Faculty of Medicine Introduction to Community Medicine Course

(31505201)

Unit 2 Nutrition and Nutrition Assessment and Diet

Introduction and Terminology used in nutrition

By

Hatim Jaber MD MPH JBCM PhD

25-09-2017

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Presentation outline

Time

Introduction to unit 2 08:00 to 08:10

Nutrition in Health and Medicine 08:10 to 08:20

The Nutrients & their Categories. 08:20 to 08:40

Food Pyramid 08:40 to 09:00

Clinical Nutrition 09:00 to 09:15

Introduction to course 31505201(cont…) Course Content

• Week 1 Unit 1: Introduction to Health and Community Health

• Week 2 Unit 2 Nutrition and Nutrition Assessment and Diet • Week 3 Unit 2 (cont.) Nutrition and Nutrition Assessment and Diet • Week 4 Unit 2 (con..): Infant and Breast Milk Characteristics • Week 5 Unit 3: Public Health/Environmental Health • Week 6 Unit 4: Epidemiology .Epidemiology :Study design • Week 7 Unit 5: Primary Health care • Week 8 Unit 6: Demography, Data and Biostatics

• Week 9 Midterm assessment (Exams.)15-11-2017 • Week 10 Unit 8 Public Health Surveillance • Week 11 Unit 9: Prevention and Control of Diseases • Week 12 Unit 10: Health Education and Communication • Week 13 Unit 11: Screening • Week 14 Unit 12: Health Administration and healthcare management • Week 15 Unit 13: Health Research

• Week 16 Final assessment (Exams.)

Unit 2 Nutrition Learning objectives

• Understand and Describe the relation between nutrition and health

• Name nutrient categories according to their physiologic roles, and outline the ecology of malnutrition with differential characterization of the various types and classes of nutritional disorders.

• Identify nutrition-risk groups by application of proper criteria and suggest ideas for the prevention and control of nutrition-related diseases.

• List the scientific reasons that justify the launching of public campaigns that target at the promotion of breast feeding practice for infants

Unit 2 Nutrition Unit contents

• Introduction and Terminology used in nutrition.

• The Nutrients & their Categories.

• Nutritional Allowances & Requirements

• Spectrum of public nutrition problems: Malnutrition & its Ecology

• Assessment of Nutritional Status.

• Anthropometric Assessment

• Common nutritional disorders in Jordan

• Formula feeding

• Breast feeding & Breast milk.

Nutrition definition

Nutrition may be defined as the:

• science of food and its relationship to health.

• It is concerned primarily with the part played by nutrients in:

- body growth,

- development and

- maintenance

Nutrition deals with providing the right nutrients in the right

amounts in the diet.

• Definition

– Deals with the nutrients needed, their metabolism, feeds that supply them, and feeding systems to provide them

PERSPECTIVES ON NUTRITION

• To scientists, nutrition is the study of: – The nutrients found in foods – The body’s handling of

nutrients to maintain health • Nutrients (some of which

provide energy for processes in the body) are substances that can promote: – Growth – Maintenance

– Repair

For many, nutrition is all

about losing weight!

Nutrition definition

• “The science/study of nutrients (that come from food), their action, interaction, and balance in relation to health and disease; and the process by which the organism (body) ingests, digests, absorbs, transports, utilizes and execrates food substances”

• .. Science of food and its relationship to health…

• .. Is a dynamic process in which the food that is consumed is utilized for nourishing the body..

NUTRITION AND HEALTH

• Health professionals agree that the overall composition of the diet has an important effect on health.

• Eating too much fat, sat. fat and cholesterol and not eating enough vegetables, fruits, and fiber has been linked to an increase in heart disease and other cancers.

• The association of nutrition with infection, immunity, fertility, maternal and child health and family health have engaged scientific attention. More recently, a great deal of interest has been focused on the role of dietary factors in the pathogenesis of non-communicable diseases such as coronary heart disease, diabetes and cancer.

• The federal government constantly revises its official U.S. Dietary Guidelines for Americans to help consumers choose a healthy diet. These guidelines make Recommendations for Americans 2 years of age and older.

