Introducing the Chapter
- An Introduction
- Selected Definitions
- Historical Aspects of Nutrition and Nutritional Trends in India
- Relationship of Nutrition with Health and Nursing
- Nutrition and Health
- Importance of Nutrition and Dietetics in Nursing
SELECTED DEFINITIONS
- Food: Food is anything eaten by men or animal to produce energy.
- SDA: Specific dynamic action of food; stimulating effect of food intake on the basal metabolism, manifested by increase in the production of energy in the form of heat.
- Food fads: Personal likes and dislikes in the selection of foods.
- Foods taboos: Religion based food habits like vegetarianism in Hindu society and prohibition of pork in Muslim society.
- Pica: The habit of eating dirt, clay, chalk, limestone, ashes, starch, etc. leading to serious health problems.
- Coeliac (celiac) disease: Gluten induced enteropathy; intolerance to the protein gluten in wheat and rye producing the malabsorption syndrome in sensitive persons (apparent at 3–6 months of age).
- Emollient: An agent which softens and soothes skin or mucous membrane.
- Diverticulitis: Inflammation of a diverticulum (pouch or sac protruding from the wall of a tube or hollow organ).
- Diverticulosis: A condition in which there are many diverticula, especially in the intestines.
INTRODUCTION
Procuring enough food for survival is the main aim of life's struggle in all the higher organisms. Food is the basic necessity of life. Life cannot be sustained without an adequate nourishment. We need food for growth and development. Since all the foods are not of the same quality from nutritional point of view, it is the man's capacity to include required food stuffs in right quantity and quality to fulfill his nutritional requirement needs.
2Nurses are important members of health team and committed for maintaining the good health status of the people traditionally health care was directed to the hospitalized points only but today it includes the concept of continuity of care, i.e. from hospital to home based care during convalescent period. To implement this continue care patient may require counseling in the proper choice of foods in planning for best use of food money and practical suggestions for preparation of food.
In the community, nurses also encounter a variety of problems related to nutrition, e.g. a family needs instructions in preparing food for sick person and another needs guidance to start weaning. So nurse is the key person to provide some of the assistance but more often a team effort of a nurse, dietician and doctor is needed.
To make nutrition as an integral part of their nursing practice in the hospital as well as in the community, nurses need to study nutrition as a subject, its principles, food values, assessment and various modifications of diet.
Some Important Concepts
Health
Health is defined by the World Health Organization of the United Nations as the ‘State of complete physical, mental and social well-being and not merely an absence of disease or infirmity.’
Food
Food may be defined as anything eaten or drunk which meets energy, to build, regulate and protect the body. In short, food is raw material from which our body is made.
Nursing
According to the American Nurses Association, ‘Nursing practice is a direct service, goal directed and adaptable to the needs of the individual, the family and community during health and illness.’
According to another definition, ‘Nursing is a dynamic, therapeutic and educative process in meeting the health needs of the individual, family and society.’
Nutrition
It may be defined as the science of food and its relationship to health. It is concerned primarily with the part played by nutrients in body growth, development and maintenance.
In its broadest sense, nutrition is ‘The science of foods, the nutrients and other substances therein, their action, interaction and balance in relationship, health and disease; the process by which the organism ingests, digests, absorbs, transports and utilizes nutrients and disposes of their end products. In addition, nutrition must be concerned with social, economic, cultural and psychological implications of food and eating’ (Robinson and co-workers).
Dietetics
‘Dietetics is the practical application of the principles of nutrition. It includes the planning of meals for well and the sick.’
Good nutrition means ‘maintaining a nutritional status that enables us to grow well and enjoy good health.’
Nutrients are organic and inorganic complexes contained in the food we eat daily. These include water, proteins, carbohydrates, vitamins and minerals, etc. There are about 50 different nutrients which are normally supplied through the foods. Each nutrient has specific function in the body. Most of natural foods contain more than one nutrients. These are of two types: macronutrients and micronutrients.
