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"ItII UNIVERSITY
YOUR FOOD AND
ITS UTILISATION
Indira Gandhi National Open University
School of Continuing Education
BODY BUILDING FOODS
ENERGY GIVING FOO:t;>.S
PROTECTIVE FOODS
. i
Nutritional Status, Food Habits and Food

Misconceptions 5
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"Education is a liberating force, and in our

age it is also a democratising force, cutting
across the barriers of caste and class,
smoothing out inequalities imposed by birth
and other circumst ances. "
- Indira Gandhi
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~ THE PEOPLE'S
UNIVERSITY Your Food and
Indira Gandhi
National Open University
its Utilisation
School of Continuing Education
Block
5
NUTRITIONAL STATUS, FOOD HABITS AND
FOOD MISCONCEPTIONS
UNIT 15
Assessment of Nutritional Status 5
UNIT 16
Our Food Habits 29
UNIT 17
Food Misinformation 36
EXPERT COl\1l\fiTfEE (ORIGINAL)
Prof G Ran Reddy ProfB.S. Shanna Dt (Mrs.j Vanaja Iyengar
Vice Chancellor Pro- Vice-Chancellor (Consul tant)
IGN"OU, New Delhi IGN"OU, New Delhi lGNOU, New Delhi
Or: (Mrs.) P.R. Reddy Dt Mehtab Banji Mrs. MlU)' Mammen

Ex. Professor ofHome Science Sr. Deputy Director ChiefDietician
School ofBiological and Earth National Institute of Nutrition Dietary Department
Sciences, SVU College ofArts Hyderabad C .M. C. Hospital, Vdlcre
and Sciences,
Dr: (Mrs.) PrabhaChawla
Sri Venkateshwara University, Mrs. A. Wadhwa
(Co-ordinator)
Tirupathi Lady Trwin College
School of Continuing
SikandraRoad
Education
Dr: (Mrs.) Sumati R Mudanbi NewDelhi
IGN"OU, New Delhi
W-l63 'A', 'S'Bl<X.:k
MIOC Pimpri, Bhosari, Pune
COURSE CONTRIBUTORS (ORIGINAL)

Course Contributors Languageand Fonmt
Dr.(Mrs.) P.R. Reddy Or. Sharda Gupta Editing
(ChiefEditor) Miss S. Jain Or B.N. Koul
Prof of Home Science Or. (Mrs.) Sumati R Mudanbi
Or P.N. Pandit
School ofBiological and Earth (Editor), W -163 'Pl, 's' BI<X.:k
Sciences, SVU College ofArts MlDC Pimpri' Bhosari, Pune Or. (Mrs.)Anita Taploo
and Sciences, Sri Venkateswara Mrs. Mahana Mrs. Neerja Sharad
University, Tirupathi Mrs. Deepti Gulati Miss. Anju Sehgal
MI5. R Sethi
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COURSE REVISION (TEAM) ~

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Director & Projessor Dt Geeta Kumari Ms. Raashri Dr. (Mrs.) P.R. Reddy
in Nutritional Sciences Consultant Jr. Consultant FonnerlyVice Chancellor,
SOCE, IGNOU, SOCE, IGNOO, SOCE, IGNOU, Shri Padmawati Maiila
New Delhi New Delhi New Delhi Vishvavidyalam, Tirupathi
Professor of Home Science
Sri Venkateshwara
University, Tirupathi
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BLOCKS NUTRITIONAL STATUS, FOOD
HABITS AND FOOD
MISCONCEPTIONS
This block has 3 units. It is intended to provide the learner with knowledge of different
methods for assessment of nutritional status of an individual. It also focuses on the
formation of good food habits and its role in establishing a good nutritional status.
After going through this block learners will be vigilant against misinformation of food
as it affects their health and wellbeing.
In Unit 15, we attempt to explain one of the important components of the environment,
i.e. the interaction between heredity and nutrition, in deciding the nutritional status of
an individual. Body dimensions can be taken as indicators of nutritional status. The
various methods that we can use to measure body dimensions are described in detail
so that you can learn to assess the nutritional status of different age groups and offer
diet advice to those who need it. Clinical examination and biochemical tests as measure
of assessing nutritional status are presented in a concise manner to expose you to this
aspect of study. Various signs and symptoms which appear as a result of nutritional
inadequacy have been described under clinical examination. In addition, dietary
assessment is explained to you to enable you to decide what changes need to be
made in the diet to improve the nutritional status.
In Unit 16, we discuss good and poor food habits, their formation, the need to lay a
strong foundation in childhood with respect to good food habits and the need to
constantly monitor our food habits to reach the goal of health at all·stages of life.
In Unit 17, we emphasise that food habits and food misconceptions have a significant
impact on our dietary intake and nutritional status. We advise you to be vigilant about
misconceptions and misinformation regarding food that we are exposed to from
various sources like friends, relatives and the media. If we wish to follow the path of
health it is up to us to be better informed, to be more vigilant and to develop good food
habits 'hot only in ourselves but also in others with whom we associate.
UNIT 15 ASSESSMENT OF NUTRITIONAL
STATUS
•
In the previous units you have learnt about the body's nutritional needs in various
stages of the life cycle: Now you may question as to how one can judge whether a
person of a particular age group has normal health or is under or overnourished. Let
us try to find out the answer to this question in this unit.
Structure
15.0 Objectives
15.1 Introduction
15.2 Does Nutrition Make a Difference?
15.3 Nutritional Status

15.4 Measurement of Body Size
15.5 Growth Monitoring of Children
15.6 Adults and their Body Size
15.7 Clinical Examination
15.8 Biochemical Assessment
15.9 Dietary Assessment
15.10 Let Us Sum Up
15.11 Glossary
15.12 Answers to Check Your Progress Exercises
15.0 OBJECTIVES
After studying this unit, you will be able to :
• explain the effect of normal nutrition on the body and its performance;
• describe the methods used to determine nutritional status;
• describe the methods used to measure body size (weight and height); and
• help monitor growth of children.
15.1 INTRODUCTION
So far you have learnt about the body's nutritional needs through the various stages
of the life cycle. You have also understood how to meet these needs by proper selection
and intake of foods. One of the questions you may be asked by people is 'Does
nutrition really make a difference in your life?' The answer is definitely YES. The
next question is: 'How do you know if one is well nourished'? Let us try to answer
these questions.
15.2 DOES NUTRITION MAKE A DIFFERENCE?

As you learnt in Unit 5, a person's growth rate and size is decided by two main
factors - his/her inborn capacity to grow and the environmental conditions. Of the
latter, nutrition is one Mportant condition, which you can modify. Obviously, these 5
Nutritional Status, Food two factors depend on each other, because you know heredity decides the final size
Habits and Food and whether you will actually reach that size is largely dependent on your nutrition. In
Misconceptions other words, the blueprint is in your heredity, but the bricks and mortar are in the
variety of foods you eat.
Body Size: You may have noticed that there is a progressive increase in the body
size with growth. Two simple measurements help you to record the changes in body
size, viz. weight and height.
Besides the skeletal frame, your body has soft tissues such as muscle and fat. It is
difficult to measure muscles, but you can measure the amount of fat. One way of
doing it is to measure the skinfold thickness.
Performance: Besides body size, your nutrition affects your capacity to learn, to
work and to live a long happy life. As you have learnt in Unit 5, your brain is the
fastest growing part of the body. By the time you are two years old, 90 per cent of
your brain size is reached. The most rapid growth of the brain takes place from the
. second half of pregnancy upto the tenth month of infancy. You will appreciate how
important it is to ensure that the mother and infant are fed well in this period. Another
aspect of learning is the ability to concentrate. You know that children, who are
hungry, are unable to concentrate on their school work.
Many factors affect your capacity to work and nutrition is an important factor. It was
found that increasing the food intake of underfed farm and road building labourers by
30 per cent increased their work output by 50 per cent. As you may have observed,
the capacity for physical work is related to your body size. Underweight persons are
not able to carry heavy loads for long. When one is malnourished, one is unable to
resist infections and may have to remain absent from work frequently. Thus work
output is inconsistent and low.
You will appreciate then that a well-fed, productive citizen is an asset to the work
force. For example, when anaemia was corrected by iron therapy among individuals
in Indonesia, their work output increased measurably.
Longevity: An Indian child born in 1901 was predicted to live to about 25 years. By
1980 life expectancy of an Indian male had increased to about 57 years and in 2006
the life expectany at birth, for Indian male and female has increased to about 63.8
and 66.9 respectively. The gain in life expectancy has been made possible by controlling
certain diseases such as small pox, tuberculosis and some childhood ailments. It is
difficult to assess the exact role of nutrition in life expectancy. But if you look at
improvement in life expectancy in countries where people are well-fed YQU can see
that it does make a difference. For example, the life expectancy of people in countries
such as the USA and UK is reported to be 78 years and 79 years respectively. With
the knowledge you have gained in this course, you can help to achieve this goal.
You will certainly agree that this is sufficient evidence for us to take care of our
health and well-being, through appropriate nutrition at all stages ofthe life cycle.
Check Your Progress Exercise 1

1) Explain how learning is affected by nutrition.
6
2) What is the effect of nutrition on work performance? Assessment of
Nutritional Status
3) Fill in the blanks.
a) The two simple measurements which help you to record body size are
...................... and .
b) By the time you are two years old pet cent of your
................. is reached.
15.3 NUTRITIONAL STATUS

You may have realised that nutritional status is the level of nourishment of your body
at a given point of time. Each of us would like to maintain our nutritional status at an
ideal level. So far you have learnt that nutrition affects your body size, your brain
development, your performance, your capacity to work and life-span. Nutritional status
reflects the kind of nourishment your body gets from the foods you eat. If foods meet
your body's needs optimally, you look and feel healthy and you enjoy ideal nutritional
status.
"The child that is born on a Sabbath day,

is bonny and happy and good and gay."
This nursery rhyme reflects our desire for normal health and happiness and describes
a child, who enjoys good nutritional status and health. When you think of signs of
good nutrition, you think of a healthy complexion, bright eyes, a good figure, a positive,
happy temperament, willingness to work, etc., in short, a person, who is an asset to
the family and community.
These are some of the indicators of normal nutritional status. You can measure and
record some while others are qualitative ones and cannot be easily measured. Body
size is a gross indicator of nutritional status. Let us get acquainted with the methods
used to measure body size.

