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Human beings need food in order to survive. Children and adults a like, need to have certain
elements in the food they eat in order to develop well, prevent diseases and stay healthy. Most
community members in the developing world such as Ghana have little, sometimes no
knowledge in these elements and their food sources. The typical Ghanaian adage “pintin biara ye
omee” which can be translated as “every fullness of the stomach is satisfaction”, can vividly
support the above statement we have made. This notion by many clients, coupled with the
numerous food taboos may be explained as the major factors of malnutrition and other micro-
nutrient deficiency diseases in the country.
Since generally, proper growth and development depends on the type of food one eats, it is
important for the community health nurse to have knowledge about the right sources of food
nutrients in order to impart this to the community members in order to improve their health,
resist infection and prolong their life (King and Burgess, 2004).
The food and drink consumed by man are the raw materials from which the body is built, kept in
good repair and helped to work efficiently in good health.
These foods are broken down by chemical processes into simple substances which are carried
into solution in the blood and absorbed by the tissue cells. The waste products are eliminated
through urine, faeces and sweat.
Nutrition
This is the study of nutrients in food and how they are used by the body. It is concerned with
how food is produced, processed, handled, sold, prepared and eaten as well as what happens to
the food in the body- how it is digested, absorbed and used.
Nutrients
Nutrients are the components of food, which the body uses to build tissues for growth, produce
energy for strength and protecting against infections to keep healthy.
For good health to be achieved through food, a variable number of different food stuff must be
eaten in their right amounts at all times.
Most diseases and conditions that occur in developing countries are as a result of inadequate or
incorrect foods in their proportions.
1. ENERGY-GIVING FOODS
Starch, sugar (carbohydrates) and fats are made of carbon, hydrogen and oxygen elements. When
these elements burn in the cells of the body, they combine with oxygen from the air we breathe
in. They then release energy and change into carbon dioxide and water which we breathe out to
be used for photosynthesis. A substantial amount of energy from sunlight is required to enable
the plant to transform the simple molecules to the more complex carbohydrate molecules. When
carbohydrates are eaten, this process is in effect put into reverse to produce energy for the body.
Energy-giving foods are needed in the body to move muscles, move the body and to keep the
body warm. The various energy-giving foods are classified and described with their individual
specific functions.
A. Carbohydrates
They are normally classified into the following:
a. Monosaccharides (glucose, fructose, galactose)
b. Disaccharides (sucrose, lactose, maltose)
c. Polysaccharides (starch, glycogen, cellulose)
Irrespective of the classification, the formation is still the same. The carbon dioxide in the
atmosphere and the water from the soil are picked up by the plant. These are combined with the
magnesium-containing pigment (chlorophyll) in the plant to form the carbohydrate.
Classification of Carbohydrates
a. Monosaccharides (glucose, fructose, galactose)
These are the simplest carbohydrate CHO) molecules that require no digestion and are
readily absorbed from the gastrointestinal tract directly into the blood stream. They all
contain the same molecules and only differ in the way in which the H and O atoms are
arranged on the carbon atom. It is basically the differences in the arrangement that account
for the different sweetening powers and solubility in them. The source of the
monosaccharides can be found in fruits, vegetables, honey and milk.
ii. Lactose: it is the main sugar found in milk. Galactose and glucose are
derived from it, thus it must be broken down to galactose and glucose to be used by the
body.
Lactose has three basic functions in the human body:
In the intestines, certain bacteria cause the production of lactic acid from unabsorbed
lactose. This increased acidity creates a medium in which the organism lactobacillus
bifidus grows to produce bifidus factor. This factor helps the infant in preventing the
growth of the less desirable bacteria that cause intestinal putrefaction. The factor is
present in the intestines of breastfed infants, and its absence is one of the disadvantages
of artificial feeding.
The acid medium created by the formation of the lactic acid increases the permeability of
the intestinal membranes to ions like calcium and other alkaline metals which are needed
for body building.
