Nutrition is an essential pillar of human life, health and development across the entire life span. From the earliest stages of fetal development, at birth, through infancy, childhood, adolescence into adulthood and old age, proper food and good nutrition are essential for survival, physical growth, mental development, performance and productivity, health and well-being.

1. CHAPTER 4
Nutrition
Assessment
and
Nutrition
Education

2. CONCEPT
Nutrition is an essential pillar of human life, health and development
across the entire life span. From the earliest stages of fetal development,
at birth, through infancy, childhood, adolescence into adulthood and old
age, proper food and good nutrition are essential for survival, physical
growth, mental development, performance and productivity, health and
well-being.

3. TYPES OF
NUTRIENTS

4. MEAL
PLANNING
Meal planning means, making a plan of meals with adequate
nutrition for every member of the family within the available
resources, nutrient requirements and individual preferences
to plan adequate and acceptable meals depending on the
local availability. The diet should also satisfy hunger and
taste. We can call it our “daily food guide”.

5. Aims of Meal Planning
To fulfill the nutritional requirements of the individual and
family members.
Make the food economical by using moneys worth to
make appropriate food choices.
Cater to the food preferences of individual members.
Save energy, time and money.
Use left over food and minimize wastage of food.
Invest on nutrient dense food items rather than energy dense foods.

6. Steps of Meal Planning
It starts with considering a person’s or the group’s age, sex and
physical activity for one full day from morning to night.
Three major meals (breakfast, lunch and dinner) and 1–3 small meals
snacks (mid-morning, evening tea/snack and bedtime) can be planned
for one full day. Details depend on the age, work schedule and
physiological status.
A gap of 2–3 hours should be kept between main and small meals and
4–6 hours between two main/major meals.
Schedule breakfast at 8–10 am, lunch at 2–3 pm, and dinner at 8–9
pm.

7. Use the food pyramid/food groups for selection of groups.
Each main meal should contain one to two from each food group
For a minor small meal even a single food preparation. Cooked or raw food or
fruit is sufficient.
Consider the monthly income spent on food, availability of food in season and
food preferences of the individuals while selecting the food items.
Write the menu plan for each meal giving the name of the food preparation along
with quantity in house-hold measures.
Make a table representation of food preparation in each meal, main food
ingredients used in each food preparation, amount of each food ingredient.
Columns can be further added for calories and other nutrients to be calculated.
For calculation value for selected nutrients, refer to the book on Nutritive.

8. DIET PLAN FOR DIFFERENT AGE
GROUPS
(Menu plan for child 3–5 years old )

9. Meal Plan for an
Adult

10. Diet Plan for an Elderly Person
Main concern in this age group is of fluid intake. Some have difficulty
in passing stool. So there is a requirement of fiber rich diet. There is
also a need to stick to meal timings. Limit foods high in saturated fat,
such as biscuits, cakes, pastries, pies, processed meats, commercial
burgers, pizza, fried foods, potato chips, crisps and other savoury
snacks. Limit foods and drinks containing added salt, and do not add
salt to foods in cooking or at the table. Limit foods and drinks
containing added sugars, such as confectionery, sugar-sweetened soft
drinks and cordials, fruit drinks, vitamin waters, energy and sports
drinks.

11. Assessment of Nutritional Status: [Mnemonic: CABFAVE]
Clinical examination
Anthrpometry
Laboratory and biochemical evaluation
Lab test like Hemoglobin, stools, and Urine
Biochemical tests
Functional assessment on the basis of their daily life style and activity
Vital and health statistics
Ecological studies

12. Objectives of Nutritional Assessment
To find out the severity and distribution of malnutrition in community.
To find out high risk groups which may fall under
malnourished category in near future.
To find out ecological factors responsible for malnourishment.
To suggest corrective measures or develop appropriate
healthcare programs.

13. Methods of Nutritional Assessment
Direct: Direct means dealing with individuals directly.
Indirect: Indirect means use of community health indices reflecting
nutritional influences.
Assessment of Dietary Intake
This can be done through dietary survey, dietary cycle (Weight of raw foods done
over a period of 7 days) and with the help of food balance sheet. Food balance sheet
can help the health personnel to decide the dietary needs of a region or state or a
country by subtracting the amount of food provide for a specified group of
population on a specific date and the amount remaining after a previously set time
limit. The 24 hours recall method is used at home to assess the type of food and
quantities consumed in the last 24 hours.

