community nutrition for gnm

1. Prepared By:Mrs Bemina J A
Assistant Professor
ESIC College of Nursing
Kalaburagi

2.  India is the second most populous country in the World next to China.
 Among its population majority of the people belongs to rural
community and they are from low socio- economic status, illiteracy
and lack of basic human needs.
 From the nutritional point of view majority are undernourished and
only a small group are well-fed.
 The high income groups are suffering from the diseases of over
nourishment.
 Nutrition is the selection of foods and preparation of foods, and their
ingestion to be assimilated by the body.
 By practicing a healthy diet, many of the known health issues can be
avoided.
 The diet of an organism is what it eats, which is largely determined by
the perceived palatability of foods.

3.  A nutritional deficiency occurs when the body doesn’t
absorb or get from food the necessary amount of a
nutrient.
 Deficiencies can lead to a variety of health problems.
 These can include digestion problems, skin disorders,
stunted or defective bone growth, and even dementia

4.  Low socio economic status
 Illiteracy
 Lack of awareness regarding nutrients and their requirement
 Over population
 Decreased food production
 Lack of health care facilities
 Large families
 Cultural influences
 Infections
 Over nourishment among the group of high socio economic status
 Superstitious beliefs, misconceptions
 Limited availability/ inadequacy of food products
 Dietary practices etc

5.  UNDER NUTRITION (MALNUTRITION)
 OVERNUTRITION

6.  UNDERNUTRITION
Is defined as a pathological state resulting from an absolute
or relative deficiency of one or more essential nutrients.
It includes:
 Protein Energy Malnutrition
 Low birth weight
 Xerophthalmia
 Keratomalcia
 Nutritional anemia
 Lathyrism
 Endemic goiter (Iodine deficiency disorders)
 Endemic fluorosis

7.  PROTEIN–ENERGY MALNUTRITION
• refers to a form of malnutrition where there is inadequate protein and calorie
intake
• It is considered as the primary nutritional problem in India
• Causes childhood morbidity and mortality Conditions/Diseases
• Kwashiorkor
• Marasmus
• Marasmic - kwashiorkor
 CAUSES/ CONTRIBUTORY FACTORS
• Inadequate intake of food
• Diarrhea
• Respiratory infections
• Measles
• Poor envt. Hygiene
• Large family size
• Poor maternal health
• Failure of lactation
• Premature termination of breast feeding
• Delayed supplementary feeding
• Use of over diluted cow’s milk

8. KWASHIORKOR
 Kwashiorkor is the most common and widespread
nutritional disorder in developing countries. It is a form
of malnutrition caused by not getting enough protein in
the diet.
MARASMUS
 Marasmus is a severe form of malnutrition that consists
of the chronic wasting away of fat, muscle, and other
tissues in the body.
 Malnutrition occurs when the body does not get
enough protein and calories.
 This lack of nutrition can range from a shortage of
certain vitamins to complete starvation.

9. COMPARISON OF CLINICAL FEATURES
KWASHIORKAR
• Edema, pot belly, swollen legs
 • Mild to moderate growth retardation
 • Weight masked by edema
 • Low subcutaneous fat
 • Muscle atrophy
MARASMUS
• Weight loss up to 40% edema
• Severe growth failure
• Severe emaciation
• Severe loss of subcutaneous fat
• Severe muscle atrophy
 PREVENTION
• Oral rehydration therapy helps to prevent dehydration caused by diarrhea
• Exclusive breast feeding for 6 months thereafter supplementary foods may be introduced along
with breast feeds
• Immunization for infants and children
• Nutritional supplements
• Early diagnosis and treatment
• Promotion and correction of feeding practices
• Family planning and spacing of birth

10.  LOW BIRTH WEIGHT
• An LBW newborn is any newborn with a birth weight of less than 2.5kg
(including 2.499kg) regardless of gestational age.
CAUSES/RISK FACTORS
• Illness/infections
• Short maternal stature
• Very young age
• High parity
• Close birth intervals
• IUGR
 PREVENTION
• Identification of mothers at risk – malnutrition, heavy work load, infections,
disease and high BP
• Increasing food intake of mother, supplementary feeding, distribution of iron
and folic acid tablets
• Avoidance if smoking
• Improved sanitation methods
• Improving health and nutrition of young girls
• Controlling infections – UTI, rubella, syphilis, malaria

