Clinical Nutrition and Dietetics Manual for Nurses V Supriya
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The first unit gives the overview of different terminologies in nutrition that will be used throughout this book. This unit also covers the history, macronutrients and micronutrients discovery. There are some common myths which are prevalent among different societies and communities, and their facts will be clarified in this chapter. Numerous superstitious beliefs, cultural taboos and food fads are also highlighted here. Reference terms, dietary recommendations, food group system would throw some light from the readers point of view. Common nutritional problems faced by people living in a country like India needs to be given awareness as to what to be eaten and how to combat those problems in near future. This particular book with its significantly rich chapters would thereby equip a nurse.
  • To know the definitions and terms involved in understanding the science of nutrition.
  • To highlight the importance of food faddism and faulty food habits.
  • To throw light on the nutritional problems in India.
The science of nutrition is relatively a youngster in the scientific community and is recognized as a distinct discipline only in 1934. It emerged only after the development of the other branch of science like chemistry, biology, etc.
The history of nutrition is divided into four eras:
  1. Naturalistic era (400 BC to 1750 AD)
  2. Chemical-analytical era (1750 to 1900)
  3. Biological era (1900 to 1955)
  4. Cellular or molecular era (1955 to present).
  • People had vague idea about food, most it revolved around taboos, magical powers or medicinal value.
  • Hippocrates—the father of medicine considered food as one universal nutrient. In the early 19th century the Italian physician Sanctorius, curious about the fate of food he ate, weighed himself before and after each meal and explained that his failure to gain weight was that there must be weight loss resulting from insensible perspiration.
  • 2Harvey and Spallanzani made some contributions in circulation and digestion (made observations that eventually facilitated the study of nutrition).
  • In 1747 Lind (British physician) attempted to find a cure for scurvy. He concluded that lime and lemon juice was effective in curing scurvy.
  • This was initiated by Lavoisier, known as father of nutrition. He studied respiration, oxidation and calorimetry, all concerned with the use of food energy.
  • Liebig suggested that the nutritive value of foods was a function of their nitrogen content. He also postulated that an adequate diet must provide plastic foods (protein) and fuel foods (carbohydrate and fat).
  • Dumas—A French chemist tested this hypothesis, produced a synthetic milk of carbohydrates, fat and protein in cow's milk. It proved unsuccessful and the animals to which it was fed had died.
  • He concluded that milk must contain some unknown nutritive substance. Similar conclusion was reached by Lunin and many others. They also postulated that addition of small amount of natural foods was necessary to promote growth and maintain health in animals. They realized that food obviously contained other substances, besides carbohydrate, fat and protein but their nature remained a mystery.
Biological Era (1900–1955)
  • In 1912, it was well established that there was another dietary essential beside carbohydrates, fats and proteins.
  • Casimir funk gave the name vitamine, vita (in Latin–essential to life) amine (because it was believed to be an amine) (Table 1.1).
  • McCollum and Davis worked on vitamin A, Eijkman observed that a water soluble substance in rice bran prevented BeriBeri, by 1920 it was established that all vitamine did not contain nitrogen. Therefore, finally ‘e’ was dropped to obtain the term vitamin which was now a household word, soon it was realized that fat soluble vitamins and water-soluble vitamins existed. Similarly, a number of studies were also done on minerals.
Since 1955, there have been many technological developments. After 1960's research in nutrition changed from a search for essential dietary components to a study of the interrelationship among nutrients, their precise role, the determination of human dietary requirements and the effect of processing on the nutrient quality of foods.
History of Vitamins
Table 1.1   Vitamins and its discovery.
Casimir Funk (1912)
Kuhn, Szent-Gyorgy and Wagner-Jaunergy (1933)
Elvehjem, et al. (1937)
Pantothenic acid
RJ Williams (1933)
Vitamin B6
Szent-Gyorgy, Kuhn (1938)
Szent-Gyorgy (1940)
Folic acid
Mitchell et al. (1941)
Vitamin B12
Riches, Folkers, et al. (1948)
Vitamin C
Szent-Gyorgy (1928) and King (1932)
Vitamin A
McCollum (1916)
Vitamin D
McCollum (1922)
Vitamin E
Evans and Bishop (1922)
Vitamin K
Dam (1935)
Vitamins and their discovery are presented in the above table 1.