Macronutrients
Proteins, fats and carbohydrates (CHO) are macronutrients. These are called proximate principles because they form the bulk of our food. In Indian diets, they contribute to the total energy in the following proportions—protein: 10 to 15%, fats: 10 to 30%, CHO: 60 to 80%.
Micronutrients
Vitamins and minerals are micronutrients because they are required in small amounts, e.g. from a fraction of milligram to several grams. Micronutrients do not supply energy but they play an important role in the regulation of metabolic activities and help in utilization of macronutrients.
Nutritional Status
Nutritional status is a state of our body as a result of food we consume. It can be determined only by the correlation of information obtained through a careful medical and dietary observations and appropriate laboratory investigations. Nutritional status can be good, fair or poor.
Nutritional Care
Nutritional care is the application of the science and art of human nutrition in helping people to select and obtain food for the primary purpose of nourishing their bodies in health or in disease throughout the life cycle.
Energy
Energy is defined as the capacity of our body to do work. Energy is a prime requisite for body function and growth. The energy produced in the body may be measured and expressed in units of work (Joule) and units of heat (Kilocalories).
Kilocalories
A Kilocalories (Kcal) is the amount of heat required to raise the temperature of 1 liter of water by 1 degree Celsius (1°C).
1 kcal = 4184 joules = 4.184 Kilojoules (KJ)
The nutritional value of CHO, protein and fats eaten in the diet may be expressed in Kilojoules per gram or kcal per gram.
1 g of carbohydrates provides 4 kcal (17 Kilojoules)
1 g of protein provides 4 kcal (17 Kilojoules)
1 g of fat provides 9 kcal (37 Kilojoules).
Metabolism
Metabolism is the sum total of building up reactions (anabolism) and breakdown reactions (catabolism) going on inside the body of a living organism.
Metabolic Rate
Metabolic rate is the rate at which energy is released from the fuel molecules inside the cells. This rate can be estimated by measuring oxygen uptake or carbon dioxide excretion.
BMR is the rate of metabolism when an individual is at rest in a warm environment and is in postabsorptive state, i.e. has not had a meal for at least 12 hours. In this state the release of energy is sufficient to meet only the essential needs of vital organs such as heart, lungs and nervous system.
HISTORICAL ASPECTS OF NUTRITION AND NUTRITIONAL TRENDS IN INDIA
- Food has been recognized as important for human beings in health and sickness through centuries. The newer knowledge of nutrition has been built upon the observations made by several pioneers during the 19th century and early part of 20th century.
- Until the turn of 19th century, the science of nutrition has a limited range. Proteins, fats and carbohydrates had been used early in the 19th century as energy yielding foods and much attention was paid to their metabolism and contribution to energy requirements.
- Then nutritional gained recognition as a scientific discipline with its roots in physiology and biochemistry.
- During past 50 years, greater advances have been made in the knowledge and practical application that knowledge.
- Specific nutritional diseases were identified in the first decade of the century and technologies developed to control them, e.g. Protein Energy Malnutrition (PEM), endemic goiter and nutritional anemia, etc. The science of nutrition was also extending its influence into other fields such as agriculture, animal husbandry and economics. This led to ‘green revolution’ and ‘white revolution’ in India and increased food production.
- Some studies showed that poor section of the population continued to suffer from malnutrition despite increased food production and this problem began to attract the international attention and intervention activities in the nutrition field initiated by League of Nations, later continued by FAO and UNICEF.
- Significant advances have been made during the past two decades. The association of nutrition with infection, immunity, fertility and maternal and child health (MCH) have engaged scientific attention. Interest has been focused on the role of diet in causation of noncommunicable diseases such as coronary heart disease, cancer and diabetes.
