Food supplemt smita -

Contents
• Introduction of food supplement
• Food supplements for several groups
• Preservation of nutritive values
• Socio-cultural aspects of nutrition
• Role of community Health Nursing in
Nutrition
• National Nutritional Programme

Food supplement
Food supplements’ are defined as foodstuffs that are
meant to supplement the normal diet and which are
concentrated sources of nutrients or other substances
with a nutritional or physiological effect, alone or in
combination, marketed in dose form (e.g. pills,
tablets, capsules, liquids in measured doses).

Food supplements for several groups
The idea behind food supplements, also called dietary or
nutritional supplements, is to deliver nutrients that may
not be consumed in sufficient quantities.
Supplements are not a substitute for a balanced healthy
diet. A diet that includes plenty of fruits, vegetables, whole
grains, adequate protein, and healthy fats. should
normally provide all the nutrients needed for good health.

Food supplements for several groups
Most European countries agree that messages aimed at the
general public should focus on food-based dietary
guidelines.
Supplements do not feature in these guidelines, but there
are certain population groups or individuals who may need
advice about supplements, even when they eat a healthy
balanced diet.

• Published online 2018 Jan 4. doi: 10.3390/nu10010041
• PMCID: PMC5793269
• PMID: 29300341
• Dietary Supplements: Regulatory Challenges and Research Resources
• Johanna T. Dwyer,1,* Paul M. Coates,1 and Michael J. Smith2,3
• Author information Article notes Copyright and License information Disclaimer
• This article has been cited by other articles in PMC.
• Associated Data
• Supplementary Materials
• Go to:
• Abstract
• Many of the scientific and regulatory challenges that exist in research on the safety, quality and
efficacy of dietary supplements are common to all countries as the marketplace for them becomes
increasingly global. This article summarizes some of the challenges in supplement science and
provides a case study of research at the Office of Dietary Supplements at the National Institutes of
Health, USA, along with some resources it has developed that are available to all scientists. It
includes examples of some of the regulatory challenges faced and some resources for those who
wish to learn more about them.

• The ODS Analytical Methods and Reference
Materials program accelerates the creation
and dissemination of validated methods and
reference materials

Preservation of nutritive values
The various vitamins and minerals are susceptible to
destruction by air, light, water, heat, time and the action of
enzymes in the foods themselves. However, you can cut
losses and significantly increase your nutrient intake by
the care you taken in choosing, storing and cooking foods.
Dark green leafy vegetables and deep yellow vegetables
have more vitamin A lighter than coloured ones.
Fresh or frozen fruits and vegetables have more nutrients
than canned ones .
.

Cooked vegetables that are reheated after being kept in the
refrigerator for two or three days lose more than half their
vitamin C.
The sooner you eat the food, the less chance of nutrient
loss. The water-soluble vitamins, especially thiamin, folic
acid and vitamin C, can be destroyed during improper
storage and excessive cooking
Heat, light, exposure to air, cooking in water and alkalinity
are all factors that can destroy vitamins.

There are three R`s for nutrient preservation. The
three R`s for nutrient preservation are to reduce
the amount of water used in cooking, reduce the
cooking time and reduce the surface area of the
food that is exposed.

Tips to preserve nutritive value of food
Farm to Table
As soon as vegetables are picked, their nutrient clock
beings to tick away. The more time it spends off the plant,
the more vitamins will be lost.
For this reason, seeking out local produce when possible is
never a bad idea -- the less time it takes for the veggies to
get to your plate, the more nutrients they'll retain.

Tips to preserve nutritive value of food
Home Storage
Once you get those fresh vegetables home, minimize
additional nutrient loss by eating them right away or
storing in the refrigerator or freezer. Cold temperatures
will limit the degradation of vitamins so use the vegetable
drawer in your fridge (where humidity is higher) and store
in an air-tight bag or container.

Tips to preserve nutritive value of food…
Avoid trimming and chopping prior to storage too,
this will limit surface area and help lock more of
the vitamins inside.