11.  VITAMIN A DEFICIENCY or hypovitaminosis A is a lack of vitamin A in
blood and tissues.
 It is common in poorer countries but rarely seen in more developed countries.
Nyctalopia (night blindness) is one of the first signs of VAD.
 • Xerophthalmia i.e., dry eyes refers to all the ocular manifestations of vitamin
A deficiency
 • It is the most widespread and serious nutritional disorder
 CLINICAL FEATURES
• Reduced vision in the night or dim light
• Dry eyes which could also lead to Xerophthalmia
• corneal inflammation
• The child or adult may experience susceptibility towards respiratory infection
and urinary infections.
• Growth can be halted in children
• Skin might also show signs of Vitamin A deficiency. For example it may get
rough and/or dry
 PREVENTION AND CONTROL
• Administering large doses of vitamin A orally on a periodic basis
• Regular and adequate intake of vitamin A
• Fortification of certain food with vitamin A – sugar, salt, tea and skimmed
milk

12.  VITAMIN B12 DEFICIENCY
 NUTRITIONAL ANEMIA
Nutritional anemia is a condition where the hemoglobin content of blood is lower than normal as a result of a
deficiency of one or more essential nutrients, regardless of the cause of such deficiency.
CAUSES / RISK FACTORS
• Inadequate diet
• Insufficient intake of iron
• Iron malabsorption
• Pregnancy
• Excessive menstrual bleeding
• Hook worm infestation
• Malaria
• Close birth intervals
• GI bleed
• Infants and children
• Pregnant women
• Pre menopausal women
PREVENTION
• Estimation of Hb to assess degree of anemia
• Blood transfusion in severe cases of anemia (<8g/dL)
• Iron and folic acid supplements
• Food fortification with iron
• Changing dietary habits
• Control of parasites
• Nutritional education and awareness

13. IODINE DEFICIENCY DISORDERS (IDD)
 IDD leads to a much wider spectrum of disorders commencing
with the intrauterine life and extending through childhood to
adult life with serious health and social implications
DISORDERS
• Goiter
• Hypothyroidism
• Subnormal intelligence
• Delayed motor milestones
• Mental deficiency
• Hearing defects
• Speech defects
• Mental retardation
• Neuromuscular weakness
• Endemic cretinism

14. EATING DISORDERS
 Anorexia Nervosa
 Bulimia Nervosa
CLINICAL FEATURES
• Amenorrhea
• rapid, dramatic weight loss at least 15% under normal body weight
• May engage in frequent, strenuous, or compulsive exercise
• Perception of self as overweight despite being told by others they are
too thin
• Intolerance to cold and frequent complaints of being cold. Body
temperature may lower in an effort to conserve energy
• Hypotension and/or orthostatic hypotension
Treatment modalities
Anorexia Nervosa
Pharmacotherapy
Psychological therapies
Bulimia Nervosa
Psychotherapy TCA’s or SSRI’s

15.  OVERNUTRITION Is defined as a pathological state resulting from an
absolute or relative excess of one or more essential nutrients.
 SKELETAL FLUOROSIS
• Associated with life time daily intake of 3-6mg/L or more
• Heavy deposition of fluoride in skeleton
• Crippling occurs leading to disability
 DENTAL FLUOROSIS
• It occurs when excess fluoride is ingested during the years of tooth
calcification – first 7 years of life
• Characterized by molting of dental enamel which has been reported
above 1.5mg/L intake
• Fluorosis seen on the incisors of upper jaw
 PREVENTION
• Changing the water sources
• Chemical defluorination
• Preventing use of fluoridated toothpaste
• Fluoride supplements not prescribed for children consuming
fluoridated water

