UNIT I

NUTRITION –
INTRODUCTION
 UNIT - I
• Nutrition - History, Concepts, Role of nutrition in maintaining health
• Nutritional problems in India
• National nutrition policy
• Factors affecting food and nutrition: Socioeconomic, cultural, traditional,
production, system of distribution, life style and food habits etc.
• Role of food and its medical value
• Classification of foods
• Food Standards
• Elements of nutrition: Macro and Micro, Calorie, BMR
 INTRODUCTION
• The foods you eat supply your body with the
• Carbohydrates, protein and fat –
Macronutrients
• Vitamins and minerals – Micronutrients -
to produce the chemicals that support
your life.
 INTRODUCTION
• Both healthy and poor diets contain macro and
micronutrients,

but

• The quantity and quality of each component

determines the status of your health, strength,
endurance, longevity and your ability to
function.
 INTRODUCTION
• Nutrient-rich foods support your
• Body’s natural ability to repair and
maintain itself, and
• Decrease your risk for life-altering illness
and disease.
 INTRODUCTION
• Nutrition includes all those processes of a
living being whereby it takes food, digests it,
and utilizes the digested materials for
• (i) its survival, (ii) growth, and (iii) repair of
worn-out parts the body.

• Digested and assimilated materials become the

food for cells.
INTRODUCTION OF TERMS- DEFINITION

• Nutrition is defined as the science of food

and its relationship to health.

• It is the study of nutrients and processes by

which they are used by the body.

• It is concerned with the part played by

nutrients in the body growth , development
and maintenance.
INTRODUCTION OF TERMS- DEFINITION
• Nutrition is the selection and preparation of
foods, and their ingestion to be assimilated by
the body.

• By practicing a healthy diet, many of the

known health issues can be avoided.

• The diet of an organism is what it eats, which

is largely determined by the perceived
palatability of foods
INTRODUCTION OF TERMS-
DEFINITION

Nutrition may be defined as the

utilization of food by living organisms.

Nutrition significantly promotes

man’s development , his health and
welfare.
INTRODUCTION OF TERMS- DEFINITION
• Dietitians are health professionals who
specialize in human nutrition, meal
planning, economics, and preparation.

• They are trained to provide safe,

evidence-based dietary advice and
management to individuals (in health and
disease), as well as to institutions.
 INTRODUCTION OF TERMS-
DEFINITION

Food : Vital for human existence.

Food may be defined as anything eaten
or drunk , which meets the needs of
tissue building , regulation and
protection of the body and its energy
needs.
 INTRODUCTION OF
TERMS- DEFINITION

 Diet : - refers to whatever people

eat, drink each day.

 The word “ nutrition “ is derived

from ‘nutricus’ meaning to suckle.
 INTRODUCTION OF TERMS- DEFINITION
• HEALTH – It is the state of complete physical, mental and emotional well
being and not merely the absence of disease or infirmity.

• NUTRIENTS – These are the components of food that help to nourish the
body. The basic nutrients are CHO, proteins, vitamins, lipids (fats),
minerals and water.

• NUTRITIONAL STATUS – It is the condition of the body as it relates to

consumption and utilization of food.
 Malnutrition : - a
pathological state resulting
INTRODUCTION Under nutrition
from a relative or absolute
deficiency or excess of one or
OF TERMS- more essential nutrients .
DEFINITION
Over nutrition

Imbalance

It comprises four forms –

Specific deficiency
• Malnutrition : It comprises four forms –
• Under nutrition - A condition which results when insufficient food is eaten
over an extended period. In extreme cases it is called starvation.
• Over nutrition - Pathological state resulting from the consumption of
excessive quantity of food over an extended period of time. Eg ; obesity,
atheroma and diabetes.

INTRODUCTION OF TERMS
• Malnutrition : It comprises four forms –
• Imbalance - Pathological state resulting from a disproportion among
essential nutrients without the absolute deficiency of any nutrients.
• Specific deficiency - A pathological state resulting from a relative or
absolute lack of an individual nutrient.

INTRODUCTION OF TERMS
 HISTORY

• The first recorded dietary advice,

carved into a Babylonian stone
tablet in about 2500 BC, cautioned
those with pain inside to avoid
eating onions for three days.
 HISTORY

• Scurvy, later found to be a vitamin

C deficiency, was first described in
1500 BC in the Ebers Papyrus1.

• According to Walter Gratzer, the

study of nutrition probably began
during the 6th century BC.
1. Egyptian compilation of medical texts
 HISTORY

 Food was classified into "hot" (for

example, meats, blood, ginger, and hot
spices) and "cold" (green vegetables) in
China, India, Malaya, and Persia
 HISTORY

 Hippocrates, who recognized and was

concerned with obesity, which may have been
common in southern Europe at the time, said,
"Let food be your medicine and medicine be
your food.“

 The book - Corpus Hippocraticum, called for

moderation and emphasized exercise.
 HISTORY
• Hippocrates also said A wise man should consider that
health is the greatest of human blessings.