- During recent years the science of nutrition has moved out of the laboratory and linked itself to epidemiology. New concepts in nutrition such as nutritional assessment, dietary surveys, growth monitoring, nutritional indicators and nutritional intervention have been developed. All these concepts are jointly known as ‘Nutritional epidemiology’. Epidemiological methods are now widely used for planning and evaluation of several nutritional programs and nutritional science has become more dynamic.
- Another concept that has emerged in the recent years is that nutrition is the corner stone of socioeconomic development and nutritional problems are not just medical problems but also are multifactorial with roots in other sectors of development. It is now realized that a broad intersectoral and integrated approach of development is needed to tackle the present nutritional problems.
- In the global campaign of health for all, ‘promotion of proper nutrition’ is one of the eighth placed on integration of nutrition into primary health care systems whenever possible. Nutritional indicators have been developed to monitor health for all.
- Some Millennium Development Goals (MDG, 2005) to be achieved by 2012 are directly related to nutrition. These are to promote gender equality and empower women and to 5improve maternal health. These goals can be achieved by improving the nutritional status of girls, pregnant women by supplementing iron, folic acid and iodine.
- The Millennium Development goals are replaced by 17 Sustainable Development Goals (SDGs) and one important target of these goals is to eliminate all the forms of malnutrition among under five children, adolescent girls, pregnant and lactating mothers and older persons.
- In modern scenario, the diet therapy is considered as important part of treatment. Before prescribing the medicine, diet is prescribed by most of practitioners, i.e. foods to be taken and foods to be avoided.
RELATIONSHIP OF NUTRITION WITH HEALTH AND NURSING
Nutrition and Health
Food is basic and fundamental part of our lives. Study after study has shown that people who eat healthy foods enjoy their life more, live longer and are at low risk of diseases.
The relationship between nutrition and diseases has long been recognized. In more recent decades the possibility of reducing the incidence of cancer, hypertension, osteoporosis and atherosclerosis by emphasizing appropriate nutrition has continued to accumulate supportive evidence. Traditionally, health care has been concerned primarily with healing the sick and helping them to maintain health. But nowadays, more emphasis is being given on prevention and public health. Adequate nutrition is the foundation of good health. Good nutrition is considered as a basic component of health. Nutrition affects human health from birth to death. If we want to make our people healthy, nutritional needs of vulnerable groups such as infants, children, pregnant and lactating women and elderly must be met. Promotion of breastfeeding and appropriate weaning practices contribute to normal growth and development. In developing countries like India, a fair section of population does not yet have enough food to eat. The children are malnourished, emaciated and stunted. The incidence of protein energy malnutrition, anemia and vitamin A deficiencies are quite high among infants and pre-school children. Studies carried out in India and other countries have revealed that extra cereals and green leafy vegetables and fortified with essential vitamins and minerals can help effectively to overcome malnutrition and improve the health status of the people. The relation of nutrition to health may be seen from the following view points:
1. Growth and Development
Good nutrition is essential for attainment of normal growth and development during fetal life and childhood. Physical growth, intellectual development, learning and behavior, all are affected by malnutrition. Adequate nutrition is also needed in adult life for the maintenance of optimum health and efficiency. Elder people need special nutrition due to their physiological and chronological changes. Pregnant and lactating mothers require more proteins, calories and some other nutrients to prevent abortion, growth retardation and low birth weight babies.
2. Nutritional Deficiency Diseases
Malnutrition is directly responsible for certain specific nutritional deficiency diseases. The commonly reported ones in India are protein energy malnutrition, blindness, goiter, anemia, beriberi and rickets, etc. There is increased incidence of abortion, prematurity, stillbirth and low birth weight in malnourished mothers. So good nutrition is essential for prevention of specific nutritional deficiency diseases, promotion of health and treatment of deficiency diseases.
Nutrition rich in proteins, vitamins and minerals prevents infections like tuberculosis. Infections in turn may aggravate malnutrition by affecting the food intake, absorption and metabolism of nutrients. So we need well balanced diet throughout life to protect ourselves from such opportunistic infections. Good nutrition also enhances wound healing in the patients with different types of surgical operations.
