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Nutrition and Adequate diet

Adequate diet:
A mixture of food stuffs selected to satisfy the nutritional requirements of the body in quality and quantity. It should be safe and of good taste and smell. It should be suitable for weather age, effort and physiological status of every one.

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Nutrition and Adequate diet

  1. 1. Dr. Dalia El-Shafei Assoc. prof., Community Medicine Department, Zagazig University http://www.slideshare.net/daliaelshafei
  2. 2. LEARNING OBJECTIVES: Identify sources, functions, effect of deficiency of nutrients. Understand the characteristics of adequate, balanced diet. Develop a diet plan by using the dietary guides and nutritional pyramid. Describe diets for vulnerable groups. Understand the causes, manifestations and control of malnutrition problems. Explain methods of assessment of nutritional status. Describe diet plans for selected chronic diseases (therapeutic diet).
  4. 4. FACTORS AFFECTING ENERGY REQUIREMENTS Physical activity • Type & duration of activity and size of the person. Lean body mass (LBM) • ↑LBM →↑Metabolic activity →↑Energy requirements. Age • ↑BMR & energy requirements during periods of growth then ↓ at older age. Climate • ↑Energy requirements in low atmospheric temperature to maintain body temperature. Fevers • ↑BMR by 7% for each ↑0.83°C in body temperature. Pregnancy & lactation • ↑BMR & energy requirements.
  5. 5. ESTIMATION OF ENERGY REQUIREMENTS BMR • 1.0 K.cal/kg BW /h (for men) • 0.9 K.cal/ kg BW /h (for women) • BMR/day = 1.0 or 0.9 x BW x 24 Physical activity requirements • Sedentary life = 20% of BMR • Very light activity = 30% of BMR • Moderate activity = 40% of BMR • Heavy activity = 50% of BMR Specific dynamic action of food (S.D.F) • Energy needed for digestion absorption & metabolism of food) = 10% of BMR. Energy requirements = BMR + Phys. Activity + S.D.F.
  7. 7.  A serving of a high-fiber food, such as backed beans results in lower blood glucose levels compared to the size serving of mashed potatoes which results in a higher blood glucose level.  Why are we concerned with the effects of various foods on blood glucose? Foods that result in a high blood glucose level elicit a large release of insulin from the pancreas which chronically will lead to many bad effects on the body.
  8. 8. Two food measurements have been developed which are useful in predicting the blood sugar response to various foods and in diet planning to avoid hyperglycemia.
  9. 9. GLYCEMIC INDEX (GI) It is a measure of how quickly foods that contain carbohydrate raise blood glucose levels. Some foods cause a rapid rise in blood glucose (with a high GI) while others cause a gradual rise (with a low GI). This depends on starch structure, fiber content, food processing and other food contents as fat.
  10. 10. GLYCEMIC LOAD (GL) • Another way of describing how different foods affect blood glucose levels • More useful because it considers the glycemic index & the amount of carbohydrate consumed. Glycemic load = Glycemic index X Grams of CHO serving /100
  13. 13. A mixture of food stuffs selected to satisfy the nutritional requirements of the body in quality and quantity. It should be safe and of good taste and smell. It should be suitable for weather age, effort and physiological status of everyone.
  14. 14. DIETARY GUIDELINES Every day, food must contain all nutritional elements (all levels of the guide pyramid). Eat nutritionally adequate food “Variety of foods; 20% of total calories from proteins, 25% from fats & the rest from carbohydrates (55%)”. Drink plenty of water. Don't eat between meals (snacking only by fruits & vegetables). Eat 5-6 small meals instead of 3 huge meals & last-meal must be before 9 PM.
  15. 15. DIETARY GUIDELINES ↓ Salt & refined sugars intake (white poisons). ↓ Intake of canned, preserved, smoked and salted foods. Check for expired dates for canned & frozen foods and do not eat nuts stored for long periods (contain aflatoxin). ↑ Consumption of fresh fruits & green leafy vegetables. ↓ Intake of ready-made foods (fast foods) and too much processed foods “full of saturated fats & cholesterol”.
  16. 16. DIETARY GUIDELINES ↑ Consumption of dietary fibers & complex carbohydrate (whole grain bread). ↑ Consumption of calcium containing foods (green leafy vegetable, fish with bones and milk). ↓ Consumption of total fats especially saturated fats and cholesterol containing foods. Use vegetable oils instead of margarine (trans- fats) for cooking
  18. 18. In (2011) the Nutritional Guide Pyramid was replaced with a new and simpler icon, My Plate. It is based on how our food, drink, and activity choices affect our health.
