INTRODUCTION TO NUTRITION AND
BALANCED DIET
C
Dr.Faryal Shaikh
MBBS,MPH
Senior Lecturer,FRPMC
Learning Objectives :
By the end of the session, the students will be able to :
• Define and explain the terms food, nutrition and diet
• Explain the relationship between health and nutrition
• Discuss food groups, sources and their functions
• Enumerate components of a balanced diet with the help of
food pyramid
• Enlist dietary goals recommended by WHO
• Discuss in detail Nutritional problems in Public Health
• Classify Protein energy malnutrition (PEM)
• State the preventive measures of PEM
• Discuss the community nutrition program
Food :
• What we eat and drink to help
keep us alive and well, to help
us grow, develop, work and play
is called food.
• Food is anything edible. It
includes all foods and drinks
acceptable for a particular
society, culture or religion.
• Food gives us a feeling of
comfort and satisfaction. Eating
certain foods establishes our
identity.
NUTRITION
• Maintaining a nutritional status that enables us to grow well and
enjoy good health (K Park)
• It is concerned primarily with the part played by nutrients in body
growth, development and maintenance
• Nutrition is the interaction between food and the body
• It is about the nutrients contained in food, and their action,
interaction and balance in relation to health and disease
• A nutrient is an active chemical component in food that plays a
specific role in the body’s activity.
DIET :
• Diet is the sequence and balance of meals in a day.
• It is concerned with the eating patterns of individuals or a group.
• Some people may eat twice in a day (breakfast and dinner);
others may eat four times (breakfast, lunch, snack and dinner);
still others may seem to be chewing all day long.
• A diet is all that we consume in a day
5
Relationship between Health andNutrition :
• Nutrition is a foundation for health and development.
• Better nutrition means stronger immune systems, less illness and
better health for people of all ages.
• Healthy children learn better and grow better.
• Healthy people are stronger, more productive, and better able
to break cycles of poverty and realize their full potential.
6
Nutrition as a component Of Primary Health
Care(PHC) :
• In the global campaign of Health for All, promotion of proper
nutrition is one of the eight elements of PHC
• Greater emphasis is now placed on integrating nutrition into
primary health care systems whenever possible and formulation
of national dietary goals to promote health and nutritional status
of families and communities
Classification of Nutrients :
• Macronutrients or “ Proximate
principles ”
Carbohydrates 70 to 80 percent
Fats 10 to 30 percent
Proteins 7 to 15 percent
• Micronutrients
Vitamins and minerals
Sources and Functions Of Micronutrients and
Macronutrients :
Balanced Diet :
• Balanced diet is a diet that
contains an adequate quantity of
the nutrients that we require in a
day
Dietary Goals
Dietary goals recommended by WHO are :
• Dietary Fat should be limited to 15-30 % of total daily intake
• Saturated fats should contribute to no more than 10 per cent of the
total energy intake
• Unsaturated vegetable oil should be substituted for the fat requirement
• Excessive consumption of refined CHO should be avoided, CHO rich in
natural fiber should be taken
• Protein should account for approximately 10-15 % of the daily intake
• Junk foods such as colas, ketchups & other foods that supply empty
calories should be reduced
• Salt intake should be reduced to an average of not more than 5 g per
day
Nutritional Problems in Public Health
1. Low birth weight (LBW) :
• LBW( i.e birth weight less than 2500g ) is a major public health
problem in developing countries
• In countries where the proportion of LBW is high, the majority are
suffering from fetal growth retardation
• The proportion of infants born with LBW was selected as one of
the nutritional indicators for monitoring progress towards Health
for All in the year 2000
2. Malnutrition
The cellular imbalance between supply of nutrients and energy and the body's
demand for them to ensure growth, maintenance, and specific functions.
13
Malnutrition and consequences
14
Malnutrition
Classification
• Macronutrient deficiencies/excess
• Protein Energy Malnutrition (PEM)/Undernutrition
• Over weight/Obesity
• Micronutrient deficiencies (Vit A,D,E,K, B,iodine, Iron, Zn etc.)
• Collectively Macro and Micro nutrient deficiencies are known as
triple burden of malnutrition
15
Protein Energy Malnutrition (PEM) :
• PEM is a range of pathological conditions or a state of
malnutrition arising from simultaneous deficiency of protein,
calories and commonly associated with infections
• It occurs more frequently in infants and young children
• Its manifestation ranges from nutritional marasmus to Kwashiorkor
Protein Energy Malnutrition :
• Marasmus
• Kwashiorkor
• Marasmic-kwashiorkor
17
Nutritional Marasmus :
• It is a condition characterized by muscle wasting, loss of
subcutaneous fat, very low body weight resulting from gross lack
of calories for a considerable period together with shortage of
proteins and other nutrients
• It occurs mainly in infants below 15 months
Kwashiorkor :
• It is a severe clinical syndrome in which deficiency of AA needed
for protein synthesis or deficiency of calories are a contributing
factor
• The syndrome occurs most frequently in children aged one to
three years.