4. Mortality and Morbidity
Health indicators show high death rates and sickness rates in the developing countries including India than developed countries. Malnutrition contributes a lot to general death rate, infant mortality rates, stillbirths and premature deliveries. Prematurity is the main cause of infant deaths. Poor nutrition also lowers the expectation of life. On the other hand, overnutrition which is another type of malnutrition, is responsible for obesity, diabetes, hypertension, cardiovascular and renal diseases, liver disorders and gallbladder diseases. More recent reports suggest that diet perhaps plays an important role in normal development and growth. Malnutrition extended in pregnancy is very harmful for the birth and low birth weight. Severe malnutrition in mothers during the 1st trimester of pregnancy may cause fetal malformations. Deficiency of certain trace elements such as zinc is considered as possible cause of growth retardation.
It is now quite well accepted that diet and certain diseases are interrelated.
To minimize the incidence of nutritional deficiency diseases, our government has launched several nutritional program, e.g. Mid-Day School Meal, Integrated Child Development Scheme, Anemia Control Programs and Iodine Deficiency Disorders Control Program, etc.
Importance of Nutrition and Dietetics in Nursing
The word nursing comes from the same root word ‘nutritious’ means ‘to nourish’, ‘to cherish’, ‘to protect’, ‘to supply’. It also means to train, to educate and to supply with the essentials of growth. We can define nursing as comprehensive as possible that nursing is a process of recognizing, understanding, interpreting and meeting the health needs of any person or society. Nursing has now emerged as a profession and it includes a wide range of acts.
Nurses constitute an important component of health care system and they are supposed to provide comprehensive services to community. When we say nursing is meeting the health needs of the people, we must know the health and factors affecting it. Today's nutrition is considered as one of the important factors affecting the human health and malnutrition is one of the leading causes of mortality and morbidity in India. Diet is as important as medicine in the treatment of diseases. We can say that the diet therapy is a very important part of treatment. Nurses should give more attention to the nutrition of patients; otherwise the prognosis of the disease will be poor. A modification in the diets can cure certain diseases, i.e. a patient suffering from peptic ulcer needs bland diet for his recovery, a salt restricted diet can help to reduce the blood pressure in hypertensive patients. In metabolic disorders, diet plays an important role and to some extent we can control such types of diseases with therapeutic diets without medicines. So it has become very important for nurses and other health personnel to study the subject of nutrition during their education so that they can apply the principles of nutrition and use their technical skills while working in hospital and community.
Learning objectives: After completion of the study of nutrition, student nurses will be able to:
- Apply the principles of nutrition and dietetics in health and sickness.
- Make the nutrition as an integral part of their daily nursing practices.
- Recognize the values of nutrition in maintaining personal and patient's health.
- Educate the patient and his family about normal and therapeutic diets.
- Plan and prepare the normal and therapeutic diets for different types of patients.
Following are some important areas in the field of nutrition where nurses can utilize their knowledge and skill of nutrition:
1. Promotion of Health
Health Promotion is the process of enabling the people to increase control over and to improve health. Nutrition is an important factor affecting our health. So nursing efforts should be directed towards children, pregnant and lactating mothers. These efforts will include nutrition education, distribution of supplements, extra protein, calcium, iron and folic acid. These can contribute to promotion of health by the following ways:
- Promotion of breastfeeding
- Development of low cost weaning
- Measures to improve family diet
- Encouragement for kitchen gardens and home economies
- Guide about cheap and best sources of nutrition, methods of cooking and preservation and feeding practices of the people.
2. Specific Protection
While guiding the parents, nurses should make sure that child's diet must contain body building and protective foods in required amounts, i.e. milk, cheese, eggs and fresh fruits if possible.
Nurses can guide them about the methods of food fortification to supplement the nutrients. Proper immunization along with vitamin A prophylaxis can prevent vitamin A deficiency diseases and provide immunity.
