- Definition of terms
- Food in relation to health
- Food pattern of implications and superstitions, culture and religion.
FOOD AND NUTRITION
The terms food and nutrition are sometime used synonymously but that is not strictly correct.
Food is a composite mixture of various substances, the quantity of which may vary from a fraction of a grams in certain cases, to hundreds of grams in others.
The term foodstuff is defined as “anything which can be used as food”.
Signifies a dynamic process in which the food that is consumed is utilized for nourishing the body.
The word nutrition is derived from nutricus meaning to suckle. No clear distinction is made between food and nutrients.
Malnutrition has been defined as “a pathological state resulting from a relative or absolute deficiency or excess of one or more essential nutrients. It comprises four forms—undernutrition, overnutrition, imbalance and specific deficiency.
This is the condition which results when insufficient food is eaten over an extended period of time. In extreme cases, it is called starvation.
This is the pathological state resulting from the consumption of excessive quantity of food over an extended period of time. The high incidence of obesity, atheroma and diabetes in western societies is attributed to overnutrition.
It is the pathological state resulting from a disproportion among essential nutrients without the absolute deficiency of any nutrient.
It is the pathological state resulting from a relative or absolute lack of an individual nutrient.
Ecology of Malnutrition
Malnutrition is a man-made disease. It is a disease of human societies. It begins quite commonly in the womb and ends in the grave. The great advantage of looking at malnutrition as a problem in human ecology is that it allows for variety of approaches towards prevention.
Ecological factors related to malnutrition are as follows: conducting influences, cultural influences, socioeconomic factors, food production and health and other services.
Definition of Metabolism
Metabolism is the changes which take place in nutrients from the time of their absorption, until they are reached the end products of the various organs through which they pass.
The Definition of Basal Metabolic Rate (BMR)
BMR is the amount of energy required by a person who is awake but he is nearly as possible as at complete mental and physical rest and has had no food for 12–14 hours. This is BMR.
Metabolism in nutrition is the general name given to the changes which take place in nutrients from the time of their absorption until they have reached the end products of the various processes through which they pass.
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:
- Building-up changes which are called “anabolic changes” or, e.g. the building-up of the muscle from the amino acids obtained from proteins, or of fat from fatty acid and glycerol.
- Breaking-down changes, which are called “catabolic changes” or “catabolism” e.g. the breaking-down of glucose or fat into carbon dioxide and water to release energy for activity. The “principal factors” which influence the rate of metabolism include: body size, age, sex, climate including the degrees of heat. The type of clothing worn and the nature of the work. The rate of metabolism will also depend on the activity of the individual.
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.
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.
Factors Affecting the Basal Metabolic Rate
There are many factors which affect the basal metabolic rate, the most important of which are:
- Surface area of the body: The larger the surface area of the body in relation to bulk, the greater is the heat lost by radiation.For example, a tall the man will have a greater surface area to the body than a short fat man will lose more heat by radiation and his Basal Metabolic Rate will be higher. This may explain, atleast in part, why a thin man often eats more than a fat man of the same weight.
- Sex: The BMR is higher per square metre of body surface area in man than in women. According to western standards, the requirements are:40 calories per square metre per hour for man37 calories per square metre per hour for woman.
- Age: Growing children and adolescents have higher Basal Metabolic Rates in relation to their weight than adults.
- Diseases: Some diseases, especially of the thyroid gland, may raise or lower the Basal Metabolic Rates. A rise in body temperature of one degree (Fahrenheit) is found to increase BMR by about 7%. This is important to remember during fever.
- Under prolonged or chronic under nutrition, the BMR is decreased.
- Psychological tension caused by worry or stress will increase the BMR.
Factors Affecting Total Energy Requirement
Total Energy Metabolism is a measure of the total amount of energy required during 24 hours, whether the person is resting or working and therefore includes the Basal Metabolic Rate. Plus the extra energy required for activity during waking hour: The relationship of Basal Metabolic Rate to Total Energy Metabolism in the average moderately active man is approximately 1 : 2.
There are certain factors which influence the total energy metabolism in the normal human being.
- Weight: Total metabolism includes work done in moving one's own weight from place to place. Therefore, the heavier the individual, the more energy is required for movement.