• One story describes the treatment of eye disease, now

known to be due to a vitamin A deficiency, by
squeezing the juice of liver onto the eye.

• Vitamin A is stored in large amounts in the liver.

 HISTORY
• 1747 Dr. James Lind, a physician in the British Navy, performed the first
scientific experiment in nutrition.
• At that time, sailors were sent on long voyages for years and they
developed scurvy.
• In his experiment, Lind gave some of the sailors sea water, others vinegar,
and the rest limes.
• Those given the limes were saved from scurvy. As Vitamin C was not
discovered until the 1930s, Lind didn’t know it was the vital nutrient.
 HISTORY
• Early 1800s It was discovered that foods are composed primarily of
four elements: carbon, nitrogen, hydrogen and oxygen, and methods
were developed for determining the amounts of these elements.

• 1930s William Rose discovered the essential amino acids, the building
blocks of protein.
HISTORY
• 1940s The water soluble B and C vitamins were identified

• 1950s to the Present -- The roles of essential nutrients as part of bodily

processes have been brought to light. For example, more became
known about the role of vitamins and minerals as components of
enzymes and hormones that work within the body
 HISTORY
 It is a new field of study , about one hundred
years old.

 Hippocrates had recognized diet on a

component of health - 300 B C.

 People began to realize the importance of

CHO, LIPIDS and PROTEINS for normal
growth and development.
 HISTORY
 Nutrition was officially recognized as an
independent field of study in 1928 with the
formation of American Institute of Nutrition.

 Nutrition research tries to find out the impact

of food on our body by examining the progress
in allied fields , such as physics, chemistry,
biochemistry, immunology
 Vitamin A – 1913
HISTORY Vitamin C - 1919
Vitamin D - 1925
Vitamin K - 1935
DISCOVERY OF
Vitamin B2 - 1935
V I TA M I N S
Vitamin E - 1936
Vitamin B1 – 1936
Vitamin B6 - 1936
Vitamin B9 - 1948
CONCEPTS

• NUTRITION

• DIETETICS

• FOOD

• DIET
 CONCEPT - NUTRITION

• Nutrition is defined as the science of food and its

relationship to health.

• It is food at work in the body.

• It includes everything that happens to food.

 CONCEPT - NUTRITION

• It is the study of nutrients and processes by

which they are used by the body.

• It is concerned with the part played by

nutrients in the body growth, development
and maintenance.
 CONCEPT - DIETETICS

• Dietetics are the practical application

of the principles of nutrition, which
includes planning of meals for the
healthy as well as the sick.
 CONCEPT - DIETETICS

• Good nutrition means maintenance of

nutritional status that enables us to
grow well and enjoy good health.
CONCEPT - FOOD

 Food is vital for human existence

just as air and water.
 Food may be defined as anything
eaten or drunk, which meets the
needs of tissue building,
regulation and protection of the
body and its energy needs.
CONCEPTS - FOOD
• Food: Raw material from which
bodies are made.
• Intake of right kinds and amounts
can ensure good nutrition and
health - evident in one’s
appearance, well-being and
efficiency.
CONCEPTS - DIET

Diet: Diet refers to whatever people eat,

d r i n k e a c h d a y.
CONCEPTS - DIET

• It includes the normal diet people

consume and the diet people consume
in groups (hotel diet), but will also be
modified for the sick as part of their
therapy (diet therapy).
R O L E O F N U T R I T I O N I N M A I N TA I N I N G H E A LT H

1. Growth

5. Giving 2. Release of
resistance Nutrition is
Energy
required
for the
following
purposes

4. Regulating 3. Formation
Metabolic of Organic
Processes substance
R O L E O F N U T R I T I O N I N M A I N TA I N I N G H E A LT H

2.
1. Release
Growth ♣ For the regular
multiplication and increase in of ♣ Energy needed for
size of Body cells & Energy ingestion, digestion,
absorption, movement, co-
♣ To replace damaged and
worn-out tissues, new ordination, secretion,
protoplasm is continuously circulation, respiration, etc.
required

♣ Food helps in the ♣ Energy required for these

formation of new protoplasm processes is released by the
in the body. oxidation of food in the
protoplasm.
R O L E O F N U T R I T I O N I N M A I N TA I N I N G
H E A LT H
3.
Formation
of Organic ♣ Many organic
substance substances like
enzymes and hormones
are required by the
living beings.