Holding on
Cooking veggies can further diminish the content of various
water-soluble vitamins including folate, thiamin, B6
and vitamin C, especially in foods that sit out heated for
more than 2 hours. Quick cooking will maximize
nutrients.

Take advantage of as many vitamins as possible by
following these tips:
• Keep skins on when possible
• Avoid continuous reheating of food
• Use a minimal amount of cooking liquid
• Choose steaming over boiling
• When you do boil, retain the cooking liquid for a future
use (like soups and stocks)

• Use the microwave
• Use a pressure cooker when possible
• Avoid using baking soda to retain color
• Cut veggies into large chunks to reduce surface area

• Research Trends on Food Preservation: A Scientometric
AnalysisAbstract The present study is aimed at
analysing the global publication trends on food
preservation using Scopus database for the period
1998-2012. The database contained 17511 publications
on food preservation. The study analysed the broad
features of literature on food preservation focusing on
year-wise distribution of publications, highly
productive countries, international collaboration,
activity index, highly productive institutes, methods of
food preservation, preservation by food types, and
channels of communication.

• To ensure food and nutrition security of more than
nine billion people is a daunting task for the entire
world. To feed humanity, it requires increased
production of grains, pulses, oilseeds, vegetables,
fruits, milk, poultry, fish, meat, etc. Preservation of
food is equally important to deal with the increased
production as both animal and plant products are
exposed to decomposition through biochemical
changes, decay, fermentation by microorganisms, and
destruction by pests. It is believed that insects and
pests destroy more grain in storage than is distributed.
This calls for better storage and preservation facilitie

• The present study attempted to highlight the
growth and development of research
publication on food preservation. A total of
17511 publications were published during
1998-2012. The average number of
publications per year was 1167.4. There was a
steady growth of publications during 1998-
2012. Out of the total publications, ‘microbial’
method of food preservation accounted for
the highest percentage

preservation accounted for the highest
percentage (30 %) of publications, followed by
‘chemical’ with 27 % of publications. Out of
the total publications, ‘meat’ food type
accounted for the highest percentage (20 %)
of publications, followed by fruits’ and ‘oil
seeds’ with 18 % of

Socio-cultural aspects of nutrition
Man is a social being, his deeply‐rooted food habits have
developed within a culture and they vary widely from one
society to another.
Food means not only proteins, fat, minerals ,vitamins but
much more;it is part of security and civilsation. Nation
and civilisation are linked together not only ideas,but also
by bread.

Socio-cultural aspects of nutrition…
It is no wonder that the growing bincidence of
hunger and malnutrition should have come to
infront of international concern.
Instead, here is a sample of some ways in which
various religious groups include food as a vital
part of their faith.

Understanding the role of food in cultural and religious
Practice is an important part of showing respect and
responding to the needs of people from a range of religious
communities.
However, it is important to avoid assumptions about a
person’s culture and beliefs.

Food habits are one of the most complex aspects of human
behavior, being determined by multiple motives and
directed and controlled by multiple stimuli. For most
people food is cultural, not nutritional. A plant or animal
may be considered edible in one society and inedible in
another. Probably one of the most important things to
remember in connection with the cultural factors involved
in food habits is that there are many combination of food
which will give same nutritional results.

In the Nepali context, household access to sufficient food
does not ensure that all household members are well-
nourished. Cultural beliefs about food consumption can
lead to low nutritional status, particularly for highly-
sensitive groups such as pregnant and lactating women
and young children.

Some of the examples of food beliefs in Nepal
A common cultural practice that affects nutrition in
Nepal is the categorization of foods into ‘hot’ or ‘cold’.
During critical periods such as pregnancy, lactation
and illness, it is common practice to avoid eating
foods classified as ‘cold’ in order to protect the body in
its vulnerable state.

