SECTION 5
Community Nutrition
Community nutrition deals with a variety of food and nutrition issues related to individuals, families, and special groups
that have a common link in terms of a particular region, language, culture or health-related issues. This segment covers
public health nutrition, nutrition education and medical nutrition therapy. Community nutrition is gaining importance in
health promotion and disease prevention, since an individual’s behavior is influenced by the living environment, local
norms and beliefs.1
Concept of Community Nutrition1
The World Health Organization (WHO) defines community as a social group determined by geographic boundaries
and/or common values or interests. A community can also be defined on the basis of a common interest or goal.
Many successful health awareness and disease prevention efforts such as improved services and awareness of certain
community-specific problems have been possible in common-interest communities. Community nutrition initiatives aim
at involving community nutrition and dietetics professionals to provide nutrition services according to the needs of the
individuals through primary, secondary and tertiary prevention.

Primary prevention involves designing activities to prevent a disease or condition before it occurs. Public health
nutrition also focuses on the promotion of good health through nutrition, primary prevention of nutrition-related
illness and maintaining the nutritional health of populations.

Secondary prevention involves planning activities related to early diagnosis and treatment including screening for
diseases.

Tertiary prevention consists of designing activities to treat a disease state or condition such as malnutrition or
injury in order to prevent it from progressing further.
These professionals liaise with other professionals for a wide range of education and human services such as child care
agencies, social work agencies, services for older individuals, and community-based epidemiological research.
Another branch, public health and nutrition, is viewed as the scientific diagnosis and treatment of the community as
a whole. Public health is defined as the science and art of preventing disease, prolonging life and promoting health
and efficiency through organized community efforts. Thus, community nutritionists and health workers can focus on
the community strengths, which could be education, support systems, spirituality among others, and provide nutrition
knowledge to reduce healthcare costs.
Malnutrition and Its Causes
Malnutrition is a pathological state resulting from a relative or absolute deficiency or excess of one or more essential
nutrients.2 In developing countries, infection and infestation are the two main important factors involved in the causation
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Section 5: Community Nutrition
of severe malnutrition among preschool children consuming inadequate and ill-balanced diet. Broadly, the causes for
malnutrition can be categorized into three groups, namely food taboos and beliefs, infectious diseases and food hygiene.
Food Taboo and Food Beliefs
Certain food habits and beliefs are deeply entrenched in culture. Many customs and beliefs exist about food
consumption, and these generally apply to the most vulnerable groups that comprise infants, toddlers, and expectant and
lactating women. The most common determinants of malnutrition are religion, geography, tradition and changing food
habits and choices.3
Geography
Early settlers consume whatever is locally cultivated. However, rampant consumption of staple foods without much
variety could lead to protein-energy malnutrition and even certain vitamin deficiencies. For example, rice is the main
food crop in tropical countries receiving high rainfall, whereas millets are grown in abundance in areas getting low
rainfall. In such areas, the incidence of vitamin B deficiency is observed.3
Religious Beliefs
India is a country with many religions and it does exert some influence on food habits. Certain foods are not allowed in
some religions. For example, in some sects, nonvegetarian foods are shunned. It is also believed that nonvegetarian food
should not be consumed on certain days like Saturdays or Fridays. Fasting is also a common practice among people. Such
practices may cause vitamin deficiencies.3
Traditional Beliefs
Certain traditional beliefs exist about food habits among populations which are illiterate about the nutritive value of
foods. The most common food taboo is seen in pregnant women, wherein they are advised against consumption of
papaya and sesame seeds due to the risk of abortion. Certain combinations of foods are also advised against for fear of
adverse effects. It is believed that snake gourd and egg if eaten together may cause death; milk and fish if consumed
together may cause leukoderma and leprosy.3 Ayurvedic texts advice against certain food combinations as it may hamper
digestion.4 However, scientific studies are warranted before following these age-old recommendations.
Concept of Hot and Cold Foods
Foods such as meat, eggs, legumes, nuts, and oilseeds are considered ‘hot’, since they produce more heat in the body. On
