 Introduction to nutrition

 Concept of nutrition and health

 Role of nutrition in maintaining health
 Importance of nutrition in Nursing
 Nutritional problem in India
 Factor affecting food and nutrition
 Nutrients clasification
 Classification of foods
 Next to air we breath and the water we drink,
food has been basic to our existence. In fact
food has been the primary concern of
human kind in its physical environment
throughout all recorded history. People
must eat to live, and what they eat will
affect in a high degree to their ability to
keep well, to work, to be happy and to live
longer. Food is the primary necessity of life.
 Nurse as important members of health team are
committed for maintaining the good health
status of the people. In community , nurse
encounters a variety of problems and needs
related to nutrition, perhaps another person
needs instructions in preparing food for sick
person in a family, while on other hand another
needs counseling so that the food conforms to
religious beliefs. Some of these situation make
nutrition as an integral part of their nursing
practice in the hospital and community, they
need to study nutrition, principles of nutrition,
food values, assessment, nutrition deficiency
disease and therapeutic diet.
 Nutrition : It is a branch of science that deals
with food and their nutritive values in relation
to maintain health.
 Health : According to WHO (1948) Health is a

state of complete physical, mental , social

and spiritual well being and not merely an
absence of disease and infirmity.
 Nutrient : A substance essential for the

growth, maintenance, function and

reproduction of a cell or of an organism.
 Dietetics : Practice application of the principles of
nutrition, including the planning of meals for well
and sick.
 Good nutrients : Means maintaining a nutritional
status that enables us to grow well and enjoy good
health.
 Macronutrients : Proteins, fats and carbohydrates are
macronutrients. These are called proximate principles
because they form the bulk of our food. In India
diets, they contribute to the total energy. E.g,
carbohydrate, proteins, fat.
 Micronutrients : Vitamins and minerals are
micronutrients because they are require in small
amounts e.g, vitamins, and minerals.
Role of nutrition in
maintain health
 Growth and Development

Nutrition Relationship
Resistance
Deficiency of nutrition
to
Disease with health
Infection

