Nutrition and Biochemistry for Nurses SM Raju
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1NUTRITION2

Relationship between Nutrition and HealthCHAPTER 1

 
INTRODUCTION
Nutrition (also called nourishment or aliment) is the provision of the materials necessary in the form of food to cells and organisms to support life. Many common health problems can be prevented or alleviated with a healthy diet.
The diet of an organism is what it eats, and is largely determined by the perceived palatability of foods. Dietitians are health professionals who specialize in human nutrition, meal planning, economics, preparation, and so on. They are trained to provide safe, evidence-based dietary advice and management to individuals (in health and disease), as well as to institutions.
A poor diet can have an injurious impact on health, causing deficiency diseases such as scurvy, beriberi, and kwashiorkor; health-threatening conditions like obesity and metabolic syndrome, and such common chronic systemic diseases as cardiovascular disease, diabetes, and osteoporosis.
According to WHO “Nutrition is an input to and foundation for health and development”. Interaction of infection and malnutrition is well-documented. Better nutrition means stronger immune systems, less illness and better health. Healthy children learn better. Healthy people are stronger, are more productive and more able to create opportunities to gradually break the cycles of both poverty and hunger in a sustainable way. Better nutrition is a prime entry point to ending poverty and a milestone to achieving better quality of life.
Freedom from hunger and malnutrition is a basic human right and their alleviation is a fundamental prerequisite for human and national development.
WHO has traditionally focused on the vast magnitude of the many forms of nutritional deficiency, along with their associated mortality and morbidity in infants, young children and mothers. However, the world is also seeing a dramatic increase in other forms of malnutrition characterized by obesity and the long-term implications of unbalanced dietary and lifestyle practices that result in chronic diseases such as cardiovascular disease, cancer and diabetes.
All forms of malnutrition's broad spectrum are associated with significant morbidity, mortality, and economic costs, particularly in countries where both under- and overnutrition co-exist as is the case in developing countries undergoing rapid transition in nutrition and life-style.
 
HISTORY OF NUTRITION
The concept of nutrition wasn'st just an idea that popped up out of thin air. Nutrition is a concept that developed itself over many, many years. Sometimes it's nice to take a quick history lesson to learn where and how nutrition originated and who played a part in bringing it to the forefront. Without nutrition, things in our society would undoubtedly be very different.
By definition, the word “nutrition” means the process of nourishing or being nourished, specifically the process by which a living organism assimilates food and uses it for growth and replacement of tissues. Since the beginning of time, ancient civilizations were quick to note when something they ate benefited them greatly, whether it was mind, body, spirit or a combination of the three.
Humans have evolved as omnivorous hunter-gatherers over the past 250,000 years. The diet of early modern humans varied significantly depending on location and climate. The diet in the tropics tended to be based more heavily on plant foods, while the diet at higher latitudes tended more towards animal products. Analysis of postcranial and cranial remains of humans and animals from the Neolithic, along with detailed bone modification studies has shown that cannibalism was also prevalent among prehistoric humans.
Agriculture developed about 10,000 years ago in multiple locations throughout the world, providing grains such as wheat, rice, and maize, with staples such as bread 4and pasta. Farming also provided milk and dairy products, and sharply increased the availability of meats and the diversity of vegetables. The importance of food purity was recognized when bulk storage led to infestation and contamination risks. Cooking developed as an often ritualistic activity, due to efficiency and reliability concerns requiring adherence to strict recipes and procedures, and in response to demands for food purity and consistency.
The first recorded nutritional experiment is found in the Bible's Book of Daniel. Daniel and his friends were captured by the king of Babylon during an invasion of Israel. Selected as court servants, they were to share in the king's fine foods and wine. But they objected, preferring vegetables (pulses) and water in accordance with their Jewish dietary restrictions. The king's chief steward reluctantly agreed to a trial. Daniel and his friends received their diet for 10 days and were then compared to the king's men. Appearing healthier, they were allowed to continue with their diet.
Around 475 BC, Anaxagoras stated that food is absorbed by the human body and therefore contained “homeomerics” (generative components), suggesting the existence of nutrients.
Around 400 BC, Hippocrates, the “Father of Medicine” said, “Let food is your medicine and medicine is your food.” During this same time period, food items were often used in everyday life, from medicines and treatment of illnesses and wounds to cosmetics. An ancient remedy used involved squeezing the juice of liver onto the eye to treat eye disease. In today's terms, this approach deals with vitamin A deficiency. Liver contains a large amount of vitamin A - so the folks back in 400 BC knew what they were talking about!
In the year 1747, physician Dr. James Lind performed an experiment to find the cure for illnesses suffered by sailors on long trips. He gave some sailors sea water, others vinegar, and another group limes. Unknown to Lind at the time, the sailors who consumed limes were free of illnesses, since the limes contained vitamin C, which cured the condition now known as scurvy. A few years later in 1770, Antoine Lavoisier came across the actual process that describes how food is metabolized. In his writings and studies, he discovered how the body uses the combination of food and oxygen. His findings were considered breakthroughs and he has been known as the “Father of Nutrition and Chemistry” ever since.
The term “vitamins” came into being in 1912, and was coined by Dr. Casmir Funk. Through his findings, Funk found that vitamins were responsible for preventing all sorts of diseases that commonly plagued the people of those times. The word “vitamin” comes from the words vital and amine. In 1930, William Rose discovered essential amino acids, which are the building blocks of protein. The progression of nutrition continued to unfold over the next few decades and without these key discoveries, things in the nutritional world may have been very different or may not have existed at all.
To protect the general public, the “Dietary and Supplement Health and Education Act” was approved by Congress in 1994, which states what can and cannot be listed about nutritional supplements without the approval of the Federal Food and Drug Administration (FDA).
Nutritional discoveries from the earliest days of history have had a positive effect on our health and well-being. Nutrients are substances that are essential to life which must be supplied by food.
Today more than ever, obtaining nutritional knowledge can make a big difference in our lives. Air, soil, and water pollution in addition to modern farming techniques, have depleted our soils of vital minerals. The widespread use of food additives, chemicals, sugar and unhealthy fats in our diets contributes to many of the degenerative diseases such as cancer, heart disease, arthritis and osteoporosis. Here is a brief history of the science that offers the hope of improving health naturally.
400 B.C. — Hippocrates, the “Father of Medicine”, said to his students, “Let thy food be thy medicine and thy medicine be thy food”. He also said “A wise man should consider that health is the greatest of human blessings.”
400 B.C. — Foods were often used as cosmetics or as medicines in the treatment of wounds. In some of the early Far-Eastern biblical writings, there were references to food and health. One story describes the treatment of eye disease, now known to be due to a vitamin A deficiency, by squeezing the juice of liver onto the eye. Vitamin A is stored in large amounts in the liver.
1500's—Scientist and artist Leonardo da Vinci compared the process of metabolism in the body to the burning of a candle.
1747—Dr. James Lind, a physician in the British Navy, performed the first scientific experiment in nutrition. At that time, sailors who were sent on long voyages for years developed scurvy (a painful, deadly, bleeding disorder). Only nonperishable foods such as dried meat and breads were taken on the voyages, as fresh foods wouldn'st last. In his experiment, Lind gave some of the sailors sea water, others vinegar, and the rest limes. Those given the limes were saved from scurvy. As Vitamin C was not discovered 5until the 1930's, Lind did not know it was the vital nutrient. As a note, British sailors became known as “Limey's”
1770—Antoine Lavoisier, the “Father of Nutrition and Chemistry” discovered the actual process by which food is metabolized. He also demonstrated, where animal heat comes from. In his equation, he describes the combination of food and oxygen in the body, and the resulting giving off of heat and water.
Early 1800's—It was discovered that foods are composed primarily of four elements: carbon, nitrogen, hydrogen and oxygen, and methods were developed for determining the amounts of these elements.
1840—Justus Liebig of Germany, a pioneer in early plant growth studies, was the first to point out the chemical makeup of carbohydrates, fats and proteins. Carbohydrates were made of sugars, fats were fatty acids, and proteins were made up of amino acids.
1897—Christiaan Eijkman, a Dutchman working with natives in Java, observed that some of the natives developed a disease called Beriberi, which caused heart problems and paralysis. He observed that when chickens were fed the native diet of white rice, they developed the symptoms of Beriberi. When he fed the chickens unprocessed brown rice (with the outer bran intact), they did not develop the disease. Eijkman then fed brown rice to his patients and they were cured. He discovered that food could cure disease. Nutritionists later learned that the outer rice bran contains vitamin B1, also known as thiamine.
1912—E.V. McCollum, while working for the U.S. Department of Agriculture at the University of Wisconsin, developed an approach that opened the way to the widespread discovery of nutrients. He decided to work with rats rather than large farm animals like cows and sheep. Using this procedure, he discovered the first fat soluble vitamin, Vitamin A. He found that rats fed butter were healthier than those fed lard, as butter contains more Vitamin A.
1912—Dr. Casmir Funk was the first to coin the term “vitamins” as vital factors in the diet. He wrote about these unidentified substances present in food, which could prevent the diseases of scurvy, beriberi and pellagra (a disease caused by a deficiency of niacin, vitamin B-3). The term vitamin is derived from the words vital and amine, because vitamins are required for life and they were originally thought to be amines — compounds derived from ammonia.
1930's—William Rose discovered the essential amino acids, the building blocks of protein.
1940's—The water soluble B and C vitamins were identified.
1940's—Russell Marker perfected a method of synthesizing the female hormone progesterone from a component of wild yams called diosgenin.
1950's to the Present —The roles of essential nutrients as part of bodily processes has been brought to light. For example, more became known about the role of vitamins and minerals as components of enzymes and hormones that work within the body.
1968—Linus Pauling, a Nobel Prize winner in chemistry, created the term Orthomolecular Nutrition. Orthomolecular is, literally, “pertaining to the right molecule”. Pauling proposed that by giving the body the right molecules in the right concentration (optimum nutrition), nutrients could be used by people to achieve better health and prolong life. Studies in the 1970's and 1980's conducted by Pauling and colleagues suggested that very large doses of vitamin C given intravenously could be helpful in increasing the survival time and improving the quality of life of terminal cancer patients.
1994-2000: Have you ever wondered why vitamin bottle labels and nutritional web sites include a phrase saying that their products and information are not intended to diagnose, cure or prevent any disease? These also usually state that their health claims have not been evaluated by the Food and Drug Administration (FDA). Here's why: The Dietary and Supplement Health and Education Act was approved by Congress in October of 1994 and updated in January 2000. It sets forth what can and cannot be said about nutritional supplements without prior FDA review.
While this law limits what vitamin manufacturers can claim about preventing or curing diseases, its passage has been a major milestone in the natural health field. It acknowledges the millions of people who believe dietary supplements can improve their diets and bestow good health. It opens the way for people to obtain the information they need to make the best nutritional choices for themselves.
In January of 2000, the FDA clarified that supplement makers can state their products can improve the structure or function of the body or improve common, minor symptoms. Allowable statements include things such as: “maintains a healthy heart”, “helps you relax”, “strengthens joint structure”, etc. Overall, due to this law, vitamin, herb and nutrient manufacturers have greater freedom to say what their products can do to improve our health.
In 2002, a natural justice study showed a relation between nutrition and violent behavior. In 2005, a study found that obesity may be caused by adenovirus in addition to bad nutrition.6
 
BASIC CONCEPTS OF NUTRITION
  1. Nutrition is the food we eat and how the body uses it. We eat food to live, to grow, to keep healthy and well, and to get energy for work and play.
  2. Food is made up of different nutrients needed for growth and health.
    • All nutrients needed by the body are available through food.
    • Many kinds and combinations of food can lead to a well-balanced diet.
    • No food by itself, has all the nutrients needed for full growth and health.
    • Each nutrient has specific uses in the body.
    • Most nutrients do their best work in the body when teamed with other nutrients.
  3. All persons, throughout life, have need for the same nutrients, but in varying amounts.
    • The amounts of nutrients needed are influenced by age, sex, size, activity, and the state of health.
    • Suggestions for the kinds and amounts of food needed are made by trained scientists.
  4. The way food is handled influences the amount of nutrients in food, its safety, appearance, and taste.
    • Handling means everything that happens to food while it is being grown, processed, stored, and prepared for eating.
  5. There are four macronutrients that include water, carbohydrates, proteins, and fats. They are the basic building blocks of a good diet.
  6. Required micronutrients are vitamins and minerals.
 
LATEST CONCEPTS OF NUTRITION
First of all, reduce weight. “Eat breakfast like a King, lunch like a Prince and dinner like a Pauper.” One should never eat to the point of being distended but rather to feeling no longer hungry. Savor your food and eat slowly. Learn to push away part of your meal and be served smaller amounts.
Secondly, change the quality of what you eat to a low fat diet. Fat is likely the culprit with the epidemic proportions of breast, colon and prostate cancer. The incidence of these cancers is decreased in cultures eating a low fat, high fiber diet. Among individuals consuming a vegetarian type diet the incidence of cancer in general is markedly decreased. Even in women already having a diagnosis of breast cancer and obesity is an adverse prognostic factor, i.e. women who are overweight do not respond as well as do women of normal weight. Strive for the lowest fat diet you can reach. Animal meat consumption should be avoided as much as possible. Fish, turkey and chicken should be source of non-vegetable protein. The majority of medical articles suggest that we eat complex carbohydrates (starches) that require digestion to break them down to simpler carbohydrates and eventually sugars. Simple sugars should be avoided. Their consumption results in jumps in blood sugar with the body reacting with insulin production and frequently hypoglycemia. Eating complex carbohydrates avoids this. Coarse-grained breads, whole wheat and bran cereals, raw or lightly steamed vegetables, fresh fruits are all in this class. Learn to use a Wok or skillet and when using it try using Pam. It contains no fat.
Increase the fiber in diet as much as possible. When doing so speed the transit through the intestine and decrease the tendency towards constipation. This also decreases the chances for getting colon cancer. High fiber in diet also lowers serum cholesterol. Fiber is filling and low in calories. Patients with diabetes eating large amounts of fiber can lower or eliminate their need for insulin. Fruits and vegetable and cereals are high in fiber. There are commercially available fiber bars as well as psyllium seed products and bran wafers. It is suggested to take 6 to 10 grams of dietary fiber in the form of bran wafers mixed with apple sauce. Drink plenty of water when on a high fiber diet and supplement the diet with calcium, zinc and iron. Substances called phytates in the fiber will bind with these elements and possibly create a deficiency unless supplements are taken.
Salt should be minimized in diet. Foods high in salt are frequently high in nitrosamines which by themselves cause cancer. Salted, smoked and pickled foods are not advised. Therefore, avoid bacon and sausage and ham. These are also high in fat. High salt intake in many individuals leads to water retention and the need for diuretics (“water pills”) and potassium supplements. Salt is dangerous for people with hypertension. Instead of salt use a salt substitute that is rich in potassium rather than in sodium. Cosalt, light salt and other salt substitutes are available in market. Their labels should indicate their contents to be potassium chloride. Only patients with kidney disease need to be concerned about potassium excess in their diets. Potassium, recently has been shown to have a blood pressure lowering effect. Low potassium resulting from diuretics taken without supplementation results in weakness and lethargy. In patients with heart disease, low potassium can cause disturbances in heart rhythm.
Cigarettes should be totally avoided as should the inhalation of passive smoke. These are cancer producing without question and one of the major causes of illness and death in the world. Not only cancer but cardiac 7disease and vascular disease all result from and are aggravated by cigarette smoking. Lung cancer and bladder cancer are related closely to cigarette smoking.
Alcohol intake should be minimized to 1 or 2 ounces a day. Alcohol will wash out many of the water soluble vitamins as well as increase the consumption of Vitamin C, zinc, selenium, magnesium, calcium and potassium. Alcohol in excess will increase fat deposits in the heart and decrease immune function. Alcohol is a toxin to the bone marrow and can cause liver injury leading to hepatitis and cirrhosis.
 
