Nutrition And Health

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Nutrition And Health

ByProf. Drs Asmaa Abdel Aziz Alla Hassan

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This chapter includes Section I Diet
Planning Section II assessment of Nutritional
status Section III Malnutrition
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Diet Planning
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Diet Planning

• It is the determination of the quantity the
  quality of diet to be consumed by individual.

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• Factors to be considered during diet planning
• A- Factors related to the individuals themselves
• Age and Sex
• Body weight and surface area which affect the
  BMR
• Physiological conditions which reflect the need
  during growth of the children, pregnancy and
  lactation.
• Level of activities.
• Pathological conditions
• BMR decreases in starvation, malnutrition and
  hypothyroidism
• BMR increases in fever (an increase in the body
  temperature by one-degree increases BMR by 13).

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B-Factors related to the environment In hot
climate, individuals need less calories and more
salts and fluids than in cold ones. In cold
regions more caloric food is required.
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C-Factors related to the diet itself The
food should - fulfill the qualitative and
quantitative requirements of the individual. - be
palatable and satisfy the food habits of the
individuals. - be variable from meal to meal - be
free from infectious agents and toxins. - be
digestable and of sufficient size to allay hunger.
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• - Its nutrients should be of certain proportion
  to get best benefit. Examples
• - Less fat intake affects the absorption of fat
  soluble vitamins.
• Vitamin C facilitates iron absorption
• vitamin D facilitates calcium absorption..
• - Excess sugar causes dental carries.

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Methods of diet Planning Quantitative
Method Qualitative Method.
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Quantitative Method of diet planning Determine
the daily caloric requirements Energy is
important for body function growth. There
should be an energy balance between energy intake
and energy output. Energy imbalance leads to
malnutrition in the form of under nutrition or
over nutrition. The energy value of foods is
expressed in terms of kilocalories (Kcal). The
dietary sources of energy are fats, carbohydrates
and proteins
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They supply energy at the following order
One gm. Fat 9 kcal/g
One gm Carbohydrate 4 kcal/g
One gm Protein 4 kcal/g
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• The energy requirement of an individual is
  defined as the amount of energy that an
  individual takes from food in order to keep
  healthy and active.
• Energy is required for
• The basal metabolism
• Daily activities e.g. walking, sitting, standing,
  dressing, climbing stairs etc.
• 3. Occupational work light, moderate and heavy
  work.

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Energy for basal metabolism The basal
metabolism is the energy expenditure of a person
who is completely at rest (relaxed and
comfortable) i.e. not moving at all, in the
morning soon after awaking and 14 hours after the
last meal. It is constant per square meter
surface area per hour. The average BMR - for
adult man is 40 kcal /square meter surface area /
hour. - for adult woman is 37 kcal / square meter
surface area/ hour. It can also be assessed by
using body weight, where the BMR is 1 kcal /one
kg body weight / hour.
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Daily Energy requirement For ages over 10
years It is based on the levels of activity
people or occupation during 24 hours. These are
called Physical Activity Levels (PAL). Daily
energy requirement BMR x PAL
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Physical activity levels (PAL) for women and men
aged 18- 60 years
Level of physical activity (PAL) Light Moderate Heavy
Women 1.56 1.64 1.82
Men 1.56 1.78 2.10
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Examples of occupations for each physical
activity level
PAL Typical occupation
Light People working in offices, students, and unemployed
Moderate Shop assistants, domestic servants, housewives, drivers
Heavy Farmers, fishermen, builders, laborers, forestry workers.
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For children (0-10 years) . Energy requirement
can be calculated using special tables which
takes into account energy needed for growth, play
and energy to fight infection.
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Qualitative Methods of diet planning A
high quality diet is the balanced diet which
contains a variety of foods that provide energy,
amino acids, vitamins, minerals, fats,
carbohydrates .
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• The best combination of foods for a balanced diet
  is as follows
• 65 of kcal comes from carbohydrates
• 25 of kcal comes from fats
• (a maximum of one third is saturated fat)
• 10 of kcal comes from proteins

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A balanced diet could be achieved through Food
groups 1-Bone building group ( as milk and milk
products cheese and ice-cream) 2-Tissue building
group (as meat, poultry, fish, eggs and
legumes) 3-Energy group (as foods rich in
carbohydrates, fats and oils) 4-Vitality or
protective group ( vegetables and fruits)
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Food guide pyramid
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Dietary requirements Protein Proteins are
needed for 1-Tissue building (growth) and tissue
repair 2-Formation of antibodies enzymes,
hormones, hemoglobin, glycoprotein etc .
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Protein requirement depends on Age Children need
more protein for growth. ( A Child needs 2-3 gms
protein/ one kg body weight/ day while adult
needs 1 gm protein /kg body weight /day) Sex
Men have more muscle and less fat than women, so
they need more protein. Body size Large-sized
people need more protein to replace more cells
tissues Pregnancy Lactation A pregnant woman
needs extra protein for the growth of the baby
and placenta and to increase her own blood and
tissues.
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Carbohydrates Carbohydrates are required
because 1-They provide the energy . Eating less
than 50 to 100 grams of carbohydrates per day
will make the body utilizes protein for
energy. 3-Carbohydrate intake is important for
fat metabolism by the liver.
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Fat Fat is needed for 1-Supplying energy where
25 of Kcal are supplied by fats 2- Improve the
taste of food, make meal less bulky but more
filling 3- It is essential for absorption of fat
soluble vitamins (A-D-E-K) 4- 7
dehydrocholesterol in the skin is the precursor
of vitamin D 5-Supporting the viscera
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• Vitamins
• Vitamins are substances necessary for the body
  in a very little quantities.
• They are essential for growth and the integrity
  of tissues and metabolism.
• They are not synthesized in the body with few
  exceptions