1) Describe the signs of good nutritional status.
2) Fill in the blanks.
a) Nutritional status reflects the : your body gets from the
b) Body size is a of nutritional status. 7

Nutritional Status, Food
Habits and Food 15.4 MEASUREMENT OF BODY SIZE
Misconceptions
In Units 5 and 7, you have learnt that body weight and height indicate your body size.
In addition, the head, chest and mid - arm circumferences give an idea of growth and
development, especially of small children (0-5 years). So you record these body
measurements at various stages of development to study the growth pattern. Let us ,
get acquainted with the correct methods of recording these measurements.
Weight: Weight is a commonly used indicator of body size, as it reflects the level of
food intake. You know that in the hospital a baby is weighed soon after birth. Even
babies born at home are weighed by the visiting mid-wife or nurse on a portable
weighing scale. The normal weight of a healthy baby varies between 2.5 to 3.5 kg. If
the baby weighs less than that, you need to take special care to see that the baby
attains good health as soon as possible after birth. After birth it is advisable to maintain
a record of the baby's weight at monthly intervals. You can advise your family members
and neighbours to maintain a periodic record of their infant's weight.
You will realise that the scales used for weighing babies need to be more sensitive
than those used for weighing adults. Baby scales, which have 100 gm divisions, are
ideal for weighing infants (Figures 15.1 and 15.2). Another weighing scale used by
field staff of various agencies is a portable one, which can be hung from a roof or a
tree, and as shown in the figure, has a sling to hold the baby. When a baby scale is not
available, you can use an adult weighing balance, and record the weight of child with
mother and then the mother alone. The difference of the two weights is the weight of
the child.
You can record the weight of children regularly to check if there i a normal gain in
weight. The weight can be plotted against age to see if the pattern of growth ir.
normal, by comparing it with the normal curve presented in Figure 5.3 (a) and 5.3 (b)
in Unit 5. If child fails to gain weight, and does not follow a normal pattern of growth,
you must find the reason and take remedial action.
You can compare the weights of adults with the weight for height (Tables 7.2) given
in Unit 7. As you noted in Unit 7, weight record helps to check energy balance in
adults. You can also compare your body mass index with the Table 6.1 given in Unit
6 of Block 2 to check whether you are underweight, overweight or obese.
Linear Measurements: As you noted above, a number of linear measurements are

included in this group, such as height, circumferences of head, chest and mid-arm.
and skinfold thickness. Let us get to know to record each of these.
8 Figure 15.1 : Weighing Pre-school child with Standard UNICEF Beam balance scale
Assessment of
Nutritional Status
Figure 15.2 : This is the hanging weighing scale which is strongly recommended. As
illustrated the child may be placed in trousers or a number of other receptacles, depending
on the local culture.
Height: Height is another measure of growth of a child. As you have learnt in Unit 5,
there is a 50 per cent increase in height in the first year and a child reaches half of
his/her adult height by.the second birthday. Thus, recording height helps you to know
if the child is growing normally.
You can use a vertical measuring tape scale fixed on the wall to record the height of
older children and adults [Figure 15.3 (a)). The scale used for measuring height should
be two metres in length and capable of measuring to an accuracy of 0.2 cm.
You need a infantometer to measure the length of infants. It can be made by attaching
a scale to a shaped wooden board [Figure 15.3 (b)). You can place the infant on it
with head touching the head board. the knees are extended by gentle pressure. A
light wooden block is moved to touch the heels and the length is read to the nearest
0.1 cm.(It is obvious that an infant cannot stand and so its length is measuring
with the body stretched on a board).
If you record the weight and height at regular intervals, the weight for height can be
checked. (Table 15.1 and Table 15.2)
Table 15.1: Weight for length for girls and boys (Birth to 2 years)
(Weight in Kg)
Length (cm) Girls Boys
45.0 2.5 2.4
45.5 2.5 2.5
46.0 2.6 2.6
46.5 2.7 2.7
47.0 2.8 2.8
47.5 2.9 2.9
48.0 3.0 2.9
48.5 3.1 3.0
49.0 3.2 3.1
49.5 3.3 3.2
50.0 3.4 3.3 --
50.5 3;5 3.4

51.0 3.6 3.5
51.5 3.7 3.6
52.0 3.8 3.8
52.5 3.9 3.9
53.0' 4.0 4.0
53.5 4.2 4.1
54.0 4.3 4.3 .9
(Weight in Kg)
Habits and Food
Misconceptions Length (cm) Girls Boys
54.5 4.4 4.4
55.0 4.5 4.5
55.5 4.7 4.7
56.0 4.8 4.8
56.5 5.0 5.0
57.0 5.1 5.1
57.5 5.2 5.3
58.0 5.4 5.4
58.5 5.5 5.6
59.0 5.6 5.7
59.5 5.7 5.9
60.0 5.9 6.0
60.5 6.0 6.1
61.0 6.1 6.3
61.5 6.3 6.4
62.0 6.4 6.5
62.5 6.5 6.7
63.0 6.6 6.8
63.5 6.7 6.9
64.0 -- 6.9 7.0
64.5 - 7.0 7.1
65.0 7.1 7.3
65.5 7.2- 7.4
66.0 7.3 7.5
66.5 7.4 7_6
67.0 7.5 7.7
67.5 7.6 7.9
68.0 7.7 8.0
68.5 7.9 8.1
69.0 8.0 82
69.5 8.1 8.3
70.0 8.2 8.4
70.5 8.3 8.5
71.0 8.4 8.3
71.5 8.5 8.8
72.0 8.6 8.9
72.5 8.7 9.0
73.0 8.8 9.1
73.5 8.9 9.2
74.0 9.0 9.3
74.5 9.1 9.4
75.0 9.1 9.5
75.5 9.2 9.6
76.0 9.3 9.7
76.5 9.4 . 9.8
77.0 9.5 9.9
77.5 9.6 10.0
78.0 9.7 10.1
78.5 9.8 10.2
79.0 9.9 10.3
79.5 10.0 10.4
80.0 10.1 10.4
80.5 10.2 10.5
81.0 10.3 10.6
81.5 10.4 10.7
82.0 10.5 10.8
10 82.5 10.6 10.9
Assessment of
(Weight in Kg)
Nutritional Status
83.0 10.7 11.0
83.5 10.9 11.2
84.0 11.0 11.3
84.5 11.1 11.4
85.0 11.2 11.5
85.5 11.3 11.6
86.0 11.5 11.7
86.5 11.6 11.9
87.0 11.7 12.0
87.5 11.8 12.1
88.0 12.0 12.2
88.5 12.1 12.4
89.0 12.2 12.5
89.5 12.3 12.6
90.0 12.5 12.7
90.5 12.6 12.8
91.0 12.7 13.0
91.5 12.8 13.1
92.0 13.0 13.2
92.5 13.1 13.3
93.0 13.2 13.4
93.5 13.3 13.5
94.0 13.5 13.7
94.5 13.6 13.8
95.0 13.7 13.9
95.5 13.8 14.0
96.0 14.0 14.1
96.5 14.1 14.3
97.0 14.2 14.4
97.5 14.4 14.5
98.0 14.5 14.6
98.5 14.6 14.8
99.0 14.8 14.9
99.5 14.9 15.0
100.0 15.0 15.2
100.5 15.2 15.3
101.0 15.3 15.4
101.5 15.5 15.6
102.0 15.6 15.7
102.5 15.8 15.9
103.0 15.9 16.0
103.5 16.1 16.2
104.0 16.2 16.3
104.5 16.4 16.5
105.0 16.5 16.6
105.5 16.7 16.8
106.0 16.9 16.9
106.5 17.1 17.1
107.0 17.2 17.3
107.5 17.4 17.4
108.0 17.6 17.6
108.5 17.8 17.8
109.0 18.0 17.9
109.5 18.1 18.1
110.0 18.3 18.3
Source: The WHO Child Growth Standards (2006). Weight for Length.
Internet Source: htt//www.WHO.intlChildgrowthlstandards. Accessed 12.6.09. 11
Habits and Food
Misconceptions
Figure 15.3 (a) : Height measurement of School Child
12 Figure 15.3 (b) : Length measurement of infant.