ROLE OF NUTRITION IN MAINTAINING HEALTH
Nutrition is an input to and foundation for health and development. Interaction of infection and malnutrition is well-documented. Better nutrition means stronger immune systems, less illness and better health. Healthy children learn better. Healthy people are stronger, are more productive and more able to create opportunities to gradually break the cycles of both poverty and hunger in a sustainable way. Better nutrition is a prime entry point to ending poverty and a milestone to achieving better quality of life.
Freedom from hunger and malnutrition is a basic human right and their alleviation is a fundamental prerequisite for human and national development.
WHO has traditionally focused on the vast magnitude of the many forms of nutritional deficiency, along with their associated mortality and morbidity in infants, young children and mothers. However, the world is also seeing a dramatic increase in other forms of malnutrition characterized by obesity and the long-term implications of unbalanced dietary and lifestyle practices that result in chronic diseases such as cardiovascular disease, cancer and diabetes.
All forms of malnutrition's broad spectrum are associated with significant morbidity, mortality, and economic costs, particularly in countries where both under- and overnutrition co-exist as is the case in developing countries undergoing rapid transition in nutrition and life-style.
 
Challenges
Poor nutrition contributes to 1 out of 2 deaths (53%) associated with infectious diseases among children aged under five in developing countries.
1 out of 2 children in Africa with severe malnutrition dies during hospital treatment due to inappropriate care
1 out of 4 preschool children suffers from under-nutrition, which can severely affect a child's mental and physical development
Under-nutrition among pregnant women in developing countries leads to 1 out of 6 infants born with low birth weight. This is not only a risk factor for neonatal deaths, but also causes learning disabilities, mental, retardation, poor health, blindness and premature death.
Inappropriate feeding of infants and young children are responsible for one-third of the cases of malnutrition.
1 out of 3 people in developing countries are affected by vitamin and mineral deficiencies and therefore more subject to infection, birth defects and impaired physical and psycho-intellectual development.
Magnitude of zinc deficiencies is unknown but likely to prevail in deprived populations; associated with growth retardation, diarrhea and immune deficiency.
40 million people living with HIV/AIDS are exposed to an increased risk of food insecurity and malnutrition, especially in poor settings, which may further aggravate their situation. But this is just one side of the problem.
2 out of 3 overweight and obese people now live in developing countries, the vast majority in emerging markets and transition economies.
By 2010, more obese people will live in developing countries than in the developed world.
Under-and over-nutrition problems and diet-related chronic diseases account for more than half of the world's diseases and hundreds of millions of dollars in public expenditure.
 
An Action Framework
In light of these challenges and trends NHD aims at building and implementing a science-based, comprehensive, integrated and action/policy-oriented “Nutrition Agenda” at global, regional and country levels that addresses the whole spectrum of nutrition problems towards attaining the millennium development goals and other nutrition-related international commitments, including the prevention the diet-related chronic diseases.
 
Strategic Approaches
Towards this aim, NHD's core function is to provide member states and the international community with science-based norms, standards, recommendations and technical guidance. It is also to provide operational and political support to member states for building their 8capacity in identifying problems and best policy options, implementing the required nutrition interventions, monitoring progress and assessing impact.
NHD acts globally and internationally to raise awareness and build alliances, networks and partnerships to support its objectives.
 
NHD 10-step Rapid Action Plan
WHO's response is amalgamated in 10 Rapid Action Plan (RAP) to provide technical support aiming at improving the effectiveness of comprehensive and integrated national nutrition policies and programs
  • The scaling up of measures to reach the nutrition-related components of MDG1, to improve child-survival (MDG4), and contribute to the attainment of all MDGs
  • The promotion of healthy diets through the life course and the reduction of obesity and diet-related chronic diseases
  • Country-led response to HIV/AIDS to address the two-way impact of HIV/AIDS on food security.
  1. Building national capacity to develop food and nutrition policies
    • Develop food and nutrition policies and strategies into national agendas
    • Develop advocacy tools
  2. Providing diagnostic reviews and country nutrition profiles
    • To provide governments with nutrition situation
    • Diagnostic reviews and assessment tools
    • Appropriate indicators
    • Integrated nutrition database
  3. Providing knowledge-based advisory services to policy makers and program managers through practice communities
    • Foster a learning community and network to access and share knowledge on nutrition
    • Share critical areas for program successes, exchange program schemes and implementation guidelines
  4. Optimizing fetal development
    • Promote optimal fetal growth and development
    • Reduce mortality and morbidity and health implication
  5. Improving infant and young child feeding practices and the care of severely malnourished children
    • Implementation of the Global Strategy for infant and young child feeding
    • WHO severe malnutrition case management guidelines
    • WHO estimates that reducing mortality 30–50% would be achievable over a period of 2–5 years (i.e. 2 million deaths per year could be prevented)
  6. Recommending vitamin and mineral requirements for children up to three years
    • Forge consensus on recommended dietary allowances (RDA) for 6–36 months
    • Ensure adequate micronutrient where this is not possible through diet or fortified complementary food
  7. Implementing guidelines on food fortification
    • Guidance to government, food industry and civil society on vitamins and mineral fortification
    • Develop rapid assessment protocol, training kits, national expects and so on
  8. Developing scientific evidence, assessment and policy guidelines on obesity and nutrition in transition
    • Assist countries in addressing obesity problem
    • Indicators to monitor overweight in various age groups
    • Database on dietary patterns
    • Producing recommendations on nutritional intervention
  9. Establishing nutrition friendly schools
    • Promote adequate nutrition and healthy eating through schools to prevent malnutrition in all its forms – underweight, micronutrient deficiencies and obesity
    • Set up global school-based nutrition agenda with set principles and strategies
    • Guidelines and reference materials and a network of resource people
  10. Ensuring the integration of nutrition into responses for people living with HIV/AIDS and people affected by conflicts and crisis.
    • Integrate nutrition into essential care, treatment and support package for people living with HIV/AIDS
    • Include global recommendations and practical nutrition assessment tools for home, community, health facility-based and emergency programs
    • Provide necessary technical guidance and support to governments and partners in countries affected 9by conflicts and crisis, in e.g. setting up or strengthening nutrition surveillance systems managing nutrition assessments and in capacity building on the improved management of severe malnutrition.
 
Four Programmatic Areas of Work
 
Growth Assessment and Surveillance
The work involves the development, testing and global introduction of the WHO Child Growth Standard. This particular project has involved several years of collaborative work with Member States and partners, and will culminate in the development of a prescriptive tool for monitoring child growth globally. This innovative tool will facilitate growth monitoring and this data will be used as one of the primary indicators for assessing the outcome of this most important MDG to eradicate extreme poverty and hunger.
The work has involved providing technical leadership in the design of growth reference protocols and studies and the development of relevant assessment tools and the supporting databases. Later stages involved comprehensive analysis of the data for the construction of growth curves, testing, and field implementation. Next steps involve plans for the development of adolescence and adult growth standards and related data collection providing a complete picture of global growth and malnutrition.
A major dimension of the work has been the development of the surveillance strategy and related tools and databases such as the WHO Global Database on Child Growth and Nutrition. The logical next step is to plan and develop a comprehensive surveillance strategy for the Department.
 
Country Focused Nutrition Policies and Programs
NHD develops norms, standards and provide guidance and support to regions and countries in developing and implementing their food and nutrition policies and Programs to address the dual burden of nutritional diseases through the life course. Working with the Regional Advisers, projects and initiatives focus on the goals and objectives of the Country Cooperation Strategies (CCS). Other partners include the Ministers of Health (MoH) and WRs in the various countries
The unit includes the following areas of work:
 
Maternal, Infant and Young Child
Major short term goals in these areas will include:
  • The development of a WHO initiative optimizing Fetal Development in close collaboration with other relevant WHO departments.
  • The implementation of the global strategy for infant and young child feeding that encompasses the promotion of breastfeeding and adequate complementary feeding, in close collaboration with CAH/WHO and other UN Agencies.
  • Providing technical expertise in management of severe malnutrition in close collaboration with CAH/WHO, other UN Agencies and Non-Government Organizations.
 
School Age and Adolescence Nutrition
Schools provide an excellent setting for promoting adequate nutrition and healthy eating and preventing school-age children and adolescent malnutrition in all its forms, i.e. underweight, micronutrient deficiencies and obesity. As a variety of school-based nutrition interventions are already in place the next step involves developing a comprehensive nutrition agenda in line with the principles and strategies set forth in the WHO Global School Health Initiative. Major goals in this area include:
  • The development of an initiative to establish Nutrition Friendly Schools addressing a comprehensive mix of school-based nutrition interventions in close collaboration with CHP/NMH and other UN Agencies
 
Nutrition in Transition
Rapid changes in diets and lifestyles resulting from industrialization, urbanization, economic development and market globalization are having a significant impact on the nutritional status of populations. Because of these changes in dietary and lifestyle patterns, diet-related diseases including obesity, diabetes mellitus, cardiovascular disease, hypertension and stroke, and various forms of cancer are increasingly significant causes of disability and premature death in both developing and newly developed countries. They are taking over from more traditional public health concerns like undernutrition and infectious disease, and placing additional burdens on already overtaxed national health budgets. Nutrition in Transition will play a significant role in planning and coordinating activities to assess and address this global phenomenon. Goals in this area include developing population wide strategies such as food based dietary guidelines, promoting dietary diversity and developing dietary indicators. Other goals include contributing to the implementation of the WHO Global Strategy on Diet, Physical Activity and Health.
 
Reduction of Micronutrient Malnutrition
This is a cross-cutting initiative to provide support and collaborate with the other NHD Units on micronutrient 10issues and related strategies. Towards this objective it will continue to develop norms and methodologies for assessment and control of micronutrient malnutrition as well as provide support to the regions and countries for the implementation of specific strategies to control micronutrient malnutrition. The work also involves applied research for the development of tools for assessing micronutrient status and strategies for control of micronutrient deficiency. In addition the work involves collaborating in the integration of the micronutrient malnutrition modules into the WHO Integrated Nutrition Database. Another important aspect of the work is the strengthening of internal and external partnership to sustain, control, and eliminate micronutrient malnutrition.
 
Nutrition in Development and Crisis
 
Nutrition Action in Emergencies and Post-Emergencies
Support initiatives in emergencies, crisis, post-emergencies, rehabilitation and development will be developed in close collaboration with HAC. This team focuses on providing support and guidance to countries, NGOs and other UN partners on nutrition related issues for early warning, preparedness, and response. It encompasses normative and standard settings work (nutritional standards, food/ration composition; assessment of malnutrition; nutritional surveillance and supplementary and therapeutic feeding); training and capacity building and direct participation in joint assessment missions for rapid response and post-emergency rehabilitation.
 
Promoting Adequate Nutrition for People Living with HIV/AIDS
This area aims at mobilizing and guiding policy makers, non-governmental organizations and the international community to incorporate nutrition considerations into comprehensive HIV prevention, treatment, and care programs. It encompasses the development, dissemination, and support for country implementation of recommendations and guidelines on:
  • Treating severe malnutrition and for nutrition care in HIV/AIDS patients taking into account the interactions between nutritional status and ARTs;
  • Nutrition counselling for feeding infants from mothers living with HIV/AIDS;
  • Multi-micronutrient supplementation for HIV/AIDS patients.
  • Community level actions towards household food security for families affected by HIV/AIDS.
 
NUTRITIONAL PROBLEMS IN INDIA
The National nutrition policy1993, Government of India (Department of women and child development, Ministry of human resource development) New Delhi, has identified the major nutrition problems of India, which can be classified as follows:
  1. Undernutrition resulting in:
    1. Protein energy malnutrition (PEM)
    2. Iron deficiency
    3. Iodine deficiency
    4. Vitamin deficiency.
    5. Low birth weight children.
  2. Seasonal dimensions of Nutrition
  3. Natural calamities and the landless.
  4. Market distortion and disinformation;
  5. Urbanization.
  6. Special nutritional problems of hill people, industrial workers, migrant workers, and other special categories
  7. Problems of over nutrition, overweight and obesity for a small section of urban population.
For India and much of the third world, nutrition status is characterized by varying degrees of undernutrition for women and children.
 