3. Prevention of Nutritional Deficiency Diseases
Number of nutritional diseases can be prevented in the community by nursing efforts. Premature deliveries, low birth weight, abortion and congenital malformations and stillbirths can be prevented by improving the diet of pregnant women. There are number of National Nutritional Programs but people are not aware of these programs. Nurses and other community workers can provide proper awareness about these supplemental programs. This can help to reduce the prevalence of protein energy malnutrition, anemia, thyroid, disorders, rickets, osteomalacia and xerophthalmia, etc.
4. Early Diagnosis and Treatment
Because the nurses are direct care providers in the hospitals, health centers and in the families, they can detect the malnourished people in the families as well as in the baby clinics, antenatal and postnatal clinics. School health nurses have good opportunity to detect undernourished children. There are number of anthropometric measurements such as weight, height, arm circumference, head circumference, etc. which can be used to assess nutritional status of the children. ‘Road to health’ cards can be used for the purpose. Other methods are periodical surveillance, early diagnosis and treatment of infectious diseases, oral rehydration of children 8suffering from diarrhea, deworming the infested people, development of supplementary feeding programs during endemic.
After diagnosis, nurses can play a vital role in the treatment of such cases. These can guide them to prepare therapeutic diets and the different ways of diet modifications as required by the sufferings.
5. Modification of Diets
The normal hospital diet which provides a patient with the energy and nutrients is intended for the patients whose conditions does not require a therapeutic diet. This regular diet may be modified with regard to selection, methods of preparation and consistency for patients who cannot tolerate a regular diet but do not require a therapeutic diet. These modifications are liquid diet, soft diet and semisolid diet. Nurses should know different types of modification of diet in the hospital because they are responsible to prepare and administer the nutritional needs according to types of disease, age, income, region, customs and food habits of individual patients.
6. Preparation of Therapeutic Diets for Patients
For everyone, eating food is an enjoyment. When the person is sick, the food intake becomes a problem. The nurses’ responsibilities in regard to nutrition can be analyzed into these areas:
- Assisting the patients with special problems in preparing and accepting therapeutic diets, i.e. salt free diet and bland diet.
- Assisting the patients to obtain nourishment either through feeding (tube feeding) or assisting helpless patient in eating.
- For motivating the patient to eat in therapeutic environment, nurses must know the principles of meal therapy, different types of therapeutic diets for the patients with different diseases because diet therapy is a part of treatment in these days.
7. Health Education and Counseling
Community health nurses are often the connecting link between community residents and health care system. Because of frequent and extended contact with patients and community people, nurses have excellent opportunities to provide information and counseling about the role of nutrition in health promotion and prevention of illness. Health education serves as an important tool for prevention of malnutrition. It is the best way to motivate the people and to be used by nurses to change their behavior and practices in relation to health and nutrition. The aim of education is to guide people to choose optimum and balanced diets, to remove prejudices and promote good dietary habits. Some common nutritional problems can be minimized by nutrition education and counseling in case of delayed weaning, ignorance about breastfeeding and our traditional misconcept about certain foods. In the recent years, the link between dietary habits and certain chronic diseases has been recognized, i.e. obesity, diabetics and cardiovascular diseases. So nutritional education is a major intervention in the hands of nurses for prevention of such diseases.
CONCLUSION
Nurses are concerned about the nutritional status of people. Eat to stay alive and what is eaten, affects the health from conception to old age. In industrialized societies, diet related conditions are among the leading causes of disease and death. The role of the nurse has changed with the 9current preventive health care focus and emphasis upon wellness, and with the expanding responsibilities that nurses are assuring in their care of the patients in hospitals as well as in primary health care facilities. She can perform her responsibilities well if she had studied the subject of nutrition in detail. So nutrition is very important for nursing education programs.