14. Assessment of
Nutritional
Status
• Clinical examination
• Anthropometry
• Laboratory and
biochemical
evolution

15. Anthropometric measurement technique

16. PLANNING SUITABLE DIET FOR INDIVIDUALS AND FAMILIES
ACCORDING TO LOCAL AVAILABILITY OF FOODS, DIETARY
HABITS AND ECONOMIC STATUS

17. GENERAL NUTRITIONAL
ADVICE
Balanced diet
Portion control
Fruits and vegetables
Whole grains
Lean proteins
Healthy fats
Limit added sugars
Reduce salt intake
Meal planning
Mindful eating
Physical activity

18. NUTRITION EDUCATION
Its the process of teaching the science of nutrition to population by health
professionals in different-different settings like clinic community, etc. with the help
of this education, health professionals enable individuals to incorporate changes in
eating patterns and behavior into their lives.
Purposes
To educate people regarding nutritional value of foods, food quality and safety,
methods of preservation, processing and handling, food preparation and eating to
help them make the best choice of foods for an adequate diet.
To educate people regarding food substitutes, changes and modifications in diet.
To teach people regarding effects of various cooking methods on nutrients of food
after cooking.
To educate people regarding sign and symptoms of various nutritional
deficiencies.

19. Principles
Needs-based approach
Evidence-based information
Cultural sensitivity
Individualized guidance
Behavioral change focus
Hands-on learning
Setting realistic goals
Long-term support
Accessible resources

20. Methods
Workshops
• It includes current topics to nutrition and its deficiencies. It also provides simplest
solutions to existing health problems in community with the help of divisions
among health personal and community population.
Film and Slide Shows
• It is the most effective method of education. It should be meeting illustrative and
easily understandable. Film are used for people who will not attend any kind of
matring.
Posters, Charts and Exhibition
• Posters should be simple, attractive and should be written in regional language.
Similarly charts should be position to stimulate the interest of people. They should
be colorful and attractive.

21. Books, Bulletins, Pamphlets and Newspapers
• These all come under printing materials, which are the basis of any
teaching program. These can be used singly or in combination with
other education methods. This is suitable for educated population.
Lectures and Demonstrations
• Lectures should be simple and elaborated in understandable language.
Demonstration is a process of learning by doing, e.g., wearing and
food preparation demonstration, proper cooking methods, food
preservation methods, etc.

24. NUTRITIONAL DEFICIENCY
DISORDERS
Nutritional deficiency disorders occur when the body lacks essential
nutrients needed for optimal health. These deficiencies can result from
inadequate intake, poor absorption, or excessive loss of nutrients. The
human body requires a balance of vitamins, minerals, proteins,
carbohydrates, and fats to function properly. When this balance is
disrupted, various health issues can arise.

25. Protein Energy Malnutrition (PEM)
Malnutrition is a state of deficiency or excess of energy, protein and
other nutrients. It can manifest as under–or over-nutrition. Under-
nutrition could result from a lower than desired intake of one or more
nutrients. It leads to a clinical spectrum ranging from no symptom to
discomforts of severe malnutrition.
Marasmus
It occurs most commonly in children less than five years. This is due to
their increased calorie requirements and increased susceptibility to
infections. It results from the body’s physiologic adaptation to starvation
in response to severe deprivation of calories and other nutrients.

26. Kwashiorkor
The term originated from Ga language in Ghana, Africa which means
“Disease associated with the birth of a second child”, or “the sickness the
baby gets when the new baby comes. “Diet low in protein results in
kwashiorkor.
Marasmic Kwashiorkor
When there is mixed picture with features of both marasmus and
kwashiorkor, then it is known as marasmic kwashiorkor. These children
have concurrent gross wasting, oedema and frequently stunted. Mild hair
skin changes are often seen and they also have an enlarged palpable fatty
liver.