Some of the examples of food beliefs in Nepal…
• One widely held belief is that if a woman eats more during
pregnancy she will have a bigger baby which can cause
problems during labour.
• Foods of animal sources are considered good for pregnant
women.
• Social factors also influence the diet of pregnant women:
women and girls usually eat after male members and
children have eaten and have less access to food from
animal sources and other special foods.

Some of the examples of food beliefs in Nepal…
• Colostrum is regarded as a form of pus, toxic, and a
harmful substance by society.
• Baby boys are commonly exclusively breastfed until
six months of age, while baby girls are generally
offered their first solid food earlier, at five months of
age.
• In some cultures, it is believed that a connection
between stomach and womb exists and womb and
stomach are rested together by not giving food to the
mothers.

Role of community health nurse in nutrition
• Community Health nurse (CHN) often serves as bridge
between community residents and health care system.
Nurses are concerned about the nutritional status of the
people in the community.
• The community health nurse will have to study about all
people in community regarding their food habits and
factors affecting their health.
• CHN have excellent opportunities to providing
information and counseling about role of nutrition in
health promotion and prevention of illness
• CHN needs to impart knowledge about good nutrition
without hurting their cultural habits.

Role of community health nurse in nutrition…
• Nutrition problems are usually the result of multiple
factors, so the nurse must follow an epidemiologic
approach while taking nutritional histories and
developing care plan for the patients with nutritional
inadequacies.
• The community health nurse needs to identify the
malnourished children and refer them to
rehabilitation center as per the need.
• She needs to use media of health education in
nutrition education.

Role of community health nurse in nutrition…
• CHN demonstrate the recipes which are affordable and
locally available.
• CHN should assist in nutritional rehabilitation program
• CHN should organize, plan, conduct or take part in
research activites to promote health of the people in the
community.

Background
Nutrition section under Family Welfare Division
(FWD) is responsible for national nutrition program
for improving the nutritional status of children,
pregnant women and adolescents. Its goal is to
achieve nutritional well-being of all people to
maintain a healthy life to contribute in the socio-
economic development of the country, through
improved nutrition program implementation in
collaboration with relevant sectors.

Background
Nutrition interventions are cost effective investments for
attaining many of the Sustainable Development Goals. In
alignment with international and national declarations
and national health policies, the Government of Nepal is
committed to ensuring that its citizens have adequate
food, health and nutrition. The Constitution (2015)
ensures the right to food, health and nutrition to all
citizens.

Background…
Focus on nutrition — Nutrition is a globally
recognized development agenda. Since the year 2000,
several global movements have advocated nutrition
for development. The Scaling-Up-Nutrition (SUN)
initiative calls for multi-sectoral action for improved
nutrition during the first 1,000 days of life. The
Government of Nepal as an early member of SUN,
adopted the Multi-sector Nutrition Plan (MSNP) in
2012 to reduce chronic nutrition. Recently, the UN
General Assembly declared the 2016–2025 period as
the Decade of Action on Nutrition

Background…
Policy initiatives — The National Nutrition
Policy and Strategy was officially endorsed in
2004 to address all forms of malnutrition
including under-nutrition and over-nutrition.
This policy provides the strategic and
programmatic directions in the health sector
while the MSNP provides a broader policy
framework within and beyond the health sector
under a Food and Nutrition Security Secretariat
of the National Planning Commission that
coordinates its implementation.

Background…
The National Health Policy, 2071 highlights
improved nutrition via the use and promotion of
quality and nutritious foods generated locally to
fight malnutrition. The Nutrition Technical
Committee was established in then Child Health
Division now FWDin 2011 to support multi-
sectoral coordination for developing nutrition
programme.

Malnutrition in Nepal
Despite a steady decline in recent years, child
under-nutrition is still unacceptable in Nepal.
Maternal malnutrition is also a problem with 17
per-cent of mothers suffering from chronic energy
deficiency alongside the increasing trend of
overweight mothers (22 %, NDHS, 2016).

