SJBU BSMLS 1B DEFINITION OF TERMS NUTRITION The study of food in relation to the health of an individual, community or society and the process through which food is used to sustain life and growth ( Claudio, 2002). FOOD - Any substance, organic, or inorganic, when ingested or eaten, nourishes the body by building and repairing tissues, supplying heat and energy, and regulating bodily processes. - Food includes articles used as drink or food, and the articles used for the component of such (FDA). FOOD GROUPS/ NUTRIENT CLASSIFICATION ACCORDING TO FUNCTION: 1. BODY BUILDING ( GROW) - includes water protein, fat, carbohydrates and minerals. 2. REGULATORY (GLOW) - They maintain homeostasis of body fluids and expedite metabolic processes. 3. FURNISH ENERGY (GO) - sometimes referred to as the "fuel nutrients". Includes carbohydrates, fat and protein. GOOD NUTRITION - The body has an adequate supply of essential nutrients that are efficiently utilized such that growth and good health are maintained at the highest possible level. MALNUTRITION - lack of one or more essential nutrients ( nutritional deficiency) - or may be due to an excessive nutrient supply to the point of creating toxic or harmful effects (e.g. overnutrition and hypervitaminosis) CAUSE OF HUNGER 1. Lack of food SJBU BSMLS 1B 2. Lack of resources to buy food 3. Lack of knowledge on proper feeding 4. Unavailability of services in community FOOD QUALITY 1. Safe to eat 2. Nutritious 3. It's palatability factors satisfy the consumer 4. It has satiety value 5. It offers variety and planned within the socio-economic context 6. Free from toxic agents FACTORS CAUSING MALNUTRITION 1. PRIMARY FACTORS - faulty diet ( nutrient intake is lacking in quality and/or quantity for a given individual. - poverty, ignorance, poor food habits, limited food supply due to over population or low food production, poor distribution of food, cultural taboos, and many other factors. 2. SECONDARY FACTOR - are multiple and all conditions within the body that reduce the ultimate supply of nutrients to the cells after the food goes beyond the mouth. - factors that interfere with normal digestions: - factors that affect metabolism and utilization in the cells. - factors that increase excretion and result in nutrient loss - physiological or pathological condition and may lead to nutritional deficiency . TYPES OF MALNUTRITION 1. UNDERNUTRITION 2. OVERNUTRITION 3. SPECIFIC NUTRIENT DEFICIENCY MACRONUTRIENTS - needed by the body in large quantities to provide energy and build tissues: 1. PROTEIN 2. CARBOHYDRATE SJBU BSMLS 1B 3. FATS PROTEINS - build and repair cells and tissues - supply energy - regulate body processes PROTEIN MALNUTRITION - EARLY SIGNS: general weakness, weight loss, reduced, resistance to infections, lethargy, and pallor . - LATER SIGNS: Edema and Dry and Scaly Skin - IN CHILDREN: growth is retarded and liver is enlarged. - PEM ( Protein -Energy - Malnutrition) - deficiency caused by prolonged malnutrition of protein as calories . 2 FORMS OF PROTEIN MALNUTRITION 1. KWASHIORKOR 2. MARASMUS DIFFERENCES BETWEEN KWASHIORKOR AND MARASMUS KWASHIORKOR - Protuberant belly - itchy rash - xerosis - poor wound healing - develops in children whose diets are deficient of protein. - it occurs in children between 6 months and 3 years of age. - Subcutaneous fat is preserved. - Oedema is present - enlarged fatty liver - ribs are not very prominent - lethargic - muscle wasting mild or absent - poor appetite - the person suffering from kwashiorkor needs adequate amounts of protein. SJBU BSMLS 1B MARASMUS - prominent bones - decrease in subcutaneous fat - loose skin - It is due to deficiency of proteins and calories - it is common in infants under 1 year of age - subcutaneous fat is not preserved - oedema is absent - no fatty liver - ribs become very prominent - alert and irritable - severe muscle wasting - voracious feeder - the person suffering from marasmus needs an adequate amount of protein, fats, and carbohydrates. DIFFERENCES BETWEEN KWASHIORKOR AND MARASMUS KWASHIORKOR - hair changes - Moon face - Thin muscles but fat is still present - edema - underweight MARASMUS - Normal hair - Old man's face - Thin muscles w/o fat - no edema - Very underweight CARBOHYDRATES - Chief source of energy - mainly as cereal grains, sugars, most fruits and starchy vegetables contribute at least half or 50% of total energy needs of people. SJBU BSMLS 1B - spares protein from being used to provide heat and energy instead of being used for building and repairing tissues. CARBOHYDRATE MALNUTRITION - FIRST CLINICAL SIGNS - decreased blood sugar level - loss of weight and retarded growth for infants and children - in severe deficiencies, the ill effects of limited total food intake result in PROTEIN ENERGY MALNUTRITION (PEM) - in excessive intake of calories, whether from carbohydrates, fats or proteins, OBESITY or ADIPOSITY becomes the problem. - if intake of fat and protein is normal, but the carbohydrates intake is lower than the recommended level to supply caloric requirements, KETOSIS or ACIDOSIS occurs. FATS - fats and lipids in the right kind kind and amount are necessary components of tissues and to regulate certain life processes. FUNCTIONS: - concentrated source of energy - structural component - supplier of essential fatty acids - carrier of fat-soluble vitamins _,_,_,_, OTHER FUNCTIONS: - has high satiety value - contributes to flavor and palatability - helps retain moistness in food products FAT MALNUTRITION - deficiency of essential fatty acids causes RETARDED GROWTH and ECZEMATOUS SKIN in infants. Excessive intake above the normal levels resulting in extra caloric supply leads to obesity. FOOD SOURCES OF FATS - The most important food sources are the VISIBLE FATS and OILS such as butter, margarine, cooking oils. SJBU BSMLS 1B - nuts, oilseeds , and some legumes, cream, cheese, whole milk, olives, chocolate, peanut butter, and fatty fish like sardines; avocado, pastries, and fried foods. MICRONUTRIENTS - needed by the body in small quantities to support important biological processes. - if our body does not get the small quantities of micronutrients needed, this may result to serious health problems - VITAMINS and MINERALS - vitamins include VITAMIN A,D,E,K and C as well as the B-complex vitamins like THIAMIN (B1), RIBOFLAVIN (B2), NIACIN (B3) , PYRIDOXINE (B6), FOLATE (B9) and CYANOCOBALAMINE (B12) - Minerals include IRON (Fe), CALCIUM (Ca), SODIUM (Na), IODINE (I), COPPER (Cu), and Zinc (Zn) VITAMIN A & VITAMIN A DEFICIENCY - vitamin A is a fat-soluble vitamin - it cannot be synthesized or made in the body - over 90% of vitamin A is stored in the LIVER . FUNCTIONS: - Vit. A is crucial for child survival. Among under five children, it significantly reduces : - The risk mortality by 23-34% - deaths due to MEASLES by about 50% - deaths due to DIARRHEA by about 40% - promotes and maintains good vision. VAD is the most important cause of preventable blindness. - promote healthy linings of the eyes and the respiratory, urinary, and intestinal tracts. ( Assignment) - essential for the normal functioning of the immune system by producing white blood cells and regulating the way other immune cells functions. - important in cell division - promotes bone growth FOOD SOURCES OF VITAMIN A 1. PREFORMED VITAMIN A - comes from animal sources and is usually in the form of retinol. SJBU BSMLS 1B - RETINOL - is readily absorbable and can be used by the body immediately. - Examples: breast milk, liver, egg yolk, whole milk, and vitamin A- fortified products 2. PROVITAMIN A CAROTENOID - comes from plants and is usually in the form of CAROTENE. this can be converted to retinol in the body. It is abundant in dark colored fruits and vegetables. - examples: fruits (mangoes, papayas, other dark orange fruits,) , yellow vegetables ( carrots, squash) - dark-green leafy vegetables (malunggay, kamoye leaves, spinach, root crops - RED PALM OIL is also a very rich source of carotene. - INCREASED risk to infection leads to XEROPHTHALMIA: - SIGNS: - night blindness - BITOT'S SPOT - foamy, soapy, whitish patches caused by the shedding of dead epithelial cells - CORNEAL XEROSIS - diminished vision even at day time - CORNEAL ULCER - KERATOMALACIA - softening and ulceration of cornea. It is in danger of rupturing CAUSES OF VAD - inadequate intake of vitamin A - non-breastfeeding - frequent illness and malnutrition ( Illness and malnutrition increases the requirement for vitamin A) PREVENTION and