16.  OBESITY • is an epidemic diseases, which consists of body weight that
is in excess of that appropriate for a person’s height and age
standardized to account for differences, leading to an increased risk to
health related problems
 BODY MASS INDEX
 • BMI = (Weight in Kilograms / (Height in Meters x Height in Meters))
 • A person with a BMI of 30 or more is generally considered obese. A
person with a BMI equal to or more than 25 is considered overweight.
 Nursing management
 • Nursing diagnosis:
 • Imbalanced nutrition less than body requirement • Muscle weakness
 • Activity intolerance
 • Impaired fluid and electrolyte balance
 • Impaired skin integrity
 • Fatigue
 • Risk for infection
 • Risk for injury

17.  The government of India has launched many nation
wide health programs to improve and restore the health
status of the vulnerable population such as
 infants,
 preschoolers,
 school children,
 antenatal and postnatal mothers etc.

18.  1) Integrated Child Development Services Scheme (ICDS);
 2) Mid-day meal Programs (MDM);
 3) Special Nutrition Programs (SNP);
 4) Wheat Based Nutrition Programs (WNP);
 5) Applied Nutrition Programs (ANP);
 6) Balwadi Nutrition Programs (BNP);
 7) National Nutritional Anaemia Prophylaxis Program (NNAPP);
 8) National Program for Prevention of Blindness due to Vitamin
A Deficiency; and
 9) National Goiter Control Program (NGCP).
 10) Tamil Nadu Integrated Nutrition Programme
 11) Antyodaya anna yojana
 12) Other Programmes

19.  Emergency feeding programme 2011 This was
introduced in May, 2001
 Pulse mission:
 Minimum needs programme
 Village grain banks scheme :
 National food for work programme
 National water supply and sanitation programme
 20 Point programme 1975
 National Rural Health Mission2005-2012

20. INDIRECT PROGRAMMES :
 National Cancer Control Programme
 National Diabetes Control Programme
 Poverty alleviation Programmes
 Environmental Sanitation Programmes
 Protected water supply programme
 Literacy programme

21. The health of a community largely depends on the safety of its
available food and water supply.
The safety of food and water supply involves government control
agencies and regulations + local and state public health officials
Potential health problems related to the food supply can arise
from several sources such as lack of sanitation, food borne
disease, and poverty
Modern food production, processing, and marketing have both
positive and negative influences on food safety
Many organisms in contaminated food transmit disease
Poverty often prevents individuals and families from having
adequate access to their surrounding community food supply.

22.  Identify government agencies that control food safety
and health promotion
 Identify food technology practices that affect the
quality of food and food products
 Describe food-borne diseases and their causes
 Describe food needs and food insecurity in America
and funding for programs to meet these needs
 Discuss food buying and handling practices for
American families

23.  Food hygiene is following good practices which lead
to the safe production of food in clean workplaces.
Keeping workplaces, staff and equipment clean is an
important part of food hygiene. working in a clean area:
 • reduces the risk of producing harmful food.
 • Prevents infestation by pests.
 • Is more attractive to customers.

24.  Everyone involved in the preparation and service of
food has a legal duty under the following regulations.
FOOD SAFETY ACT 1990.
 FOOD SAFETY (GENERAL FOOD HYGIENE)
REGULATIONS 1995.
 On average there are up to 40 deaths each year due to
food poisoning.
 This number has increased in recent years with cases
such as E Coli.
 Usually the people who die are in a high risk group,
such as children and elderly.

25. The Food Safety Act 1990 was introduced because of public concern
about risks during food preparation.
The main provisions are:
• It is an offence to supply food that fails to comply with food safety
requirements.
• It strengthened powers of enforcement, including detention and
seizure of food.
• It requires training in basic food hygiene for all food handlers.
• It requires that all food premises are registered.
• It enables Environmental Health Officers:
• To issue Improvement Notices if they feel there is a potential risk.
• To issue emergency Prohibition Notices to force caterers to stop using
the food premises or equipment immediately.

26.  Are responsible for enforcing the regulations and have
a number of powers which include:
• Being able to enter food premises to investigate
possible offences.
• Inspecting food and where necessary detaining
suspect food or seizing it to be condemned.
• Asking for information and gaining assistance.

