Orientation of TermsChapter One

The word nutrition is derived from nutricus meaning to suckle. No clear distinction is made between food and nutrients.

Ecological factors related to malnutrition are as follows: conducting influences, cultural influences, socioeconomic factors, food production and health and other services.

The expenditure or using up of the energy in the body is known as energy metabolism.

The changes included in the process of metabolism are of two distinct varieties:

It will be higher in a manual worker than in an office worker leading a more sedentary life.

The state of nervous tension is a most important factor as this will affect the rate of breathing and the rate and force of the action of the heart.

Basal metabolism is the metabolism that goes on when the body is at absolute rest.

When the body is at complete rest the energy requirement is at its lowest. This is called the Basal Metabolic Rate which is the amount of energy required by a person who is awake but is as nearly as possible at complete mental and physical rest and has had no food for 12 to 14 hours.

The basal metabolic rate (BMR) is sometimes calculated as an indication of the presence or absence of disease. Since overactivity of the thyroid gland raises rate and underactivity lower it.

The basal metabolic rate is calculated by measuring the amount of heat produced in the body, either directly, in a respiratory chamber or indirectly, by measuring the amount of carbon dioxide produced, and calculating from it the quantity of oxygen used.4

The test is made after rest in bed for the night, at least 12 hours after taking a meal with the individual relaxed and in as tranquil a state of mind as possible. The indirect method is generally used, and in this the expired air is collected in a bag, over a period of time, usually five minutes, and the amount of oxygen used and therefore the amount of heat produced in the body is calculated.

The normal basal metabolic rate is expressed as a per centage of the normal rate; thus a BMR of + 10 means that the rate is 10 per cent above the normal for the individual, taking into consideration age, weight, height and sex, a BMR of –10 means that it is 10 per cent below normal. The rate is normally higher in young persons, in males and in persons with a large surface area and therefore a greater heat loss. Metabolic rate is calculated per square metre of the body surface area. The surface area is assessed from a person's height and weight: 1.8 metres is an average surface area for an adult male, and 40 calories per metre per hour is an average metabolic rate.

There are certain factors which influence the total energy metabolism in the normal human being.

Nutrition plays an important role in the promotion and maintenance of health and in the prevention of human diseases. Malnutrition and undernutrition are the greatest international health problems of the present day. A sound knowledge of nutrition is therefore essential for a nurse.

In the global campaign of health for all, promotion of proper nutrition is one of the eight elements of primary health care. Greater emphasis is now placed on integrating nutrition into primary health care systems whenever goals to promote health and nutritional status of families and communities.

Good nutrition therefore is essential for the prevention of specific nutritional deficiency diseases and promotion to health.

In the present chapter, the following aspects of the problem have been discussed:

People choose diets because of cultural influences which vary widely from country to country and from region to region. These may be stated as follows:

Rice is the staple cereal in the eastern and southern states of India and wheat is the staple cereal in the northern states.

During the Second World War, when wheat was made available in place of rice in south India people refused to buy wheat because it was not their staple cereal.

The story is told of a Philippine students who died of beri-beri after writing an essay explaining how the disease could be prevented. The crux of the problem is that many customs and beliefs apply most often to vulnerable groups, i.e., infants, toddlers, expectant and lactating women, e.g.

This may also explain the large scale cultivation of certain roots and tubers viz. Cassava, yam and sweet-potato and maize (corn) in many countries of Africa, central and south America over the past several centuries.

For example, pellagra was also widely prevalent among poor maize eater.

Rice is the main food crop in the tropical countries where rainfall is high and water is available for irrigation, while millets are cultivated in areas of low rainfall.

Incidence of beriberi was high among the population consuming highly milled raw rice.

Wheat is mainly cultivated in temperate regions.

In South Pacific Islands, it is believed that certain shell fish eaten during pregnancy will cause the child to be born with scales on its head.

In Ethiopia, a pregnant woman must avoid roasted meat as it is believed to induce abortion. Eggs are thought to cause boldness or sterility and hence not assumed by pregnant women.

In India, consumption of papaya fruit by pregnant women is believed to lead to abortion.

