chp310: community health program mohamed m. b. alnoor & mona m. h. diab nutrition and health

CHP310: Community Health ProgramMohamed M. B. Alnoor & Mona M. H. Diab

Nutrition And Health

Objectives: To define nutrition and related words. To identify nutritional requirements. To understand Food pyramid. To list types of nutrients and their relation

to health. To define malnutrition and its

classification. To list main malnutrition problems. To understand Obesity.

Nutrition

Definitions

NUTRITION AND HEALTH

Nutrients Macronutrients Micronutrients

Community Nutrition:

Dietetics:

Nutritional Epidemiology:

Definitions

Nutrition is defined as the science

of food and its relationship to

health. It is concerned primarily

with the part played by components

of food (nutrients) in body growth,

development and maintenance.

Definitions

Nutrients are specific dietary

constituents that are crucial for human

life, growth & well-being.

Macronutrients: carbohydrates, lipids,

proteins & water.

Micronutrients: minerals & vitamins.

Definitions

Dietetics: Is the application of

the principles of nutrition;

including the planning of meals

for the well and the sick.

Definitions

Community Nutrition:

Identification of nutritional

needs of population groups

and available resources.

Definitions

Nutritional Epidemiology:

The investigation of the

relationship between diet and

disease/health

- Foods of animal origin

- Foods of vegetable origin

CLASSIFICATION OF FOODS by origin

Carbo-hydratesProtein Fat

Water

Vitamins

Minerals

-Proteins-Fats

-Carbohydrates

-Minerals-Water

-Vitamins

CLASSIFICATION OF FOODS by chemical composition

Body building foods:

CLASSIFICATION OF FOODS by predominant function

Energy giving foods:

Protective foods:

The adequate diet & Food Pyramids

Food Group System: Classifies foods according to similarity in nutrient content.

Nutritional Requirements

2- Eat good fats (avoid bad fats):Oils found in nuts, seeds, grains and fish. Rich in unsaturated fats necessary for good health.Should constitute > 30 to 45% of the total fat.

1- Maintain a healthy weight. BMI: 18.5 to 24.9

Food PyramidsLessons for healthy diet


19 to 25

More nutritious than refined carbohydrates More slowly digested Less stress on pancreas.

Food Pyramids Lessons for healthy diet


3 .Eat whole-grain carbohydrates . (whole meal bread, whole wheat, brown

rice) Why?

4-Avoid red meat as a protein source and emphasize plant proteins.

6- Take a multivitamin daily. Insurance against any deficiency.

Food PyramidsLessons for healthy diet


5- Eat plenty of dark green leafy vegetables and fruits.

Lowers blood pressure and cholesterol and reduces the risk of cancer.

Carbohydrates Lipids Protein

Vitamins Minerals Water

Energy Supplying Nutrients:

Main types of Nutrients

Non-Energy Supplying Nutrients:

PROTEINS

Complex organic nitrogenous compounds.

Contain sulfur, phosphorous and iron. About 20 different amino acids(aa) in

human body. 8-9“essential” aa

Why are they called “essential” ?Essential for what ?

Main types of NutrientsEnergy Supplying Nutrients

Protein Needs: Adults: 0.8 gm/kg body weight per

day Excess protein is not used to build

more muscle - extra aa are used for energy - or converted to fat and stored.

PROTEINS


Animal sources : Complete proteins; have all essential aa.

Plant sources : Incomplete proteins; lack one or more essential aa.

Sources of Proteins :

PROTEINS


Body building Repair and maintenance of body

tissues Maintenance of osmotic pressure Synthesis of bioactive substances

and vital molecules e.g. immunoglobulins

Functions of Proteins:

PROTEINS


Lipids include cholesterol and triglycerides

Fats are necessary for health

Functions 1 – Highest source of energy (9Kcal/g). 2 - Spare protein. 3 - Adipose tissue holds the body organs

and nerves in place. 4 - Maintain body temperature. 5 - Transportation of fat soluble

vitamins.