MANAGEMENT of VAD - exclusive breastfeeding for the first 6 months of life. - increased intake of vit.A rich foods and adequate intake of dietary fat, protein, zinc, and vit. E - Vitamin A supplementation IRON - an essential trace mineral that is needed for HEMOGLOBIN (Hb) FORMATION. FUNCTIONS: - Iron makes Hb. it prevents iron-deficiency anemia ( IDA). - It is part enzymes which help to transfer O2 within the cells. - It is needed in the synthesis of hormones that support brain development and function - Prevents maternal death from severe anemia ( associated with severe bleeding that occurs during delivery) - Increases the chances of infant survival during early childhood. SJBU BSMLS 1B SOURCES OF IRON - HEME IRON - from animal sources: liver, kidney, spleen, heart, blood, meat, chicken, and fish/shellfish. - NON-HEME IRON - iron from plant sources: legumes, cereals, dark green, leafy vegetables. IRON INHIBITORS: - Food that contains tannin, a substance found in tea and coffee. - Foods that contain phytate, a substance found in whole grains, legumes, and seeds. IRON ENHANCERS: - Meat, fish, and poultry - Organ meats - Vitamin c-rich foods and vegetables; guava, atis, pineapple, papaya, aratiles, mango, orange, dalanghita, guyabano, kamatsile, sinigwelas, suha, and tomatoes, bell pepper etc. IRON DEFICIENCY - a condition resulting from inadequate iron in the body. - It is the most common nutritional deficiency and the leading cause of anemia IRON DEFICIENCY ANEMIA (IDA) - Refers to the whole severe depletion of iron stores which results in low Hb concentration. The body cannot make enough Hb and healthy RBC because it lacks iron. CAUSES OF IDA - Lack of dietary iron intake - Poor iron absorption in the body - Increased needs for iron d/t high iron requirement for infants, adolescent girls, pregnant and lactating women - Chronic blood loss - Malaria and parasitism EFFECTS OF IDA IN INFANTS: - Long-term delayed or impaired psychomotor functions - Frequent attack of illness IN CHILDREN - Growth retardation - Impaired motor development and coordination - Decreased physical activity (easily fatigability) - Poor mental development or poor scholastic achievement - Impaired language development - Poor psychological and behavioral activity SJBU BSMLS 1B IN PREGNANT WOMEN - Premature births - Intra-uterine growth retardation and low birth weight - Reduced ability of pregnant women to survive prolonged bleeding during and after childbirth - Easy fatigability, making child labor difficult - 3.5 times more likely to die than those who are non-anemic. IN ADULTS (both sexes) - Decreased physical activity - Decreased productivity HOW ANEMIA IS DIAGNOSED: Clinical signs & symptoms: - Palmar pallor - Pale conjunctiva - Pale nail beds - Pale buccal mucosa LABORATORY TESTS: - Hb determination - Other lab tests PREVENTION & MANAGEMENT OF ANEMIA - Improve dietary intake of iron-rich foods - Consume iron-fortified foods’ - Take iron supplements - Increase consumption of vit. C-rich foods - Take deworming tablets - Improve personal hygiene - Proper health and environmental sanitation FOLATE / FOLIC ACID - A water-soluble B- vitamin - Folate is the form found in foods - Folic acid is a synthetic compound of folate and form available as a supplement. - Folate is not stored in the body in large amounts, therefore the body needs daily supply of this vitamin through diet. FUNCTIONS OF FOLATE/FOLIC ACID - Folate is involved in the synthesis of DNA - It helps to produce and maintain new cells - It is important in the normal development of the neural tube during fetal growth - Keeps blood healthy SOURCE OF FOLATE: - Organ meats SJBU BSMLS 1B - Shellfish ( tahong ,talaba, tulya, halaan, and suso) Egg yolk Legumes (mongo, red, white and black beans) Vitamin c-rich foods Green leafy vegetables Other vegetables like radish and asparagus Cereals like oats, corn, and root crops like gabi and camote CAUSES OF FOLATE DEFICIENCY IN PREGNANCY - Low nutrient intake - Increased demand during growth periods (infancy and puberty) - High demand during pregnancy and lactation - Short interval between pregnancies - High demand and high losses during multiple pregnancies EFFECTS OF FOLATE/FOLIC ACID DEFICIENCY - Megaloblastic Anemia - Neural