  19. 19. Make most of your meal vegetables & fruits – ½ of your plate: • Aim for color and variety • Potatoes don’t count as vegetables because of their negative impact on blood sugar”. Go for whole grains – ¼ of your plate: • Whole and intact grains—whole wheat, barley, oats, brown rice, and foods made with them, • Milder effect on blood sugar & insulin than refined grains. Protein power – ¼ of your plate: • Fish, chicken, beans, and nuts. • Limit red meat and avoid processed meats such as hamburger and sausage. Healthy plant oils – in moderation: • Healthy vegetable oils like olive, canola, soy, corn, sunflower, peanut • Avoid partially hydrogenated oils “contain unhealthy trans fats”. • Low-fat does Not mean “healthy.” Drink water, coffee, or tea: • Skip sugary drinks • Limit milk & dairy products to 1-2 servings per day • Limit juice to a small glass per day. Stay active: • The red figure running across the Healthy Eating Plate’s placemat is a reminder that staying active is also important in weight control.
  20. 20. ARE THE RELATIVE SIZES OF THE HEALTHY EATING PLATE SECTIONS BASED ON CALORIES OR VOLUME? The Healthy Eating Plate does not define a certain number of calories or servings per day from each food group. The relative section sizes suggest approximate relative proportions of each of the food groups to include on a healthy plate. They are not based on specific calorie amounts, and they are not meant to prescribe a certain number of calories or servings per day, since individuals’ calorie and nutrient needs vary based on age, gender, body size, and level of activity.
  22. 22. Nutrition plays a major role throughout each stage of the life cycle. There are nutritionally vulnerable groups who are at risk due to increased physiological needs to certain nutrients. Infants & preschool children. School children. Adolescents. Pregnant(s) & lactating(s). Elderly group.
  23. 23. NUTRITIONAL DAILY, REQUIREMENTS OF VULNERABLE GROUPS Nutrient Infants Adolescents Pregnant Lactating Elderly Energy 110 kcal/kgm 3600 kcal (boys) 2600 kcal (girls) 2800 kcal 3200 kcal 1800 kcal Protein 2-3 gm/kg 1 gm/kg 2-3 gm/kg 3 gm/kg 1 gm/kg Vit. A 375 µgm 1000 µgm 800 µgm 1300 µgm 800 µgm Vit. D 10 µgm 10 µgm 10 µgm 10 µgm 10 µgm Vit. C 30 mg 60 mg 70 mg 95 mg 60 mg Calcium 240 mg 1300 mg 1200 mg 1200 mg 1200 mg Iron 8 mg 15 mg 30 mg 15 mg 10 mg Iodine 50 µgm 150 µgm 175 µgm 200 µgm 150 µgm Zinc 5 mg 15 mg 15 mg 19 mg 15 mg Folic acid 30 µg 200 µg 400 µg 280 µg 180 µg
  24. 24. FEEDING OF INFANTS “BREAST FEEDING” Advantages of breast milk • Secreted in the first 3-4 days in small amount. • High contents of carotene, maternal antibodies, digestible proteins, less sugar and fat and more sodium, potassium and chloride. Colostrum • Rich in proteins, vitamins, mineral, IgA and galactolipid (for brain growth). • Contains hormones, growth factors & anti-bacterial factors as lysozymes, macrophages. • Contains lactoferrin which binds iron for absorption and prevents bacterial multiplication. • It is bacteriologically safe, ready made, sterile always fresh and of suitable temperature. • Its amount regulated by baby suckling according to his need. • It reduces risk of infections, allergy and obesity of infants. Mature breast milk
  25. 25. Advantages of breast-feeding process Has good psychological effect on baby & mother and initiating early mother baby bonding. Promotes development of jaws, teeth and speech pattern of baby. Helps uterine involution. ↓ Risk of post partum hemorrhage. ↓ Risk of cancer breast & ovarian cancer. Easier for mother and saves her money that paid in bottle feeding.
  26. 26. Requirements of breast feeding After birth • Start as early as possible to stimulate milk secretion. 1st 6 months • Exclusive "No other food”. After 6th month • Weaning started by introduction of other foods with breast milk • To face the rapid growth & development of baby and compensate some deficient nutrients in milk as iron. • Start is with fluids, semisolid and solid foods. • Use spoon or cup not bottle before breast feeding. • If diarrhea occurs, stop this food and replace by another gradually.