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1- Vitamin D is synthesized in skin by the
action of ultraviolet rays on 7
dehydrocholesterol 2-Carotenes are the
precursors of vitamin A in the body 3-Vitamin K
is synthesized in the intestines
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• Minerals
• Such as calcium, iron, iodine, fluorine etc.
  Deficiencies of minerals produce diseases in man
• Iron (Iron deficiency anemia)
• Goiter (iodine deficiency).
• Fluorine ( dental carries)
• Calcium ( osteoporosis)

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• Water
• It constitutes 70 of body weight.
• It is the main constituent of all body fluids.
• It has a role in all biological processes
  (digestion, absorption, metabolism, excretion
  etc.)
• The average intake is 2.5-4 liters or more
  according to weather, activity, occupation and
  health status.

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• Vulnerable groups
• These are groups more liable to different
  nutritional problems than the general population,
  due to their physiological status. They include
• Pregnant and lactating women.
• Infants and growing children.
• Adolescents specially girls.
• Some industrial workers.
• Elderly sick persons as they need special
  nutritional attention.

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• Pregnant and lactating women
• They are considered the most vulnerable.
• They share their nutrients with their children.
• Their BMR increases by 20 and, consequently,
  their requirements increase.
• During pregnancy women need extra kcal
• to build up their own tissues,
• to build fat stores for making breast milk
• to build the baby and the placenta..

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• Lactating mother needs more calories, proteins,
  vitamins, minerals
• Two to three months after labor, mother should be
  back to her pre-pregnancy weight

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The recommended dietary intakes
Folic acid Ug/d Iron mg/d Calcium mg/d Fat g/d Protein g/d Net energy kcal/d Body weight (kg) Activities Group
100 28 400 20 60 2425 60 Sedentary work Man
100 28 400 20 60 2875 60 Moderate work Man
100 28 400 20 60 3800 60 Heavy work Man
100 30 400 20 50 1875 50 Sedentary work Woman
100 30 400 20 50 2225 50 Moderate work Woman
100 30 400 20 50 2925 50 Heavy work Woman
400 38 1000 30 15 300 50 Pregnant woman Woman
150 30 1000 45 25 500 50 Lactation 0-6 months Woman
150 30 1000 45 18 500 50 Lactation 6-12 months Woman
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• Health consequences of maternal malnutrition
• A-Fetal effects
• Intrauterine growth retardation
• Stillbirth
• Low birth weight
• B- Maternal effects
• Maternal depletion syndrome
• 1- Iron deficiency anemia ,
• 2- protein energy malnutrition,
• 3-Iodine deficiency disorders
• 4-Osteomalacia
• Maternal infection (puerperal sepsis)
• Maternal mortality

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Indicators to assess maternal nutritional
status 1-Pre-pregnant weight and height This
is a factor affecting the size of placenta and
hence the weight of the baby. 2-weight gain
during pregnancy well-nourished women gain on
average about 12kg during pregnancy. 3-
Maternal mortality ratio
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• Industrial workers
• Malnutrition of industrial workers may lead to
  many health problems as
• Deterioration of the workers health.
• Reduction of productivity.
• Increased absenteeism.
• Decreased resistance to infections.
• Susceptibility to to accidents, which is related
  to deficiency in some nutrients such as vitamin
  B1.

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• Factors to be considered in feeding of industrial
  workers
• 1-Type of work whether light, moderate or heavy.
  Sedentary work requires fewer kcal, while heavy
  activities require more kcal.
• 2. Climatic condition
• In hot climate, there is much sweating and water
  loss, extra fluid and salt intake should be
  stressed upon.
• In cold environment more kcal are required, so,
  more fats and carbohydrates, and more frequent
  meals are needed.

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3. Working condition ( indoor, outdoor, in mines
or on mountains) 4. Exposures to toxic materials
and fumes Minerals, vitamins proteins are
needed as detoxifying nutrients
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4. Social background. Migratory workers need
special attention. workers are at lower
socioeconomic condition having improper food
habits and behavior. Thus, they require
nutritional education that may be provided in the
workplace/ restaurant and / or canteen. 5.
Adolescents, working pregnant and lactating women
may need special attention as they are
vulnerable.
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Thank You