- Specific Dynamic Action of Food: It has been found by experiment that there is an increase in the production of energy in the form of heat after taking food. This is not due to any work done indigestion or absorption but is due to the stimulating effect of food on the Basal Metabolism. This is known as the specific Dynamic Action of food and the stimulating effect varies according to the different nutrients.Specific dynamic action of carbohydrate—5–6%””””fat—4%””””protein—30%””””mixed diet—12%This means that to maintain the weight of a person not doing any work it is necessary to supply as mixed diet 12 per cent more food than basal requirement.
- Age: Age also affects total metabolism. e.g. adolescents require more total energy than adults.
- Temperature: The body must have sufficient food to make up for heat loss. The amount of heat lost from the body depends on two main factors:
- The amount of work done:The more active a person is, either at work or play, the more heat is produced, and this must be eliminated or removed from the body.
- External temperature:The greater the difference of temperature between the body and the surrounding atmosphere, the greater will be the heat lost from the body. If a person is exposed to cold without doing work, he will need extra food to provide heat to keep up the body temperature. In India in the hot season the difference in temperature between the body and its surroundings is very small or surrounding temperature may even be higher than the body temperature. People, therefore, try to increase the heat lost from the body by sitting in the breeze or sitting under the fan. In colder regions people try to prevent heat loss from the body by putting on more clothes or heating their houses.
- Muscular activity: In the USA it has been estimated that the energy used up under different conditions of muscular activity are as follows:Forms of activityCalories per hour for 70 kg manSleeping65Awake lying still77Sitting/standing relaxed105Dressing and undressing118Sweeping169Walking 4 km per hour200Bicycling, moderate speed245Walking 6 km per hour300Walking downstairs364Swimming500Running 8.5 km per hour570Walking upstairs1,100There is as yet no proof that mental work causes any increase in metabolic rate.
- Pregnancy: During pregnancy energy requirements are increased due to growth of foetus, placenta, increase in size of uterus and breast, as well as increase in blood volume. The increased weight of the woman, also mean an increase in energy required to carry the load. The requirement is more (15–20%) during the latter half of pregnancy.
NUTRITION AND HEALTH
Nutrition may be defined as the science of food and its relationship to health.
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.
Definition of Terms
Nutrient: (or) food factor is used for specific dietary constituents such as proteins, vitamins and minerals.
Dietetics: is the practical application of the principles of nutrition. It includes the planning of meals for the well and the sick.
FOOD RELATION OF NUTRITION TO HEALTH
Good nutrition is a basic component of health. The relation of Nutrition to Health may be seen from the following view points.
- Good nutrition is essential for the attainment of normal growth and development not only for physical growth and development, but also for the intellectual developmentLearning and behaviour is affected by malnutrition. Malnutrition during pregnancy, may affect the foetus resulting in still birth, premature birth and small for date babies.Malnutrition during early childhood delays physical and mental growth. Such children are slow in passing their milestones and are slow learners in school.Good nutrition is essential for adult to maintain optimum health and efficiency. In short nutrition affects human health from birth till death.
- Malnutrition is directly responsible for certain specific nutritional deficiency disease.The commonly reported ones in India are;
- Blindness due to vitamin A deficiency
- Goitre, etc.
Good nutrition therefore is essential for the prevention of specific nutritional deficiency diseases and promotion to health.
- To give resistance against infectionMalnutrition predisposes to infection like tuberculosis. Infection in turn may aggravate malnutrition by effecting the food intake, absorption and metabolism.
- To reduce morbidity (Death due disease) and Mortality (Death)Indirect effects of malnutrition are:
- High general death rate
- High infant mortality rate
- High sickness rate or morbidity rate
- Lower expectation of life
- Overnutrition which is another form of malnutrition. It is responsible for:
- Cardiovascular diseases
- Renal diseases
- Disorder of the liver and gallbladder.
FOOD FADDISM AND FAULTY FOOD HABITS OR FOOD PATTERNS IMPLICATION SUPERSTITIONS CULTURE AND RELIGION
A number of factors influence the food habits. These include, educational and economic level of the community, availability and cost of foods and social and cultural practices. Once the food habits are established, they are handed down from generation to generation.