FACTORS AFFECTING FOOD AND NUTRITION INTAKE OR NUTRITIONAL STATUS
For designing a balanced diet it is essential to know the daily requirement of energy and different nutrients which varies for different age group, occupation and health status, etc. Total energy metabolism is a measure of total amount of energy required during 24 hours whether the person is resting or working. There are certain factors which influence the energy metabolism in the normal human beings. So following factors must be considered while estimating the calorie requirement:
1. Basal Metabolic Rate
Basal metabolic rate is the main factor which influences our nutritional requirement. It is defined as the amount of energy required to carry on the involuntary activities of the body. Generally for an approximate determination of BMR, simple method is used, i.e. one kcal per kilogram per hour, so BMR = 1 kcal × body weight (in kg) × 24 hours. Body surface area, age, sex, sleep, climate and secretions of ductless glands are some factors affecting BMR.
2. Weight of the Person
Total metabolism includes work done in moving one's own weight from place to place. Therefore, the heavier the individual, the more energy is required for movements.
3. Age
Young children need more energy and protein in their growing age and adolescents require more calories than the adults. The energy requirement with the age decreases because of a fall in BMR and decreased physical activities.
4. Sex
Sex also makes variation in energy requirements. The BMR of women is 6 to 10 percent lower than the men. For example, a moderate man requires 2,875 kcal whereas a moderate woman needs 2,225 kcal.
5. Climate and Environment
Poor environment may lead to infections, especially in children. Infection and hot temperature both increase BMR, which increases our nutritional requirement. Our body must have sufficient food to makeup for heat loss. The amount of heat loss depends on the amount of work done and the temperature. This is the reason that in persons living in tropical climates, the BMR is about 10% less than those living in temperate zone.
6. Physical Activities
Activity of any kind involves an expenditure of energy in addition to the total BMR. The type of activity and total time spent in each activity determines to a large extent of body's need of total energy. So, energy requirement depends on the type of work or occupation, i.e. a sedentary 10worker (man of 60 kg) needs 2,425 kcal per day, moderate worker 2,875 and a heavy worker requires 3,800 kcal. In the USA, it has been estimated that the energy used up under different conditions of muscular activities varies which is given in Table 1.1.
7. Specific Dynamic Action (SDA) of Food
It has been found that there is 8% increase in the production of energy in the form of heat after taking food. This is not due to any work done (digestion or absorption) but it is due to stimulating effect of food on the basal metabolism. This stimulating effect is known as Specific Dynamic Action of food. It varies according to different nutrients, e.g. SDA of Carbohydrate is 5 to 6%, of Protein is 30%, of Fat is 4% and of mixed diet is 12%.
8. Physiological State
There is increased demand of food in certain physiological conditions because of increased BMR. The energy requirements of women are increased in pregnancy by 300 kcal daily throughout pregnancy, and in lactation 550 kcal extra daily during the first 6 months and 400 kcal during the next 6 months. The need of extra energy is associated with deposition of tissues during pregnancy and secretion of milk during lactation.
9. Socioeconomic Factors
Nutritional status is largely affected by some socioeconomic factors like income, level of education, sanitation, family size, knowledge regarding the nutritive values of foods. These factors bear most directly on the quality of life and are the true determinants of nutritional status of society. Malnutrition is the by-product of poverty, ignorance, lack of education, large family size in India. In short, the causes of malnutrition are built into the very nature of society, in the socioeconomic and political structure.