An undigested residue of lactose is a major asset because it gives the intestinal normal
peristaltic action. This is because it regulates water in the gastro-intestinal tract, thereby
softening the stools and preventing constipation. Research has also shown that the colon
functions better when there is a reasonable amount of bulk or residue present. This speeds
the passage of food materials through the gastro-intestinal tract, thus shortening the
‘transit time’ and helping to prevent exposure of the tissues to cancer-causing agents in
the food. They also build lipids like cholesterol and carry them out of the body with the
faeces in order to lower the body lipids concentration, and possibly the risk of artery and
heart diseases as well.
One other advantage of the cellulose is that, if it is absent in a diet, one has to push hard
when evacuating the bowel contents. The result is that some of the faeces will remain in
the lower gastro-intestinal tract, resulting complications like rectal or colonic cancer.
It has also been found that dietary fibre tends to reduce hypertension and diabetes, though
the exact mechanism is not yet clearly understood. Lastly, they also exercise the muscles
of the gastro-intestinal tract so that they retain their healthy characteristics of preventing
inflammation.
iii. Maltose: this is the disaccharide found in germinating cereals like maize, millet,
sorghum. It is made up of two molecules of glucose.
Functions of carbohydrates
1. Source of energy: the primary function of carbohydrates in nutrition is to provide energy.
Although there are other sources of energy supply of the body like proteins and fats,
carbohydrates are also the least expensive sources. However, the availability if the energy
depends on the presence of vitamin B complex and other factors which help with their
metabolism.
Special functions of carbohydrates in the vital organs
i. Liver
a. a glucose derivative conjugates with certain toxic materials (drugs) to make them
harmless for excretion.
b. The presence of sufficient carbohydrates for energy demands prevents the
channeling of too much protein for this purpose. This protein-sparing action of the
carbohydrates allows the protein to be used for its basic structural purpose of
tissue building.
c. The presence of carbohydrates for energy provision also determines the amount of
fat to be broken down. When the body is called upon to break down fat in the
absence of oxygen, a condition called acidosis occurs due to the products of
incomplete oxidation of fatty acids which are toxic to the body.
ii. Heart
a. The glycogen in the cardiac muscle is an important emergency source of
contractile energy. In a damaged heart, poor glycogen stores or a low
carbohydrate intake may cause cardiac angina.
iii. The brain does not contain any stored supply of glucose hence it depends on the
supply of glucose at any given time from the blood. When the brain is deprived of
energy, it reacts by firing off uncontrolled impulses to give convulsion. It can also
lead to irreversible brain damage if it is deprived of glucose supply for a very long
period.
2. BODY-BUILDING FOODS
Body-building foods consist of proteins. The body uses protein elements called amino acids to
build new tissues and repair worn out ones.
PROTEINS
They are the most complex of foodstuffs. They are made up of carbon, oxygen, hydrogen,
nitrogen, sulphur and phosphorous. They are the only foodstuff that has an element of nitrogen.
They made up of about 20 amino acids and each protein contains only a few of them. Among the
amino acids, 10 are essential in that, they cannot be built up by the body itself. The remaining
amino acids are non-essential because they can be made in the human body cells from other
amino acids.
Certain animal protein sources such as eggs, milk, meat, offal, milk, cheese, fish, poultry, but it
contains all of them in good proportions (first class proteins). Plant protein sources such as all
kinds of legumes and nuts, contain second class proteins. Hence the first class animal protein
sources are advisable to be included in a diet. However, soya beans contain more protein than
other beans, and the protein is more complete (King and Burgess, 2004).
Sources of protein
Animal Plant
Eggs Pulse foods (groundnut, all types of beans and soya beans )
Meat Some constituents of cereals (maize, millet, Guinea corn, sorghum and
Milk Rice.
Fish
Functions of Protein
a. Essential for growth - The chief use of protein is to provide building materials for
the body. This is because no other foodstuff contains the nitrogenous component essential for
the making of a living cell. The amino acids are carried in the blood to all parts of the body
for this purpose. If these amino acids are not available, there will be a loss of total body
protein, thus resulting in weight loss.
c. Maintenance of body neutrality - They are considered buffers reacting with both
acids and bases. Their presence in the blood helps to prevent the accumulation of too much
acid or alkaline, either of which would interfere with normal body function.
e. Regulation of water balance in the body - Since plasma protein cannot penetrate
the capillary membranes, it remains in the bloodstream. When oncotic pressure exerted by
the plasma proteins exceeds the lowered hydrostatic pressure, the fluid is drawn back into the
blood.