Thiamine (Vitamin B1)
Takaki: Surgeon in Japanese navy demonstrated that addition of meat and whole grains to diet resulted in disappearance of beriberi.
Eijkman: Dutch physician reported neurological abnormalities in birds fed on highly polished rice diet.
Grijns: Physician suggested the importance of a dietary constituent in preventing deficiency.
Thiamine occurs in the aleuronic layer of food grains and is removed during milling and polishing. Isolated first in 1926.
Riboflavin which has also been known as vitamin B1, vitamin G and the yellow enzyme was recognized as a vitamin in 1917. At that time, it became clear that vitamin B retained some growth promoting properties even after its anti beriberi properties (B1) had been destroyed by heat to differentiate the heat labile component of vitamin B1 and vitamin B2, respectively. Vitamin B2 is known to be essential for growth and tissue repair in all animals, from microbes to humans. Riboflavin derives its name from yellow color.
Pyridoxine or vitamin B6 is unique among the B complex vitamins, in that it functions primarily in protein metabolism. A deficiency of vitamin was first identified in 1951 among infants of middle class families who developed neuromotor seizures as the result of the use of an over processed infant formula. Pyridoxine was first identified in 1934 as a substance capable of curing a characteristic dermatitis in rats that did not respond to any of the 3 factors then known in B complex. It was isolated in 1938 and the structure was identified in 1939.
Vitamin B12
Vitamin B1 was discovered simultaneously in UK and USA. It is the only vitamin that has the element cobalt in its structure. In 1926, Minot and Murphy determined pernicious anemia to be a fatal disease, until B12 was discovered and was cured with feeding large amounts of raw liver. Also in 1926 castle noted that patients with pernicious anemia had a low gastric secretion. He postulated that anti-pernicious substances (i.e. vitamin B12) were formed by combination of an Extrinsic factor present in food and an Intrinsic factor in the normal gastric secretion. The search for the extrinsic factor led to the discovery of vitamin B12 now identified as ‘Castle's extrinsic factor’.
Vitamin D
Through many years, early in twentieth century, sunlight or body's exposure to ultraviolet light has been contemporarily used in the treatment of rickets. Later on, in 1918, Sir Edward Mellanby showed some evidence of a fat-soluble substance which has the property to prevent the so-called rickets. Mellanby and his co-workers found that the fat-soluble factor D in the diet or body exposure to ultraviolet light is responsible for the prevention and cure of rickets. Vitamin D rich cod liver oil was found to have some active principle, similarly, body exposure to sunlight, initiates the conversion of sterol into vitamin D, which gets activated in liver and kidneys.
Vitamin E
Vitamin E was first recognized in 1922 by Evans and Bishop as a dietary factor obtained from plant-based foods that were essential for normal reproduction in rats. In 1933, it was identified as essential for humans and found to comprise a range of substances known as tocopherols and tocotrienols.
Vitamin K
Vitamin K was first discovered in 1934 by a Danish scientist named Dam. He found that bleeding in chickens can be prevented by giving lucerne/alfalfa and decayed fish meal. The active principle in these materials were extracted and thus a new fat-soluble vitamin was discovered. Dam named it vitamin K (coagulation vitamin) and isolated it in 1939 along with Swiss chemist Karrer and his colleagues.
Nutrition may be defined as the science of food that deals with its relationship to health with the help of the nutrients such as carbohydrates, proteins, fats, vitamins and minerals to maintain body's growth, repair and maintenance.
Nutrition is a process by which an organism ingests, absorbs, transports, utilizes and excretes food substances.
Nutrition is also concerned with certain social, economical, cultural and psychological implications of food and eating.
Nutrition and Health
Good nutrition is a basic component of health. The relation of nutrition to health may be seen from the following view points.
  • Growth and development: Good nutrition is essential for the attainment of normal growth and development. Not only physical growth and development, but also the intellectual development, learning and behavior are all affected by malnutrition. Malnutrition during pregnancy may affect the fetus resulting in stillbirth, premature birth and small for the gestational age babies. Babies are usually underweight due to inadequate intake of food required for optimal growth. Good nutrition is also essential in adult life for the maintenance of optimum health and efficiency. So nutrition is important for an individual's health from birth to death.