Table 15.2: Weight for height for girls and boys (2 to 5 years) Assessment of
Nutritional Status
.Height (cm) (Weight in kg)
Girls Boys
65.0 7.4 72
65.5 7.6 7.4
66.0 7.7 7.5
66.5 7.8 7.6
67.0 7.9 7.7
67.5 8.0 7.8
68.0 8.1 7.9
68.5 8.2 8.0
69.0 8.4 8.1
69.5 8.5 8.2
70.0 8.6 8.3
70.5 8.7 8.4
71.0 8.8 8.5
71.5 8.9 8.6
72.0 9.0 8.7
72.5 9.1 8.8
73.0 9.2 8.9
73.5 9.3 9.0
74.0 9.4 9.1
74.5 9.5 9.2
75.0 9.6 9.3
75.5 9.7 9.4
76.0 9.8 9.5
76.5 9.9 9.6
77.0 10.0 9.6
77.5 10.1 9.7
78.0 10.2 9.8
78.5 10.3 9.9
79.0 10.4 10.0
79.5 10.5 10.1
80.0 10.6 10.2
80.5 10.7 10.3
81.0 10.8 10.4
81.5 10.9 10.6
82.0 11.0 10.7
82.5 11.1 10.8
83.0 11.2 10.9
83.5 11.3 11.0
84.0 11.4 11.1
84.5 11.5 11.3
85.0 11.7 11.4
85.5 11.8 11.5
86.0 11.9 11.6
86.5 12.0 11.8
87.0 12.2 11.9
87.5 12.3 12.0
88.0 12.4 12.1
88.5 12.5 12.3
89.0 12.6 12.4 13
Nutritional Status, Food (Weight in Kg)
Habits and Food
Misconceptions Length (cm) Girls Boys
89.5 12.8 12.5

90.0 12.9 12.6
90.5 13.0 12.8
91.0 13.1 12.9
91.5 13.2 13.0
92.0 13.4 13.1
92.5 13.5 13.3
93.0 13.6 13.4
93.5 13.7 13.5
94.0 13.8 13.6
94.5 13.9 13.8·
95.0 14.1 13.9
95:5 14.2 14.0
96.0 14.3 14.1
96.5 14.4 14.3
97.0 14.6 14.4
97.5 14.7 14.5
98.0 14.8 14.7
98.5 14.9 14.8
99.0 15.1 14.9
99.5 15.2 15.1
100.0 15.4 15.2
100.5 15.5 15.4
101.0 15.6 15.5
101.5 15.8 15.7
102.0 15.9 15.8
102.5 16.1 16.1
103.0 16.2 16.1
103.5 16.4 16.3
104.0 16.5 16.4
104.5 16.7 16.6
105.0 16.8 16.8
105.5 17.0 16.9
106.0 17.2 17.1
106.5 17.3 ·17.3
107.0 17.5 17.5
107.5 17.7 17.7
108.0 17.8 17.8
108.5 18.0 18.0
109.0 18.2 18.2
109.5 18.3 18.4
110.0 18.5 18.6
110.5 18.7 18.8
111.0 18.9 19.0
111.5 19.1 19.2
112.0 19.2 19.4
112.5 19.4 19.6
113.0 19.6 19.8
113.5 19.8 20.0
14 114.0 20.0 20.2
Assessment of
(Weight in Kg)
Nutritional Status
114.5 20.2 20.5

115.0 20.4 20.7
115.5 20.6 20.9
116.0 20.8 21.1
116.5 21.0 21.3
117.0 21.2 21.5
117.5 21.4 21.7
118.0 21.6 22.0
118.5 21.8 22.2
119.0 22.0 22.4
119.5 22.2 22.6
I
120.0 22.4 22.8
Source: The WHO Child Growth Standards (2006). Weight for Length.
Internet Source: htt://www.WHO.intlChild growth/standards. Accessed 12.6.09
The weight for height is a sensitive indicator of current nutritional status. It is useful
as it requires no knowledge of age i.e. it is age independent. Low weight for height is
indicativeof wasting or thiness. On the other hand, more weight for height indicates
overweight and obesity.
Body Mass Index for age (BHI for Age) is another index for assessment of nutritional
status of children (5-19 years) in terms of both overnutrition and undernutrition. Table
15.3 gives the median BMI for age for children between 5-19 years.
Table 15.3 : BMI for Age Median (BMI in Kg/m')
- BMI
Age (years) Boys Girls
5 15.3 15.2
6 15.3 15.3
7l- .. 15.4 15.5
8 15.7 15.7
9 16.1 16.0
10 16.6 16.4
11 17.2 16.9
12 18.0 17.5
13 18.8 18.2
14 19.6 19.0
15 20.2 19.8
16 20.7 20.5
17 21.0 21.1
18 21.3 21.7
19 21.4 22.2
-
Source: The WHO child growth Standards (2006), weight for Length.
Internet source: htt//www ..who.intlchild growth/standards
From the Figure 15.4 it will become more clear how BMI is a good indicator of the
nutritional status in children. The child in Figure 15.4(a) is a normal child as he has
normal height and in Figure 15.4(b) the child has normal height but low BMI and
appears thin so he is a wasted child. The child in Figure 15.4(c) is less in height but
has a normal BMI so he is a short child. The child in Figure 15.4(d) is less in height
and has low BMI so this child is short and wasted. 15
....• ..
~s:~::l.
"
0\
"'0'-
t) ~
e '" ~
NORMAL SHORT ~ § g
WASTED of!! c. e-
CHILD CHILD CHILD SHORT a.§.~ fJl
AND
e
51 J£;
WASTED
CHILD l
Nonnal
height
Normal
BMI
a b c d
Figure 15.4 : Body Mass Index an Indicator of Nutritional Status

Head, Chest, Mid-arm Circumferences: In addition to height, three other lerigth Assessment of
measurements help you to note the gross status of your body. These are head, chest Nutritional Status
and mid-arm circumferences. You will find that these are very useful to check growth
in small children. You can measure these very easily with a measuring tape and
record these.
Head Circumference: You have noticed that babies have a large head at birth compared
to the rest of their body. The head circumference continues to increase rapidly upto
six months after birth, and then it increases slowly.
You use a narrow (less than 1 cm wide), flexible, non-stretch tape to measure the
head circumference. Please avoid using a cloth tape, as it tends to stretch with use.
You measure the greatest head circumference by placing the tape firmly around the
head and passing it at the centre of the forehead. Please be sure that it is at the level
on each side of the head and it passes over the maximum protrusion (which is called
the occipital prominence) at the back of the head [Figure 15.5 (a)]. Measure the
head circumference to the nearest O.lcm. Head circumference is often used in clinical
settings for screening the potential development in children but is of less value for
assessing the nutritional status.
Chest Circumference: It is useful as a measure of growth only upto three years. If

your child grows normally in the first year, the head and chest circumferences are
almost equal at about six months of age. After that, the head grows slowly and the
chest more rapidly (Table 15.4). The chestlhead circumference ratio is useful to
detect undernutrition in early childhood.
Table 15.4 : Head and Chest Circumference Measurements in

First Five Years
Age Head Chest

(months) (cm) (cm)
BIRTH 35.0 35
3 40.4 40
6 43.4 44
12 46.0 47
18 47.4 48
24 49.0 50
36 50.0 52
48 50.5 53
60 50.8 55
Source : Growth and Development of Children, 4th ed. by E.H. Watson and G.H.Lowrey Yearbook
Medical Publishers Inc. 1962.
You can use the same tape, which you used to measure head circumference, to
record the chest circumference. Be sure to measure the chest circumference at the
nipple line, preferably in mid-inspiration (that is half way between full breathing in
and full breathing out) [Figure 15.5 (c)]. Please do not take the reading when the
child is crying or breathing irregularly. Measure the chest circumference to the nearest
0.1 cm.
If you find that the chest circumference to head circumference ratio is less than one
between six months and five years, you know that the child is undernourished and
needs special attention. If you don't have a tape measure, you can compare the two
circumferences with a piece of string and note if the chest. circumference is more or .
less than the head circumference after six months of age.
17
Nutritional Status, Food Mid-upper arm circumference (MUAC) : The mid-arm circumference gives you an
Habits and Food idea of the size of the arm muscle and the fat layer below the skin. To measure arm
Misconceptions circumference, you let the arm hang loosely by the side of the body and measure the
arm circumference at the midpoint of the upper arm, between the tip of the shoulder
and the elbow [Figure 15.5 (b)]. Use a measuring tape with divisions of 0.1 cm (the
same tape used for measuring chest and head circumferences). MUAC is proposed
as an alternative index of nutritional status in emergency situations such as famines
and during refugee crises. Low MUAC based on fixed cut-off points of 12.5cm can
be taken as an indicator of wasting.
Figure 15.5 : Measurement of head, mid-upper arm and chest circumference
Skinfold Measurement: About 50 per cent of the fat in your body is in a layer
directly beneath the skin. Insufficient intake of calories over a period of time leads to
reduction in the thickness of the fat layer under the skin. You can measure the double
layer of skin and subcutaneous fat, which is known as skinfold thickness by using
skinfold caliper and tell the state.of fat reserves of your body. This measurement
helps you to know the extent of the body's fat reserves. If the reading is lower than
the norm, you are undernourished; if it is higher than the norm, it indicates obesity
18 which has an adverse effect on your health.
Skin-fold measurement can be used along with other measurements such as weight Assessment of
for height to evaluate nutritional status. However, skin-fold measurement requires -, Nutritional Status
more training and expertise than measuring weight and height.
Generally, in order to evaluate nutritional status, weight and height are the easiest to
determine. In small children, the three circumferences are also very useful.
1) Why is weight measurement important in early childhood?
2) List the linear measurements used to record growth in children.
3) What is the significance of head and chest circumference in the first year?
4) Match the following:
Item A Item B
1) There is 50 per cent increase a) is an indirect measure of fat reserves.
2) Head circumference is greater b) in height in the first year.

than
3) Mid-arm circumference c) chest circumference at birth.
155 GROWTH MONITORING OF CHILDREN