In protein deficiency, the plasma albumen level drops reducing the oncotic pressure to the point
where the fluid is not drawn back and it accumulates in the interstitial spaces. Hence, oedema is
the first sign of protein deficiency.
3. PROTECTIVE FOODS
Protective foods include vitamins and minerals, which are also called micro-nutrients. They are
needed in the body to resist and fight infection and to recover from infections.
Vitamins
Vitamins are organic substances essential to good health. With the exception of vitamin D, they
are not synthesized by the body and must be obtained from the diet. They are normally present in
small quantities in food stuff. However, they can be made synthetically today. They are required
in minute traces daily to play a part in metabolic reactions of the body often as regulators or
components of enzyme systems.
When light hits the retina in the dark, the visual purple splits into two compounds. There is
normally enough retinene in the pigment layer behind the rods which comes to combine with
the opsin to form the visual purple again. When the body is deficient in vitamin A, less
retinene is available for the formation of visual purple and it leads to night blindness.
The cornea is also affected. The lachrymal gland fails to secrete or the duct is blocked. The
reason is that the gland has to form the secretion. Consequently, the cells of the cornea which
are deprived of these secretions begin to slough and eventually rupture. This is termed
keratomalacia. As the condition progresses, infections set in and pus is formed (Bitot’s
Spots). This progresses to xerosis conjunctivae and to xerophthalmia in the advanced stages.
2. Health of Epithelial Tissues - It maintains the healthy functioning of the epithelial tissues of
the skin from the mucous membrane lining the eyes, gastro-intestinal, respiratory and genito-
urinary tracts. These cells secret mucous and it is Vitamin A which helps to synthesize the normal
constituent of mucus. Without this, they keratinize, that is, they become dry and flat. When this
happens the following changes occur:
3. Growth. – An animal deprived of vitamin A will cease to grow. Bones fail to grow in length
and the remodeling process slows down. Since there is no change in the growth of the
nervous tissues, there may be pressure on the brain whose growth is not affected by the
vitamin A deficiency. This leads to paralyses that affect the extremities.
4. Teeth - There are specialized epithelial cells surrounding the tooth buds in a child called
ameloblasts, for forming the enamel structure of the developing tooth. Inadequate vitamin A
produces faulty enamel forming epithelial cells which impairs the structure of teeth.
5. Thyroid gland:
Studies with radioactive iodine gave shown that vitamin A deficiency reduces the rate of
thyroxin formation and that goiter has been shown to occur more in people whose diet is
deficient in vitamin A
6. Reproduction – it is for normal reproduction in rats. Its deficiency may lead to infertility.
VITAMIN B 1 (THIAMINE)
This vitamin is not stored in the body so a deficiency can develop quickly, and any excess
intake is lost in the urine, it is essential for carbohydrate metabolism and controls the
nutrition of nerve cells.
Sources include - pork (highest value), kidneys, livers, eggs, yeast whole cereals not polished
and legumes.
Functions of Thiamine
In order to utilize energy from glucose, the body changes it to pyruvite acid, and thiamine
combines with other enzymes to form energy which muscles depend greatly on. When there
is lack of thiamine then the pyruvite acid accumulates and is toxic to the body.
a) Wet Beriberi
Due to lack of vitamin B1, carbohydrates are incompletely metabolized and there is an
accumulation of lactic acid and pyruvic acid in the body fluids. Hence, these metabolites
cause dilatation of the peripheral blood vessels. This may cause fluid to leak out through
the capillaries, causing oedema. To maintain circulation, the heart rate has to increase
exerting pressure on it. As the condition progresses there is enlargement of the right side
of the heart leading to biventricular congestive heart failure (only one ventricle) as well
as pulmonary congestion. The patient then manifests pitting oedema, dyspnoea,
palpitation and extended neck veins.
b) Dry Beriberi
The effect is on the peripheral nerves of the legs and arms, this leads to polyneuropathy.