♣ These are produced

from the raw materials
provided by food.
R O L E O F N U T R I T I O N I N M A I N TA I N I N G H E A LT H

4.
Regulating 5. Giving
Metabolic resistance
♣ Food is required ♣ Food is also
Processes by the organisms helpful in building
for various other up the resistance
metabolic activities. against diseases..

♣ For maintaining
and repairing ♣ Nutrition is
various parts, the classified into two
food provides basic types - autotrophic
raw materials. and heterotrophic
ROLE OF NUTRITION IN
M A I N TA I N I N G H E A LT H
Primary importance as

• It is fundamental for own health.

• It is essential for the health and well-being of

patients and clients from the time of eating
till it is utilized for various functions.
ROLE OF NUTRITION IN
M A I N TA I N I N G H E A LT H

• Nutrition helps growth and development

• Prevents malnutrition

• Resists infection

• Prevents diseases
R O L E O F N U T R I T I O N I N M A I N TA I N I N G H E A LT H

• Proper nutrition supports wellness

• Wellness is more than the absence of
disease
• Physical, emotional, and spiritual
health
• Active process
 NUTRITIONAL
PROBLEMS IN INDIA
 M A J O R H E A LT H P R O B L E M S I N I N D I A
• COMMUNICABLE DISEASE PROBLEM

• POPULATION PROBLEM

• ENVIRONMENTAL SANITATION PROBLEM

• MEDICAL CARE PROBLEM

• NUTRITIONAL PROBLEM
 NUTRITIONAL PROBLEMS IN INDIA
• World’s poverty results because of chronic and persistent hunger.

• Under – nutrition results from inadequate intake of food or more

essential nutrients resulting in deterioration of physical growth and
health.

• Under nutrition – manifests among large sections of the poor particularly

among women and children.
NUTRITIONAL PROBLEMS IN INDIA
• The adequacy of food and nutrients needed to maintain good health,
growth, physical activity, work levels – that are socially necessary.

• Under nutrition – reduces work capacity, productivity among adults,

enhances mortality (death) and morbidity (disease) among children.

• Reduced productivity – translated in terms of reduced earning capacity,

leading to further poverty, and vicious cycle go on
 NUTRITIONAL PROBLEMS IN INDIA

• 75% of preschool children suffer from iron deficiency anemia. (Indian

Diatetic Association (IDA)

• 57% of preschool children have sub-clinical Vitamin A deficiency (VAD)

• Iodine deficiency is endemic in 85% of districts

• 11% of Indian population in India are over-nourished

 NUTRITIONAL PROBLEMS IN INDIA
• Over 30 million people with diabetics in 1985 and by next year (2010) India
is projected to have 50.8 million diabetics

• India is hence considered as the country with the largest population of

diabetics
 Low intake of
Poverty food and
nutrients

Under nutrition repeated insults

Low earning
from nutrition related diseases &
capacity
VICIOUS CYCLE Infections
OF POVERTY
AND
MALNUTRITION

Stunted
Impaired development of
Productivity children and growth
faltering
Small
body size
of adults
 CAUSE OF NUTRITIONAL PROBLEM

• POOR NUTRITION
• UNDER NUTRITION (MALNUTRITION)
• OVERNUTRITION
 CAUSE OF NUTRITIONAL PROBLEM
• The World Bank estimates that India is ranked 2nd in the world of the
number of children suffering from malnutrition.

• Undernutrition is found mostly in rural areas.

• 10% of villages and districts accounting for 27-28 % of all underweight

children.

• Children of scheduled tribes have the poorest nutritional status and the
highest wasting.
 DETERMINANTS OF MALNUTRITION

• MATERNAL MALNUTRITION • FREQUENT INFECTIONS

• LOW BIRTH WEIGHT • LARGE FAMILIES

• FAULTY CHILD FEEDING • HIGH FEMALE ILLITERACY

PRACTICES • TABOOS AND SUPERSTITIONS
• DIETARY INADEQUACY
  
FAC TO RS AF F EC T I N G N U T RI T I O N AL S TATU S
 HIGH RISK GROUP

• Pregnant women • Adolescent girls

• Lactating women • Elderly
• Infants • Socially deprived
• Preschool children
 NUTRITIONAL PROBLEMS IN INDIA

1 PROTEIN ENERGY MALNUTRITION

2 LOW BIRTH WEIGHT

3 XEROPHTHALMIA

4 NUTRITIONAL ANEMIA

5 FLUROSIS
 NUTRITIONAL PROBLEMS IN INDIA

6 LATHYRISM

7 OBESITY

8 CARDIO VASCULAR DISEASES

9 DIABETES

10 CANCER
1. PROTEIN–ENERGY MALNUTRITION

• Protein–energy malnutrition (or protein–calorie

malnutrition) refers to a form of malnutrition where there is
inadequate protein and calorie intake

• PEM refers to the deficiency of energy and protein in the

body.