• C/F include : Arrested growth, edema, dermatosis, hair changes,
enlarged liver, diarrhea, mental apathy
Marasmus Kwashiorkor
➢ Prevalence: Prevalence:
1. 20:1 1. Rarer
2. <2yrs old 2. 1-5 yrs age
Etiology:
1. Lack of caloric intake Etiology:
2. Improper weaning, 1. Severe lack of proteins in diet
over diluted milk, infections 2. Calories may/not be deficient
➢ Features:
➢ Features:
1. Growth retardation
1. Growth retardation
2. Edema NEVER present
2. Generalized edema (puffy face, belly, feet)
3. Muscle & Subcutaneous fat loss
3. Weak, but present subcutaneous fat
4. Good appetite
4. Poor appetite
5. Aged face
.5. Sparse hair, peeling skin 12
6. Anemia, diarrhea, infections, vit. deficiencies
Gomez Classification :
• It is based on weight retardation. It locates the child on the basis
of his or her weight in comparison with a normal child of the same
age
• Weight for age= weight of the child ˣ 100
weight of a normal child of same age the child
Between 90 and 110% : normal nutrition status
Between 75 and 89% : 1st degree, mild malnutrition
Between 60 and 74% : 2nd degree, moderate malnutrition
Under 60% : 3rd degree, severe malnutrition
WATERLOW’S CLASSIFICATION :
Waterlow’s Classification :
Nutritional Status Stunting ( % of height / age ) Wasting ( % of weight/
height)
Normal ˃ 95% ˃ 90%
Mildly impaired 87.5% - 95% 80% -90%
Moderately impaired 80% -87.5% 70%-80%
Severly impaired ˂ 80% ˂70%
Over weight/ Obesity :
• Short-term effects: infections and poor self-esteem
• Long-term effects: obesity, diabetes etc.
26
WHO Child Growth Standards :
• Underweight : If a child has weight –for- age Z -score that is at
least two standard deviations (-2SD) below the median
• Stunting : If a child has a height- for -age Z -score that is at least
two standard deviations (-2SD) below the median
• Wasting : If a child has weight-for -height Z -score that is at lease
two standard deviations (-2SD) below the median
• SAM : Very low weight- for- height/length ( Z-score below -3SD of
the median )
Micronutrient Deficiencies :
• Micronutrients are needed for proper functioning of the immune
system
• Some other examples are:
• Iron deficiency anemia affects energy levels as well as school
attendance and performance
• Vitamin A deficiency can lead to night blindness, growth
retardation
• Vitamin D deficiency can lead to Rickets (bone deformity in
children)
28
Preventive Measures of PEM:
Health Promotion
• Measures directed to pregnant and lactating women
• Promotion of breast feeding
• Development of low cost weaning foods
• Measures to improve family diet
• Nutrition education
• Family planning and spacing of births
Specific Protection
• The child’s diet must contain protein and energy rich foods.
• Immunization
• Food fortification
Preventive Measures of PEM (contd)
Early diagnosis and treatment :
• Early diagnosis and treatment of infections and diarrhea
• Development of program for early rehydration of children with
diarrhea
Rehabilitation :
• Nutritional rehabilitation services
• Hospital treatment
Community Nutrition Program :
• Vitamin A prophylaxis program
• Prophylaxis against nutritional anemia
• Control of iodine deficiency disorders
• Special nutrition programme
• Integrated Child development Services (ICDS )
programme
• Mid day meal programme
• Mid day meal scheme
To Summarize :
• Balanced diet is a diet that contains an adequate quantity of the
nutrients that we require in a day
• Recommended daily caloric intake is 2000 calories for women and
2500 for men
• CHO and proteins provide 4kcal/g while fat provides 9kcal/g
• PEM is a spectrum of conditions ranging from growth retardation to
overt marasmus or kwashiorkor
• The first indicator of PEM → underweight for age (acute/chronic)
• Low weight/height (wasting)→ acute malnutrition
• Low height for age (stunting) → chronic malnutrition
Discussion:
Being a Public Health Professional, a renowned NGO invites you
to plan a program on nutritional health problems in a
community.
Explain how you would proceed as a public health professional
in such a scenario ???
References:
• Park’s Textbook of Preventive and Social Medicine 25th edition
• Public Health and Community Medicine by Mohammad Ilyas
• The State of the World’s Children 2019
• World health Organization Introduction, Facts (Malnutrition)
• Irfsanullah Siddiqui, Public Health and Community Medicine. 8th
edition
Thanks