Undernutrition
 
Protein Energy Malnutrition (PEM)
Protein energy malnutrition is the most widespread form of malnutrition among pre-school children of our country. A majority of them suffer from varying grades of malnutrition. As many as 43.8 percent children suffer from moderate degrees of PEM and 8.7 percent suffer from severe extreme forms of malnutrition. The child population of urban slums had the lowest proportion of children with normal body weight and recorded the highest proportion of severely malnourished children. Between 1975 and 1990, increase in the percentage of normal children was appreciable in all the States, except Karnataka and Orissa, where the increase was marginal. The percentage of severely malnourished children in the States of Gujarat and Madhya Pradesh failed to show any marked upward trend.
 
Iron Deficiency
Nutritional anemia among the pre-school children and expectant and nursing mothers is one of the major preventable health problems in India. It has been estimated in various studies particularly those conducted by NIN 11that roughly 56 percent pre-school children and almost 50 percent of the expectant mothers in the third trimester of pregnancy suffer from iron deficiency, which is basically due to inadequate or poor absorption of iron from a predominantly cereal-based diet. Low iron intake, coupled with hookworm infestation and infections, further aggravates the problem.
 
Iodine Deficiency Disorder
In India, nearly 40 million persons are estimated to be suffering from goiter and 145 million are living in the known goiter endemic regions. The prevalence of goiter in these endemic regions ranges from 1.5 percent in Assam (Cachar District) to 68.6% in Mizoram. It is also estimated that 2.2 million children are afflicted with cretinism and about 6.6 million are mildly retarded and suffer from varied degrees of motor handicaps. It is estimated that iodine deficiency also accounts for 90,000 still births and neonatal deaths every year.
 
Vitamin A Deficiency
Nutritional blindness which affects over seven million children in India per year results mainly from the deficiency of Vitamin A, coupled with protein energy malnutrition. In its severest form, it often results in loss of vision and it has been estimated that around 60,000 children become blind every year (Source: NIPCCD: Situational Analysis of Children: March 1989: p42). Vitamin A deficiency is assessed on the basis of conjuctival xerosis and Bitot's spot
 
Prevalence of Low Birth Weight Children
The prevalence of low birth weight children is still unacceptably high in India. The nutritional status of infants is closely related to the maternal nutritional status during pregnancy and infancy. In India 30% of all the infants born are low birth weight babies (Weight less than 2500 grams.) and this pattern is almost constant since 1979. An ICMR study reported that the average birth weight ranged between 2.5 and 2 kg and the prevalence of low birth weight between 26 and 57 percent in the urban slums and 35 to 41 percent in the rural communities. This is a matter of concern since 90 percent of the deaths occur among infants with birth weight below 2000 gms. Low birth weight was found to be connected with several factors such as age of the mother, maternal weight, weight gain during pregnancy, interpregnancy interval, hemoglobin less than 8 gms, and illiteracy.
Keeping in view the fact that birth weight is the most important determinant of child survival and that the maternal nutritional status is the most decisive factor in preventing low birth weight, the National Health Policy has set a goal of bringing down incidence of low birth weight by 10 percent and the present maternal mortality rate from existing rate of 4 per 1000 to 2 per 1000 live births by 2000 A.D. It was found by the NNMB in 1989 that in the state of Karnataka, consumption of energy by men was the highest i.e. 2992k calories as compared to that of other states viz. West Bengal (2580k calories) and Orissa (2468k calories). In the rest of the states the consumption of calories was less than the recommended 2400k calories. Women face high risks of malnutrition and disease at all the three critical stages; infancy and childhood, adolescence, and reproductive phase. Child mortality rate figures show high rates for female children than their male counterparts. This is perhaps indicative of social prejudices leading to neglect of female babies. When girls attain adolescence, they go through a second spurt of growth and their bodies grow much more rapidly to prepare them for child bearing. But, unfortunately, the intake of nutrients during this period is significantly low. The calories and protein gaps ranging from 300-400 calories and 2-22 Gms of protein respectively. It is seen that the daily intake of Vitamin A by all age groups, including child. Adolescent and adult population is very much lower than the recommended level. The intake of iron is also lower than the recommended level in children of all age groups, adolescent girls and adult women.
 
Seasonal Dimensions
In the duality of the Indian situation where high-yielding modern agriculture co-exists with rain-fed subsistence farming. There are serious seasonal dimensions of the nutrition question. In large parts of India the rainy months are the worst months for the rural, landless poor. This is when cultivation, deweeding, ploughing and other works demand maximum energy from them. While food stores at home dwindle and market prices rise. These are again the months when water-borne diseases are so frequent. This condition goes on aggravating till late October or even November. These are the months of rural indebtedness and compulsive market involvement of the landless and the small/marginal cultivators. When the first kharif harvest arrives the situation is no better with widespread distress sales by the small/marginal farmers. All these make nutrition a casualty during this period. Seasonality of employment in subsistence agriculture affects nutrition through the double jeopardy of high energy demand of 12peak work seasons and fluctuation in household level food availability, which tends to exacerbate differential food intake among men, women, and children. As a result in very poor household women and children may actually fall below the survival line during lean periods.
 
Natural Calamities
This same group of rural landless poor is most vulnerable to droughts. floods and famines; as has been established in famine periods, worst affected groups are the landless agricultural laborers, artisans, craftsmen and non-agricultural laborers in that order.
 
Market Distortion and Disinformation
A striking feature which has now been established is that famines are caused not so much by any real decline in food availability as by a sudden erosion of purchasing power of these marginal groups who compulsively depend on the market (landless laborers, etc.). In fact lessons from all over the world have proved that it is not any substantial food shortage, but the psychosis of food shortage and the widespread belief regarding crop failure, that triggers off price rise spirals resulting in major malnutrition situations.
 
Urbanization
Undernutrition in urban areas is a major area of concern. Studies by NNMB have actually shown that the nutritional status of urban slum dwellers in India is almost as bad as that of rural poor. This is borne out both by figures relating to intake of food as well as intake of nutrients. The deleterious effect of rural urban movements on nutrition in most parts of the third world is quite well known. The children of urban slum dwellers and of the urban informal sector arc nutritionally the most fragile of all groups. Uncertainty of income and the absence of informal nutritional support systems within society are common to rural areas of India; place many of these families on the very edge of survival. The fallout of a spreading urban culture which encourages diversion of a high proportion of family expenditure to luxury goods and entertainment aggravates the situation. Poor sanitary conditions, acute respiratory infections and communicable diseases characterize these urban' settlements.
 
Regional and Occupational Specificities of the Problems of Nutrition
The nutritional imbalance of hill people engaged in very strenuous labor, the special nutritional problems of some categories of industrial workers and migration workmen are other examples wb1ch need a detailed and specific response.
 
With the Burgeoning Size of Indian Middle Class
Overnutrition with attendants of cardiovascular problems and other health hazards arc affecting large number of people particularly in the cities.
 
NATIONAL NUTRITIONAL POLICY
In 1993, the Union Cabinet of India approved a national nutrition policy which many people have promoted for more than 10 years. Approval occurred at the same time as rapid agricultural diversification and economic liberalization. Just 9.9% of children in India fall within normal nutritional grades. 8.7% suffer severe malnutrition. Health officials are mainly concerned about anemia in pregnant women, vitamin deficiency in school children, and iodine deficiency in endemic areas. The policy presents guidelines for short-term measures to address these nutritional problems, e.g., fortifying essential foods with iron and salt with iodine. The successful and community-based Integrated Child Development Services project will be strengthened and expanded to implement the nutrition policy. Goals of the policy are reducing anemia in pregnant women by 25%, eliminating nutritional blindness, assuring certain quantities of grains for everyone, and production of enough food grains to create a reserve. Some people are worried that the government will distribute massive doses of synthetic vitamin A to address vitamin deficiency in children instead of promoting diversification of the diet, especially inclusion of green leafy vegetables and other foods rich in beta-carotene. On the other hand, a retired professor thinks that distribution of vitamin A to prevent blindness and increased food production and consumption of ‘vitamin A’ rich foods complement each other. The technical expertise and instruments required to implement the policy are in short supply in India and may result in its collapse. The policy calls for improved enforcement of existing laws pertaining to food contamination. Food contaminants are becoming more and more common. For example, many cow milk samples are contaminated with Hexachlorocyclohexane (HCH) isomers at limits higher than allowed by law. Infant formula contains dichloro-diphenyl-trichloroethane (DDT), HCH isomers, and metal contaminants. Laws do not address fluoride as a food contaminant, yet India's soils and groundwater in some states contain fluoride.13
The booklet ‘National nutrition policy in India’ published in 1993 by department of women and child development has seven parts.
  • The first part is an introduction that gives an overview on the vicious cycle of poverty.
  • The second part states the need for a nutrition policy, which is implicit in both the importance of nutrition in development as well as in the complexity of the problem.
  • The third part discusses the nutrition status of India. The major nutrition problems of India can be classified as the following:
    • Undernutrition in the forms of protein-energy malnutrition, deficiencies in iron, iodine, and vitamin A, and low-birth-weight children
    • Seasonal dimensions of nutrition
    • Natural calamities and the landless;
    • Market distortion and disinformation
    • Urbanization; and
    • Special nutritional problems of hill people, industrial workers, migrant workers, and other special categories.
  • The fourth part presents the existing policy instruments for combating malnutrition.
  • The fifth part discusses the nutrition policy instruments.
  • The sixth part comprises the administration and monitoring.
  • Lastly, the intervention programs to combat malnutrition are addressed.
 
Nutrition Policy Instruments
Nutrition is a multisectoral issue and needs to be tackled at various levels. Nutrition affects development as much as development affects nutrition. It is therefore important to tackle the problem of nutrition both through direct nutrition intervention for especially vulnerable groups as well as through various development policy instruments which will create conditions for improved nutrition.
 
Direct Intervention (Short Term)
Expanding the Safety Net—The Universal Immunization Program, Oral Rehydration Therapy, and the Integrated Child Development Services (ICDS) have had a considerable impact on child survival, and extreme forms of malnutrition. The position however is that the silent form of hunger and malnutrition continues with over 43.8% (1988-90) children suffering from moderate malnutrition and about 37.6% (1988-90) from mild malnutrition. Therefore, while more children are surviving today, an overwhelmingly large number of them are destined to remain much below their genetic potential. This is the enormity of the demographic trap which faces us as we move towards the next century. There is therefore an immediate imperative to substantially expand the Nutrition intervention net through ICDS so as to cover all vulnerable children in the age group 0 to 6 years. Presently India's child population for 0-6 years is around 18% of the total population and out of this 30.76 million comprise the children from the households living below the poverty line in rural areas. Presently ICDS covers around 15.3 million children (most of them in the rural areas). It should be our conscious policy to cover the remaining 15.46 million children who are nutritionally at risk by extending ICDS to all the remaining 2388 blocks (5153 minus 2765 blocks existing) of the country by, the year 2000. [Source: Nutrition News Vol 12 No.3 May 1991 (NIN)].
With the objective of reducing the incidence of severe and moderate malnutrition by half by the year 2000 AD a concerted effort needs to be made to trigger appropriate behavioral changes among the mothers. Improving growth monitoring between the age group 0 to 3 years in particular with closer involvement of the mothers is a key intervention. Presently growth monitoring has become a one-way process and the mothers are mere passive observers of the entire process. This needs to be changed because after all nutrition management of the children will have to be done by the mothers at home. Getting involved in the growth monitoring of her child will give her a feeling of control over the child's nutrition process and combined with adequate nutrition and health education. Empower her to manage the nutrition needs of her children effectively.
The Government's recent initiative of including the adolescent girl within ‘the ambit of’ ICDS should be intensified so that they are made ready for a safe motherhood. Their nutritional status (including iron supplementation in the body) is improved and they are given some skill upgradation training in home-based skills and covered by non-formal education, particularly nutrition and health education. All adolescent girls from poor families should be covered through the ICDS by 2000 A.D. in all CD blocks of the country and 50% of urban slums.
  1. Ensure better coverage of expectant women: To achieve a target of 10% incidence of low birth weight by 2000 A.D, the coverage should include supplementary nutrition right from 1st trimester and should continue 14during the major period of lactation at least for the first one year after pregnancy.
  2. Fortification of essential foods: Essential food items shall be fortified with appropriate nutrients (for example, salt with iodine and/or iron). However, given the highly extensive and decentralized process of salt marketing in the country, there is the need to identify a vehicle which can be better controlled. Research in iron fortification of rice and other cereals should be intensified. The distribution of iodized salt should cover all the population in endemic areas of the country to reduce the iodine deficiency to below endemic levels.
  3. Popularization of low cost nutritious food: Efforts to produce and popularize low cost nutritious foods from indigenous and locally available raw material shall be intensified. It is necessary to involve women particularly in this activity.
  4. Control of micro-nutrient deficiencies amongst vulnerable groups: Deficiencies of Vitamin A, iron and folic acid, and iodine among children, pregnant women, and nursing mothers shall be controlled through intensified programs. Iron supplementation to adolescent girls shall be introduced. The program shall be expanded to cover all eligible members of the community. The prophylaxis programs at present do not cover all children. For example, the Vitamin A program covers only 30 out of about 80 million. It is necessary to intensify all these efforts and work on a specific time frame. Nutritional blindness should be completely eradicated by the year 2000 A.D. The National Nutritional Anemia Prophylaxis Program should be extended and strengthened to reduce anemia in expectant women to 25% by 2000 A.D.
 