Growth monitoring is very important in children. As children between 0 to 5 years are
at a vulnerable stage of growth, detecting any faltering in growth is very useful. At
this stage, it is possible to bring the child back to normal state, by judicious improvement
in food intake. Thus you can prevent further adverse changes, which take longer to
reverse and hence cost more.
You have learnt how to record the physical growth by taking weight, height and head,
chest and mid-arm circumferences of children. You should carry out these
measurements at regular intervals and record these. You must be wondering how
often these should be measured. The infant grows very fast, so you should record
these every month in the first year, every other month in the second and about once
in three months from 3 to 5 years of age.
19
Nutritional Status, Food Monitoring Growth - Weight and Height
Habits and Food
First check if there is an increase in weight each time you weigh the child. If you find
Misconceptions
successive increase in the weight of a child, it shows that the child is growing. Secondly,
check if the weight increase is normal by comparing with the growth curve [Figure
5.3(a) and 5.3(b)]. When you compare this weight increase with the growth curve
you can see if the weight increase is normal. Thirdly, compare the weight for height
with the help of the growth chart. The comparison of the weight for height with a
growth chart tells us if there is proportional growth of the body.
Monitoring Growth- Other Measurements

You have learnt that the head circumference is greater than the chest circumference,
until the infant is about six months old. After that the chest circumference exceeds
the head circumference. If you find that the chest circumference is less that the head
circumference between six. months and five years, you know that the child is
undernourished and needs special attention. Therefore these measures are useful
only in early childhood.
The mid-arm circumference is a gross measure of body fat reserve and muscle
development. When a child is chronically undernourished, there is poor muscle
development. The muscle tissue and fat are used up to meet the body's need for
energy. This results in reduction in mid-armcircumference. Therefore you can measure
it to detect undernutrition in young children. Note that it is useful only when there is
no oedema.
15.6 ADULTS AND THEIR BODY SIZE

In India, a large number of adults suffer from malnutrition. As you may remember,
adults normally maintain the body weight attained at 25 years of age (if that was
desirable weight) throughout their life. A change of ±5 per cent away from this weight
must be a cause for concern. Periodic record of weight can help to detect a change
in the early stages when simple modification in food intake may be needed to return
to normal state.
At the other end of the scale you may find those who have started gaining weight,
especially after 35 years of age.
As already mentioned above, regular monthly measurements of body weight can

help to note the changes in weight early enough to avoid becoming obese. Other
measurement that is useful in adulthood is body mass index which is used to detect
whether a person is overweight, underweight or obese. You have already read about
the BMI in Unit 6.
Another measurement that is useful in adulthood is the waist and hip circumference
measurement. A waist to hip ratio (WHR) of more than 1.0 for men and more then
0.85 for women is an indicator of abdominal obesity.
15.7 CLINICAL EXAMINATION

Clinical examination is one of the simplest methods to assess the nutritional status. It
involves looking for changes (clinical signs/symptoms) in the body which are indicative
of a particular deficiency. This method does not require expensive apparatus. However,
it requires an experienced investigator to assess the symptoms. With careful training
we can learn to recognise the crucial clinical signs while conducting the clinical
examination. Table 15.5 summarises the clinical signs and symptons which we should
20 look for in clinical examination.
Table 15.5 : Classified list of signs used in clinical examination Assessmentof
Nutritional Status
Area of examination Signs known to. be of value in surveys
1) Hair • Lack of lusture : dull, dry hair
• Sparseness
• Discolouration : the hair loses its black colour

and appears reddish brown. Easy pluckability.
2) Face Moonface : the face appear puffy with the

cheeks sagging.
3) Eyes • Conjunctival xerosis: dryness of the

transparent membrane that cover the cornea
and lines inside of the eyelid, the conjunctiva
becomes discoloured (muddy coloured; and
looses its brightness)
• Xerophthalmia (including keratomalacea) :

Cornea becomes soft and raw and easily
infected
• Bitot's spot: dry foamy, triangular spots

appearing on the temporal side of the eye
• Night blindness: inability to see in dim light
4) Lips • Angular stomatitis : lesions (cracks)

appearing on both the sides of the mouth.
• Angular scars : healed lesions of angular

stomatitis
• Chelosis : lips develop cracks and become

red
5) Tongue • Red and raw (tongue is bright red in colour

and very painful)
• Magenta tongue (tongue is purplish red in

colour)
• Atrophic papillae (pappillae have disappeared

giving the tongue an extremely smooth
appearance)
6) Teeth • Mottle enamel : mottled teeth with chalky

white and brownish areas with or without
erosion of the enamel.
7) Gums • Spongy, bleeding gums, purplish, swelling of

the gums, bleeding on slight pressure.
8) Glands • Thyroid enlargement : gland it visible and

enlarged. Enlargement might be diffused or
nodular.
21
labitsand Food 9) Skin • Xerosis: generalised dryness with
lisconceptions desquamation
• Dermatosis: Skin lesions which are

symmetrical and are evident only on the parts
of the body exposed to the sum (like forearm,
legs, face and exposed part of the neck). The
skin become dry and scaly.
10) Nails • Brittle and spoon-shaped
11) Skeletal system • Beading of ribs
• Pigeon chest: protuding breast-bone
• Knock-kness or bow-legs
12) Internal Systems:
a) Grastrointestinal • Enlargement of liver (soft, firm, hard)
• Enlargemetn of spleen
b) Nervous • Irritability
• Forgetfulness, headache, sleeplessness
• Mental depression
• Loss of orientation (not being able to relate

to time, place and events)
15.8 BIOCHEMICAL ASSESSMENT

Now that you know about the various external body measurements like height, weight,
MUAC etc. and clinical methods for assessing the nutrional status, we will now get
familiar with different biochemical tests that can be used to assess the nutritional
status. Biochemical assessment mainly deals with measuring the level of essential
dietary constituents (nutrient concentration) in the body fluids like blood and urine.
Table 15.6, 15.7, 15.8 and 15.9 depict the different biochemical tests that are used for
diagnosing anaemia, iodine deficiency disorders, protein energy malnutrition and vitamin
A deficiency which are the four major nutritional deficiency disorders affecting
large population groups in our country.
Table 15.6: WHO guidelines for diagnosing anaemia
Group Cut-off for Haemoglobin (gldl)
Children < 6 years 11
Children 5-11 years 11.5
Non-pregant and non-lactating adult women 12
Pregnant women 11
Lactating women 12
Adult males 13
Children 12-14 years 12

22
Assessment of
Table 15.7 : Criteria for defining the iodine status of a population
Nutritional Status
based on median urinary concentration
Iodine status Median urinary iodine

concentration (~gll)
Severe iodine deficicieny <20
Moderate iodine deficicieny 20- 49
Mild iodine deficicieny 50 - 99

Ideal iodine intake 100 - 199
More than adequate iodine intake 200 - 299
(may increase the risk of iodine
induced hyperthyroidism)
Excessive iodine intake >300 ',j
Table 15.8 : Serum albumin levels as an indicator to assess protein

nutritional staus in children < 5 years (malnourished children)
S.No. Albumin status Serum Albumin level (g/dl)
1 Deficient (high risk) < 2.8

2 Low (moderate risk) .2.8-3.4
3 Acceptable (low risk) > 3.5
Table 15.9 : Vitamin A status based on serum vitamin A levels
S.No. Vitamin A status

. Serum vitamin A levels
ug/dl umol/lltre
1 Deficient (high risk) <20 <0.7
2 Low (moderate risk) 20 - 30 0.7 - 1.05
3 Acceptable >30 > 1.05
15.9 DIETARY ASSESSMENT

You have learnt that your nutritional status is altered by the amounts and kinds of
foods you normally eat. In the first part of this unit you have got acquainted with
some of the physical measurements which can help you to assess the nutritional
status (condition). If the condition is not satisfactory, you will want to modify your
diet. How will you do it? You must know the present food intake pattern to be able to
modify it suitably. Hence the dietary assessment needs to be carried out.
When and How to Record Food Intake
You need to know your normal or habitual pattern of food intake. So you select three
normal working days to record the food intake. On Sundays, holidays and festivals,
you generally have special menus, and the schedule of eating changes. So please
avoid such days while recording your normal food pattern.
You write down the foods you eat each day at each meal. Please record the snacks,
fruits and beverages you take between the meals, or with the meals. Record the 23
Nutritional Status, Food amount of each preparation eaten and also the time when you ate it. The amount can
Habits and Food be recorded either in volume or weight. Later you can convert all the amounts into
\1isconceptions weights. This process of conducting the dietary assessment is the 24-hour recall
method. In Unit 3, you learnt about normal servings of individual foods; you will find
that (knowledge) helpful in recording food intake. Please pool the data as shown in
Table 3.1.
Evaluation of Food Intake Data
You can evaluate the food intake to check how the food selection compares with the
daily food guide. This is qualitative check and will help you to identify if any of the
food groups are missing from the day's intake. Secondly, you can compare the amounts
of foods taken with the suggested minimum number of servings to see if the amounts
of foods included are insufficient.
This evaluation will help you to decide what changes need to be made in the diet to
improve the nutritional status.