27. Food Safety Act Penalties.
 Offence.
 Magistrates Court.
 Crown Court.
 Selling food that does not comply with Food Safety
Act. Obstructing an EHO.
 6 months in prison or £20,000 max fine.
 3 months in prison and/or £2,000 max fine.
 6 months in prison or £20,000 max fine.
 2 years in prison and/or unlimited fine. Other serious
Offences.
 2 years in prison and/or unlimited fine.

28.  As a food handler, you need to be aware of the ways in
which your clothes, habits and your personal
cleanliness can increase or reduce the risk of food
contamination.
 Under the above regulations the food handler’s
responsibilities are clearly stated.

29.  Protect food from the risk of infection.
 Wear suitable protective clothing.
 Wash hands after visiting the toilet, smoking or eating .
 Not smoke, spit or sneeze in food rooms.
 Cover cuts or wounds with a clean washable dressing.
 Report illnesses or contact with illnesses.
 Food Handler’s Must also:
 Not wear excessive jewellery and/or nail varnish.
 Not attend work while suffering from or have symptoms of
food poisoning.
 Not continue to work with eczema and dermatitis.
 Not scratching sores or spots.

30.  Much of the guidance given to food handler’s is aimed
at reducing the risk of bacterial food poisoning, this is
achieved by:
• Protecting the food from contamination by people
through the wearing of protective clothing.
• Ensuring that everyone is aware of the main sources
of bacteria, i.e. throat.
• Ensuring that everyone follows basic guidelines on
personal hygiene.

31. As you are involved in food handling it is important to
be aware of the most common sources of infection.
 There are 3 main sources of food poisoning.
 • Natural sources.
 • Chemical or metal contamination.
 • Bacteria.
 • NLN Causes and symptoms of food poisoning.

32.  Natural Sources.
Such as poisonous plants (certain types of Fungi) people
will develop food poisoning due to the poisons in the food
item.
Chemical/Metal contamination.
Such as pesticides, cleaning fluids, copper, mercury. Food
poisoning can be caused by spilling chemicals into foods.
 Bacteria.
These are naturally present all around us and can easily
contaminate food.
Common bacteria found:
Staphylococcus Aureus: found in Nose, Mouth, Cuts.
Salmonella: Animals & Human carriers.
Bacillus Cereus: Soil, Dust, Vegetation & Cereals.
Clostridium Botulinum: Damaged or Bloated Cans of food.

33.  Protective Clothing.
• Wear the correct protective clothing in food preparation
areas i.e. correct chefs whites and safety shoes.
• DO NOT wear food protective clothing to and from work.
• Keep your clothing in good order and change daily.
• Keep outdoor footwear separate.
 Personal Hygiene.
• Keep fingernails short, free from nail varnish.
• Jewellery: only wedding ring.
• Keep hair neat and tidy and covered.
• Shower or bath regularly.
All work places should have changing and shower facilities
available to use.

34. In commercial farming crops are grown and animals
are reared for sale in market. The area cultivated and
the amount of capital used is large. Most of the work is
done by machines. Chemical fertilizers, pesticides,
insecticides and high yielding variety of seeds are used
in order to get maximum output.
Commercial farming includes commercial grain
farming, mixed farming and plantation agriculture.

35.  1. Commercial Grain Farming:
• Crops are grown for commercial purpose.
• Wheat and maize are common commercially grown crops.
• Major areas where commercial grain farming is practiced are temperate
grasslands of North America, Europe and Asia. These areas are thinly
populated with large farms spreading over hundreds of hectares.
• Severe winters restrict the growing season and only a single crop can be
grown.
 2. Mixed Farming:
• In mixed farming the land is used for growing food and fodder crops and
rearing livestock.
• It is practiced in Europe, eastern USA, Argentina, southeast Australia, New
Zealand and South Africa.
 3. Plantations:
• It is also known as "Monoculture", i.e. single crop grown over a large area.
• Plantations are a type of commercial farming where single crop of tea, coffee,
sugarcane, cashew, rubber, banana or cotton are grown.
• Large amount of labour and capital are required.
• The produce may be processed on the farm itself or in nearby factories.
• The development of a transport network is thus essential for such farming.
• Major plantations are found in the tropical regions of the world. Rubber in
Malaysia, coffee in Brazil, tea in India and Sri Lanka are some examples.