There is a degeneration of the myelin sheath which leads to numbness with bilateral and
symmetrical burning sensation. There is also tickling sensations on the feed. The knee
and ankle jerk becomes sluggish. As the condition progresses, there is a wasting of the
muscles of the feet and hands resulting in a characteristic foot and wrist drop. Eventually,
he loses sense of position (ataxia) or even paralysis if not treated.
c) Infantile Beriberi
It occurs mostly in young children who are not getting enough of the vitamin through
breastfeeding. The reason may be that the mother is also not getting enough of the
vitamin in her diet. Such a child blots up due to edema. If the child cries the sound is not
heard but only the emotion. The child also develops gastro-intestinal problems. As the
cells of the smooth muscles and the secretary glands can not receive enough energy from
glucose due to its deficiency, anorexia, indigestion, gastric agony, result. Like the wet
beriberi, the heart muscle weakens due to lack of energy and a cardiac failure can result
from that.
Mental depression and confusion is relieved by thiamine hence it is called Morale
Vitamin. People on low thiamine intake show pronounced mood changes.
The deficiency of thiamine occurs basically in rice eating areas where there is a lot of
polishing of rice. It is also destroyed at high temperature. The vitamin is easily destroyed by
alkaline and preservation. Since it is water-soluble, when washing rice, it should take a very
short period.
Functions of Riboflavin
1. One of the riboflavin enzymes remove the amino group (NH2 ) from certain amino acids ,
hence rendering them useful to the body
2. It acts as a co-enzyme of the flavor-proteins which transfers hydrogen to cytochrome to
form energy during tissue oxidation
3. It is needed for the good health of tissues which come from the ectodermal regions such as
the skin, eye, nerves, and so on.
4. It is also needed for general growth since it is basically needed for protein metabolism
Functions of Niacin
Niacin is important in various metabolic functions like any of the B groups and act as co-
enzymes. These enzymes take part in oxidation and reduction actions of the cells. Hence, all
living tissues will require this enzyme. They also take part in pyruvite, lipids and protein
metabolisms.
In sub-clinical cases, there is weakness of the body, irritability and burning sensation of the
tongue.
VITAMIN D (CALCIFEROL)
Vitamin D is fat soluble and is found with vitamin A in small amounts in animal fat provided the
animal has been in the sun. It is made in the skin by the action of ultraviolet rays. It can also be
produce synthetically.
Vitamin D deficiency
In infants it causes rickets and ostoemalacia in adults. It is commonest in children. The causes
of the deficiency are varied: -
i) Lack of vitamin and calcium in diet
ii) Renal diseases (renal oeteodystrophy) which speeds its excretion from the body
iii) Excessive demand during stress, pregnancy and lactation
iv) In cultures where clothes are worn all the time. This does not allow the sunrays to
change all provitamin into the vitamin d.
v) Malabsorption syndrome or fatty diarrhoea in which the vitamin cannot be absorbed
in the gastro-intestinal tract.
Clinical Manifestations
a. Head - The bones of the cranium become soft and if pressed they go down and up. The
middle of the skull is depressed and the fontanelles are not properly closed. This is an
early sign in children
b. Legs and arms - the epiphyseal ends of the legs and arms are not well calcified and as the
child begins to sit or walk, the epiphyses are pulled out of position and deformities
develop in different planes leading to ‘bowed and knocked’ knees. In view of the
muscular weakness, when the child is sitting he attempts to support his trunk with his
outstretched hand. This causes knobbing deformity at the wrists.
c. Ribs – the joints between the ribs become enlarged and there is undue protrution of the
sternum known as Pigeon chest. Later, bending of the ribs occur which interferes with
normal expansion of the chest during respiration.
d. Spine - The gradual curving of the spine may lead to kyphosis (hump back) or lordosis.
e. Muscles - weak and flabby muscles make the child slow to sit or walk. If the serum
calcium level is very low, pathological conditions like tetany, carpo-pedal spasms and
convulsions may occur.
Clients should be advised to take diets rich in whole milk, cream, eggs and tablets containing
vitamin D.