Indirect Policy Instruments (Long Term Institutional and Structural Changes)
  1. Food security: In order to ensure aggregate food security a per capita availability of 215 kg/person/year of food grains needs to be attained. This requires production of 250 million tonnes of food grains per year by 2000 AD and buffer stocks of 30-35 million tonnes in order to guard against exigencies such as flood and droughts. However, taking into account the present trends and the possibility of improved availability of non-cereal food items there should be a target of at least attaining 230 Million tonnes food grains production by 2000 AD.
  2. Improvement of dietary pattern through Production and Demonstration: Improving the dietary pattern by promoting the production and increasing the per capita availability of nutritionally rich foods. The production of pulses, oil seeds and other food crops will be increased with a view to attain self sufficiency and building surplus and buffer stocks. The production of protective food crops, such as vegetables, fruits, milk, meat, fish and poultry shall be augmented. Preference shall be given to growing foods such as millets, legumes, vegetables and fruits (carrots, green leafy vegetables, guava, papaya and amla). For this purpose the latest and improved techniques shall be increasingly applied, high-yielding varieties of food crops developed and extensively cultivated. Adequate extension services must be available to farmers. Wastage of food in transit and storage reduced to the minimum, available food conserved and effectively utilized and adequate buffer stocks built up. Certain imbalances and anomalies in our agricultural policy need to be redressed immediately. Our Agricultural Policy has been hitherto concerned with production exclusively and not nutrition, which is the ultimate end. While the Green Revolution has largely remained a cereal revolution, with bias towards wheat, coarse grains and pulses, which constitute the poor man's staple and protein requirements, have not received adequate attention. The prices of pulses, which were below cereal prices before the ‘Green Revolution’ is now almost, double the prices of cereals. Our Food Policy should be consistent with our national nutritional needs. Introduction of appropriate incentives, pricing and taxation policies are needed.
  3. Policies for effecting income transfers so as to improve the entitlement package of the rural and urban poor.
    1. Improving the purchasing power: Poverty alleviation programs, like the Integrated Rural Development Program (IRDP) and employment generation schemes like Jawahar Rozgar Yojana, Nehru Rozgar Yojana and DWCRA are to be re-oriented and restructured to make a forceful dent on the purchasing power of the lowest economic segments of the population. In all poverty alleviation programs nutritional objectives shall be incorporated explicitly and the nutritional benefits of income generation shall be taken for granted. Existing programs shall be scrutinized for their nutrition component. It is necessary to improve the purchasing power of the landless and the rural and urban poor by implementing employment generation programs so that additional employment 15of at least 100 days is created for each rural landless family and employment opportunities are created in urban areas for slum dwellers and the urban poor.
    2. Public distribution system: Ensuring an equitable food distribution, through the expansion of the public distribution system. The Public distribution system shall ensure availability of essential food articles such as coarse grains, pulses and Jaggery, beside rice, wheat, sugar and oil conveniently and at reasonable prices to the public, particularly to those living below the poverty line, “not only in urban areas but throughout the country. For this purpose encouragement shall be given to the consumer cooperatives and fair price shops shall be opened in adequate number in all areas. Effective price and quality control shall be exercised over the cooked foods in restaurants and other eating places. The ‘Public Distribution System’ should be strengthened especially during the monsoon months for giving special rations at specially subsidized rates for at least four months (July - October) to the seasonally at risk” population. The beneficiaries of this program should include landless laborers and their families and the migrant laborers and their families.
  4. Land reforms: Implementing land reform measures so that the vulnerability of the landless and the landed poor could be reduced. This will include both tenure reforms as well as implementation of ceiling laws.
  5. Health and family welfare: The health and family welfare programs are an inseparable part of the strategy. Through “Health for All by 2000 AD” program increased health and immunization facilities shall be provided to all. Improved pre-natal and post-natal care to ensure safe motherhood shall be made accessible to all women. The population in the reproductive age group shall be empowered through education to be responsible for their own family size. Through intensive family welfare and motivational measures small family norm and adequate spacing shall be encouraged so that the food available to the family is sufficient for proper nutrition of the members.
  6. Basic health and nutrition knowledge: Basic health and nutrition knowledge with special focus on wholesome infant feeding practices shall be imparted to the people extensively and effectively. Nutrition and health education concepts shall be effectively integrated into the school curricula, as well as into nutrition programs. Nutrition and Health Education are very important in the context of the problems of overnutrition also.
  7. Prevention of food adulteration: Prevention of food adulteration must be strengthened by gearing up the enforcement machinery.
  8. Nutrition surveillance: Nutritional surveillance is another weak area requiring immediate attention. Periodical monitoring of the nutritional status of children, adolescent girls, and pregnant and lactating mothers below the poverty line takes place through representative samples, and results are transmitted to all agencies concerned. The NNMB should not only try and assess the impact of ongoing nutrition and development programs but also serve as an early warning system for prompt action.
    Since the Department of Women and Child Development is the nodal Department for National Nutrition Policy, it is necessary for the NNMB to be accountable for this department in so far as nutrition Surveillance is concerned.
  9. Monitoring of nutrition programs: Monitoring of Nutrition Programs (viz ICDS) and of Nutrition Education and Demonstration by the Food and Nutrition Board, through all its 67 centers and field units, should be continued. The transfer of Food and Nutrition Board to the Department of Women and Child Development has already been approved by the Prime Minister. This will ensure an integrated set up to deal with the problem of nutrition with adequate technical and field level set up.
  10. Research: Research into various aspects of nutrition, both on the consumption side as well as the supply side, is another essential aspect of the strategy. Research must accurately identify those who are suffering from various degrees of malnutrition. Research should enable selection of new varieties of food with high nutrition value which can be within the purchasing power of the poor.
  11. Equal remuneration: Special efforts should be made to improve the effectiveness of programs related to women. The wages of women shall be at par with that of men in order to improve women's economic status. This requires a stricter enforcement of the Equal Remuneration Act. Special emphasis will have to be given for expanding employment opportunities for women.
  12. Communication: Communication through established media is one of the most important strategies to be adopted for the effective implementation of the Nutrition Policy. The Department of Women and Child Development will have a well established, 16permanent communications division with adequate staff and fund support. While using the communication tools both mass communication as well as group or inter-personal communication should be used. Not only the electronic media but also folk and print media should be used extensively. The existing facilities in the Song and Drama Division and the Directorate of Advertising and Visual Publicity (DAVP) in the Ministry of Information and Broadcasting could help in a big way to improve nutrition and health education. To give a new direction to communication and media, efforts will be made for promoting sound feeding practices, which are culturally acceptable and based on local food habits. Alongside the information gap, existing social attitudes and prejudices, inherent in our milieu, which discriminate against girls and women and affect their health and nutrition, need to be countered through educational programs. Further, the media policy shall focus on ways and means to combat malnutrition among girl children, adolescent girls and women in the reproductive age group. Educational programs will be made meaningful and interesting to meet the growing needs of the population. The role of information is crucial for nutrition. Such information is not only important with regard to improved health and nutrition practices but can also have a vital influence on the market, particularly during natural calamities, war etc. The role of information during such exigencies is to ensure that the market remain stable without any panic being created. This also needs to be carefully monitored.
  13. Minimum wage administration: Closely related to the market, is the need to ensure an effective minimum wage administration to ensure its strict enforcement and timely revision and linking it with price rise through a suitable nutrition formula. A special legislation should be introduced for providing agricultural women laborers the minimum support, and at least 60 days leave by the ‘employer in the last trimester of her pregnancy. Excessive loss of energy during the working seasons has serious nutritional implications. The legislation should take care of this problem also.
  14. Community participation: The active involvement of the community is essential not only in terms of being aware of the services available to the community but also for deriving the maximum benefit from such services by giving timely feedback necessary at all levels. After all, communication must form an essential part of all services and people themselves are the best communicators. Community participation will include:
    1. Generating awareness among the community regarding the National Nutrition Policy and its major concerns;
    2. Involving the community through their Panchayat or where Panchayat do not exist, through beneficiary committees in the management of nutrition programs and interventions related to nutrition such as employment generation, land reforms, health, education etc.:
    3. Actual participation particularly of women in food production and processing activities.
    4. Promoting schemes relating to kitchen gardens, food preservation, preparation of weaning foods and other food processing units, both at the home level as well as the community levels, and
    5. Generation of effective demand at the level of the community for all services relating to nutrition.
  15. Education literacy: It has been shown that education and literacy particularly that of women, is a key determinant for better nutritional status. For instance, Kerala state which has the highest literacy level, also has the best nutrition status despite the fact that calorie intake in Kerala is not the highest among all states in the country.
  16. Improvement of the status of women: The most effective way to implement nutrition with mainstream activities in agriculture, health, education and rural development is to focus on improving the status of women, particularly the economic status. After all, women are the ultimate providers of nutrition to household, both through acquisition of food as well as preparation of food for consumption. There is evidence that women's employment does benefit household nutrition, both through increase in household income as well as through an increase in women's status, autonomy and decision-making power. Moreover, female education also has a strong inverse relationship with IMR.
Educated women have greater roles in household decision making, particularly those relating to nutrition and feeding practices. Therefore, emphasis on women's employment and education particularly nutrition and health education should provide the bedrock of the nation's nutritional intervention. If a self sustaining development model is to be pursued in which the community is able to manage its nutrition and health needs on its own. This underscores the importance of improving the employment status of women. The 17voluntary action created through the National Literacy Mission should be harnessed and channelized into the areas of child survival and nutrition.
 
FACTORS AFFECTING FOOD AND NUTRITION
Various factors are known to affect food and nutritional status of an individual. They include diverse factors such as socioeconomic, cultural, tradition, life style, food choices, food habits, technology, food production, and food distribution system.
Clinical nutrition is the use of food and eating habits to promote health and treat and prevent disease. Nutrition is an established part of conventional medicine. From a reductionistic viewpoint, nutrition provides the basic fuel and building blocks for the body. An expanded approach to nutrition, however, includes specific regimens used to treat specific conditions (e.g. the DASH diet for hypertension) as well as preventive measures (e.g. omega-3 fatty acids to decrease inflammatory states).
 
Socioeconomic
Several factors have been found to determine the dietary habits of the people. Food consumption pattern has dramatically changed as a result of sudden increase in income. It has adversely affected the food habits by encouraging the intake of fat, sugar, rice, wheat flour and meat. Socio-cultural factors such as religion, beliefs, food preferences, gender discrimination, education and women's' employment all have a noticeable influence on food consumption patterns. Mass media, especially televised food advertisements, play an important role in modifying the dietary habits. The migration movement has a great impact on the food practices.
Men and women with a lower level of educational achievement tended to have a ‘less healthy’ diet than men and women with more education. Men and women with less education ate fewer vegetables and more chips, fried and roast potatoes. Less educated women also consumed less fruit and fruit juice.
Price/value/money available for food was the most important influence on their choice of food.
 
Cultural
Emotional and cultural factors are of exceptional importance in determining food intake. The deeply ingrained pattern of three meals daily may be the cultural factor most open to criticism. Established nutritional habits are particularly potent factors in determining food intake. Proper nutritional education in early childhood may establish patterns of food selection that will be helpful in avoiding specific deficiencies and gross excesses in later life. Appetite may prove adequate for selection of a nutritionally acceptable diet under certain circumstances but selection of food on the basis of nutritional principles is more reliable and is to be recommended. Knowledge of normal variations in food intake in relation to age, sex, environmental temperature, and caloric expenditure is beneficial in interpreting the feeding behavior of children. Complaints by parents that their children have “poor appetites,” are commonly based on a misconception regarding normal patterns of food intake. Vitamins, iron, and other specific nutrients act as appetite stimulants only in the presence of deficiency of the particular nutrient.
Culture includes the shared customs, traditions, and beliefs of a group of people. This culture is part of what makes the group unique and helps to define its identity. Culture can be defined by geography, heritage or ethnic origin, or religion. Food customs are found in virtually every culture. In some cases the food customs are influenced by the climate or geography. Family, friends, and the community also influence an individual's food choices. Families often develop rituals or customs.
 
Tradition
For one family, birthdays may be celebrated by cake and ice cream parties with family members only. Another family celebrates birthdays by allowing the “birthday person” to select the foods for the dinner menu. Another family tradition might include eating brunch out every Sunday.
Some communities have food customs such as chili suppers, pancake breakfasts, founder's day celebrations, or festivals to feature a food harvested locally. Friends also influence food choices. Since we spend a great deal of time in social groups, friends influence when, where and what we eat.
 
Lifestyle
Lifestyle is a broad term that addresses nutrition, physical fitness, hygiene, sleep, and stress management, which is determined by one's level of social adjustment, worldview, culture, and personal choices.
Emotional health and the management of stress are also critical in regards to lifestyle choices. For example, when people are pressed for time or overwhelmed, they tend to grab quick and usually unhealthy foods. They also don'st find the time to exercise. Medical training is one such stressful situation. The continuous juggling of 18responsibility, information overload, patient care, and personal stresses with significant time and financial pressures can promote maladaptive coping techniques. Unfortunately, very little training in stress management is given in medical schools to address these demands. Stress management can be defined as recognizing causes of stress and managing those effects on a person in a more healthy way through strategic tools. It is critical to learn and practice healthy skills – ones that enable us to maintain our wholeness through medical training and beyond, as well as enabling us to serve as living examples for our patients. Mind-body medicine principles for stress reduction, exercise, regular sleep and good hygiene are essential tools for achieving this balance of stress management.
 
Food Choices
Food choices and eating habits are influenced by factors other than hunger. Hunger is the body's way of signaling it is time to eat, not what to eat. Many people eat when they are not actually hungry. Food choices are influenced by variety of factors that affects health.
Not only is food necessary for life, it is one of life's great pleasures. Food sustains us emotionally and physically. We often talk of ‘comfort’ foods, and most of the special events in our lives are celebrated with food as a centerpiece. For example, birthdays, holidays, or events such as weddings, sports, and graduations all include food as part of the celebration. These are all related to the psychological comfort that food provides rather than the physical need for energy.
People eat food to satisfy many needs. They eat to satisfy their physical needs when they are hungry. They sometimes eat to satisfy their psychological needs when they are stressed, bored, anxious, frustrated, happy, frightened, or wanting to enjoy companionship over a meal. Food provides a sense of security, a feeling of belonging, and psychological pleasure or enjoyment. Appetite is the psychological desire to eat; hunger is the physical need to eat.
 
Food Habits
The food preferences established in early childhood may affect food choices throughout life. Previous research has indicated that the choice of food is a learned experience and that familiarity with food is a major basis of likes and dislikes. Several studies have shown that children's liking for particular foods increases as a function of exposure frequency, suggesting that parents' choices of the foods to offer to their children may be an important determinant of their food preferences.
There was a strong concordance (more than 80%) of food preferences between the toddlers and other family members, with a significant similarity between foods never offered to the child and the mother's dislikes. On average, the children had been offered 77.8% of the foods listed and liked 81.1% of them. The foods liked and eaten by the largest number of children included French fries, pizza, potato chips, apple juice, banana saltine crackers, spaghetti, biscuits, popcorn, and white rolls. [It may be a cause for concern that popcorn, was “liked and eaten” by 95.8% of the children, since experts advice that popcorn, should not be offered to young children because it poses a high risk of choking.] Among the 22 foods disliked by 20% or more of the children, 21 were vegetables (the other one was grapefruit juice). No food was disliked and not eaten by a majority of the children; however, 31 foods were not eaten by a majority of the children because they had never been offered. These foods included lamb chops, veal cutlets, liver, avocado, pork chow mein, buttermilk, prunes and prune juice, rye bread, collards, winter squash, navy beans, beets, and a variety of forms of coffee and coffee creamers.
The findings of this study indicate that the most limiting category related to young children's food preferences is those foods never offered to the child. Thus, it may be worthwhile to encourage parents to offer their children as wide a variety of foods as possible, including foods that the parents themselves dislike. If, as previous research suggests, children learn to accept food by repeated exposures, denying young children the opportunity to taste a wide variety of foods may limit their range of acceptable foods as they mature.
 