Mortality and
Morbidity
 Good nutrition is essential for attainment of
normal growth and development during foetal
life and childhood. Physical growth, intellectual
development, learning and behavior, all are
affected by malnutrition. Adequate nutrition is
also needed in adult life for the maintenance of
optimum health and efficiency. Elder people need
special nutrition due to their physiological and
chronological changes. Pregnant and lactating
mothers require more proteins, calories and
some others nutrients to prevent abortion,
growth retardation and low birth weights babies.
 Malnutrition is directly responsible for certain
specific nutrition deficiency diseases. The
commonly reported ones in India are protein
energy malnutrition, blindness, goiter,
anaemia, beri beri and rickets. There is
increased incidence of abortion, prematurity,
still birth and low birth weights in
malnourished mothers. So good nutrition is
essential for prevention of specific nutritional
deficiency diseases, promotion of health and
treatment of deficiency disease.
Nutrition rich in proteins, vitamins and
minerals prevents infections like tuberculosis.
Infection in turn may aggravate malnutrition
by affecting the food intake, absorption and
metabolism of nutrients. So we need well
balanced diet throughout life to protect
ourselves from such opportunistic infection.
Good nutrition also enhances wound healing
in the patients with different types of surgical
operation.
 Health indicators show high death rate and
sickness rates in the developing countries
including India than developing countries a lot to
general death rate, infant mortality rates, still
births and premature deliveries. Prematurity is
the main cause of infant deaths. Poor nutrition
also lower the expectation of life. On the other
hand, over nutrition, which is another type of
malnutrition, is responsible for obesity, diabetes,
hypertension, cardiovascular and renal disease,
liver disorders and gall bladder disease.
 To the incidents of nutritional deficiency disease, our
government has launched several nutritional
programmers', e.g, Mid day school meal, Integrated
child development scheme, Anemia control
programme and Iodine deficiency disorders control
programme, etc
 Subject of nutrition is beings tough to all Nursing
educational programmers (diploma and degree
course) and paramedical course to enhance the
staff with knowledge and skill regarding nutrition
so that they may be able to contribute in promotion
of
health, prevention of deficiency diseases and to
prepare therapeutic diets by applying principles of
nutrition and dietetics, and they will be able to teach
the community about nutrition.
Nurses constitute an important component of
health care system and they are supposed to
provided comprehensive services to
community. When we say nursing is meeting
the health needs of the people, we must
know the health and factors affecting it.
Today’s nutrition is considered as one of the
important factors affecting the human health
and malnutrition is one of the leading cause
of mortality and morbidity in India.
 1. Promotion of health
 2. Specific protection
 3. Prevention of nutritional deficiency disease
 4. Early detection and treatment of deficiency
disease
 5. Modification of diets.
 6. Preparation of therapeutic diets
 7. Health education and counseling.
 Health Promotion is the process of enabling the people
to increase control over and improve health. Nutrition
is an important factor affecting our health. So,
nursing efforts should be directed towards pregnant
and lactating mothers. These efforts will includes
education, distribution of supplements, extra protein,
calcium, iron, and folic acid. These can contribute to
promotion of health by the following ways : -
 Promotion of breast feeding
 Development of low cost feeding
 Measures to improve family diet
 Encouragement for kitchen gardens and home
economies
 Guide about cheap and best source of nutrition,
methods of cooking and preservation and feeding
practices of the people.
 While guiding the parents, nurse should make
sure that child’s diet must contain body
building and protective foods in required
amounts, i.e. milk, cheese, eggs, and fresh
fruits if possible.
 Nurses can guide them about the methods of
food fortification to supplement the
nutrients. Proper immunization along with
vitamin A prophylaxis can prevent vitamin A
deficiency disease and provide immunity.
 Number of nutritional disease can be
prevented in the community by nursing
efforts. Premature deliveries, low birth
weight, abortion and congenital malformation
and still births can be prevented by
improving the diet of pregnant women.
There are number of National Nutrition
Programmers' but people are not aware of it.
Nurses and others community workers can
provide proper awareness about these
supplemental programmers'.
Because the nurses are directed care providers in
the hospital, health center’s and in the families
as well as in the baby clinics, antenatal and
postnatal clinics. School health nurse have good
opportunity to detect undernourished children.
There are number of anthropometric
measurements such as weight, height, arm
circumference, head circumference, etc. which
can be used to assess nutritional status of the
children. After diagnosis, nurse can play a vital
role in the treatment of such cases.
 The normal hospital diet which provides a patient
with the energy and nutrients intended for the
patient whose condition do not require a
therapeutic diet. These modification of diet are
liquid diet, soft diet, and semisolid diet. Nurse
should know different types of modifications of
diet in the hospital because they are responsible