36.  In commercial farming crops are grown and animals
are reared for sale in market.
 Commercial farming includes commercial grain
farming, mixed farming and plantation agriculture .
In commercial grain farming crops
are grown for commercial purpose.
 Wheat and maize are common commercially
grown grains.

37.  Important vegetables like carrots, broccoli, spinach,
bananas, apples, citrus, and berries are readily available
at our local grocery stores and are another example
of commercially grown food.
 Pesticides are used in many commercially
grown fruit, vegetable, and grain crops to protect them
from insects, weeds, fungi, diseases, mice and other
animals, bacteria, viruses, and mold.

38.  To meet a country’s sanitary and phyto sanitary requirements, food
must comply with the local laws and regulations to gain market access.
 These laws ensure the safety and suitability of food for consumers.
 Factors on which it depends, In some countries food laws also govern
food quality and composition standards.
 Food laws and Regulations
 The requirement of food regulation may be based on several factors
such as whether a country adopts international norms developed by
 The Codex Alimentarius Commission of the Food and
 Agriculture Organization of the United Nations and
 The World Health Organization or
 A country may also has its own suite of food regulations.
 Each country regulates food differently and has its own food
regulatory framework.

39.  Food laws implemented for 2 reasons- • Regulation of
specification of food • Regulation of hygienic
conditions of processing/manufacturing. • Food laws
are either mandatory or voluntary, they are set up to
established by authorities to as a rule to measure of
quantity, weight, value or quality

40.  1. World Health Organization (WHO)
 2. World Trade Organization (WTO)
 3. Food And Agriculture Organization (FAO)
 4. Codex Alimentarus Commission (CAC) [Under
FAO/WHO]
 5. International Organization For Standardization (ISO)
 6. National advisory Committee For Microbiological
Criteria For Foods (NACMCF)
 7. International Commission For Microbiological
Specification For Foods (ICMSF)

41.  Different voluntary legislations are made for the
purpose to guarantee stated quality and sales
promotion.
 Number of control orders have been formulated under
the provisions of Essential Commodities Act, which
operate on the main objectives of regulating the
manufacture, commerce and distribution of essential
commodities.
 There are various commodity boards such as Spices
board, Tea board, Coffee board, National Horticulture
Board operating in India which undertake research and
development work for respective fields.

42.  The Indian Parliament has recently passed the Food Safety
and Standards Act, 2006 that overrides all other food related
laws. Such as;
• Prevention of Food Adulteration Act, 1954
• Fruit Products Order,1955
• Meat Food Products Order ,1973
• Vegetable Oil Products (Control) Order, 1947
• Edible Oils Packaging (Regulation) Order 1988
• Solvent Extracted Oil, De- Oiled Meal and Edible Flour
(Control) Order, 1967,
• Milk and Milk Products Order, 1992 etc are repealed after
commencement of FSS Act, 2006.

43.  Is one of the constituent laboratory under the aegis of the Council of Scientific and
Industrial Research (CSIR).
 It was established on 21 October 1950 in Mysore, Karnataka
 C.F.T.R.I. also has its resource centers in Hyderabad, Lucknow and Mumbai, rendering
technical assistance to numerous entrepreneurs.
 CSIR-CFTRI is a large and diversified laboratory presently headed by Dr. Sridevi
Annapurna Singh, Director, CSIR-CFTRI.
 There are nearly 200 scientists, technologists, and engineers, and over 100 technicians,
skilled workers, and support staff.
 There are sixteen research and development departments, including laboratories
focusing on food engineering, food biotechnology, microbiology, grain sciences, sensory
science, Biochemistry, Molecular Nutrition and food safety.
 The institute has developed over 300 products, processes, and equipment types.
 It holds several patents and has published findings in reputed journals.
 India is the world's second largest food grain, fruit and vegetable producer,and the
institute is engaged in research in the production and handling
of grains, pulses, oilseeds, along with ahty spices, fruits, vegetables, meat, fish,
and poultry.
 The institute develops technologies to increase efficiency and reduce post-harvest losses,
add convenience, increase export, find new sources of food products, integrate human
resources in food industries, reduce costs, and modernize