MINERALS
Minerals are inorganic compounds. They are forms of micro-nutrients, most of which are
contained in foods in a natural form.
The mineral ions are found in tissue fluids around cells and also inside the cells. The tissue
contains most of the potassium magnesium and phosphate ions.
CALCIUM
Of all the minerals in the body calcium occurs in the greatest amount. It is found principally in
the bones and teeth and in the case of the teeth, contributes to the hardness and resistance to
decay.
Source of calcium
The richest sources of calcium are animal sources as, milk and milk products, whole fish, kidney,
meat, snails, crustaceans (shrimps, crabs and lobsters) eggs and liver. Plant sources include
beans, green leafy vegetables.
Deficiency of calcium
When the calcium intake falls below the minimum requirement, it leads to softening and
weakening of the bones and teeth. In children the weakened condition of the bones is referred to
as rickets and is associated with growth retardation.
IRON
Iron is an essential component in our body. It is involved in the transfer of oxygen in blood
which is of great importance to our survival.
A deficient supply of iron therefore is a very common cause of anaemia which is initially mild
and moderate in degree. If the supply is gravely deficient for a long period, a severe degree of
anaemia may develop which may lead to fatal results.
Sources of iron
Among the richest animal sources of iron are beef, liver, egg yolk and land snails. Plant sources
of iron include whole wheat, all kinds of dark green vegetables, onions, okro, coconut, and
‘bedru’.
Functions of Iron
1. It is an essential constituent of haemoglobin and is responsible for the red colouring of
blood.
2. It is necessary for the transportation of oxygen to the tissues.
Deficiency of iron
Deficiency of iron may be due to insufficient iron intake in the diet, loss of blood through
menstruation or delivery, worm infestation, and severe malaria. Deficiency leads to iron
deficiency anaemia. This is discussed fully under micro-nutrient deficiency disorders.
IODINE
Iodine is essential for the formation of the thyroid gland hormones such as thyroxine, which is
needed in the body for proper growth and development.
Sources of iodine
The amount of iron in the plant foods depend on whether or not, iodine was present in the soil in
which the plant was grown. Vegetables grown in iodine rich soil will be good sources of iodine.
Sea fish eaten with the head and iodized salt in the diet are also good sources.
Functions of iodine
1. Iodine is required for normal physical and mental development.
2. It is required by the thyroid gland for the production of thyroxine.
Deficiency of iodine
1. If sufficient iodine is not available for the formation of thyroxine the thyroxine the thyroid
gland enlarges in an effort to maintain its normal output of hormone and gives rise to a
swelling in the neck. This condition is known as goiter.
2. Deficiency of iodine during pregnancy and infancy results in a failure of physical and mental
development of the child, a condition sometimes known as cretinism.
3. Abortions can also result during pregnancy.
FLUORIDE
Sources
The chief source of fluoride is in the form of fluoride in drinking water. Small quantities of it can
be found in foods especially in tiny fish which bones can be eaten. Some tooth pastes also
contain fluoride.
Functions of fluoride
1. Fluoride helps in the formation of bones and teeth.
2. It is necessary for the prevention of dental carries.
Deficiency
The absence of fluoride in the diet will lead to dental carries.
Note that, too much of fluoride causes a condition known as fluorosis.
ZINC
Zinc is an anti-oxidant which is needed to destroy free radicals to prevent tissue damage during
infection.
Sources of zinc
Sources of zinc include meat, chicken, fish, whole grain cereals and legumes. There is substantial
amount of zinc in breast milk which is well absorbed.
Functions of zinc
. Zinc is needed in the body for proper growth and development in children.
2. It is also needed to heal wounds and fight diseases in both children and adults.
Deficiency of zinc -Lack of zinc is usually due to general poor diet. Deficiency results in:
1. Slow growth and development.
2. Slow sexual development in boys.
3. Slow healing of wounds.
4. Mental changes such as apathy.
5. Skin changes
6. It may also cause persistent diarrhoea.
KWASHIORKOR
This is a condition which results where the child is given foods which are rich in carbohydrates
but lack protein. The incidence of this condition is high during the second year of the child’s life,
usually during complementary feeding, or when he is put off the breast.
