Proper & Adequate

NUTRITION
Dr. Georgina T. Paredes, DTMH,MPH
Department of Preventive & Community Medicine
2013

S
 Learning Objectives

At the end of the session, the students shall be able to:

1. Discuss the rationale for satisfying the nutritional requirements

for health promotion and maintenance.
2. Identify and explain briefly the factors that determine nutritional
needs.
3. Explain the various ways of assessing the nutritional state at
individual and community levels.
4. Describe quantitatively the nutritional status of specific special
groups based on FNRI survey.
 Basic Definitions

S Nutrition-

S Food fortification-

S Food additives

S Conventional food

S Convenience food
S Nutrition – branch of science dealing with all aspects of
interaction between living organisms and substances that
help organism to grow and sustain itself.

S Human nutrition- deals with food and the nutritional

requirements of different groups of human beings (age, sex,
physiologic status) and the measures used to overcome
imbalances and deficiencies.
S Food fortification vs. additive – incorporation of nutrients
vs. substances that enhance taste and appearance to
common food items

S Conventional vs. convenience food- food items in natural

forms vs. processed, ready made – “fast food” items.
 Basic Definitions

Dietary reference intake (DRI) –consist of 4 types of reference

values that guide adequacy and safety:

S Recommended daily allowance(RDA)

S Adequate Intake (AI)

S Tolerable upper intake level (UL)

S Estimated Average Requirement (EAR)

 Basic Definitions

S Recommended daily allowance(RDA)- average daily dietary

intake sufficient to meet nutrient requirement of healthy
individuals in a group*.

S Adequate Intake (AI)- estimate of the RDA based on

approximations of nutrient intake of a group of healthy
people*.
 Basic Definitions

S Tolerable upper intake level (UL)- highest level of daily

nutrient intake likely to pose no risks of adverse health
effects to the general population

S Estimated Average Requirement (EAR)- nutrient intake

value estimated to meet the requirement of half the healthy
individuals in a group.
Malnutrition in the Philippines

S FNRI 7th National Survey of 2008

Among 0-5 years old children:

Prevalence Rate% of under nutrition 0-5 yrs. Old:

-undernourished 26.2

-Height for age 27.9

-Weight for height 6.1

Prevalence of overweight for 2-10 years old and 11-19 years old population 20%
 MD’s General Roles in
Nutrition

S Promotion of healthy diet for health maintenance

S Malnutrition and nutrition related disease prevention

S Therapeutic nutrition

S Assessment of state of nutrition

S Planning and implementation of nutrition intervention .

 MD’s Role in Nutrition

S Knowledge of dietary components and sources and

guidelines
S Promotion of optimal diet through: counseling, patient care

S Identify those at high nutritional risk:

S Pregnancy and lactation
S Infants and children
S Adolescence
S Older adults
 MD’s Role in Nutrition

S Promotion of optimal diet through: dietary counseling,

patient advice and care

S ROLE PLAYING:
S Pregnant mom and her 2 children at MD’s clinic for usual
check up. Doctor and team give advice.
 MD’s Role in Nutrition

S Promotion of optimal diet through: dietary counseling, patient

advice and care
S Eat nutritionally adequate diet from a variety of sources
S Maintenance of desirable or ideal body weight
S Less intake of saturated fat and cholesterol
S More complex carbohydrate containing foods & fiber
S Limit foods high in sugars
S Reduce salt intake
S Alcohol in moderation
S Maintain adequate intake of iron, calcium, fluoride
S Maintain protein intake at moderate levels
 Nutrition in Health Maintenance

S Healthful diet - eating nutritionally adequate diet from a variety of

foods.
S 7 Main components of FOOD
S Carbohydrates - energy
S Fats- energy
S Protein-
S Vitamins- micronutrients
S Minerals
S Water
S fiber
Food Pyramid
 Nutritional Requirements

S Physiologic needs :
S Health maintenance
S growth & development,
S pregnancy & lactation
S Ageing