• It is considered as the primary nutritional problem in India

1. PROTEIN–ENERGY MALNUTRITION
• PEM is due to the “food gap” between the intake and
requirement

• Causes childhood morbidity and mortality

• 1-2% of preschool children in India suffer from PEM.

1. PROTEIN–ENERGY MALNUTRITION

KWASHIORKOR

PE MARASMUS
M
MARASMIC -
KWASHIORKOR
1. PROTEIN–ENERGY MALNUTRITION
CAUSES AND RISK FACTORS CONTRIBUTORY FACTOR

• Inadequate intake of food • Poor environmental Hygiene

• Large family size
• Diarrhea
• Poor maternal health
• Respiratory infections
• Failure of lactation
• Measles
• Premature termination of breast
• Intestinal worms
feeding
• Infants and pre-schoolers • Delayed supplementary feeding
• Use of over diluted cow’s milk
KWASHIORKOR

• Kwashiorkor is the most common and

widespread nutritional disorder in
developing countries.

• It is a form of malnutrition caused by

not getting enough protein in the diet.
 KWASHIORKER
• Kwashiorker occurs in children between 2-3 years
of age

• Acute form of PEM due to deficiency of protein in

the diet (Both in quantity and quality)

• Deficiency of micronutrients (Fe, Folic acid,

Iodine, Selenium, and Vitamin C)
 KWASHIORKOR

• Deficiency of antioxidants (albumin, vitamin E,

Polyunsaturated Fatty Acid, glutathione).

• Kwashiorkor is identified as swelling of the

extremities and belly, which is deceiving to their
actual nutritional status.
• Malnourished child with pedal edemas, K WA S H I O R K E R
• Growth failure, Moon face,
• Distended abdomen,
• Ascitis (abnormal accumulation of fluid)
• Enlarged liver with fatty infiltrates, thinning of hair,
• Loss of teeth,
• Skin depigmentation
• Dermatitis, Irritability, Anorexia
 MARASMUS

• Marasmus is a severe form of malnutrition that

consists of the chronic wasting away of fat,
muscle, and other tissues in the body.

• Malnutrition occurs when the body does not get

enough protein and calories.
 MARASMUS

• This lack of nutrition can range from a

shortage of certain vitamins to complete
starvation.

• It is one of the most serious forms of protein-

energy malnutrition (PEM) in the world.
 MARASMUS
Extensive tissue and muscle wasting
Dry skin, Fat wasting, small for age
Loose skin folds hanging over gluteus and axilla,
Sparse hair that is dull brown or reddish yellow,
Mental retardation
Behavioral retardation,
Low body temperature (hypothermia),
 Slow pulse and breathing rates.
Absence of edema
MARASMIC - KWASHIORKOR
• A malnutrition disease, primarily of children,
resulting from the deficiency of both calories
and protein.

• The condition is characterized by severe tissue

wasting, dehydration, loss of subcutaneous fat,
lethargy, and growth retardation.
 C O M PA R I S O N O F
MARASMUS - KWASHIORKOR
KWASHIORKOR MARASMUS
• Some causes - Acute illness/infections, • Severe prolonged starvation,
measles, Acute Gastro Enteritis (AGE), chronic/recurring infections
trauma, sepsis are
• Calories and protein are principal nutrients
• Protein is principal nutrient
• 6 months to 2 years
• 18 months to 3 years
• Chronic, slow onset
• Rapid, acute onset
• Severe weight loss
• Some weight loss
• Low mortality unless related to underlying
• High mortality disease condition
 C O M PA R I S O N O F C L I N I C A L F E ATU R E S
KWASHIORKOR MARASMUS
• Edema, pot belly, swollen legs • No edema
• Mild to moderate growth retardation • Weight loss up to 40% Severe growth failure
• Weight masked by edema • Severe emaciation
• Low subcutaneous fat • Severe loss of subcutaneous fat
• Muscle atrophy, Round face (moon face) • Severe muscle atrophy
• Dry, flaky peeling skin • Wrinkled face (old man’s face)
• Thin dry easily plucked hair • Rare skin changes, Common hair changes
• Enlarged liver, Xerophthalmia • Mildly enlarged liver
• Anemia, diarrhea, infection • Anemia, diarrhea, infection
 PREVENTIVE MEASURES OF PEM
• Oral rehydration therapy helps to prevent dehydration caused by diarrhea

• Exclusive breast feeding for 6 months there after supplementary foods

may be introduced along with breast feeds

• Immunization for infants and children

• Nutritional supplements
 PREVENTIVE MEASURES OF PEM
• Health promotion & correction of feeding practices
• Low-cost weaning food,
• Nutrition education, Periodic surveillance
• Family planning and birth spacing,
• Protein energy rich food (milk, egg, fresh fruits),
• Early diagnosis and treatment
• Nutritional Rehabilitation
 
 LOWBIRTH WEIGHT
• Birth weight less than 2500Gm.30% 0f babies born in India
are LBW 33
35 30
30
PER CENT 23
25 20
18
20 16

15 11
2
7.
10
5
0
l a ar es a n ia
pa di v k ta s nd
e In nm ld
i an u
on
e il a
N a a iL Bh a
M
y M Sr
In
d Th
L O W B I RT H W E I G H T - C AU S AT I V E FAC TO R S
• Maternal malnutrition and anemia.