44.  The Central Food & Technological Research Institute
(CFTRI) will play an important role in the country's shift
of focus from hunger to nutrition as India prepares itself to
introduce the right to food law
 CFTRI, like all other institutes and laboratories of CSIR,
has a Research Council which plays a crucial role in the
institutes functioning by
 Orienting the R&D programmes towards national goals
 Monitoring utilisation of the resources
 Evaluating the work output
 Strategic planning
 Constituting the assessment/selection committees and peer
groups
 Guiding the overall growth and pursuit of excellence

45.  INTRODUCTION
Food & Agricultural Organization (FAO) was the first
specialized agency of UN established after II world war
in 1945 in Quebec, Canada which subsequently moved
in to Rome.

46.  FORMATION
16 October 1945, in Quebec City, Canada.
 TYPE :
Specialized Agency
 HEAD (2015)
José Graziano da Silva(current)
 PARENT ORGANIZATION
• UN Economic and Social Council
• Websitewww.fao.org
 • Is an agency of the United Nations that leads
international efforts to defeat hunger.
 • Serves both developed and developing countries.

48.  • The idea of an international organization for food and agriculture
emerged in the late 19th and early 20th century, advanced primarily by
the US agriculturalist and activist David Lubin.
 • In May–June 1905, an international conference was held in Rome,
Italy, which led to the creation of the International Institute of
Agriculture
 • Later in 1943, the United States President Franklin D. Roosevelt
called a United Nations Conference on Food and Agriculture.
 • Representatives from forty four governments gathered at The
Homestead Resort in Hot Springs, Virginia from 18 May to 3 June.
 • They committed themselves to founding a permanent organization for
food and agriculture, which happened in Quebec City, Canada on 16
October 1945 with the conclusion of the Constitution of the Food and
Agriculture Organization
 • The First Session of the FAO Conference was held in the Chateau
Frontenac at Quebec, Canada, from 16 October to 1 November 1945

49.  MOTTO
Its Latin motto, fiat panis, translates as "let there be bread".
 MEMBERS
As of 8 August 2013, FAO has 194 member states, along
with the European Union (a "member organization"), and
the Faroe Islands and Tokelau, which are associate
members.
 STRUCTURE
FAO is composed of seven departments:
Administration and Finance,
Agriculture and Consumer Protection,
Economic and Social Development,
Fisheries and Aquaculture, Forestry, Natural Resource
Management and Environment, and
Technical Cooperation.

51.  BUDGET
• FAO's Regular Programme budget is funded by its
members, through contributions set at the FAO
Conference.
ACTIVITIES
 • FAO acts as a neutral forum where all nations meet
as equals to negotiate agreements and debate policy.
 • FAO is also a source of knowledge and information,
and
 Helps developing countries and countries in transition
modernize and improve agriculture, forestry and
fisheries practices, ensuring good nutrition and food
security for all.

52. PRIORITY WORK AREAS
 • Help eliminate hunger, food insecurity and malnutrition.
 • Make agriculture, forestry and fisheries more productive and
sustainable.
 • Reduce rural poverty.
 • Enable inclusive and efficient agricultural and food systems.
 • Increase the resilience of livelihoods from disasters.
 • In this context, FAO initiated “ A World Freedom from Hunger
campaign during 1960 and disseminated nutrition information and
education to people.
 • In Dec 1992, an international conference on Nutrition was held in
Rome in collaboration with WHO.
 • They jointly sponsored a large number of expert committees on Food
& Nutrition.
 • Several projects have been developed on nutrition education, food
quality and safety, micronutrient deficiency and nutrition surveillance.
 • FAO also shares interest in the control of brucellosis and other
zoonosis.