NUTRITION

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NUTRITION

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You are what you eat!

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Introduction

The human body must be fed daily to be able to function normally. The choices that you make may benefit or harm you(FNA, 2007). It is important for everyone to have some knowledge of nutrition, as it can help us to make proper use of traditional and modern foods.
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Cont. Introduction

Increase in life expectancy is attributed to 80% nutrition and 20% modern medicine(Wootton,2008 cited by NFNC,2011) This unit discusses dietary issues as well as weight control, and provide guidelines so as to guide families in the attainment of optimal weight 4/14/12 nutritional status throughout the and

Objectives

At the end of the session the student is able to; (1) Identify the nutrients in food, their source and functions (2) Explain the following the objectives and policies of the nutrition program (3)Identify the prevalence of the nutrition related diseases in the 4/14/12 community & its prevention

Cont.objectives

(4)Calculate the Body Mass Index(BMI) to determine the nutritional status of an individual (5)Describe the following; - the food pyramid and its

importance - nutritional assessment of infants, pre-schoolers(MCH Clinic)school children, ante-natal 4/14/12 mothers and sick infants.

Cont. objectives

(6)Explain: (i) factors contributing to nutritional problems

(ii)tactics in developing self reliance of families & communities (iii)nutritional survey and its purpose

(7)The role of the community health nurse in the nutrition program

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Nutrition

Nutrition is the science that deals with food that we eat and how it is used in the body(NFNC,2001). The substance in food needed for growth, health and energy are known as nutrients

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Nutrients

There are 6 nutrients; Carbohydrates Proteins Fats Vitamins Minerals Water

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Calorie

This is a unit of measure for energy Nutrients that have calories (i)Proteins (ii)Carbohydrates (iii)Fats

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Cont.

Carbohydrates, proteins and fats are known as macro-nutrients Vitamins and minerals are known as micro-nutrients Each nutrient has specific uses in the body. They work together as a team and a healthy diet must provide a balance of all nutrients

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Cont. nutrient

They work together as a team and a healthy diet must provide a balance of all nutrients Malnutrition arises where there is an imbalance/insufficient consumption of nutrients A no. of different disorders may arise depending on which nutrient one is lacking in e.g. lack of vit A causes 4/14/12 poor eye sight, lack in iron causes

Functions overlap

Some food sources can have 2 or more nutrients for e.g. (a) brown rice has energy,protein,vitamins and minerals

(b)cassava leaves & bele has protein and vitamins

In the Pacific, selecting foods from the 3 food groups is always safe to 4/14/12 give a person the required nutrient

3 Food Groups

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3 Food Groups

The 3 food groups are; Health Body building Energy

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Nutrient cont.

1.Carbohydrates It comes from plant food Foods which contain carbohydrates are called energy foods Carbohydrates are classified in 3 groups (i)Sugar (ii)Starch
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Sources

Sources of carbohydrates; Sugars are found in honey & fruit(both fresh and dried), soft drinks and sugar Starches are found in cereals, pasta, flour, roots and pulse vegetables Fibres are found in fruits, vegetables & whole meal bread.
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Functions of carbohydrates

Provides the body with heat & energy Fibre helps the movement of food through the intestine Fibre rich & starchy foods provide a full feeling

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2.Proteins

Are made up of small units called amino acids Proteins are classified into 2 groups (i) high biological value(haem iron) (ii) low biological value(non haem iron) The amount of iron absorbed from animal foods is higher (18%) compared to vegetable sources(10%) 4/14/12 so vegetarian will need 80% higher

Sources of proteins

Proteins of high biological value(haem iron) come mainly from animal foods such as meat, fish, cheese,liver,chicken,shellfish,eggs and milk. Proteins with low biological value(non haem iron) come mainly from plant foods such as peas, dark leafy vegetables such as bele,tubua,ota,chauraiya,saijan,cerea 4/14/12

Functions of proteins

Growth of new cells such as skin, hair and blood Repair damaged cells Production of heat and energy( in cases when there is not enough carbohydrate, protein will change to carbohydrates) Manufacture of important body chemicals such as enzymes, 4/14/12 hormones & antibodies