to prepare and administer the nutritional needs
according to types of disease, age, income,
region, customs and food habits of individual
patients.
 For every one, eating food is an enjoyment. When
the person is sick, the food intake becomes a
problem.
 A) Assisting the patients with special problems in
preparing and accepting therapeutic diets, i.e.,
salt free diet and bland diet.
 B) Assisting the patient to obtain nourishment
either through feeding or assisting helpless
patient in eating.
 C) For motivating the patient to eat in therapeutic
environment, nurse must know the principles of
meal therapy.
 The aim of education is to guide people to
choose optimum and balanced diets, to remove
prejudices can be minimized by nutrition
education and counseling in case of delayed
weaning, ignorance about breast feeding and our
traditional misconception about certain foods.
In the recent, years, the link between dietary
habits and certain chronic disease has been
recognized,
i.e. obesity, diabetics and cardiovascular disease.
So, nutritional education is a major intervention
in the hands of nurses for prevention of such
disease.
1. Protein energy malnutrition
2. Low birth weight
3. Vitamin – A deficiency
4. Nutritional anemia
5. Iodine deficiency disorders
6. Fluorosis
7. Lathyrism
8. Obesity
 Malnutrition is the major nutritional problem
widespread among children under five year of
age in India. A majority of them suffer from
varying (various) grades of malnutrition. The
most of the children suffers from moderate
grade of PEM. The prevalence (no. of cure pt.)
has increase now a days due to various
program's run by government of India. E.g;
Mid day meals .
 Pregnant women
 Lactating women
 Infants
 Preschool children
 Adolescent girls
 Elderly
 Socially deprived
1. Marasmus : This is due to insufficient of
calories intake body. It mostly affect
the children under 1 year.
2. Kwashiokor : This disease is due to the
protein deficiency in the body. It mostly
occurs in children between 2 - 3 years of age.
This is due to insufficient of calories intake
in the body. Common type of PEM observed
among children below 1 year of age. It is
caused by severe deficiency of nearly all
nutrient especially protein and calories.
Conditions are characterized by extreme
wasting of the muscles and a daunt
expression.
Sign and symptoms
Extensive tissue and muscle wasting
Dry skin
Loose skin folds hanging over gulutie and axilla
Fat wasting
Sparse hair that is dull brown or reddish yellow
Mental retardation
Behavioral retardation
Low body temperature
Slow pulse and
breathing rates
Absence of edema
  This disease is due to the protein deficiency
in the body
1. Kwashiorkor occurs in mostly children
between 2 - 3 years of age
2. Acute form of PEM due to deficiency
of protein in the diet
3. Deficiency of micronutrient
4. Kwashiorkor is identified as swelling of the
extremities and belly, which is deceiving
to their actual nutritional status.
 Malnourished child with pedal edemas
 Growth failure
 Moon face
 Distended abdomen
 Acitis
 Enlarged liver with fatty infiltrates, thinning of
hair, loss of teeth, skin depigmentation
 Dermatitis
 Irritability
 Anorexia
Sign and Symptoms
Malnourished child with pedal edemas
Growth failure
Moon face
Distended abdomen
Acitis
Enlarged liver with fatty infiltrates, thinning of hair,
loss of teeth, skin depigmentation
Dermatitis
Irritability
Anorexia
1. Basal Metabolic Rate :-BMR is the main factor
which influences our nutritional requirement. It
is defined as the amount of energy required to
carry on the involuntary activities of the body.
Generally for an approximate determination of
BMR, simple method is used, i.e. one k cal per
kilogram per hour, so BMR = 1 k cal body
weight (in kg) x 24 hours.
2. Factors affecting BMR:- Body surface area,
age, sex, sleep, climate and secretions of
ductless glands.
 2. Weight : - Total metabolism includes work done in
moving one's own weight from place to place.
Therefore, the heavier the individual, the more energy
is required for movements.
 3. Age : - Young children need more energy and
protein in their growing age and adolescents require
more calories than the adults. The energy
requirement with the age decreases because of a fall
in BMR and decreased physical activities.
 4. Sex : - Sex also makes variation in energy
requirements. The BMR of women is 6 - 10% lower
than the men. For example a moderate man requires
2875 k cal whereas a moderate woman needs 2225 k
cal.(in compression to weight and height)
 5. Climate and environment : - Poor environment may lead
to infections, especially in children. Infection and hot
temperature both increase BMR, which increases our
nutritional requirement. Our body must have sufficient
food to make up for heat loss. The amount of heat loss
depends on the amount of work done and the
temperature. This is the reason that in persons living in
tropical climates, the BMR is about 10% less than those
living in low temperate zone.
 6. Physical activities : - Activity of in addition to the total
BMR. The type of activity and total time spent in each
activity determines to a large extent of body's need of
total energy. So, energy requirement depends on the type
of work or occupation, i.e. a sedentary worker (man of 60
kg)needs 2425 k cal per day, moderate worker 2875 and a
heavy worker requires 3800k cal.
 7. Specific Dynamic Action of food (SDA) : - It has been
found that there is 8%increase in the production of energy in
the form of heat after taking food. This is not due to any
work done (digestion or absorption) but it is due to
stimulating effect of food on the basal metabolism. This