  • Specific deficiency: Malnutrition is directly responsible for certain specific nutritional deficiency diseases. The common ones are kwashiorkor, marasmus, vitamin A deficiency, anemia, beriberi, goiter, etc. Good nutrition therefore is important for the prevention of specific nutritional deficiency diseases and improving the nutritional status of the population.
  • Resistance to infection: Malnutrition predisposes to infections like tuberculosis. It also influences the course and outcome of many clinical disorders. Infection, in turn, may aggravate malnutrition by affecting the food intake.
  • Mortality and morbidity: The indirect effects of malnutrition on the community are even more striking a high general death rate, high infant mortality rate, high sickness rate and a lower expectation of life.
It is now quite well acceptable that diet and certain diseases are interrelated.
Dietetics is the practical application of the principles of nutrition. It includes the planning of meals for the well and sick.
Foods are those substances which when eaten or drunk and absorbed by the body gives energy, promotes growth, repair worn out tissues.
Nutrients or food factor: Chemical substances in food which perform the function of the body are called nutrients. The various nutrients are carbohydrates, proteins, fats, minerals, vitamins and fiber.
Nutrient requirement: It can be defined as the minimum amount of the absorbed nutrient that is necessary for maintaining the normal physiological functions of the body.
Recommended dietary allowances (RDA): It is defined as the nutrients present in the diet which satisfies the daily requirement of nearly all individuals in a population. These imply addition of safety factor amount to the estimated requirement to cover the variation among the individuals, losses during cooking and the lack of precision inherent in the estimated requirement.
RDA = requirements + safety factor.
Nutritional status: It is the condition of health of the individual as influenced by the utilization of nutrients. It can be determined only by the correlation of information obtained through a careful medical and dietary history, a thorough physical examination and appropriate laboratory investigation.
According to WHO, health is a state of complete physical, mental, social well-being and not merely the absence of any disease or infirmity.
Malnutrition is an impairment of health resulting from a deficiency, excess or imbalance of nutrients. It includes:
  • Undernutrition: Which refers to a deficiency of calories and/or more essential nutrients.
  • Overnutrition: Which is an excess of one or more essential nutrients and usually of calories.
  • Imbalance: It is the pathological state resulting from a disproportion among essential nutrients with or without the absolute deficiency of any nutrient.
  • Specific deficiency: It is the pathological state resulting from a relative or absolute lack of an individual nutrient.
Balanced diet: It is one which contains different types of foods in such quantities and proportions so that the need for calories, proteins, minerals, vitamins and other nutrients is adequately met and a small provision is made for extra nutrients to withstand short duration of leanness.
In addition, a balanced diet should provide bioactive phytochemicals such as dietary fiber, antioxidants and nutraceuticals which have positive health benefits.
To calculate balanced diet, as a first step there is a need to know RDA for different age groups prescribed by nutrition expert committee of ICMR. The five group food system is convenient in formulating normal as well as therapeutic diets.
Five Food Group System (Table 1.2)
The five food group plan permits an individual to plan a menu to achieve nutrient intakes as specified by RDA. It i s presented in the table below:
Table 1.2   Five food groups and their nutrients.
Food group
Main nutrients
Cereal grains and products: Rice, wheat, ragi, bajra, maize, jowar, barley, rice flakes, wheat flour
Energy, protein, invisible fat, vitamin B1, vitamin B2, folic acid, iron, fiber
Pulses and legumes: Bengal gram, green gram, red gram, lentil (whole as well as dhal). Cow pea, peas, rajmah, soybean, beans
Energy, protein, invisible fat, vitamin B1, vitamin B2, folic acid, calcium, iron, fiber
Milk and meat products: Milk, curd, skimmed milk, cheese, chicken, liver, fish, egg and meat
Protein, fat, vitamin B2, calcium
Fruits and vegetables
Fruits: Mango, guava, tomato, papaya, orange, sweet lime, water melon
Vegetables: (green leafy) amaranth, spinach, gogu, drumstick leaves, coriander leaves, fenugreek leaves
Other vegetables: Carrots, brinjal, ladies finger, beans, capsicum, onion, drumstick, cauliflower
  • Carotenoids, vitamin B2, vitamin C, invisible fat, folic acid, calcium, iron, fiber
  • Carotenoids, vitamin B2, folic acid, calcium, iron, fiber
  • Carotenoids, folic acid, calcium, fiber
Fats and sugar
Fats: Butter, ghee, hydrogenated fat, cooking oils like groundnut, mustard, coconut
Sugar: Jaggery and sugar
  • Energy, fat, essential fatty acids
  • Energy
Source: Gopalan C, Rama Sastri BV and Balasubramanian SC, 2010. Nutritive Value of Indian Foods, National Institute of Nutrition, ICMR, Hyderabad.