Deficiency of proteins

Retarded growth in children Worn out cells are not replaced. This prevent healing of wounds Malfunctions of various organs due to hormonal enzyme deficiency Susceptibility to diseases due to lack of antibodies
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3. Fats

Fats are nutrients that gives a lot of energy The body stores energy as a layer of fat under the skin known as adipose tissue Fats are classified in to 2 groups a. Saturated fats: (animal sources) meat,eggs,milk,dairy products, cream & butter)

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Functions of fats

Fats insulates the body(keeps you warm) Protects delicate organs such as kidneys & nerves by a surrounding layer of fat Provides body with energy Helps keep body @ the right temp.
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4. Minerals

The human body require about 20 mineral elements. The major ones are calcium,phosphorus,sodium and potassium A good varied diet should supply all essential. Sources Ca milk,chicken,meat,eggs,green leafy vegetables
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K-

Cont. Minerals

Phosphorus milk and milk products Na - common salt,meat,milk eggs and vegetables such as carrots Trace Elements This include minerals includes iron, iodine,zinc,copper,floride They are needed in small amounts for existence and their absence brings death 4/14/12

5.Vitamins

They are chemical compounds that the body needs to help it function properly. They are vital nutrients needed to prevent deficiency diseases and support optimal health. Important vitamins are vitamin A,B,C,D,E Each has different functions in the body
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Sources of vitamins carrots, dark

6. Water

It is absolutely essential for life > 70% of the human body is made of water The main source is drinking water and is also found in other beverages Fruits and vegetables are also high in water
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Functions of water

Chief component of all body fluids Helps dissolve foods and aids digestion Helps remove waste material from the body
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Objectives and Policies of the Nutrition Programs

Fiji Plan for Action for Nutrition(FPAN) (2010 2014)

Policies
1.

Advocate nutritional issues & mainstreaming in to govt. Decision making system. Endorsed on 3/12/2009

2.

Promote & sustain household food security 4/14/12

Cont. Policy

4. Protect consumers thru improved quality & safety of food & water 5. Improve nutritional status of the socio-economically disadvantaged and the groups that are nutritionally vulnerable 6. Nutrition policy for school 7. Promote healthy diets and life styles

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Cont.policy

8. Establish & promote a nutrition surveillance & monitoring system 9. Strengthen collaboration with development partners.

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Prevalence of Nutrition related diseases

Anemia Coronary Heart Disease(CHD) Diabetes Hypertension & Stroke Overweight & Obesity Protein Energy Malnutrition Diarrhoeal Disease in Children
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Cont.

Iodine Deficiency Gout Vitamin A Deficiency Zinc Deficiency Dental Caries

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Prevalence of nutrition related disease

1. ANAEMIA Rate of anemia in 1993 27% 2004 - 32.4% Rate of Anemia by age groups Males Females 6/12 - > 5yrs 46.1%
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53%

Cont.
Males Females 12 14yrs 32.9% 14 - 44% 40.9% 45yrs & over 35.4% 4/14/12 25.4% 19.6% 30.6%

Prevention

(i) Balance diet in every meals Eating food high in iron (ii)Medication iron tablets given to pregnant

women. It can be taken over several months to increase iron level in the blood. Can be taken with food/orange juice, to increase absorption.
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Cont.

De-worming Hookworm infection may also be a reason for anemia NIMS project NB// - Health Education: Empowerment (If they know - they will choose what to eat)
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2.Overweight & Obesity

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Overweight & Obesity

They are a major Health problem in Fiji & the Pacific Region, affecting all age groups(NFNC,2009). These increases the risk of developing diabetes,CHD & other non communicable diseases

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Prevalence

(Nutrition survey - 2004) Children Age groups Percentage 0-4yrs 12.9% 5-9yrs 15.3% 10-14yrs 14.9% 4/14/12

Prevalence by specific age group & gender

Age Males(%) Females(%) F ij. Ind. 14.3 7.7 16.7 40 61.3 I nd. 45.7 82.3 80.7 10

Fij.