Malnutrition in Nepal…
Forty-one percent of women of reproductive age and 46
percentof pregnant women are anaemic. About 68 percent
(NDHS 2016) of children aged 6-23 months are anaemic
while the prevalence of that among adolescent women (15-
19) has been increased from 38.5 percent in 2011 to 43.6
percent in 2016 (NDHS).

Nutrition programmes implemented by FWD Nutrition
Section (1993–2018)
Nationwide programmes:
• Growth monitoring and counseling
• Prevention and control of iron deficiency anaemia
(IDA
• Prevention, control and treatment of vitamin A
deficiency (VAD)
• Prevention of iodine deficiency disorders (IDD)

• Control of parasitic infestation by deworming
• Mandatory flour fortification in large roller mills.
• Maternal, Infant, and Young Children Nutrition
(MIYCN) programme.

Scale-up programmes:
• Comprehensive Nutrition Specific Interventions
• Integrated Management of Acute Malnutrition (IMAM)
• Micronutrient Powder (MNP) distribution linked with
infant and young child feeding(IYCF)
• School Health and Nutrition Programme
• Vitamin A supplementation to address the low coverage in
6–11month olds • Multi-sector Nutrition Plan (MSNP)

OBJECTIVES OF NATIONAL NUTRITION
PROGRAMME
The overall objective of the national nutrition
programme undertaken by nutrition section is to
enhance nutritional well-being, reduce child and
maternal mortality and contribute to equitable
human development.
The specific objectives of the programme are as follows:
 To reduce protein-energy malnutrition in children
under 5 years of age and women of reproductive age.

PROGRAMME…
• To improve maternal nutrition
• To reduce the prevalence of anaemia among adolescent
girls, women and children
• To eliminate iodine deficiency disorders and vitamin A
deficiency

PROGRAMME…
• To reduce the critical risk of malnutrition and life
during very difficult circumstances
• To strengthen the system for analysing, monitoring
and evaluating the nutrition situation
• Behaviour change communication and nutrition
education at community levels
• To align health sector programmes on nutrition with
the Multi-Sectoral Nutrition Initiative

PROGRAMME…
• To promote the practice of good dietary habits to improve
the nutritional status of all people
• To prevent and control infectious diseases to improve
nutritional status and reduce child mortality
• To control lifestyle related diseases including coronary
disease, hypertension, tobacco related diseases, cancer and
diabetes
• To improve the health and nutritional status of
schoolchildren

Targets
Current Global Nutrition Targets
a. Sustainable Development Goal
Goal — End hunger, achieve food security and improved
nutrition and promote sustainable agriculture
• By 2030, end hunger and ensure access by all people, in
particular the poor and people in vulnerable situations,
including infants, to safe, nutritious and sufficient food all
year round;
• By 2030, end all forms of malnutrition, including achieving,
by 2025, the internationally agreed targets on stunting and
wasting in children under 5 years of age, and address the
nutritional needs of adolescent girls, pregnant and
lactating women and older persons;

Targets…
• By 2030, double the agricultural productivity and incomes
of small-scale food producers, in particular women,
indigenous peoples, family farmers, pastoralists and
fishers, including through secure and equal access to land,
other productive resources and inputs, knowledge,
financial services, markets and opportunities for value
addition and non-farm employment

Targets
b. Global Nutrition Target by 2025 (World Health
Assembly [WHA])
• Reduce the global number of children under five who are
stunted by 40 percent
• Reduce anaemia in women of reproductive age by 50
percent
• Reduce low birth weight by 30 percent • No increase in
childhood overweight
• Increase the rate of exclusive breastfeeding in the first six
months up to at least 50 percent
• Reduce and maintain childhood wasting to less than 5
percent.

STRATGIES OF NATIONAL NUTRITION
PROGRAMME
Specific strategies to improve nutrition in Nepal Control
of protein energy malnutrition (PEM)
Control of protein Energy malnutrition
• Promote breastfeeding within one hour of birth and
avoid pre-lacteal feeding.
• Promote exclusive breastfeeding for first six months and
the timely introduction of complementary food.
• Ensure continuation of breastfeeding for at least 2 years
and the introduction of appropriate complementary
feeding after 6 months.
• Strengthen the capacity of health workers and medical
professionals for nutrition and breastfeeding
management and counselling.