In the present chapter, the following aspects of the problem have been discussed:
- Cultural influences
- Geographic locations
- Religious beliefs
- Traditional beliefs
- Food fads and cults
- Changing foodhabits.
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:
- Foodhabits, customs, beliefs, traditions and attitudes
- Food fads
- Cooking practices
- Child rearing practices
Food Habits, Customs, Beliefs, Traditions and Attitudes
Food habits are among the oldest and most deeply entrenched aspects of any culture. They have deep psychological roots and are associated with love, affection, warmth, self image and social prestige. The family play 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 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.
- Papaya is avoided during pregnancy because it is believed to cause abortion.
- In Gujarat, valuable foods such as dhals, greens leaf, rice and fruits are avoided by the nursing mother.
- There is a widespread belief that if a pregnant woman eats more her baby will be big and delivery difficult.
- Certain “Foods are forbidden” as being harmful for the child.
- Then there are certain beliefs about hot and cold foods, light and heavy foods.
Religion has a powerful influence on the food habits of the people. Hindus do not eat beef, and Muslims pork. Some orthodox Hindus and Jains do not eat meat, fish, eggs and certain vegetables like onion. These are known as “Food Taboos” which prevent people from consuming nutritious foods even when these are easily available.
In the selection of foods, personal likes and dislikes play an important part. These are called “food fads”. The food fads may stand in the way of correcting nutritional deficiencies.
Draining away the ricewater at the end of cooking, prolonged boiling in open pans, peeling of vegetables, all influence the nutritive value of foods.
Child Rearing Practices
These vary widely from region to region and influence the nutritional status of infants and children. Examples of this situation are premature curtailment of breastfeeding, the adoption of bottle feeding and adoption of commercially produced refined foods.
In some communities men eat first and women eat last and poorly. Consequently, the health of women in these societies may be adversely affected.
Consumption of diets based predominantly on these staple foods has given rise to large scale incidence of protein—calorie malnutrition among preschool children in these regions.
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.
Traditional beliefs in food habits are still prevalent with a large majority of the population who are illiterate or ignorant regarding the nutritive value of foods. These beliefs influence profoundly the pattern of food eaten.
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:
- Consumption of brain will lead to premature greying of hair and baldness of head.
- Consumption of tongue of goat by children will make them talkative.
- Eating goat's leg by children will lead to improper development of knees and ankle joints.
- Consumption of pig's stomach by girls and young women will darken their complexion.
- Consumption of meat from the underside of an animal by young married women will prevent child-bearing.
- In some parts of Africa, it is believed that eggs, if given to children before the teeth have erupted, will lead to stupidity, fish will produce skin rashes and meat will make a child greedy.
Hot and Cold Foods
Foods are classified as ‘hot’ and ‘cold’ by different cultures in many countries. ‘Hot’ foods are believed to produce more heat in the body and lead to the development of boils. ‘Cold’ foods are supposed to lower the heat production and lead to the development of cold, sore throat, etc. Meat, eggs, legumes, nuts and oilseeds are supposed to be ‘hot’ foods, while fruits, vegetables and milk are supposed to be ‘cold’ foods.
Pica is a common practice among pregnant women and children in many countries. Pica is the habit of eating dirt, clay, chalk, lime stones, plaster, ashes starch, etc.
Food Fads and Cults
Foods fads of various kinds have persisted ever since.
For example, bitter gourd is reputed to cure diabetes mellitus
- Yogurt, wheatgerm, and honey have been widely promoted by some food faddists as possessing extra ordinary nutritional and medicinal qualities.
- Brown sugar is reputed to possess higher nutritive value than white sugar.
A survey made by a committee of the American Dietetics Association showed that the following to be more commonly observed food fallacies in USA.
- Fruits, especially citrus and tomato are too acid to be handled by the body.
- Garlic cures high blood pressure.
- Beets build blood.
- Foods cooked in aluminium vessels will cause cancer.
- The following combinations of foods are poisonous; milk and orange juice or other citrus fruits, milk and fish.
- Raw cucumbers without salt are poisonous.
- A good way to diet is to skip breakfast.
- Honey is not fattening.