Technology
Technology and the media also influence food decisions. Advertising, television cooking shows, and in-store marketing using product samples are all ways the media influences our decision-making process regarding food choices. Food additives that prolong shelf-life, enhance flavor, or improve nutritional value are all ways that technology can influence our food choices.
 
Food Production and Distribution System
Food production and distribution systems have wide-ranging impacts on the nutritional attributes of food. However, agricultural production can be and often is enormously destructive of ecosystems. The increasing incidence of obesity, diabetes, food-borne illnesses, and other health conditions are linked to nutritional factors and the food production and distribution system more generally.19
Large numbers of people do not eat a healthy diet. The composition of food products and the nature of the diet are in large part a result of food production, distribution, and marketing methods, which are overwhelmingly based on products for large commodity markets. Many preventable conditions, including various kinds of cancer, diabetes, coronary artery disease, obesity, low birth weight, and food-borne infectious diseases are directly linked to dietary factors, often in combination with genetic and other environmental contributors. These diseases are increasingly expensive to treat and are obvious targets for preventive measures.
The transportation system that distributes food produced at long distances from the point of consumption also contributes substantially to resource consumption, air and water pollution, and habitat loss and fragmentation. Time delays due to transport over long distances increase opportunities for contamination and loss of nutrients.
 
ROLE OF NUTRITION AND ITS MEDICINAL VALUE
“Functional foods,” “nutraceuticals,” “designer foods” and “medicinal foods” are terms that describe foods, and key ingredients isolated from foods, that have non-nutritive properties. The available scientific information on the physiologic actions of known constituents and combinations of constituents that occur in “functional foods,” highlights their medicinal and nutritive mechanisms of action in the body.
The study of free radicals, antioxidants and the phytochemical-rich whole foods in human medicine is producing revolutionary data that promises a new age of health and neurodegenerative disease management. Of particular interest is the role of reactive oxygen species (ROS) in chronic neurodegenerative diseases (e.g. Alzheimer's disease, Parkinson's disease, multiple sclerosis) and how antioxidant-rich foods protect the integrity of neuronal cells in the central nervous system, particularly when challenged by neurotoxins.
Medical interest in the relationship between nutrition and neurodegenerative disorders has focused largely on etiology and the influence of dietary macronutrients (fat, carbohydrates and protein) on the rate and severity of disease. Recent studies on antioxidant intake from foods and oxidative stress in neurodegenerative disorders are strengthening the rationale in support of a nutritionally sound, antioxidant and phytochemical-rich, whole food-based eating regime. The central nervous system is most vulnerable to oxidative stress simply because it consumes very high amounts of oxygen, have low glutathione content, and their membranes are rich in polyunsaturated fatty acids (PUFA). Thereby they exhibiting reduced free radical scavenging capabilities under stress.
The free radical hypothesis has been most utilized to explain the onset, progression and increased incidence of heart disease and cancer. Diseases such as diabetes mellitus, hypertension, ischemic heart disease and hyperlipidemia are known to increase the level of oxidative stress in the body and have been associated with an increased risk for vascular dementia and other neurodegenerative diseases such as Parkinson's disease. The precise mechanism whereby oxidative stress causes its deleterious effects is not fully understood. However, factors such as increases in DNA oxidation products, deficits in calcium regulatory mechanisms that lead to cell death, and lipid and protein peroxidation, are known to play a role.
Experiments that examined the effects of diets rich in select herbs, fruits and vegetables on neurodegeneration suggest that the combined effects of known (antioxidant) and unknown compounds within whole foods improve neuronal and behavioral parameters in susceptible individuals.
Strawberries and spinach have both been identified as being high in antioxidant activity. Research has shown that spinach diet is more effective in reducing neuronal vulnerability to oxidative stress than vitamin E even though both diets are of equal antioxidant capacity. This reflects the importance of the whole food matrix in the bioavailability of dietary micronutrients. Further, these researchers speculate that there are other effects of the phytochemicals contained in spinach and straw–berries in addition to antioxidant protection. Flavonoids in these foods increase membrane fluidity hence reducing susceptibility to neuronal membrane rigidity. This suggests that diets high in antioxidants, especially spinach, may protect neuronal function in these cells.
Diet rich in antioxidants, particularly Vitamin E, appears to be important for aspects of brain function. Fruits and vegetables contain large amounts of antioxidant molecules, including vitamin E. In addition to protecting brain cells from free radical attack, Vitamin E may even have structure-specific roles in the signal transduction pathways and neurotransmitter distribution in neurons.
Phytochemicals possess many properties including antioxidant, antiallergic, anti-inflammatory, antiviral, antiproliferative, and anticarcinogenic.20
 
Medicinal Value of some Super Foods
Heart problems: Flax powder, Walnut, Figs, Pomegranate, Fish, Prawn, Olive oil, Peanut, Oats, Garlic, Soya bean, and Palak.
Blood pressure: Walnuts, Figs, Prawn, Peanut, apricots, drumstick leaves, Soya bean, Palak, and Pomegranate.
High cholesterol: Walnut, Figs, Oats, Carrot, and Papaya
Diabetes: Figs, Flax Powder, Cinnamon, Olive Oil, Oats, Drum stick leaves, Fenugreek, Carrot, Soya bean, watermelon, papaya, and muskmelon.
Cancer: Walnut, Figs, Prawn, Fish, Soya bean, Pomegranate, and Tomato.
Paralyses: Walnut.
Memory booster: Walnut, Flax, Mak, and Fish.
Women problems: Figs, Flax, Ginger, Coriander, Soya bean, and Amla.
Men problems: Pomegranate, Figs, and Ginger.
Body, knee Pains: Guggul, Prawn, Olives, Ginger, and Pumpkin seeds.
Boosts immunity: Flax, Fish, Oats, Kalonji, Papaya and basil leaves.
Acidity and Indigestion: Isabgol, Flax, Mooli, Ginger, Garlic, Coriander powder, cucumber, and Papaya.
Facial cleansing: Rub slice of cucumber or papaya on face daily all face related problems.
Palpitation: Figs, Almonds, Spinach, Oranges, banana, and Oats.
Dental problems: Amla.
Hyperthyroid: Figs, Almonds, Spinach, Oranges, banana, and Oats.
Hair fall: Eat plenty of oats.
For good Sleep: One banana and two teaspoon of honey in warm milk 2-3 hrs before sleep.
Stopping vomiting: Basil juice stops vomiting immediately.
Honey: Wholesome food preserves health and likewise prevents or aids the cure of a disease. The advantages attributed to honey as an aliment apply as well to its medicinal properties. The rapid assimilation of invert sugars which honey contains makes it, for instance, a desirable source of quick energy, a practical food and, at the same time, an effective heart stimulant.
The use of honey as an internal and external remedial agent must be much older than the history of medicine itself; it is, beyond doubt, the oldest panacea. While primeval man had to search first and probe the curative effects of the various organic and inorganic substances, honey, the greatest delicacy of Nature within his easy reach, surely could not have escaped his attention very long and he must soon have become convinced of its supreme curative value.
 
NUTRITIONAL CLASSIFICATION OF FOODS
The different groups of foods listed above may be broadly classified under three heads from the nutritional point of view.
  1. Energy-yielding foods;
  2. Body- building foods and
  3. Protective foods.
 
Energy Yielding Foods
The group includes foods rich in carbohydrates and also fats. They may be broadly divided into two groups:
  1. Cereals, roots and tubers and
  2. Carbohydrates and Fats. Cereals provide, in addition to energy the greater part of the proteins, certain minerals and vitamins in the diets of the low income groups in the developing countries. Roots and tubers also provide some amounts of proteins, minerals and vitamins while pure carbohydrates and fats provide only energy.
 
Body Building Foods
Foods rich in proteins are called body building foods. These may be broadly divided into two groups:
  1. Milk, egg and fish rich in proteins of high biological value and
  2. Pulses, oilseeds and nuts and low fat oilseed flours rich in proteins of medium nutritive value.
 
Protective Foods
Foods rich in proteins, vitamins and minerals are termed protective foods. Protective foods are broadly classified into two groups:
  1. Foods rich in vitamins, minerals and proteins of high biological value, e.g. milk, egg, fish and liver and
  2. Foods rich in certain vitamins and minerals only, e.g. green leafy vegetables and some fruits.
 
FOOD SAFETY STANDARDS
The food sector in India is governed by a multiplicity of laws under different ministries. A number of committees, including the Standing Committee of Parliament on 21Agriculture in its 12th Report submitted in April 2005, have emphasized the need for a single regulatory body and an integrated food law.
The Food Safety and Standards Bill, 2005, aims to integrate the food safety laws in the country in order to systematically and scientifically develop the food processing industry and shift from a regulatory regime to self-compliance. As part of the process of consolidation, the Bill proposes to repeal eight existing laws related to food safety.
The Bill proposes to establish the Food Safety and Standards Authority of India (FSSA), which would lay down scientific standards of food safety and ensure safe and wholesome food. The FSSA would be assisted by a Central Advisory Committee, a Scientific Committee and a number of Scientific Panels in specifying standards. The standards would be enforced by the Commissioner of Food Safety of each state through Designated Officers and Food Safety Officers.
 
Standards for Food Articles
The Bill prohibits the use of food additives, processing aid, contaminants, heavy metals, insecticides, pesticides, veterinary drugs residue, antibiotic residues, or solvent residues unless they are in accordance with specified regulations. Certain food items such as irradiated food, genetically modified food, organic food, health supplements and proprietary food cannot be manufactured, processed or sold without adhering to specific regulations.
The Bill makes it mandatory for the distributor of a food article to identify the manufacturer and the seller to identify either the manufacturer or the distributor of a food item. Every packaged food product has to be labeled as per regulations in the Bill. The packaging and labeling of a food product should not mislead consumers about its quality, quantity or usefulness.
Though standards are specified for water used as an input in manufacture/preparation of food, the Bill does not require any specific standards for potable water (which is usually provided by local authorities). Thus, it is the responsibility of the manufacturer to ensure that clean and adequate quality water is used even when tap water does not meet the required safety standards. This could be a tall order given the scale of operation of small food enterprises and street food vendors. Cost of preparing food could also rise if each vendor or manufacturer has to invest in water purification systems.
 
Food Recall Procedures
The Bill has special provisions for food recall procedures. If a food business operator (i.e., anyone owning or carrying out a business relating to food) considers that a food item is not in compliance with the specified standards, he has to initiate procedures to withdraw the food in question and inform the competent authorities.
 
Enforcement
Every food business operator is required to have a license in order to operate his food business. Petty manufacturers who make their own food, hawkers, vendors or temporary stall holders do not require a license. Instead, they need to get their businesses registered with the local municipality or Panchayat.
The Bill empowers the FSSA and State Food Safety Authorities to monitor and regulate the food business operators. The Commissioner of Food Safety of each state appoints a Designated Officer (DO), not below the level of Sub-Divisional Officer, for a specific district whose duties include issuing or canceling licenses, prohibiting sale of food articles that violate specified standards, receiving report and samples of food articles from Food Safety Officers and getting them analyzed. The DO also has the power to serve an ‘improvement notice’ on any food operator and suspend his license in case of failure in compliance with such a notice. The DO also investigates any complaint made in writing against Food Safety Officers. Food Safety Officers are appointed for a specified local area and their duties include taking samples of food articles, seizing food articles that are of suspect quality or inspecting any place where food articles are stored or manufactured.
The State Commissioner, on the recommendation of the Designated Officer, decides whether a case of violation would be referred to a court of ordinary jurisdiction or to a Special Court. Cases relating to grievous injury or death for which a prison term of more than three years is prescribed are tried in Special Courts.
The Bill provides for a graded penalty structure where the punishment depends on the severity of the violation. Offences such as manufacturing, selling, storing or importing sub-standard or misbranded food could incur a fine. Offences such as manufacturing, distributing, selling or importing unsafe food, which result in injury, could incur a prison sentence. The sentence could extend to life imprisonment in case the violation causes death. Petty manufacturers who make their own food, hawkers, vendors or temporary stall holders could be fined up to Rs 1 lakh if they violate the specified standards.22
In order to judge cases related to breach of specified regulations, the state government has the power to appoint an Adjudicating Officer, not below the rank of Additional District Magistrate. Any person not satisfied by the decision of an Adjudicating Officer has the right to appeal to the Food Safety Appellate Tribunal (or to the State Commissioner until the Tribunal is constituted). The Tribunal enjoys the same powers as a civil court and decides the penalty in case of non-compliance with the provisions of the act.
 
Implementation and Enforcement
Managing pesticide residue: The bill excludes plants prior to harvesting and animal feed from its purview. Any harmful input (such as pesticides in vegetables or antibiotics in animal feed) that could affect the safety standards of food products is not effectively covered. Therefore, the onus for ensuring that pesticide residue is within acceptable levels lies with every manufacturer/vendor.
Traceability: As per codex guidelines, traceability covers the whole chain from the farm to the consumer.
Testing facilities: The bill states that samples of food articles would be sent for testing to various accredited laboratories. It also stipulates how many samples should be taken.
Promote or penalize: The bill aims to provide for a ‘systematic and scientific development of the food processing industry’.
Penalty provisions: The DO has the power to issue an ‘improvement notice’ to any food operator, and suspend his license in case of non-compliance.
Consumer safeguards: The bill provides a safeguard for consumers with a provision for food recall procedure. It states that if a food business operator considers that a food item which it has processed, manufactured or distributed is not in compliance with the act, it shall immediately initiate procedures to withdraw the food in question and inform the competent authority.
Safeguards for food businesses: The food safety officer, while taking food samples for analysis, has to give one part of the sample to the food business operator to make available to the authorities. Providing the food business operator with the right to get the sample tested independently from an accredited laboratory could reduce opportunities for harassment and corruption.
Any customer can get an article of food examined by a food analyst. If this sample is found to be in violation of specified standards, penal action can be initiated.
Labeling: The bill does not specify details about labeling, and leaves it to the regulations which will be issued by the FSSA. However, there is a view that certain items are important enough to be specified in the bill such as labels identifying genetically modified food and labels detailing nutrition content in packaged food.
 