Significance of nutrition

• Adequate nutrition is required for growth, development and maintenance of normal functions

• Under nutrition contributes to 60% deaths amongst under five children (WHO, 2002)

• More than 85% children in India suffer from malnutrition (44% Mild malnutrition, 38% moderate malnutrition and 4.6% severe malnutrition) (Gomez classification, NNMB 2007)

• About 55% men and 75% non pregnant non lactating women are anemic

• Epidemiological data shows strong association between under nutrition and morbidity / mortality

• Chronic degenerative disorders such as coronary artery disease, hypertension, type 2 diabetes, certain cancers, etc are related to diet and nutritional status

• Obesity is associated with higher risk of developing cancer breast, colon, endometrium, gallbladder, esophagus, pancreas, etc.

• Consumption of foods rich in dietary fibre and antioxidants is associated with reduced risk of certain cancers

• Under nutrition during fetal and early childhood is known to be associated with chronic degenerative disorders in later life

Diet, Dietetetics and Good nutrition

– Diet: a mixture of foodstuffs, which are selected to satisfy the daily nutritional requirements of the body…. The foods one consumes: The quality of which

affects the risk of chronic diseases

• Dietetetics:.the practical application of principles of nutrition: includes the planning of meals for the well and the sick.

• Good nutrition : “ maintaining a nutritional status that enables us to grow well and enjoy good health”

Characteristics of a Healthy Diet Include:

– Balance

– Variety

– Moderation

These three are the framework of the Food Guide Pyramid:

• Balance - Eat foods from all groups of the Food Guide Pyramid.

• Variety - Eat different foods from each food group.

• Moderation - Eat more foods from the bottom of the pyramid, and fewer and smaller portions of foods from the top of the pyramid.

Adequate nutrition is characterized by:

1-Daily intake of nutrients, which are

(quantitatively and qualitatively).

2-Adequate nutrition should consider

physiological status and pathological

disorders.

3- Normal digestion, absorption,

metabolism, excretion.

FOOD

• Is a composite mixture of various nutrients in a varying proportion, together with water

FOOD LABELS

• Food labels provide the following information: – Common name of product. – Name and address of manufacturer,

packer or distributor. – Net contents (wt, measure or count). – Nutrient content of product – Serving size – Servings per container – Calories/calories from fat – Nutrient amounts and percentages of

Daily Values – Daily values and calories/gram

reminder – Ingredients

Food label

Food Additives

• Many additives occur naturally or are extracted from food. Others are synthetic but chemically identical to natural substances.

• All food additives are carefully regulated by the Food and Drug Administration.

• Additives help keep food wholesome and appealing during transport to markets.

• Without additives, many food items would be less attractive, less flavorful, less nutritious, more likely to spoil, and more costly.

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A food additive is a chemical substance or combination of substances present in food as a result of processing, production, or packaging.

HOW MUCH FOOD DO WE NEED?

RDA (recommended dietary allowances)

• The RDA of a nutrient is the amount (of that nutrient) sufficient for the maintenance of health in nearly all people

DRI (dietary reference intake) Standards to guide safe & adequate intakes of essential nutrients for healthy humans.

Sick individuals have different needs

• Recently replaced RDA as primary standards

• Expands on RDAs

• DRIs are a collection of values to express a persons nutrient need based on their life stage & gender.

• The exact DRI value may be as an RDA, AI, EAR depending on scientific information available for each nutrient.

• DRIs are expressed as ULs and AMDRs.

• For Calories the DRI is called the EER.

• There is DRI recommendation for Physical activity.

• The DRIs are standards that have many important purposes and uses.

Resources for Planning a Healthy Diet

• Dietary Reference Intakes (DRIs)

– Reference values for nutrients developed by the Food and Nutrition Board (FNB) of the Institute of Medicine

– These reference values are used to

• suggest nutrient intake levels for different population groups

• plan and evaluate the diets of healthy people in the United States and Canada

DRI Reference Values

• Acceptable Macronutrient Distribution Ranges (AMDR)

– Addresses the recommended balance of fuel nutrients to meet physiological needs

• Carbohydrates 45–65% of daily kcal

• Fats 20–35% of daily kcal

• Proteins 10–35% of daily kcal

How are DRIs established? • By scientific committee

literature review. • Nutrients are given an

Recommended Dietary Allowance (RDA),

• or Adequate Intake (AI),

• Estimated Average Requirement (EAR) value by life stage & gender.