Clinical Features
1. Growth retardation: the child is normally shorter than normal due to lack of proteins
to build the tissues.
2. Oedema: there is oedema which starts with the swelling of the feet and progressively
involves the whole legs, hands and the face. The face is normally round giving a ‘moon
face’ appearance which is an important early sign of kwashiorkor. This oedema is present
because of the lack of serum protein in the blood (hypproteinaemia).
3. Gastro-intestinal disturbance: the mouth and lips become sore and there is loss of
appetite which may result in anaemia. The stools become loose containing undigested
food particles, which is offensive and some times watery.
4. Emotional changes: the child is often dull, miserable and apathetic. He is not attracted
to happening around him.
5. Skin changes: the skin is hypopigmented (becomes lighter in colour). The skin peels off
(flaky paint dermatosis) which can give rise to ulcers under the skin especially on the
legs, behind and around the ear.
6. Hair changes: the hair changes to reddish-brown, silky, straighter than normal and is
easily pulled out.
7. Liver enlargement: in severe cases there may be enlargement of the liver as a result of
fatty changes.
Figure 8.1 A Two and Half Year Old Child with Severe Kwashiorkor
MARASMUS
The word marasmus is a Greek word meaning ‘wasting’. It occurs when there is too little food
intake than the body requires. It occurs when children are fed with a diet which is grossly
deficient in energy to meet the requirement of the rapidly growing children. It occurs mostly
during the first year of life when for some reason the child does not get enough breast milk, and
other foods are also inadequate. It is thus a disease of starvation.
Given too quickly the nutrients may overload the intestines and other tissues which can cause
heart failure and other serious problems and the child may die.
a. Day Care Nutritional Rehabilitation Centres: this is a centre that handles those with
moderate protein-energy malnutrition on daily basis. The child is brought to centre by the
mother every morning, roughly five to six times in a week. The facilities used there are similar
to those used by the mother in her home. She is helped to prepare the food and feed the child.
They also use local cooking utensils and local food stuff to prepare the food for the child. In
addition to that, they are taught personal and environmental hygiene. The mothers ultimately
get to understand that the child’s condition is caused by the food only, so when she is
discharged she would practice what she has learned.
b. Residential Nutritional Rehabilitation: the severely malnourished child and the mother are
admitted and the mother prepares the meals and feeds the child under supervision of trained
personnel. The mother and child are kept in the institution until the child’s condition
improves. The principles are the same as in day care institutional centres.
It is the role of the nurse in the community to supervise the care of malnourished children and
their families in the home. She assesses the home environment, as well as the social and cultural
factors that might have contributed to the illness and counsels accordingly
Prevention of malnutrition
A number of factors if taken seriously can ease the problems of malnutrition as below:
a. Establishment of nutritional rehabilitation centres: these are areas that are set up to
deal with malnourished to them for management and advice as described above.
b. Health education in nutrition: this should be directed to parents on the importance of
breastfeeding and a good inter-family distribution of food. It should also be extended to
school health education. All children should be taught the importance of a balanced diet.
c. Health education on family planning: the parents should be made to understand that
spacing of births gives more time to be spent on each child in order to prevent
malnutrition. It also enables them have an ideal family size that can be managed and
catered for well.
d. Health education on immunization: most of the nutritional conditions are precipitated
by conditions like measles and whooping cough. In view of this, parents should be
encouraged to immunize their children.
e. Government intervention: the government should try to develop local complementary
foods like weanimix and soya beans at cheaper prices for the parents to afford. Apart
from this, the agriculture officers should research into quicker maturing foods for the
farmers.
According to Vlok (1994), obesity is the most important condition in affluent societies, and that,
rise in privilege among them usually leads to less physical activity as well as the consumption of
richer diets.
Obesity is excessive development of fat throughout the body than the body requires. A person is
said to be obese when his weight does not correspond to his height (Body Mass Index). It is
usually a state of gross mass excess.
Causes of Obesity
1. The cause of obesity is the intake of calories in excess of the body’s requirement for
energy. The excess energy is converted to fat and deposited in the body. Excessive intake
of fatty foods and refined sugars are mostly enjoyed by the affluent as a prestigious.