1) What is growth monitoring?
2) How would you monitor growth of children?
3) Why is dietary assessment important?
4) Explain how you would evaluate food intake data of a pre-school child .
•................•••••......•...••••••••••••••••....................••.•••...•
!..•••.•.••
o I ••••••••• , •••••••••••••••••••••••••
24
Assessment of
Practical Activity 1 Nutritional Status
Assessment of Nutritional Status
A) Record Weight of 10 Children (3-10 year old)
Please ensure accuracy in weighing by taking the following precautions:
1) Place the scale on a firm, flat level surface. (If it is the hanging type of
scale, be sure to hang it from a firm bar or hook. The scale should hang
freely away from a wall)
2) Bring the needle to zero, by zero adjustment, before recording the weight.
3) Take the weight after the needle comes to a stop after moving.
4) Do not hold the child while weighing. If the scale is the hang type, the
feet of the child should not touch the ground. The scale should be hung
at a reasonable height.
5) Record the weight in a notebook immediately to avoid error in entering

it. If you have a growth chart for the child, enter it in the chart.
B) Record Height of 10 children (3-10 year old)
Please observe the following precautions to ensure accuracy:
1) Take the height without shoes or chappals.
2) Fix the scale on the wall, near a flat floor.
3) Request the child to stand on the floor near the scale with feet parallel
and heels, hips, shoulders and back of the head erect and touching the
rod with arms hanging at the sides.
4) Place a light wooden block on the head, press it firmly and read the
height at the point where its lower end touches the rod.
Record of Weight and Height
No. Name of the child Age Weight in kg. Height in cm
25
llabits and Food C) Record the body mass index of 10 childen ( 6 to 12 years)
vlisconceptions
No. Name of the child Age Height in cm Weight in kg. BMI
15.10 LET US SUM UP

In this unit you have learnt that ideal nutrition is essential not only for optimal growth
and development of your body, but also to ensure your capacity to work and longevity.
Therefore you would like to maintain a normal nutritional status. You can use several
methods to measure nutritional status of individuals. You can record physical
measurements such as weight, height and skin-fold thickness for all individuals. In
addition, you can record head, chest and mid-arm circumferences of small children
(below 5 year ), to assess the nutritional status, if needed. You can record the normal
dietary intake so that it can be modified suitably to improve the nutritional status, if
there is a need to do so.
15.11 GLOSSARY
Assess Evaluate, estimate.
Edemaloedema Swollen state of body due to retention of fluid.
Heredity The phenomenon of inheritance of characterstics from

parents to off- springs.
Life Expectancy A statistical prediction at birth about the number of years

a person can be expected to live, when he/she is born
in a particular country. It is based on the general health
conditions and vital statistics of that country.
Longevity Long life.
Monitor To keep control through regular vigilance.
26 Vuln r b Liable be easily affected.

Assessment of
15.12 ANSWERS TO CHECK YOUR PROGRESS Nutritional Status
EXERCISES
1) The most rapid growth of the brain takes place from the second half of pregnancy
to the 10th month of infancy and this mental growth is directly affected by the
nutrition received during this period. If nutrition of the pregnant mother or infant
is inadequate the development of the brain will be affected.
The ability to concentrate among school children also depends upon the food
they eat. Hungry children are not able to concentrate and therefore their learning
ability is poor.
2) Food gives energy to do physical work. Therefore if labourers involved in physical

work are underfed, they will have less energy to work and their work output will
be decreased.
3) Fill in the blanks
a) Weight, height.
b) 90%, brain size.

1) The signs of good nutritional status are a healthy complexion, bright eyes, good
figure, a positive, happy temperament, willingness to work, etc.
2) Fill in the blanks
a) Kind of nourishment, food you eat.
b) Gross indicator.

1) Weight gain during childhood indicates the pattern of growth of the child. In
case gain in weight is not normal, it requires remedial action.
2) Height head, chest and mid-arm circumferences, skin-fold thickness.
3) Head circumference continues to increase rapidly upto six months after birth
and then it increases slowly and is therefore useful as a measure of growth in
the first year.
If growth is normal, head and chest circumference are almost equal at 6 months.
The chest! head circumference ratio is a useful indicator of growth in early
childhood.
4) Match the following
Item A Item B
1) There is 50% increase in height in the first year

2) Head circumference is greater than chest circumference at birth
3) Mid-arm circumference is an indirect measure of fat
reserves.
1) Growth monitoring is the regular measurement of growth in children to check if
growth is normal. Any faltering in growth can be detected by growth monitoring
and corrected by improvement in food intake. 27
Nutritional Status, Food 2) Growth in children can be monitored by taking their weight, height and head,
Habits and Food chest and mid-arm circumference.
Misconceptions
3) In case the nutritional status is not satisfactory, the diet has to be modified. This
would require an assessment of the present diet before any modifications could
be made. Dietary assessment would indicate where the diet is lacking.
4) Food intake data of a pre-school child would be evaluated by comparing it

with the daily food guide of that age group. This would indicate if any food
groups are missing. Secondly, the amounts of foods taken can be compared to
see if intake is sufficient.
28
UNIT 16 OUR FOOD HABITS
In this unit you will learn about the relation between food habits and nutritional status
and factors determining the food habits of most people.
Structure
16.0 Objectives
16.1 Introduction
16.2 Formation of Food Habits
16.3 Factors Affecting Food Acceptance
16.4 Creating Good Food Habits in Children
16.5 Convenience of Food Preparation
16.6 Guiding the Food Habits of Adults
16.7 Monitor Your Food Habits
16.8 Let Us Sum Up
16.0 OBJECTIVES
After studying this unit, you will be able to:
• explain the main factors which affect food habits,
• state the reasons for variatiohs in food preferences,
• help children to form healthy food habits,
• guide adults to adopt good food habits, and
• identify motives for modifying food habits and use these as/guide to improve
their food habits.
16.1 INTRODUCTION
You have learnt how the foods you eat become a part of you. In the last unit you
learnt how to assess nutritional status. When you carried out dietary evaluation, you
must have found some whose food intake was not satisfactory, and needed to be
modified. You may have noticed that food intake is related to food habits. Habit is a
powerful force in deciding what you eat. We tend to eat according to our set food
habits and like all habits these may be good or poor. Let us understand how food
habits are formed so that we can take appropriate measures towards building good
. food habits.
16.2 FORMATION OF FOOD HABITS

Your food habits are affected by a number of factors. Some of these are dictated by
the region and community you belong to while others are personal in nature.
Regional and Community Variations: Food habits are affected by food production
and supply. For example, rice is the main staple food in the West and South of India
29
Nutritional Status, Food while jowar is the staple on the Deccan plateau and wheat in the North. Secondly the.
Habits and Food amounts and kinds of foods you eat depend on the money that one can spend for
Misconceptions
food. Thirdly, your family eating pattern is dictated by the geographic region, religion,
community and family beliefs and practices developed over several generations.
You may know that in India certain communities are vegetarians and others non-
vegetarian. You may have observed that even non-vegetarians may abstain from
meat or fish on Mondays, Saturdays or Tuesdays due to religious reasons. Besides
these, a large number of non-vegetarians in India may rarely, include meat in their
diet due to its high cost. The part of the country you belong to affects your eating
habits. In the coastal regions, people use fish. In Punjab and Bengal, milk production
is high, and you find that it is an essential part of their food pattern, e.g. Punjabis use
a large amount of milk and lassi while Bengalis include sweets made from milk.
You find that the dhal, the vegetables and fruits you habitually eat are those which are
part of your regional dietary pattern. Even when you move to other regions for work
or business, you tend to retain a large part of your food habit heritage. For example,
Tamilians residing in Bombay or Calcutta retain their food pattern which includes
rice, sambar made from tur dhal, and vegetables such as ash gourd, amaranth, etc. A
Punjabi, in a similar situation, would include. wheat preparation, rajamah, palak and
peas. You may realise that from the nutritional point of view it makes little difference
whether the leafy vegetable is amaranth or palak. Thus all regional patterns can meet
the nutritional needs of people if sufficient food from each group (Unit 3) is included.
The particular food chosen and the way it is prepared and seasoned is a matter of
your own choice. Your social customs about when and with whom and what you can
eat, will affect your exposure and hence your acceptance pattern.
Personal Factors: At the personal level, your attitudes may be modified. by the
atmosphere in which you eat. A happy atmosphere or an unhappy one will affect your
reactions to food and eating. You have your own personal response to the taste of
foods. You may like pungent foods or acid foods while your friends may prefer mild
or astringent foods. Lastly, your selection of foods may be based on the knowledge of
food values. These basic influences affect your food habits as you tend to adopt the
food practices of your family.
Other Influences: There are other influences that modify bur food habits. For
example, during the Second World War, rice, wheat, jowar and maize were distributed
through the ration shops every where. As a result, people who were used to a single
cereal diet learnt to eat a multi-cereal diet. When you move away from your region
for education or work, you are exposed to new foods and your eating pattern is
modified. Travelling within your food region and outside also influences your food
habits. Though food habits are affected by many influences, individual food intake is
dependent on personal preferences which are an important factor in deciding your
nutritional status.
16.3 FACTORS AFFECTING FOOD

