Human nutrition for public health

students.

bhu
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 Introduction
Human Nutrition describes the processes whereby cellular

organelles, cells, tissues, organs, systems, and the body as a whole

obtain and use necessary substances (nutrients) obtained from foods
to maintain structural and functional integrity.

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Definition of terms.
Nutrition – is the science of nutrients and their action,
interaction and balance in relation to health and disease
Study processes by which nutrients are :

Ingested

Digested

Absorbed

Transported

Metabolized

Excreted
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Definition of terms.
 Food :are products that derived from plants or animals .

that can be taken into the body to yield energy and nutrients for

maintenance of life ,for growth and repair tissues.

 Diet : is the foods and beverages a person eats and drinks.

 Balanced diet: is diet that contains all essential nutrients in the

proportion that is optimal for longer term health and survival.

 Nutrients : Components in foods that an organism utilizes to

survive and grow .

The chemical constituents of food .

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 Cont..
Roughage: - is defined as food fibres which enable the body to get

rid of waste products, which would otherwise become poisonous to

the body.
It prevents :

 gastrointestinal disorders (gastritis, appendicitis, gallbladder

stone and constipation)

metabolic disorders (diabetes mellitus, hypertension, ischemic

heart disease and colon cancer).

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Classification of nutrients
There are 6 Classes of Nutrients

1. Carbohydrates
2. Lipids (fats)
3. Proteins

4. Vitamins
5. Minerals
6. Water

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Classification of nutrients
There are several ways to classify the 6 classes of nutrients.

Essential or nonessential

Organic or inorganic

Macronutrient or micronutrient

Energy yielding or not

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Classification 1 based on body requirement
Macronutrient
Micronutrients
s

Carbohydrates Vitamins

Protein Minerals

Fat

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 Cont.…
Macronutrients
Provide the bulk energy for an organism's metabolic system to

function.
Needed in larger quantity

Micronutrients
Provide the necessary cofactors for metabolism to be carried out.

Needed in very small amounts

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Classification 2 based on composition

Nutrients

Organic Inorganic

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Cont..
Organic nutrients - contain carbon

 Carbohydrates

 Lipids

 Proteins

 Vitamins

Inorganic nutrients - do not contain carbon

 Minerals

 Water

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Classification 3
Nutrients

Essential

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 Classification 4 based on energy yielding
Energy-yielding nutrients :

Carbohydrates

Fats (lipids)

Proteins

Non Energy yielding :

Vitamins

Minerals

Water

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 Why human beings need food?
Human beings need food to provide energy for the essential

physiological functions like:- ƒ

Respiration .ƒ

Circulation .ƒ

 Digestion .ƒ

Metabolism .ƒ

Maintaining body temperature. ƒ

Growth and repair body Tissues .

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Relationship between nutrition and health

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 Nutrition in life course
Nutritional needs and concerns vary during different stages of life.

Five stages: –

Pregnancy

Infants

Children

Teenagers

Adults and Elderly

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Nutritional Needs During Pregnancy
Baby’s growth and development depend on nutrients from mother .

 Poor eating habits by the mother place the baby at risk.

Folate, folic acid

 More foods from: –

 Dairy Group

 Protein Foods Group

Fruit ,Vegetable and Grains Group.

Should add 300 calories a day to diet.

Pre-natal vitamin and mineral supplement .

 No alcohol
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 Nutritional Needs for Infants
Grow and develop quickly in first year

 Triple in weight

 Brain and organs continue to develop

Birth to 6 months –

 Breast milk (is recognized as the best food to foster brain

development)
Infant formula

 No cow’s milk

 After 6 months – Cereal introduced

6 to 8 months – Mashed fruits and vegetables – Single item foods

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Cont..
7 to 10 months

 Finger foods

 Dry cereal

Teething biscuits

 8 to 12 months

Soft or cooked table foods

 1 to 2 years

 Feed themselves

 Enjoy same food as family

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Cont.…
Energy – highest needs of any life stage

Protein – highest needs of any life stage

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Cont..

Key vitamins and minerals

Vitamin D

Vitamin K

Vitamin B12

Iron

Fluoride

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Nutritional need for children
 Serving sizes/portions for children are SMALLER than adults.
 Children need a variety of nutrient-dense foods in small
amounts, frequently
 Be sure they eat Breakfast, lunch, and dinner.
 SNACKS can provide added nutrients if they have trouble eating
enough at meals
 Expose children to new foods one at a time, not all at once
 Do not use food as a PUNISHMENT or REWARD

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Cont..
Avoid Sweet foods as snacks.

Make foods interesting and inviting for children: COLOR, texture,

shape, size, and temperature.

Note: The eating habits and attitudes of children usually do not

change in ADULTHOOD.
Encourage eating a variety of foods from the all food groups daily.

Encourage the consumption of nutrient-dense foods such as milk,

meat, whole grains, fruits and vegetables.