27. NATIONAL NUTRITION POLICY
It is a set of nationwide guidelines that specify how the nutritional needs of the
population will be met. National Nutrition Policy was adopted by Government of
India in 1993 under the department of Women and Child Development. It advocated
a multisectoral strategy for eradicating malnutrition and achieving optimum
nutrition for all. Policy advocates the monitoring of nutrition levels across the
country. Also sensitizing Government machinery on the needs for good nutrition and
prevention of malnutrition.
Aims of National Nutrition Policy
• To emphasize the need for intersectoral coordination to achieve national goals.
• To acquaint the relevant sectors to observe nutrition as an outcome of
their sectoral activities.
• To draw attention toward the immediate needs to reduce the incidence
of
malnutrition in the country.
• To establish short-term, intermediate and

28. Nutrition Policy Instruments
• Direct short-term intervention
• Indirect policy instruments
Strength of the Policy
• Identified that nutrition is key to country’s development.
• Identified that malnutrition has to be tackled at various levels through
a multisectorial approach.
• Identified a series of activities in different sectors like food
production, distribution, education, empowerment of women and
nutrition surveillance.
• Both direct and indirect interventions were identified.

29. NATIONAL NUTRITIONAL PROGRAMS IN
INDIA
Vitamin A Prophylaxis Program
The National Vitamin A Prophylaxis Program against blindness due to
deficiency of vitamin A was started in 1970. The program was launched
as an urgent remedial measure to combat the unacceptably high
magnitude of xerophthalmic blindness in the country seen in the 1950s
and 1960s. Vitamin A deficiency is mainly seen among the young
children as they have high requirements due to increased physical
growth and have low dietary intake. Also episodes of acute respiratory
tract infection and measles, which deplete vitamin A reserves from
body, was common in this age group.

30. National Nutritional Anemia Prophylaxis Program
At present the National Nutritional Anemia Prophylaxis program is
operated as part of the RCH program. The program was launched in
1970. It was launched by the government of India during the fourth
Five-year plan. The program was consist of distribution of iron and folic
acid tablets to pregnant women and young children (1–12 year).

31. Iodine-Deficiency Disorders Control Program
India was one of the first countries in the world to start a public health program to
address iodine-deficiency disorders based on salt iodization. Government of India
established the National Goiter Control Program (NGCP) in 1962 with the
objectives of identify the goiter endemic regions of the country and supplements the
intake of iodine to entire population in these regions. Subsequently it was found that
IDD (iodine deficiency disorder) was not limited to few areas of India but to every
geographical region of country.

32. Integrated Child Development Service
Integrated child development service (ICDS) scheme was launched on
2nd October 1975 by the Government of India under the Ministry of
Social and Women Welfare in the pursuance of national policy for
children. The ICDS is one of the worlds largest and most unique
program for early childhood care and development. Now the goal is
universalization of ICDS throughout the country.

33. Poshan Abhiyan
Poshan Abhiyan is India’s flagship programe to improve nutritional
outcomes for children, adolescents, pregnant women and lactating
mothers by leveraging technology.

34. FOOD BORNE DISEASES
Definitions
• “Foodborne disease or food poisoning is defined as any illness of a
toxic or infectious nature contracted through consumption of
contaminated water or food”.
• “Foodborne illness” is an umbrella term that describes any illness
caused by consuming foods or beverages contaminated with harmful
pathogens — such as bacteria, viruses, and fungi — or their toxins”.

35. Ways of Transmission of Food-borne Pathogens
Irrigation Water
Water is the main part of food production, processing and proportion. So
pathogens can be transmitted by sewage or contaminated water.
Irrigation with poor-quality water is one way that fruit and vegetables
can become contaminated with food borne pathogens.
Zoonotic Transmission
Zoonotic transmission means transmission from animals to humans. E.g.
Taenia solium. Humans became infected by contaminated raw or
undercooked pork and develop Taenia. Direct contact with animals and
consumption of animal products has been linked to human infections.
Rotavirus can also be transmitted from animals to humans. Vertebrate
animal species are natural reservoirs for many pathogens that cause
human infections after transmitted through food.

36. Food-borne Pathogens Transmitted Through Insects
Insects are well-recognized vectors for food-borne pathogens. Their association with
decaying matter, along with their endophily (the ability to enter buildings)
and synanthropy (the cohabitation with humans) are behaviors that make flies,
cockroaches and ants particularly relevant for their ability to transmit food-borne
illness.
Food-processing Environment
Contaminated food, food preparation surfaces, food handlers, etc. are the source of
food contamination. Where food is prepared, multiple factors can shape
contamination and transmission. E.g., In kitchen, microbial pathogens can be
introduces from commercial food products, by cross-contamination of food from
kitchen utensils or by insufficient cooking or inadequate storage.