10. Cultural Factors
Cultural factors in health and nutrition have engaged the attention of medical scientists and sociologists. Every culture has its own customs and beliefs regarding nutritional practices. It is 11now widely recognized that cultural factors are deeply involved in all affairs of man including health and nutrition. Not all cultural factors are bad, some are based on centuries of trial and error and have positive values while other may be useless. Cultural influences vary widely from country to country and from region to region. These factors are as follows:
10.1 Lifestyle and Food Habits
Food habits have deep psychological roots and are associated with love, affection, self-image and social prestige. Family plays an important role in shaping the food habits and lifestyle and these habits are passed from one generation to another. In recent years the link between dietary habits and certain chronic diseases has been recognized, i.e. obesity, diabetes and cardiovascular diseases. So nutrition education is a major intervention for the hands of nurses for prevention of such diseases by little modification in their lifestyle and dietary habits. Here are some examples of food habits:
Rice is the staple cereal in the eastern and southern states of India and wheat is staple cereal in the northern states. During the Second World War when wheat was made available in place of rice in south India, people refused to buy wheat because it was not their staple cereal. The story is told of a Philippine student who died of beriberi after writing an essay explaining how the disease could be prevented. The crux of the problem is that many of these customs and beliefs are being applied to vulnerable groups, i.e. infants, toddlers, pregnant and lactating women.
10.2 Food Fads
Personal likes and dislikes play an important role in selection of foods. These likes and dislikes are called ‘food fads’. The food fads may cause obstacle in the way of correcting nutritional deficiencies.
10.3 Cooking Practices
The methods of cooking like draining away the rice water at the end of cooking, prolonged boiling, peeling of vegetables, all influence the nutritive value of foods.
10.4 Child Rearing Practices
Child rearing practices vary from region to region and greatly influence the nutritive status of children, especially newborn infants. In some families, colostrum (first breast milk) is not given to baby. The people say that this is hard and hot and is not digested easily (colostrum contains antibodies which prevents newborn from certain diseases).
10.5 Others
In some man-dominating families, men eat first and women eat last and poorly. Chronic alcoholism also leads to serious malnutrition.
11. Religious Factors
Religion has a powerful influence on the food habits of the people. Hindus do not eat beef and Muslims pork. Some orthodox Hindus do not eat certain vegetables like onion and garlic is not eaten by Jainies and Braham Kumaris. Vegeterianism is given a place of honor in Hindu society. These food habits are known as food taboos and have a religious sanction from early days. These food taboos prevent people from consuming nutritious foods even when these are easily available. Muslim observe fasts during Ramzan and Hindus on several occasions.
- Food is a subject of widespread traditional beliefs and customs which vary from country to country and from one region to another. The concept of hot and cold food is widely prevalent in the country. Foods such as meat, fish, eggs and jaggery are considered to generate heat in the body and are known as hot foods. On the other hand, foods such as curd, milk, bananas and lemon are considered cold foods. In some rural areas, people avoid their children from hot and cold foods which leads to malnutrition. Vulnerable groups like pregnant women and small children become the victims of such taboos. Adulteration of milk with water is a common practice. A deep rooted belief is responsible for this practice, i.e. if pure milk is boiled, the milk secretion of the donor animal may dry up.
- Eating and drinking from common utensils is considered as a sign of brotherhood among Muslims. Hindu women often take food left over by their husbands. In some societies, men eat first and women last. Some people do not eat unless they have taken a bath. Some society people do not allow pregnant women to eat papaya. They think that this leads to abortion.
- Pica is a common practice among pregnant women and children in many countries. Pica is the habit of eating dirt, clay, chalk, lime stone, ashes, starch, etc. which leads to serious health problems.
- All above beliefs influence profoundly the pattern of food eaten and vulnerable groups especially pregnant women and small children become the victims of these malpractices.
13. Food Production and Distribution
The rate of food production and distribution is another important factor influencing the nutritional status of a country. Increased food production should lead increased food consumption. The average Indian has 0.6 hectare of land surface compared to 5.8 hectare per head in the developed countries. Given the best technology known at present, most developing countries could increase their food production several fold but increased food production will not solve the basic problem of hunger and malnutrition. Scarcity of food as a factor responsible for malnutrition is still a serious problem. It is a problem of uneven distribution between the countries and within the countries. It is said that there will be very little malnutrition in India today if all foods available can be equally distributed in accordance with physiological needs.