S Body repair

S Environmental factors
 Diet Standards

ENERGY Requirement in kilocalories/day:

S Energy requirement for basal metabolism

S Energy for routine light activity

S Energy for professional work

Carbohydrate 50-70%

Fat 10-20%

Protein 10-30%

Vitamins, Minerals, fiber

 Nutrition Disorders

S Nutritional deficiencies
S Protein energy malnutrition (PEM)
S Kwashiorkor, Marasmus
S Hypovitaminosis

S Nutrition overload
S Obesity
S Chronic diseases related to excess intake of saturated fats,
cholesterol, salt, sugar, alcohol,
 Assessing State of Nutrition:
Anthropometric Measurements

S Weight for height – wasting

S Weight for age- underweight

S Height for age- stunting

S BMI – weight kg / height m2

* Take note of guidelines on proper measurements and the interpretations

Nutritional Disorders
Kwashiorkor & Marasmus
Interpretation of Anthropometric
Measurements

S Waterlow Classification for wasting

S Normal >= 90% of reference standard
S Mildly wasted 80 to <90% of reference standard
S Moderately wasted 70 to <80%
S Severely wasted < 70%

S Estimation= actual weight + ideal weight for height X 100 =

%
Interpretation of Anthropometric
Measurements

S Waterlow Classification for wasting

S Normal >= 90% of reference standard
S Mildly wasted 80 to <90% of reference standard
S Moderately wasted 70 to <80%
S Severely wasted < 70%

S Estimation for stunting:

= (actual height + ideal height for age) X 100

Interpretation of Anthropometric
Measurements

S Gomez Classification : Weight for age

S Normal 91 - 100 of reference standard
S 1st degree malnutrition 76 to 90% of reference standard
S 2nd degree 61 to 75%
S 3rd degree < = 60%

S Gomez Classification

S Wellcome Classification
Interpretation of Anthropometric
Measurements

S Wellcome Classification : based on degree of weight loss

and edema
S Kwashiorkor - 60 to 80% of weight for age + edema
S Undernutrition – 60 to 80% of weight for age without edema
S Marasmus/kwashiorkor - <60% + edema
S Marasmus - <60% without edema
 Factors Determining Nutritional
Risk

Inadequate dietary intake –

S Impaired nutrient digestion, absorption, metabolism, increased requirement or loss of

nutrients

S Limited education

S Poverty

S Poor housing and water supply

S Environmental factors
 Environmental Factors:
Barriers to Proper Nutrition in Modern Times

S Production and aggressive marketing of processed food

S Demand for convenience and low cost of food

S Confusing messages
 Nutritional Assessments
Individual

S Medical history and physical examination

S Anthropometry
S Weight standards
S Triceps skinfold thickness
S Arm circumference

S Hematologic screening

S Biochemical assessment

S Immunologic assessment

S Dental screening
 Nutritional Assessments
Community level

S Nutrition-related indices
S What are these direct & indirect indices?

S Anthropometric measurements

S Dietary assessment
S Quantitative dietary assessment: 24 hour recall of food intake,
long form diet history, 7-day diet diaries,, food frequency
record, household survey (food basket), actual food intake
 Nutritional Assessments
Community level

S Community (geographic) and population descriptors

S Food and nutrition resources

 References:

S Speer SJ. Felmar EA. Nutrition & Family Medicine in Rakel’s Textbook of
Family Practice. 6th Ed. 2002.

S Wallace/Maxcy, Rosenau, Last. Public Health & Preventive Medicine. 15th

Ed. 2008

S Schneider MJ. Introduction to Public Health 3rd Ed. 2011.

S Gupta, MC & Mahajan BK. Textbook of Preventive & Social Medicine. 3rd
Edition 2003.

S Clark & Mac Mahon. Preventive & Community Medicine 2nd Ed.

S FRNI 7th National Nutrition Survey. http://www.fnri.dost.gov.ph