stimulating effect is known as Specific Dynamic Action of
food. It varies according to different nutrients, e.g., SDA of
Carbohydrate is 5 - 6%, of Protein is 30%, of Fat is 4% and of
mixed diet is 12%.
 8. Physiological state : - , There is increased demand of food
in certain physiological conditions because of increased
BMR. The energy requirements of women are increased in
pregnancy by 300 k cal daily throughout pregnancy, and in
lactation 550 k cal extra daily during the first six months
and 400 k cal during the next 6months. The need of extra
energy is associated with deposition of tissues during
pregnancy and secretion of milk during lactation.
 9. Socio-economic factors : - Nutritional status is
largely affected by some socio-economic factors
like income, level of education, sanitation,
family size, knowledge regarding the nutritive
values of foods. These factors bear most
directly on the quality of life and are the true
determinants of nutritional status of society.
Malnutrition is the product of poverty,
ignorance, lack of education, large family size in
India. In short, the causes of malnutrition are
built into the very nature of society, in the
socio-economic and political structure.
 10. Cultural factors : - Cultural factors in
health and nutrition have engaged the
attention of medical scientists and
sociologists. Every culture has its own
customs and beliefs regarding nutritional
practices. It is now widely recognized that
cultural factors are deeply involved in all
affairs of man including health and nutrition.
Not all cultural factors are bad, some are
based on centuries of trial and error and have
positive values while other may be useless.
 11. Life style and Food habits : - what kind of
life style we live it directly impact our health
e.g, sedentary life style leads to obesity and
Food habit also plays an important role in
health as we know bad food habits leads to
various kind of disease. E.g, hypertension ,
Diabetes etc.
 12. Food Fads : - A fad diet is a diet that is
popular for a time, similar to fads in
fashion, without being a standard dietary
recommendation, and often promising
unreasonable fast weight loss or nonsensical
health improvements.
 13. Cooking practice : - The methods of
cooking like draining away the rice water at
the end of cooking, prolonged boiling,
peeling of vegetables, all influence the
nutritive value of foods.
 11. Religious : - Religion has a powerful influence
on the food habits of the people. Hindus do not
eat beef and Muslims pork. Some orthodox
Hindus do not eat certain vegetables like onion,
and garlic is not eaten by Janis and Braham
kumaris. Vegetarian is given a place of honour in
Hindu society. These food habits are known as
food taboos and have a religious sanction from
early days. The seafood taboos prevent people
from consuming nutritious foods even when
these are easily available. Muslim observe fasts
during Ramzan and Hindus on several occasions.
 12. Traditional factors : - Food is a subject of
widespread traditional beliefs and customs which
vary from country to country and from one
region to another. The concept of hot and cold
food is widely prevalent in the country. Foods
such as meat, fish, eggs and jaggery are
considered to generate heat in the body and are
known as hot foods. On the other hand, foods
such as curd, milk, bananas and lemon are
considered cold foods. In some rural areas,
people avoid their children from hot and cold
foods, which leads to malnutrition.
 13. Food production and distribution : - The rate of
food production and distribution is another
important factor influencing the nutritional status of
a country.
Increased food production should lead to increased
food consumption. Given the best technology known
at present, most developing countries could increase
their food production several fold but increased food
production will not solve the basic problem of
hunger and malnutrition. It is a problem of uneven
distribution between the countries and within the
countries. It is said that there will be very little
malnutrition in India today if all foods available can
be equally distributed in accordance with
physiological needs.
 Nutrients
classification
 These are proteins, fats, and carbohydrates.
They form the main bulk of food in the
Indian dietary.
 Proteins - 7 to 15 %
 Fat - 10 to 30 %
 Carbohydrate - 65 to 80 %
 This group includes vitamins and minerals.
 They are required in a small amounts which
may vary from a fraction of milligram to
several grams. That’s why they are called
micronutrients.
3. Organic nutrients- they
contain anything food based
carbon.
 Proteins are required for growth in children
and maintenance of body weight in adults.
 Proteins constitute about 20% of the body
weight.
 Carbohydrates form the bulk of our food and
are the main source of energy for doing
work.
 About 50-70% of energy value in the average
diets is provided by Carbohydrates.
 Oils and fats serve mainly as the source of
energy. They contains some essential
nutrients like essential fatty acids and fat
soluble vitamins.
 Excessive fats leads to obesity.
 Vitamins are a class of organic compounds
categorized as essentials nutrients. They fall
in category of micronutrients.
 Vitamins are divide into two groups vitamin
A,D,E,K are fat soluble and B group and
vitamins C are water soluble.
4. Inorganic nutrients- they do
not contain carbon.
 Human body contains more than 50
chemicals elements which are required for
growth, repair and regulation of vital
body functions.
 The important minerals are calcium,
phosphorus, sodium chloride, potassium,
iron, copper, iodine, fluorine and zinc.
5. Energy yielding nutrients