Importance of Five Food Group System
The five food group system is applicable for:
  • Planning menus in appropriate manner. A balanced diet can be achieved by using the correct proportions or quantities of the five food groups.
  • Assessment of nutritional status—collecting an individual's diet history would be of use in knowing their inclusion/avoidance of the specific food item under the five food group system; this can help the nutritionist/dietitian to know the nutritional adequacies/inadequacies of the food as well as the nutrients consumed by the individual. If a particular food group is found lacking in the diet, emphasis/education would be laid on the same.
Food Pyramid (Fig. 1.1)
The food guide pyramid introduced by USDA (United States Department of Agriculture) in 1992, is used a tool in planning a balanced diet. It is based on five food group concept. It is given in Figure 1.1
Foods and Food Groups
Foods may be broadly classified into 11 groups based on their nutritive value: (1) Cereals and millets, (2) Pulses (legumes), (3) Nuts and oilseeds, (4) Vegetables, (5) Fruits, (6) Milk 8and milk products, (7) Eggs, (8) Meat, fish and poultry, (9) Fats and oils, (10) Sugar and other carbohydrate foods and (11) Spices and condiments.
zoom view
Fig. 1.1: Food pyramid.Source: ICMR, Dietary guidelines for Indians, 2010.
  1. Cereals and millets: Form the staple food contributing 70-80% of the diet. They are good sources of some vitamins e.g.—thiamine, niacin, pantothenic acid. They are deficient in vitamins A, D, B12 and C.
  2. Pulses: Dried pulses are rich in protein. Good sources of B-complex vitamins and minerals. Pulses supplement effectively with cereals. Deficient in vitamins A, D, B12 and C.
  3. Nuts and oilseeds: They are rich in proteins. Soybean is the richest source of protein (40%). They are rich in fat and good source of vitamin B and vitamin E, minerals such as phosphorus and iron.
  4. Vegetables
    • Green leafy vegetables, e.g. spinach, drumstick leaves—rich in carotene, good source of calcium, riboflavin, folic acid and vitamin C.
      Daily consumption—100 g by adult 50 g by children.
    • Roots and tubers, e.g. potato, tapioca, yam, carrot.
      Good source of carbohydrates, but poor source of protein.
      Carrot and sweet potato contains carotene.
    • Other vegetables, e.g. gourd varieties, pumpkin.
      Good source of vitamin C and carotene.
  5. Fruits: Good sources of vitamin C—tomato, orange, mango, amla.
    Poor sources of vitamin C—Banana and grapes, apple.
  6. Milk and milk products: Almost a complete food except for iron and vitamin C which are deficient. Milk proteins are of high biological value.
  7. Eggs: Hen's egg has protein of high biological value. It is rich source of vitamin A and some B vitamins.
  8. Meat, fish and other animal foods: Meat, rich in protein, but only a fair source of B vitamins, does not contain vitamins A, C or D. Fish is rich in protein, but a fair source of B vitamins. Liver is the richest source of vitamin B12.
  9. Fats and oils: Sources of energy, provides essential fatty acids, e.g. butter, ghee, vanaspathi—good source of vitamin A, vegetable oil and fat—good source of vitamin E.
  10. Sugar and other carbohydrate foods, e.g. cane sugar, jaggery, glucose, honey syrup, sago. Serves as a source of energy.
  11. Condiments and spices: Mainly enhance the taste and increase the acceptability of foods, helps to improve flavors, e.g. ginger, garlic, cardamom, cloves, fenugreek seeds.
  • To provide energy for doing work, carbohydrates and fats are being used.
  • To promote growth or body building, and for repair of tissues, protein foods are mainly used.
  • To help the body to function properly and to protect from disease, vitamins and minerals are consumed.
The different groups of foods listed above may be broadly classified under three heads from the nutritional point of view.
zoom view
Flowchart 1.1: Nutritional classification of foods.