• Illness and infections during pregnancy,

• High parity,

• Close birth intervals

 FAC TO R S M O D I F Y I N G P R E VA L E N C E O F L B W
• More Institutional deliveries

• Improving No.of ANCs (minimum: >5)

• Improving Quality of ANC

Includes: Number of ANCs, Inj. TT, weight, BP, Examination of blood,

Examination of urine
 Vit A Deficiency

• Disease due to deficiency of Vitamin A

• Also Called Xeroma

• Absence of tears

• Xerophthalmia is most common in children

aged 1-3 years

• Cornea and conjunctiva become horny and

necrotized
 BITOT’S SPOTS

• Collection of dried epithelium,

microorganisms etc. forming shiny
grayish white spot on the cornea

•A sign of Vitamin A deficiency

 K E R AT O M A L A C I A

• Ulceration and softening of

Cornea due to deficiency of
vitamin A
B I L AT E R A L B L I N D N E S S
 R I S K FA C T O R S

• Ignorance

• Faulty feeding practices

• Infections

• Diarrhea

• Use of skimmed milk (totally devoid of vitamin A)

 PREVENTION

• Short term action – oral Administration of large dose of Vitamin A (retinol

Palmitate)

• Medium term action – Food fortification with Vitamin A. Eg: Dalda,

Sugar, Salt, Tea etc

• Long term action – Promote BF, consumption of Green Leafy Vegetables,

Immunisation to infections
 NUTRITIONAL ANEMIA

• A Condition in which the Hb content of

blood lower than normal as a result of a
deficiency of one or more essential
nutrients

• Primarily due to lack of absorbable

iron in the diet
 ANAEMIA IN FEMALES IN INDIA

95

90

85

80
Percent

75

70
84.6 92
65

60

55 Adolescent girls
50
Pregnant Women
CAUSES OF IRON DEFICIENCY ANEMIA

• Inadequate intake of iron

• Poor bioavailability (only less than 5 percent is

absorbed)

• Excessive loss of iron (menstruation, repeated

pregnancies, hookworm infestations, other
illnesses)
 EFFECTS OF ANEMIA

• Increases the risk of maternal and fetal

mortality and morbidity

• Increase susceptibility to infection due to

impaired cellular response and immune
functions

• Reduction of work performance and

productivity
 INTERVENTIONS

• Iron and folic acid supplementation

• Nutritional anemia prophylaxis programme (daily Fe &

folic acid supplementation to Pregnant Women lactating
mothers & Children under 12 years)

• Iron fortification - Fortification of salt with iron

• Control of parasite and nutrition education

 IODINE DEFICIENCY DISORDERS (IDD)

• IDD refers to a spectrum of disabling

conditions arising from an inadequate
dietary intake of iodine.

• IDD affects the health of humans from

fetal stage to adulthood.
CAUSES OF IDD
Deficient iodine Intake – Consuming foods with
low Iodine content, Crops grown in iodine
depleted soil.

Increased demand for Iodine in the body –

Demand of Iodine is increased during the stage
of rapid growth (Infancy, Puberty, pregnancy,
lactation), Demand exceeds supply results in
deficiency.

Presence of Goitrogens – goiter producing

substances naturally present in some foods
(cabbage, cauliflower etc.) interfere with Iodine
utilization.
 IODINE DEFICIENCY DISORDERS (IDD)

• Endemic Goiter
• Cretinism
 ENDEMIC GOITER
•Also called Derbyshire Neck

•Enlargement of thyroid gland causing

swelling in front part of the neck

•Due to lack of iodine in the diet

•Goiter belt – Himalayan region

•Graded from 0 – 4

•Common among girls than boys

 CRETINISM
• Severe form of IDD
• Occurs during fetal stage
• Interfere with brain development causing brain damage and death
• Result in Growth failure, MR, Speech and hearing defects
 FLUROSIS