ACCEPTANCE
You may have noticed as you tried to collect information about food intake that each
person has a pattern of eating. Each one eats certain foods and may not eat others
for a variety of reasons. The reasons may have little relation to the foods.
Favourite Foods: Your favourite foods may have been made for you by a loving
relation or may be associated with a happy company of relatives or friends. Perhaps
your favourite sweet and puri may have been served on your birthday; you may
associate laddu with the Diwali festival and gujias with Holi frolics. You may like
some foods because your mother made these very tasty. Mangoes may remind you
30
of an enjoyable visit to your favourite aunt. If you could not have particular foods for
some reasons, it can affect your food habits. Do you have a special preference for Our Food Habits
gulab jamuns now, because you could not afford it when you were young? If you
analyse your attitude to foods you may gain a new understanding of your food habits.
Food Rejections: Your eating pattern reflects the foods accepted and, also those
rejected. As your food habits are being formed, there are positive as well as negative
influences. If leafy vegetables served at your home were overcooked, olive-green
and stringy, you may develop a dislike for leafy vegetables. You may dislike foods
that you were made to eat when you were sick or unhappy. Do you remember your
first day in the hostel or a new place? You were so lonely that you could not eat the
meal, though you were hungry. Trying to understand the reasons for your likes and
dislike makes a fascinating study.
Try to analyse your attitudes towards the foods in each category, assess how these
affect your nutrition and what you can do to modify it, if necessary.
Food Associations: Food habits begin to form almost as soon as the baby is born.
When you feed a baby when it is hungry, it has happy associations with food and
people. If the child is forcibly fed when it is not hungry, it is likely to have adverse
associations with food. As children grow up, some parents use food as a reward or as
a means of discipline. For example, chocolates are given as a reward and favourite
foods are withheld as a punishment. This results in confusing the child about the
rational place of food in hislher well-being. The 2hild may learn to use food acceptance
or rejection to get attention. Thus when you use food in ways which have no relation
to their basic function, you encourage development of poor food habits. As you know
food is a basic need for life and health. If you retain this focus you can help the child
to develop good habits.
1) How is an individual's food acceptance pattern formed?
16.4 CREATING GOOD FOOD HABITS IN

CHILDREN
You must be wondering why we should worry about the children's food habits. There
are many reasons. As you remember,children will grow and develop to their full
potential, both physcially and mentally, only if they eat the right kinds and amounts of
food. What you eat as an adult depends a lot on the eating habits you formed as a
child. As you grow up you get used to eating foods made in a certain way and without
realising it develop a preference for it.
In childhood parents are your models. You tend to copy whatever your parents do.
Food is no exception. There are parents who send their children to the best school but
unknowingly set a poor example by practising poor food habits. Children learn from
parents how to enjoy a wide variety of foods and be healthy. If you are a parent,
setting a good example in food selection is as important as giving him the opportunity
for good education. Educate your child on good food habits. 31
Nutritional Status, Food School-age Children: Once the child leaves home, his/her choice is influenced by
Habits and Food friends, teachers and many others. Quite often your child comes home and asks,
Misconceptions
"Can I have a dosa in my lunch box? I liked the dosa my friend Mani brought to
school yesterday". Thus you find that his food world is enlarged.
You must pay special attention to help school-age children retain the good habits
formed in early childhood. Once the child enters school, your attention is diverted to
books, uniforms, etc., and food takes a back seat. The school schedule affects. their
food habits. You tend to serve breakfast and lunches in a hurry. You pack concentrated
sweets or fried snacks if you give a packed lunch. Having learnt about children's
needs for growth (in Unit 10) you will realise that the child does not get the quantity
and quality of foods needed by eating such snacks.
With a little pre-planning you can alter the schedule to ensure that the child has time
for a proper breakfast and has packed lunch which meets her / his needs. If you had
developed a habit of meeting your food needs in the school/college years, you are
likely to retain these through adult life.
1) Why is it important to help children to develop good food habits?
2) How does school timing affect a child's food pattern?
3) How can parents help children to form healthy food habits?
16.5 CONVENIENCE OF FOOD PREPARATION

You must have observed that much emphasis is placed on convenience of food
preparation in recent years. This has affected our food habits to a large extent. The
man of the house, as well as his wife are very much interested in this aspect of meal
planning, preparation and service. One of the reasons may be that more and more
women either form a part of the work force or participate in community activities. As
a result, there is a lot of emphasis on the ease of food preparation.
You may have observed that in a large number of families, time to prepare a meal is
kept to the minimum and they select foods and plan menus with this target in view. A
number of things have contributed to this change. A number of convenience foods
32 have come into the market. We have discussed about these at length in Unit 21 of the
first course "You and Your Food". You get ready-made mixes, instant beverages, and Our Food Habits
a lot of ready-made foods such as bread, biscuits and snacks (sev, chiwda mixture),
to reduce food preparation to the minimum. Though ease in food preparation is a very
important goal, you should not let it lead you to poor nutrition at high cost.
You can serve quick and easily prepared meals and not sacrifice nutrition and money
if you put your nutritional know how to use. When you select ready-made foods,
check how these fit into the menus you made using the daily food guide. For example,
the increased use of salads and fruits is certainly a step in the right direction. But the
extensive use of fried and sweet snacks and of the instant beverages contribute very
little nutrients in comparison to the caloric content. If you use these once in a while, it
may not matter. But if these have become a part of your tea-time and hospitality, you
need to check how these affect your day's food intake. You need to be vigilant in your
selection of convenience and ready-made foods so that you prevent unbalanced food
patterns.

1) How has the emphasis on convenience of preparation affected food habits?
.................................................................................................. ~ .
16.6 GUIDING THE FOOD HABITS OF ADULTS

Ideally, by the time you reach adulthood, you should have developed a healthy eating
pattern. Unfortunately for some this does not happen. Some of you may think that
reaching adulthood is a signal for you to eat what you please and when you please.
Since you are economically independent, you may tend to buy expensive foods, which
have status symbol. These changes are likely to affect your health and well-being, if
continued for long. If you persist in these habits, you will not be a suitable model for
youngsters in your family, or for your children in later life.
As you know, food habits are closely associated with your sense of security, and any
modification, particularly in the adult stage, will require a strong motivation. In Unit
14, you learnt that your energy need decreases with age. You will realise that
modification in food habits need to be made to reduce energy intake as people grow
older. The overweight people you see is a proof that they have not made the
adjustment. You may observe some people, who are not overweight, but eat foods
that do not meet their need for other nutrients, except calories. It is difficult for such
people to see the need for change because they maintain their weight and do not
associate any symptoms of poor health they may have due to their eating habits. You
will agree that cause and effect are not easily noted.
When do we attempt to change food habits in adults? You must be wondering about
this. If you find, after careful checking, that the dietary habits lead to poor health, you
may attempt to modify them.
You must be cautious in your approach in modifying the food habits of people. You
will need to understand the background of their food habits before you can help them
to improve/change their diet. The desire for good health is universal. This can be used
as a motivating force to help yourself and also others. Remember, setting an example
is the most effective teacher. You can motivate others by your own example. 33
Nutritional Status, Food You will find that those who understand the.impl ications of their poor food habits and
Habits and Food wish to improve their health through diet change, have a clear goal. For example, a
Misconceptions
diabetic, who wants to control her diabetes, or a heart patient, who wants to lose
weight, have a strong motivation for change. All you need to provide them is reliable
information about how to select and prepare foods to meet their specific needs.

1) Do adults also need to modify their food habits?
.................................................. ~ .
2) Explain when to modify food habits of adults.
3) How can you decide if your food habits are healthy?
Motivating people to change their food habits, leading to their good health, is still a
challenging task and requires further study. You do know however that those who
have a good attitude towards all foods have a spirit of adventure that prompts them to
taste new foods or try new ways of preparing food. They adjust more easily to
modifications in diet, be it for health reasons or due to changes in availability of
familiar foods.
16.7 MONITOR YOUR FOOD HABITS

It is good to remember that our appetite is not necessarily a guide to help us select
foods for adequate nutrition. If appetite could guide us, we would not see so many
obese and underweight people around us. Many foods, which we are tempted to eat·
are low in nutritive value. You would be well advised to monitor your food habits
periodically with the daily food guide (Unit 3) to ensure meeting your nutritional needs.
You can also help your family and friends to do the same.
How can you decide if your food habits are good or not? Your food habits are good if
you like and eat a variety offood from each of the food groups which were discussed
in Unit 3. It does not mean you like and eat all foods with equal enjoyment. Most of us
have our special preferences, our likes and dislikes. But if you like and include some
of the foods from each group to meet your nutritional needs, your food habits are
good. If we eat only what we like and what is tasty and exclude foods from one of the
food groups, we are likely to suffer from nutritional lack. Thus our food habits can be
either an asset or a liability.
You can note how you look and feel and it will be a reflection of your food habits. You
can observe the visible signs of good nutrition at any age, in appearance, vigour and
34 stamina. Isn't it a goal worthacheiving?
Our Food Habits
16.8 LET US SUM UP
Food habits are influenced by the food supply, region, community, personal preferences
and also our knowledge of food values. The associations you have with foods influence
your eating behaviour. Parents are responsible for creating good food habits in children
by their own example. They need to ensure that children retain healthy food habits
even after they go to school and college.
The ease of food preparation affects our food habits. You find that adults who have a
strong motivation, succeed in changing food habits to improve their health. A little
check-up at regular intervals can ensure your nutritional needs through healthy food
habits.
16.9 ANSWERS TO CHECK YOUR PROGRESS

EXERCISES
1) Food acceptance pattern is based on a variety of factors which determine an

individual's likes or dislikes regarding food. Favourite foods are usually associated
with happy and loving memories and occasions or with persons one loves.
Negative influences regarding food lead to the dislike of certain foods. If certain
foods were cooked badly or if one was forced to eat certain foods during
childhood, one may develop a dislike for a lifetime. Dislikes of foods are also
associated with unhappy occasions, loneliness, etc.