Do not restrict NUTRIENT- DENSE foods just because they contain

some fat.
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Cont..
 Parents should urge kids to eat a good breakfast. Include low fat
milk or yogurt, high fiber bread or cereal, protein from peanut
butter, cheese, lean meat, fruit or 100% fruit juice.
 Be careful with soft drinks. Caffeine can dull appetite and may
lead to excluding more nutritious food.
 Children who drink too much JUICE risk gaining weight and
losing their appetite for milk which provides protein, calcium, and
other vital nutrients.
 Diets for healthy children should foremost provide ENERGY and
NUTRIENTS to support optimal growth and development.
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Cont..

Obesity is common among

children.
Parents should :

encourage their child to be active

provide healthy snacks

 provide moderate portions

allow the child to stop eating when they are FULL

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Nutritional Needs for Teenagers
 This is a time of great activity and Most rapid growth period
Dramatic physical changes.

 Teenagers need a VARIETY of nutritious foods throughout the

day.
 Teens should include foods that contain
 calcium (bones),
 iron( support increase of blood volume and muscle mass),
 Zinc, vitamin A ( reproductive maturity)
 vitamin E and C ( healthy tissue and immune system).
 Nutritious snacks are especially important.
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 Cont.…

Nutritional HABITS originating in adolescence often persist into

adulthood.
Obese adolescents often become obese adults.

Remember that fast food meals usually contain more fat and sodium

than home-cooked meals.

Meal Skipping is not recommendable .

You can’t lead a high-energy life on a low-energy diet!!!

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Nutritional Needs for Adults
Metabolism slows down.

 Generally total food intake needs to be reduced

Due to busy schedules, nutritious meals are replaced with fast food

and snacks.
It is important to get fruits, vegetables, whole grains, lean meats,

and low-fat dairy, while avoiding foods high is sugar and fat
Sedentary lifestyle creates a greater need for daily exercise

exercising is the key to balancing food intake and output.

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Nutritional Needs for Elderly
 Aging adults have les sensitive to TASTE and SMELLS
 Adults overs the age of 50 need to increase their intake of vitamin D,
calcium, Folate,B6 and B12
 Because they are less active they need:
 less fat, sodium, and calories in their diet, and
 more nutrient-dense foods.
 Some form of daily exercise is still important.
 Elderly who live alone have a harder time eating a variety of
nutritious food. MALNUTRITION is a concern.
 Many health concerns and diseases incident to aging affects eating
habits and food choices. 29
Factors affects energy requirement
 The energy requirements of individuals depend on :

 Physical activities

 Body size and composition

 Age may affect requirements in two main ways –

 During childhood, the infant needs more energy because

of rapid growing
 During old age, the energy need is less because aged
people are engaged with activities that requires less
energy.
 Climate: Both very cold and very hot climate restrict outdoor

activities. 30
Daily calorie requirements of individuals Š

 Infants 1 - 3 years need 1,000 cal/day Š

 Children 5 years need 1,500 cal/day

 Š Children 5 – 8 years need 1,800 cal/day Š

 Children 10 – 12 years need 2,000 cal/day Š

 For adolescents and adults calorie requirements depend on the

degree of physical activities

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Cont...
From 13 – 20 years of age
Office worker 2, 800 cal/day

Heavy work 3,500 cal/day

Adults
Office worker 2,300-cal/day

Heavy work 2,700 cal/day

Very heavy work up to 4,000 cal/day

For pregnant woman, the daily figure must be increased by 150 calories

for the first trimester and 350 for the second and third trimester.
For the nursing mother the daily figure must be increased by 800

calorie.
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A well-nourished individual:-
ƒ Is alert mentally and physically fit ƒ
Has optimistic outlook on life ƒ

Has good resistance to infection ƒ

Shows numerous other signs of good health such as an

increased life span extending the active and energetic period of

life.

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Dietary guidelines ƒ
 Eat a wide variety of foods ƒ

 Maintain healthy weight ƒ

 Choose a diet low in fat, saturated fat, and cholesterol

 ƒ Choose a diet with plenty of vegetable, fruits and grain

products ƒ
 Use sugar in moderation

 ƒ Use salt and sodium in moderation ƒ

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 Malnutrition
Malnutrition: - is the condition that results from an imbalance between

dietary intake and requirements.

under nutrition: which results from less food intake and hard physical

work .

 which includes :

stunting (low height for age),

 wasting (low weight for height),
underweight (low weight for age) and
micronutrient deficiencies or insufficiencies (a lack of important

vitamins and minerals).

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Cont.…
Over nutrition : results from excess food intake and less physical

activities.
Which includes :

 overweight

 obesity

 diet-related non communicable diseases (such as heart

disease, stroke, diabetes and cancer).

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Causes of malnutrition
Individual level or immediate causes:

Food and nutrient intake, physical activity, health status/infection,

social structures, care, taboos, growth, personal choice

 Household level or intermediate causes:

Family size and composition, gender equity, rules of distribution
of food within the household, income, availability of food, access
to food

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Cont..
National level or underlying causes:

Health , education , sanitation, agriculture and food security, war,

political instability, urbanization, population growth, distribution
and conflicts, war, natural disasters, decreased resources

International level or basic causes:

Social, economic and political structures, trade agreements,

population size, population growth distribution, environmental
degradation.