LIPIDS


Classification of Fats

Saturated fat: Animal foods

Palm oil

coconut oil

LIPIDS


(Richest source)

Monounsaturated fat:


Olives oil Peanuts oil

canola oil

LIPIDS


Polyunsaturated fat:


Corn oil

Sunflower oil

cotton seed oil

nut oil

LIPIDS


Richest source

Trans Fatty AcidsHydrogenated &Partially hydrogenated fats


LIPIDS


liquid oilsmore solid margarinehydrogenation

LIPIDS


Trans fat is the common name for some unsaturated fat. The term refers to the configuration of a double carbon-carbon bond. Trans fats do exist in nature but also occur during the processing of polyunsaturated fatty acids in food production. The consumption of trans fats increases the risk of coronary heart disease by raising levels of LDL cholesterol and lowering levels of "good" HDL cholesterol.

Trans Fatty Acids

Saturated fat and trans fatty acids could be harmful to health

Baked products and fried foods are often made with hydrogenated fats

Hydrogenated fat:

LIPIDS


Necessary for:

Cholesterol:

LIPIDS


cell membranes

production of: vitamin D Bile some hormones

Only in animal foods

Cholesterol:

LIPIDS


blood levels risk of heart disease

The WHO Expert committee on Prevention of Coronary Heart Disease has recommended that only 20 to 30% of total dietary energy is to be provided by fats. (<30%)

At least 50 % of fat intake should consist of vegetable oils rich in essential fatty acids.

Fat requirementsLIPIDS

Energy Supplying Nutrients

1 - Main source of energy: 4 Kcals/gram.

2 - Essential for the synthesis of certain non-essential aa.

3 - Necessary for normal fat metabolism.

4 - Necessary for integrity of nerve cells.

CARBOHYDRATES


Functions:

5 - Lactose allows growth of beneficial bacteria in the intestine. 6 - Important for normal elimination (excretion); fibers

Recommended intake is 55% to 65% of calories, primarily from

starchy foods.

CARBOHYDRATES


Functions:

The inability of the body to metabolize carbohydrates properly = DM

1- Monosaccharides: glucose , fructose2-Disaccharides: Sucrose, Lactose 3- Oligosaccharides (3-10). 4- Polysaccharides (11-1000) a-Digestible e.g. starch b-partially digestible e.g. dextrin c-Indigestible e.g. cellulose

Classification of CHOS

CARBOHYDRATES

Oligosaccharides

Fructo-oligosaccharides (short chains of fructose molecules).

Galactooligosaccharides (short chains of galactose molecules).

Oligosaccharides are often found as a component of glycoproteins or glycolipids are often used as chemical markers, often for cell recognition.

Fibers

Soluble fiber swells or dissolves in water.It is found in vegetables, fruits and grainsRich sources include apples, bananas, citrus fruits, carrots

CARBOHYDRATES

Importance:Reduces cholesterol absorption Slows absorption of glucose

Soluble

FibersCARBOHYDRATES

Fibers

Insoluble Remains unchanged in waterIndigestible plant material e.g. celluloseDietary fiber is mainly non-starch polysaccharide It is found in vegetables, fruits and grainsRich food sources include brown rice, wheat bran, and whole grain products

CARBOHYDRATES

Reduces the risk of:

Fibers

InsolubleImportance:

Heart disease Diabetes type II Diverticulosis Hemorrhoids Constipation Colorectal cancer

CARBOHYDRATES

Refined CHOS Versus Whole Grains

Whole grains are higher than refined carbohydrates in fiber, vitamins, minerals, and other beneficial compounds

Whole grains:

• Take longer to digest• Make people feel full sooner• Cause a slower rise in glucose

levels

Choose foods that have a whole grain as the first item on the ingredient list on the food label

• Whole wheat, whole rye, whole oats, oatmeal, whole-grain corn, brown rice, popcorn, barley, etc.

ADVICE

Vitamins

Minerals

Water

Main types of NutrientsNon-Energy Supplying Nutrients

Regulate growth. Maintain tissues. Help carbohydrates, proteins,

and fats release energy.