  27. 27. FEEDING OF PREGNANT & LACTATING MOTHERS They need more nutritional elements because of: Growth of the fetus & placenta. ↑ Mother weight. ↑ BMR. Production of milk.
  28. 28. FEEDING OF PRESCHOOL & SCHOOL CHILDREN Characterized by rapid growth & development. ↑ Need of food rich in proteins, calcium, iron, vit.D, vita.C, vit.B complex and calories.
  29. 29. FEEDING OF ADOLESCENTS During adolescence period body mass ↑ by 35% in boys & 20% in girls. Dramatic physical, biochemical and emotional changes.
  30. 30. FEEDING OF THE ELDERLY ↓ Requirements of all nutrients due to ↓ BMR, & ↓ activities.
  32. 32. Methods of Nutritional Assessment Relevant data Food data Availability Prices Production Importation Vital indices Morbidity rates Mortality rates Investigation of the nutritional status National food consumption Dietary survey Health appraisal Dietary history Medical history 24-hours recall Clinical examination Anthropometric measurements Weight & height Skin fold thickness Mid-upper arm circumference Waist circumference Laboratory investigations Blood Hg Serum or urine Stool analysis Physiological tests
  33. 33. Food data Availability Prices Production Importation Vital indices Morbidity rates Diarrheal diseases among children L.B.W. Parasitic infestations T.B. Mortality rates Stillbirth Perinatal mortality Neonatal mortality Infant & preschool mortality rates Relevant data
  34. 34. National food consumption Dietary survey Health appraisal Dietary history Medical history 24-hours recall Clinical examination Anthropometric measurements Weight & height Skin fold thickness Mid-upper arm circumference Waist circumference Laboratory investigations Blood Hg Serum or urine Stool analysis Physiological tests Investigation of the nutritional status
  35. 35. NATIONAL FOOD CONSUMPTION For estimation of the average food consumption (the national diet) the food-balance sheet technique is used.
  36. 36. Food balance sheet technique Aim • Determining the individual share from different foods assuming that the available foods are distributed equally among the population. • It is used for the community as a whole Steps • The different foods are divided into “11” similar groups as cereals, starchy roots, pulses and legumes, sugar and honey, fresh vegetables, fruits, meat and poultry …etc. • Calculation of local production of these food groups plus the amount of foods imported or donated. • From the above calculation a subtraction of the amount of food exported plus that not used by human beings (not-edible) is done. • The difference is called the “Balance” which is the amount consumed by the population. It is then divided by No. of population and by 360 to get the individual share in grams from the national foods per day.
  37. 37. The consumption of different food items as milk, meat, eggs ….etc are analyzed into their nutrients and energy to give the individual consumption of each nutrient (as protein, fats, vitamins, iron …etc) and energy per day.
  38. 38. Advantages • Explores the national food consumption & the main defects in it. • Used to compare between average food consumption in successive years to show the trend of consumption. • Used to compare between different countries. • By using it, we can identify the main sources of different nutrients in the national diet as protein & iron contents in Egyptian diet are mainly from plant sources. Disadvantages • Assumes that the food is distributed equally throughout the year among the population which is not true due to different socio- economic conditions and seasons. • Ignores differences in requirements of people regarding age, sex, occupation, physical activity …etc.
  39. 39. Pattern of food consumption in Egypt Cereals (especially bread) & legumes form the main bulk of diet. “Supply the greater part of energy, proteins, iron, vit. B & fibres” Energy is in excess than required (high carbohydrates & fats). The protein content is mainly from the plant sources (low biological value). Moderate consumption of vegetables & fruits. Low consumption of meat, milk & eggs. Iron intake is high but mainly from plant sources (cereals) which is of low absorbability.
  40. 40. Impact on nutritional status of Egyptians Iron & B12 deficiency anemias Protein deficiency among children Obesity
  41. 41. DIETARY SURVEY • Carried out to find out if the food intake satisfies the individuals’ requirements. • Can be done on individuals or homogenous groups (families, camps, patients in a hospital) provided that these groups of population eat from a common kitchen. It is more precise and feasible. • All foods used in preparing meals are weighing every day with subtracting the unused parts and wastes. The actual amount of food which eaten/day are calculated for a special period (one week) then the end amount divided/No. of individuals in the group/No. of days (7) to get the actual individual share in food consumption/day. The method
  42. 42. Limitations • Concerned with what people are eating which considered a private issue. • Its occurrence by itself might involuntarily change the pattern of food consumption. Advantages • More accurate & feasible (represents the food actually eaten). • Suitable for nutritional experimentation e.g., to test variations in diet or the effect of introduction of new foods.