ELEMENTS OF NUTRITION(CLASSIFICATION OF FOODS)
There are seven major classes of nutrients: carbohydrates, fats, proteins, minerals, vitamins, fiber, and water.
These nutrient classes can be categorized as either macronutrients (needed in relatively large amounts) or micronutrients (needed in smaller quantities). The macronutrients are carbohydrates, fats, fiber, proteins, and water. The micronutrients are minerals and vitamins.
The macronutrients (excluding fiber and water) provide energy, which is measured in Joules or kilocalories (often called “Calories” and written with a capital C to distinguish them from gram calories). Carbohydrates and proteins provide 17 kJ (4 kcal) of energy per gram, while fats provide 37 kJ (9 kcal) per gram. Vitamins, minerals, fiber, and water do not provide energy, but are necessary for other reasons.
Molecules of carbohydrates and fats consist of carbon, hydrogen, and oxygen atoms. Carbohydrates range from simple monosaccharides (glucose, fructose, galactose) to complex polysaccharides (starch). Fats are triglycerides, made of various fatty acid monomers bound to glycerol. Some fatty acids, but not all, are essential in the diet: they cannot be synthesized in the body. Protein molecules contain nitrogen atoms in addition to the elements of carbohydrates and fats. The nitrogen-containing monomers of protein are amino acids, and they include some essential amino acids. They fulfill many roles other than energy metabolism; and when they are used as fuel, getting rid of the nitrogen places a burden on the kidneys.
Other micronutrients include antioxidants and phytochemicals.
Most foods contain a mix of some or all of the nutrient classes. Some nutrients are required regularly, while others are needed only occasionally. Poor health can be caused by an imbalance of nutrients, whether an excess or a deficiency.
 
Carbohydrates
Carbohydrates supply the body with the energy it needs to function. They are found almost exclusively in plant 23foods, such as fruits, vegetables, peas, and beans. Milk and milk products are the only foods derived from animals that contain a significant amount of carbohydrates.
Carbohydrates are divided into two groups-simple carbohydrates and complex carbohydrates. Simple carbohydrates, sometimes called simple sugars, include fructose (fruit sugar), sucrose (table sugar), and lactose (milk sugar), as well as several other sugars. Fruits are one of the richest natural sources of simple carbohydrates. Complex carbohydrates are also made up of sugars, but the sugar molecules are strung together to form longer, more complex chains. Complex carbohydrates include fiber and starches. Foods rich in complex carbohydrates include vegetables, whole grains, peas, and beans.
Carbohydrates are the main source of blood glucose, which is a major fuel for all of the body's cells and the only source of energy for the brain and red blood cells. Except for fiber, which cannot be digested, both simple and complex carbohydrates are converted into glucose. The glucose is then either used directly to provide energy for the body, or stored in the liver for future use. When a person consumes more calories than the body is using, a portion of the carbohydrates consumed may also be stored in the body as fat.
When choosing carbohydrate-rich foods for your diet, always select unrefined foods such as fruits, vegetables, peas, beans, and whole-grain products, as opposed to refined, processed foods such as soft drinks, desserts, candy, and sugar. Refined foods offer few, if any, of the vitamins and minerals that are important to your health. In addition, if eaten in excess, especially over a period of many years, the large amounts of simple carbohydrates found in refined foods can lead to a number of disorders, including diabetes and hypoglycemia (low blood sugar). Yet another problem is that foods high in refined simple sugars often are also high in fats, which should be limited in a healthy diet. This is why such foods-which include most cookies and cakes, as well as many snack foods-are usually loaded with calories.
Dietary fiber is the part of a plant that is resistant to the body's digestive enzymes. Only a relatively small amount of fiber is digested or metabolized in the stomach or intestines. Most of it moves through the gastrointestinal tract and ends up in the stool.
Although most fiber is not digested, it delivers several important health benefits. First, fiber retains water, resulting in softer and bulkier stools that prevent constipation and hemorrhoids. A high-fiber diet also reduces the risk of colon cancer, perhaps by speeding the rate at which stool passes through the intestine and by keeping the digestive tract clean. In addition, fiber binds with certain substances that would normally result in the production of cholesterol, and eliminates these substances from the body. In this way, a high-fiber diet helps lower blood cholesterol levels, reducing the risk of heart disease.
It is recommended that about 60 percent of your total daily calories come from carbohydrates. If much of your diet consists of healthy complex carbohydrates, you should easily fulfill the recommended daily minimum of 25 grams of fiber.
 
Fat
Although much attention has been focused on the need to reduce dietary fat, the body does need fat. During infancy and childhood, fat is necessary for normal brain development. Throughout life, it is essential to provide energy and support growth. Fat is, in fact, the most concentrated source of energy available to the body. However, after about two years of age, the body requires only small amounts of fat-much less than is provided by the average American diet. Excessive fat intake is a major causative factor in obesity, high blood pressure, coronary heart disease, and colon cancer, and has been linked to a number of other disorders as well. To understand how fat intake is related to these health problems, it is necessary to understand the different types of fats available and the ways in which these fats act within the body.
Fats are composed of building blocks called fatty acids. There are three major categories of fatty acids-saturated, polyunsaturated, and monounsaturated. These classifications are based on the number of hydrogen atoms in the chemical structure of a given molecule of fatty acid.
Saturated fatty acids are found primarily in animal products, including dairy items, such as whole milk, cream, and cheese, and fatty meats like beef, veal, lamb, pork, and ham. The fat marbling you can see in beef and pork is composed of saturated fat. Some vegetable products including coconut oil, palm kernel oil, and vegetable shortening-are also high in saturated fatty acids.
The liver uses saturated fats to manufacture cholesterol. Therefore, excessive dietary intake of saturated fats can significantly raise the blood cholesterol level, especially the level of low-density lipoproteins (LDLs), or “bad cholesterol.” Guidelines issued by the National Cholesterol Education Program (NCEP), and widely supported by most experts, recommend that the daily intake of saturated fats be kept below 10 percent of total caloric intake. However, for people who have severe problems with high blood cholesterol, even that level may be too high.24
Polyunsaturated fatty acids are found in greatest abundance in corn, soybean, safflower, and sunflower oils. Certain fish oils are also high in polyunsaturated fats. Unlike the saturated fats, polyunsaturated fats may actually lower your total blood cholesterol level. In doing so, however, large amounts of polyunsaturated fats also have a tendency to reduce high-density lipoproteins (HDLs) - the good cholesterol.” For this reason-and because, like all fats, polyunsaturated fats are high in calories for their weight and volume-the NCEP guidelines state that an individual's intake of polyunsaturated fats should not exceed 10 percent of total caloric intake.
Monounsaturated fatty acids are found mostly in vegetable and nut oils such as olive, peanut, and canola. These fats appear to reduce blood levels of LDLs without affecting HDLs in any way. However, this positive impact upon LDL cholesterol is relatively modest. The NCEP guidelines recommend that intake of monounsaturated fats be kept between 10 and 15 percent of total caloric intake.
Although most foods-including some plant-derived foods contain a combination of all three types of fatty acids, one of the types usually predominates. Thus, a fat or oil is considered ‘saturated” or “high in saturates' when it is composed primarily of saturated fatty acids. Such saturated fats are usually solid at room temperature. Similarly, a fat or oil composed mostly of polyunsaturated fatty acids is called “polyunsaturated,” while a fat or oil composed mostly of monounsaturated fatty acids is called “monounsaturated.”
One other element, trans-fatty acids, may also play a role in blood cholesterol levels. These substances (also called trans-fats), occur when polyunsaturated oils are altered through hydrogenation, a process used to harden liquid vegetable oils into solid foods like margarine and shortening. One recent study found that transmonounsaturated fatty acids raise LDL cholesterol levels, behaving much like saturated fats. Simultaneously, the trans-fatty acids reduced HDL cholesterol readings. Much more research on this subject is necessary, as studies have not reached consistent and conclusive findings. For now, however, it is clear that if your goal is to lower cholesterol, polyunsaturated and mono-unsaturated fats are more desirable than saturated fats or products with trans-fatty acids. Just as important, the total calories from fat should not constitute more than 20 to 25 percent of daily calories.
 
Protein
Protein is essential for growth and development. It provides the body with energy, and is needed for the manufacture of hormones, antibodies, enzymes, and tissues. It also helps maintain the proper acid-alkali balance in the body.
When protein is consumed, the body breaks it down into amino acids, the building blocks of all proteins. Some of the amino acids are designated nonessential. This does not mean that they are unnecessary, but rather that they do not have to come from the diet because they can be synthesized by the body from other amino acids. Other amino acids are considered essential, meaning that the body cannot synthesize them, and therefore must obtain them from the diet.
Whenever the body makes a protein-when it builds muscle, for instance-it needs a variety of amino acids for the protein-making process. These amino acids may come from dietary protein or from the body's own pool of amino acids. If a shortage of amino acids becomes chronic, which can occur if the diet is deficient in essential amino acids, the building of protein in the body stops, and the body suffers.
Because of the importance of consuming proteins that provide all of the necessary amino acids, dietary proteins are considered to belong to two different groups, depending on the amino acids they provide. Complete proteins, which constitute the first group, contain ample amounts of all of the essential amino acids. These proteins are found in meat, fish, poultry, cheese, eggs, and milk. Incomplete proteins, which constitute the second group, contain only some of the essential amino acids. These proteins are found in a variety of foods, including grains, legumes, and leafy green vegetables.
Although it is important to consume the full range of amino acids, both essential and nonessential, it is not necessary to get them from meat, fish, poultry, and other complete-protein foods. In fact, because of their high fat content-as well as the use of antibiotics and other chemicals in the raising of poultry and cattle-most of those foods should be eaten in moderation. Fortunately, the dietary strategy called mutual supplementation enables you to combine partial-protein foods to make complementary protein -proteins that supply adequate amounts of all the essential amino acids. For instance, although beans and brown rice are both quite rich in protein, each lacks one or more of the necessary amino acids. However, when you combine beans and brown rice with each other, or when you combine either one with any of a number of protein-rich foods, you form a complete protein that is a high-quality substitute for meat. To make a complete protein, combine beans with any one of the following:
  • Brown rice.
  • Seeds.
  • Corn.25
  • Wheat
  • Nuts.
Or combinebrown rice with any one of the following:
  • Beans.
  • Seeds.
  • Nuts.
  • Wheat.
All soybean products, such as tofu and soymilk, are complete proteins. They contain the essential amino acids plus several other nutrients. Available in health food stores, tofu, soy oil, soy flour, soy-based meat substitutes, soy cheese, and many other soy products are healthful ways to complement the meatless diet.
Yogurt is the only animal-derived complete-protein source recommended for frequent use in the diet. Made from milk that is curdled by bacteria, yogurt contains Lactobacillus acidophilus and other “friendly” bacteria needed for the digestion of foods and the prevention of many disorders, including candidiasis. Yogurt also contains vitamins A and D, and many of the B-complex vitamins.
Do not buy the sweetened, flavored yogurts that are sold in supermarkets. These products contain added sugar and, often, preservatives. Instead, either purchase fresh unsweetened yogurt from a health food store or make the yogurt yourself, and sweeten it with fruit juices and other wholesome ingredients.
 
Minerals
Dietary minerals are the chemical elements required by living organisms, other than the four elements carbon, hydrogen, nitrogen, and oxygen that are present in common organic molecules. The term “mineral” is archaic, since the intent is to describe simply the less common elements in the diet: heavier than the four just mentioned; including several metals; and often occurring as ions in the body. Some dietitians recommend that these be supplied from foods in which they occur naturally or at least as complex compounds, or sometimes even from natural inorganic sources (such as calcium carbonate from ground oyster shells). On the other hand, minerals are often artificially added to the diet as supplements, the most famous being iodine in iodized salt.
 
Macrominerals
Many elements are essential in quantity; also called “bulk minerals”. Some are structural, but many play a role as electrolytes. Elements with recommended dietary allowance (RDA) greater than 200 mg/day are the following, in alphabetical order (with informal or folk-medicine perspectives in parentheses):
Calcium, a common electrolyte, but also structural (for muscle and digestive system health, builds bone, neutralizes acidity, clears toxins, helps blood stream)
Chlorine as chloride ions; very common electrolyte; see sodium, below
Magnesium, required for processing ATP and related reactions (builds bone, causes strong peristalsis, increases flexibility, increases alkalinity)
Phosphorus, required component of bones; essential for energy processing
Potassium, a very common electrolyte (heart and nerve health)
Sodium, a very common electrolyte; not generally found in dietary supplements, despite being needed in large quantities, because the ion is very common in food: typically as sodium chloride, or common salt
Sulfur for three essential amino acids and therefore many proteins (skin, hair, nails, liver, and pancreas).
 