VITAMINS

Functions:

• Provide no calories (no energy)

• Needed in very small amounts

Water Soluble:

Fat Soluble:

VITAMINS

Classification of Vitamins

Water Soluble: Vitamin B (8 different types) and vitamin C

Fat Soluble: vitamin A, D, E, and K - Healthy people do not need supplements;

Classification of Vitamins

-Supplementation toxic levels

«Vitamin A» covers both: a pre-formed vitamin: retinol

(animal sources) a pro-vitamin: beta carotene

(plant sources) which is

converted to retinol in the

intestinal mucosa.

Fat Soluble Vitamins

Vitamin A

Essential for normal vision.

Necessary for maintaining the integrity

and the functioning of glandular and

epithelial tissue which lines intestinal,

respiratory and urinary tracts as well

as the skin and eyes.

Functions of Vitamin A

Vitamin A

It supports growth, especially skeletal

growth

It may protect against some epithelial

cancers such as bronchial cancers.

Functions of Vitamin A CONT-

Vitamin A

The nutritionally important forms

of Vitamin D are:

-Calciferol (Vitamin D2) and

-Cholecalciferol (Vitamin D3)

Vitamin D

Functions of Vitamin D

Intestine: Promotes intestinal absorption of calcium and phosphorus.

Bone: Stimulates normal mineralization, enhances bone reabsorption( resorption), affects collagen maturation.

Kidney: Increases tubular reabsorption of phosphate.

Vitamin D

Leads to:

Deficiency of Vitamin D:

Vitamin D

-Rickets in children

-Osteomalacia in adults

Rickets

is a softening of bones in children due

to deficiency or impaired metabolism of

vitamin D, magnesium, phosphorus or

calcium, potentially leading to fractures

and deformity

Osteomalacia

caused by defective bone

mineralization secondary to

inadequate amounts of available

phosphorus and calcium.

Its signs : diffuse body pains, muscle

weakness, and fragility of the bones.

Antioxidant, Protects RBCs from haemolysis.

Vitamin E deficiency :

Neurological

problems:• spinocerebellar ataxia• myopathies

Aaemia

Vitamin E

Important for blood coagulation

Deficiency causes hemorrhagic

manifestations.

Vitamin K

Function:

Essential for the utilization of

carbohydrates (found on

the membranes of

neurons).

Vitamin B1 (Thiamine)

Water Soluble Vitamins

Deficiency of (Thiamine) Beriberi may occur in three main forms:


Infantile beriberi

Wet beriberi Dry

beriberi


Beriberi

Beriberi is a nervous system ailment caused by a thiamine deficiency in the diet. Symptoms of beriberi include severe lethargy and fatigue, together with complications affecting the cardiovascular, nervous, muscular, and gastrointestinal systems

Beriberi cont- Its symptoms : weight loss, emotional

disturbances, impaired sensory perception )Wernicke's encephalopathy(, weakness and pain in the limbs, and periods of irregular heart rate.Edema )swelling of bodily tissues( is common. It may increase the amount of lactic acid and pyruvic acid within the blood. In advanced cases, the disease may cause heart failure and death.

Important for cellular metabolism,

oxidation and reduction. Deficiency: angular stomatitis &

glossitis (magenta tongue).

Vitamin B2 (Riboflavin)


Important for maintenance of the nervous system and healthy epitheliumDeficiency: Pellagra, dermatitis, dementia and diarrhoea

Vitamin B3 (Niacin, Nicotinic acid)

Pyridoxine (vitamin B6) plays an

important role in the metabolism of amino acids, fats and carbohydrate.

The requirement of adults varies directly with protein intake.

Vitamin B6 (Pyridoxine)


The primary role of vitamin B6 is to act as a coenzyme to many enzymes in the body that are involved predominantly in metabolism.

Toxicity: Can occur with supplementation with high doses for long periods of time.

Vitamin B6 (Pyridoxine)


Destruction of dorsal root ganglia

Vitamin B12 is a complex organo-

metallic compound with a cobalt atom

Vitamin B12 (Cyanocobalamine)


Cooperates with folate in the synthesis of DNA.

Separate biochemical role, in synthesis of fatty acids in myelin.