Nutritional classification of foods is explained in the above flowchart 1.1
Nutritional Classification (Flowchart 1.1)
  • Energy yielding foods: This group includes foods rich in carbohydrates and fats. Cereals and tubers, dried fruits, sugar and fats form the important energy yielding foods.
  • Body building foods: Foods rich in proteins are called body building foods. This may be broadly divided into—milk, egg, meat and fish rich in proteins of high biological value and pulses, oilseeds and nuts and low-fat oilseed meals 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: i) Foods rich in vitamins, minerals and proteins of high biological value, e.g. milk, eggs, fish, liver and ii) Foods rich in certain vitamins and minerals only e.g. green leafy vegetables and some fruits.
    Foods are classified by origin/source also:
    Plant source—cereals, potato, vegetables.
    Animal source—egg, fish, meat, milk.
Nutritional Balance
A good diet must fulfill these criteria. It must furnish the appropriate amount of all nutrients meet the physiologic and biochemical needs of body at all stages of the lifecycle.
It must avoid the excess of calories, fat, sugar, salt and alcohol associated with increased risk of diet.
Nutrition and Growth
Growth comprises of increase in size of the body as well as development and maturation of organs and systems of the body. During the growth spurt, a child needs more food in relation to body size than it does as an adult.
Nutrition and Infection
There is a relationship of two types between nutrition and infection.
  1. The effect of infection on nutritional status.
  2. The effect of malnutrition on resistance to infection.
Reference Man
Aged between 29–39 years, weighing 60 kg, sleeping 8 hours, working for 8 hours a day on moderate activity, 4–6 hours on light activity and 2 hours of walking or other household activities.
Reference Woman
Aged between 29–39 years, weighing 50 kg, sleeping 8 hours, working 8 hours a day on moderate activity, 4–6 hours on light activity and 2 hours of walking or other household activities.
Factors Affecting Food and Nutrition
Food Fads
Personal likes and dislikes in the selection of foods are called as food fads. It may stand in the way of correcting nutritional deficiencies.
Food fads that exist are as follows:
  • Bitter gourd is found to cure diabetes mellitus.
  • Brown sugar has been believed to have higher nutritional value than white sugar.
Food Fallacies
  • Raw cucumbers without salt are poisonous.
  • A good way to diet is to skip breakfast.
  • Honey is not fattening.
These beliefs have no scientific basis.
Food Myths
There are some food myths that are prevalent among certain communities, myths could be due to ignorance or lack of knowledge about nutrition. In the present scenario, knowledge/awareness about nutrition is wide spreading so people are becoming more conscious about diet than before. Common myths and facts are listed below in the Table 1.3.
Table 1.3   Common myths that are prevalent and the facts.
Brown eggs are more nutritious than white
Nutritive value does not depend on color, but on the breed of the hen
Papaya consumption during pregnancy leads to abortion
Not true, papaya is a rich source of vitamin A
Nonvegetarian foods give more strength than vegetarian foods
It is wrong, combination of different vegetarian foods in different proportions, can make it more nutritious
Water should not be taken along with foods because it dilutes digestive enzymes and hampers the process of digestion
No, water aids in digestion process
Colostrum is harmful to infant
No, these are abundant in antibodies and immunoglobins which are very much needed for immunity
Food Habits
Food habits have deep psychological roots and are also considered as the oldest of any culture.
Factors influencing food habits and selection of food includes:
  • Superstitions
  • Social and cultural factors
  • Religious factors
  • Income
  • Geography/availability
  • Advertising and media.
Superstitions and Cultural Factors
Food habits are handed over from generation to generation in the society particularly in the developing countries.
  • In many parts of India, pregnant women are not allowed to consume papaya as it is believed that papaya produces a lot of heat in the body which in turn induces abortion. Pineapple also is not given for the same reason.
  • Pregnant ladies are given milk with a few strands of saffron in it as it would supposedly result in a baby with a very fair complexion. In parts of Bengal, people believe that consumption of tongue of goat by children will make them more talkative.
Religious Belief
  • Hindus do not eat beef, since cow is considered as a sacred animal.
  • Among Hindus, some communities do not eat fruits, onions and garlic. Many Hindus are vegetarians. Jains do not eat curds and do not eat after sunset. The basic ideology of Buddhism is vegetarianism.