STRATGIES OF NATIONAL NUTRITION PROGRAMME…
• Improve skills and knowledge of health workers on growth
monitoring and nutrition counselling
• Strengthen the system of growth monitoring and its
supervision and monitoring.
• Promote the use of appropriate locally available
complementary foods such as jaulo and SarBottam Pitho.
• Increase awareness on the importance of appropriate and
adequate nutrition for children and pregnant and lactating
mothers.

STRATGIES OF NATIONAL NUTRITION PROGRAMME…
• Distribute fortified foods to pregnant and lactating women
and children aged 6 to 23 months in food deficient areas.
• Improve maternal and adolescent nutrition and low birth
weight through improved maternal nutrition.
• Create awareness of the importance of additional dietary
intake during pregnancy and lactation.
• Strengthen nutrition education and nutrition counselling

PROGRAMME…
Control of iron deficiency anaemia (IDA)
• Advocate to policy makers to promote dietary diversity.
• Iron folic acid supplementation for pregnant and post-
partum mothers.
• Iron fortification of wheat flour at roller mills

STRATGIESOF NATIONAL NUTRITIONPROGRAMME…
Household food security
• Promote kitchen garden and agricultural skills.
• Promote the raising of poultry, fish and livestock for
household consumption.
• Inform community people how to store and preserve
food.
• Improve technical knowledge of food processing and
preservation.
• Promote women’s group income generation activities.

STRATGIESOF NATIONAL NUTRITIONPROGRAMME…
Improved dietary practices
• Conduct a study to clarify the problems of culturally-
related dietary habits
• Promote nutrition education and advocate for good
diets and dietary habits.
• Develop and strengthen programmes for behaviour
change to improve dietary habits.
• Strengthen nutritional education and advocacy
activities to eliminate food taboos that affect
nutritional status.
• Promote the household food security programme.

PROGRAMME…
Infectious disease prevention and control
• Promote knowledge, attitudes and practices that will
prevent infectious diseases.
• Ensure access to appropriate health services.
• Improve nutritional status to increase resistance
against infectious disease
• Improve safe water supplies, sanitation and housing
conditions.
• Improve food hygiene.

PROGRAMME…
School Health and Nutrition Programme
• Build capacity of policy and working level stakeholders.
• The biannual distribution of deworming tablets to
grade 1 to 10 school children.
• Celebrate School Health and Nutrition (SHN) week
each June to raise awareness on malnutrition at the
community level through school children and health
worker
• Multiple micronutrient supplementation for children
aged 6-23 months.

PROGRAMME…
• Create awareness of importance of iron in
nutrition, promote consumption of iron rich foods
and promote diverse daily diets.
• Control parasitic infestation among nutritionally
vulnerable groups through deworming pregnant
women and children aged 12-23 months.

PROGRAMME…
• Control of iodine deficiency disorders
• • The universal iodization of salt.
• • Strengthen implementation of the Iodized Salt Act, 2055
to ensure that all edible salt is iodized.
• • The social marketing of certified two-child logo iodized
salt.
• • Ensure the systematic monitoring of iodized salt

PROGRAMME…
• . • Increase the accessibility and market
share of iodized packet salt with the two-
child logo.
• • Create awareness about the importance of
using iodized salt to control iodine
deficiency disorder (IDD) through social
marketing campaign

STRATGIES OF NATIONAL
NUTRITION PROGRAMME…
Control of vitamin A deficiency
• The biannual supplementation of high dose vitamin A
capsules to 6-59 month olds.
• Post-partum vitamin A supplementation for mothers
within 42 days of delivery.
• Strengthen implementation of vitamin A treatment
protocol for severe malnutrition, persistent diarrhoea,
measles and xerophthalmia.