Milk which is an essential protective food in western countries, is disliked in many Asian and African countries and not even fed to weaned infants and preschool children.

In some parts of India (West Bengal), it was believed that consumption of milk and fish at the same meal will lead to the development of leprosy and leucoderma.

Other similar beliefs include the following:

For example, bitter gourd is reputed to cure diabetes mellitus

A survey made by a committee of the American Dietetics Association showed that the following to be more commonly observed food fallacies in USA.

Most of the above beliefs have no scientific basis.

We do not know enough the dimensions of the problem. According to FAO reports, there are about 460 million people— 15 per cent of the world's population, excluding China—who are malnourished, of which about 300 million live in South Asia where they constitute one-third of the population. What makes the situation most serious is that malnutrition's main victims are children under the age of 15. But children under the age of 5 years 15are hit the hardest. On a global scale the five principal nutritional deficiency diseases that are being accorded the highest priority action are kwashiorkor, marasmus, xerophthalmia, nutritional anaemias and endemic goitre. These diseases represent the tip of the “iceberg” of malnutrition: A much larger population are affected by “hidden” malnutrition which is not easy to diagnose.

The effects of malnutrition on the community are both direct and indirect. The direct effects are the occurrence of frank and subclinical nutrition deficiency diseases such as kwashiorkor, marasmus, vitamin and mineral deficiency diseases. The indirect effects are a high morbidity and mortality among young children (nearly 50 per cent of total deaths in the developing countries occur among children under 5 years of age as compared to less mental growth and developed countries), retarded physical and mental growth and development (which may be permanent), lowered vitality of the people leading to lowered productivity and reduced life expectancy. Malnutrition predisposes to infection and infection to malnutrition: and the morbidity arising from as a result of complications from such infectious diseases as tuberculosis and gastroenteritis is not inconsiderable. The high rate of maternal mortality, still birth and low birth weight are all associated with malnutrition.

In the more developed countries of the world nutritional problems are somewhat different. Overnutrition is encountered much more frequently than undernutrition. The health hazards from overnutrition are a high incidence of obesity, diabetes, hypertension, cardiovascular and renal diseases, disorders of liver and gallbladder.

The ecological factors related to malnutrition are as follows: conditioning influences, cultural influences, socioeconomic factors, food production and health and other services.

It has been shown that where environmental conditions are poor, small children may suffer from some infection or the other for almost half of their first three years of life.

The family plays an important role in shaping the food habits, and these habits are passed from one generation to another. Rice is the staple cereal in the eastern and southern state of India and wheat is the staple cereal in the northern states.

Then there are certain beliefs about hot and cold foods, light and heavy foods.

It is said that there will be very little malnutrition in India today if all the food available can be equitably distributed in accordance with physiological needs.

Harmful food taboos and dietary prejudices can be identified and corrected.

Since food expenditure often amounts to 50 to 70 per cent of family budgets, nutrition education programmes should be a good investment.

Attention should also be focussed on the nutritional needs of expectant and nursing mothers and children in the family.

The shortage of protective foods can be met to some extent by planning a kitchen garden.

Other related activities at the family level are the “package” of mother and child health, family planning and immunization services.

The community health workers and multipurpose health workers are the kind of people in key positions to impart nutrition education to the families in the respective areas.

To obtain this information, diet and nutrition surveys in carefully chosen. Population samples will have to be carried out using standardised methodologies which will permit comparison in time and space.

The real permanent solution and fundamental measures that will correct the basic causes of malnutrition are:

Some of the strategies and approaches undertaken at the national level in India are:

This implies a broad based programme of development. Increasing agricultural production.

Increased food production is meaningless if not accompanied by an effective food distribution system. This implies marketing, land tenure and food price policies.

These programmes have a direct impact on the health and nutritional status of particular segments of the population. These programmes alleviate situation as temporary measure.

All these programmes may be considered as alternative approa ches in improving the nutritional status of the people.

The FAO/WHO Expert Committee on Nutrition stressed that food and nutrition planning must be an integral part of the overall socioeconomic development.

Several international agencies such as the FAO, UNICEF, WHO, World Bank, are working in close collaboration in helping the national Governments in different parts of the world in their battle against malnutrition.