the other hand, foods such as fruits, curd, vegetables and milk are considered ‘cold’.3
Food Fads and Changing Food Habits
Certain beliefs attribute great curative or preventative properties to certain foods or ingredients. Some prevalent food fads
are that beetroots help build ‘blood’, meat gives strength, raw cucumber without salt could be poisonous, curds should
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Section 5: Community Nutrition
not be consumed at night, etc. On the other hand, milling and processing of rice and flour has increased the consumption
of white rice and maida.3 Processing removes the fibre layer and also processes out the gastroprotective lipids naturally
contained within the germ.5
Faulty Feeding Habits of Mothers
There are some misconceptions regarding feeding practices in infants. Many mothers think that it would be fine to feed
cow’s milk to infants or to feed solid foods to a hungry infant before 4 months of age.6 Feeding cow milk to an infant puts
them at an increased risk for iron deficiency. In addition, cow milk protein and mineral content are too high which will
increase the renal load causing host of problems.7
The prevalence of such food fads and beliefs, especially among vulnerable groups, can contribute to nutritional
deficiencies and malnutrition. These problems can be overcome by increasing nutrition education and awareness.
Cultural changes are difficult to bring about, but by proposing simple alterations backed by scientific evidence, these
rigorous beliefs can be eventually changed.3
Infectious Diseases
Studies have found that frequent occurrence of infectious diseases such as diarrhea, dysentery or even malaria adversely
affects the health of the infant. Most field studies have identified diarrhea as the major determinant factor leading to
malnutrition in developing countries. A child suffering multiple episodes of diarrhea loses nutrients and water through
stools, and may also have malabsorption and poor appetite.8 Malnutrition, in return, reduces the immunity predisposing
to acute respiratory infections.9 Another vulnerable population is older adults, with community-acquired pneumonia
being the most common infection. World over, an estimated 90% deaths occur due to pneumonia among adults aged
over 65 years. Urinary tract infection is also one of the common sources of bacteria among this age group.10
Food Hygiene
Food hygiene is an important determinant of health, as it can lead to infections. Consumption and use of contaminated
food, milk or water can predispose one to diarrhea and in case of the vulnerable populations, it can lead to malnutrition.8
The Codex Alimentarius defines food hygiene as all conditions and measures necessary to ensure the safety and suitability
of food at all stages of the food chain. Thus, effective hygiene control is imperative to avoid adverse health events such
as food-borne illness and injury.11 The 2006 Food Safety and Standards Act consolidated all the laws related to food
safety. The Food Safety and Standards Authority in India lays down science-based standards for foods and regulates their
manufacture, storage, distribution, sale, and import.12
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Section 5: Community Nutrition
References
1.
Illinois State University Nweze Nnakwe, Community Nutrition: Planning Health Promotion and Disease Prevention, 2nd edn. Jones & Bartlett
Publishers, 2012. Available at: https://books.google.co.in/books?id=GqTYBAAAQBAJ&pg=PA4&dq=%22concept+of+community+nutrition%27&h
l=en&sa=X&ei=wsmwVJydE8rluQSsj4HgBQ&redir_esc=y#v=onepage&q=%22concept%20of%20community%20nutrition’&f=false.
2.
Srilakshmi B. Nutrition Science, 4th edn. New Delhi: New Age International Publishers, 2012.
3.
MS Swaminathan. Advanced textbook on Food and Nutrition, vol. 2, Mysore: The Bangalore Press, 2012.
4.
Vasant Lad. Food Combining. Accessed at: http://www.ayurveda.com/pdf/food_combining.pdf. Accessed on: 17 January 2015.
5.
Tovey FI, Hobsley M. Milling of wheat, maize and rice: Effects on fibre and lipid content and health. World J Gastroenterol.
2004;10(12):1695–1696.
6.
Infant Feeding Myths. Available at: http://health.mo.gov/living/families/wic/wicfamilies/education/infantfeedingmyths.php.
Accessed on: 10 January 2015.
7.
Ziegler EE. Adverse effects of cow’s milk in infants. Nestle Nutr Workshop Ser Pediatr Program. 2007;60:185–196;discussion 196–199.
8.
Srilakshmi B. Dietetics, 6th edn. New Delhi: New Age International Publishers, 2011.
9.
Rodríguez L, Cervantes E, Ortiz R. Malnutrition and gastrointestinal and respiratory infections in children: A public health problem.
Int J Env Res Public Health. 2011;8(4):1174–1205.
10. Community Infection in older adults. Available at: http://www.aafp.org/afp/viewRelatedDocumentsByMesh.htm?meshId=D017714.
Accessed on: 17 January 2015.
11. General principles of food hygiene. Codex Alimentarius 2003. Available at: www.codexalimentarius.org/input/download/standards/.../
CXP_001e.pdf. Accessed on: 16 January 2015.
12. Food Safety and Standards Act, 2006. Available at: http://www.fssai.gov.in/portals/0/pdf/food-act.pdf. Accessed on: 16 January 2015.
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