tube defects: 1. Spina bifida - characterized by incomplete fusion of the vertebral arches with protruding sac with minges, spinal cord and nerve roots 2. Ancephaly (anencephaly) - absence of a forebrain PREVENTION OF FOLATE/FOLIC ACID DEFICIENCY: - Avoid drinking alcohol - Have a regular medical check-up during pregnancy - Take prenatal supplements, if they are prescribed - Eat well and include fresh vegetables, meat, and other sources of animal protein - Do not overlook food - Do not smoke, as smoking increases vitamin requirements IODINE - Is a mineral that is an essential component of thyroid hormones FUNCTIONS OF IODINE: Functions of thyroid hormones are categorized as: - Growth development - Important in the development of the brain and CNS during fetal growth and development - Support bone maturation processes - Control of metabolic processes - Controls carbohydrate, protein, fat and vitamin metabolism - Controls the cells O2 use - Controls body temperature SOURCES OF IODINE: SJBU BSMLS 1B - Seafoods such as fish/shellfish; dilis, tanigui, crabs, squid, clams, shrimps, tahong, kuhol, susong, pilipit, and alamang Seaweeds; ararosep, alto, pokpoklo Iodized salt Iodinated water and other iodine-fortified foods IODINE DEFICIENCY DISORDER (IDD) - IDD refers to the abnormalities that result when the body does not get enough iodine. It is the most common cause of preventable mental retardation. - These abnormalities include; goiter, miscarriage, stillbirth, congenital anomalies, growth and mental retardation, and physical and motor abnormalities. CAUSES OF IDD - Inadequate intake of iodine - Increased requirement of iodine during adolescence, pregnancy , and lactation - Consumption of food sources grown in areas with depleted levels of iodine - High intake of raw foods with high goiterogens (cassava, cauliflower, cabbage, bamboo shoots) EFFECTS OF IDD In pregnant women and the fetus: - Abortion and miscarriages - Congenital abnormalities - Stillbirth In infants and preschoolers: - Lack of iodine results to physical retardation in the form of CRETINISM ( mental retardation, squint, deaf-mutism and paralysis.) - Less neurological effects on motor and cognitive development (delayed walking, delayed speech) - Increased neonatal and infant mortality In school children: - Poor learning ability - Low motivation - Poor school performance and general cognitive function In adults: - Impaired mental function - Poor work capacity resulting in low productivity PREVENTION AND MANAGEMENT OF IDD - Increased intake of iodine-rich foods - Consumption of iodized salt SJBU BSMLS 1B - Iodine supplementation 4 GENERAL METHOD OF NUTRITIONAL ASSESSMENT 1. ANTHROPOMETRIC ASSESSMENT - Most common is the determination of height and weight. These are compared to standards. Should be repeated on an individual to note the degree of change in nutritional status over time. 2. BIOCHEMICAL ASSESSMENT - Urine and blood laboratory tests 3. CLINICAL ASSESSMENT - Physical assessment (P.E) of an individual for signs and symptoms suggestive of nutritional health and/or clinical pathology 4. DIETARY ASSESSMENT - Collection of information regarding actual and habitual dietary intake. e.g, food recall and food frequency questionnaire. HOW TO COMPUTE FOR AGE Ex: 2011 - 06 - 30 (date of weighing) 2004 - 08 - 24 ( pupils birthdate) 6 - 10 - 06 Years months BODY MASS INDEX BMI = weight (kg) / height (m2) Ex; 11 kg / (0.99’2) = 11/0.98 = 11.22 Determine BMI level using BMI charts for boys and girls BMI TABLE FOR ADULTS Category Severely underweight Underweight Normal Overweight Obese class I Obese class II Obese class III BMI range kg/m2 < 16.5 16.5 - 18.5 18.5-25 25-30 30-35 35-40 > 40 SJBU BSMLS 1B PREVENTION & MANAGEMENT OF MALNUTRITION - Eating a balanced meal - Exclusive breastfeeding for 6 months - Micronutrient supplementation; and - Food fortification SUMMARY IN PLANNING NUTRITIOUS MEAL - Balance - Variety - Moderation FILIPINO PYRAMID FOOD GUIDE EAT A LITTLE - Fats - Oils - Sugars - Salt EAT SOME - Fish poultry - Dry beans - Buts - Eggs - Lean meats - Low fat dairy EAT MORE - Vegetables - Green salads - Fruits - Juices EAT MOST - Rice - Root crops - Corn - Noodles - Breads - Cereals DRINK A LOT - Water - Clear broth SJBU BSMLS 1B