Human body need calories to function e.g

carbohydrates proteins lipids.
6. Non energy yielding nutrients

Vitamin minerals water etc.

 1. On bases of origin:
 A) Foods of animals origin, e.g milk, and eggs
etc.
 B) Foods of vegetables origin, e.g pulses,
cereals and fruits etc.
 On chemical composition of foods:
 Proteins

 Fats

 Carbohydrates

 Vitamins

 Minerals
 On nutritive values of foods:
 Cereals
 Pulses
 Vegetables
 Nuts
 Fruits
 Animals foods
 Fats and oils
 Sugar and jaggery
 On predominant function:
1) Body building foods: Foods rich in proteins are
called body building foods because they are
responsible for building and repair of body
tissues. E.g- milk, fish, eggs, pulses
2) Energy yielding foods: Foods rich in
carbohydrates and fats are called energy
yielding foods. E.g – cereals, dried fruits, sugars,
oils and fats.
3) Protective foods: Foods rich in proteins,
vitamins are minerals are called protective
foods. E.g – fruits and green leafy vegetables.
 Bureau of Indian standards (ISI standards) –
Various committees including
representatives from the govt., consumers
and industry formulate the Indian and
standards (ISI) for vegetables and fruit
products, spices, animal products and
processed foods. Once these standards are
accepted, manufacture whose products
conforms to these are allowed to use. An ISI
label on each unit of their products is a
guarantee of good quality.
 The AGMARK standards : - These standards
were set up by the Directorate of Marketing
and Inspection of Govt. of India by
introducing an Agricultural production Act in
1937. This act defines quality of cereals,
spices, oil seeds, oil, butter, ghee, egg, etc.
and provides various grades depending upon
the degree of purity in each case.
 CODEX Alimentarius:- The Codex
Alimentarius commission, which is the
principle organ of the joint FAO (Food and
Agriculture) and WHO food standards
programme, formulates food standards for
international market. The food standards
in India are based on the standards of the
Codex Alimentarius.
 PFA Standards:- Standards have been
established under the Prevention of Food
Adulteration Act (1954) and are revised from
time by the ‘Central Committee’ for food
standards. The purpose of PFA standards is
to obtain a minimum quality of food stuffs
attainable under Indian standards.
 Standards of Weights and Measures : - The
standards of weights and measure Act (1985)
contains provision for effective legal control
on weights, measures and
weighing/measuring instruments used in
industrial production and protection of public
health and human safety. This ensure that
the consumer gets the correct inspection of
weight and measure.
 Misbranding : - It is also forbidden by law. A
food may be considered as misbranded if it
has a label which gives false or misleading
information about the product failure to
specify weight, measure, name of additives,
limitations in use of the product, name of the
manufacturer, as well as misleading the
consumer in terms of size are all considered
as misbranding of food.
 Adulteration is define as the process by which
the quality of the product is reduced through
addition of baser substance or removal of a
vital element.