- Meat, gives strength.
- Fruit juices do not contribute calories to the diet.
- Toast has fewer calories than bread
- Vegetable fats and oils can be used in any quantity and are not fattening.
- Adults need no milk.
- Skim milk has no nutritive value.
- Natural foods are the only one that are safe for the consumer.
- White shelled eggs are more nutritious than brown shelled eggs.
- Water is fattening.
Most of the above beliefs have no scientific basis.
Changes Due to Technology
Milled rice and white flour are preferred to undermilled rice and whole meal flour because of their eye appeal. Sago (starch globules) and corn starch are considered as nutritious foods and used for feeding weaned infants and preschool children in some countries.
For many years vegetarianism has been practised on religious grounds by Hindu, Buddhists, Zorastrians, Jains, etc. Strict vegetarians do not even consume milk and hence suffer from vitamin B12 deficiency.
Changing Food Habits
Food fads and faulty food habits are the important contributory causes for the wide prevalence of malnutrition among preschool children expectant and nursing mothers in developing countries. These can be overcome only by education in nutrition. The guiding principles in the educational process are:
- Change cannot be superimposed but must be integrated into the existing cultural pattern
- Proposed changes should be acceptable to the individuals concerned
- The changes should be minimal and use such foods which are familiar to the people concerned
- Participation of representatives of the group in implementing the proposed change is essential and
- The individuals should be satisfied that the changes food habits have improved their health.
Social Aspects of Nutrition
Food means not only proteins, fats, minerals, vitamins and other nutrients—but much more: it is part of security and civilisation. Nations and civilisations are linked together not only by ideas, but also by bread. Hunger and malnutrition are problems everywhere and have harassed mankind and threatened peace throughout history. It is no wonder that the growing incidence of hunger and malnutrition should have come to the forefront of international concern.
The Problem of Malnutrition
Malnutrition has been defined as “a pathological state resulting from a relative or absolute deficiency or excess of one or more essential nutrients”. It comprises four forms—undernutrition. overnutrition, imbalance and specific deficiency.
- Undernutrition: This is the condition which results when insufficient food is eaten over an extended period of time. In extreme cases, it is called starvation.
- Overnutrition: This is the pathological state resulting from the consumption of excessive quantity of food over an extended period of time. The high incidence of obesity, Atheroma and diabetes in western societies is attributed to overnutrition.
- Imbalance: It is the pathological state resulting from a disproportion among essential nutrients with or without the absolute deficiency of any nutrient.
- Specific deficiency: It is the pathological state resulting from a relative or absolute lack of an individual nutrient.
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 are 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.
Ecology of Malnutrition
Malnutrition is a man-made disease. It is a disease of human societies. It begins quite commonly in the womb and ends in the grave. The great advantage of looking at malnutrition as a problem in human ecology is that it allows for variety of approaches towards prevention.
The ecological factors related to malnutrition are as follows: conditioning influences, cultural influences, socioeconomic factors, food production and health and other services.
Infectious diseases are an important conditioning factor responsible for malnutrition. In small children, diarrhoea, intestinal parasites, measles, whooping cough, malaria, tuberculosis all contribute to malnutrition. In fact it is a vicious circle-infection contributing to malnutrition.
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.
Lack of food is not the only cause of malnutrition. Too often there is starvation in the midst of plenty. People use poor diets when good ones are available because of cultural influences which vary widely from country to country, and from region to region. These may be stated as follows: Food habits, customs, beliefs, traditions and attitudes.
Food habits are among the oldest and most deeply entrenched aspects of any culture. They have deep psychological roots and are associated with love, affection, warmth, self-image and social prestige.
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.
Many customs and beliefs apply most often to vulnerable groups, i.e., infants, toddlers, expectant and lactating women. Papaya is avoided during pregnancy because it is believed to cause abortion. In Gujarat, valuable foods such as dhals, leaf greens, rice and fruits are avoided by the nursing mother. There is wide-spread belief that if a pregnant woman eats more, her baby will be big and delivery will be difficult. Certain foods are “forbidden” as being harmful for the child.
Then there are certain beliefs about hot and cold foods, light and heavy foods.