Trace Minerals
Many elements are required in trace amounts, usually because they play a catalytic role in enzymes. Some trace mineral elements (RDA < 200 mg/day) are, in alphabetical order:
  • Cobalt required for biosynthesis of vitamin B12 family of coenzymes
  • Copper required component of many redox enzymes, including cytochrome coxidase
  • Chromium required for sugar metabolism
  • Iodine required for the biosynthesis of thyroxin; needed in larger quantities than others in this list, and sometimes classified with the macrominerals
  • Iron required for many enzymes, and for hemoglobin and some other proteins
  • Manganese (processing of oxygen)
  • Molybdenum required for xanthine oxidase and related oxidases
  • Nickel present in urease
  • Selenium required for peroxidase (antioxidant proteins)
  • Vanadium (Speculative: there is no established RDA for vanadium. No specific biochemical function has been identified for it in humans, although vanadium is found in lower organisms.)
  • Zinc required for several enzymes such as carboxypeptidase, liver alcohol dehydrogenase, carbonic anhydrase
    26
 
Vitamins
As with the minerals discussed above, twelve vitamins are recognized as essential nutrients, necessary in the diet for good health. (Vitamin D is the exception: it can alternatively be synthesized in the skin, in the presence of UVB radiation.) Certain vitamin-like compounds that are recommended in the diet, such as carnitine, are indispensable for survival and health; but these are not strictly “essential” because the human body has some capacity to produce them from other compounds. Moreover, thousands of different phytochemicals have recently been discovered in food (particularly in fresh vegetables), which may have desirable properties including antioxidant activity (see below). Other essential nutrients not classed as vitamins include essential amino acids (see above), choline, essential fatty acids (see above), and the minerals discussed in the preceding section.
Vitamin deficiencies may result in disease conditions: goitre, scurvy, osteoporosis, impaired immune system, disorders of cell metabolism, certain forms of cancer, symptoms of premature aging, and poor psychological health (including eating disorders), among many others. Excess of some vitamins is also dangerous to health (notably vitamin A); and deficiency or excess of minerals can also have serious health consequences.
 
Fiber
Fiber is a carbohydrate (polysaccharide) that is incompletely absorbed in humans and in some other animals. Like all carbohydrates, when it is metabolized it can produce four Calories (kilocalories) of energy per gram. But in most circumstances it accounts for less than that because of its limited absorption. Dietary fiber consists mainly of cellulose, a large carbohydrate polymer that is indigestible because humans do not have the required enzymes. There are two subcategories: soluble and insoluble fiber. Whole grains, fruits (especially plums, prunes, and figs), and vegetables are rich in dietary fiber. Fiber is important to digestive health and is thought to reduce the risk of colon cancer. It can help in alleviating both constipation and diarrhea. Fiber provides bulk to the intestinal contents, and insoluble fiber stimulates peristalsis: the rhythmic muscular contractions passing along the digestive tract. Some soluble fibers produce a solution of high viscosity: a gel, which slows the movement of food through the intestines. Fiber, especially from whole grains, may help lessen insulin spikes and reduce the risk of diabetes [type 2].
 
Water
The human body is two-thirds water. Although water does not provide energy, it is considered an essential nutrient since it is involved in every function of the body.
  • Water helps transport nutrients and waste products in and out of cells.
  • Water is necessary for all digestive, absorption, circulatory, and excretory functions
  • Water is needed for the utilization of water-soluble vitamins.
  • It is needed for the maintenance of proper body temperature.
About 70% of the non-fat mass of the human body is made of water. To function properly, the body requires between one and seven liters of water per day to avoid dehydration; the precise amount depends on the level of activity, temperature, humidity, and other factors. With physical exertion and heat exposure, water loss will increase and daily fluid needs may increase as well.
It is not clear how much water intake is needed by healthy people, although some experts assert that 8–10 glasses of water (approximately 2 liters) daily is the minimum to maintain proper hydration. The notion that a person should consume eight glasses of water per day cannot be traced back to a scientific source. The effect of water intake on weight loss and on constipation is also still unclear. Original recommendation for water intake in 1945 by the Food and Nutrition Board of the National Research Council read: “An ordinary standard for diverse persons is 1 milliliter for each calorie of food. Most of this quantity is contained in prepared foods.” The latest dietary reference intake report by the United States National Research Council in general recommended (including food sources): 2.7 liters of water total for women and 3.7 liters for men. Specifically, pregnant and breastfeeding women need additional fluids to stay hydrated. According to the Institute of Medicine—who recommend that, on average, women consume 2.2 litres and men 3.0 litres—this is recommended to be 2.4 litres (approx. 9 cups) for pregnant women and 3 litres (approx. 12.5 cups) for breastfeeding women since an especially large amount of fluid is lost during nursing.
For those who have healthy kidneys, it is rather difficult to drink too much water, but (especially in warm humid weather and while exercising) it is dangerous to drink too little. People can drink far more water than necessary while exercising, however, putting them at risk 27of water intoxication, which can be fatal. In particular large amounts of de-ionized water are dangerous.
Normally, about 20 percent of water intake comes in food, while the rest comes from drinking water and assorted beverages (caffeinated included). Water is excreted from the body in multiple forms; including urine and feces, sweating, and by water vapor in the exhaled breath.
 
Other Nutrients
Other micronutrients include antioxidants and phytochemicals. These substances are generally more recent discoveries which have not yet been recognized as vitamins or contribute to health but are not necessary for life. Phytochemicals may act as antioxidants, but not all phytochemicals are antioxidants.
Antioxidants: Antioxidants are a recent discovery. As cellular metabolism/energy production requires oxygen, which can form potentially damaging (e.g. mutation causing) compounds known as free radicals. Most of these are oxidizers (i.e. acceptors of electrons) and some react very strongly. For normal cellular maintenance, growth, and division, these free radicals must be sufficiently neutralized by antioxidant compounds. Some are produced by the human body with adequate precursors (glutathione, Vitamin C) and those that the body cannot produce may only be obtained through the diet through direct sources (Vitamin C in humans, Vitamin A, Vitamin K) or produced by the body from other compounds (Beta-carotene converted to Vitamin A by the body, Vitamin D synthesized from cholesterol by sunlight). Phytochemicals and their subgroup polyphenols are the major antioxidants. Different antioxidants are now known to function in a cooperative network, e.g. vitamin C, can reactivate free radical-containing glutathione or vitamin E by accepting the free radical itself, and so on. Some antioxidants are more effective than others at neutralizing different free radicals. Some cannot neutralize certain free radicals. Some cannot be present in certain areas of free radical development (Vitamin A is fat-soluble and protects fat areas; Vitamin C is water soluble and protects those areas). When interacting with a free radical, some antioxidants produce a different free radical compound that is less dangerous or more dangerous than the previous compound. Having a variety of antioxidants allows any byproducts to be safely dealt with by more efficient antioxidants in neutralizing a free radical's butterfly effect.
Phytochemicals: A growing area of interest is the effect upon human health of trace chemicals, collectively called phytochemicals. These nutrients are typically found in edible plants, especially colorful fruits and vegetables, but also other organisms including seafood, algae, and fungi. The effects of phytochemicals increasingly survive rigorous testing by prominent health organizations. One of the principal classes of phytochemicals are polyphenol antioxidants, chemicals which are known to provide certain health benefits to the cardiovascular system and immune system. These chemicals are known to down-regulate the formation of reactive oxygen species in cardiovascular disease.
Perhaps the most rigorously tested phytochemical is zeaxanthin, a yellow-pigmented carotenoid present in many yellow and orange fruits and vegetables. Repeated studies have shown a strong correlation between ingestion of zeaxanthin and the prevention and treatment of age-related macular degeneration (AMD). Less rigorous studies have proposed a correlation between zeaxanthin intake and cataracts. A second carotenoid, lutein, has also been shown to lower the risk of contracting AMD. Both compounds have been observed to collect in the retina when ingested orally, and they serve to protect the rods and cones against the destructive effects of light.
Another carotenoid, beta-cryptoxanthin, appears to protect against chronic joint inflammatory diseases, such as arthritis. While the association between serum blood levels of beta-cryptoxanthin, and substantially decreased joint disease has been established, neither a convincing mechanism for such protection nor a cause-and-effect has been rigorously studied. Similarly, a red phytochemical, lycopene, has substantial credible evidence of negative association with development of prostate cancer.
The correlations between the ingestion of some phytochemicals and the prevention of disease are, in some cases, enormous in magnitude.
Even when the evidence is obtained, translating it to practical dietary advice can be difficult and counter-intuitive. Lutein, for example, occurs in many yellow and orange fruits and vegetables and protects the eyes against various diseases. However, it does not protect the eye nearly as well as zeaxanthin, and the presence of lutein in the retina will prevent zeaxanthin uptake. Additionally, evidence has shown that the lutein present in egg yolk is more readily absorbed than the lutein from vegetable sources, possibly because of fat solubility. At the most basic level, the question “should you eat eggs?” is complex to the point of dismay, including misperceptions about the health effects of cholesterol in egg yolk, and its saturated fat content.28
Table 1.1   Sources of phytochemicals and their possible benefits
Family
Sources
Possible benefits
Flavonoids
Berries, Herbs, Vegetables, wine, grapes, tea
General antioxidant, oxidation of LDLs, prevention of arteriosclerosis and heart disease
Isoflavones (phytoestrogens)
Soy, Red clover, Kudzu Root
General antioxidant, prevention of arteriosclerosis and heart disease, easing symptoms of menopause, cancer prevention.
Isothiocyanates
Cruciferous vegetables
Cancer prevention.
Monoterpenes
Citrus peels, Essential oils, Herbs, Spices, Green plants, Atmosphere
Cancer prevention, treating gallstones.
Organosulfur Compounds
Chives, Garlic, Onions
Cancer prevention, lowered LDLs, assistance to the immune system
Saponins
Beans, Cereals, Herbs
Hypercholesterolemia, Hyperglycemia, Antioxidant, cancer prevention, Anti-inflammatory
Capsaicinoids
All capiscum (chile) peppers
Topical pain relief, cancer prevention, cancer cell apoptosis
As another example, lycopene is prevalent in tomatoes (and actually is the chemical that gives tomatoes their red color). It is more highly concentrated, however, in processed tomato products such as commercial pasta sauce, or tomato soup, than in fresh “healthy” tomatoes. Yet, such sauces tend to have high amounts of salt, sugar, and other substances a person may wish or even need to avoid (Table 1.1).
Ash: Though not really a nutrient as such, an entry for ash is sometimes found on nutrition labels, especially for pet food. This entry measures the weight of inorganic material left over after the food is burned for two hours at 600°C. Thus, it does not include water, fiber, and nutrients that provide calories, but it does include some nutrients, such as minerals. There have been some concerns that too much ash may contribute to urological syndrome.
Intestinal bacterial flora: It is now also known that animal intestines contain a large population of gut flora. In humans, these include species such as Bacteroides, L. acidophilus and E. coli, among many others. They are essential to digestion, and are also affected by the food we eat. Bacteria in the gut perform many important functions for humans, including breaking down and aiding in the absorption of otherwise indigestible food; stimulating cell growth; repressing the growth of harmful bacteria, training the immune system to respond only to pathogens; producing vitamin B12, and defending against some infectious diseases.
 
CALORIES
Calorie is a unit of heat content or energy. Calorie is the amount of heat necessary to raise 1 g of water from 14.5–15.5°C (small calorie). Calorie is being replaced by joule, the SI unit equal to 0.239 calorie.
 
Are Calories Bad?
Calories are not bad. Your body needs calories for energy. But eating too many calories and not burning enough of them off through activity can lead to weight gain.
Most foods and drinks contain calories. Some foods, such as lettuce, contain few calories. (A cup of shredded lettuce has less than 10 calories.) Other foods, like peanuts, contain a lot of calories. (A cup of peanuts has 854 calories.)
You can find out how many calories are present in a food by looking at the nutrition facts label. The label also will describe the components of the food - how many grams of carbohydrate, protein, and fat it contains. Here's how many calories are in 1 gram of each:
  • Carbohydrate - 4 calories
  • Protein - 4 calories
  • Fat - 9 calories
That means if you know how many grams of each one are in a food, you can calculate the total calories. You would multiply the number of grams by the number of calories in a gram of that food component. For example, if a serving of potato chips (about 20 chips) has 10 grams of fat, 90 calories are from fat. That's 10 grams × 9 calories per gram.
Some people watch their calories if they are trying to lose weight. Most kids don'st need to do this, but all kids can benefit from eating a healthy, balanced diet that includes the right number of calories - not too many, not 29too few. But how do you know how many calories you need?
 
How Much Calories Do Kids Need?
Kids come in all sizes and each person's body burns energy (calories) at different rates, so there is not one perfect number of calories that a kid should eat. But there is a recommended range for most school-age kids: 1,600 to 2,500 per day.
When they reach puberty, girls need more calories, but they tend to need fewer calories than boys. As boys enter puberty, they will need as many as 2,500 to 3,000 calories per day. But whether they are girls or boys, kids who are active and move around a lot will need more calories than kids who do not.
Most kids do not have to worry about not getting enough calories because the body and feelings of hunger help regulate how many calories a person eats. But kids with certain medical problems may need to make sure they eat enough calories. Kids with cystic fibrosis, for instance, have to eat high-calorie foods because their bodies have trouble absorbing the nutrients and energy from food.
Kids who are overweight might have to make sure they do not eat too many calories. (Only your doctor can say if you are overweight, so check with him or her if you'sre concerned. And never go on a diet without talking to your doctor!)
If you eat more calories than your body needs, the leftover calories are converted to fat. Too much fat can lead to health problems. Often, kids who are overweight can start by avoiding high-calorie foods, such as sugary sodas, candy, and fast food, and by eating a healthy, balanced diet. Exercising and playing are really important, too, because activity burns calories.
 
How the Body Uses Calories?
Some people mistakenly believe they have to burn off all the calories they eat or they will gain weight. This isn'st true. Your body needs some calories just to operate - to keep your heart beating and your lungs breathing. As a kid, your body also needs calories from a variety of foods to grow and develop. And you burn off some calories without even thinking about it - by walking your dog or making your bed.
But it is a great idea to play and be active for at least 1 hour and up to several hours a day. That means time spent playing sports, just running around outside, or riding your bike. It all adds up. Being active every day keeps your body strong and can help you maintain a healthy weight.
Watching TV and playing video games doesn'st burn many calories at all, that is why you should try to limit those activities to 1 to 2 hours per day. A person burns only about 1 calorie per minute while watching TV, about the same as sleeping!
 