  • All plant foods are considered appropriate to eat except the ‘five pungent foods’—garlic, onion, leeks, scallions and chives. These foods are considered unclean and are believed to generate envy when eaten cooked and to induce anger when eaten raw.
  • Jews do not eat pork and shellfish.
  • It is a custom in most communities in India that women and girls eat only after men and boys finish their eating.
Thus, the health of the female is affected as they eat poorly with the left over food.
Child Rearing Practices
  • Another factor that block the normal food pattern in India is child rearing practices.
  • The late introduction of weaning foods, prolonged breastfeeding and the adoption of commercially produced baby foods play an important part in the nutrition of children and have adverse effects in their growth and development.
  • The current trend in cooking practices in achieving a balanced diet, e.g. using polished rice, draining away the rice water and prolonged boiling of vegetables add to the great loss of nutrients in the diet of Indians which lead to nutritional deficiencies.
  • In the olden days, man would eat whatever was available to satisfy his hunger. The food he got was the type he cultivated in his locality. Rice is the main food crop grown in tropical areas.
  • 12The nutritive value of natural foods does not vary from country to country. But there is a great variation in the composition of prepared foods such as breads, biscuits, cakes, etc, due to variation in recipes and basic ingredients used in different regions.
Nutrition and Immunity
Nutrition and immunity are always interrelated. Nutrients such as proteins, lipids, zinc, vitamin C, vitamin A, iron, copper have been proved to act on defense mechanisms of immune system. Malnutrition leads to infection and infection to malnutrition as a vicious cycle. Malnutrition and health can be described with an example.
A properly built hut/house will be able to withstand hot temperatures as well as storms due to heavy rainfall. But, a hut/house which is not built properly cannot with stand extreme conditions. A human body can be compared to the hut/house, if the body has good immunity, it can fight/resist against infections. If the body has poor immunity because of under nutrition, poverty, the ability to withstand infections becomes a question mark. This is how, nutrition is linked up with immunity.
Nutrition and Cancer
Many nutrients are documented to have a protective role in fighting/preventing certain types of cancers. More recent reports suggest that diet perhaps plays an important role in certain types of gastrointestinal cancers, e.g. dietary fiber has been proved to protect against colon cancer, antioxidants such as vitamins E, A, C, selenium proved to be linked with all types of cancers. A colorful rainbow diet with lot of antioxidant rich fruits can help to prevent cancers.
National Health Policy
National Health Policy was initiated by the Ministry of Health and Family Welfare, Government of India in 1982. Main motto is to attain the goal of health for all by 2000 AD. Some of the integrated approaches apart from providing good health is to have population control, achieve fuller employment, elementary education, welfare/nutrition programs for women and children, etc.
National Nutritional Policy
It was constituted by department of women and child development, Government of India and was approved by the cabinet in April, 1983. It was discussed and approved by both the houses of the parliament in August, 1993. It focuses on ‘comprehensive, integrated, intersectoral strategy for alleviating the multifaceted problem of malnutrition and achieving the optimal nutrition for the people.1
The main aims of National Nutrition policy are:
  • To focus on reducing the incidence of malnutrition in the country.
  • To emphasize the need for intersectoral co-ordination to achieve nutritional goals.
  • To acquaint the relevant sectors to observe nutrition as an outcome of their sectoral activities.
  • To establish short-term, intermediate, long-term strategies for achieving nutritional goals either by direct policy changes or indirect institutional or structural changes.1
Nutritional Problems in India
Protein Energy Malnutrition
Malnutrition is a man made disease, the ecological factors related to malnutrition are—poverty, cultural influences, food production, availability and sanitation. Malnutrition predisposes to infection and infection to malnutrition. Direct and indirect effects are seen because of malnutrition. Direct effects lead to nutritional deficiency diseases like kwashiorkor, marasmus, anemia, vitamin A deficiency. High incidence of mortality and morbidity is the indirect form of malnutrition (nearly 50% of total deaths in the developing countries occur among children under 5 years of age compared to less growth and developed countries).
In the more developed countries of the world, nutritional problems are somewhat different.
Over nutrition, which is another form of malnutrition is responsible for obesity, diabetes, hypertension, cardiovascular and renal diseases, disorders of liver and gallbladder.