Food material Adulterations

Wheat, rice Mud
Haldi powder Lead chromate powder
Dhania powder Cow dung or horse dung powder
Chilli powder Brick powder
 Enacted by the Indian Parliament in 1954,
with the objective of ensuring pure and
wholesome food to the consumers and to
protect them from fraudulent and deceptive
trade practices, the Prevention and Food
Adulteration (PFA) Act was amended in 1964,
1976 and lately in 1986 to make the Act
more stringent.
 Consumer rights have become an important
issue. The CPA is a piece of comprehensive
legislation and recognized six rights of the
consumers namely-
 1. Right to safety
 2. Right to choose
 3. Right to heard
 4. Right to seek redressal
 5.Right to information
 6. Right to consumer education
 Adequate and sufficient nutrition is a fundamental
right of every human being. Improving the nutritional
status of people is one of the prime duties of the
government and is an essential factor in improving
their health status and the quality of life. The World
Health Report 2002 clearly describes how child and
maternal underweight are the greatest risk factor that
affect people's health and disease status. In this
report, underweight has been adopted as a key
indicator of poverty and hunger. From these points of
view, it is recognized that policies, programs and
processes for nutrition improvement have a great role
to play in promoting healthy lives and development
across the globe.
 Aim: The general objective of the National Nutrition Policy is to improve
the nutritional status of the people. Achieving nutritional well-being of
all people in India so that they can maintain a healthy life and contribute
to the socio-economic development of the country, through improved
nutrition-program implementation in collaboration with relevant sectors.
 Objectives
 To promote the practices, that is favourable to the improvement of the
nutritional status of human being.
 To reduce the prevalence of diseases linked to nutritional malnutrition,
deficiencies and excesses.
 To prevent mother-to-child transmission of HIV through appropriate
breastfeeding and infant and young child feeding practices.
 To assure adequate treatment and rehabilitation of malnutrition due to
nutritional deficiencies and excesses.
 To provide nutritional care, education, counselling and support for
people living with HIV/AIDS.
 The Human rights: Accesses to nutritionally adequate and safe
food and services for nutrition education are the rights of each
individual.
 Pre-condition for development: Nutritional well-being should be a
key
objective for progress in human development.
 Healthy life style: Nutritional improvement has to be enhanced to ensure
the healthy life of all people.
 Primary education: Under nutrition in infancy and early childhood affects
school enrolment and on cognitive and behavioural development.
 Venerable groups: Infants, young children, pregnant and nursing
women, disabled people and the elderly within poor households are the
most nutritionally vulnerable groups.
 Community participation: People-focused policies for nutritional
improvement must acknowledge the fact that people's own knowledge,
practices and creativity are important driving forces for social change.
 Gender: Special attention should be given to the nutrition of women
during pregnancy and lactation.

Promotion of optimal infant and young
child feeding.
 Scaling up of community-based nutrition

programs.
 Food fortification.

 Promotion of household food security.

 Prevention and management of malnutrition

and related diseases.

 Nutritional support to their families.

 Communication for behaviour change.

 To ensure effective implementation of planned activities, monitoring
and evaluation is essential in all development programs. In addition,
periodic and continuous evaluations are necessary for establishing level
of objective achievement in the programme and policy.
 The follow up implementation of nutrition programs properly and data
will be collected on regularly basis at the health centre and
community level, In addition, other opportunities for nationwide
surveys will be identified and utilized.
 Nutritional surveys and epidemiologic surveillance will be conducted
regularly and periodically, with appropriate indicators, to evaluate the
progress and impact of nutritional interventions.
 Operational research will also be carried out to address specific
nutritional and other problems identified during the implementation of
nutritional activities.
 To prevent nutritional emergencies, nutrition unit will reinforce
collaboration with all existing structures that collect and analyze
bioclimatic, environmental, demographic and agricultural data for early
warning and timely intervention measures against disasters that can
negatively affect the nutrition.