1) Children will grow and develop to their full potential both physically and mentally
only if they eat the right kinds and amounts of food. It is, therefore, important to
form good food habits in childhood.
2) When a child starts going to school the school timings affect his food pattern.
Breakfast is always had in a hurry and lunches are usually packed. Packed
lunches often become an assortment of sweet or savoury snacks which are not
nutritious.
3) Parents can set a good example to children by selecting and encouraging

consumption of a variety of nutritious foods. Moreover, they can make the children
understand the basic function of food by not using it as a reward or punishment.

1) Since a large number of women have started working, the time to prepare a
meal is limited. Food which is convenient to prepare has, therefore, become
more and more popular. Availability of ready-made mixes, instant beverages,
ready-made foods has helped to reduce time in food preparation and change
food habits toward an unhealthy trend.

1) Yes. There in so age bar for a change in food habits to maintain ideal nutritional
and health status.
2) As adults grow older they need to reduce energy intake to avoid obesity. Other
attempts at modification of food habits of adults should be made after confirming
that their dietary habits led to poor health.
3) If a person does not have any symptoms of poor health is alert and active, it
may be said that his food habits are healthy. 35
UNIT 17 FOOD MISINFORMATION
Unit 17 deals with the prevalent food misconceptions, their origin, and ways to find
out the truth.
Structure
17.0 Objectives
17.1 Introduction
17.2 Misconceptions about Water
17.3 Fallacies about Cereals and Cereal Products
17.4 Misinformation about Oils and Fats
17.5 Claims about Other Foods and Food Products
17.6 Fallacies about Choice of Food
17.7 Weight Gain-Facts and Fancies
17.8 Vigilance about Food Misinformation
17.9 Let Us Sum Up
17.10 Glossary
17.0 OBJECTIVES
After studying this unit, you will be able to:
• recognise some of the prevalent misconceptions about foods;
• identify the misrepresentation of food products by manufacturers;
• be aware of the fallacious claims of reducing diets; and
• be vigilant about food misinformation.
17.1 INTRODUCTION
You are well aware that food forms an essential part of your daily life. You spend a
considerable part of your time and income to select and purchase foods. Besides
food habits, your choices are affected by prevalent misconceptions you may have
about foods and food products. Some of these ideas can be entrenched in your mind.
You are exposed to a variety of views about the foods and their nutritional contribution-
through conversation, through newspapers, magazines and books and through television.
You see and hear advertisements about foods and drinks. So your ideas are indirectly
modified by what you hear and see. You may like to examine some ofthe notions you
have or hear about, the claims made in food product advertisements and the printed
material you read, and see how true or false these are in the light of your knowledge.
Lastly, you may also like to know how to check for food misinformation so that you
may not be misled. <
36
Food
17.2 MISCONCEPTIONS ABOUT WATER Misinformation
A lot of advice may have been given to you about the water you drink. As you learnt
in Unit 1, water is an essential part of your body. It is needed to digest food, absorb
and transport nutrients in the body. It helps in exeretion of waste products from the
body apart from participating in metalolism of nutrients. Let us examine some of the
misconceptions people have about water.
Some people think drinking water can help them lose weight. But you know that
water cannot wash away the fat from the cells, or those extra calories you get from
overeating. But, if you drink water instead of the calorie-rich soft drinks, you might
cut down on your calorie intake.
At the other end of the scale, you are advised that a good way to lose weight is to
restrict intake because water is fattening. As you know water does not contain any
calorie providing nutrient (carbohydrates, fats or proteins), and therefore it does not
provide any calories. Please remember, you should not restrict water intake or use
diuretics (medicines which increase urine output) along with crash diets. Athletes and
airline pilots resort to such diets in order to reduce weight in a hurry before periodic
weight checking. This can cause dehydration, serious stress on your cardiovascular
system and may even cause kidney damage. Drinking plain water is the best and
cheapest way to replace fluid loss from the body.
When a person or a child suffers from diarrhoea and vomiting, some people restrict
their water intake, in the vain hope of stopping it. As you learnt in Unit 9, it is very
important to feed clean, boiled, cooled water, with added sugar, salt and lemon, to a
person who has suffered loss of body fluids due to diarrhoea or vomiting. Water
intake in such a condition is crucial to prevent dehydration especially in children.
l) List some of the misconceptions about water. How do these affect health?
Practical Activity 1
Do you know of any other misconceptions about water prevalent in your region?
Analyse how these affect water intake of children and older members.
37
Habits and Food 17.3 FALLACIES ABOUT CEREALS AND
Misconceptions
CEREAL PRODUCTS·
As you know, a fallacy is a false belief (misleading idea). There is a wrong notion that
starchy foods, such as rice and bread, are high in calories. Many dieters frequently
reduce or cut out some of the cereals from their diet. What you need to remind them
is that basic cereals and plain breads (chapati, roti included), are not very high in
calories. The calories come from the foods they add such as ghee, butter, cheese,
jam, sugar oil seeds, chutney, etc. It is these extra high-calorie foods that they should
omit, not the breads and cereals.
Another misconception is that weight reduction is possible jf you eat bread or chapati
instead of rice. As you know both rice and wheat contain about the same number of
calories. It is the total calorie intake that needs to be reduced not calories from a
particular food.
You must have noticed that a lot of people cut the sugar from tea/coffee to reduce
their calorie intake but do not skip the biscuits, cake, or other snacks that are served
with the tea or coffee. As you know, the teaspoon of sugar they skip is only 20
calories, but the snacks they eat may add 50-100 calories. So they end up having 2-
5 times the calories they would have got from sugar.
1) Have you heard about the fallacies about cereals mentioned above?
2) List two of the fallacies about cereals held by some people .
.
.................. ...............................~ , , .
38
3) Indicate whether the following statements are true or false: Food
Misinformation
a) You must increase water intake during an attack of diarrhoea.
b) Rice and bread are high-calorie foods.
c) Claims made for the promotion of food products are a reliable source of
nutrition information.
Practical Activity 2
List some of the fallacies about selection of cereals prevalent in your region.
Explain how these affect the cereal intake of people.
17.4 MISINFORMATION ABOUT OILS AND FATS
You may have noticed that manufacturers of vegetable oils make a number of claims.
They play on your fear of getting heart trouble. Some claim that you should use a
particular vegetable oil, as it has a high content of poly-unsaturated fatty acids (PUFA)
and contains no cholesterol, and is beneficial for heart patients. The fact is, all vegetable
oils (except coconut and olive oil) contain a high amount of PUFA. Please note
vegetable oils do not contain any cholesterol. To say that a particular brand of vegetable
oil contains no cholesterol is intended to misguide you to think that other brands of
vegetable oils contain cholesterol. All these claims make a layman feel that he can
consume as much oil as he wants and have no problem. This is far from the truth.
Please do not confuse the nature of the oil of fat (unsaturated or saturated, fatty acid
content, cholesterol content, etc.) with their calorie value. As you learnt earlier, all
oils, ghee and vanaspati provide the same number, i.e. nine calories per gram. So you
realise that when you read an advertisement of an oil that contains less or low calories,
you must know that it is not true.
1) Please state whether the following statements are true or false.
a) You should use only groundnut oil, as it has a high content of poly-
unsaturated fatty acids. 39
Nutritional Status, Food b) Vegetable oils do not contain any cholesterol.
Habits and Food
Misconceptions
c) You can consume any quantity of vegetable oils, as these have high content
of PUFA and contain no cholesterol.
17.5 CLAIMS ABOUT OTHER FOODS AND

FOOD PRODUCTS'
In modern times you buy many food products which your mother or grandmother
used to make at home. Not only that, you crave for and tryout new food products.
You find that food advertisements occupy a large part of media coverage. Now you
know the main aim of manufacturers is to increase sales and make profits, not to
promote health. Since the consumers have become health conscious, the advertisers
use this focus to project their products. Let us examine some of the claims made by
the manufacturers.
We are all concerned about the growth and health of our infants and children. So you
find that weaning food products are advertised as 'Doctors recommend' or 'more
nourishing food for growth'. The fact is that there is nothing special about these
products. Most of these are made from the cereals you use at home, to which they
add some milk powder, sugar, minerals and vitamins. As you learnt in Unit 9, your
infant can get all these and more in the food you make as supplements, from cereal,
dhal, curd/milk, vegetables and fruits. It will cost you a fraction of the price you pay
for commercial weaning foods. Another advantage would be that your child will
develop healthy food habits in this way, which will help him/her through the lifetime.
In a number of advertisements, a lot more is claimed than the products provide as a
part of sales gimmickry. For example, you hear about some brand of biscuits being
the best food for children. Actually most biscu its are made from maida (refined wheat
flour), with the addition of varying amounts of fat and sugar. Thus biscuits provide
mainly calories. When you feed children these as a main supplement instead of a
meal, your child gets mainly calories and not all the nutrients needed for growth.
Another group of products very much advocated are a variety of synthetic drinks and
carbonated beverages. As you read in Unit 20 on beverages (Course I-You and Your
Food), these contain only sugar, flavouring agent, colour and acid and provide only
energy. A few may have a little vitamin C, but nothing else.