• Occurs due to consumption of excessive amount of fluorine through drinking

water

• Two types of flurosis

Dental Flurosis

Skeletal flurosis
 D E N TA L F L U R O S I S
• Seen in children 5- 7 years of age
• Teeth lose their shiny appearance and chalk white
patches develop on them
• Changes are called mottling of enamel
• In severe cases loss of enamel gives teeth a
corroded appearance
• Dental flurosis is confined to permanent teeth and
develops only during the period of formation
 S K E L E TA L F L U R O S I S
• Seen in older adults

• Heavy fluoride deposition on skeleton

• Manifested as pain numbness &tingling sensation of the

extremities, stiffness of neck

Genu Valgum

• A form of skeletal deformity associated with flurosis

• The lower limbs appear as knock kneed due to

osteoporosis.
 PREVENTION OF FLUROSIS

• Keep the drinking water fluorine level below 1mg/lit

• Defluorination of water using Nalgonda Technique (Flocculation,

Sedimentation & filtration)

• Prevent use of fluoride toothpaste in areas of endemic flurosis

L AT H Y R I S M

• Disease occur by consuming large quantities of

Lathyrus sativus (Kesari dhal)

• Lathyrism in human is referred as Neurolathyrism

• The disease presents as Crippling disease of nervous

system characterized by gradually developing
spastic paralysis of lower limbs
 L AT H Y R I S M
• It contains a toxin called Beta oxalyl amino Alanine (BOAA)
• Lathyrus Kesari Dhal) is good source of protein.
• It is relatively cheaper.
Removal of toxin INTERVENTION
• Steeping method
• Soaking the pulse in hot water for about 2 hours and the soaked water is
drained off completely

• Genetic Approach
• Development of low toxin varieties of Lathyrus

• Banning the crop

• The Prevention of food adulteration act in India has banned Lathyrus in all
forms
 OBESITY
• Most Prevalent form of malnutrition

• Abnormal growth of adipose tissue due to enlargement of fat cells

(Hypertrophic), Increase in no. of fat cells (hyperplasic)or Combination of both
 OBESITY
• Obesity - When the body weight is 20% more than the desirable
weight.

• Over weight - When the body weight is between 10-20% more

than the desirable weight
FAC TO R S CO N T R I B U T I N G TO O B E S I T Y
• Age, sex, Genetic factors, physical inactivity
• Socio economic status
• Eating habits, psychosocial factors, alcohol
The direct cause of overweight in India is
• Lack of physical activity due to sedentary lifestyle,
• Loss of traditional diet,
• Faulty diet, high stress
• High rate of economic growth
 BMI
BMI = Height in kilogram
(Weight in Meter)2

20-25 IDEAL
26-30 OVERWEIGHT
31-40 OBESE
40+ VERY OBESE
 CONTROL OF OBESITY
• Eat food according to body’s requirement
• At least 3-4 hrs intervals between meals
• Avoid in between snacks
• Eat more leafy vegetables which contain high fiber
• Avoid intake of fatty and fried foods
• Regular Physical exercise
 CARDIO VASCUL AR DISEASES

• Classified as one of the Food habit related Illness

• Change in food habits and lifestyle has increased the risk of CVD in
Indian population mostly in Middle Class and upper middle class
groups.
 CANCER
80 % of cancer due to environmental factors
• Dietary fat – positive correlation with Colon cancer, breast cancer
• Dietary fiber – Risk of colon cancer is inversely related
• Micronutrients – Lack of Vitamin C & Vitamin A arise the risk of stomach
cancer and lung cancer.
• Food additives – Saccharin, cyclamate, Coffee, aflatoxin associated with
bladder cancer
• Alcohol – liver cancer, Rectal Cancer
N AT I O N AL N U T RI T I O N P O L I C Y
 N AT I O N A L N U T R I T I O N P O L I C Y ( N N P )
• The National Nutrition Policy adopted by the Government of India in 1993
under the aegis of the Department of Women and Child Development

• The strategy of NNP was a multi-sectoral strategy for eradicating

malnutrition and achieving optimum nutrition for all.
 Setting up inter sectoral
coordination mechanism at
centre, state and district levels,

Advocacy and sensitisation

Reaching nutrition NNP
IMPLEMENTATION of policy makers and
information to people STRATEGIES
programme managers