18yrs 25yrs 22.3

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35yrs

Prevention

A modest wt.loss of 500g per wk. or 2kg.per month can lead to improvement in the health of a person This can be achieved by Eating healthy- consuming less of the following foods, butter,ghee,oil,fries,& fried foods,chocolates,meat pies, fatty 4/14/12 meats, processed meats

Cont.

Consuming less sweetened beverages & fizzy drinks. Replace them with water and take less sugar with tea & coffee. Consume foods that are rich in fiber, such as fresh fruits and vegetables, whole grain cereals &root crops Eat regular meals because skipping meals is not the best way to loose weight as it leads to over eating in 4/14/12

Cont.

Drink water before and with meals Consume alcohol in minimal quantities Eat only when you are hungry Dont eat while watching TV as there is a higher tendency to overeat Physical activity with dietary restriction: This is important for long- term

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Cont.

Brisk walking for at least 30 mins. Per day on most days of the week Increased the amount of activity in the daily routine, and look for opportunities to walk during the day, use stairs instead of lifts Reduce the amount of time spent in activities that involve sitting down/sleeping, watchingt.v people 4/14/12 who work in an office to try some

3.Protein Energy Malnutrition(PEM)

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Protein energy malnutrion(PEM)

These dietary deficiency disorders are mainly related to shortage of all nutrients or to protein & energy deficiency Most common amongst children in poorer developing countries Although not common, there children been admitted for marasmus & kwashiorkor in Fiji hospitals 4/14/12 (NFNC,2009)

(a)Kwashiorkor

Related to severe lack of protein foods Affects children 1-3yrs old Causes Untimely introduction of complementary foods Foods given to children are deficient in protein e.g. giving only cassava, yam, rice, rice water 4/14/12

Signs of kwashiorkor

Poor growth Muscle wastage Apathetic looking Edema in face, hands& feet Swollen liver & abdomen Hair changes in color & is more brittle
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Nutritional treatment

To increase food intake of the child, gradually esp. high protein foods like; Meat, fish, milk & cheese, eggs, dhal, pulses

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(b)Marasmus

This is an energy deficient condition Affects children under 2yrs causes Early weaning from breast milk to other foods and milk in adequate in nutritive value Repeated diarrhoea Tuberculosis & gut disease
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Signs of marasmus

Child looks old & wrinkled Skin is dry & faces thin with sunken cheek & large eyes, abdomen looks swollen Stunted growth Considerable wt. loss Muscle wasting sagging skin on legs & buttocks
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Cont.

Diarrhoea Is irritable & cries a lot Vitamin & mineral deficiencies

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Nutritional treatment

Increase energy (calories) in diet. This is by adding oils & fats such as ghee, butter, margarine or cooking oil to the childs food before feeding while maintaining a balance diet (c)Marasmic kwashiorkor: Is a combination of both condition & is most severe
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Cont.

The child is very under weight usually <60% of normal for that age Treatment A combination of high protein and high energy (calories) foods in the diet

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Healthy Food Pyramid

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The food Pyramid

It has a pyramid shape It tells us which food we should eat little, moderate or most The food that make up the pyramid base(the widest part) should provide the biggest part of your diet, as you go up the pyramid the amount of different foods you need gets smaller
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Body Mass Index

It is a measure of body fat based on height and weight This is commonly used in calculating overweight and obesity but excluding pregnant women(NFNC,2009) Formula weight(kg) height(m)2
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Intepretation of BMI
Range Implication < 18.5 Underweight 18.5 24.9 25 29.9 Overweight
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Healthy

> 30

Obese

Example

A 25year old female who weighs 50kg., and has a height of 1.60m would have a BMI of 19.5 . Thus this person is in a healthy weight range. Can you work out your BMI? Infants and pre-schoolers assessment indicators are weight for age
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How about school age children?

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Nutritional assessments

Infants & pre-schoolers The childs weight is taken every clinic(MCH) and charted on the card

With the use of the anthropomical table the weight is compared to the age. The childs nutritional status is either obese, normal range, mildly malnourished, moderate or severe.
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Cont.