2. Eating in-between the normal meal times also contributes to the development of obesity.
3. Some obese people claim it runs in their families, that is, genetic. But from our
experience of supervising different types of families with problems, including those with
obese clients, and not from any empirical point of view, the behavioural factor which is
handed on in the family, remains the strongest than genetic, if it is.
4. Socially, in this part of the world people especially women are admired and adored when
they look fat. When this is not controlled, such people easily become obese.
Children are sometimes obese because of the following reasons.
They eat more calories than the body uses. The reasons are the same as in adults. They may
eat too much energy foods or take too little time exercises or both.
A child who is overweight becomes less active, so he may become more obese when he
grows older.
Children at greater risk of being obese are those from richer families who eat many sweets
and fatty foods and those who are overfed on formula (King and Burgess, 2004).
Effects of obesity
1. King and Burgess, 2004 also described the effects of obesity as:
2. As the child grows, patches of fat build up in the lining of the arteries making them
narrow.
3. A clot of blood forms when there is a patch of atheroma and blocks the artery completely.
4. When an artery in the brain is blocked and may lead to paralysis.
5. Due to the above, they have a shorter life span.
6. Obesity also interferes with the action of insulin and is one of the factors that contribute
to diabetes.
7. They may disfigure resulting embarrassment and lack of confidence.
Management and Prevention of obesity
The management of obesity is mainly behavioural change in eating and activity levels. The same
principles are also employed in its prevention. These include:
Avoidance of formula foods for children as much as possible
Children’s foods should contain a lot of fibre and not too fat or sugar
Children should be discouraged from eating too much sweets and ice-cream
The diet should contain a lot of fibre to help promote a sense of fullness to prevent eating
more.
Reduction in the amount of calorie foods eaten.
People should be encouraged to do regular exercising by running, playing football, jogging,
dancing and so on.
MICRO-NUTRIENT DEFICIENCIES
Micro-nutrients have been discussed under vitamins and minerals, but the following are worth
mentioning again because they have become the focus priority of the Ministry of Health. These
include iron, vitamin A and iodine deficiency disorders.
NUTRITIONAL ANAEMIA
Nutritional Anaemia is a condition in which there is decrease amount of haemoglobin in the red
blood cells. This substance is carried inside red blood cells to give its colour and transport
oxygen to all parts of the body. Therefore, anaemia will occur if each of the red blood cells
contains too little haemoglobin or if the number of red cells is low. Anaemia is one of the causes
of deaths in childhood, and one of the commonest conditions affecting children and women,
especially pregnancy women in Ghana.
Effects of Anaemia
Management
1. Breast milk contains low levels of highly absorbable iron that is sufficient until about six
months of age. After that, iron supplements should be given to infants every six months
until they are five tears of age to maintain normal iron status.
2. Infants born with low birth weights should take supplemental iron starting at two months
of age.
3. There should be increased intake of foods containing iron.
4. Iron supplementation should be given to pregnant women. Folate is also given to help
with the absorption of iron.
Iron deficiency is often worse by blood loss from the gut caused by feeding infants with formula
or other forms of animal milk, or in young children and women by infection.
Treatment
For treatment of anaemia refer to the previous lessons on vitamins and minerals.
NIGHT BLINDNESS
Night blindness is a condition in which a person finds it difficult to see in dim light. This is
followed by the presence of tiny white patches on the conjunctiva (white part of the eye). These
white patches are called Bitot’s spots. At later stages the conjunctiva dries out and looses its
shiny nature. This is known as xerosis. There is later on a softening of the cornea leading to a
breakdown of the eye ball.
You should never attempt to treat any person you suspect to be suffering from night blindness.
The condition you think is night blindness may be something else. Refer to appropriate personnel
where the eyes would be examined and correct diagnosis is made.