Vitamin B12 (Cyanocobalamine)

Dietary deficiency of B12 may affect subjects who are strict

vegetarians and eat no animal product.

Vitamin B12 deficiency

Associated with : megaloblastic anaemia (pernicious anaemia), demyelinating neurological lesions in the spinal cord.

Vitamin B12 deficiency

Vitamin C (ascorbic acid) is a water-soluble vitamin.

It is the most sensitive of all vitamins to heat.

Vitamin C has an important role to play in tissue oxidation

Vitamin C (Ascorbic acid)


It is needed for the formation of collagen in connective tissue, which constitutes 25% per cent of total body protein.

Present in vegetables and fruits.



Deficiency of vitamin C

Results in scurvy. Signs of scurvy are:

Swollen and bleeding gums, Subcutaneous bruising, Bleeding into the skin or joints, Delayed wound healing, Anaemia and weakness.


Small amounts are needed for health Minerals are certain elements that may:

regulate chemical reactions in the body be part of organic molecules:

Iron in hemoglobin Calcium in bone and teeth

Minerals

Most plentiful mineral in the body

regulating blood pressure, blood clotting, and muscular movements

Calcium

Minerals

Involved in

Needed for strong bones and teeth

Bones store calcium.Deficincy lead to : Osteoporosis

Bones lose mineral density and strength

classified as primary type 1, primary type 2, or secondary.

Calcium

Minerals

Most of the body’s iron is in

hemoglobin, which is in red blood

cells The iron in hemoglobin picks

up oxygen from the lungs and

transports it to the different

body parts.

Iron

Minerals

Helps transport of materials in the body,

Involved in many chemical reactions.

Beverages and most foods, especially

fruits and vegetables, supply water.

Diuretics such as alcohol and caffeine

increase losses of water from the body.

Waterfunctions

To be properly hydrated, a person needs

at least 8 cups of water daily.

Dehydration can be fatal.

Sports, drinks replenish minerals and

water that are lost during heavy

exercise

Water

Thirst sensation is not sensitive

enough

Continue drinking after you are no

longer thirsty

Clear or near clear urine output

indicates hydration

Water

Signs of Dehydration

Headache Fatigue Needlessly lifeless Dark, concentrated urine

Water

Malnutrition is a pathological state

resulting from a relative or absolute

deficiency or excess

of one or more of the essential nutrients.

Definition:

MALNUTRITION

Under-nutrition:

MALNUTRITION

Over-nutrition:

The major forms of malnutrition :

It is a pathological state resulting

when nutrient intake does not

meet the nutrient needs for cell

activities and body maintenance.

Under-nutrition:

MALNUTRITION

It includes: Macronutrient deficiency e.g., protein-

energy malnutrition (marasmus &kwashiorkor).

Under-nutrition:

MALNUTRITIONThe major forms of malnutrition :

Micronutrient deficiency e.g.

iron deficiency anaemia, vitamin

A deficiency, Iodine

deficiency….etc.

Under-nutrition:

MALNUTRITION

MALNUTRITION

Kwashiorkor

Is an acute form of protein-energy

malnutrition.

characterized by edema, irritability,

anorexia, ulcerating dermatitis, and

an enlarged liver with fatty infiltrates.

Kwashiorkor occurrence increases

after

18 months

MALNUTRITION

Marasmus

• Is a form of severe protein-energy malnutrition .

• characterized by energy deficiency, emaciation

• Marasmus occurrence increases prior to age 1 .

The major malnutrition problems in the world are:

1 .Protein–energy malnutrition

(PEM)

2. Iron deficiency anaemia

3. Iodine deficiency disorders

(IDD)

4. Vitamin A deficiency (VAD)

Under-nutrition:

MALNUTRITION

Over 2 billion people suffer from some form of iron deficiency

One of the most common nutritional disorders worldwide.

Iron deficiency anemia

Incidence Africa & South Asia.

Parasitic infestation contributes to high percent of cases in developing countries.