PROGRAMME…
• Advocate for increased home production, consumption and
preservation of vitamin A rich foods.
• Strengthen the use of the vitamin A Treatment protocol.
• Distribute first aid kits to public schools.
• Introduce child-to-child and child-to-parent approaches

PROGRAMME…
• Nutrition education to promote dietary diversification and
consumption of vitamin A rich foods.
• Ensuring the availability of vitamin A capsules at health
facilities.
• Increase awareness of importance of vitamin A
supplementation.
• The biannual distribution of vitamin A capsules to 6 to 59-
month olds through FCHVs

PROGRAMME…
Integrated management of acute malnutrition
• Build capacity of health workerson managing acute
malnutrition and of other community workers on
screening and the referral of cases.
• Establish and implement the key parts of the IMAM
programme: community mobilization, inpatient
therapeutic care, outpatient therapeutic care and
management of MAM.
• Implement the IMAM programme based on maximum
coverage & access, timeliness of service provision,
appropriate care and care as long as it is needed.

PROGRAMME…
• Integrate the management of acute malnutrition
across sectors to ensure that treatment is linked to
support for rehabilitating cases and to wider
malnutrition prevention programme and services.
• Support and promote IYCF, water, sanitation and
hygiene (WASH), early childhood development, social
protection and child health and care along with the
management of acute malnutrition.
• Promote the IMAM programme as the bridge between
emergency and development programmes.

PROGRAMME…
• The supportive supervision and monitoring of IMAM
programme activities.
• Harmonize the community and facility-based management
of acute malnutrition.
• Strengthen the coordination and capacity of nutrition
rehabilitation homes

PROGRAMME…
Nutrition in emergencies
• Develop adequate capacity and predictable leadership in
the nutrition sector for managing humanitarian responses.
• Formulate an emergency nutrition in emergency
preparedness and response contingency plans.
• Establish and strengthen stronger partnerships and
coordination mechanisms between government, UN and
non-UN agencies

PROGRAMME…
• Agencies to respond in emergencies through the activated
nutrition cluster.
• Promote the consumption of vitamin A rich foods and a
balanced diet through nutrition education
• Provide vitamin A capsules (200,000 IU) to postpartum
mothers through healthcare facilities and community
volunteers.

PROGRAMME…
Low birth weight
• Reduce maternal malnutrition by preventing PEM,
VAD, IDD and IDA. • Reduce the workloads of
pregnant women.
• Increase awareness of the risks of smoking and alcohol
to pregnant women.
• Increase awareness of risks of early pregnancy to infant
and maternal health.
• Promote activities for nutrition monitoring and
counselling at antenatal clinics

STRATGIES OF NATIONAL
NUTRITION PROGRAMME…
• • The supportive supervision and
monitoring of IMAM programme activities.
• • Harmonize the community and facility-
based management of acute malnutrition.
• • Strengthen the coordination and capacity
of nutrition rehabilitation homes

PROGRAMME…
Lifestyle related diseases
• Create awareness among adults about the importance
of maintaining good dietary habits.
• Develop the capacity for nutritional counselling at
health facilities.
• Create awareness among adolescents and adults about
the importance of controlling smoking and body
weight.
• Create awareness to increase physical activity and
improve stress management

References
• Ghimire B, A text Book of Community Health Nursing,
2nd edition, Heritage Publishers & Distributors P. Ltd
• Dr swaminathan M, Handbook of Food and Nutrition,
5th edition, The Banglore Printing &Publishing Co. Ltd
• Clement I,Mannual of Community Health Nursing, 1st
edition, Jaypee Brothers Medical Publishers,2012
• https://www.nytimes.com/1982/07/07/garden/preservin
g-the-nutrients-of-food-with-proper-care.html
•
• https://www.foodnetwork.com/healthyeats/healthy-
tips/2013/04/how-to-prevent-vitamin-loss-when-
cooking-vegetables

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