RDA: level to meet 97-98% of needs AI: average or mean intake level. EAR: average daily nutrient intake level

estimated to meet the requirement of half the needs.

What Is MyPlate?

• Food guidance system – Graphics used to summarize guidelines to healthy

eating

• Visual depiction of the recommendations in the Dietary Guidelines for Americans 2010

• Online components provide personalized diet plan based on the latest nutrition and health recommendations from – Dietary Guidelines Advisory Committee Report – DRIs

• Illustrates the diet and lifestyle themes

Functional Foods

• Functional foods = foods that provide health benefits beyond their normal nutrient contributions

– Whole foods

– Fortified foods

– Modified foods

– http://whonucookies.com/

Functional Foods: What Role Do They Play in Your Diet?

•Functional Foods: have a positive effect on health beyond providing basic nutrients – Example: Carrots, which contain beta-carotene, a

phytochemical that protects cells from damaging substances that increase risk of some chronic diseases, including cancer

– Zoochemicals: compounds in animal food products that benefit health • Example: Omega-3 fatty acids in fatty fish

– Manufacturers also fortify food products with phyto- or zoochemicals

Food security and safety

• Food security: availability of the right quality and quantity of food to supply the recommended daily nutrients to maintain good health and prevent malnutrition.

• Food safety: reflection of food sanitation and is related to safeguarding from the immediate or late health hazards resulting from biological, chemical , or physical contamination of food ( production, transport, distribution, processing, and subsequent use are properly handled )

• Vitamins - only organic nutrient that does not supply energy but is needed to get energy from foods.

• Essential nutrient - body cannot make enough of and must get from food.

• Some dietary and lifestyle practices (smoking, inactivity, drinking alcohol) are risk factors for many health conditions.

• Substances (non-nutrients) in foods are phytochemicals that give foods the characteristic taste and smell.

MORE FOOD RELATED FACTS

Classifications of foods

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CLASSIFICATION OF FOODS

• Classification by origin: - Foods of animal origin

- Foods of vegetable origin

• Classification by chemical composition: - Proteins

– Fats

– Carbohydrates

– Vitamins

– Minerals

Foods are grouped on the basis of their

predominant function into:

1-Energy yielding foods (carbohydrates and fats).

2-Body building foods (Protein) .

3-Maintenance and regulation of tissue functions

(vitamins and minerals)

- Formation of Cells.

Required Nutrients: mainly protein.

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CLASSIFICATION BY PREDOMINANT FUNCTION

Body building foods: • -meat, milk, poultry, fish, eggs, pulses etc

Energy giving foods: -cereals, sugars, fats, oils etc.

Protective foods: • -vegetables, fruits, milk, etc

• Food gives us enjoyment : We want to enjoy food and entertain our guests with tasty food.

• Classification by nutritive value • 1) Cereals and millets • 2) Pulses (legumes) • 3) Vegetables • 4) Nuts and oilseeds • 5) Fruits • 6) Animal foods • 7) Fats and oils • 8) Sugar and jaggery • 9) Condiments and spices • 10) Miscellaneous foods.

التصنيف حسب القيمة الغذائية

الحبوب والميليتس( 1

(البقوليات)البقول ( 2

الخضراوات( 3

المكسرات والبذور الزيتية( 4

الفواكه( 5

األطعمة الحيوانية( 6

الدهون والزيوت( 7

السكر والجاجري( 8

التوابل والتوابل( 9 .األطعمة المتنوعة( 10

Food Constituents Macronutrients &

Micronutrients

• Protein

• Carbohydrates

• Fat -Water Soluble Vitamins

• Fat Soluble Vitamins

• Minerals

• Trace elements Water

Building and Maintenance of Bones and Teeth:

Required Nutrients:

• Calcium and phosphorus are the basic nutrients.