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 Types of malnutrition
 There are two major types of malnutrition:
Protein-energy malnutrition - resulting from deficiencies in any or

all nutrients
Micronutrient deficiency diseases - resulting from a deficiency of

specific micronutrients

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 Protein-energy malnutrition
There are three types of protein-energy malnutrition :

Type Appearance Cause

Acute Wasting or Acute inadequate nutrition leading to
malnutrition thinness rapid weight loss or failure to gain weight
normally
Chronic Stunting or Inadequate nutrition over long period of
malnutrition shortness time leading to failure of linear growth
Acute and chronic Underweight A combination measure, therefore, it
malnutrition could occur as a result of wasting,
stunting, or both

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 Clinical Features PEM
The severest clinical forms of PEM are :

 Marasmus,

 kwashiorkor and
 features of both called Marasmic- kwashiorkor.
The following symptoms and signs clinically characterize them: -

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Marasmus
 Common in the 1st year of life

Etiology:
 “Balanced starvation”
 Insufficient breast milk
 Dilute milk mixture or lack of
hygiene
 deficiency of ALL nutrient

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Clinical Manifestations of Marasmus
 Growth retardation
 Wasting of subcutaneous fat and muscles (flabby muscles)

 Weight is more effected than Height

 Wrinkled monkey (old man face)

 Depressed eye orbs

 Increased appetite

Mood change (always irritable)

Mild skin and hair changes

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Kwashiorkor
 Between 1-3 yrs old

Etiology:
 Very low protein but calories from CHO
 In places where starchy foods are main staple
 Never exclusively dietary

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Clinical Manifestations of kwashiorkor
ƒA. Diagnostic Signs
C. Occasional Signs:
1. Edema 1. Flaky-paint rash
2. Muscle wasting 2. Noma
3. Psychomotor changes 3. Hepatomegaly

B. Common Signs Laboratory:

1. Hair changes 1. Decreased serum albumin
2. Diffuse depigmentation of 2. Iron & folic acid deficiencies
skin 3. Liver biopsy fatty or fibrosis
3. Moon face may occur
4. Anemia 46
Marasmic kwashiorkor

State intermediate phase between marasmus &kwashiorkor

when a previously marasmic child develops edema due to higher

nutritional requirement.

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Complications of Protein-Energy Malnutrition
Acute

 Electrolyte imbalance
 Diarrhea, dehydration and shock
 Hypoglycemia
 Hypothermia

Chronic

Rudeness to the brain development leading to low school

performance.
 Stunting and ending up in short adult with low fitness for

physical activity
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 Diagnosis of Protein-Energy Malnutrition
The clinical work up of cases of PEM mainly focuses on four

factors, which do contribute to accurate diagnosis and

management.
These are:-

1.Detailed history—
 relevant to child feeding practices,

 weaning conditions,

 staple diet and other relevant history on the socio-cultural,

environmental and other predisposing factors

2. Careful physical examination--of all systems of the body 50

 Cont..
3. Anthropometric assessment—
 Measurement of weight and height of children and
comparing it with the standard
4.Epidemiological considerations--information regarding the
 age, sex
 birth weight, height,
 season

 existence of epidemics
 drought and other natural and man made calamities will
have to be assessed critically.
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Cont..
5. Laboratory findings—
 determination of albumin level or pre-albumins like retinal
binding proteins, etc.
 in the plasma may give some clues.
 Laboratory investigations for the diagnosis of concurrent
infections, micronutrient deficiencies like anemia are
important to consider.

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Case Management of PEM
focuses on the correction of specific nutrient deficiencies (dietary

management), treatment of complications and covered infections.

Dietary Management

1 , Acute Phase
• Children are most at risk of dying during the acute phase.

• Dehydration, infection and severe anemia are the main dangers.

• In PEM, cardiac and renal functions are impaired

• This is b/c of malnourished children have a reduced capacity to

excrete excess water and a marked inability to excrete Sodium.

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Cont..

The amount of fluid given and the Sodium load must be, carefully

controlled to avoid cardiac failure.

Small frequent feeds are ideal as they reduce the risks of diarrhea,

vomiting, hypoglycemia and hypothermia.

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2. Rehabilitation Phase
Inpatient Management of PEM: -

Reducing mortality through: rehydration, treatment of infection,

and small frequent feeds.

 Reducing length of stay: through administration of high-energy

feeds in the rehabilitation phase.

Reducing relapses through: parental education, follow up,

improvement of family resources.

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Cont..
A child with severe protein energy malnutrition (weight for height <

60%) and the following conditions should be admitted to a hospital or

health centre for inpatient management:
 Infection ƒ Age < 1 year ƒ
 Sever dehydration
ƒ Intractable vomiting ƒ
 Sever diarrhea ƒ
 Sever loss of appetite ƒ
 Hypoglycemia
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