Prevention
Though you may be able to treat xerophthalmia, you can prevent the disease by giving dietary
advice. You should advice pregnant women to eat foods rich in vitamin A. this helps to build up
stores of vitamin A in the liver of the foetus. You should also advice mothers to include green
leafy vegetables or yellow orange fruits in the weaning foods for the child. These are locally
available, cheap and are known to be rich sources of vitamin A. It is important to give education
on this condition to all relevant groups to create awareness and to help them make informed
choices.
b. Hypothyroidism
This means the thyroid gland works below its normal level of functioning and therefore does
not produce enough thyroid hormones. Low level of thyroid hormones in blood leads to
sluggishness, dry skin, inability to tolerate cold conditions and constipation. In very young
children, it produces not only this feature but also mental growth retardation because the
thyroid hormones are essential for normal development of the body.
c. Cretinism
Cretins have retarded mental and physical development of the body. They are often deaf and
dumb. Some are never able to walk properly. You may find a cretin in an area where IDD is
very common.
d. Reproductive Failure
Women in very severely iodine deficient areas have more miscarriages, still birth and other
problems related to reproduction than women in iodine sufficient areas. Continued
miscarriages endanger the health of women and especially in marriage.
In Ghana production of iodized salt is being encouraged. Most manufacturers are now fortifying
salt produced with iodine. The problem however is that, iodized salt is much more expensive
than ordinary salt. This is compelling most consumers to buy the cheaper non-iodated salt. A law
exists but needs to be enforced to make it mandatory for every salt producer to produce iodized
salt.
Foods rich in protein, iron, calcium and vitamin A are important during pregnancy and are also
advised to take iron supplements in the form of ferrous sulphate. It is particularly important to
increase iron intake during the last trimester since this is the period the foetus will be storing iron
in its liver for use in the first few days of its extra-uterine life. Foods rich in calcium and fruits
should also be increased during the last six months of pregnancy.
Women who are well developed physically and enjoy good health are more likely to have
successful pregnancies than those who are poorly developed or sickly.
Anaemia most usually arises from an inadequate intake of iron, folic acid or vitamin B12 or a
combination of these.
It is therefore necessary that throughout the lactation period the nursing mother require her
normal diet with additional proteins, calcium, calories and vitamins. An ample fluid intake is
required. She must also eat at regular intervals, as well as be encouraged on all other measures
that would promote lactation as discussed in chapter four.
It must be remembered that the survival of the breastfeeding baby depends largely on the health
and nutritional state of his mother.
Where the amount of money available for the purchase of food is strictly limited it is important
to supervise them to spend on food before other things. Advice should be given on the buying of
food items which are nutritious.
The most expensive food items such as meat, egg or fish may not be necessary if there is
inadequate money. The community health nurse can support by educating the family to find
alternative food items. Food recommended for the elderly should also be easy to prepare. Milk
intake should be encouraged to provide enough calcium. Intake of both water and fat soluble
vitamins should be increased and a lot of vegetables should be included in elderly patients’ diets.
Vegetarianism
According to Helman and Dornton-Hill as cited in Bullough and Bullough (1990), vegetarianism
remains a fairly popular practice with nontraditional groups. These are persons who are already
vegetarians, those who have recently become vegetarians and those who have alternative
lifestyles and philosophies.
There are three types of vegetarians:
1. Pure vegetarian – one who live wholly or principally on vegetable foods and avoids any
form of animal food.
2. A person who eats only grains, fruits and vegetables.
3. Lacto-ovo vegetarian – one who avoids meat but consumes egg, milk and milk products as
well as grains, fruits an vegetables.
The community health nurse should bear in mind that some of these forms of vegetarians, if not
all, are found in the country. Diets of these type in a child needs to be based on adequate
assessment and counseling by the community health nurse.
i. Their protein sources need to be varied to ensure adequate amounts of
essential amino acids, since the amino acids in one food can supplement those in another.
ii. A diet that is devoid of all animal food is deficient in vitamin B12,
supplementation is therefore essential.
iii. Iodine can be obtained by using iodized salt.
The above discussion on community health nutrition, based on different stages and situations in
life show clearly that, the education on diet should shift from the traditional mode of asking
every client to take all kinds of nutrient sources of foods, but should try to have social and
medical a background, as well as the health state of each client before effective education on diet
can be given.