  43. 43. HEALTH APPRAISAL (COMPREHENSIVE CLINICAL EXAMINATION) Health appraisal Dietary history Medical history 24-hours recall Clinical examination
  44. 44. Dietary history • Comprehensive nutritional interview to detect living conditions, habits, culture and economic & psychological factors ... etc. Medical history • Malnutrition, parasitic & chronic diseases. 24-hours recall • Simple & cheap method “Recall of all foods consumed the previous day to the test but it is not suitable for old persons”.
  45. 45. HEALTH APPRAISAL (COMPREHENSIVE CLINICAL EXAMINATION) It is done to detect physical signs of nutritional deficiency. However, this will be somewhat late as against every case showing frank clinical manifestations at least there are “10” cases in the subclinical (biochemical or functional) stages.
  46. 46. Defect in body functions and frank manifestations of malnutrition Detected by clinical examination and anthropometric measurements. ↓Enzymatic activity and physiological functions Detected by biochemical and physiological testing ↓Plasma levels of some nutrients Detected by biochemical testing ↓Food intake or ↑loss Detected by dietary history, survey. Effect of nutritional deficiency passes into stages:
  47. 47. Skin, hair & nails • To detect manifestations of vit. A, B1, B3 & protein deficiencies Head & neck • To detect signs of iron, Ca, iodine, vit.B2, C & fluorine deficiencies. Muscles & skeletal system • To detect P.E.M. & rickets manifestations. Nervous system • To detect signs of vit. B1, B3, B12 & Ca deficiencies. Cardiovascular system • To detect vit. B1 deficiency.
  48. 48. Clinical signs & symptoms are not often specific. Body can adapt to very low intake especially with sufficient body stores. Clinical signs take long period to be manifested “young women having deficient intake of Ca & vita.D often suffers no ill effects in young age, but they face ↑ risk of osteoporosis after many years”. Limitations of clinical examination method:
  49. 49. Anthropometric measurements Weight & height Skin fold thickness Mid-upper arm circumference Waist circumference
  50. 50. Weight & height They are used mainly to evaluate nutritional status of children. Each of them is plotted on growth charts against age for growth monitoring.
  51. 51. Height for age • <5th percentile of the reference population → Stunted child (short for age) in chronic under- nutrition. Weight for height • <5th percentile of the reference population → Wasted child (thin for age) in acute under-nutrition. Weight for age • <5th percentile of the reference population →Underweight child for age in both acute & chronic under- nutrition. WHO indices for growth monitoring of children:
  52. 52. Preschool children in Egypt Stunted Wasted Under-weight
  53. 53. Body Mass Index (BMI)(Quetelet's index): Good measure of overweight not obesity as weight may increase due to excess muscularity or oedema not always due to excess fat deposition.
  54. 54. Skin fold thickness (S.F.T.) Skin thickness over mid- triceps or mid biceps muscles or subscapular or suprailiac regions are measured by certain caliber in millimeters. It is used in infants & children to assess obesity (fat deposition).
  55. 55. Mid-upper arm circumference (MUAC) Measuring the circumference of mid-non dominant upper arm by using non-stretchable tape. Readings are measured in centimeters and compared with standard reference tables. It provides a good measure of the subcutaneous fat reserve as S.F.T.
  56. 56. Waist circumference Should not exceed 88cm for females & 102 cm for males. Waist hip ratio (WHR): Should be <1, if above denotes android obesity.
  57. 57. Laboratory investigations Blood Hg Detection of iron deficiency anemia Serum or urine Assess the level of the different nutrients “amino acids, serum retinol, iodine, some vitamins & alkaline phosphatase enzyme level to diagnose vit. D deficiency” Stool analysis Intestinal parasites Physiological tests Dark adaptation test & muscle activity test
  58. 58. THESE METHODS OF ASSESSMENT CAN BE USED: On the community level • National food consumption method. • Dietary survey. • Relevant data & vital indices. On the individual's level • Dietary survey. • Clinical health appraisal. • Anthropometric measurements. • Laboratory investigations.