesterol.
Control your blood pressure. (Your blood pressure should not go over 130/80.)
Decrease or possibly prevent the development of diabetes-related health problems.
You hold the keys to managing your diabetes by:

Planning what you eat and following a balanced meal plan.

Exercising regularly.
Taking medication, if prescribed, and closely following the guidelines on how and when to take
it.
Monitoring your blood glucose and blood pressure levels at home.
Dietary Guidelines for diabetes :

Foods to eat for a type 2 diabetic diet include complex carbohydrates such as brown rice, whole
wheat, quinoa, oatmeal, fruits, vegetables, beans, and lentils. 
Foods to avoid include simple carbohydrates, which are processed, such as sugar, pasta, white
bread, flour, and cookies, pastries.
Foods with a low glycemic load (index) only cause a modest rise in blood sugar and are better
choices for people with diabetes. Good glycemic control can help in preventing long-term
complications of type 2 diabetes.
Fats don't have much of a direct effect on blood sugar but they can be useful in slowing the
absorption of carbohydrates.
Protein provides steady energy with little effect on blood sugar. It keeps blood sugar stable, and
can help with sugar cravings and feeling full after eating. Protein-packed foods to eat include
beans, legumes, eggs, seafood, dairy, peas, tofu, and lean meats and poultry.
Five diabetes "superfoods" to eat include chia seeds, wild salmon, white balsamic vinegar,
cinnamon, and lentils.
Healthy diabetes meal plans include plenty of vegetables, and limited processed sugars and red
meat.
Diet recommendations for people with type 2 diabetes:
Guidelines on what to eat for people with type 2 diabetes include eating low glycemic load
carbohydrates, primarily from vegetables, and consuming fats and proteins mostly from plant
sources.
What to not to eat if you have type 2 diabetes: sodas (regular and diet), refined sugars, processed
carbohydrates, trans fats, high-fat animal products, high-fat dairy products, high fructose corn
syrup, artificial sweeteners, and any highly processed foods.

Hypertension- definition, causes, symptoms, diagnosis, management, dietary

guidelines. 
Hypertension (HTN or HT), also known as high blood pressure (HBP), is a long-term medical
condition in which the blood pressure in the arteries is persistently elevated.
 High blood pressure usually does not cause symptoms. Long-term high blood pressure,
however, is a major risk factor for coronary artery disease, stroke, heart failure, atrial fibrillation,
peripheral vascular disease, vision loss, chronic kidney disease, and dementia.
Normal Blood pressure is 120/80 mm Hg
Lifestyle changes and medications can lower blood pressure and decrease the risk of health
complications. Lifestyle changes include weight loss, physical exercise, decreased salt intake,
and a healthy diet.If lifestyle changes are not sufficient then blood pressure medications are used.
Symptoms
Most people with high blood pressure have no signs or symptoms, even if blood pressure
readings reach dangerously high levels.
symptoms:
A few people with high blood pressure may have headaches, shortness of breath or nosebleeds,
but these signs and symptoms aren't specific and usually don't occur until high blood pressure
has reached a severe or life-threatening stage.
Risk factors
High blood pressure has many risk factors, including:

1. Age. The risk of high blood pressure increases as you age. Until about age 64, high blood
pressure is more common in men. Women are more likely to develop high blood pressure after
age 65.
2. Race. High blood pressure is particularly common among people of African heritage, often
developing at an earlier age than it does in whites. Serious complications, such as stroke, heart
attack and kidney failure, also are more common.
3. Family history. High blood pressure tends to run in families.
5. Being overweight or obese. The more you weigh the more blood you need to supply oxygen
and nutrients to your tissues. As the volume of blood circulated through your blood vessels
increases, so does the pressure on your artery walls.
5. Not being physically active. People who are inactive tend to have higher heart rates. The
higher your heart rate, the harder your heart must work with each contraction and the stronger
the force on your arteries. Lack of physical activity also increases the risk of being overweight.
6. Using tobacco. Not only does smoking or chewing tobacco immediately raise your blood
pressure temporarily, but the chemicals in tobacco can damage the lining of your artery walls.
This can cause your arteries to narrow and increase your risk of heart disease. Secondhand
smoke also can increase your heart disease risk.
7. Too much salt (sodium) in your diet. Too much sodium in your diet can cause your body to
retain fluid, which increases blood pressure.
Too little potassium in your diet. Potassium helps balance the amount of sodium in your cells. If
you don't get enough potassium in your diet or retain enough potassium, you may accumulate too
much sodium in your blood.
8. Drinking too much alcohol. Over time, heavy drinking can damage your heart. Having more
than one drink a day for women and more than two drinks a day for men may affect your blood
pressure.

9. Stress. High levels of stress can lead to a temporary increase in blood pressure. If you try to
relax by eating more, using tobacco or drinking alcohol, you may only increase problems with
high blood pressure.
Certain chronic conditions. Certain chronic conditions also may increase your risk of high blood
pressure, such as kidney disease, diabetes and sleep apnea. 

DASH is an acronym for “Dietary Approaches to Stop Hypertension” and was designed to
help lower blood pressure in people with hypertension (high blood pressure).  This eating pattern
promotes eating more vegetables, fruits, whole grains, nuts, seeds, and lower fat or fat-free dairy
products, poultry and fish. This eating pattern also limits foods high in sodium (salt) saturated
fat, red meat, sweets, added sugars and sugar sweetened drinks.  The DASH diet is also higher in
fiber and is rich in nutrients, such as potassium, calcium, and magnesium, which may help to
lower blood pressure.
These foods may include the following:

Fruits
Vegetables
Whole grains
Fat-free or low-fat dairy products
Fish
Poultry
Nuts
DASH limits the following:

Red meats (including lean red meats)

Sweets
Added sugars
Sugar-containing drinks
Importance of physical exercise in maintenance of health.
Regular physical activity can help you get rid of excess fat. Your body burns calories as you
exercise. The more you exercise, the more calories you burn! This helps you maintain a healthy
weight.

Fat and carbohydrates are the fuels that our muscles burn when we exercise. Aerobic activity
increases the oxygen consumption of your muscles, allowing your body to burn body fat more
efficiently.​

Physical activity keeps your heart, lungs and bones healthy

Physical activity improves blood circulation through your heart, lungs and blood vessels. Your
heart muscles get stronger with regular aerobic activity. You will realise that you have more
energy to do the things you enjoy and won't tire so easily.

In addition, muscle-strengthening activities keeps your bones and muscles strong. Activities such
as resistance training work on the major muscle groups in your body, making them stronger and
more resilient. Regular muscle-strengthening activities also increase bone density which can help
prevent osteoporosis.

​ erform 8-10 exercises including all major muscle groups at least twice a week. Each exercise
P
should consist of 8-12 repetitions.
Physical activity makes you feel good
Physical activity can enhance your emotional and psychological well-being by improving your
self-esteem. Your body releases chemicals called endorphins when you exercise. Endorphins are
"feel-good" chemicals that uplift your mood and can even reduce feelings of stress, anxiety and
depression.
Physical activity keeps diseases away
Regular physical activity reduces the risk of:
heart disease
high blood pressure
diabetes
stroke
osteoporosis
some cancers
With a total of two to three hours of physical activity a week, you can reduce your chances of
developing chronic diseases and enjoy a better quality of life.

Reap the rewards of physical activity

Don't miss out on the excellent health benefits that physical activity can bring you. Let's get
active today! When you're planning on jogging, line dancing, swimming, rollerblading, rock
climbing or playing football – it does not matter. Physical activity in any form is not only good
for you but it can and should be fun!