This is the most reported nutritional problem in India. Infants, adolescent girls, pregnant women, elderly people face this common problem. Various strategies such as mandatory iron supplements to children, pregnant women, food fortification programs are all in existence now to reduce the incidence/prevention/treatment of anemias.
Role of Food and its Medicinal Value
There are a specific group of foods which has some components present in them that helps in reducing or minimizing the risk of certain disease conditions and these foods are termed as functional foods. Examples include whole grains, fruits, vegetables, etc. on knowing their health benefits, one can make wise choice of all these food stuffs and get benefitted.
Functional foods are defined as foods that provide more than simple nutrition. They supply additional physiologic benefit for the consumer. They contain a bioactive principle which is responsible for the physiologic benefit. Tables 1.4 and 1.5 depicts the bioactive component present in food item.
Table 1.4   Functional component and their properties.
Food item
Oat products
Green tea
Flax seed
Beta glucan
Omega 3 fatty acid
Wheat bran
Beta glucan
Cancer preventing
To relieve colic pain
To relieve constipation
To prevent flatulence
To keep away ulcers
Foods to treat nausea
Ajwain (Omum)
Table 1.5   Bioactive component of food items.
Food item
Tomatoes, processed tomato products, watermelon, red/pink grape fruit
Has antioxidant, anticancer properties. Supports for maintaining prostrate health
Carrots, papaya, pumpkin, spinach, sweet potatoes
Beta carotene
Helps in neutralizing free radicals, which damages the cells. Anticancer helps in macular degeneration—cataracts, eye disorders
Spinach, beetroot, carrots, kale, asparagus
Lutein, zeaxanthin
Maintains eye health
Apples, beans, citrus fruits, psyllium seed husk, peas, citrus fruits
Soluble fiber
It reduces the risk of coronary heart disease and some types of cancer
Oat bran, oats, oat meal, oat flour, barley, rye
Beta glucan
Has hypocholesterolemic property, beta glucan help stabilize blood sugar, has antioxidant property
Wheat bran, corn bran, fruit skins
Insoluble fiber
Helps in reducing/alleviating gastrointestinal symptoms, protects gut health, anticancer properties
Cereal grains, oat meal, whole wheat bread
Whole grains
Helps in maintenance of blood glucose levels, prevents certain type of cancers
Soluble fiber, glutathione
Helps in circulation, lowers cholesterol, dilates blood vessels. It is main fat, monounsaturated oleic acid, acts as an antioxidant to block artery-destroying toxicity of bad-type-LDL cholesterol. Glutathione, a powerful antioxidant shown to block thirty different carcinogens
Banana and plantain
Soluble and insoluble fiber
Strengthens the stomach lining against acid and ulcers, has antibiotic activity
Olive oil, tree nuts, canola oil
Monounsaturated fatty acids (MUFA)
They block the arteries which has deleterious effects on LDL cholesterol
Beef, lamb
Conjugated linoleic acid (CLA)
Supports immune health
Flaxseeds, flaxseed oil, walnuts
Polyunsaturated fatty acids (PUFA) omega-3 fatty acids, ALA
Maintains heart health, supports mental function
Salmon, tuna, marine and other fish oils
Polyunsaturated fatty acids (PUFA) omega- 3 fatty acids, EPA/DHA
It reduces the risk of coronary heart disease, eye health
Flax seeds and oil
Used primarily for constipation. Lowers blood fat levels often associated with heart attacks and strokes. Reduces harmful blood cholesterol levels with its soluble fibers
Fish and fish oil
Omega-3 oil in fish can relieve symptoms of rheumatoid arthritis, osteoarthritis, asthma, psoriasis, high blood pressure. A known anti-inflammatory agent and anticoagulant. Raises good type HDL cholesterol, lowers triglycerides. Fish highest in omega-3 fatty acids include sardines, mackerel, herring, salmon, tuna.