Religion has a powerful influence on the food habits of the people. Hindus do not eat beef, and Muslims pork. Some orthodox Hindus and Jains do not eat meat, fish, eggs and certain vegetables like onion. These are known as food taboos which prevent people from consuming nutritions foods even when these are easily available.
In the selection of foods, personal likes and dislikes play an important part. These are called “food-fads”. The food fads may stand in the way of correcting nutritional deficiencies.
Draining away the rice water at the end of cooking, prolonged Boiling in open pans, peeling of vegetables, all influence the nutritive value of foods.
In some communities, men eat first and women eat last and poorly. Consequently, the health of women in these societies may be adversely affected. Chronic alcoholism is another factor which may lead to serious malnutrition.
Malnutrition largely the byproduct of poverty, ignorance, insufficient education, lack of knowledge regarding the nutritive value of foods, etc. These factors bear most directly as the quality of life and are the true determinants of malnutrition in society.
Increased food production should lead to increased food consumption. But increased food production will not cure the basic problem of hunger and malnutrition in much of the developing world. Scarcity of food, as a factor responsible for malnutrition, may be true at the family level; but it is not true on global basis nor is it true for most of the countries where malnutrition is still a serious problem.
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.
Health and Other Services
Some of the remedial actions that can be taken up by the health sector are:
Nutritional surveillance implies the continuous monitoring in a community or area of factors or conditions which indicate, related to the nutritional status of individuals or groups of people.
Immediate measures are required as soon as the malnourished subjects are located. Children suffering from severe PEM with complications need urgent care, may be in a hospital. Less severely affected children can be treated on a domiciliary basis or in special nutrition rehabilitation centres. These centres should be linked with health centres.
The target group are mothers and children. Supplementary feeding is normally regarded as a stop-gap measure for the rehabilitation of malnourished children.
It is opined that by appropriate educational action, about 50 per cent of nutritional problems can be solved.
Preventive and Social Measures
Since malnutrition is the outcome of several factors, the problem can be solved only by taking action simultaneously at various levels family, community, national and international levels. It requires a coordinated approach of many disciplines—nutrition, food technology, health administration, health education, marketing programme, etc. In short, it calls for a comprehensive programme of social programme of the entire country.
Action at the Family Level
The principal target of nutritional improvement in the community is the family, and the instrument for combating malnutrition at the family level is nutrition education.
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.
Action at the Community Level
Action at the community level should commence with the analysis of the nutrition problem in term of: (a) the extent, distribution and types of nutritional deficiencies, (b) the population groups at risk, and (c) the dietary and non-dietary factors contributing to malnutrition.
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:
- Increasing the availability of foods both in quantity and quality but much more important—making sure that the people suffering or at risk of malnutrition can obtain these foods.
- The Applied Nutrition Programme is an attempt at production of various types of protective foods by the community for the community.
- Significance improvements in the overall living conditions of the people is also called for at the community level. This includes such measures as health education, improvement of water supply, control of infectious diseases. (In brief, a broad socioeconomic development of the entire community is called for).
Action at the National Level
The burden of improving the nutritional status of the people, by and large, is the responsibility of the State.
Some of the strategies and approaches undertaken at the national level in India are:
The nutritional uplift of people, especially in a country like India, can come about only as part and parcel of an overall socioeconomic development. It is, therefore, necessary to raise the living standards and purchasing power of the people.
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.
Stabilisation of Population
The population policy in India is related to food and nutrition policy. The accent now is on birth spacing and a small family norm.
Nutrition Intervention Programmes
The prevention and control of endemic goitre through iodized common salt; the central of anaemia through distribution of iron and folic acid tablets to pregnant and nursing mothers, or possibly through fortification of common foods with iron; the control of nutritional blindness through periodic administration of massive oral doses of vitamin A to children at risk; supplementary feeding programmes for preschool children are examples of such measures.
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.
Nutrition-related Health Activities
Since malnutrition is closely related to infection, all progammes of immunisation and improvement of environmental sanitation will inevitably have a beneficial effect on nutrition.
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.
Action at the International Level
Food and nutrition are global problems, just as health and sickness, and both are interrelated. There is considerable scope for international co-operation in solving the problems of malnutrition.
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.