Common causes are dietary deficiency and chronic blood loss


Reduces work capacity, thus reduces productivity & earnings

Associated with 50% of maternal deaths

Retards fetal growth, causes low birth weight (LBW) & increases infant mortality

Impairs ability to resist disease; in childhood it reduces learning ability

Consequences


Improving Iron status

Iron tablets Iron fortification of basic foods (bread) Increased consumption of iron rich

foods & factors which enhance

absorption(e.g. vit. C) Control of parasitic infections


2 billion people worldwide at risk of IDD At least 655 million with goitre 11 million with cretinism 43 million with mental impairment the single greatest preventable cause of

mental retardation Moderate deficiency : over 13 IQ

points

Iodine deficiency disorders(IDD)

Adequate intake of Iodine can:

prevent all IDD make milder forms of goiter

disappear improve development of older

children mildly affected

Prevention of(IDD)


Severe forms of IDD such as cretinism, cannot be reversed; but can be prevented by:

Prevention of(IDD)

Adequate intake of Iodine during pregnancyNow, iodized salt is all over the world


Vitamin A deficiency (VAD)

May be subclinical, severe or moderate

Clinical (xerophthalmia) 2.8 million children 0-4 years old

Blindness, total or partial at least half a million children a year

Conjunctival xerosis

The signs :

Follicular hyperkeratosis

Night blindness


The signs :

Keratomalacia

Corneal xerosis

Bitot's spots


Improving vitamin A status

Increased intake of vitamin rich foods e.g. eggs; butter, whole milk; liver; red palm oil; dark green, yellow & red fruits

& vegetables Fortification of food (oils & margarine) Supplements e.g. capsules of Vitamin

A 2-3 times per year to young children


It is a pathologic state resulting

when nutritional intake exceeds the body

needs. This leads to caloric excess, usually over

an extended period of time.

Over-nutrition:

MALNUTRITION

It is a disorder of Body Regulatory System leading to Excess Body

Fat Assessment: Body Mass Index (BMI) Waist Circumference (WC) Waist to Hip ratio (WHR)

Fat

OBESITY

Causes & Associated Factors

OBESITY

Genes Metabolism Behavior Environment Culture SES

Assessment of Obesity

Body Mass Index (BMI)

Waist circumference

Waist Hip Ratio (WHR)

The international standard for assessing body size in adults .

BMI is computed using the following formula: BMI = Weight (kg)/ Height (m²)

Evidence shows that high BMI (obesity level) is associated with:

• type 2 diabetes & • cardiovascular morbidity &

mortality


BMI (WHO - Classification)

Underweight…………………………………….……………….<18.50

Normal range…………………………………..……….….18.50 - 24.99 Overweight …................................................….25.00 - 29.99(Pre-obese)

Obese class I…………………………………………....30.00 - 34.99 Obese class II………………………..……………...35.00 - 39.99 Obese class III……………….................…..≥40.00

Source: Adapted from WHO, 1995, WHO, 2000 and WHO 2004.


Waist circumference

Waist circumference predicts mortality better than any other anthropometric measurement.Waist measurement alone can be used to assess obesity.Two levels of risk have been identified:

MALES FEMALELEVEL 1 > 94cm > 80cmLEVEL2 > 102cm > 88cm

Level 1 is the maximum acceptable waist circumference of the adults and there should be no further weight gain.Level 2 denotes obesity and requires weight management to reduce the risk of type 2 diabetes & CVS complications.

MALES FEMALELEVEL 1 > 94cm > 80cmLEVEL 2 > 102cm > 88cm

Waist circumference


Visceral obesity (apple shaped)

Peripheral obesity (Pear shaped)

WHR > 0.8 F > 1.0 M

WHR< 0.8 F< 1.0 M

Interpretation of WHR

Females: WHR= >0.80 or >80% Males: WHR= >0.95 or >95%

It indicates central (upper body) or visceral obesity and is considered high risk for diabetes & CVS disorders.

A WHR below these cut-off levels is considered low risk (peripheral obesity).


High risk :

chp310: community health program mohamed m. b. alnoor & mona m. h. diab nutrition and health

Documents

origin slide

diseasehealth slide

predominant function

fats classification

protective foods

foods of animal origin

chemical composition

body building foods