• Vitamin D for absorption and metabolism of calcium and

phosphorus.

• Fluorine for healthy decay - resistant enamel of teeth.

Formation of Blood Cells

a) Red cells are formed in the bone marrow.

Haemopoictic nutrients are:

• Iron and protein, to form hemoglobin.

• Vitamin B12 and folic acid, for development and

maturation of red cells in the bone marrow.

• Vitamin C helps absorption of iron.

• Copper helps absorption of iron, and synthesis of

hemoglobin.

b) White cells also need adequate nutrition

3- Protective (Vitality) foods: For maintenance and regulation of tissue functions:

Required nutrients are.

• B-vitamins.

• Vitamin A:

Iodine:

• Others: cytochrome (intracellular iron), vitamin K,

calcium, phosphorus

Water

• Inorganic

• Not energy-yielding

• Essential

Copyright 2005 Wadsworth Group, a division of Thomson Learning

The Importance of Water

• It is necessary for an individual to drink 6-8 cups of water daily and more if participating in sports or exercising.

• Water is the most critical nutrient for sustaining life. • Two-thirds of the human body is water. • Water makes up 60% of your total body weight and 70% of your

muscles; raw meat is about 75% water and fruits and vegetables up to 95% water.

• It may take us weeks to starve, but only a very few days to dehydrate. About 3/4 of our water is contained within individual cells.

• Of the rest, most is fluid surrounding the cells, with a small amount in the blood plasma. Outside the cells, water is a means of transporting nutrients and wastes, a physical cushion, a lubricant.

• When exhaled or perspired, water removes excess heat energy from the body.

• Within the cell, it is the solvent in

Water

• What are the main functions of water? – Transports nutrients

– Carries away wastes

– Moistens eyes, mouth, nose; hydrates skin

– Forms main component of body fluids

– Acts as an insulator

– Protects against heat exhaustion

– Lubricates joints

– Helps with digestion

Types of Vitamins

• Water Soluble – Dissolve in water

– Needed for energy release

– Too many water soluble vitamins are excreted in urine

• Fat Soluble – Dissolve in fat

– Remain in the body for long periods of time

– 4 fat-soluble vitamins: A,D,E,K

– Too many can lead to a toxic build up – stored in fatty tissues, liver, & kidneys

Vitamins do NOT provide energy!!!

Adequate diet provides the

basic food nutrients (protein,

carbohydrates, fat, vitamins,

essential elements, water) and

energy.

Definitions and concepts

• Food is a composite mixture of various

nutrients in a varying proportion,

together with water.

• Nutrients are chemical substances,

which are required in grams (e.g.

macronutrients) or in milligrams or

micrograms (e.g. micronutrients).

Background definitions

• Nutrients: “Chemical substances in food that nourish the body by providing energy, building materials, and factors to regulate needed chemical reactions.”

• Essential nutrients: Must be provided by food because the body does not produce them in sufficient quantities or can not make them at all.

• Nonessential nutrients: Healthy, well-nourished bodies can make them in sufficient quantities to satisfy their needs.

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The 6 Essential Nutrients

• Water

• Carbohydrates

• Protein

• Fat

• Vitamins

• Minerals

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NUTRIENTS Organic and inorganic complexes contained in

food are called nutrients. They are broadly divided in to:

• Macronutrients: • -proteins • -fats • -carbohydrates

• Micronutrients: • -vitamins • -minerals

The Nutrients

Energy-Yielding Nutrients

• Calories and kilocalories

Copyright 2005 Wadsworth Group, a division of Thomson Learning

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Dietary Supplements Foods or Drugs?

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What is a Dietary Supplement?