Intensifying micronutrient
malnutrition control activities
1. The implementation strategy involves  setting up Inter Sectoral Coordination mechanism at Centre, State and
District levels,  Advocacy and sensitisation of policy makers and programme managers,  intensifying
micronutrient malnutrition control activities,  reaching nutrition information to people,  establishing nutrition
monitoring and mapping at State, District and Community level, and  developing district-wise disaggregated
data on nutrition.
2. 4.  To reduce the incidence of severe (8.7 per cent) and moderate (43.8 per cent) malnutrition by half by the year
2000 A.D.  All adolescent girls from poor families to be covered through the ICDS by 2000 A.D. in all CD
blocks of the country and 50% of urban slums  To increase per capita availability of 215Kg, for that , to achieve
production targets of 230 MT by 2000  At least 100 days of employment created for each rural landless family,
employment opportunities in urban slum dwellers and urban poor  Distribution of iodized salt to cover all
endemic areas  Nutritional blindness to be completely eradicated by 2000 A.D.  To expand the Nutrition
intervention net through ICDS so as to cover all vulnerable children in the age group 0 to 6 years.
COMMUNITY NUTRITION
PROGRAMMES
I N T E G RAT E D C H I L D D E V E L O P M E N T S E RV I C E ( I C D S )
SCHEME 
• Integrated Child Development Service (ICDS) scheme was launched on 2nd
October, 1975 (5th Five-year Plan) in pursuance of the National Policy.

• For Children started in 33 experimental blocks

I N T E G RAT E D C H I L D D E V E L O P M E N T S E RV I C E ( I C D S )
SCHEME 
• Success of the scheme led to its expansion to 2996 projects by the end of
March 1994.

• The goal (Ninth Five Year Plan 1997-2002) is universalization of ICDS

throughout the country.
BENEFICIARIES (ICDS) SCHEME
1. Children below 6 years

2. Pregnant and lactating women

3. Women in the age group of

15-44 years

4. Adolescent girls
 OBJECTIVES (ICDS) SCHEME

1. Improve the nutrition and health status of

children in the age group of 0-6 years

2. Lay the foundation for proper

psychological, physical and social
development of the child;
 OBJECTIVES (ICDS) SCHEME

3. Effective coordination and implementation

of policy among the various departments.

4. Enhance the capability of the mother to

look after the normal health and nutrition
needs through proper nutrition and health
education.
 1. Supplementary
nutrition, Vitamin-
A, Iron and Folic
8. Convergence of Acid
other supportive
services like water 2. Immunization
supply, sanitation,
etc

7. Pre-school The Package

education of of services
children in the age 3. Health check-ups
group of 3-6 years, provided by
and ICDS

6. Nutrition and
health education to 4. Referral services
women
5. Treatment of
minor illnesses
 V I TA M I N A P R O P H Y L A X I S P R O G R A M M E ( 1 9 7 0 )
• Programme launched by Ministry of H&FW

• Component of National programme for control of blindness.1968,1976

• Single massive dose of oily preparation of vitamin A containing

• 200000 IU orally
• To all preschool children in the community
• Every 6 months through peripheral health workers
 PROPHYLAXIS AGAINST NUTRITIONAL ANAEMIA
• Launched by Govt. of India during 4th five-year plan

• Distribution of iron and folic acid tablets to pregnant women and

young children (1-12 years

• MCH centres and ICDS projects implement this programme

 SCHEME FOR ADOLESCENT GIRLS (KISHORI
SHAKTI YOJNA)
• A scheme for adolescent girls in ICDs was launched by the
Department of Women and Child Development, Ministry of
Human Resource Development in 1991.

• Targeted All adolescent girls in the age group of 11-18 years

 1. Watch over
menarche 

7. Referral to PHC. 2. Immunization

District hospital in
case of acute need.

Common
Services of
6. Prophylactic KISHORI
measures against 3. General health
anemia, goiter, SHAKTI check-ups once in
vitamin deficiency, YOJNA every six-months
etc.,

4. Training for minor

5. De-worming
ailments
 IODINE DEFICIENCY DISORDER PROGRAMME
• Launched in 1962

• Focuses on
• Use of Iodized Salt – Replace of common salt with iodized salt, Cheapest
method to control IDD.
• Use of Iodized tablets – iodine tablets administered to school children (not
widely accepted)
 IODINE DEFICIENCY DISORDER PROGRAMME
• Use of Iodized oil – 1ml Injection of Iodized oil to those suffering from IDD,
Oral administration as prophylaxis in IDD severe areas.

• Mass communication – Public awareness through mass media and public

health programmes
 M I D - D AY M E A L P RO G RA M M E
• Also known as School launch programme
• Programme in operation since 1961
• Objective
• To attract more children for admission to schools
 P R I N C I P L E S O F M I D D AY M E A L P RO G RA M M E
• The meal should be supplement and not a substitute to home diet.
• The meal should supply at least one third of the total energy requirement and
half of the protein needed
• The cost of meal should be reasonably low.
• The Meal should be prepared easily in schools, no complicating cooking
procedures involved
• Locally available foods should be used
• The menu should be frequently changed
 M I D D AY M E A L P RO G RA M M E
R E C O M M E N D AT I O N S

• Cereals 75 gm/day/child

• Pulses 30 gm/day/child

• Oils and fats 8 gm/day/child

• Leafy vegetables 30 gm/day/child

• Non leafy vegetables 30 gm/day/child

 B A LWA D I N U T R I T I O N P RO G RA M M E

Nutritional support to pre school children

• Started on 1970 Under the Department of Social welfare
• For children age group 3-6 years in rural areas
• Programme implemented through Balwadis
• Food supplement
• 300kcal and 10grams of protein per child per day
 NAT I O NAL P RO G RAM M E FO R N U T RI T I O N S U P P O RT
TO P RI M ARY ED U C AT I O N

• This system was called provision of ‘dry rations’.