37. EARLY IDENTIFICATION, INITIAL MANAGEMENT,
AND REFERRAL OF FOODBORNE DISEASES
Recognize Symptoms
Isolate the Affected Person
Seek Medical Attention
Provide Rehydration
Avoid Medication Without Medical Advice
Collect Information
Report the Illness
Preserve Evidence
Follow Medical Advice
Educate on Prevention etc.

38. FOOD POISONING
Faood poisoning is an illness caused by the consumption of contaminated food.
It can result from bacterial, viral, or parasitic contamination of food.
Causes of Food Poisoning
• Food poisoning is transferred from following foods:
• Unpasteurized milk
• Spoiled dairy products or soft cheese
• Under cooked or raw meat
• Unwashed hand handling foods
• Room temperature food that should be refrigerator
• Cutting boards, bowls, or knives if remained unwashed or is cross contaminated
with bacteria.
• Cross contamination of food bacteria.

39. Types of Food Poisoning
• Bacterial: Caused by consumption of food contaminated with bacteria
or their toxins.
• Non bacterial: Caused by chemical like arsenic, certain sea
foods, fertilizers, pesticides, etc.

40. Prevention of Food Poisoning
To prevent recontamination of cooked food, you should wash your
hands properly, and also clean or wash the surfaces and utensils
thoroughly.
Refrigerated food should be kept below 40°F.
Hot food should be served immediately or should be kept heated
above 140°F.
For rapid cooling in refrigerator large volume of food should be
divided into small portion. If we put hot bulky food without cooling in
the refrigerators it will increase the temperature of those foods which
are already cooled in the refrigerator.

41. FOOD INTOXICATION
Food poisoning or food intoxication can be result of either
chemical poisoning or the ingestion of toxicant (which is
produced by micro organism, plant and animals).

42. Types of Intoxication
Bacterial intoxications
Fungal intoxicants
Chemical intoxicants
Plant intoxicants
Poisonous animal

43. Fungal Intoxicants
These are caused by consumption of metabolites produced by fungi,
when growing in food. These are approx 150 fungi which produces
toxins in food. These metabolites are called mycotoxins e.g. grains,
oilseeds, fruits and vegetables mostly involved if not properly dried
before storage.
Chemical Intoxication
As the name suggests, it is a toxication of food due to some chemicals
which are fetal in nature. We use such chemicals intentionally or
unintentionally during cultivation, processing, transportation or storage
time. e.g., pesticides, heavy metals, antibiotics and hormones,
radionuclides, preservatives, adulteration through hazardous chemicals.

44. Plant Toxin
Some foods contain potentially harmful natural toxins. Apple and pear
seeds and the inner seed (kernel) of apricot and peaches contain a
naturally occurring substance called amygdalin. Amygdalin can release
hydrogen cyanide in the gut causing discomfort or illness. It can be fatal
if too much is consumed in a short period of time.
Animal Toxicant
Sea food toxins include ciguatera toxin (reef fish), scombroid toxin
(decayed fish) shellfish toxins. After eating, these causes respirational
paralysis and death can occur.

45. Preventive and Control Measures
• Purchase from reputable sources: Buy food products from reputable
suppliers or sources that adhere to food safety regulations and have
proper storage and handling practices in place.
• Proper storage and temperature control: Store perishable foods,
such as meats, dairy products, and leftovers in the refrigerator at or
below 40°F (4°C). Freezing food at 0°F (-18°C) can also help to
prevent bacterial growth and toxin production.
• Cooking and reheating: Cook foods thoroughly, especially meats, to
kill any potential pathogens or toxins. Use a food thermometer to
ensure proper cooking temperatures. When reheating leftovers, make
sure they reach an Internal temperature of 165°F (74°C).

46. • Avoid cross-contamination: Prevent cross-contamination by keeping
raw and cooked foods separate. use separate cutting boards, utensils,
and plates for raw and cooked foods to avoid the transfer of harmful
bacteria or toxins.
• Proper hygiene: Practice good personal hygiene, such as washing
hands thoroughly with soap and water before and after handling food.
Avoid touching your face, hair, or other surfaces while handling food
to reduce the risk of contamination.
• Identify potential toxins: Educate yourself about potential sources of
toxins in food, such as certain types of mushrooms, fishes, or plants.
Be cautions and only consume foods that you are familiar with or
have been properly identified.