Physical growth serves as an excellent measure of adequacy of the diet(Stanhope & Lancaster,2004) Normally the childs weight should increase as the age progresses.

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CONT.

Cases of mild malnutrition, apply the nursing process in nursing the case and book for frequent visit so as to evaluate the progress and if not improving refer(if the dietician is not available) Cases of moderate and severe malnutrition, refer to dietician/higher level of care
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Cont.

If the child is mildly malnourished. Assess: - age, weight,activity,overal appearance Take the history: - Ask if the child is sick? A 24hr diet recall by the parent is a helpful screening tool to assess the amount and the variety of food intake.(Ask about the parents 4/14/12 concern). Look at the familys meal

School Children

The weight (kg) for height. Use of the anthropomical table the nutritional status of the child is determined As with infants and pre-school the nursing process is applied as problem is found with the involvement of the teachers and parents
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Cont.

The behavior and problems during meal hours Plan: Plan with the mother, steps to take to be achievable Implement: Advice at mothers level of understanding. Mention the name of the food. Food that is available at home and she can afford
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Cont.

Note ; Clients ethnicity taboos religion income age of the child

Evaluation : Ask the mother to repeat what you have said

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Sick infants

Ask if the child able to drink/breast feed, if not refer urgently Weight for age check nutritional status Ask if breastfeeding /formula If the child is > 6 months is she taking supplementary feeds Advice according to the complaints that the child presented with. 4/14/12

Cont.

The childs nutrition is very important is during illness so as to fasten recovery and optimal weight is attained Nutrition is an important aspect of management of illness

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Ante natal mother

Take weight at bookings The wt. gain is slow in the 1st half of pregnancy & more rapidly in the 2nd 20 weeks The general appearance of the woman is considered. Does she looks dehydrated, weak, obese. Advice. Hb level is also considered. Normal Hb 11g, if below she must be 4/14/12 followed up closely

Cont.

An optimal gain of an average pregnancy is 12.5kg & of which 9 kg is gained in the last 20 weeks(Fraser& Cooper,2003).

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Factors contributing to nutritional problem

Lack of knowledge: unaware of the importance of choosing a variety of foods from the 3 food groups- not knowing the food pyramid. Eat anything to satisfy the hunger Culture and religion Poverty Illnesses- acute or chronic health problems

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Cont.

Poor eating habit eat fast food Lack parenting skills teenage pregnancy Food preparation: hygienic or not, attractive ? Method overcooked ?

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Tactics in developing self reliance

Families & communities - Gibbs Trust Model Empower them by: teach/educate (show pictures) Demonstrate (clinic) Home visiting Follow up to check on the progress If client/ family is able to sustain 4/14/12 what you have taught them self

Purpose of nutritional survey

Make a conclusion of the nutritional status of the people Submit a report a of the nation/ communities nutritional status Create awareness to the public about the report found To improve the services provided
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Role of the Community Nurse

Frontline care giver must be knowledgeable in all aspect of nutrition Assess nutritional status of all age groups & refer Health Educator & promoter in regards to nutrition(nutrition educator recommends health selection & healthy eating habits)
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Cont. Role

Advisor and correct wrong practices Collaborator with stake holders Follow-up of cases at home & clinic Early identification of high risk cases Research in nutrition
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Once we used to eat this

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Now we eat this

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Once we were

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Now we are .

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Reference

Dudec,S.G.(2007).Nutrition Essentials for Nursing Practice(5th ed.)Philadelphia: Lippincott Williams & Wilkins. Fraser.D.M.& Cooper,M.A. (2003).Myles Textbook for Midwives.London: Churchill Livingstone Fiji Nurses Association.(2007). 4/14/12 Nutritional Manual for School

Cont.

King,F.S.,& Burgess,A. (2003).Nutrition for Developing Countries(2nd ed.).New York: Oxford University Press National Food & Nutrition Centre. (2001). Canteen Guidelines. Suva: UNICEF.

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