I) What is the aim of advertisers of food products?
............................................................................................................ ; .
........................................................................................................................... .
2) List two of the claims made about food products. How true are these?
....................................................................................................... - .
40
3) Can biscuits given in the packed lunch meet the needs of a child? Food
Misinformation
17.6 FALLACIES ABOUT CHOICE OF FOOD

You may have some fallacies about the foods you buy. Some of these may result in
spending more for a product than desirable.
For example, desi or vilayati eggs are thought to be more nutritious than vilayati
(English) eggs. They are not. The prefix desi or Vilayati indicates the breed of the
hen. It does not affect the composition of the egg.
When you choose foods as gift, you tend to mix your feelings of love and ability to
spend with your choice. So you buy expensive boxes of mithai; chocolates or fancy
cakes and pastries. As you may have observed high cost and high calories go together,
for these two ingredients -fat and sugar account for the high calorie. Don't you think
you create a special attachment to these high calorie foods in the minds of the recei vers,
who are mostly children? Would not seasonal fruits be an ideal gift for the young as it
is for the old? You might like to consider this as it will be a positive step towards
developing healthy food habits.
You may as parents continue to feed too much milk to your children, especially the 1
to 5 year age group of children. Therefore they may not have any room for other
foods they need, and become malnourished and finicky eaters. As you have learnt,
milk is a nutritious food but it cannot provide all the needs of the growing child after
the first 5-6 months of infancy. So you need to shift the child to the family meals by
the first birthday and give milk only as a beverage.
1) List two fallacies about the choice of food.
17.7 WEIGHT GAIN-FACTS AND FANCIES

You may have noticed that there is a lot of consciousness about weight, body build,
figure and health in our society. People are willing to spend money just to look fit.
Naturally a whole new type of products and services are being developed to meet
this demand. You need to balance the energy you spend with the energy you get
from the foods you eat to maintain your body weight. But people, who are obese
are looking for a new weight reduction method that will miraculously melt away
accumulated body fat. So you find that reducing regimens are promoted as quick
remedies. Unpleasant realities such as changing diet and eating patterns, exercise
and the need for will power are ignored. The result is a lot of disillusionment, loss
of money and faith.
Let us examine some of the fallacies people have about weight reduction. Some
obese people think that everything they eat turns to fat; they are fated to be fat 41
Nutritional Status, Food while others are lucl y to be slim. As you know, everything eaten in excess of the
Habits and Food
body's expenditure turns to fat. So you find obese people frequently tend to nibble.
Misconceptions
at high- calorie snacks and take soft drinks when they watch TV or play a game
of cards. But they hardly spend any energy for physical activity at work as also
in leisure hours. On the other hand, the slim person tends to eat well at meals but
do not eat snacks in between meals, drinks water rather than soft drinks to
quench thirst and the activity level is generally higher. It is the life style that decides
how fat or thin you will be and not fate.
Another misconception is that it is dangerous for an obese heart patient to lose

weight. As you know, obesity puts an extra burden not only on the heart, but the
whole body. So weight reduction is not only desirable but also. a vital need for such
a person. It is important to impress on such a patient that he/she should seek
guidance and supervision of a well-qualified dietician or a physician, to lose
weight.
There are obese people who skip meals in the hope of losing weight. But it usually
results in their being too hungry to control food intake at the next meal. Eating
small and frequent (three or four) meals permits you to exercise judgement and
reduce food intake.
There are so many new reducing diets you hear or read about. Some are
dangerous and most do not result in a sustained weight loss. How will you
decide if these are reliable? Whenever you see a new reducing diet, you should
check if:
a) it is nutritionally balanced by using the daily food guide.
b) it is really, low in calories.
c) it provides a variety of well-liked foods and you can keep it up.
d) it helps you to develop new eating habits.
e) it can be followed, with appropriate modifications, after you reduce weight to

the desirable level.
f) it fits into your normal food budget.

1) How will you check a reducing diet for reliability?
17.8 VIGILANCE ABOUT FOOD

MISINFORMATION
You have had a glimpse of some examples of the prevalent fallacious information
about foods. The number of examples covered has been kept to the minimum for
42 these are intended to be only examples. You may know of many more examples of
such fallacious statements about food made by commercial agencies. The aim of this Food
discussion is to give you an idea about how to evaluate claims made by people the on Misinformation
basis of what you have learnt. .
When you choose manufactured foods you must analyse the claims made about the.
food products by the manufacturers. What is the claim? Is it available at reasonable
price? Does it agree with what you have learnt in this course? The answers to these
questions will help you to decide if the product is worth buying and will fit in the
regular diet or not.
A lot of advertisements aim to reach the children in the audience. It is important for
you to share your evaluation of the claims made with the youngsters around you, to
prevent them being misled.
17.9 LET US SUM UP

As you have learnt, food is an essential part of our life. It is an important topic of your
conversation; you read about it in newspapers, magazines and books. You see and
hear a lot of advertisements about foods and drink through television. Some of this
information may be valuable but a lot may not be.
A lot of fallacies, notions or claims are made about water, cereals, oils, fats and other
food products which need to be ~xamined logically in the light of your knowledge.
There are convenient notions about obesity. A wide variety of questionable weight
reduction regiments are advocated and most cause a greater loss of money than
weight. /
You need to c~eck the reliability of evidence presented before you accept any claims
about foods and food products you select because it is a questions of your health and
well- being.
17.10 GLOSSARY
Cholesterol : A sterol found in animal bodies.
Crash reducing diets : Drastic reduction in food intake with a view to
reducing excess body weight in a very short period.
Diuretics : Substances which increase the output of urine.
Fallacy : Misleading argument, delusion, error.
Fancy : Delusion, unfounded idea.
Misinformation : Wrong or misleading information.
Polyunsaturated fatty acids : Fatty acids which have more than one double bond
in the molecule. Y
17.11 ANSWERS TO CHECK YOUR PROGRESS

EXERCISES
1) Misconceptions about water:
• drinking water can help to lose weight
• drinking water can help put on weight
• stopping water intake can stop diarrhoea.
Water is an essential part of the body and is required to digest, absorb and
transport food in the body apart from excretion of waste products. So any
misconceptions about water can interfere with our use of food in the body. 43
Nutritional Status, .Food Check Your Progress Exercise 2
Habits and Food
Misconceptions 1) Give answer on your own.
2) Fallacies about cereals:
• starchy foods like rice and bread are high in calories
• rice has more calories than chapati.
3) a) True b) False c) False
a) False b) False c) False

l) Aim of advertiser is to promote their food product sales.
2) • Some brand of biscuits are advertised as the food for children. In reality
these biscuits supply mainly calories and no other nutrients required for
growth.
• Doctors recommended' weaning foods. This claim is not true as the same
weaning food can be made at home at far less the cost.
3) No.
1) Fallacies regarding choice of food
.' that deshi eggs are more nutritious than vilayati eggs.
• that milk should be given in large quantities to 1-5 years olds,

1) If it
• is nutritionally balanced
• is really low in calories
• provides a variety of well-liked foods
• helps to develop new eating habits
• can be followed with appropriate modifications after weight reduction
takes place
• fits into the food budget
44
MPDD-IONOUIP.O. 2K1 May, 2016 (Reprint)
ISBN: 978-81-7091-191·]

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BODY BUILDING FOODS

ENERGY GIVING FOO:t;>.S

Nutritional Status, Food Habits and Food

"Education is a liberating force, and in our

Or: (Mrs.) P.R. Reddy Dt Mehtab Banji Mrs. MlU)' Mammen

COURSE CONTRIBUTORS (ORIGINAL)

COURSE REVISION (TEAM) ~

PRINT PRODUCTION TEAM

15.2 Does Nutrition Make a Difference?

15.3 Nutritional Status

15.5 Growth Monitoring of Children

15.6 Adults and their Body Size

15.7 Clinical Examination

15.8 Biochemical Assessment

15.9 Dietary Assessment

15.10 Let Us Sum Up

15.12 Answers to Check Your Progress Exercises

15.2 DOES NUTRITION MAKE A DIFFERENCE?

Check Your Progress Exercise 1

3) Fill in the blanks.

15.3 NUTRITIONAL STATUS

"The child that is born on a Sabbath day,

Check Your Progress Exercise 2

2) Fill in the blanks.

a) Nutritional status reflects the : your body gets from the

b) Body size is a of nutritional status. 7

Linear Measurements: As you noted above, a number of linear measurements are

50.5 3;5 3.4

Figure 15.3 (a) : Height measurement of School Child

12 Figure 15.3 (b) : Length measurement of infant.

89.5 12.8 12.5

114.5 20.2 20.5

120.0 22.4 22.8

Table 15.3 : BMI for Age Median (BMI in Kg/m')

Figure 15.4 : Body Mass Index an Indicator of Nutritional Status

Chest Circumference: It is useful as a measure of growth only upto three years. If

Table 15.4 : Head and Chest Circumference Measurements in

Age Head Chest

Figure 15.5 : Measurement of head, mid-upper arm and chest circumference

Check Your Progress Exercise 3

1) Why is weight measurement important in early childhood?

2) List the linear measurements used to record growth in children.

4) Match the following:

1) There is 50 per cent increase a) is an indirect measure of fat reserves.

2) Head circumference is greater b) in height in the first year.

3) Mid-arm circumference c) chest circumference at birth.

155 GROWTH MONITORING OF CHILDREN

Monitoring Growth- Other Measurements

15.6 ADULTS AND THEIR BODY SIZE

As already mentioned above, regular monthly measurements of body weight can

15.7 CLINICAL EXAMINATION

• Discolouration : the hair loses its black colour

2) Face Moonface : the face appear puffy with the

3) Eyes • Conjunctival xerosis: dryness of the

• Xerophthalmia (including keratomalacea) :

• Bitot's spot: dry foamy, triangular spots

• Night blindness: inability to see in dim light

4) Lips • Angular stomatitis : lesions (cracks)

• Angular scars : healed lesions of angular

• Chelosis : lips develop cracks and become

5) Tongue • Red and raw (tongue is bright red in colour

• Magenta tongue (tongue is purplish red in