Berries, cherries, red grapes
Anthocyanins cyanidin, malvidin, resveratrol
Maintains cellular antioxidant defenses
Rich in antioxidant compounds. Red grapes are high in the antioxidant quercetin. Grape skins contain resveratrol, which inhibit blood-platelet clumping (and consequently, blood clot formation) and boost good-type HDL cholesterol
Grape fruit
It has anticancer activity and appears particularly protective against stomach and pancreatic cancer. The juice is antiviral and high in various antioxidants, especially vitamin C
Kiwi fruit
Commonly prescribed in Chinese traditional medicine to treat stomach and breast cancer. High in vitamin C
Tea, cocoa, chocolate, grapes, apples
Flavanols, catechins, epicatechins, epigallocatechin
Supports and maintains heart health
Citrus fruits
Flavanones—hesperidin, naringenin
Helps in neutralizing free radicals which damage cells
Tea (including black oolong and green tea, not herbal teas)
Tea acts as an artery protector, antibiotic, antiulcer agent, cavity-fighter, antidiarrheal agent, antiviral agent, diuretic (caffeine), analgesic (caffeine), mild sedative (decaffeinated)
Cauliflower, cabbage, broccoli sprouts
Boosts the immune systems and helps in antioxidant defenses
Spinach, yoghurt, sardines, low-fat dairy products
Important for bone formation and they reduce the risk of osteoporosis
Milk fat promotes cancer and heart disease. May retard healing of ulcers
Antioxidants and cancer antagonists, it is rich in fiber that helps lower blood cholesterol
Two cups of yoghurt per day boosts immune functioning by stimulating production of gamma interferon, helps prevent and cure diarrhea
Almonds, beans, brazil nuts, whole grain breads, cereals
Aids in nerve and muscle function, bone health
Potatoes, almonds, whole grain breads and cereals, low fat dairy products
It reduces the risk of hypertension and stroke along with low sodium diet
Fish, red meat, liver, eggs, whole grains
Boosts immune system, it neutralizes free radicals
Soy, wheat and corn
Free stanols/sterols
These compounds reduce the risk of coronary heart disease
Stanol ester dietary supplements
Stanol/sterol esters
They reduce the risk of coronary heart disease
Onions, whole grains, garlic, honey, banana, leeks
Inulin, fructo-oligosaccharides (FOS)
Aids in calcium absorption, improves gut health
Yoghurts and other dairy products
Maintains gut and immune functions
Soya beans and soy based foods
Isoflavones, genistein, daidzein
Supports women health—especially for menopausal women
Flax seeds, rye, some vegetables, seeds and nuts
It maintains heart health and boosts immune function
Soya beans, soy based foods like cheese, tofu
Soy protein
Reduces the risk of coronary heart disease (CHD)
Garlic, onions, leeks
Diallyl sulfide, allyl methyl trisulfide
Enhances detoxification of undesirable compounds, enhances heart health
An antiseptic and helps in curing the wounds very quickly, prevents and relieves chronic bronchitis, respiratory problems—a nasal decongestant and expectorant
Anti-inflammatory, antibiotic, antiviral, thought to have diverse anti-cancer powers
Carrots, sweet potato, spinach, organ meats
Vitamin A
Maintains cell integrity, helps in eye, immune health
Dairy products, eggs, poultry, fish, nuts
Vitamin B3 (niacin)
Regulates metabolism, supports cell growth
Organ meats, lobsters, soy beans, lentils
Pantothenic acid
Regulates hormone synthesis
Ajwain (omum)
Antispasmodic, stimulant used for treating digestive disorders
Aniseed (somfu)
Counteracts flatulence, used in treating colic pain
Used in treating bronchitis and whooping cough. Counteracts intestinal flatulence
Cardamom (elaichi)
Appetizer and effective remedy for indigestion
Fenugreek seeds (methi)
Reduces blood sugar levels, used to treat dysentery
Used in hot-milk for throat infection. Used in relieving body ailments
Saffron (kesar)
Used as a sedative and in eye infections
Cumin (jeera)
Stimulant and diuretic
Used in tooth pain. Aids digestion, relieves muscular cramps and headache
Reduces inflammation and pain in joints, used to treat migraine headaches and helps to relieve nausea
Mustard seeds
Used as body massage oil
The history of nutrition gives us a bird's eye view of the nutritional deficiencies; problems encountered which can be corrected by proper nutritional intervention strategies.
Write Short Notes on
  1. History of nutrition
  2. Classification of foods
  3. Define the terms:
    • Malnutrition
    • Balanced diet
  4. Nutrition and immunity.
  1. Kathleen Mahan, Sylvia Escott Stump. Krause Food Nutrition and Diet Therapy (2007). W.B. Saunders Company,  Philadelphia.