BASAL METABOLIC RATE (BMR)
Basal metabolic rate, or BMR, is the minimum calorific requirement needed to sustain life in a resting individual. It can be looked at as being the amount of energy (measured in calories) expended by the body to remain in bed asleep all day!
BMR can be responsible for burning up to 70% of the total calories expended, but this figure varies due to different factors. Calories are burned by bodily processes such as respiration, the pumping of blood around the body and maintenance of body temperature. Obviously the body will burn more calories on top of those burned due to BMR.
BMR is the largest factor in determining overall metabolic rate and how many calories are needed to maintain, lose or gain weight. BMR is determined by a combination of genetic and environmental factors, as follows:
  • Genetics: Some people are born with faster metabolisms; some with slower metabolisms.
  • Gender: Men have a greater muscle mass and a lower body fat percentage. This means they have a higher basal metabolic rate.
  • Age: BMR reduces with age. After 20 years, it drops about 2 percent, per decade.
  • Weight: The heavier your weight, the higher your BMR. Example: the metabolic rate of obese women is 25 percent higher than the metabolic rate of thin women.
  • Body Surface Area: This is a reflection of your height and weight. The greater your body surface area factor, the higher your BMR. Tall, thin people have higher BMRs. If you compare a tall person with a short person of equal weight, then if they both follow a diet calorie-controlled to maintain the weight of the taller person, the shorter person may gain up to 15 pounds in a year.
  • Body Fat Percentage: The lower the body fat percentage, higher is the BMR. The lower body fat percentage in the male body is one reason why men generally have a 10-15% faster BMR than women.30
  • Diet: Starvation or serious abrupt calorie-reduction can dramatically reduce BMR by up to 30 percent. Restrictive low-calorie weight loss diets may cause BMR to drop as much as 20%.
  • Body temperature/health: For every increase of 0.5° C in internal temperature of the body, the BMR increases by about 7 percent. The chemical reactions in the body actually occur more quickly at higher temperatures. So a patient with a fever of 42°C (about 4°C above normal) would have an increase of about 50 percent in BMR.
  • External temperature: Temperature outside the body also affects basal metabolic rate. Exposure to cold temperature causes an increase in the BMR, so as to create the extra heat needed to maintain the body's internal temperature. A short exposure to hot temperature has little effect on the body's metabolism as it is compensated mainly by increased heat loss. But prolonged exposure to heat can raise BMR.
  • Glands: Thyroxin (produced by the thyroid gland) is a key BMR-regulator which speeds up the metabolic activity of the body. The more thyroxin produced, the higher the BMR. If too much thyroxin is produced (a condition known as thyrotoxicosis) BMR can actually double. If too little thyroxin is produced (myxoedema) BMR may shrink to 30-40 percent of normal. Like thyroxin, adrenaline also increases the BMR but to a lesser extent.
  • Exercise: Physical exercise not only influences body weight by burning calories, it also helps raise your BMR by building extra lean tissue. (Lean tissue is more metabolically demanding than fat tissue.) So you burn more calories even when sleeping.
 
Short Term Factors Affecting BMR
Illnesses such as a fever, high levels of stress hormones in the body and either an increase or decrease in the environmental temperature will result in an increase in BMR. Fasting, starving or malnutrition all result in lowering of BMR. This lowering of BMR can be one side effect of following a diet and nothing else. Solely dieting, i.e. reducing the amount of calories the body takes on, will not be as affective as dieting and increased exercise. The negative effect of dieting on BMR can be offset with a positive effect from increased exercise.
 
How to Calculate Basal Metabolic Rate (BMR)
The first step in designing a personal nutrition plan for yourself is to calculate how many calories you burn in a day; your total daily energy expenditure (TDEE). TDEE is the total number of calories that your body expends in 24 hours, including all activities. TDEE is also known as “maintenance level”. Knowing your maintenance level will give you a starting reference point from which to begin your diet. According to exercise physiologists William McArdle and Frank Katch, the average maintenance level for women in the United States is 2000-2100 calories per day and the average for men is 2700-2900 per day. These are only averages; caloric expenditure can vary widely and is much higher for athletes or extremely active individuals. Some athletes and ultra-endurance athletes may require as many as 6000 calories per day or more just to maintain their weight! Calorie requirements may also vary among otherwise identical individuals due to differences in inherited metabolic rates.
 
Methods of Determining Caloric Needs
There are many different formulas you can use to determine your caloric maintenance level by taking into account the factors of age, sex, height, weight, lean body mass, and activity level. Any formula that takes into account your lean body mass (LBM) will give you the most accurate determination of your energy expenditure, but even without LBM you can still get a reasonably close estimate.
 
The “Quick” Method (Based on Total Body weight)
A fast and easy method to determine calorie needs is to use total current body weight times a multiplier.
Fat loss = 12 - 13 calories per lb. of bodyweight
Maintenance (TDEE) = 15 - 16 calories per lb. of bodyweight
Weight gain: = 18 - 19 calories per lb. of bodyweight
This is a very easy way to estimate caloric needs, but there are obvious drawbacks to this method because it does not take into account activity levels or body composition. Extremely active individuals may require far more calories than this formula indicates. In addition, the more lean body mass one has, the higher the TDEE will be. Since body fatness is not accounted for, this formula may greatly overestimate the caloric needs if someone is extremely over fat. For example, a lightly active 50 year old woman who weighs 235 lbs. and has 34% body fat will not lose weight on 3000 calories per day (255 × 13 as per the “quick” formula for fat loss).
 
Equations Based on BMR
A much more accurate method for calculating TDEE is to determine basal metabolic rate (BMR) using multiple 31factors, including height, weight, age and sex, then multiply the BMR by an activity factor to determine TDEE. BMR is the total number of calories your body requires for normal bodily functions (excluding activity factors). This includes keeping your heart beating, inhaling and exhaling air, digesting food, making new blood cells, maintaining your body temperature and every other metabolic process in your body. In other words, your BMR is all the energy used for the basic processes of life itself. BMR usually accounts for about two-thirds of total daily energy expenditure. BMR may vary dramatically from person to person depending on genetic factors. If you know someone who claims they can eat anything they want and never gain an ounce of fat, they have inherited a naturally high BMR. BMR is at its lowest when sleeping undisturbed and not digesting anything. It is very important to note that the higher your lean body mass is, the higher your BMR will be. This is very significant if you want to lose body fat because it means that the more muscle you have, the more calories you will burn. Muscle is metabolically active tissue, and it requires a great deal of energy just to sustain it. It is obvious then that one way to increase your BMR is to engage in weight training in order to increase and/or maintain lean body mass. In this manner it could be said that weight training helps you lose body fat, albeit indirectly.
 
Harris-Benedict Formula (BMR based on Total Body Weight)
The Harris Benedict equation is a calorie formula using the factors of height, weight, age, and sex to determine basal metabolic rate (BMR). This makes it more accurate than determining calorie needs based on total bodyweight alone. The only variable it does not take into consideration is lean body mass. Therefore, this equation will be very accurate in all but the extremely muscular (will underestimate caloric needs) and the extremely over fat (will overestimate caloric needs).
Men: BMR = 66 + (13.7 × wt in kg) + (5 × ht in cm) - (6.8 × age in years)
Women: BMR = 655 + (9.6 × wt in kg) + (1.8 × ht in cm) - (4.7 × age in years)
Note: 1 inch = 2.54 cm.
1 kilogram = 2.2 lbs.
 
Example
You are female
You are 30 yrs old
You are 5′ 6 ″ tall (167.6 cm)
You weigh 120 lbs. (54.5 kilos)
Your BMR = 655 + 523 + 302 - 141 = 1339 calories/day
Now that you know your BMR, you can calculate TDEE by multiplying your BMR by your activity multiplier.
 
Activity Multiplier
Sedentary = BMR × 1.2 (little or no exercise, desk job)
Lightly active = BMR × 1.375 (light exercise/sports 1-3 days/wk)
Moderately active = BMR × 1.55 (moderate exercise/sports 3-5 days/wk)
Very active = BMR × 1.725 (hard exercise/sports 6-7 days/wk)
Extra active = BMR × 1.9 (hard daily exercise/sports and physical job or 2 × day training, i.e. marathon, contest etc.)
 
Example
If BMR is 1339 calories per day
Activity level is moderately active (work out 3-4 times per week)
Activity factor is 1.55
The TDEE = 1.55 × 1339 = 2075 calories/day
 
Katch-McArdle Formula (BMR Based on Lean Body Weight)
If you have had your body composition tested and you know your lean body mass, then you can get the most accurate BMR estimate of all. This formula from Katch and McArdle takes into account lean mass and therefore is more accurate than a formula based on total body weight. The Harris Benedict equation has separate formulas for men and women because men generally have a higher LBM and this is factored into the men's formula. Since the Katch-McArdle formula accounts for LBM, this single formula applies equally to both men and women.
 
BMR (Men and Women) = 370 + (21.6 × Lean Mass in kg)
 
Example
If female
Weighing 120 lbs. (54.5 kilos)
The fat percentage is 20% (24 lbs. fat, 96 lbs. lean)
Your lean mass is 96 lbs. (43.6 kilos)
Your BMR = 370 + (21.6 × 43.6) = 1312 calories
To determine TDEE from BMR, you simply multiply BMR by the activity multiplier:32
 
Example
The BMR is 1312
The activity level is moderately active (work out 3-4 times per week)
The activity factor is 1.55
The TDEE = 1.55 × 1312 = 2033 calories.
As can be seen, the difference in the TDEE as determined by both formulas is statistically insignificant (2075 calories vs. 2033 calories) because the person used as an example is average in body size and body composition. The primary benefit of factoring lean body mass into the equation is increased accuracy when the body composition leans to either end of the spectrum (very muscular or very obese).
 
Adjust Your Caloric Intake According to Your Goal
Once the TDEE (maintenance level) is known, the next step is to adjust calories according to primary goal. The mathematics of calorie balance is simple: To keep the weight at its current level, one needs to remain at daily caloric maintenance level. To lose weight, one needs to create a calorie deficit by reducing the calories slightly below maintenance level (or keeping the calories the same and increasing the activity above current level). To gain weight one need to increase calories above maintenance level. The only difference between weight gain programs and weight loss programs is the total number of calories required.
 
Negative Calorie Balance is Essential to Lose Body Fat
Calories not only count, they are the bottom line when it comes to fat loss. If you are eating more calories than you expend, you simply will not lose fat, no matter what type of foods or food combinations you eat. Some foods do get stored as fat more easily than others, but always bear in mind that too much of anything, even “healthy food,” will get stored as fat. You cannot override the laws of thermodynamics and energy balance. You must be in a calorie deficit to burn fat. This will force your body to use stored body fat to make up for the energy deficit. There are 3500 calories in a pound of stored body fat. If you create a 3500-calorie deficit in a week through diet, exercise or a combination of both, you will lose one pound. If you create a 7000 calories deficit in a week you will lose two pounds. The calorie deficit can be created through diet, exercise or preferably, with a combination of both. Because we already factored in the exercise deficit by using an activity multiplier, the deficit we are concerned with here is the dietary deficit.
 
Calorie Deficit Thresholds: How Low is Too Low?
It is well known that cutting calories too much slows down the metabolic rate, decreases thyroid output and causes loss of lean mass, so the question is how much of a deficit do you need? There definitely seems to be a specific cutoff or threshold where further reductions in calories will have detrimental effects. The most common guideline for calorie deficits for fat loss is to reduce your calories by at least 500, but not more than 1000 below your maintenance level. For some, especially lighter people, 1000 calories may be too much of a deficit. The American College of Sports Medicine (ACSM) recommends that calorie levels never drop below 1200 calories per day for women or 1800 per day for men. Even these calorie levels are extremely low. A more individualized way to determine the safe calorie deficit would be to account for one's bodyweight or TDEE. Reducing calories by 15-20% below TDEE is a good place to start. A larger deficit may be necessary in some cases, but the best approach would be to keep the calorie deficit through diet small while increasing activity level.
 
Example 1
Your weight is 120 lbs.
Your TDEE is 2033 calories
Your calorie deficit to lose weight is 500 calories
Your optimal caloric intake for weight loss is 2033 - 500 = 1533 calories
 
Example 2
Your calorie deficit to lose weight is 20% of TDEE (0.20% × 2033 = 406 calories).
Your optimal caloric intake for weight loss = 1627 calories
Positive calorie balance is essential to gain lean bodyweight.
If you want to gain lean bodyweight and become more muscular, you must consume more calories than you burn up in a day. Provided that you are participating in a weight-training program of a sufficient intensity, frequency and volume, the caloric surplus will be used to create new muscle tissue. Once you'sve determined your TDEE, the next step is to increase your calories high enough above your TDEE that you can gain weight. It is a basic law of energy balance that you must be on a positive calorie balance diet to gain muscular bodyweight. A general guideline for a starting point for gaining weight 33is to add approximately 300-500 calories per day onto your TDEE. An alternate method is to add an additional 15 - 20% onto your TDEE.
 
Example
Your weight is 120 lbs.
Your TDEE is 2033 calories
Your additional calorie requirement for weight gain is + 15 - 20% = 305 - 406 calories
Your optimal caloric intake for weight gain is 2033 + 305 - 406 = 2338 - 2439 calories.
 
Adjust Your Caloric Intake Gradually
It is not advisable to make any drastic changes to your diet all at once. After calculating your own total daily energy expenditure and adjusting it according to your goal, if the amount is substantially higher or lower than your current intake, then you may need to adjust your calories gradually. For example, if your determine that your optimal caloric intake is 1900 calories per day, but you have only been eating 900 calories per day, your metabolism may be sluggish. An immediate jump to 1900 calories per day might actually cause a fat gain because your body has adapted to a lower caloric intake and the sudden jump up would create a surplus. The best approach would be to gradually increase your calories from 900 to 1900 over a period of a few weeks to allow your metabolism to speed up and acclimatize.
 
Measure Your Results and Adjust Calories Accordingly
These calculations for finding your correct caloric intake are quite simplistic and are just estimates to give you a starting point. You will have to monitor your progress closely to make sure that this is the proper level for you. You will know if you'sre at the correct level of calories by keeping track of your caloric intake, your bodyweight, and your body fat percentage. You need to observe your bodyweight and body fat percentage to see how you respond. If you don'st see the results you expect, then you can adjust your caloric intake and exercise levels accordingly. The bottom line is that it's not effective to reduce calories to very low levels in order to lose fat. In fact, the more calories you consume the better, as long as a deficit is created through diet and exercise. The best approach is to reduce calories only slightly and raise your daily calorie expenditure by increasing your frequency, duration and or intensity of exercise.