• Government of India will provide grains free of cost and the States will
provide the costs of other ingredients, salaries and infrastructure

• On November 28, 2001 the Supreme Court of India gave direction that made
it mandatory for the state governments to provide cooked meals instead of
‘dry rations.
 AK S H AYA PAT RA AN D P RIVAT E S EC TO R
PA RT I C I PAT I O N I N M I D - DAY M E A L S
• Successfully involved private sector participation
in the programme

• The programme is managed with an ultra modern

centralized kitchen that is run through a
public/private partnership.

• Food is delivered to schools in sealed and heat

retaining containers just before the lunch break
every day.
 EMERGENCY FEEDING PROGRAMME 2001
• This was introduced in May, 2001 in selected states (Orissa)

• Emergency Feeding Programme, is a food-based intervention

targeted for old, infirm and destitute persons belonging to BPL
households to provide them food security in their distress
conditions.

• Cooked food containing, rice- 200gms, Dal (pulse)- 40 gms,

vegetables- 30 gms is provided in the diet of each EFP beneficiary
daily by the Government.
 VILLAGE GRAIN BANKS SCHEME

• Implemented by the Ministry of Tribal Affairs

• To provide safeguard against starvation during the period of natural

calamity or during lean season when the marginalized food insecure
households do not have sufficient resources to purchase rations.
 W H E AT B A S E D N U T RI T I O N P RO G RA M M E ( W B N P )
• Implemented by the Ministry of Women & Child Development

• Providing nutritious/ energy food to children below 6 years of age and

expectant /lactating women from disadvantaged sections

• Implemented through ICDS

 SC/ST/OBC HOSTELS

• Introduced in October, 1994 by Ministry of Consumer Affairs, Food & Public

• The residents of the hostels having 2/3rd students belonging to SC/ST/OBC 

are eligible to get 15 kg food grains per resident per month.
 SAMPOORNA GRAMIN ROZGAR YOJANA

• 50 lakh tones of food grains is to be allotted to the States/UTs

free of cost by Ministry of Rural Development
 N AT I O N A L F O O D F O R W O R K P RO G RA M M E
• To provide supplementary wage employment and food
security

• Implemented in tribal belts.

• The scheme will provide 100 days of employment at

minimum wages for at least one able-bodied person from
each household in the country
  
PULSE MISSION

• Pulse production has been stagnant for five decades.

• Pulse mission (India’s Food Security Mission) aimed at increasing pulse

production.
• Aimed to improve pulse production by 2 million tones by 2011-12
N AT I O N A L WAT E R S U P P LY A N D S A N I TAT I O N
PROGRAMME

• Launched in 1954

• Provide safe water supply and adequate drainage facilities for the
entire urban and rural population of the country
 MINIMUM NEEDS PROGRAMME
• Launched on 1974 with the objective of
• To provide basic minimum needs and thereby improve the living standards
of people
• It Includes
• Rural Health, Rural water Supply, Rural electrification
• Elementary education
• Adult education, Nutrition
• Environmental improvement of urban slums
• House for landless laborers
 20 POINT PROGRAMME 1975

Objectives:

• Eradication of poverty,

• Raising productivity,

• Reducing inequality,

• Improving quality of life.

• National Children's Fund 1979
This Fund Provides support to the voluntary organizations that help the
welfare of children.
• National Plan of Action for Children1990
• United Nations Children's Fund
• National Rural Health Mission2005-2012
 National Rural Health Mission 2005-2012
• Reduce the infant mortality rate (IMR) and the maternal mortality ratio (MMR)
• To have universal access to public health services
• Prevent and control both communicable and non-communicable diseases,
including locally endemic diseases
• To have access to integrated comprehensive primary healthcare
• Create population stabilization, as well as gender and demographic balance
• Revitalize local health traditions and mainstream AYUSH
• Finally, to promote healthy life styles
 INDIRECT PROGRAMMES

• NATIONAL CANCER CONTROL PROGRAMME 1975-76

• NATIONAL DIABETES CONTROL PROGRAMME

• POVERTY ALLEVIATION PROGRAMMES
• ENVIRONMENTAL SANITATION
• PROTECTED WATER SUPPLY PROGRAMME
• LITERACY PROGRAMME