• Definition: – A product (other than tobacco) intended to

supplement the diet that bears or contains one or more of the following dietary ingredients • Vitamins

• Minerals

• Herbs or other botanicals

• Amino acids

• Concentrate, metabolite, constituent, extract or combination of above listed ingredients

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Dietary Supplements

• Distinguished from Drugs:

– Drug = article intended to diagnose, cure, mitigate, treat, or prevent disease

– Both intended to affect structure and function of body

– Drug must undergo FDA approval after clinical studies to determine effectiveness and safety

– D/S = no pre-market testing

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Dietary Supplements

• Distinguished from Foods:

– Foods not intended to affect structure and function

– D/S intended only to supplement diet

• Not represented for use as conventional food

• Not intended as sole item of a meal or the diet”

Eating Pattern for Longevity

• Healthy habits of the Okinawans

• Enough is enough

• Moderation & a healthful lifestyle are key cultural values

• Psychological & spiritual health matters

FOOD CHOICES

• Advertising • Availability • Convenience • Economy • Comfort • Ethnicity • Habit

• Personal Preference

• Positive Associations

• Geographical location

• Social Pressure

• Values and beliefs

• Body weight

• Select foods to provide adequate amounts of nutrients and energy!

• When humans eat, foremost in their minds is that they are consuming foods, not nutrients!

• The following influence food choices:

• Nutritional Value

Understanding Our Food Choices

• Hunger vs. appetite

• Availability

• Income, food prices, & convenience

• Advertising & the media

• Social & cultural factors

• Personal values or beliefs

Variables which affect nutrient needs:

1. Age

2. Gender

3. Activity Level

4. Climate

5. Health

6. State of nutrition

Aim for Fitness

1. Aim for a healthy weight

2. Be physically active each day

Build a Healthy Base

3. Let the pyramid guide your choices

4. Choose a variety of grains daily, especially whole grains

5. Choose a variety of fruits and vegetables daily.

6. Keep food safe to eat.

Choose Sensibly 7. Choose a diet that is low in saturated fat and cholesterol and moderate in total fat

8. Choose beverages and foods to moderate your intake of sugars

9. Choose and prepare food with less salt

10. Individuals over 21 who drink alcoholic beverages should do so in moderation

FOOD PYRAMID::

diagram that represents a healthy diet by placing food groups ina pyramid according to the number of servings from each group to be eaten every day.

Food Guide Pyramid

Daily exercise and weight control

Clinical Nutrition (Medical Nutrition Therapy)

Purpose

– To achieve or maintain good nutritional status.

Patient Care: Team Approach (Interdisciplinary)

• Physician

• Registered Dietitian

• Registered Nurse, Licensed Vocational Nurse, Certified Nursing Assistant

• Pharmacist

• Speech Therapist

• Occupational Therapist

• Social Worker

The Nutrition Care Process Identifying and meeting a person’s nutrient and nutrition

education needs. Five steps:

1. Assess Assessment of nutritional status

2. Analyze Analyze assessment data to determine nutrient requirements

3. Develop Develop a nutrition care plan to meet patient’s nutrient and education needs.

4. Implement: Implement care plan

5. Evaluate: Evaluate effectiveness of care plan: ongoing follow-up, reassessment, and modification of care plan.

What is a vegetarian diet?

• one that does not include meat (including fowl) or seafood, or products containing those foods

– The American Dietetics Association

• Includes: fruits, vegetables, beans, legumes, cereal grains, nuts, and seeds, with or without dairy products and eggs

Other Forms of Vegetarian Diets

• Vegan-excludes meat, dairy, eggs, honey

• Lacto – excludes meat, eggs (but includes dairy products and honey)

• Ovo – excludes meat, dairy products (but includes eggs and honey)

Why?

A vegetarian diet may be chosen for: Ethical

Health

Environmental

Religious

Political

Cultural

Aesthetic

Economic

…or other reasons

Health Advantages

• Vegetarian diets have been associated with the following when compared to nonvegetarian diets:

– Lower LDL cholesterol levels

– lower risk of death from ischemic heart disease

– lower blood pressure

– lower rates of hypertension

– lower rates of type 2 diabetes

– lower body mass index

– lower overall cancer rates

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Vegan Food Pyramid (Adapted from J Am Diet Assoc.

2003;103:771-775)

The Student Diet صحة وهنا Thank You